22 (3.5%) did not finished the study 5 No consent 5 Sensitive-motor deficit
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Transcript of 22 (3.5%) did not finished the study 5 No consent 5 Sensitive-motor deficit
22 (3.5%) did not finished the study
5 No consent5 Sensitive-motor deficit9 Advanced cognitive impairment3 Other reasons
34 subject (5.44%) no considered because incomplete data
Figure1:Participant subjects
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4/6/152
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19 Centers25 Neurologists625 selected subjects (570)
Acknowledgment
Partially supported by SAS (Exp. 230/00)
Tests• 498 (87%) underwent
at least one short test– 302 MMSE– 207 MEC– 436 Animal Fluency
• 63 (11%): Three tests• 321 (56%): Two tests• 114: (20%): One test
2
63 105212
3735
56
72Fluency = 436
MT = 570
MMSE = 302
MEC = 207
Demographics• Age: 72.7 6.8 years
• Sex: 310 Women (54.5%)
• Procedence: 370 (65%) urbans (>30.000 inhabitants)
• Educational level:– 13% Never went to
school– 45% Primary studies
• Alphabetization: – 8% illeterate– 28% can read
97938985817773696561
80
60
40
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0
5,8%
9,6%
26,1%
45,4%
12,6%
4%Universitaries
Secundaries
Primary StudiesPrimary Incomplete
Never went to school
Not avalilable
2,5%
11,7%
16,5%
15,8%
53,5%
Severe D.
Moderate D.
Mild D.
MCI
Noimpairment
7,5%
22,5%
70,0%
Other Dementias
Enf. Alzheimer
No Dementia
Clinical characteristics
62% had another process which could lead to cognitive impairment
Cognitive Diagnosis:305 No cognitive impairment (53.5%)
90 Mild cognitive impairment (15.8%)
175 Dementia (30.7%)Mild: 94 (53.7%)
Moderate: 67 (38.3%)
Severe: 14 (8%)
128 Alzheimer ´s disease(73% out of the whole dementias)
MT: discriminative validity
0.79
0.83
0.86
0.86
0.85
CC
0.930.710.660.95 23
0.910.770.760.91 22
0.880.830.840.87 21
0.850.870.890.81 20
0.810.910.930.75 19
VPNVPPESPoint
L.S.
L.I.
0.920.890.880.91
0.840.780.80.82IC95%
0.880.830.840.87 21
VPNVPPES
Criteria validity with other tests (Best cut point)
0.76
0.81
0.79
0.86
CC
0.880.65 10436Fluency
0.760.84 29207MEC
0.890.7 23302MMSE
0.840.87 21570MT
ESPuntNTest
Compared Criteria Validity ROC curves
Fluency
MEC
MMSE
0.940.890.010.91570MT
LSLIe.e.ÁREANPRUEBA
0.850.770.020.81436
0.930.840.020.89207
0.920.840.020.88302
1-100806040200
100
80
60
40
20
0
1-Specificity100806040200
Se
nsi
bili
ty
100
80
60
40
20
0
Concurrent Validity
n = 302
n = 275
n = 65
1
MMSE
1n = 436n = 207MT
.74*1n = 170Fluency
.79*.72*1MEC
.80*.68*.95*MMSE
MTFluencyMEC
Spearman´s Correlation Coeficient
* p < 0.0001
Test-Retest Feasibility
44
45
47
N
0.59 – 0.860.75TFV
0.77 – 0.930.87MEC
0.86 – 0.960.92MT
IC 95%CCI
TOTAL
25,0020,0015,0010,005,00,00
Fre
cuen
cia
60
50
40
30
20
10
0265305N =
Cognitive ImpairmentYesNo
TO
TA
L
30
20
10
0
COMPARATION
Usefulness of the Money Test for detection of Cognitive ImpairmentUsefulness of the Money Test for detection of Cognitive ImpairmentA Frank*, C Carnero**, A Tallón*, A García*, MS Barquero***, JL Dobato, J Ferrero, J Díaz, A Pérez, S Mola, J Morera, on behalf the “Money Test Group”. H. La Paz, Madrid; H. Torrecárdenas, Almería; H. Clínico San Carlos, Madrid; Spain
P04-034
Objective
To analyze the usefulness of the “Money Test” (MT) to detect cognitive impairment in a general neurological practice.
Design
Multicentric, transversal study of 635 subjects aged > 60 years.
MT was applied in addition to other tests, such as the Mini-mental state examination (MMSE), the Spanish version of MMSE (MEC) and the verbal fluency test (VFT).
Independently of the results of these tests, the sample population was classified by an independent neurologist as “Not cognitively impaired” (NCI) or “Cognitively Impaired” (CI) and the latter group was subdivided into two subgroups: “Mild Cognitive Impairment” (MCI) or “Dementia” (DEM).
Methods
The following parameters were calculated by standard statistical methods: sensibility (S), specificity (Sp), predictive value (PV) and area under the ROC curve (AUR), each with each its own 95% confidence intervals. Concurrent validity was calculated by Spearmans correlation coefficient (r). In a sample of 47 subjects test-retest reliability was analyzed using the interclass correlation reliability coeficient (ICC).
Results
Data from 570 subjects were analyzed (Figure 1). Of the whole series, 56 subjects were excluded because the protocol was incompleted. The number of subjects classified in each group was: 305 NCI and 265 CI (90 MCI, 175 DEM). 8% of the sample was illeterate and 45% had <5 years of schooling.
The best MT cut-point shows S=0.87(0.82-0.91); Sp=0.84(0.8-0.88); positive PV=0.83(0.78-0.89); negative PV=0.88(0.84-0.92) and AUR=0.91(0.89-0.93). MT has a high concurrent validity: MMSE (r=0.8); MEC (r=0.79), VFT (r=0.74), as well as excellent test-retest reliability (ICC=0.92). Results in this series show MT to have either a higher validity or reliability than other frequently employed tests.
Conclusions
MT has a high discriminative validity for cognitive impairment detection and appears to be more reliable than other frequently used instruments.
It is also ecological and has content validity.
An important additional advantage is that it is easy to appliy, quick and can be used in uneducated persons.
All these properties together with the possibility of adapting the test to different environments, cultures and currency systems, make the MT a useful international instrument for the detection of cognitive impairment.
H. Torrecárdenas – AlmeríaCristóbal Carnero Pardo*Elena Márquez Báez Teresa García LópezPedro Guardado SantervásJesús Olivares RomeroPedro Serrano CastroTeresa Montoro Ríos
H. General Yagüe – BurgosMiguel Góñi ImízcozSara Merino
H.Virgen de la Arrixaca – MurciaCarmen Antúnez AlmagroRafael Carles Díez
H. de Navarra – PamplonaFrancisco Lacruz BescosIsabel Aramendia Etxeberria
H.Cruz Roja Española – CórdobaAntonio Arjona Padillo
H.Universitario La Paz – Madrid
Anna Frank García
Antonio Tallón Barranco
Ángel García González
H.Universitario La Fe – Valencia
Miguel Baquero Toledo
Anabel Campos
H.Gómez Ulla – Madrid
Julio Ferrero Arias
Clínica San Rafael - Cádiz
Pedro A. Sánchez Ayaso
H.Virgen de la Macarena - Sevilla
Carlos Martínez Parra
José Manuel Gata Gata
H.Vega Baja - Orihuela
Ángel Pérez Sempere
Santiago Mola Caballero de Rodas
Fundación Hospital Alcorcón
José Luis Dobato Ayuso
H. Ntra.Sra. Aranzazu - San Sebastián
Begoña Indakoetxea Juanbeltz
H. Virgen de las Nieves - Granada
Rosa Vilches Carrillo
H. Virgen del Camino - Pamplona
José M. Manubens Bertrán
H. Clínico San Carlos - Madrid
María S. Barquero Jiménez
María A. Payno Vargas
H. General Universitario - Murcia
Mª Luisa Martínez Navarro
H. Río Carrión - Palencia
Valentín Bueno Rodríguez
H. Marina Alta - Denia
Jaume Morera Guitart
H. 12 de Octubre - Madrid
Jaime Díaz Guzmán
*Actualmente en el Hospital Virgen de las Nieves (Granada, Spain)e-mail: [email protected]
Money Test Group
Background
MT is an easy, short (< 5 minutes), ecological test (it uses common currency) and is well accepted by study populations independently of their educational level.
Its factorial structure allows the evaluation of several independent cognitive domains.
These characteristics suggest that MT would be a good instrument for cognitive impairment detection, mainly in poorly-educated populations in which other frequently-used tests do not seem to be effective enough.