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Objective: The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project. Methods: We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (< 50 and ≥ 50 years). Results: Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (< 50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥ 50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable. Conclusion: The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population. Resumen: Objetivo: el presente estudio tiene como objetivo proporcionar normas y ajustes para edad, educación y el género para el Wisconsin Card Sorting Test (WCST), la Figura Compleja Modificada de Taylor (FCMT) y el Ruff-Light Trail Learning Test (RULIT) como parte del proyecto NEURONORMA-Plus. Método: la muestra consiste en 308 individuos cognitivamente sanos de entre 18 y 92 años. Se proporcionan tablas para convertir las puntuaciones brutas en puntuaciones escalares ajustadas por edad y ajustes por educación y género tras aplicar modelos de regresión independientes en dos grupos de edad (

Resumen: Objetivo: El presente estudio tiene como objetivo proporcionar normas y ajustes para edad, educación y género para el Wisconsin Card Sorting Test (WCST), la Figura Compleja Modificada de Taylor (FCMT) y el Ruff-Light Trail Learning Test (RULIT) como parte del proyecto NEURONORMA-Plus. Método: La muestra consiste en 308 individuos cognitivamente sanos de entre 18 y 92 años. Se proporcionan tablas para convertir las puntuaciones brutas en puntuaciones escalares ajustadas por edad y ajustes por educación y género tras aplicar modelos de regresión independientes en 2 grupos de edad (

Introduction: Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project. Methods: The sample included 308 cognitively unimpaired individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (< 50 and ≥ 50 years). Results: Overall, age had a negative impact on DK-DFT and CTT performance. We observed a positive effect of education on DK-DFT scores only in the older group (≥ 50 years). Moreover, younger men performed slightly better in the basic condition of this test. Education was positively associated with all CTT scores in both age groups, with the exception of the CTT-1 subtest in the younger group. Age and education did not influence DT performance, whereas sex did, with young women performing slightly better. Conclusions: These normative data may be useful in the interpretation of neuropsychological assessments in the Spanish population. Resumen: Objetivo: Las tareas de atención compleja y fluencia no verbal se utilizan en las valoraciones neuropsicológicas con el objetivo explorar subdominios de las funciones ejecutivas. El objetivo de este estudio es proporcionar datos normativos ajustados por edad, escolaridad y género de las pruebas Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Tests (CTT) y Dual Task (DT) como parte del Proyecto NEURONORMA-Plus. Método: Se incluyeron 308 individuos sin deterioro cognitivo de entre 18 y 92 años de edad. Se convirtieron las puntuaciones brutas en puntuaciones escalares ajustadas por edad y se realizaron ajustes por escolaridad y género aplicando regresiones lineales estratificando en dos grupos de edad (

Resumen: Introducción: Las tareas de atención compleja y fluencia no verbal se utilizan en las valoraciones neuropsicológicas con el objetivo de explorar subdominios de las funciones ejecutivas. El objetivo de este estudio es proporcionar datos normativos ajustados por edad, escolaridad y género de las pruebas Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Tests (CTT) y Dual Task (DT) como parte del Proyecto NEURONORMA-Plus. Método: Se incluyeron 308 individuos sin deterioro cognitivo de entre 18 y 92 años de edad. Se convirtieron las puntuaciones brutas en puntuaciones escalares ajustadas por edad y se realizaron ajustes por escolaridad y género aplicando regresiones lineales estratificando en dos grupos de edad (< 50 y ≥ 50 años). Resultados: Globalmente la edad tuvo un impacto negativo en el DK-DFT y el CTT. La escolaridad mostró un efecto positivo en las puntuaciones del DK-DFT sólo en el grupo de mayor edad (≥ 50 años) y se halló un rendimiento discretamente superior en los hombres más jóvenes en la condición básica de esta prueba. La escolaridad se asoció positivamente con todas las puntuaciones de CTT en ambos grupos de edad, excepto en la subprueba CTT-1 en el grupo de adultos jóvenes. La edad y la escolaridad no mostraron influencia sobre el rendimiento en el DT, a diferencia del género, ya que las mujeres jóvenes tuvieron un rendimiento ligeramente superior. Conclusión: Estos datos normativos pueden resultar útiles para la interpretación de las evaluaciones neuropsicológicas en población española. Abstract: Introduction: Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project. Methods: The sample included 308 cognitively healthy individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (

Introduction: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment. Methods: We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets. Results: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5−91.4]; Comb-LR: 91.6 [88.2−94.3]; Comb-RDT 95.2 [92.5−97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1−85.4] and 84.9 [80.8−88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001). Conclusions: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy. Resumen: Introducción: El Fototest y el Mini-Cog incluyen todos los dominios que debieran formar parte de una evaluación cognitiva. Nuestro objetivo es evaluar la utilidad diagnóstica del uso conjunto de ambos instrumentos para el diagnóstico de deterioro cognitivo (DC). Métodos: Estudio Fase III de evaluación de pruebas diagnósticas con dos muestras independientes, ESTUDIO (448 sujetos), dividida aleatoriamente en dos dataset (BASE 80%, TEST 20%), y EXTERNA (61 sujetos). Prueba index: Fototest y Mini-Cog aplicados consecutivamente; prueba de referencia: evaluación cognitiva formal. Se evalúa la UD del uso combinado y escalonado de los modelos Simple (Comb-Simple), Regresión Logística (Comb-RL) y Árbol Aleatorio (Comb-AA) para identificar DC (GDS ≥ 3). Se realiza un análisis exploratorio en BASE seleccionando los criterios que maximizan la Exactitud; la evaluación se realiza en las muestras TEST y EXTERNA mediante un análisis preespecificado con los criterios seleccionados. Resultados: La UD de los modelos combinados en BASE (Comb-Simple 88.3 (88.5−91.4) [Exactitud (LI95%-LS95%)], Comb-RL 91.6 (88.2−94.3) y Comb-AA 95.2 (92.5−97.2)) es significativamente superior a la de Mini-Cog y Fototest (81.6 (77.1−85.4) y 84.9 (80.8−88.5) respectivamente); estos resultados son replicados en TEST (Comb-Simple 88.9 (Exactitud), Comb-RL 95.6 y Comb-AA 92.2) y EXTERNA (Comb-Simple 91.8, Comb-RL 90.2 y Comb-AA 88.5). La aplicación escalonada mantiene la misma UD pero requiere menos tiempo (197.3 ± 56.7 vs 233.9 ± 45.2, p < 0.0001). Conclusiones: El uso conjunto del Fototest y el Mini-Cog requiere menos de cuatro minutos y mejora la UD de ambos instrumentos. El uso escalonado es más eficiente porque manteniendo la misma UD requiere menos tiempo de aplicación.

Resumen: Introducción: El Fototest y el Mini-Cog incluyen todos los dominios que debieran formar parte de una evaluación cognitiva. Nuestro objetivo es evaluar la utilidad diagnóstica del uso conjunto de ambos instrumentos para el diagnóstico de deterioro cognitivo (DC). Métodos: Estudio fase iii de evaluación de pruebas diagnósticas con 2 muestras independientes, estudio (448 sujetos), dividida aleatoriamente en 2 dataset (Base 80%, Test 20%), y Externa (61 sujetos). Prueba index: Fototest y Mini-Cog aplicados consecutivamente; prueba de referencia: evaluación cognitiva formal. Se evalúa la UD del uso combinado y escalonado de los modelos simple (Comb-Simple), regresión logística (Comb-RL) y árbol aleatorio (Comb-AA) para identificar DC (GDS ≥ 3). Se realiza un análisis exploratorio en Base seleccionando los criterios que maximizan la exactitud; la evaluación se realiza en las muestras Test y externa mediante un análisis preespecificado con los criterios seleccionados. Resultados: La UD de los modelos combinados en Base (Comb-Simple 88,3 [(88,5-91,4] [exactitud, LI95%-LS95%], Comb-RL 91.6 [88,2-94,3] y Comb-AA 95,2 [92,5-97,2])) es significativamente superior a la de Mini-Cog y Fototest (81,6 [77,1-85,4] y 84,9 [80,8-88,5], respectivamente); estos resultados son replicados en Test (Comb-Simple 88,9 [exactitud], Comb-RL 95,6 y Comb-AA 92,2) y externa (Comb-Simple 91,8, Comb-RL 90,2 y Comb-AA 88,5). La aplicación escalonada mantiene la misma UD pero requiere menos tiempo (197,3 ± 56,7 vs. 233,9 ± 45,2, p

Introduction: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery. Aim: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors. Methods: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery. Results: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p

Introduction: The Free and Cued Selective Reminding Test (FCSRT) is widely used for the assessment of verbal episodic memory, mainly in patients with Alzheimer disease. A Spanish-language version of the FCSRT and normative data were developed within the NEURONORMA project. Availability of alternative, equivalent versions is useful for following patients up in clinical settings. This study aimed to develop an alternative version of the original FCSRT (version B) and to study its equivalence to the original Spanish-language test (version A), and its performance in a sample of healthy individuals, in order to develop reference data. Methods: We evaluated 232 healthy participants of the NEURONORMA-Plus project, aged between 18 and 90. Thirty-three participants were assessed with both test versions using a counterbalanced design. Results: High intra-class correlation coefficients (between 0.8 and 0.9) were observed in the equivalence study. While no significant differences in performance were observed in total recall scores, free recall scores were significantly lower for version B. Conclusions: These preliminary results suggest that the newly developed FCSRT version B is equivalent to version A in the main variables tested. Further studies are necessary to ensure interchangeability between versions. We provide normative data for the new version. Resumen: Introducción: El test Free and Cued Selective Reminding Test (FCSRT) es una prueba de uso extendido para evaluar la memoria episódica verbal, principalmente en el ámbito de la enfermedad de Alzheimer. Existe una versión española de la prueba con datos normativos proveniente del proyecto NEURONORMA.ES. Disponer de versiones alternativas equivalentes de las pruebas resulta útil para el seguimiento de los pacientes en la práctica clínica. El objetivo del presente estudio es ofrecer una versión alternativa a la original, denominada “B”, estudiar su equivalencia con la versión original española (A) y el rendimiento en la misma de una muestra de sujetos para proporcionar datos de referencia. Métodos: Se evaluaron 232 sujetos sanos entre 18 y 90 años en el contexto del proyecto NEURONORMA-Plus. A 33 de ellos se les administraron ambas versiones con un diseño contrabalanceado. Resultados: En el estudio de equivalencia se observaron coeficientes de correlación intraclase elevados (entre 0,8 y 0,9) y diferencias no significativas en las variables de recuerdo total. Sin embargo, sí se hallaron diferencias significativas en los ensayos de evocación libre, en los que el rendimiento en la nueva versión fue menor. Conclusiones: Los resultados iniciales sugieren que la versión B del FCSRT aquí presentada resulta equivalente a la versión A en las variables principales de la prueba. Se requieren de futuros estudios para asegurar la total intercambiabilidad entre versiones. Se aportan datos normativos de la versión presentada.

Objective: The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project., Methods: We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (< 50 and ≥ 50 years)., Results: Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (< 50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥ 50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable., Conclusion: The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project., Methods: The sample included 308 cognitively unimpaired individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (< 50 and ≥ 50 years)., Results: Overall, age had a negative impact on DK-DFT and CTT performance. We observed a positive effect of education on DK-DFT scores only in the older group (≥ 50 years). Moreover, younger men performed slightly better in the basic condition of this test. Education was positively associated with all CTT scores in both age groups, with the exception of the CTT-1 subtest in the younger group. Age and education did not influence DT performance, whereas sex did, with young women performing slightly better., Conclusions: These normative data may be useful in the interpretation of neuropsychological assessments in the Spanish population., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment., Methods: We performed a phase III diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets., Results: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs 233.9 s [45.2]; P < .0001)., Conclusions: Combined application of the Fototest and Mini-Cog takes less than 4 minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy., (Copyright © 2021 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery., Aim: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors., Methods: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery., Results: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors., Conclusions: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment., (Copyright © 2020 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: The present study aims to provide norms and age-, education-, and sex-adjusted data for the Wisconsin Card Sorting Test (WCST), the Modified Taylor Complex Figure (MTCF), and the Ruff-Light Trail Learning Test (RULIT) as part of the NEURONORMA-Plus project., Methods: We recruited 308 cognitively healthy individuals aged between 18 and 92 years. Tables are provided to convert raw scores to age-adjusted scaled scores, as well as adjustments for education and sex after applying independent regression models in 2 age groups (<50 and ≥50 years)., Results: Older age had a negative effect on performance in both age groups. We observed a positive effect of education on WCST performance in the younger group (<50 years), and on all MTCF measures (with the exception of the recognition task) in the older group (≥50 years). Education had no impact on performance in the RULIT, although sex did, with a small but significant effect whereby young men showed higher performance for one variable., Conclusion: The normative data provided can contribute to the clinical interpretation of performance in these tests in the Spanish population., (Copyright © 2021. Publicado por Elsevier España, S.L.U.)

Introduction: Complex attention and non-verbal fluency tasks are used in neuropsychological assessments with the aim of exploring subdomains of executive function. The purpose of this study is to provide norms and age-, education-, and sex-adjusted data for the Delis Kaplan-Design Fluency Test (DK-DFT), Color Trails Test (CTT), and Dual Task (DT) as part of the NEURONORMA-Plus project., Methods: The sample included 308 cognitively healthy individuals aged between 18 and 92 years. Raw scores were converted to age-adjusted scaled scores. These were further converted into education- and sex-adjusted scaled scores by applying linear regression, with 2 age groups (< 50 and ≥ 50 years)., Results: Overall, age had a negative impact on DK-DFT and CTT performance. We observed a positive effect of education on DK-DFT scores only in the older group (≥ 50 years). Moreover, younger men performed slightly better in the basic condition of this test. Education was positively associated with all CTT scores in both age groups, with the exception of the CTT-1 subtest in the younger group. Age and education did not influence DT performance, whereas sex did, with young women performing slightly better., Conclusions: These normative data may be useful in the interpretation of neuropsychological assessments in the Spanish population., (Copyright © 2021 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The Free and Cued Selective Reminding Test (FCSRT) is widely used for the assessment of verbal episodic memory, mainly in patients with Alzheimer disease. A Spanish-language version of the FCSRT and normative data were developed within the NEURONORMA project. Availability of alternative, equivalent versions is useful for following patients up in clinical settings. This study aimed to develop an alternative version of the original FCSRT (version B) and to study its equivalence to the original Spanish-language test (version A), and its performance in a sample of healthy individuals, in order to develop reference data., Methods: We evaluated 232 healthy participants of the NEURONORMA-Plus project, aged between 18 and 90. Thirty-three participants were assessed with both test versions using a counterbalanced design., Results: High intra-class correlation coefficients (between 0.8 and 0.9) were observed in the equivalence study. While no significant differences in performance were observed in total recall scores, free recall scores were significantly lower for version B., Conclusions: These preliminary results suggest that the newly developed FCSRT version B is equivalent to version A in the main variables tested. Further studies are necessary to ensure interchangeability between versions. We provide normative data for the new version., (Copyright © 2018 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The Fototest and Mini-Cog include all the domains that are necessary in a cognitive assessment. This study aims to evaluate the diagnostic accuracy of the combined use of both instruments for detecting cognitive impairment., Methods: We performed a phase iii diagnostic accuracy study with 2 independent samples: STUDY, which included 448 participants randomly allocated to 2 datasets (BASE [80%] and TEST [20%]); and EXTERNAL, which included 61 participants. The index test was consecutive administration of the Fototest and Mini-Cog, and the reference test was formal cognitive assessment. We evaluated the diagnostic accuracy of two-step vs. consecutive application of the tests and simple (Comb-Simple), logistic regression (Comb-LR), and random decision tree (Comb-RDT) models of their combined use for detecting cognitive impairment (Global Deterioration Scale score ≥ 3). We performed an exploratory analysis of the BASE dataset, selecting criteria that maximise accuracy; a pre-specified analysis was used to evaluate the selected criteria in the TEST and EXTERNAL datasets., Results: The diagnostic accuracy (95% confidence interval) of the combined models in the BASE dataset (Comb-Simple: 88.3 [88.5-91.4]; Comb-LR: 91.6 [88.2-94.3]; Comb-RDT 95.2 [92.5-97.2]) was significantly higher than the individual values observed for the Mini-Cog and Fototest (81.6 [77.1-85.4] and 84.9 [80.8-88.5], respectively). These results were replicated in the TEST (Comb-Simple: 88.9; Comb-LR: 95.6; Comb-RDT: 92.2) and EXTERNAL datasets (Comb-Simple: 91.8; Comb-LR: 90.2; Comb-RDT: 88.5). Two-step application had the same diagnostic accuracy than consecutive application but required less time (mean [SD] of 197.3 s [56.7] vs. 233.9 s [45.2]; P<.0001)., Conclusions: Combined application of the Fototest and Mini-Cog takes less than 4minutes and improves the diagnostic accuracy of both instruments. Two-step application is more efficient as it requires less time while maintaining the same diagnostic accuracy., (Copyright © 2021 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery., Aim: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors., Methods: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery., Results: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p<0.01), history of smoking (p<0.01), arterial hypertension (p=0.022), diabetes mellitus (p=0.024), heart failure (p=0.036) and preoperative cognitive dysfunction (p<0.01), and surgery-associated aspects such as EuroSCORE (p<0.01) and operation time (p<0.01) were identified as related risk factors., Conclusions: Older patients who underwent heart surgery had long-term POCD. Both patient- and surgery-related risk factors were established as related risk factors. These findings suggest that the prevalence of cognitive dysfunction after cardiac surgery in older patients could be related to a possible progression to dementia. In addition, many of the risk factors identified may be modifiable but in practice, these patients are not attended to for their possible cognitive impairment., (Copyright © 2020 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)