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    6 views44 pages

    SKM 28718122010190

    Uploaded by

    Juliana Restrepo

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    © All Rights Reserved
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    132 : (G. CALDERON NARVABZ CUADROL (CUESTIONARIO PARA EL DIAGNOSTICO DE LOS CUADROS DEPRESIVOS DEL DR. GUILLERMO CALDERON Norte: ‘Se: ied Eade ot soba Fete a 0 ooo | REGULAR | muCHO [=e raion aT [2- etre ps det [Dame alert [4 ifn nara sos oo? [s-_dLa cm nba concen? [s=_aLa hada apetor Tana eae 0 np =a [ala nind sutwns sara? [a- Corea qursu dons enol ata wt mer? 10 Ser pao wpe 11 Selo rnin, args earshas? fan Se slrcarsnno abo? : 13-__Sesire pesn, sea ots costo asa ma? = dadehcentosencatecaben ola mx? 15= iE ds abo rin aw ees? 5 Sede azo, co kad clas en sed ne? [jews tees nares a sutnda? [sac Seid ear cae? 19 {Sone on oral? : fan Seas an us ea oe? + Calear qua sitay uma ote 0 apo [eALRCACON Progra anaes on pa ott NO) — _ [Pures ers en 2u cra POCO) — [Prepares concen teas REGULAR) — [operat ened onl fa okra MUCHO) : slo Tota. [EOOWALEWER PUNTA lana NORMAL M16: REACCIONDE ASEDAD len 65: OEPRESION MEO 4: DEPRESON SEVERA chor olen: Fr bi veka ei aia, sala ab peated : = see “abla A8. Puntuacionsesclares ‘Grupo de eded 70 y mis afos Prucbes VERBALES v8 ASCS*~<‘ _™*‘ CC 7 7 oF 7 2 + 1 3 0 0 2 30 wm 2 4 3 402 0 8H ies =e gl 5 Ul 6 2 2 6 2 + + 8 7 09 4 2 + § § + 7 a oo 6 6 7 + 6 - 8 9 we 7 + 68 6 W 3 28 pe ef 7 9 78 oH 4 1 oe ot 8 HOt! 2 2 2 + 12 1 M5 5B i ue 89 18 48 tN)? 3 4 4) 6 t0 me 278 15 4d T19 19 192 220985 6 92 mes 2 2 10 16 7 85 OK ue 7 on oT e 8 - 8 7 8 ROB 19 57s 3 tee magn 8 ODA t9 Te A fA NcoC*WMASC«éY~SC«éwSSC*iROSCée = a 2 0 0 0 2 3 0 4 +t 0 o 41 3 er: eee 1 4 4 5 ot 4 2 0 Bw Ss 6 + 6 sf. 4 OE 7 29 wn em 9 1 5 7% 7 3 48 oh OB OB ee eS to 38 tea HBO 11 oto 205 ete; ttt ATH 12 ia m4 2008 78) 58 ISAT 19212 43 1318 Osa 2527 | SHO 78 8D S18 18 4382 2800 ti? BT HH tS tHe Seo 088 1GN8 1012 205 BRS ie Goes SST ISOS 7; G78 Hea) 1020 1618 2788 O77 ® 2 2 9 2 9 3% % 18 10 2405 entaa Sig 2205 om 6) HR pestis. 7 4 abba aenaehiLS, 125 i ltt tlabe! i Sabah. aR Mab AES Tabla A2. Puntuaciones esoalares Grupo de edad 20-24 afios Pruobas VERBALES Pov OSs AO T cl Pe TT ss WH 280 8467 2D 9 48 60 8G 258 7 9 6 er 6 4 a 1013 8 | 6087S mo 8 tO, eas 15 1243 1249 HBT Be 1618 10 14 TB m4 1920 0«120=*C«OS HG “46 138 6th 10 B47 222 «14 T1980 tH a | 15 18D N12 sos 2 (1617 Hs 253 2627 18 NTH BLS BCD DBE | GH 58 80; STB oo BHT B - 2 8 Fw mM 1 1B me 8 2 2 8 389 22 19 Pruebas MANIPULATIVAS Pe AGN OCC HBS Pe 1 07 025 O40 0 08 08 2 BAD 2682 1S 1 OH 2 3 SHO 1620 25 2 88 4 1249 447 2128 6 187 HT 4 514 4bS2 9 79 182 18S 6 1546 S36. 2082 10 «196 7 7 eT 8395 112 2628 23057 8 tet BATT St 13 8 6208 9 2 TBTh Ald 140 a3 9089 40 + 7580 4548 1516 34-35-4510 1 at BIB 48ST 7 (3738 BH 12 BTR RBA 18 M1 g9My 2 13-23 93068 5558 19 ARdS a2 13 4} sri05 5961 2% 4s S14 1 0610962 = ATH AT 18 1% OHA 8}! A ABB w+ ENB 053 505117 6 - Be - eB 19 SSHRC GED 424 * iT RB Aba ih pieetsspetadlee: Bed Tabla A4, Putuasiones escalares Grupo de edad 35-54 aos Pruebas VERBALES yk 8 a 0S a F Poh for) ees iss | an ke! “yg 3 Bo rN pclae esa ag, 4 28 28 6 a7 5 gr gg § 45 67 - 6 § g ¢ ¢ 6 2 8 7 9 7% wr s & 7 Br © 8 wn so we ¢ & 8 Be Wy 9 2 nas jas pe 8 39 HIS 10 8 Mts 87 gg 0 940 tT te 8 et7 tg Ho 44s eta 43118 1820 2021, 2 48 moe ats? 13 451 mar eH e192 asp 4 85 2525 18ers OF 7 8 2 - 9 © i 8 2 2s weg wv 9 moe eres sot org 1 6169 3591547 249 2 7075 ee tH 21 768 4540 1920 16 2 389° 5082 at arte 2% 4 855g + $5103. 5653 23a ~ 104109 6.60 24 at % one —e - " 120428 6263 2s PG 68 sD 192119 T Oo 87 2 25 69g 69 10194 1012 W455 1315 1647 6 1819 1822-7 2023-325 B 2427 2828 9 290 3110 388 a5 Hy HI 382 8740 994013 414s 414214 4550 34415 5153 HBG 55474817 789 49 B aida ene 123 4 fet pase ie shah Si bers 99 Tebla A. Puntuacones esa Pruebas VERBALES a ee ee) 1 cL Pe 88S 2 0 4 4 - 3 1 fe 3 : o 6 5s 3 4 8 4 1 1 - - 4 5 2 4 5 2-29 . 67 5 8. - 8 6 39 468g - : a - 8 T 17 78 7g 6 80 3 7 8 wage 9 78 He 4g 9 22 wi2 8 10 940 13% § 9 10 2341844 tts 10 M3590 5 ttt ae] 2 4043 1617 1421344 88a k tk 1S M47 1820 1314 151920 2223 oto tg 7M 4851 2122 1516 1617 2105 % 285 7819 2425 2528s 1% 8758 2428 e419 oat eek tg iw 622728 0228184 1 haa 1B iis AaB i aah ares vied ae H ah Grupo de edad 55-69 afios 19" 6566 000850 teat ig SSS tet ia Pruebas MANIPULATIVAS he NeW Ss Oe To 2 1 5 2 0 o 4 8 8 2 6 45 1 lo eS ag 4 3 79 69g M6 4 5 4 0M 0 tS ogg 6 68 mI of 8 gk tate we 7 $0 223 5 ko tae 7 & M2 2428 16198 kta BHT 9 1314 2885 20037 58H? tact og 0 8 9643. 2427 B10 781820 222510 Ho i617 si 23g Ha ott 123 Dba? 1819 S258 ST 1345128 DRT e708 te19 1914 Brat gH Hg Mo T7847 SG OST 1 8 aeSY 1748 BST 1% mS Saad w - eo7 570k aS sete sD. 18% rim eee 226 B60 ibs i - 124 dibdin a bias hi i abhi bina biisy ‘Tabla At. Puntuaciones escalares Grupo de edad 16-19 afos Pruebas VERBALES fe VS ATO 1 ct Pe 1 04 OF OST 2 4 5 @ 4 5 5 8 3 52 13 8 9 § 6 6 3 4 a 410 7 100 6B OG 5 m7. 1 8 Wf 7 op - 5 6 BSI 1249 «9 «29H t2 BO 7 BS 15 10-8 8 MS 117 1 13d HB 9 4 19 12 Gt 24 0 1 18 1748 1819 1 10 No 4546 2122S tat 2 47493261819 OR ates 19 SST ST mT 4 26 OBS % 65S 7 19 - mm BOS 16 88RD kK he : - 5 + BT ® 7 0 BM 22 2 BB 19 886 91-83 Pruebas MANIPULATIVAS = Pe ACN COOMA OW RO Pe T 09 08 O17 08 0 08 O19 1 2 0 10 Bt 6 1 YON 14152 8 233202387 28H 8H 4 + 3446-2426 HID 451821 5 15 4782 779 136 Rg 6 16 «5367 «SH 2428 2028, «6 7 1749 586s 9597 116 01 27-29 2729 | 7 8 19 58 RATT tS SED 8 + 67s 424d 184 SIH 10 7579 4548 1920 15 HG HSS 10 M21 e083 dose IIT 8B 379K + eT 5355 - gd2 dO 12 1 8.06 HEED THN ABMS 18 4 g-tOh G2 AGTH 15-15 636524 maw 1 eS BSH vo. eT : - . - 7 1 - metz2 675s 58D SOT 9 a a a or er ai aka daa aight ts 7 jab is oboe HEE 120 - 2 shal Bi. bes ir iH, aR a : ele mene Tia Aa, Pumcionsesclores Grupo dl cad 25-94 ait Pruebas VERBALES Pe v s A D i c L Pe T wa 85 8 > 2 2 2 5 ee SF 8 3 0 4 6 8 56 4 «4 3 | 4 om 60: 8 eo 8 8g 5 mo 0 7 0 68 mH 68 § 6 mo He 8 6 te mts Fg 7 Be ie om 2 Be mw 3 8 mG is 1 14s Bg 9 9842 17-19 12 15 1617 17-18 10 es / 10 AAS 20 1814 16 1819 19-20 " 10, 64s zige re aol ate cra 4950 23-24 16 19 a2 2324 1213912 8 5S 0 oe Ws 5455 7 8 meets 7 me om me OOS 5 Doser vo 8 Bw ne 2 A ew Bl Oe 19+ 64-66 33 i 30 28 2 2119, 84s 8 2 9% sew Pruebas MANIPULATIVAS i Pe A cN ce MA Ht BS RO Po a a a 2 39 eek sae 3 eH sw i 56 23 Hs Ds 4 1213 4a 1628 7845 t620 tata 5 W15 4852 24-29 10641 68 21-23 19:20 5 6 16 5356 3082 1243 HO 228 Oe, 7 7 ‘S762 3395 HS N12 27-28 (25-26 T 8 8 6367 36-99 16-17 13 29:30 27-20 8 8 8 sm Oe te Sims tae 10 a 1478 4447 1920 1516 405 S510. Ho ee wee tt been ates 2 2 wm me 2) oO BA i 3 - 8105 55-58 . 19 N43 424413, Mm bio se sma ios "setae om io os tes vee “es ess amet Ms okies Ieee Peer wl Bo me" 2 @ 8 422 CRITERIOS CORRECCION FIGURA COMPL ’JA MODIFICADA DE TAYLOR * TODAS LAS LINEAS DE LA FIGURA NO DEBEN EXCEDER MAS DE 3mm DE SUS PUNTOS DE UNION, A EXCEPCION DE CASOS COMENTADOS EN EL PROTOCOLO. Tromo N°] eas a tener en Cuenta — || Angulos rectos de 1, no su. “| Hace referencia a la linea (acabada en flecha) que sobresale de la esquina del Hace referencia al cuadrado principal de la Figura Ha de ser un cuadrado: diferencia entre largo y ancho mayor a I em se penaliza Aunque las Iineas que forman el cuadrado sean curbas an en S, si, los sinygulos estin rectos y es un cuadrado, esté bien Mal situado en 1= Todo e! I en un solo cuadrante Hace referencia a las dos lineas diagonales de T ~ Puede estar dibujado de manera discontinua y recibir la méxima puntuacién ~ El punto medio del cuadrado ( 1 ) debe estar definido por la interseccién de las dos diagonales y estas para ser validas han de estar a 6 mm de la bien del centro imaginario del euadrado | = Si s6lo dos cuadrantes o un cuadrante tienen la diagonal se contaré como 0.5 puntos Siesté ddrantes se contaré como 1 punto Hacen referencia a las lineas horizontal y vertictl medias de 1 - | Las lineas deben cortar en la mitad: se penaliza un desplazamiento superior a 6 mm a _| cada lado del 3 0 a cada lado del 4 | Hace referencia a la corta linea horizontal del cuadrante superior derecl - La linea debe ser la continuacién de 16, se penaliza un desplazamiento | superior a 3 mm del punto medio de 4 (la mitad proporcional al cuadrante superior) ~ La linea debe terminar en en punto medio del cuadrante superior derecho, en unién con la mitad proporcional de 2, se considera valido un desplazamiento no superior a 3 mm del punto medio En todo caso Ia Tinea no debe exceder de los 4 em de longitud (se penalizaré ____como mal dibujado) oe oe Hace referencia a la corta linea diagonal del cuadrante superior derecho ~ La linea debe sobresalir por la esquina superior izquierda del cuadrante | ~ La linea debe coincidir con el punto medio del euadrante superior derecho | (unién con 5), consideréndose vilido un desplazamiento no superior a 3 mm | | } del punto medio | ~ Bn todo caso la linea no debe sobrepasar los $ cm de longitud (se penalizari | como mal dibujado) cuadrante superior derecho | ~ La flecha no ha de sobrepasar mas de 6 mm el rectingulo 18 (no mas de 4 em) - La linea (acabada en flecha) debe ser la continuacién de 2, se penaliza una | desviacién inferior o superior a 5* | Si s6lo aparece la linea, se contard como 1 punto = _ Si s6lo aparece la flecha, se contara como 0,5 puntos — Hace referencia al tridngulo derecho dentro de.1 (incluidas las dos lineas verticales) ~ Ha de ser un tridngulo: los angulos no deben ser superiores o inferiores a 5° = El apéndice del triangulo debe estar unido al punto medio de la parte | proporcional de 3 (se penaliza un desplazamiento superior a 3 mm del punto | medio) |= La base del tridngulo no debe exceder de los 3 em en ambos lado de 2, considerandose el punto medio de Ia linea horizontal de 3 (el conjunto no debe exceder de los 6 em) |= Deben haber dos lineas verticales paralelas en el interior del tridngulo, se | penaliza una s-paracién superior a 1,6 cm entre ellas, asi como una separaciéin | inferior a 5 mun entre ellas = Si s6lo aparece el tridngulo, se contaré como 1 punto = Si sélo aparecen las lineas verticales, se contard como 0,5 puntos ul | Hace referencia ala corta linea horizontal del cuadrante inferior derecho Hace referencia al semicirculo derecho fuera de | (incluidas los dos puntos) > Ha de ser un semicirculo con una anchura no superior a 2 cm, si excede la longitud de 7, se consideraré mal = Los extremos del semicirculo no deben exveder mas de 3 mm de tos extremos de la base del triéngulo 8 ~ Ha de contener dos puntos paraiclos en el extremo inferior del semicircula, no Superior a 6 mm @eFpunto- medio dalesmicizsuta 4? 2, Wa Sens eo - Al menos 2 puntos rellenos para considerarse bien dibujado ~ Si s6lo aparece el semicitculo, se contaré como 1 punto Si s6lo aparecen los dos puntos, se contard como 0,5 puntos Hace referencia al tridngulo que se encuentra unido a una corta linew horizontal que | sobresale de la esquina del cuadrante inferior derecho ~ El triéngulo debe tocar con el extremo de Ja linea horizontal que sobresile de 1, se permite una separacién de 3 mm | ~ La linea horizontal no debe sobresalir mas de 1,6 em de la esquina inferior derecha - ~-La-tongitud-dees-lados del-tiéngule-debe-sexla-misma,-bL3-ram | ~ El segmento imaginario que une el vértice superior i la base del tridngulo no debe estar rotado mas de 30° + El vértice del tridngulo no ha de sobrepasar més de 3 mm de la linea horizontal de 1 - La linea horizontal no debe estar rotada mis de 30° - Para considerar que Ja Tinea esté situada en la parte inferior del punto medio imaginario, ésta ha de estar a mis de 6 mm del teérico punto medio iB | Hace referencia a la linea ondulada (incluidas las dos cortas lineas) ~ Ha de ser una linea ondulada con dos picos a cada lado de Ia divisién diagonal | del cuadrante, y un pico inferior (a mas de 6 mm del punto medio tedrico del | cuadrante) - Los extremos de la linea ondulada deben coincidir con las esquinas de} cuadrante inferior izquierdo (al lado opuesto a 2) ~ Las dos cortas lineas han de estar situadas en el centro de los dos picos superiores (se acepta desviacién de +/- 3 mm en cada lado) ~ Las dos cortas lineas no han de exceder de 1,6 cm de longitud y deben ser paralelas a la diagonal de 2 + Sis6lo aparece la linea ondulada, se contaré como 1 punto ~__ Si solo aparecen las dos cortas lineas, se contard como 0,5 puntos ‘Hace referencia al tridngulo grande de la izquierda fuera de 1. Proporcién: se permite 1/3 del tamaio de error en mis grande o mis pequefio. La | proporcién real es un 30% de 1. Estard permitido entre un 43% y un 17% de 1 Por ejemplo, si | mide 11 om, la distancia de 1 al vértice de 13 podrd ser entre 4,73 y 1,87 cm. El vértice del 13 no se puede desviar mds de 6 mm del punto medio tedrico del 1 ‘Hace referencia a las cuatro lineas horizontales en 13 Las lineas deben ser paralelas: cada linea respecto 2 la anterior. El 14 debe formar | angulo recto con el 3. Se acepta desviacién maxima de 30° La primera linea horizontal debe iniciarse entre 7 mm y 1,3 cm del punto medio tedrico de3 Puntuar como mal situada si la primera linea se superpone con la linea horizontal 3 Hace referencia ala linea diana! (acabada en jlecha) que sobresale del apéndice de 13 penclicoler - Ha de ser una linea vertical paralela 4 4, acabada en flecha Se penaliza uma desviecién superior 0 inferisv 2 5° Debe sobresalir del extremo de 13, cons'derindase vélido un desplazamiento no superior a 3 mm Le longitud de 15 no he de ser inferior a 2,7 cm ni superior a 3,6 cm Si sélo aparece la linea, se contaré como 1 punto Si s6lo aparece la flecha, se contar como 0,5 puntos | jace referencia a las lineas horizontal y vertical del cwadrante superior tequierdo di | - Las lineas no deben sobrepasar més de 6 mn del punto medio tedricn det | cuadrante superior i2quierdo de 1 ' ~ Ta Mnea horizontal ha de ser varalela a3 | LC a linea vertical ha de ser paralela a4 7 Hace referencia al circulo en cuadrante superior izquierdo | ~ El diémetro del citeuto no ha de ser superior a 4 em ~ El cfreulo debe estar situado en el centro dle fa interseecién de 16 + Seconsidera que el circulo esté cerrado si la abertura no excede de los 2 mm ~ Sil circulo esta sobredibujado més de 1/3, se considera erréneo | + Si la proporcién del diémetro es > al 15% de la altura del cuadrante, se consideraré mal _ Hace referencia al recténgulo a la izquierda, fuera de 1 (incluidas Tax seis lineas verticales) | | Ha de ser rectingulo: diferencia entre largo y ancho menor de cm se pensliza | | Las lineas verticales de los lados del rectangulo han de coineidir con los extrems del | cuadrante superior izquierdo, se consideraré vilido un desplazamiento no superior a 4 | | mm | = Las seis Iineas verticales han de ser paralelas y no estar rotadas mis de 30" | ~ Ninguna de ellas debe coincidir con el punto mediqté6neD del rectingulo (<1 |6 © le | | - Deben haber 3 lineas a cada lado del punto medio teorico del rectingulo ake -__Las lineas no deben sobreponerse con los lados del Tectingulo « ¥ - — - —_ i — (OW Sea APPENDIX C REGRESSION FORMULA FOR CALCULATION OF THE DKS-2 Torat AGE- AND Epucation-CoRRECTED MOANS Scatep Scores (AEMSS) Ags_and Education Corrected MOANS Scaled Scores (AEMSS) for DRS Total Scores are calculated by using the ‘AgeCorrected MOANS Scaled Scores (AMS) from Appendix A and education in years) in the following formule: AEMSS = 2.56 + (1.11 x AMSS) - (0.30 x EDUC) {ote From “Normative Data for the Matis Dementia Rating Scale,” by J. A. Lucas, RJ. nik, GE Smith, D, L Bohaw EG sro ges Kokmen, N.R. GraftRadford, and RC, Petersen, 1998, Journal of Clinical and Experimenta! Neuropayeholocy, 20, p. 545. Copyright 1998 by Swets & Zetlinger. Adapted with permission. 47 CLINICAL DEMENTIA RATING Specific rules by Morris (1993) Use all information and make the best judgment. Score each category as independently as possible. Mark in oniy one box for each category, rating impairment as decline from the person's usual level due to cognitive loss alone, not impairment due to other factors such as physical handicap or depression. Occasionally, the evidence is ambiguous and the clinician's best judgment is that a category could be rated in either one of two adjacent boxes, such as mild (1) or moderate (2) impairment. In that situation, the standard procedure is to check the box of greater impairment. Aphasia is taken into account by assessing both language and nonlanguage funetion in each cognitive category. If aphasia is present to a greater degree than the general dementia, the subject is rated according to the general dementia. Supply evidence of nonlanguage cognitive function. The global CDRs derived from the scores in each of the six categories (box scores) as follows: Memory (M) is considered the primary category and all others are secondary. CDR = M if at least three secondary categories are given the same score as memory. Whenever three or more secondary Categories are given a score greater or less than the memory score, CDR = score of majority of secondary categories on whichever side of M has the greater number of secondary categories. However, when three secondary categories are scored on one side of M and two secondary categories are scored on the other side of M, CDR = M. When M = 0.5, CDR = 1 if at least three of the other categories are scored 1 or greater. If M 0.5, CDR cannot be 0; it can only be 0.5 or 1. If M = 0, CDRO, unless there is impairment (0.5 or greater) in two or more secondary categories, in which case CDR = 0.5. Although applicable to most AD situations, these rules do not cover all possible scoring combinations. Unusual circumstances that occasionally occur in AD and may be expected in non-Alzheimer's dementia as well are scored as follows: (1) With ties in the secondary categories on one side of M, choose the tied scores closest to M for CDR (eg, M and another secondary category = 3, two secondary categories = 2, and two secondary categories = 1; CDR = 2) (2) When only one or two secondary categories are given the same score as M, CDR = M as long as no more than two secondary categories are on cither side of M (3) When M = 1 or greater, CDR cannot be 0; in this circumstance, CDR = 0.5 when the majority of secondary categories are 0. 2.5(1999) CLINICAL DEMENTIA RATING Specific rules by Morris (1993) Use all information and make the best judgment. Score each category as independently as possible. Mark in only one box for each category, rating impairment as decline from the person's usual level due to cognitive loss alone, not impairment due to other factors such as physical handicap or depression. Occasionally, the evidence is ambiguous and the clinician's best [judgment is that a category could be rated in either one of two adjacent boxes, such as mild (1) or moderate (2) impairment. In that situation, the standard procedure is to check the box of greater impairment. ‘Aphasia is taken into account by assessing both language and nonlanguage funetion in each cognitive category. If aphasia is present to a greater degree than the general dementia, the subject is rated according to the general dementia. Supply evidence of nonlanguage cognitive function. The global CDRis derived from the scores in each of the six categories (box scores) as follows: Memory (M) is considered the primary category and all others are secondary. CDR = M if at least three secondary categories are given the same score as memory. Whenever three or more secondary Categories are given a score greater or less than the memory score, CDR score of majority of secondary categories on whichever side of M has the greater number of secondary categories. However, when three secondary categories are scored on one side of M and two secondary categories are scored on the other side of M, CDR = M. When M = 0.5, CDR = 1 ifat least three of the other categories are scored 1 or greater. If M 0.5, CDR cannot be 0; it can only be 0.5 or 1. If M = 0, CDR, unless there is impairment (0.5 or greater) in two or more secondary categories, in which case CDR = 0.5. Although applicable to most AD situations, these rules do not cover all possible scoring combinations. Unusual circumstances that occasionally ‘occur in AD and may be expected in non-Alzheimer's dementia as well are scored as follows: (1) With ties in the secondary categories on one side of M, choose the tied scores closest to M for CDR (eg, M and another secondary category = 3, two secondary categories = 2, and two secondary categories = 1; CDR = 2). (2) When only one or two secondary categories are given the same score as M, CDR = M as long as no more than two secondary categories are on cither side of M. (3) When M = 1 or greater, CDR cannot be 0; in this circumstance, CDR = 0.5 when the majority of secondary categories are 0. CLINICAL DEMENTIA RATING (CDR) Hughes etal 1982. 1988) Nombre: Varén [ ] Mujer (J Fecha: F. nacimiento: Edad: Estudios/Profesién: NEP: Observaciones: Demencia Demencia ‘Demenca Indliduo normal postle Demencialigera ——-moderada grave cbRO conas CORT con? cons Memort Sn périda de me- Trastoros loves da Pérdila_modaada Péidda grave de Péréda grave 0 maria ri oVides mamaria, @ioca- dela mera so- _meraria memoria loves iin parcial dales bre Yodo para ls Sélo se conserva dl Solo se conservan Feoueréos; oN recuerdos recion- rater fuerte: recueidos frag os berignes: tas, con reparcur mente consolda- _mentados sonenlavidada- do ie Les recuerdos re ‘lntes 80 oMisan rdpicarente Orientackin Completamente Completaments Akgunas dfcutadss Normalmente deso- Sdio otentado en ‘fentado ‘ofentado, aunque Ge orentacin en rienadoenaltem- —relaciin con las coniges dcu- temo: erata — poyamenusoen personae ‘aes pera Gocenrespectosi espacio iontacin tom- gar dal ere, oral puede haber oe- sonortaccn geo aca con res ecto a ots Le ares iio, Resuave conectar Ligeraateraciin on Diicutad modera- Ateracon grave en lncapaz de razonar resolicién de mente es protle- la capacidad de daparacompren- lacomprensién de 0 resoker proble- problemas mgs; judo ade- resokiciéndapro- der problemes problemas, seme- mas cuado en relacién —blemas, samen —compleos; cD janzas_y deren con a capacidad © zas y Berencias socal normal cis, La vaoraién de que cisfrtaba mente conserve. social est nor ne pasado cs male tera Actvideces vol do autonemia Si existe atoracén, No puede realizar Incapar de autora Incapaz de augono- sociales ranterido en ol ésta es eve Independiente- ma fuera de su mia fuse de su ‘vabao, negocios, mente estas act--_domicilo omic comeras y act vides, aunque clades socales fogavia' partcipe en algunas. Puede apareose normal ante una coservacon &: petal ‘Actidedes Somantenonbionla Estas acthicades Las acthidaces do- Preservada la ca- Uricamento act omésicss vida en casa, is Se manfionen 0 mécteas sehalan paced para tra- dat turcional on pase pasatems yea 9010 estn igera:levemanle dism- bejos senclos; su propia habia femecs —acihidedas Inte» mantle. disminu—nuidas pero de oe cantos de in-tn lectuales as forma eidenie, teres son muy F Los vabejos aici milagos y la act- les loa pasa- vida poco soste- tiempos comel —nida cados son aban denacos Cuidados _Autonoria'comple- Autorama comple: Necasta estindos Neoasta ayuda pa- Necasita mucha ‘personales ta ta esporicicamenis ra vestse, lva- ayuda on los cul sey para mante- dados person: nerelaseo perso- ‘es; a menudo al ray inoontinencia CLINICAL DEMENTIA RATING Specific rules by Morris (1993) Use all information and make the best judgment. Score each category as independently as possible. Mark in only one box for each category, rating impairment as decline from the person's usual level due to cognitive loss alone, not impairment due to other factors such as physical handicap or depression. Occasionally, the evidence is ambiguous and the clinician's best judgment is that a category could be rated in either one of two adjacent boxes, such as mild (1) or moderate (2) impairment. In that situation, the standard procedure is to check the box of greater impairment ‘Aphasia is taken into account by assessing both language and nonlanguage funetion in each cognitive category. If aphasia is presentto a greater degree than the general dementia, the subject is rated according to the general dementia. Supply evidence of nonlanguage cognitive function. The global CDR is derived from the scores in each of the six categories (box scores) as follows: Memory (M) is considered the primary category and all others are secondary. CDR = M if at least three secondary categories are given the same score as memory. Whenever three or more secondary categories are given a score greater or less than the memory score, CDR = score of majority of secondary categories on whichever side of M has the greater number of secondary categories. However, when three secondary categories are scored on one side of M and two secondary categories are scored on the other side of M, CDR = M. When M = 0.5, CDR = 1 ifat least three of the other categories are scored 1 of greater. If M 0.5, CDR cannot be 0; it can only be 0.5 or 1. If M = 0, CDRO, unless there is impairment (0.5 or greater) in two or more secondary categories, in which case CDR = 0.5. Although applicable to most AD situations, these rules do not cover all possible scoring combinations. Unusual circumstances that occasionally Occur in AD and may be expected in non-Alzheimer’s dementia as well are scored as follows: (1) With ties in the secondary categories on ane side of M, choose the tied scores closest to M for CDR (eg, M and another secondary category = 3, two secondary categories = 2, and two secondary categories = 1; CDR = 2) (2) When only one or two secondary categories are given the same score as M, CDR = M as long as no more than two secondary categories are on cither side of M. (3) When M = 1 or greater, CDR cannot be 0; in this circumstance, CDR = 0.5 when the majority of secondary categories are 0. 469.1999) SMENERCA UEAYEEIN ELA INA LENG (CUI) Hu; ghes et al (1982, 1988) Nombre Veron [] Mujer (J Fecha: F. nacimiento: Edad: Estudios/Profesion: N.Ht: Observaciones: amend Demencla Damenca Inchviduo normal posible Demencia igera —-roderada gave coRO coROs coo) con? cor3 ‘Memeria Sin pédida de me- Trastornos loves de Pérukda moderada Pérdida grave de Pérdda grave do ‘maria ni oWvdos memoria; evoca- dolamemora, so- memoria, memoria loves clon paral de los bre todo para los Sto se consena el Sdlo se conservan recuerdos; 0M recuerdos. rocen- material fueria- recuerdos. frag- ‘Gos berignes+ tes. con repercu- mente consolda- —mentados sin entavide dee do vis Los recuerdos. re ‘lentes go oben ‘apdamente Grentacién Completamente Completamonte Aguas diicutades Normalmente dss0- S30 eniaio en oventado ‘fentado, aunque de ofentaoin en rienladoeneltiom- —relacién con las Cconligeras dficu- tempo; crenta- poyamerudoen personas fades pe la doconrespectoal al aspacio rontacion tem- ugar de examen poral puede haber oe so‘entaciin goo ges con es ecto a ots bi ores akin, FRosuebe covecta- Ligeraatractn en Difcultad modera- Atrackin grave en ncapaz de razonar rasolicién de mente los proole: la capacidad de daparacomeren- la oompxension de 0 rescher provle- ‘problemas mae; ucio ade- _resoluciéndepro- der problemas problemas, some- mas, ‘cued en relacién biemas, semeian-comelgos: io fanzas ere (con la capacidad © zasy dlerancas social rota: cas, La veloracén de que dsfutaba mente consene- social est ner- ene pasado co rmalmente aterada Actividades Nivel de autonomia Si evsteateraciin, No puede reaver Incapaz de autona- Ineapaz de autor: sociales mantonido on el éataes kve independisnte- mia fuera de su mia fuera do. su trabeo, negocios, merte estas aci- mic. omiilo ‘compres y act videdes, eunque dades socks ‘todavia participa er algunas Puede apareoer normal arte una coservaciin su perc ‘Actridsces | Semanterontblenla Esiss actividades Las actividades do- Presenvada la ca Ucarrento acti doméstcas vida on casa, los se mantienen o mésticassehalan pacidad para ta dad furconal en ‘ypase- _pasallempos y lasso estén ligara- leverarta dsm- bajos. sencilos; Su prope reba. eros aihidares inte: ments dismnul- nuldss pero de os cantvos 08 in” dn lectuales as forma vente. tres gon muy F- Los raboos dic mitedos y i act les y los pasa- vidad poco soste- tempos compl rida cados son aban: sdonadios (Cuidados | Autonomia comple- Autonoma comple- Necesita estimuos Necestia ayuda pa- Necesta mucha arsonales ta @ ‘esporédcamenta ra vest, lvar- ayuda en fos cu soy para mante- dados persona nerelasooperso- les; a menudo a hay incontinencia MEMORIA VERBAL DE FIJACION Table 10—16, RAVLT Sees fir Children, Age 71015 age? et ee ne Bh vom OM SOM MM Thal List a) 88, 62 2 Tid 24st A as 8 Ss u MS “Talat A en 98 sz dH 109 “Tal List A a wo Wa) SB Val 51st 2613 W5a)D “aad mo) 487 9 GBS Distatrst B Le 60 370 BLD Taal A6 Relation ao an 2 at Til AT Delayed Recall ol a6 al Hd List A Teropton on MSO 3 OH) ast Reva 2 72 ga 38 aS Fake fotos io ai iw) BO Serer: rvs el Ge LL: rode dita LOoysand Msn cao age ops. 78,910, 1-13. aed 14-15 sens. Reprated wth pernsin of Sets &Zeling A comet MPENDIUM OF NEUROPSYCHOLOGICAL TESTS d Recormized According ta Age ane Trial Tata tilt : Tosa a x ao an oo 36 al tata 3 mo as a Te Dit a W903 ah ne oe wee as Tal 20 16 25 3 hy Ma Ba istranton Last B ‘ G18 ATA 8 se Til Aiton: assay Go a ee 20 ‘a3 2h 98 8 86 ho a 33 'Dalised fat Qv wo ak as ae a ha oy Bs ag ay 2 na ay ‘se 2 ae ‘ot wh aw s 9 OH Os oF OF 01 96 as 08 Wh ar OF lay 188, Table 1018. Feanies: Mean SID! Numberol Words Becalied and Recognized tial Age HI) Agra ACSIA noe Acword 1 MSD) MSD) M Moosm MSD trial ers 1m 6h 5) os Qh 3b a Visa Lis ws an 9s waa 9 Ls oy am 69 Qt roa 3 1st 6 1a 1a Wy Woo de SYS! Tina List 8 6 6 IT BN 6 2 by od ny Tad 5 List A bs a8 Bo wu Ba Lb Ho he ata SI 9 DS wa) 506 IT 5. Distrartor sth 73 L6G 2h aN Te 53 18 Trial A6sKetentoont ILD) ELE al wa at wo as fad at us. wt Os We 28 100 al ‘Delage Neva Neveu List A Be 2h 65 1H BE 1 he 22 El at Ha as Be ao List Ty Gd TN SE OAS bs TA A 6H Jo) HI BS TS BT PAWS A! fo wal 09 01 OY AE OF A OY ME OF IY OS OH Pinshist Br Or Wr OF il Os Ob OT wh OT MT aT Ot OF Source, ellen ta, personal eonsmnictonn, May 1865 Notes WA! = O51 + habrate fe positon ates i ip N= Wm ate 30 te | (oa4 at aie nd ote is . | pass ted td a ols fetta ao Has Ba ieies 2 ie i ye go ag a ar aay haa be aed { Bea US Us SN ae od to alps! faa at ae ai s7 23 ‘99 inal sy a3 ‘Ss BAUGRSUMG EEGs ANOMIA: Nivel universitario < 50 13 —14 afios de escolarizacion << 45 Menos de 13 afios de escolarizacion 38 -45 Analfabetos < 38 MEMORIA VERBAL DE FIJACION Table 1016. RAVLE Seores lor Chileon, Age? 10 15 wll awl my " Asc in 3 tial se a wt Fra 218 6 43 “1 Wik List al 8a m9 Tina List © 4 us ks Tul SLi m2 te Bd “hal any wo 85 Dioraton Lit B 3t By Til at Betti: so gs at Wa ol AFDeavra Bowl BA ba a) List A lascethon I a Lat eve on T2 gn TR as abe Eats M Shs) se, boursteanel Cellet 1981 prone tafe FOr i gilsateachot rages, 7=8.9 20 11 at to ith pers of Sets & Zeithne. 1 Ben, Be 7 A COMPLNDIUM Ros 1 Aco F DIUM OF NEUROPSYCHOLOGICAL TES IS her of Words 2 Table 10—17. Males. Mean SDN: Recalled. - Males. Mt eeallesd and Bev Distt bxt Hal We teen tial 7 Kecogmtions “ sth " i" mite nt, at a ay at Fave eit rt MEMORIA VERBAL DE FIJACION Table 10—16. RAVLT'Seores or Children, Age? to 15 Age? Ae! Agel i= 2m neath i= 3 Ms ws MSD ‘Tl List A 45 Ls) SB 62 (LB Til 2Lst A a7 SD usw) ‘Wisk BLast 8 st pa MH a 109 ‘Tul ist 8 94 ah 19 a BS Wid 5 List & 2 B63 us a Wal nt mn 85 Distractr Lisl B 45 kG 60 37 Sh 88 Trl 46 Retention) so 28 os an oa Trl ATWDeksed Recall Ba g8 Ld 1st 8 Bevopaiton 46 M5 OS. ist Beorgition 61 7 7200 aT Fae Bostves Ld 24 at ws 8 unre: Forester ane ellen: 11 pride dat Whowsand Mginswwesckollorae gra, 78.9 10.11-12 anh 14-13 sea. Reprinted with pernson ef Swe & Zeng, 334 MPENOIUM OF NEUROPS: LOGICAL TESTS a COMPENDIUM OF NEUROPSYCHOLOGICAL TE Table 10— fable 10—17. Males, Mean (SD! Number of Words Recalled andl Recognised Securing to A — _ —_ 1619 20.29 a0) way i Tral tata ial 3 Lint as me renstned ; fn tte nH 5h4 7. iat Distractor List B te ts w Last 6y 5. rm rial AW Ret 4 2 Radserheeton 2 UW to yak on Wake st (Delayed tecall) Be eo os * List 7 Auta ay iar tr Oh as ut SBE aS eat ie Wi o OF Ob OF an a6 a Suuery: Gell, perma eonmunication, May 185, Nate: AS = 08 = Archives of Clinical Neuropsychology Advance Access published August 5, 2009 Archives 6 ‘ CLINICAL OXFORD JOURNALS NEUROPSYCHOLOGY Spanish Multicenter Normative Studies (NEURONORMA Project): Norms for Verbal Span, Visuospatial Span, Letter and Number Sequencing, Trail Making Test, and Symbol Digit Modalities Test Jordi Pefia-Casanova"”*, Sonia Quifiones-Ubeda®, Marfa Quintana-Aparicio®, Miquel Aguilar‘, Dolors Badenes*, José Luis Molinuevo!, Laura Toner“, Alfredo Robles®, Marfa Sagrario Barquero", Clara Villanueva’, Carmen Anttinez#, Carlos Martinez-Parra®, Anna Frank-Garcia', Azucena Sanz}, Manuel Fernéndez’, Verdnica Alfonso, Josep M. Sol, Rafael Blesa!, for the NEURONORMA Study Team* *Section of Behavioral Newroogs and Demeoias, Hospital del Ma, Iain Municipal Assisi Samiti Barcelona, Spain "Behevioral Newrologs Groxp, Ht Municipal dTmeigcis Medion, Barcelone, Spin “Senice of Neurol, Hospital Mia de Terrssa Terrassa Spt Service of Newtons, Hosptel Cline, Barcelo Spain “Serve of Neurology. Hospital Chino Universi, Santiago de Compostela, Soin ‘service of Neworoay, Hapa scr Sun Calor Maid. Spin Senice of Nearologs Hostal Virgen Aiaca, Murcia. Spain Service of Neurology: Mogpil Virgen Macarena, Sel, Spain "department of Neurology Hospital Universitario La Bac. Maid. Spain ‘service of Neurology. Hospital de Crcer, Biber. Spain “Ewopean Biometric Insite, Barelone, Spain 'sertce of Nearoogs Hospital de a Santa rent Sant Pan, Barcelona. Spin Acceped 29 Jone 2009 Abstract ‘As par of the Spanish Multicenter Normative Studies (NEURONORMA project), we provide age- and education-adjuted norms forthe following instruments: verbl span (digs), visuospatial span (Cors’s test, letter-nomber sequencing (WAIS-II, tail making fest, and symbol digit modalities test. The sample consists of 354 participants who are cognitively normal, community-dwelling, and age ranging from 50 to 90 years. Tables are provided to conver: raw scores to age-adjusted scaled scores, These were further converted into edh- cation-adjusted scaled scores by applying repression-based adjustments, The current norms should provide clinically wsefel data for evaluat- ing elderly Spanish people. These dats may be of considerable use for comparisons with other normative studies, Limitations of these normative data are mainly related tothe techniques of recruitment and stratification employed. Kewords: Atenton; Problem solving: Wechsler sles; Dmogsaphy; Educational status: Reference vales Introduction Attention is very important aspect of neuropsychological assessment (Lezak. Howieson, & Loring, 2004), and attentional disorders affect a significant number of brain-injured patients (Strauss, Sherman, & Spreen, 2006). Many attentional tasks are * Consponding author at Instat Municipal Tnvestigacié Mica, Biomedial Research Pak Building. Carrer Dr. Aiguer 8, 08003 Barcelo, Spin "Tok: $34 34 953160765; fox 34 3493316072, | Email abies: jcatanova@imas iim 2x (, Pea Casanov), Deceased. * For te NEURONORMA.ES Study Team members, see Append. {The Author 2009, Published by Oxford Univers Pes. A sights oi: 10 1093rtivacp O38 For permissions, please e-mal: journals permissions oxforducnl rg. 2 Peta Covanova et oh Archives of Clinical Newrpyehotog multifactorial and overlap with other neuropsychological domains such as executive functions and memory, including ‘components such as inhibition, switching capacity, or mental tracking (Strauss et al, 2006). Classification of these tasks is controversial and they may appear under different headings, for example, attention, working memory (WM), or executive tests. In fact, attention overlaps with the executive function of WM (Baddeley. 1986, 2003), so many existing tests of attention are a combination of attentional and executive functions. Attention is considered a complex system of interacting circuits that allow the filtering of relevant and irrelevant information within the context of internal and external stimuli A seties of functional models of attention have been proposed (see Banicih, 2064; Cohen, 1993). The standard model of WM. (Baddeley. 1986) can no longer accommodate many empirical findings, and an alternative has been suggested: WM functions arise through the recruitment, via attention, of brain systems that have evolved to accomplish sensory-, representation, and action-related functions (Poste, 2006). A recent computational and neural model, called PBWM (prefrontal cortex, basal ganglia WM model), relies on actively maintained representations in the prefrontal cortex which are dynamically updated) ‘gated by the basal ganglia (Hazy, Frank. & O'Reilly, 2006). Functional connectivity argues for separate contributions of Ventral and dorsal visual and auditory streams in WM (Buchsbaum, Olsen, Koch, & Berman, 2005). Tn this paper, normative data are presented for the attention measures included inthe Spanish Multicenter Normative Studies (NEURONORMA project) (Pefia-Casanov etal. this issue). Some tests cover aspects of selective attention (i.c., WM) such as digit span or symbol substitution tasks, whereas others include capacities such as mental flexibility and motor speech, for example, the Trail Making Test. The Stroop Test (Golden, 1978; Stroop, 1935), which also measures attention, has also been studied, but is presented in another paper in this issue. Verbal Span (Digit Span Forward and Backward) ‘This is both an attention and memory task. The digit span requires repeating sequences of digits of increasing length forward ‘and then in reverse order. Both tests consist of seven pairs of random number sequences thatthe examiner reads aloud at the rate of one per second. Bach test involves different mental activities and is affected differently by brain lesions (Banken. 1985; Kaplan, Fein, Morris, & Delis, 1991). The digit span test in the Wechsler tests is the format most commonly used to measure the span of immediate recall, Current Spanish norms are included in the WAIS-IIL and WMS-III manuals (Wechsler, 1987, 1997, 2004a, 2004b). Artiola. Hermosillo, Heaton, and Pardce (1999) included in the Spanish battery a digit span test adapted from the WAIS. The sample included 205 subjects from Spain, of whom only 33 were in the 55+ year range. Forward Span ‘The digit forward span has a relatively restricted range and 89% of the subjects show spans within the 5-8 digit range (Kaplan ef al,, 1991), The normal range for forward digits is 6 ++ 1 (Miller, 1956; Spitz, 1972), and education has an effect ‘on the score (Ardila & Rosselli, 1989; Kaufman, McLean. & Reynolds. 1988). Age minimally affects forward span beyond the ages of 65 or 70 years (Hickman, Howieson, Dame, Sexton, & Kaye, 2000; Howieson, Holm, Kaye, Oken, & Howieson, 1993; Orsini, Grossi, Capitani. Laiacoma, Papagno, & Vallar. 1987). Its important to point out that differences in digit span forward performance between English and Spanish speakers are probably due to the greater number of syllables per digit in the Spanish language (Olazarén, Jacobs, & Stern, 1996). Backward Span This task involves mental tracking with verbal and visual processes (Larrabee & Kane, 1986) and includes a strong WM. component. It is distinct from the more passive span measured by Digits Forward (Banken, 1985; Black, 1986). The normal raw score difference between forward digits and backward digits tends to range around 1 (from 0.59 to 2) (Black & Strub, 1978; Kaplan et al, 1991; Mueller & Overcast, 1976; Orsini et al., 1987). The normal span for backward digits is 4-5, and a'scote of 3 is considered borderline defective or defective depending on the educational level of the subject (Borwinick & Storand, 1974; Lezak et al, 2004), Scores typically decrease about one point beyond age 70, but not all older subjects get lower scores than younger ones (Canavan et a., 1989; Howieson et al, 1993). Visuospatial Span (Corsi's Test) Tt consists of nine cubes fastened in a random order in a board, Each time the examiner taps the blocks into a prearranged sequence, the patient must attempt to copy this pattern (Milner. 1971, 1972). Block span is normally one to two points below digit span (Kaplan etal, 1991; Ruff, Evans. & Marshall, 1986) although in young controls a disparity of more than two points may be found (Smirni. Villarita, & Zappala, 1983). Education contributes ‘Significantly to performance on the test, and men tend to achieve slightly higher scores than women although this discrepancy is Pesa-Casanoa et al J Archives of Clinical Nenropavlogs Virtually nonexistent for people with more than 12 years of education (Orsini, Chiaechio, Cinque, Cocchiara, Schiappa & Grossi, 1986). Age effects appear after 60 years (Mittenberg. Seindenberg. O'Leary, & DiGiuglio, 1989). In a comparative study, English and Spanish speakers had similar scores on Visual Span (Olazarin et al., 1996), ‘The rate of age-related performance decline is equivalent for forward and backward measures of digit and spatial spans (Hester, Kinsella, & Ong, 2004), Letter-Number Sequencing Letter Number Sequencing (NS) is an addition to the standard measures of WM (digit span and visual span) included in the WAIS (WAIS-III, Wechsler. 1997), Patients are required to listen to an auditory presentation of altemating numbers and letters and then repeat back the numbers in ascending order, followed by the Ieters alphabetically, This test assesses processing speed and verbal and visual spatial WM (Crowe, 20; Haut, Kuwabara, Leach, & Arias, 2000). Normative data show a moderate age effect (Crowe, 2000). Spanish norms of ths test are included in the WMS-III Spanish edition (Wechsler, 20042, 2004), Trail Making Test ‘Trail Making Test (TMT) assesses speed of visuomotor tracking, divided attention, mental flexibility, and motor function (Crowe, 1998). For historical aspects and versions of the test, see Strauss etal, (2006), The test has two parts: (A) drawing 2 line linking numbers in sequence and (B) drawing a line linking letters and numbers in sequence (Partington & Leiter. 1949; Reitan & Wolfson, 1993), The score derived for each trail is the number of seconds required to complete the task. Motor agility and speed make a strong contribution to successful performance in this test (Schear & Sato, 1989) Normative data vary markedly according to the characteristics of the normative samples (Ashendorf et all, 2008; Giovagnioli et al, 1996; Lezak et al. 2004; Mitrushina, Boone, Razani, & D'Elia, 2005; Peri et al, 2007; Suokup et al., 1988; Strauss et al., 2006). Demographic effects such as age, education, ethnicity, and sex have been associated with ‘TMT scores (Horton & Roberts, 2003), A recent meta-analysis study stressed that normative data from different countries and cultures are not equivalent, a fact that might lead to serious diagnostic errors (Fernindez & Marcopulos, 2008), Performance oo TMT is affected by age: increased age is related to poorer test scores (Ernst, Warmer. Townes, Peel, & Preston, 1987; Periéier et al,, 2007; Rasmusson, Zonderman, Kawas, & Resnick, 1998; Salthouse et al.. 2000; Stuss. Stethem, & Poirier, 1987; Wecker, Kramer. Wisniewski, Delis. & Kaplan, 200). Lower levels of education are associated with the poorest test scores (Bornstein, 1985; Bornstein & Suga, 1988; Ernst, 1987; Stuss, Stethem, Hugenholtz, & Richard. 1989). Sex has litle impact on performance in adults (Hester. Kinsella. Ong, & McGregor, 2005; Lucas et a 2005; Tombaugh, 2004) although women may perform slower than men in part B (Bornstein, 1985; Ernst, 1987) ‘The TMT was included in the MOANS (Steinberg, Bieliauskas, Smith, & Ivnik, 2005) and MOAANS (Lucas et al.. 2005) projects. Spanish norms are available (Del Ser etal, 2004; Peril. et al.. 2007). The study of Peridiiez and colleagues (2007) ‘consisted of 223 healthy control subjects: 69 were in the 16.~24 year range, 89 were in the 25~54 year range, and 65 were in the 55-80 year range. The study of Del Ser and colleagues (2004) examined a population sample aged more than 70 years. Spanish speakers commonly use two versions of the alphabet, one that includes the sound/rapheme “Ch” between C and D ‘and another that goes directly from C to D. Recently, versions of the TMT part B have been created and compared (Cherner ct al, 2008). The findings of the comparison suggest that both versions are equivalent and can be administered to Spanish speakers without affecting comparability. Symbol Digit Modalities Test Symbol Digit Modalities Test (SDMT) (Smith, 1982 [First Edition, 1973) measures divided attention, visual scanning, visual tracking, perceptual speed, motor speed, and memory (Shum, McFarland, & Bain, 1990). A coding key is presented, consisting of nine meaningless geometric designs each paired with a number. The subject is required to scan the key and write down the number corresponding to each design as rapidly as possible in 90 seconds. There is a practice period (10 boxes). The number of correct responses is recorded. The maximum score is 110. A series of normative studies have been published (Lezak et al, 2004; Mitrushina et al. 2005; Smith, 1982 (Revised Manual}; Strauss et al, 2006; Sheridan et al,, 2006) including @ Spanish version (Smith, 2002). The Spanish normative study consists of 1,054 adult subjects from 18 to 85 years old. Norms are presented for six age groups and only two groups ‘of education (basic and superior. ‘Manual speed und agility contribute significantly to SDMT performance (Scheur & Sato, 1989). SDMT scores decline with age (See Strauss et al, 2006 for a review). This decline probably reflects changes in the speed of both motor response and ‘ Pe Casanova eta Archives of Clad Newroptycotogs information processing (Gilmore, Royer. & Gruhn, 19838, 1983b) and in memory (Joy. Kaplan. & Fein, 2004), Performance improves with increasing education (Richardson & Marottoli, [996). Education- and age-corrected norms for people older than 75 years have been developed (Richarson & Marottli, 1996). Sex differences have not always been found and appear to be of insufficient magnitude to create separate gender-based norms (Gilmore et al.. 1983a, 1983b), although this finding has not always been consistent (Jom, Anstey, & Christensen, 2008), Materials and Methods Research Participants Recruitment procedures, socio demographic characteristics and participant characteristics ofthe entite NEURONORMA sample have been reported in a previous paper (see Pefia-Casanova eta, 2009). Due to logistic organization, not all the participants were administered one or more neuropsychological measures, Data from all completed tests were included in the normative studies, leading to minor sample size variations among tests. The distribution of demographic variables by testis presented in Table I Neuropsychological Measures ‘The neuropsychological measures were administered as part of a larger neuropsychotogical test battery, the NEURONORMA battery (Pefia-Casanova et al 2009). Tests were administered by neutopsychologists specifically trained for this projec. Verbal Span ‘The two parts of the digit span test (forward and backward) in the Spanish version (Pefta-Casanova, 2005) were adminis- tered following standard procedures as indicated in the WAIS-II manual (Wechsler. 1997). The range of raw scores (last series) is the following: forward digits 0-9: backward digits 0-8. ‘Table 1. Sample size by demopraphis and tet Verbal Span Visual INS ‘Tell Making Test Symbol: Digi Span Modules Test Pana Part B wy ® ym n% x * x # y® Age Gop 50-36 Ce ae 6 3 moe 5817 57-89 st st Sg st WR st lat 60-62 Mo 8m MY M 0 8 63-65 sar Sse in Ie asa 66-68 es a MT on Sow ISG ° 1498 ta m4 33 932 ne 2 2% BST 95 18-77 318% as u % 795 MT 78-40 a 583 6m Ey Ce >a 367 a4 0 R fo 30512 [Bdscaton (Years) <5 1% ay) mse wk mST ST Taw ot 2% 1M SST 9 oF 18936 BST GEIS? BT 1888 it ase ahs a6) 6) 8 3986S] as 3932 8G ATS ATS HTT HTH HBT M3 4040 0a. kata? 40293229 os Female 21 5960209308996 SRHK 20H SATB. STK 05.84 ‘Tal Sample (a) 384 40 sa 380 37 a6 ees: 9 = number (count); CNS = late —namber sequencing. Poso-Casanov eal / Archives of Clvicel Neaopascatee s Viswospatial Span ‘The two parts of the visual memory span (tapping forward and tapping backward) were administered following adminis- tration procedures as indicated in the WMS-R-NI manual (Cossi’s Test, from the WAIS-R-NI, Kaplan et al. 1991). This version requires two administrations at each level. The longest span was recorded (last item score) and the global score as ‘well (sum of all administrations). The range scores for forward and backward formats ate the following: last item (longest score) 0-8; raw score (global score) 0-16. Letter—Number Sequencing ‘Standard administration procedures were followed as indicated inthe test manval (WAIS-III, Wechsler, 1997). The range of the possible raw scores is from 0 to 21. The last item (the longest score) has a maximum of 7. Trail Making Test Parts A and B were administered following the procedures described by Reitan and Wolfson (1985), Following these stan- dard procedures, “Ch” was not included. We allowed unlimited time for participants to complete the test. Score was recorded as the time in seconds to complete each of the two parts of the test Symbol Digit Modaliries Test Standard administration procedures were followed as indicated in the test manual (Smith, 1973). In all eases, 10 sample practice boxes were administered prior to the presentation of the actual 110 test items, The score of the testis the number of correct substitutions in a 90-second interval. The maximum score is 110 Statistical Analysis ‘The same statistical procedures as those used in other NEURONORMA normative studies were applied to all measures (see Peii-Casanova et al., 2009). Briefly, the primary steps ofthis process were: (a) use of midpoint age intervals (Pauker, 1988) to ‘maximize the information available at each age and measure. Each midpoint age group provides norms for individuals ofthat age, + 1 year; (b) coefficients of correlation (r) and determination (r°) of all raw scores with age, years of education, and sex Were determined; (c) to ensure a normal distribution, the frequency distribution of the raw scores was converted into age-adjusted scaled scores, NSS, (NEURONORMA Scaled Score age-adjusted), For each age range, a cumulative frequency distribution of the raw scores was generated, Raw scores were assigned percentile ranks in function of their place within distribution, Subsequently, percentile ranks were converted into scaled scores (from 2 10 18) based on percentile ranges. From these data, normative tables (NSS) were created. This transformation of raw scores to NSS. produced a normalized distribution (mean =10; SD =3) on which linear regressions could be applied; (d) years of education were modeled using the following equation: NSSq=k+(B * Educ). The regression cveflicient (B) from this analysis was taken as the basis for ‘education adjustments. A Tinear regression was employed to derive age- and education-adjusted scaled scores, The following formula outlined by Mungas, Marshall, Weldon, Haan, and Reed (1996) was employed: NSSage = NSSq — (B* [Educ ~ 12). ‘The obtained value was truncated to the next lower integer (e.g., 10.75 would be truncated to 10). Results Age distribution of the sample made it possible to calculate norms for 10 midpoint age groups. The sample sizes resulting, from mid-point age intervals are shown in each normative table. Effects of age, education, and sex (correlations and shared variances) on raw scores are presented in Table 2, Age and edu: cation accounted significantly for raw score variance for all measures, Sex differences were minimal (2-36) or not observed, indicating no need to control this demographie variable. Age-adjusted NEURONORMA scaled scores (NSSq), percentile ranks, ranges of ages contributing to each nonmative group, and the number of participants contributing to each test normative estimate are shown in Tables 312. To use these data, select the appropriate normative table corresponding fo the patient’s age, find the appropriate test heading, find the patient's raw score, and subsequently refer to the corresponding NSS, and associated percentile rank (left part of the table). 6 ‘Table 2, Conltions (9 and shared variance of rw scores with ag, years af edcaton and sex Peb-Casanows et 1 Archives of Clinical Neuropsscotogy ‘Newrpsychologcal Measure Age Gea) "Beaton yes) se ° = Verbal Span Forward 0.22085 01966 oasi46 023180) 0.14805 oars Backwards =026008 ‘6918, ose 269 0.18675 ones Visuospatia Span Last em Forward =02108 oouaia o2sei2 ose oases oo1sis Forwatd Raw Sere 0207 0.05879 33336 omnis ~a.14ss5 oan Las om Backwards 0.30096 oats 4261 ons omen 0204 Backwards Raw Score =031082 Done 04298 o2uas ~o1a4 01534 Letter Number Sequencing Lt Kem 0.34826 o1229 sisi 0.26505 ~os12 oon Raw See 139787 01580 039019 one 03682 ss ‘Til Making Tet Part 367s 13507 049575 022664 ona 8.00550 Pat B oie osio1 051500 1.26528 ooas2 00899 ‘Symbol Digt Modalities Test Toa Score 0.47709 022761 ast6 oat? 0.04979 0.00048 ‘Table 3. Age-adjusted NEURONORMA scores (NSS,) forage S056 age rags for noms = 50-60 Sealed Percentile Dig Span ‘Con Blocks Tra Making Tex SDMT Sew Renee Forward Backward Formad Bickward Lae Pata Pa Taste Tat hem Hem Score Score Seow 2 =O = =I 2 0 3 = 3 = xo 5 4 - 2 eos 6 a = ~ 2 5 2 7 Se ~ so5 6 8 So 5 7 ° 5 3 3 - 5 8 10 4 4 6 3 90 u - 7 4 — 4 2 — = - = nos 3 - os 5 soo 2 4 7 ~ os = 1s 5 ‘ 6 oS = 6 ~ = 0 = - 7 a 7 — 6 8 ar) 7 8 Bi 26 7 Sample Sine 136, ‘Notes: LNS = letenonier sequencing: SDMT= symbol digit modalities Correlation (7) and shared variances (7) for age and education with NSS, are presented fr all nuropsychological measures in Table 13. As expected. the normative adjustments eliminated the shared variance for al tests. Education, however, continues {0 account for up to 38% of shared variances with NSS, ‘The transformation of raw scores to NSS, produced a normalized distribution on which liner regressions could be applied. Lincar regressions resulted in computational formulae to calculate NSSaac (Table 14), From these data we have constructed NSSaxe adjustment tables (Tables 1525) to help the clinician make the necessary adjustments. To use the tables select the appropriate column corresponding to the patient's years of education, find the patient's NSS, and subsequently refer to the corresponding NSS,en. When these formulae were applied tothe normative sumple, the shared variances between NSS uy and years of education fell to <1, 8 Pei Casanova ea Archives of Cincal Neropastolege ‘Table 6, Age-adjusted NEURONORMA scores (NSS) fr abe 6-65 (as 18 for norms = 39-49) Scaled Pevewntle Range Digit Span ‘con Blea LN ‘rll Making Test SDMT Forward Backward Forward Backward Raw Lastfem Pata Pan Rav Lastlem Raw Late Sem Seo Seow See Ssore Scare 2 =I ar) 2 a a 0 20 Bin 3 1 Se a= = ' Bist 49-499 — ‘ 2 a So H2-120 402-448 714 5 as = 3 » 2 2 1 soe Wot 30r—401 12-46 6 oan a eo - srt 722-300 15-16 7 tae 4 — So 3 4 S586 17-20 ® 28 Se rr re! nn 2124 9 2-40 - 3 5 6 39-63 25-30 in ans 5 3 6 ~ 3 re 58 31-36 on ~ 4 74 Ses aa 2 mai oo eo 5 4 on 4 337081 1-46 8 82-49 6 — os 18 u jo ote 7-50 u 90-94 — os 9 8s Be Se SIs Is 95-97 7 - - ~- = = 5 25-26 55S 16 98 8 ~ es We 0 9° ~ - wo 6 no BG =< ks 18 >% 5° 6 BN 2? bin be ate 7 = sta 5e Sample Size 109 foo ia Kes 9s ‘Table 7, Age-adjusted NEURONORMA scores (NSS, for ap 66-68 (age ne for norms = 62-72) Scaled Pervntle Range i Span ‘Cos Boks INS ‘Toll Making Tew SDMT Sos Forward Baskord Forward Rew Lastlem Pata Pat = os = 6 see a7H158 0 5 ~ 6 el 29-57 106-136 uv - 4 - 3 = as opens 2 ~ 7 4 - 4 srs 79-91 a 6 — se oF S236 72-78 6 —- 5 oo 0 ss 687 15 7 5 a5 nos 2.0 60.67 16 oF a 2 me aRS9 v 5 = 6 — 6 = ana i ° 6 Bnos7 su 23 sk Sample Size 14 ne mrs ‘Notes: LNS = leter~nunber sequencing: SDM symbol gt modalities ae Data from Table 2 show that education had more effect than age on raw scores of all tests, The effect of age for the raw score variance was £9% for Verbal Span (VS) and Visuospatial Span (VSS). The effect of age was higher for more complex tests (LNS, TMT, SDMT) and especially for SDMT (23% frounded]). Education accounted significantly for the raw seore variance of all measures and particularly, again, for SDMT (44%). The effect of sex was very small (£34) or practically absent (<1) in all tests, PefaCasonova es al. Archives of Cinical Menropchoogy ‘Table 8, Age-adjusted NEURONORMA scores (NSS) forage 69-71 (age range for norms = 65-75) Sealed Pevznlle Range Digi Span (Cos Bloke ENS ‘Tra Making Test SMT Seow Fonwacd Backward Forward Backward Rav Lastien Pata Pan Row Last em Raw Laie SOF Soom Score See Score Score 2 = 20 2 st sl 0 oO Sm S30 3 1 Se =e SO 19-170 449-500 ‘ 2 3 — = 2 — = 4 ise ganas 5 bs - 2 2 24 1s 111s? 309-420 911 ‘ 6-10 OS a 10-120 241-308 12-14 7 tts - er! aoe 79-109 198-240 15-19, 5 19-28, eof Se e878 168-198 20-20, 8 20-40 Se a3 5 6 2 oo) 139-167 23-26 0 as 5 2 6 Ts 3 SIs) 1-138 27-31 n 60-71 Se 7 4 = 7 = 5 4850 97-11 as 2 ns = 4 Bo 6 5 8 Bat 929 36-40 6 a299 6S Sf Fg — 4 xo “97 4 90-94 5 a ae oo 283 48-50 8 93-97 TOO = os os ms 231 sinss 16 38 a Se a ” » 5 6 = w 6 bo 6 - 5658 18 99 es 7 20 26 0 Brak <4 239 Sample Size 9, 19 ho na 2s, ‘Notes’ LNS — eter—pumbor sequencing: SDMT — symbol digit wodalics ew “Table 9, Age-adjusted NEURONORMA scores (NSS) forage 72-74 (age range for nonms= 68-78) Scaled Peventle Range Digi Span Coni Blooke TNS ‘aall Making Test SDMT Seow Forward Backward Forward Backward Raw Lasttem PARA Pan Raw Lat tem Raw Lasom Sm" Seore Seow Sone Score Score

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