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Facultad & Psicología Universidad & Salamanca Campus & excelencia internacional Facultad & Psicología Departamento & Personalidad, Evaluación y Tratamientos psicológicos Tesis doctoral “Estudio preliminar del CogVal-Senior, una nueva prueba informatizado para la detección de la demencia Alzheimer en personas mayores” Presentado por: Abdel Alexander Solís Rodríguez Licenciado en Psicología, con especialidad de Neuropsicología Clínica Dirigido por: Dr. Manuel A. Franco Martín Dr. Vicente Merino Barragán Salamanca, enero & 2014 FACULTAD DE PSICOLOGÍA DEPARTAMENTO DE PERSONALIDAD, EVALUACIÓN Y TRATAMIENTO PSICOLÓGICOS PROGRAMA DE DOCTORADO EN NEUROPSICOLOGÍA CLÍNCA D. Manuel Franco Martín Doctor en Psiquiatría Profesor Asociado de la Facultad de Psicología de la Universidad de Salamanca D. Vicente Merino Barragán Doctor en Psicología Profesor Asociado de la Facultad de Psicología de la Universidad de Salamanca Certifican Que el trabajo de investigación realizado por D. Abdel A. Solís Rodríguez, licenciado en Psicología, titulado: “Estudio preliminar del CogVal-Senior, una nueva prueba informatizada para la detección de la demencia Alzheimer en personas mayores”, ha sido realizado bajo nuestra dirección y supervisión, reúne los requisitos para ser leído y defendido ante un tribunal como Tesis doctoral para optar por el Grado de Doctor en Psicología por la Universidad de Salamanca. Salamanca, a 3 de noviembre de 2013. ____________________________ ____________________________ Fdo. Dr. Manuel A. Franco Martín Fdo. Dr. Vicente Merino Barragán 2 Dedicatoria A Aida Luz, mi madre por tantos sacrificios y los más loables ejemplos de trabajo y superación. A mi padre Irene y mi hermano Irkim, por su apoyo incondicional, y a mis sobrinos Noemí, Emily y Alexander, y a toda mi familia. A mi familia “Zamorana”, a todas aquellas amistades que tengo en Salamanca y Zamora, amistades que siempre estarán conmigo. 3 Agradecimiento Emprender este trabajo de investigación es el fruto de un esfuerzo directo e indirecto, de muchas agentes, personas e instituciones que sin la contribución de todos ellos y de mi parte no hubiese dado a la luz este trabajo de investigación y que es este momento es necesario agradecer. En primer lugar mi especial agradecimiento a mis directores, el Dr. Manuel Franco y Dr. Vicente Merino, quienes aceptaron ser mis tutores y me han ayudado a elaborar esta investigación y llevar a la práctica muchos de los conocimientos adquiridos en neuropsicología en el Servicio de Psiquiatría del Hospital Provincial de Zamora. Agradezco también a todos los profesores del Programa de Doctorado en Neuropsicología Clínica de la Universidad de Salamanca, en especial a su directora la Dra. María Victoria Perea Bartolomé, quienes con sus experiencias y conocimientos en el campo de la neuropsicología y las neurociencias, han cimentado las bases de mi formación y de esta investigación. Mi eterno agradecimiento al Gobierno Nacional de la República de Panamá, que a través de la Secretaria Nacional de Ciencia y Tecnología (SENACYT) y el Instituto para la Formación y Aprovechamiento de los Recursos Humanos (IFARHU), han financiado mi formación doctoral por medio del Programa Nacional de Becas doctorales y postdoctorales 2005-2010. Un agradecimiento muy especial a la Fundación INTRAS, quien con su apoyo en mi formación me ha permitido colaborar en muchos de los proyectos de investigación con los que cuenta, en especial en los de rehabilitación neuropsicológica con el programa Gradior en Enfermedad Mental, los Talleres de Memoria, y la experiencia adquirida en Ensayos Clínicos. Además gracias a la Fundación INTRAS, el programa CogVal es fruto 4 de los proyectos: BIEN-E-ESTAR: Nuevas tecnologías de la información y la comunicación (TIC): integración y consolidación de su Uso en Ciencias Sociales para mejorar la salud, la Calidad de Vida y el Bienestar (Nº de Ref: SEJ2006-14301/PISC del programa CONSOLIDER-C del Ministerio de Ciencia e Innovación de España); y del Proyecto de Investigación y Desarrollo de tecnologías en la atención socio-sanitaria: INDESS (programa de cooperación transfronterizo POCTEP 0184 INDESS 2E). Un sincero agradecimiento a todos mis colegas del equipo de investigación que han colaborado en la realización de este estudio, desde los que me dieron sus orientaciones, a los que colaboraron en el proceso de evaluación. En el plano personal, quiero agradecer a todos los amigos que a lo largo de este camino me han acompañado directa o indirectamente, su mera presencia, sus palabras de apoyo, las noches de fiesta, en fin… tantas vivencias alegres y tristes que complementan a esta formación y hacen de la vida una mezcla sana de intelectualidad y humanidad, para un mejor servicio a la sociedad. Haciendo honor al refrán “los últimos son los primeros”, quiero agradecer de manera muy especial a todos las personas que voluntariamente aceptaron participar en este investigación, si ellos este trabajo no sólo no tendría sentido y sino que además, sin su colaboración realmente no hubiese sido una realidad. A todos y todas los que me han acompañado, apoyado y claro por qué no a Dios y la Virgen santísima, como le llama mi querida abuela, por ponerlos a todos en el camino y por ser el pilar donde me he sustentado en muchos momentos de desánimo, y que ahora es justo reconocer y ser agradecido por todos los favores concedidos y en especial éste. gracias! 5 Resumen La enfermedad de Alzheimer (EA) es una de las patologías más prevalentes y suponen una verdadera epidemia entre la población mayor de 65 años en el mundo pudiendo afectar a más de 27 millones de personas en todo el mundo. Por ello el diagnóstico precoz se convierte imprescindible y actualmente se acepta como beneficioso tanto para los pacientes, los familiares y la sociedad, además de ser un factor determinante en la eficacia terapéutica y el pronóstico de la enfermedad. Las nuevas tecnologías ofrecen grandes aportaciones en la evaluación y la atención especializada a las personas mayores, permitiendo aumentar la sensibilidad de las medidas, permitiría hacer un cribado cognitivo a gran escala y hacer seguimientos con costes relativamente más accesibles y económico. Pero la utilidad real dependerá de la validez de los instrumentos aplicados: tienen que ser sensibles y específicos para el campo de aplicación. Además es necesario que estos instrumentos sean fáciles de usar y comprensibles por las personas mayores, para integrarlos a la práctica clínica habitual. Es por ello que esta investigación tenía como objetivo principal valorar la utilidad diagnóstica y usabilidad del CogVal-Senior como una prueba informatizadas para detección para la demencia en una población mayor. Paralelamente se valoraron las posibles influencias asociadas a los resultados y la usabilidad de la prueba A todos los sujetos se les administró el protocolo de evaluación del estudio que incluía el CogVal-Senior, cuestionario de usabilidad, el MEC y el Test del Reloj. La 6 muestra fue de 220 sujetos, normal (N=110) y DTA (N=110) con una media de edad de 79,74±8,723 años y en su mayoría con escolaridad primaria. Los resultados encontrados en el estudio, indican que el CogVal-Senior, posee una alta exactitud diagnóstica para discriminar entre sujetos con y sin demencia, y en comparación con las otras pruebas aplicadas, es la que posee una mejor exactitud global. Además posee buenos índices de fiabilidad y validez. Es una prueba que no parece estar influenciada por el nivel de escolaridad de los participantes, pero sí por el grado de deterioro y por la edad de éstos. En general, los participantes consideraron a la prueba muy fácil de usar y entender, lo que indicaría que es una prueba usable por las personas mayores. Estos resultados indicarían que el CogVal-Senior es una prueba con correlaciones significativas con pruebas de screening de reconocida utilidad clínica, como también una alta exactitud para detectar la demencia, además de ser muy fácil de usar y entender. Estas buenas características psicométricas obtenidas por el CogVal-Senior, unidas a las ventajas que ofrece una evaluación automatizada refuerzan la idea de los beneficios de las nuevas tecnologías en la detección temprana de la demencia. PALABRAS CLAVES: Enfermedad de Alzheimer, Evaluación Informatizada, utilidad diagnóstica, pruebas de screening, usabilidad. 7 ÍNDICE Pág. i. Índice 8 ii. Abreviaturas 12 iii. Índice de Tablas y Figuras 13 Capítulo I Introducción 16 Envejecimiento y Cognición Capítulo II Marco teórico 29 2.1 La detección temprana del deterioro cognitivo y la demencia 30 2.2 Característica de una prueba de valoración cognitiva breve 38 2.3 Pruebas rápidas de cribado cognitivo, en papel y lápiz 46 2.3.1 Mini-Mental State Examination (MMSE) y Mini-Examen 46 Cognoscitivo (MEC) 2.3.2 El test de Pfeiffer 48 2.3.3 Test Mental Abreviado 49 2.3.4 El Test del Reloj 50 2.3.5 Memory Impairment Scren (MIS) 52 2.3.6 Test de las Fotos (TdF) 53 2.3.7 Test de los 7 minutos (T7M) 55 2.3.8 Prueba Cognitiva Leganés (PCL) 56 2.3.9 El MoCa 57 2.3.10 El Eurotest 58 2.3.11 El TYM 59 2.3.12 Neuropsi 61 2.3.13 Addenbrooke’s Cognitive Examination (ACE) 62 2.4 Las nuevas tecnologías en la evaluación neuropsicológica 67 2.4.1 Ventajas de las nuevas tecnologías en la evaluación cognitiva 68 2.4.2 Limitaciones técnicas de las nuevas tecnologías en la evaluación 74 8 cognitiva 2.4.3Pruebas de cribado cognitivo informatizadas 81 2.4.3.1 Kana Pick-out Test 82 2.4.3.2 Hasegawa Dementia Scale 85 2.4.3.3 MSP-1000 87 2.4.3.4 Automated Neuropsychological Assessment Metrics 89 (ANAM) 2.4.3.5 Computer-Administered
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