Clinical utility of phototest via teleneuropsychology in chilean rural older adults

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mi...

Full description

Autores:
Caldichoury Obando, Andrea Nicole
Soto-Añari, Marcio
Camargo, Loida
Porto Torres, María Fernanda
Herrera-Pino, Jorge Alfredo
Shelach , Salomon
RIVERA FERNANDEZ, CLAUDIA
Ramos-Henderson, Miguel
GARGIULO, Pascual
López Velásquez, Norman Darío
Tipo de recurso:
Article of investigation
Fecha de publicación:
2022
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
OAI Identifier:
oai:repositorio.cuc.edu.co:11323/10762
Acceso en línea:
https://hdl.handle.net/11323/10762
https://repositorio.cuc.edu.co/
Palabra clave:
Neuropsychological tests
Telemedicine
Cognitive dysfunction
Rural population
COVID-19
Testes neuropsicológicos
Telemedicina
Disfunção cognitiva
População rural
Rights
openAccess
License
Atribución 4.0 Internacional (CC BY 4.0)
id RCUC2_1268bccf951ccecd350711afd8da168c
oai_identifier_str oai:repositorio.cuc.edu.co:11323/10762
network_acronym_str RCUC2
network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.eng.fl_str_mv Clinical utility of phototest via teleneuropsychology in chilean rural older adults
dc.title.translated.none.fl_str_mv Utilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenos
title Clinical utility of phototest via teleneuropsychology in chilean rural older adults
spellingShingle Clinical utility of phototest via teleneuropsychology in chilean rural older adults
Neuropsychological tests
Telemedicine
Cognitive dysfunction
Rural population
COVID-19
Testes neuropsicológicos
Telemedicina
Disfunção cognitiva
População rural
title_short Clinical utility of phototest via teleneuropsychology in chilean rural older adults
title_full Clinical utility of phototest via teleneuropsychology in chilean rural older adults
title_fullStr Clinical utility of phototest via teleneuropsychology in chilean rural older adults
title_full_unstemmed Clinical utility of phototest via teleneuropsychology in chilean rural older adults
title_sort Clinical utility of phototest via teleneuropsychology in chilean rural older adults
dc.creator.fl_str_mv Caldichoury Obando, Andrea Nicole
Soto-Añari, Marcio
Camargo, Loida
Porto Torres, María Fernanda
Herrera-Pino, Jorge Alfredo
Shelach , Salomon
RIVERA FERNANDEZ, CLAUDIA
Ramos-Henderson, Miguel
GARGIULO, Pascual
López Velásquez, Norman Darío
dc.contributor.author.none.fl_str_mv Caldichoury Obando, Andrea Nicole
Soto-Añari, Marcio
Camargo, Loida
Porto Torres, María Fernanda
Herrera-Pino, Jorge Alfredo
Shelach , Salomon
RIVERA FERNANDEZ, CLAUDIA
Ramos-Henderson, Miguel
GARGIULO, Pascual
López Velásquez, Norman Darío
dc.subject.proposal.eng.fl_str_mv Neuropsychological tests
Telemedicine
Cognitive dysfunction
Rural population
COVID-19
topic Neuropsychological tests
Telemedicine
Cognitive dysfunction
Rural population
COVID-19
Testes neuropsicológicos
Telemedicina
Disfunção cognitiva
População rural
dc.subject.proposal.por.fl_str_mv Testes neuropsicológicos
Telemedicina
Disfunção cognitiva
População rural
description The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27–28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
publishDate 2022
dc.date.issued.none.fl_str_mv 2022
dc.date.accessioned.none.fl_str_mv 2024-02-21T19:16:11Z
dc.date.available.none.fl_str_mv 2024-02-21T19:16:11Z
dc.type.spa.fl_str_mv Artículo de revista
dc.type.coar.spa.fl_str_mv http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.content.spa.fl_str_mv Text
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/article
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/ART
dc.type.version.spa.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.coarversion.spa.fl_str_mv http://purl.org/coar/version/c_970fb48d4fbd8a85
format http://purl.org/coar/resource_type/c_2df8fbb1
status_str publishedVersion
dc.identifier.issn.spa.fl_str_mv 1980-5764
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/11323/10762
dc.identifier.doi.none.fl_str_mv 10.1590/1980-5764-DN-2021-0082
dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv REDICUC – Repositorio CUC
dc.identifier.repourl.spa.fl_str_mv https://repositorio.cuc.edu.co/
identifier_str_mv 1980-5764
10.1590/1980-5764-DN-2021-0082
Corporación Universidad de la Costa
REDICUC – Repositorio CUC
url https://hdl.handle.net/11323/10762
https://repositorio.cuc.edu.co/
dc.language.iso.spa.fl_str_mv eng
language eng
dc.relation.ispartofjournal.spa.fl_str_mv Dementia e Neuropsychologia
dc.relation.references.spa.fl_str_mv Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, et al. Dementia care during COVID-19. Lancet. 2020;11;395(10231):1190-1. https://doi.org/10.1016/s0140-6736(20)30755-8 » https://doi.org/https://doi.org/10.1016/s0140-6736(20)30755-8
Bilder RM, Postal KS, Barisa M, Aase DM, Cullum CM, Gillaspy SR, et al. InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. Clin Neuropsychol. 2020;34(7-8):1314-34. https://doi.org/10.1080/13854046.2020.1767214 » https://doi.org/https://doi.org/10.1080/13854046.2020.1767214
Tsapanou A, Papatriantafyllou JD, Yiannopoulou K, Sali D, Kalligerou F, Ntanasi E, et al. The impact of COVID-19 pandemic on people with mild cognitive impairment/dementia and on their caregivers. Int J Geriatr Psychiatry. 2021;36(4):583-7. https://doi.org/10.1002/gps.5457 » https://doi.org/https://doi.org/10.1002/gps.5457
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet Respir Med. 2020;8(4):e21. https://doi.org/10.1016/s2213-2600(20)30116-8 » https://doi.org/https://doi.org/10.1016/s2213-2600(20)30116-8
Barguilla A, Fernández-Lebrero A, Estragués-Gázquez I, García-Escobar G, Navalpotro-Gómez I, Manero RM, et al. Effects of COVID-19 pandemic confinement in patients with cognitive impairment. Front Neurol. 2020;24;11:589901. https://doi.org/10.3389/fneur.2020.589901 » https://doi.org/https://doi.org/10.3389/fneur.2020.589901
Kitaigorodsky M, Loewenstein D, Curiel Cid R, Crocco E, Gorman K, González-Jiménez C. A teleneuropsychology protocol for the cognitive assessment of older adults during COVID-19. Front Psychol. 2021;12:651136. https://doi.org/10.3389/fpsyg.2021.651136 » https://doi.org/https://doi.org/10.3389/fpsyg.2021.651136
Zane KL, Thaler NS, Reilly SE, Mahoney JJ, Scarisbrick DM. Neuropsychologists’ practice adjustments: the impact of COVID-19. Clin Neuropsychol. 2021;35(3):490-517. https://doi.org/10.1080/13854046.2020.1863473 » https://doi.org/https://doi.org/10.1080/13854046.2020.1863473
Wadsworth HE, Dhima K, Womack KB, Hart J, Weiner MF, Hynan LS, et al. Validity of teleneuropsychological assessment in older patients with cognitive disorders. Arch Clin Neuropsychol. 2017;33(8):1040-5. https://doi.org/10.1093/arclin/acx140 » https://doi.org/https://doi.org/10.1093/arclin/acx140
Marra DE, Hamlet KM, Bauer RM, Bowers D. Validity of teleneuropsychology for older adults in response to COVID-19: a systematic and critical review. Clin Neuropsychol. 2020;34(7-8):1411-52. https://doi.org/10.1080/13854046.2020.1769192 » https://doi.org/https://doi.org/10.1080/13854046.2020.1769192
Hewitt KC, Rodgin S, Loring DW, Pritchard AE, Jacobson LA. Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings. Clin Neuropsychol. 2020;34(7-8):1335-51. https://doi.org/10.1080/13854046.2020.1811891 » https://doi.org/https://doi.org/10.1080/13854046.2020.1811891
Hammers DB, Stolwyk R, Harder L, Cullum CM. A survey of international clinical teleneuropsychology service provision prior to and in the context of COVID-19. Clin Neuropsychol. 2020;34(7-8):1267-83. https://doi.org/10.1080/13854046.2020.1810323 » https://doi.org/https://doi.org/10.1080/13854046.2020.1810323
Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, et al. Inter organizational practice committee guidance/recommendation for models of care during the novel coronavirus pandemic. Arch Clin Neuropsychol. 2021;36(1):17-28. https://doi.org/10.1093/arclin/acaa073 » https://doi.org/https://doi.org/10.1093/arclin/acaa073
Caze T, Dorsman KA, Carlew AR, Diaz A, Bailey KC. Can You Hear Me Now? Telephone-Based Teleneuropsychology Improves Utilization Rates in Underserved Populations. Arch Clin Neuropsychol. 2020;35(8):1234-9. https://doi.org/10.1093/arclin/acaa098 » https://doi.org/https://doi.org/10.1093/arclin/acaa098
Salinas CM, Cullum CM, Harder L, Bordes Edgar V. Accelerating teleneuropsychology within diverse populations. Arch Clin Neuropsychol. 2020;35(1187-8). https://doi.org/10.1093/arclin/acaa102 » https://doi.org/https://doi.org/10.1093/arclin/acaa102
Dang S, Gomez-Orozco CA, van Zuilen MH, Levis S. Providing dementia consultations to veterans using clinical video telehealth: results from a clinical demonstration project. Telemed J E Health. 2018;24(3):203-9. https://doi.org/10.1089/tmj.2017.0089 » https://doi.org/https://doi.org/10.1089/tmj.2017.0089
Mattos MK, Snitz BE, Lingler JH, Burke LE, Novosel LM, Sereika SM. Older rural- and urban-dwelling appalachian adults with mild cognitive impairment. J Rural Health. 2017;33(2):208-16. https://doi.org/10.1111/jrh.12189 » https://doi.org/https://doi.org/10.1111/jrh.12189
Quispe-Juli CU, Moquillaza-Alcántara VH, Arapa-Apaza KL. Telesalud en Latinoamérica: una mirada a los estudios registrados en clinicaltrials.gov. Rev Cub Salud Publica. 2019;e1389-e1389. https://doi.org/10.1590/scielopreprints.164 » https://doi.org/https://doi.org/10.1590/scielopreprints.164
Arias F, Safi DE, Miranda M, Carrión CI, Santos ALD, Armendariz V, et al. Teleneuropsychology for monolingual and bilingual spanish-speaking adults in the time of COVID-19: rationale, professional considerations, and resources. Arch Clin Neuropsychol. 2020;35:1249-65. https://doi.org/10.1093/arclin/acaa100 » https://doi.org/https://doi.org/10.1093/arclin/acaa100
Custodio N, Duque L, Montesinos R, Alva-Diaz C, Mellado M, Slachevsky A. Systematic review of the diagnostic validity of brief cognitive screenings for early dementia detection in Spanish-speaking adults in Latin America. Front Aging Neurosci. 2020;12:270. https://doi.org/10.3389/fnagi.2020.00270 » https://doi.org/https://doi.org/10.3389/fnagi.2020.00270
De Roeck EE, de Deyn PP, Dierckx E, Engelborghs S. Brief cognitive screening instruments for early detection of Alzheimer’s disease: a systematic review. Alzheimers Res Ther. 2019;11(1):21. https://doi.org/10.1186/s13195-019-0474-3 » https://doi.org/https://doi.org/10.1186/s13195-019-0474-3
Carnero-Pardo C, Lopez-Alcalde S, Allegri RF, Russo MJ. Revisão sistemática e meta-análise da acurácia diagnóstica do phototest em comprometimento cognitivo e demência. Dement Neuropsychol. 2014;8(2):141-7. https://doi.org/10.1590/s1980-57642014dn82000009 » https://doi.org/https://doi.org/10.1590/s1980-57642014dn82000009
Scarabelot LF, Monteiro MM, Rubert MCS, Zetola VHF. Is the mini-mental state examination the best cognitive screening test for less educated people? Arq Neuro-Psiquiatria. 2019;77(5):330-4. https://doi.org/10.1590/0004-282x20190043 » https://doi.org/https://doi.org/10.1590/0004-282x20190043
Carnero-Pardo C, Montoro-Ríos MT. The photo test. Rev Neurol. 2004;39(9):801-6. https://doi.org/10.33588/rn.3909.2004095 » https://doi.org/https://doi.org/10.33588/rn.3909.2004095
Baos Sánchez E, Muñoz R, Angeles M, López B, Dolores M, Rodríguez B, et al. Estudio de validez del Test de las Fotos en el cribado de Deterioro Cognitivo en Atención Primaria. Rev Clín Med Fam. 2007;2(2):57-62.
Carnero-Pardo C, Rego-García I, Mené Llorente M, Alonso Ródenas M, Vílchez Carrillo R. Diagnostic performance of brief cognitive tests in cognitive impairment screening. Neurologia (Engl Ed). 2022;S2173-5808(22)00037-2. https://doi.org/10.1016/j.nrleng.2019.05.011 » https://doi.org/https://doi.org/10.1016/j.nrleng.2019.05.011
Carnero-Pardo C, Sáez-Zea C, de la Vega Cotarelo R, Gurpegui M. Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica. NeurologIa. 2012;27(2):68-75. https://doi.org/10.1016/j.nrl.2011.06.001 » https://doi.org/https://doi.org/10.1016/j.nrl.2011.06.001
Carnero-Pardo C, López-Alcalde S, Florido-Santiago M, Espinosa-García M, Rego-García I, Calle-Calle R, et al. Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo. Neurología. 2021. In Press. https://doi.org/10.1016/j.nrl.2021.01.017 » https://doi.org/https://doi.org/10.1016/j.nrl.2021.01.017
Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. Journal of Periodontology. 2015; 86(2):244-53. https://doi.org/10.1902/jop.2014.140340 » https://doi.org/https://doi.org/10.1902/jop.2014.140340
Pinto J, Lopes E, Gonçalves G, Silva Â, Carnero-Pardo, Peixoto B. Phototest for neurocognitive screening in multiple sclerosis. Dement Neuropsychol. 2016;10(1):12-8. https://doi.org/10.1590/s1980-57642016dn10100003 » https://doi.org/https://doi.org/10.1590/s1980-57642016dn10100003
Muñoz Silva CA, Rojas Orellana PA, Marzuca-Nassr GN. Criterios de valoración geriátrica integral en adultos mayores con dependencia moderada y severa en Centros de Atención Primaria en Chile. Rev Méd Chile. 2015;143(5):612-8. https://doi.org/10.4067/s0034-98872015000500009 » https://doi.org/https://doi.org/10.4067/s0034-98872015000500009
Wylie CM. Measuring end results of rehabilitation of patients with stroke. Public Health Rep. 1967;82(10):893. https://doi.org/10.2307/4593156 » https://doi.org/https://doi.org/10.2307/4593156
Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323-9. https://doi.org/10.1093/geronj/37.3.323 » https://doi.org/https://doi.org/10.1093/geronj/37.3.323
Herrera P. MS, Saldías P, Testa N. Validación de un test breve para el diagnóstico de capacidad funcional en adultos mayores en Chile. Rev Méd Chile. 2014;142(9):1128-35. https://doi.org/10.4067/s0034-98872014000900006 » https://doi.org/https://doi.org/10.4067/s0034-98872014000900006
Podsiadlo D, Richardson S. The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):1428. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x » https://doi.org/https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Ministerio de Salud S de SP. Manual de Aplicación del Examen de Medicina Preventiva del adulto mayor. Santiago, Chile; Ministerio de Salud; 2021 [cited on Aug 10, 2021]. Available from: Available from: https://www.minsal.cl/portal/url/item/ab1f81f43ef0c2a6e04001011e011907.pdf » https://www.minsal.cl/portal/url/item/ab1f81f43ef0c2a6e04001011e011907.pdf
Jiménez D, Lavados Manuel, Rojas P, Henríquez C, Silva F, Guillón Marta. Evaluación del minimental abreviado de la evaluación funcional del adulto mayor (EFAM) como screening para la detección de demencia en la atención primaria Performance of an abbreviated mini mental examination to detect dementia in older people. Rev Méd Chile. 2017;145(7):862-8. https://doi.org/10.4067/s0034-98872017000700862 » https://doi.org/https://doi.org/10.4067/s0034-98872017000700862
Martínez M, Vilches M, Dueñas Herrero R, Colomer A, Aguado Taberné R, Luque Luque. Version Española del cuestionario de Yesavage abreviado (GDS) para el despistaje de depresión en mayores de 65 años: adaptación y validación. MEDIFAM. 2002;12(10):620-30. https://doi.org/10.4321/s1131-57682002001000003 » https://doi.org/https://doi.org/10.4321/s1131-57682002001000003
Quiroga LP, Albala BC, Klaasen PG. Validación de un test de tamizaje para el diagnóstico de demencia asociada a edad, en Chile. Rev Méd Chile. 2004;132(4):467-78. https://doi.org/10.4067/s0034-98872004000400009 » https://doi.org/https://doi.org/10.4067/s0034-98872004000400009
Lopez N, Russo M, Véliz A, Martella D, Carnero Pardo C, Allegri RF. Diagnostic accuracy of the phototest for cognitive impairment and dementia in Chile. J Neurol Sci. 2015;357:e230. https://doi.org/10.1016/j.jns.2015.08.791 » https://doi.org/https://doi.org/10.1016/j.jns.2015.08.791
Beaman SR de, Beaman PE, Garcia-Peña C, Villa MA, Heres J, Córdova A, et al. Validation of a Modified Version of the Mini-Mental State Examination (MMSE) in Spanish. Aging Neuropsychol Cogn. 2010;11(1):1-11. https://doi.org/10.1076/anec.11.1.1.29366 » https://doi.org/https://doi.org/10.1076/anec.11.1.1.29366
Franco-Marina F, García-González JJ, Wagner-Echeagaray F, Gallo J, Ugalde O, Sánchez-García S, et al. The Mini-mental state examination revisited: Ceiling and floor effects after score adjustment for educational level in an aging Mexican population. Int Psychogeriatr. 2010;22(1):72-81. https://doi.org/10.1017/s1041610209990822 » https://doi.org/https://doi.org/10.1017/s1041610209990822
Mitchell AJ. The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In: Larner A, editor. Cognitive screening instruments. London: Springer; 2013. p. 37-48. https://doi.org/10.1007/978-3-319-44775-9_3 » https://doi.org/https://doi.org/10.1007/978-3-319-44775-9_3
Hunt HA, van Kampen S, Takwoingi Y, Llewellyn DJ, Pearson M, Hyde CJ. The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol. Diagn Progn Res. 2017;1(1). https://doi.org/10.1186/s41512-017-0014-1 » https://doi.org/https://doi.org/10.1186/s41512-017-0014-1
Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43(4):411-31. https://doi.org/10.1016/j.jpsychires.2008.04.014 » https://doi.org/https://doi.org/10.1016/j.jpsychires.2008.04.014
Larner AJ. Introduction to cognitive screening instruments: rationale and desiderata. In: Larner AJ, editor. Cognitive screening instruments. Cham: Springer; 2017. p. 3-13. https://doi.org/10.1007/978-3-319-44775-9_1 » https://doi.org/https://doi.org/10.1007/978-3-319-44775-9_1
Jagust WJ. The changing definition of Alzheimer’s disease. Lancet Neurol. 2021;20(6):414-5. https://doi.org/10.1016/s1474-4422(21)00077-6 » https://doi.org/https://doi.org/10.1016/s1474-4422(21)00077-6
Ciemins EL, Holloway B, Coon PJ, McClosky-Armstrong T, Min SJ. Telemedicine and the mini-mental state examination: Assessment from a distance. Telemed J E Health. 2009;15(5):476-8. https://doi.org/10.1089/tmj.2008.0144 » https://doi.org/https://doi.org/10.1089/tmj.2008.0144
Villarejo A, Puertas-Martín V. Utilidad de los test breves en el cribado de demencia. NeurologIa. 2011;26(7):425-33. https://doi.org/10.1016/j.nrl.2010.12.002 » https://doi.org/https://doi.org/10.1016/j.nrl.2010.12.002
Olazarán J, Hoyos-Alonso MC, del Ser T, Garrido Barral A, Conde-Sala JL, Bermejo-Pareja F, et al. Aplicación práctica de los test cognitivos breves. Neurologia. 2016;31(3):183-94. https://doi.org/10.1016/j.nrl.2015.07.009 » https://doi.org/https://doi.org/10.1016/j.nrl.2015.07.009
Freire Pérez A. Screening methods for mild cognitive impairment in primary care. Rev Esp Geriatr Gerontol. 2017;52:15-9. https://doi.org/10.1016/S0211-139X(18)30074-X » https://doi.org/https://doi.org/10.1016/S0211-139X(18)30074-X
Arévalo SP, Kress J, Rodriguez FS. Validity of cognitive assessment tools for older adult Hispanics: a systematic review. J Am Geriatr Soc. 2020;68(4):882-8. https://doi.org/10.1111/jgs.16300 » https://doi.org/https://doi.org/10.1111/jgs.16300
Quitoriano J, Hamm RM. In patients suspected of cognitive decline, what is the most accurate in-office screening instrument to determine if there is dementia needing further evaluation and management? J Okla State Med Assoc. 2017;110(8):454-7. PMID: 29242671
Custodio N, Alva-Diaz C, Becerra-Becerra Y, Montesinos R, Lira D, Herrera-Pérez E, et al. Rendimiento en pruebas cognitivas breves, de adultos mayores con demencia en estadios avanzados, residentes de una comunidad urbana de Lima, Perú. Rev Peru Med Exp Salud Publica. 2016;33(4):662-9. https://doi.org/10.17843/rpmesp.2016.334.2549 » https://doi.org/https://doi.org/10.17843/rpmesp.2016.334.2549
Burke SL, Grudzien A, Burgess A, Rodriguez MJ, Rivera Y, Loewenstein D. The utility of cognitive screeners in the detection of dementia spectrum disorders in Spanish-speaking populations. J Geriatr Psychiatry Neurol. 2021;34(2):102-18. https://doi.org/10.1177/0891988720915513 » https://doi.org/https://doi.org/10.1177/0891988720915513
Villarejo A, Puertas-Martín V. Utilidad de los test breves en el cribado de demencia. NeurologIa. 2011;26(7):425-33. https://doi.org/10.1016/j.nrl.2010.12.002 » https://doi.org/https://doi.org/10.1016/j.nrl.2010.12.002
Cullum CM, Weiner MF, Gehrmann HR, Hynan LS. Feasibility of telecognitive assessment in dementia. Assessment. 2006;13(4):385-90. https://doi.org/10.1177/1073191106289065 » https://doi.org/https://doi.org/10.1177/1073191106289065
Martin-Khan M, Burkett E, Schnitker L, Jones RN, Gray LC. Methodology for developing quality indicators for the care of older people in the Emergency Department. BMC Emerg Med. 2013;13:23. https://doi.org/10.1186/1471-227x-13-23 » https://doi.org/https://doi.org/10.1186/1471-227x-13-23
Harrell KM, Wilkins SS, Connor MK, Chodosh J. Telemedicine and the evaluation of cognitive impairment: the additive value of neuropsychological assessment. J Am Med Dir Assoc. 2014;15(8):600-6. https://doi.org/10.1016/j.jamda.2014.04.015 » https://doi.org/https://doi.org/10.1016/j.jamda.2014.04.015
Brearly TW, Shura RD, Martindale SL, Lazowski RA, Luxton DD, Shenal BV, et al. Neuropsychological test administration by videoconference: a systematic review and meta-analysis. Neuropsychol Rev. 2017;27(2):174-86. https://doi.org/10.1007/s11065-017-9349-1 » https://doi.org/https://doi.org/10.1007/s11065-017-9349-1
Crivelli L, Quiroz YT, Calandri IL, Martin ME, Velilla LM, Cusicanqui MI, et al. Working group recommendations for the practice of teleneuropsychology in Latin America. Arch Clin Neuropsychol. 2021;37(3):553-67. https://doi.org/10.1093/arclin/acab080 » https://doi.org/https://doi.org/10.1093/arclin/acab080
Hwang K, de Silva A, Simpson JA, LoGiudice D, Engel L, Gilbert AS, et al. Video-interpreting for cognitive assessments: An intervention study and micro-costing analysis. J Telemed Telecare. 2022;28(1):58-67. https://doi.org/10.1177/1357633x20914445 » https://doi.org/https://doi.org/10.1177/1357633x20914445
Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Hernandez-Córdova G, et al. Validation of the RUDAS in patients with a middle-level education in Lima, Peru. Am J Alzheimers Dis Other Demen. 2019;34(7-8):513-22. https://doi.org/10.1177/1533317519869709 » https://doi.org/https://doi.org/10.1177/1533317519869709
Custodio N, Montesinos R, Diaz MM, Herrera-Perez E, Chavez K, Alva-Diaz C, et al. Performance of the Rowland Universal Dementia Assessment Scale for the detection of mild cognitive impairment and dementia in a diverse cohort of illiterate persons from rural communities in Peru. Front Neurol. 2021;12:629325. https://doi.org/10.3389/fneur.2021.629325 » https://doi.org/https://doi.org/10.3389/fneur.2021.629325
dc.relation.citationendpage.spa.fl_str_mv 323
dc.relation.citationstartpage.spa.fl_str_mv 316
dc.relation.citationissue.spa.fl_str_mv 3
dc.relation.citationvolume.spa.fl_str_mv 16
dc.rights.license.spa.fl_str_mv Atribución 4.0 Internacional (CC BY 4.0)
dc.rights.uri.spa.fl_str_mv https://creativecommons.org/licenses/by/4.0/
dc.rights.accessrights.spa.fl_str_mv info:eu-repo/semantics/openAccess
dc.rights.coar.spa.fl_str_mv http://purl.org/coar/access_right/c_abf2
rights_invalid_str_mv Atribución 4.0 Internacional (CC BY 4.0)
https://creativecommons.org/licenses/by/4.0/
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.extent.spa.fl_str_mv 8 páginas
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.coverage.country.none.fl_str_mv Chile
dc.publisher.spa.fl_str_mv Academia Brasileira de Neurologia
dc.publisher.place.spa.fl_str_mv Brazil
dc.source.spa.fl_str_mv https://www.scielo.br/j/dn/a/gHjKNTdGcxHg3WyDH5TySmF/?lang=en#
institution Corporación Universidad de la Costa
bitstream.url.fl_str_mv https://repositorio.cuc.edu.co/bitstreams/77223875-e683-4665-9272-cc314d26258a/download
https://repositorio.cuc.edu.co/bitstreams/24d728df-cca1-417d-90f7-d55754cf44d1/download
https://repositorio.cuc.edu.co/bitstreams/202b1b1b-d697-42c8-9d13-7400cec3e0a8/download
https://repositorio.cuc.edu.co/bitstreams/ac66eaf1-a05b-4e06-9ef4-b5cf3312c8dc/download
bitstream.checksum.fl_str_mv 5eb6487e1471b957f919b8a00b42a1cc
2f9959eaf5b71fae44bbf9ec84150c7a
96489ba3bcd86208f01a12c87f829dd6
7f4b7c0da3f94dc34ed10b4a690e85e8
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio de la Universidad de la Costa CUC
repository.mail.fl_str_mv repdigital@cuc.edu.co
_version_ 1811760720280289280
spelling Atribución 4.0 Internacional (CC BY 4.0)https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Caldichoury Obando, Andrea NicoleSoto-Añari, MarcioCamargo, LoidaPorto Torres, María FernandaHerrera-Pino, Jorge AlfredoShelach , Salomon RIVERA FERNANDEZ, CLAUDIARamos-Henderson, MiguelGARGIULO, PascualLópez Velásquez, Norman Darío2024-02-21T19:16:11Z2024-02-21T19:16:11Z20221980-5764https://hdl.handle.net/11323/1076210.1590/1980-5764-DN-2021-0082Corporación Universidad de la CostaREDICUC – Repositorio CUChttps://repositorio.cuc.edu.co/The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27–28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.8 páginasapplication/pdfengAcademia Brasileira de NeurologiaBrazilhttps://www.scielo.br/j/dn/a/gHjKNTdGcxHg3WyDH5TySmF/?lang=en#Clinical utility of phototest via teleneuropsychology in chilean rural older adultsUtilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenosArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a85ChileDementia e NeuropsychologiaWang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, et al. Dementia care during COVID-19. Lancet. 2020;11;395(10231):1190-1. https://doi.org/10.1016/s0140-6736(20)30755-8 » https://doi.org/https://doi.org/10.1016/s0140-6736(20)30755-8Bilder RM, Postal KS, Barisa M, Aase DM, Cullum CM, Gillaspy SR, et al. InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. Clin Neuropsychol. 2020;34(7-8):1314-34. https://doi.org/10.1080/13854046.2020.1767214 » https://doi.org/https://doi.org/10.1080/13854046.2020.1767214Tsapanou A, Papatriantafyllou JD, Yiannopoulou K, Sali D, Kalligerou F, Ntanasi E, et al. The impact of COVID-19 pandemic on people with mild cognitive impairment/dementia and on their caregivers. Int J Geriatr Psychiatry. 2021;36(4):583-7. https://doi.org/10.1002/gps.5457 » https://doi.org/https://doi.org/10.1002/gps.5457Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet Respir Med. 2020;8(4):e21. https://doi.org/10.1016/s2213-2600(20)30116-8 » https://doi.org/https://doi.org/10.1016/s2213-2600(20)30116-8Barguilla A, Fernández-Lebrero A, Estragués-Gázquez I, García-Escobar G, Navalpotro-Gómez I, Manero RM, et al. Effects of COVID-19 pandemic confinement in patients with cognitive impairment. Front Neurol. 2020;24;11:589901. https://doi.org/10.3389/fneur.2020.589901 » https://doi.org/https://doi.org/10.3389/fneur.2020.589901Kitaigorodsky M, Loewenstein D, Curiel Cid R, Crocco E, Gorman K, González-Jiménez C. A teleneuropsychology protocol for the cognitive assessment of older adults during COVID-19. Front Psychol. 2021;12:651136. https://doi.org/10.3389/fpsyg.2021.651136 » https://doi.org/https://doi.org/10.3389/fpsyg.2021.651136Zane KL, Thaler NS, Reilly SE, Mahoney JJ, Scarisbrick DM. Neuropsychologists’ practice adjustments: the impact of COVID-19. Clin Neuropsychol. 2021;35(3):490-517. https://doi.org/10.1080/13854046.2020.1863473 » https://doi.org/https://doi.org/10.1080/13854046.2020.1863473Wadsworth HE, Dhima K, Womack KB, Hart J, Weiner MF, Hynan LS, et al. Validity of teleneuropsychological assessment in older patients with cognitive disorders. Arch Clin Neuropsychol. 2017;33(8):1040-5. https://doi.org/10.1093/arclin/acx140 » https://doi.org/https://doi.org/10.1093/arclin/acx140Marra DE, Hamlet KM, Bauer RM, Bowers D. Validity of teleneuropsychology for older adults in response to COVID-19: a systematic and critical review. Clin Neuropsychol. 2020;34(7-8):1411-52. https://doi.org/10.1080/13854046.2020.1769192 » https://doi.org/https://doi.org/10.1080/13854046.2020.1769192Hewitt KC, Rodgin S, Loring DW, Pritchard AE, Jacobson LA. Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings. Clin Neuropsychol. 2020;34(7-8):1335-51. https://doi.org/10.1080/13854046.2020.1811891 » https://doi.org/https://doi.org/10.1080/13854046.2020.1811891Hammers DB, Stolwyk R, Harder L, Cullum CM. A survey of international clinical teleneuropsychology service provision prior to and in the context of COVID-19. Clin Neuropsychol. 2020;34(7-8):1267-83. https://doi.org/10.1080/13854046.2020.1810323 » https://doi.org/https://doi.org/10.1080/13854046.2020.1810323Postal KS, Bilder RM, Lanca M, Aase DM, Barisa M, Holland AA, et al. Inter organizational practice committee guidance/recommendation for models of care during the novel coronavirus pandemic. Arch Clin Neuropsychol. 2021;36(1):17-28. https://doi.org/10.1093/arclin/acaa073 » https://doi.org/https://doi.org/10.1093/arclin/acaa073Caze T, Dorsman KA, Carlew AR, Diaz A, Bailey KC. Can You Hear Me Now? Telephone-Based Teleneuropsychology Improves Utilization Rates in Underserved Populations. Arch Clin Neuropsychol. 2020;35(8):1234-9. https://doi.org/10.1093/arclin/acaa098 » https://doi.org/https://doi.org/10.1093/arclin/acaa098Salinas CM, Cullum CM, Harder L, Bordes Edgar V. Accelerating teleneuropsychology within diverse populations. Arch Clin Neuropsychol. 2020;35(1187-8). https://doi.org/10.1093/arclin/acaa102 » https://doi.org/https://doi.org/10.1093/arclin/acaa102Dang S, Gomez-Orozco CA, van Zuilen MH, Levis S. Providing dementia consultations to veterans using clinical video telehealth: results from a clinical demonstration project. Telemed J E Health. 2018;24(3):203-9. https://doi.org/10.1089/tmj.2017.0089 » https://doi.org/https://doi.org/10.1089/tmj.2017.0089Mattos MK, Snitz BE, Lingler JH, Burke LE, Novosel LM, Sereika SM. Older rural- and urban-dwelling appalachian adults with mild cognitive impairment. J Rural Health. 2017;33(2):208-16. https://doi.org/10.1111/jrh.12189 » https://doi.org/https://doi.org/10.1111/jrh.12189Quispe-Juli CU, Moquillaza-Alcántara VH, Arapa-Apaza KL. Telesalud en Latinoamérica: una mirada a los estudios registrados en clinicaltrials.gov. Rev Cub Salud Publica. 2019;e1389-e1389. https://doi.org/10.1590/scielopreprints.164 » https://doi.org/https://doi.org/10.1590/scielopreprints.164Arias F, Safi DE, Miranda M, Carrión CI, Santos ALD, Armendariz V, et al. Teleneuropsychology for monolingual and bilingual spanish-speaking adults in the time of COVID-19: rationale, professional considerations, and resources. Arch Clin Neuropsychol. 2020;35:1249-65. https://doi.org/10.1093/arclin/acaa100 » https://doi.org/https://doi.org/10.1093/arclin/acaa100Custodio N, Duque L, Montesinos R, Alva-Diaz C, Mellado M, Slachevsky A. Systematic review of the diagnostic validity of brief cognitive screenings for early dementia detection in Spanish-speaking adults in Latin America. Front Aging Neurosci. 2020;12:270. https://doi.org/10.3389/fnagi.2020.00270 » https://doi.org/https://doi.org/10.3389/fnagi.2020.00270De Roeck EE, de Deyn PP, Dierckx E, Engelborghs S. Brief cognitive screening instruments for early detection of Alzheimer’s disease: a systematic review. Alzheimers Res Ther. 2019;11(1):21. https://doi.org/10.1186/s13195-019-0474-3 » https://doi.org/https://doi.org/10.1186/s13195-019-0474-3Carnero-Pardo C, Lopez-Alcalde S, Allegri RF, Russo MJ. Revisão sistemática e meta-análise da acurácia diagnóstica do phototest em comprometimento cognitivo e demência. Dement Neuropsychol. 2014;8(2):141-7. https://doi.org/10.1590/s1980-57642014dn82000009 » https://doi.org/https://doi.org/10.1590/s1980-57642014dn82000009Scarabelot LF, Monteiro MM, Rubert MCS, Zetola VHF. Is the mini-mental state examination the best cognitive screening test for less educated people? Arq Neuro-Psiquiatria. 2019;77(5):330-4. https://doi.org/10.1590/0004-282x20190043 » https://doi.org/https://doi.org/10.1590/0004-282x20190043Carnero-Pardo C, Montoro-Ríos MT. The photo test. Rev Neurol. 2004;39(9):801-6. https://doi.org/10.33588/rn.3909.2004095 » https://doi.org/https://doi.org/10.33588/rn.3909.2004095Baos Sánchez E, Muñoz R, Angeles M, López B, Dolores M, Rodríguez B, et al. Estudio de validez del Test de las Fotos en el cribado de Deterioro Cognitivo en Atención Primaria. Rev Clín Med Fam. 2007;2(2):57-62.Carnero-Pardo C, Rego-García I, Mené Llorente M, Alonso Ródenas M, Vílchez Carrillo R. Diagnostic performance of brief cognitive tests in cognitive impairment screening. Neurologia (Engl Ed). 2022;S2173-5808(22)00037-2. https://doi.org/10.1016/j.nrleng.2019.05.011 » https://doi.org/https://doi.org/10.1016/j.nrleng.2019.05.011Carnero-Pardo C, Sáez-Zea C, de la Vega Cotarelo R, Gurpegui M. Estudio FOTOTRANS: estudio multicéntrico sobre la validez del Fototest en condiciones de práctica clínica. NeurologIa. 2012;27(2):68-75. https://doi.org/10.1016/j.nrl.2011.06.001 » https://doi.org/https://doi.org/10.1016/j.nrl.2011.06.001Carnero-Pardo C, López-Alcalde S, Florido-Santiago M, Espinosa-García M, Rego-García I, Calle-Calle R, et al. Utilidad diagnóstica y validez predictiva del uso conjunto de Fototest y Mini-Cog en deterioro cognitivo. Neurología. 2021. In Press. https://doi.org/10.1016/j.nrl.2021.01.017 » https://doi.org/https://doi.org/10.1016/j.nrl.2021.01.017Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. Journal of Periodontology. 2015; 86(2):244-53. https://doi.org/10.1902/jop.2014.140340 » https://doi.org/https://doi.org/10.1902/jop.2014.140340Pinto J, Lopes E, Gonçalves G, Silva Â, Carnero-Pardo, Peixoto B. Phototest for neurocognitive screening in multiple sclerosis. Dement Neuropsychol. 2016;10(1):12-8. https://doi.org/10.1590/s1980-57642016dn10100003 » https://doi.org/https://doi.org/10.1590/s1980-57642016dn10100003Muñoz Silva CA, Rojas Orellana PA, Marzuca-Nassr GN. Criterios de valoración geriátrica integral en adultos mayores con dependencia moderada y severa en Centros de Atención Primaria en Chile. Rev Méd Chile. 2015;143(5):612-8. https://doi.org/10.4067/s0034-98872015000500009 » https://doi.org/https://doi.org/10.4067/s0034-98872015000500009Wylie CM. Measuring end results of rehabilitation of patients with stroke. Public Health Rep. 1967;82(10):893. https://doi.org/10.2307/4593156 » https://doi.org/https://doi.org/10.2307/4593156Pfeffer RI, Kurosaki TT, Harrah CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol. 1982;37(3):323-9. https://doi.org/10.1093/geronj/37.3.323 » https://doi.org/https://doi.org/10.1093/geronj/37.3.323Herrera P. MS, Saldías P, Testa N. Validación de un test breve para el diagnóstico de capacidad funcional en adultos mayores en Chile. Rev Méd Chile. 2014;142(9):1128-35. https://doi.org/10.4067/s0034-98872014000900006 » https://doi.org/https://doi.org/10.4067/s0034-98872014000900006Podsiadlo D, Richardson S. The Timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):1428. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x » https://doi.org/https://doi.org/10.1111/j.1532-5415.1991.tb01616.xMinisterio de Salud S de SP. Manual de Aplicación del Examen de Medicina Preventiva del adulto mayor. Santiago, Chile; Ministerio de Salud; 2021 [cited on Aug 10, 2021]. Available from: Available from: https://www.minsal.cl/portal/url/item/ab1f81f43ef0c2a6e04001011e011907.pdf » https://www.minsal.cl/portal/url/item/ab1f81f43ef0c2a6e04001011e011907.pdfJiménez D, Lavados Manuel, Rojas P, Henríquez C, Silva F, Guillón Marta. Evaluación del minimental abreviado de la evaluación funcional del adulto mayor (EFAM) como screening para la detección de demencia en la atención primaria Performance of an abbreviated mini mental examination to detect dementia in older people. Rev Méd Chile. 2017;145(7):862-8. https://doi.org/10.4067/s0034-98872017000700862 » https://doi.org/https://doi.org/10.4067/s0034-98872017000700862Martínez M, Vilches M, Dueñas Herrero R, Colomer A, Aguado Taberné R, Luque Luque. Version Española del cuestionario de Yesavage abreviado (GDS) para el despistaje de depresión en mayores de 65 años: adaptación y validación. MEDIFAM. 2002;12(10):620-30. https://doi.org/10.4321/s1131-57682002001000003 » https://doi.org/https://doi.org/10.4321/s1131-57682002001000003Quiroga LP, Albala BC, Klaasen PG. Validación de un test de tamizaje para el diagnóstico de demencia asociada a edad, en Chile. Rev Méd Chile. 2004;132(4):467-78. https://doi.org/10.4067/s0034-98872004000400009 » https://doi.org/https://doi.org/10.4067/s0034-98872004000400009Lopez N, Russo M, Véliz A, Martella D, Carnero Pardo C, Allegri RF. Diagnostic accuracy of the phototest for cognitive impairment and dementia in Chile. J Neurol Sci. 2015;357:e230. https://doi.org/10.1016/j.jns.2015.08.791 » https://doi.org/https://doi.org/10.1016/j.jns.2015.08.791Beaman SR de, Beaman PE, Garcia-Peña C, Villa MA, Heres J, Córdova A, et al. Validation of a Modified Version of the Mini-Mental State Examination (MMSE) in Spanish. Aging Neuropsychol Cogn. 2010;11(1):1-11. https://doi.org/10.1076/anec.11.1.1.29366 » https://doi.org/https://doi.org/10.1076/anec.11.1.1.29366Franco-Marina F, García-González JJ, Wagner-Echeagaray F, Gallo J, Ugalde O, Sánchez-García S, et al. The Mini-mental state examination revisited: Ceiling and floor effects after score adjustment for educational level in an aging Mexican population. Int Psychogeriatr. 2010;22(1):72-81. https://doi.org/10.1017/s1041610209990822 » https://doi.org/https://doi.org/10.1017/s1041610209990822Mitchell AJ. The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In: Larner A, editor. Cognitive screening instruments. London: Springer; 2013. p. 37-48. https://doi.org/10.1007/978-3-319-44775-9_3 » https://doi.org/https://doi.org/10.1007/978-3-319-44775-9_3Hunt HA, van Kampen S, Takwoingi Y, Llewellyn DJ, Pearson M, Hyde CJ. The comparative diagnostic accuracy of the Mini Mental State Examination (MMSE) and the General Practitioner assessment of Cognition (GPCOG) for identifying dementia in primary care: a systematic review protocol. Diagn Progn Res. 2017;1(1). https://doi.org/10.1186/s41512-017-0014-1 » https://doi.org/https://doi.org/10.1186/s41512-017-0014-1Mitchell AJ. A meta-analysis of the accuracy of the mini-mental state examination in the detection of dementia and mild cognitive impairment. J Psychiatr Res. 2009;43(4):411-31. https://doi.org/10.1016/j.jpsychires.2008.04.014 » https://doi.org/https://doi.org/10.1016/j.jpsychires.2008.04.014Larner AJ. Introduction to cognitive screening instruments: rationale and desiderata. In: Larner AJ, editor. Cognitive screening instruments. Cham: Springer; 2017. p. 3-13. https://doi.org/10.1007/978-3-319-44775-9_1 » https://doi.org/https://doi.org/10.1007/978-3-319-44775-9_1Jagust WJ. The changing definition of Alzheimer’s disease. Lancet Neurol. 2021;20(6):414-5. https://doi.org/10.1016/s1474-4422(21)00077-6 » https://doi.org/https://doi.org/10.1016/s1474-4422(21)00077-6Ciemins EL, Holloway B, Coon PJ, McClosky-Armstrong T, Min SJ. Telemedicine and the mini-mental state examination: Assessment from a distance. Telemed J E Health. 2009;15(5):476-8. https://doi.org/10.1089/tmj.2008.0144 » https://doi.org/https://doi.org/10.1089/tmj.2008.0144Villarejo A, Puertas-Martín V. Utilidad de los test breves en el cribado de demencia. NeurologIa. 2011;26(7):425-33. https://doi.org/10.1016/j.nrl.2010.12.002 » https://doi.org/https://doi.org/10.1016/j.nrl.2010.12.002Olazarán J, Hoyos-Alonso MC, del Ser T, Garrido Barral A, Conde-Sala JL, Bermejo-Pareja F, et al. Aplicación práctica de los test cognitivos breves. Neurologia. 2016;31(3):183-94. https://doi.org/10.1016/j.nrl.2015.07.009 » https://doi.org/https://doi.org/10.1016/j.nrl.2015.07.009Freire Pérez A. Screening methods for mild cognitive impairment in primary care. Rev Esp Geriatr Gerontol. 2017;52:15-9. https://doi.org/10.1016/S0211-139X(18)30074-X » https://doi.org/https://doi.org/10.1016/S0211-139X(18)30074-XArévalo SP, Kress J, Rodriguez FS. Validity of cognitive assessment tools for older adult Hispanics: a systematic review. J Am Geriatr Soc. 2020;68(4):882-8. https://doi.org/10.1111/jgs.16300 » https://doi.org/https://doi.org/10.1111/jgs.16300Quitoriano J, Hamm RM. In patients suspected of cognitive decline, what is the most accurate in-office screening instrument to determine if there is dementia needing further evaluation and management? J Okla State Med Assoc. 2017;110(8):454-7. PMID: 29242671Custodio N, Alva-Diaz C, Becerra-Becerra Y, Montesinos R, Lira D, Herrera-Pérez E, et al. Rendimiento en pruebas cognitivas breves, de adultos mayores con demencia en estadios avanzados, residentes de una comunidad urbana de Lima, Perú. Rev Peru Med Exp Salud Publica. 2016;33(4):662-9. https://doi.org/10.17843/rpmesp.2016.334.2549 » https://doi.org/https://doi.org/10.17843/rpmesp.2016.334.2549Burke SL, Grudzien A, Burgess A, Rodriguez MJ, Rivera Y, Loewenstein D. The utility of cognitive screeners in the detection of dementia spectrum disorders in Spanish-speaking populations. J Geriatr Psychiatry Neurol. 2021;34(2):102-18. https://doi.org/10.1177/0891988720915513 » https://doi.org/https://doi.org/10.1177/0891988720915513Villarejo A, Puertas-Martín V. Utilidad de los test breves en el cribado de demencia. NeurologIa. 2011;26(7):425-33. https://doi.org/10.1016/j.nrl.2010.12.002 » https://doi.org/https://doi.org/10.1016/j.nrl.2010.12.002Cullum CM, Weiner MF, Gehrmann HR, Hynan LS. Feasibility of telecognitive assessment in dementia. Assessment. 2006;13(4):385-90. https://doi.org/10.1177/1073191106289065 » https://doi.org/https://doi.org/10.1177/1073191106289065Martin-Khan M, Burkett E, Schnitker L, Jones RN, Gray LC. Methodology for developing quality indicators for the care of older people in the Emergency Department. BMC Emerg Med. 2013;13:23. https://doi.org/10.1186/1471-227x-13-23 » https://doi.org/https://doi.org/10.1186/1471-227x-13-23Harrell KM, Wilkins SS, Connor MK, Chodosh J. Telemedicine and the evaluation of cognitive impairment: the additive value of neuropsychological assessment. J Am Med Dir Assoc. 2014;15(8):600-6. https://doi.org/10.1016/j.jamda.2014.04.015 » https://doi.org/https://doi.org/10.1016/j.jamda.2014.04.015Brearly TW, Shura RD, Martindale SL, Lazowski RA, Luxton DD, Shenal BV, et al. Neuropsychological test administration by videoconference: a systematic review and meta-analysis. Neuropsychol Rev. 2017;27(2):174-86. https://doi.org/10.1007/s11065-017-9349-1 » https://doi.org/https://doi.org/10.1007/s11065-017-9349-1Crivelli L, Quiroz YT, Calandri IL, Martin ME, Velilla LM, Cusicanqui MI, et al. Working group recommendations for the practice of teleneuropsychology in Latin America. Arch Clin Neuropsychol. 2021;37(3):553-67. https://doi.org/10.1093/arclin/acab080 » https://doi.org/https://doi.org/10.1093/arclin/acab080Hwang K, de Silva A, Simpson JA, LoGiudice D, Engel L, Gilbert AS, et al. Video-interpreting for cognitive assessments: An intervention study and micro-costing analysis. J Telemed Telecare. 2022;28(1):58-67. https://doi.org/10.1177/1357633x20914445 » https://doi.org/https://doi.org/10.1177/1357633x20914445Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Hernandez-Córdova G, et al. Validation of the RUDAS in patients with a middle-level education in Lima, Peru. Am J Alzheimers Dis Other Demen. 2019;34(7-8):513-22. https://doi.org/10.1177/1533317519869709 » https://doi.org/https://doi.org/10.1177/1533317519869709Custodio N, Montesinos R, Diaz MM, Herrera-Perez E, Chavez K, Alva-Diaz C, et al. Performance of the Rowland Universal Dementia Assessment Scale for the detection of mild cognitive impairment and dementia in a diverse cohort of illiterate persons from rural communities in Peru. Front Neurol. 2021;12:629325. https://doi.org/10.3389/fneur.2021.629325 » https://doi.org/https://doi.org/10.3389/fneur.2021.629325323316316Neuropsychological testsTelemedicineCognitive dysfunctionRural populationCOVID-19Testes neuropsicológicosTelemedicinaDisfunção cognitivaPopulação ruralPublicationORIGINALClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdfClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdfArtículoapplication/pdf378755https://repositorio.cuc.edu.co/bitstreams/77223875-e683-4665-9272-cc314d26258a/download5eb6487e1471b957f919b8a00b42a1ccMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-814828https://repositorio.cuc.edu.co/bitstreams/24d728df-cca1-417d-90f7-d55754cf44d1/download2f9959eaf5b71fae44bbf9ec84150c7aMD52TEXTClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdf.txtClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdf.txtExtracted texttext/plain43904https://repositorio.cuc.edu.co/bitstreams/202b1b1b-d697-42c8-9d13-7400cec3e0a8/download96489ba3bcd86208f01a12c87f829dd6MD53THUMBNAILClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdf.jpgClinical utility of Phototest via teleneuropsychology in Chilean rural older adults.pdf.jpgGenerated Thumbnailimage/jpeg13451https://repositorio.cuc.edu.co/bitstreams/ac66eaf1-a05b-4e06-9ef4-b5cf3312c8dc/download7f4b7c0da3f94dc34ed10b4a690e85e8MD5411323/10762oai:repositorio.cuc.edu.co:11323/107622024-09-17 10:47:43.684https://creativecommons.org/licenses/by/4.0/open.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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