Validation of the German version of the DSQIID in adults with intellectual disabilities

BACKGROUND

An observer-rated screening questionnaire for dementia for people with intellectual disabilities (ID), DSQIID, was developed in the UK. So far, the German version has not yet been validated in adults with ID.

AIMS/METHODS

We validated a German version of DSQIID (DSQIID-G) among adults with ID attending a German clinic.

PROCEDURES/OUTCOMES

DSQIID-G was completed by the caregivers of 104 adults with ID at baseline (T1), 94 at six months (T2) and 83 at 12 months (T3). A Receiver Operating Curve (ROC) was used to determine the total DSQIID-G cutoff score for the best fit between sensitivity and specificity.

RESULTS

Sixteen of the 104 participants at T1 (15%) received a diagnosis of dementia. At T1, the scores among the non-dementia group ranged from 0 to 33 (mean: 6.7; SD: 7.65), and the dementia group ranged from 3 to 43 (mean: 22.12; SD: 11.6). The intergroup difference was statistically significant (W: 158; p < .001) (AUC:.89). A total score of 9 provided the best fit between sensitivity (.94) and specificity (.72).

CONCLUSIONS AND IMPLICATIONS

DSQIID-G total score can discriminate between dementia and non-dementia cases in adults with ID. A lower cutoff score with a higher sensitivity is desirable for a screening instrument.

[Autism Spectrum Disorders in Adulthood: Empirical Findings on Comorbidities, Differential Diagnoses, and the Clinical Utility of the AQ]

AUTISM: spectrum disorders (ASD) often remain undiagnosed until adulthood. The aim of this study is to report differential diagnoses (DDX) and comorbidities of adults without intellectual impairment suspected of having an ASD and to test the self-assessment questionnaire Autism Quotient (AQ) for its suitability for screening.

METHODS

DDX and comorbidities were recorded with standardized scales in an autism outpatient clinic in 106 individuals. The AQ was tested against the expert judgment of an interdisciplinary case conference using ROC analysis.

RESULTS

Affective disorders were common in both groups (48%); other DDX were phobias (33%) and personality disorders (22%). The AQ showed an AUC of 0,527 with sensitivity/specificity of 70%/35%.

CONCLUSIONS

Adults suspected of having autism are highly burdened by DDX and comorbidities. An interdisciplinary diagnostic procedure based on standardized scales is useful, whereas the AQ hardly differentiates between persons with and without ASD.

Social individuation: Extending the scale of emotional development - Short (SED-S) for adolescent reference ages

BACKGROUND

The SED-S is a standardized diagnostic instrument for assessing emotional development (ED) in people with a disorder of intellectual development. The SED-S defines five ED stages covering emotional reference ages up to 12 years in eight domains (5 items per domain). Stage 6 will extend the scale for early adolescent reference ages.

AIMS

The aim of this study is to define the SED-S items for stage 6 ('Social Individuation').

METHODS AND PROCEDURES

Experts in developmental psychology phrased 56 items (7 items/domain) describing typical behaviors for emotional reference ages 13th-18th year (145th-216th month) in English, German and Dutch. Twenty-eight independent experts assessed the items' content validity and observability on a Likert scale (0 = good to 3 = unacceptable). Two items/domain with the lowest ratings were excluded to finally select 5 items/domain for SED-S stage 6.

OUTCOMES AND RESULTS

The ratings were good with results ranging from 0.06 to 0.78 for validity and 0.06-1.78 for observability. After exclusion of the 2 lowest ranking items/domain, a set of 40 items was selected.

CONCLUSIONS AND IMPLICATIONS

The SED-S is extended to allow the assessment of emotional reference ages up to 18 years. Further research should evaluate the scale's psychometric properties. WHAT THIS PAPER ADDS?: The current version of the SED-S covers emotional reference ages up to 12 years (144 months). Extending the SED-S for emotional reference ages up to 18 years (145th-216th months of life) in Dutch, German and English allows better differentiation in the higher ED range and expands the applicability of the scale. Specifically, it makes it possible to apply the SED-S in people with borderline intellectual functioning. Accounting for the level of ED may provide valuable information about the behaviors and needs of individuals with higher reference ages and may support targeted treatment options in a population highly vulnerable to behavioral or mental disorders.

POS1011 THE STUDY OF DETECTION OF FECAL CALPROTECTIN AS A MARKER OF EARLY DIAGNOSIS OF THE DEVELOPMENT OF INFLAMMATORY BOWEL DISEASES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

Background

Ankylosing spondylitis (AS) can be characterized not only by the detection of the musculoskeletal system, but by the probable contribution of extraskeletal manifestations (ESMs), which can aggravate the course of the disease, and may occur in the first place in terms of the activity of the process. At the same time, according to the findings, in 3.5-10% of patients with AS, a diagnosis of IBD was detected, and in 70% of patients with AS, subclinical symptoms of intestinal disorders were detected. AS and IBD have common links of pathogenesis: microbiota and intestinal wall condition. Currently, highly sensitive fecal laboratory tests are used to monitor inflammation activity in IBD prior to ileocolonoscopy. Fecal calprotectin (FCP) is a marker of neutrophilic inflammation in gastrointestinal diseases and an indicator of the intensity of the inflammatory process in the intestine. The concentration of FCP is statistically significantly higher in IBD patients with signs of clinical activity and, as a rule, does not go beyond the normal range in patients with irritable bowel syndrome. These data make it possible to consider fecal calprotectin as a promising marker of the onset and latent course of inflammatory bowel disease in patients with ankylosing spondylitis.

Objectives

To reveal the peculiarities of fecal calprotectin concentration in patients with ankylosing spondylitis in case of occurrence and recurrence of inflammatory bowel diseases as extraskeletal manifestations.

Methods

The study included 80 patients with ankylosing spondylitis: women - 28 (35%), men - 52 (65%). The average age of patients was 45.12±12.4 years, the average age of onset symptoms - 28.43±13.18 years, mean duration of AS - 18.7±11.75 years. Patients already diagnosed with AS were asked to complete a questionnaire using the Universal Questionnaire to identify signs of immunoinflammatory diseases - psoriasis, psoriatic arthritis, IBD (Crohn’s disease, ulcerative colitis) to identify clinical signs of intestinal damage. With a positive answer to one main and one additional questions, the patient was asked to conduct a qualitative determination of fecal calprotectin. Before the study, patients were stopped taking non-steroidal anti-inflammatory drugs for two weeks. Patients in whom the presence of calprotectin in the feces was detected, at the next stage, a semi-quantitative determination of calprotectin in the feces was carried out by immunochromatographic method. Patients who had an increase in the concentration of fecal calprotectin above 200 µg/g were recommended to perform a diagnostic colonoscopy on an outpatient basis to clarify the diagnosis. The next step was the determination of fecal calprotectin in patients with a positive survey result. In 26 patients (32.5%) a positive result was revealed.

Results

In 71 (88.7%), according to the results of the questionnaire, subclinical signs of intestinal damage were identified. At the next stage, patients with a positive result in the determination of FCP underwent an immunochromatographic test to detect the concentration of calprotectin in the feces. Of these, 22 patients (84.6%) had a concentration of 50-200 µg/g, which indicates the need for dynamic monitoring of this group of patients. In 4 patients (15.38%), the concentration of PCP was found to be higher than 200 µg/g.

Conclusion

Аmong patients with ankylosing spondylitis, 88.7% have subclinical signs of intestinal damage. Of these, calprotectin is determined in feces in 32.5%, which may indicate a latent course or debut of inflammatory bowel disease. Determination of the presence of fecal calprotectin in patients with ankylosing spondylitis contributes to the early diagnosis of inflammatory bowel disease.

Disclosure of Interests

None declared

Assessment of dementia in a clinical sample of persons with intellectual disability

BACKGROUND

Assessment of age-associated disorders has become increasingly important.

METHODS

In a clinical setting, people with intellectual disability with and without dementia were assessed retrospectively using the Neuropsychological Test Battery (NTB) and the Dementia Questionnaire for People with Learning Disabilities (DLD) at two different times to analyse neuropsychological changes and diagnostic validity. One group (n = 44) was assessed with both instruments, while the DLD was applied in 71 patients.

RESULTS

In the NTB (n = 44), only patients with dementia (n = 26) showed a decline in the NTB total score and three subscales. Receiver operating characteristic analysis revealed a diagnostic sensitivity of .67, a specificity of .81, and an area under the curve (AUC) of .767. In the DLD group (n = 71), only those with dementia displayed a decrease in the cognitive and social scale; diagnostic sensitivity and specificity values were low (.61/.63) and the AUC was .704.

CONCLUSIONS

Neuropsychological assessment was sensitive to detect cognitive changes over time. Sensitivity values of both instruments suggest a reassessment at a later time point.

AB1365-HPR FREQUENCY OF JOINT DAMAGE IN PATIENTS WITH ULCERATIVE COLITIS

Background:

Ulcerative colitis (UC) is considered as a systemic autoimmune disease with lesions of the colon mucosa. The current of UC is often accompanied by different extra-intestinal manifestations. Their frequency, according to various studies, varies widely – from 25 to 60 %. It is a serious problem that affects the quality of life and the effectiveness of therapy [1, 2]. Rheumatological manifestations, in particular, damage to the joints and spine, are one of the extra-intestinal manifestations and they are of particular importance. To date, the relationship between UC and joint damage has not been fully studied. These diseases can occur independently in the body or have a common autoimmune or inflammatory nature. It is believed that having common pathogenetic mechanisms of development, UC and joint damage can be different clinical forms of the same disease.

Objectives:

To evaluate the frequency of clinical manifestations of joint damage in patients with ulcerative colitis.

Methods:

The study was conducted at the gastroenterological Department of the Hospital №25 (Russia, Volgograd). Archived data from the case histories of 69 patients with a confirmed diagnosis of ulcerative colitis were analyzed, including 58 men (30.4%) with an average age of 33.4 years, and 38 women (69.5%) with an average age of 37.6 years.

Results:

Among 48 patients with UC, extra-intestinal manifestations were detected in 40 (41.6%) patients. A total lesion of the large intestine was found in 20 patients (20.8%), left-sided colitis in 14 (14, 6%), proctosigmoiditis in 6 (6.25%). The diagnosis was made for the first time in 4 patients (4.16%), 36 patients (37.5%) were admitted to the hospital again due to an exacerbation of the disease. Among the extra-intestinal manifestations, joint lesions prevailed: 20 patients (20.8%) showed clinical signs of peripheral arthritis, spondyloarthritis was detected in 8 patients (8.3 %), and 6 patients (6.25 %) had symptoms of unilateral sacroiliitis. 4 (4.16%) patients were diagnosed with nodular erythema. Primary sclerosing cholangitis was detected in two patients (2.08%).

Conclusion:

The development of extra-intestinal manifestations in UC is largely determined by the course of the disease and the length of the inflammatory process in the colon. More than a third of patients with UC revealed extra-intestinal manifestations, among which the most common signs of joint damage were present, which necessitates timely diagnosis of extra-intestinal manifestations and involvement of a rheumatologist in the management of this category of patients.

References:

[1]Knyazev O. V. et al. Epidemiologi of inflammatory bowel disease. Yesterdey, today, tomorrow. Eksperimental’naya i Klinicheskaya Gastroenterologiya 2017; 139 (3): 4–12 (In Russ.)

[2]Sadygova G.G. Extraintestinal manifestations of inflammatory bowel diseases: arthropathy and arthritis. Ross z gastroenterol gepatol koloproktol 2016; 26(6):101-5 (In Russ.)

Disclosure of Interests:

None declared