Diagnostic validity of the Alzheimer's disease functional assessment and change scale in mild cognitive impairment and mild to moderate Alzheimer's disease

BACKGROUND

The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS) is a functional assessment instrument widely used in clinical research.

AIMS

To test the diagnostic and concurrent validity of the Spanish version of this scale and to describe the functional deficit pattern for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia.

METHODS

The ADFACS, the Interview for Deterioration in Daily Living Activities in Dementia (IDDD), and the Mini Mental State Examination (MMSE) were administered to 146 control subjects (CS) and 165 patients (67 MCI and 98 AD). Nonparametric tests were used to compare the diagnostic groups. Cronbach's α and correlations with the MMSE and the IDDD were calculated. Sensitivity, specificity and predictive values were studied.

RESULTS

The ADFACS had a high internal consistency (α = 0.95). Three cutoff points of 1, 4, and 17 were provided to separate CS and MCI patients, MCI and mild AD patients, and mild AD and moderate AD patients, respectively. The ADFACS strongly correlated with functional (IDDD, 0.927) and cognitive (MMSE, 0.747) measures. A similar pattern of dysfunction, but in different grades, was found for the MCI and AD groups.

CONCLUSION

The ADFACS is a reliable, valid, and sensitive instrument to assess functional abilities; it is useful in dementia assessment for elderly populations.

[Anticonvulsant hypersensitivity syndrome with severe repercussions in the skin and kidneys due to carbamazepine]

INTRODUCTION

Anticonvulsant hypersensitivity syndrome (AHS) is characterised by fever, skin rashes and involvement of the internal organs. Owing to the low frequency with which it appears and its high clinical heterogeneity, it is not always suspected. Moreover, the symptoms often overlap with those of a vasculitis or of an infection. The most commonly associated antiepileptic drugs (AED) are the aromatic agents. We report the case of a female patient who developed AHS with several different AED and presented an especially severe kidney and skin disorder due to carbamazepine (CBZ).

CASE REPORT

We describe the case of a 26-year-old woman who, after being diagnosed as suffering from secondarily generalised partial seizures, began treatment with 200 mg/12 hours CBZ. A few weeks later, she developed itchy skins lesions compatible with exanthematic pustulosis, together with acute kidney failure requiring haemodialysis. A biopsy study of the kidney revealed immunoallergic tubulointerstitial nephropathy, which is a lesion that has only very occasionally been reported in relation to CBZ therapy. The patient also presented a moderate rise in the level of transaminases and leukocytosis with eosinophilia. She was discharged from hospital without AED but suffered new seizures and was treated with phenytoin and, later, with valproic acid, both as monotherapy. With these drugs she developed AHS consisting in fever, rashes, eosinophilia and subclinical hepatitis. In epicutaneous tests with anticonvulsants, the three AED presented a positive reading, as well as others. The patient was treated with tiagabine, and there were no further hypersensitivity phenomena and a good control of seizures was achieved.

CONCLUSIONS

AHS is an infrequent, but potentially serious, clinical entity and must therefore be suspected in patients taking AED who develop fever, rashes or disorders affecting the internal organs.

[Correlation between reaction time and bradykinesia in Huntington's disease]

BACKGROUND

Bradykinesia is the clinical feature of Huntington's disease most closely related to functional discapacity and stage, probably as a consequence of spreading of neuronal injury. The aim of the present article is to verify whether a choice reaction time could be considered an estimate measurement of clinical bradykinesia, and its possible relationships with other evolutive parameters such as functional discapacity, clinical stage and prefrontal executive dysfunction.

METHODS

Fifteen patients were studied (9 in advanced stage and 6 initials), equal number of controls and 3 asymptomatic gene carriers. We used clinical bradykinesia and functional capacity scales, an extensive prefrontal battery and a computerized paradigm of reaction time.

RESULTS

Clinical bradykinesia and reaction time are closely related. The associations between reaction time with those parameters indicatives of prefrontal dysfunction, functional discapacity and clinical stage are closer and more significatives than those that could be established with clinical bradykinesia.

CONCLUSIONS

Reaction time is an objective measurement of global motor slowness that allow us assigning each subject to a specific stage, and avoid possible errors derived from interobserver bias in clinical scales.

[Sensitivity and efficiency of intrathecal IgG secretion in multiple sclerosis. Comparison of several indices and formulas using pre-established values of specificity]

To furnish greater specificity in the analysis of cerebrospinal fluid from patients suspected of having multiple sclerosis, we studied the sensitivity and efficiency of indices and formulas used to calculate intrathecal IgG synthesis in a group of 49 patients with clinically defined multiple sclerosis, using cutoff values based on preestablished levels of specificity (75 and 90%), and compared the findings to those for a control group of patients with other neurological diseases. The best results were obtained with the indices and formulas based on computer models of brain-blood barrier function set forth most recently, namely Reiber's formula and Ohman's index, which had the highest specificity with the least loss of sensitivity.

[Correlation between magnetic resonance and disability scales (EDSS and ISS) in multiple sclerosis]

In the present study the lesions in MRI imaging were quantified and compared with the clinical and functional abnormalities in 56 patients (27 females and 29 males) with definite multiple sclerosis (MS). The evolution was relapsing in 30, there were relapses followed by progressive evolution in 10, and evolution was progressive from the onset in 16. A good correlation was found between the disability scale EDSS and total lesions in MRI (r = 0.45), and also with the disability scale EDSS and hemispheric (r = 0.45) and centrioval (r = 0.41) involvements and with lesions near the third ventricle (r = 0.32). The clinical parameters predicting a greater surface of involvement in MRI were late onset (beyond 45 years) and progressive evolution. The best correlation between disability scale and MRI lesions was found between EDSS and periventricular (lateral ventricles) lesions (r = 0.46). The linearly correlation between both disability scales was good (r = 0.86), but it improved when an exponential equation was used (r = 0.91). This could allow to use the more simple scale (ISS) with a mathematical transformation. When the patients with a greatest surface of involvement were compared with the remaining MS patients, significant differences were found for nearly all evaluated disability items. Patients with greater involvement surfaces in MRI had greater disability.

[Progression of functional disability in 70 patients with multiple sclerosis]

We have carried out a follow-up study in 70 patients that were included in a follow-up protocol when they met the criteria of MS, so as to evaluate the variations in the disability scale per unit of time of follow-up (index of progression) in relation to the several risk factors. There were 31 females and 39 men followed up for 19.6 +/- 12 months. One half of the patients (35) had their first symptoms between 25 and 45 years of age, in 27 the onset was after age 25 and in 8 after age 45. At the end of follow-up 42 patients were classified as having remitting forms, 12 as progressive forms after a remitting phase and 16 as progressive forms from the onset. Significant differences in the evolutive forms were only found in remitting-progressive forms, which had a quicker progression than the purely remitting and chronic progressive forms. The patients who initially had cerebellar symptoms had a quicker progression than those with any other type of presentation. Whereas patients with late onset had a quicker progression than the group with intermediate onset, the patients with early onset had a slower progression.

[Intrathecal secretion of antiviral antibodies in multiple sclerosis in patients in Seville]

To assess the presence of antiviral antibody synthesis in the cerebrospinal fluid in patients with multiple sclerosis, concurrent plasma and spinal fluid determination of antibody titers against measles, varicella-zoster, rubella, mumps, cytomegalovirus, and herpes viruses were performed in 29 samples and were compared with a control group. The study revealed an increased titre of antiviral antibodies in the spinal fluid in patients with multiple sclerosis. This increased activity was markedly significant for the varicella-zoster and cytomegalovirus in patients with clinical symptoms of multiple sclerosis. There was also and increased antibody titre against cytomegalovirus and varicella-zoster in patients with well defined illness. No antibody reaction was observed in the control group. The study of the antiviral antibody activity in the spinal fluid in patients with multiple sclerosis is useful in the follow-up control and in the diagnosis of the disorder specially in our community, where the investigation of antibodies anti cytomegalovirus appears to be the most appropriate method due to its high sensitivity and absence of false positive tests.