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Diagnostic value of a simplified Pfeiffer questionnaire for polypathological patients
Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos
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Bernabeu-Wittel, D. Nieto Martín, L. Moreno-Gaviño, M. Ollero-Baturone" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Bernabeu-Wittel" "email" => array:1 [ 0 => "wittel@cica.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "Nieto Martín" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." 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"apellidos" => "Ollero-Baturone" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:2 [ "colaborador" => "on behalf of researchers from the Proyecto Profund" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 2093 "Tamanyo" => 179408 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Proposal for a practical approach for screening cognitive impairment in polypathological patients.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cognitive impairment is common in polypathological patients, both in the primary care and hospital settings.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> The prevalence of cognitive impairment in multicenter cohorts has been 37–39%, with a notably high percentage of patients with previously undetected occult cognitive impairment.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> The risk of dementia for patients with mild cognitive impairment is known, as is the case for polypathological patients. Its early detection is therefore recommended.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a> One of the most widely used questionnaires for screening dementia in those over 65 years of age is the Pfeiffer test (Short Portable Mental State Questionnaire [SPMSQ]),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> which has been validated in Spanish and shows generally good and diagnostically useful indices.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> The questionnaire is structured into 10 simple questions that explore various cognitive areas. The estimated time for completing the questionnaire is 5–10<span class="elsevierStyleHsp" style=""></span>minutes. A result with 3 or more errors (4 or more in the case of illiteracy) is highly suggestive of cognitive impairment, using this cutoff operationally to indicate an in-depth study of dementia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is useful to implement psychometric screening tests that easily enable the ruling out of the presence of cognitive deficit, in such a way as to avoid the additional use of other, more complex instruments.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Therefore, we investigated the sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for polypathological patients of each of the 10 questions in the SPMSQ, as well as the possibility that 1 or 2 questions could be used as a screening for cognitive impairment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a cross-sectional study using the baseline data from a multicenter sample of 1632 polypathological patients included in the PROFUND project from 37 Spanish hospitals.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> This project recruited elderly hospitalized patients, elderly patients in home hospitalization follow-up and elderly patients in outpatient internal medicine units or consultations, after signing an informed consent document. We collected clinical, functional, psychometric and healthcare parameters.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The SPMSQ score was considered pathological if there were 3 or more errors (4 or more in the case of illiteracy), establishing this result as the gold standard for the presence or absence of cognitive impairment. For each of the 10 questions, we calculated the correlation using the kappa index, S, Sp, PPV and NPV with respect to the gold standard. We then analyzed whether the diagnostic validity indices improved through the use of combinations of 2 questions. We employed the SPSS statistical package version 20.0 for the calculations.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">Of the 1632 polypathological patients included (mean age, 77.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.8 years, 53% men), 1434 performed the SPMSQ (the remaining 198 presented active delirium through the Confusion Assessment Method at the time of the interview).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> The prevalence of cognitive impairment (3 or more errors) was 39%, which was distributed as mild-moderate in 28% of the cases (3–7 errors) and severe in the remaining 11% (8 or more errors). The median number of errors was 2 (interquartile range, 5). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the correlation and the diagnostic validity indices for each of the 10 questions and for the combinations of 2 questions with higher indices. Question 1 (“What is the date today [day, month year]?”) and question 10 (“Count backwards in threes from 20”) were the 2 questions with highest NPV (85% and 89%, respectively) and had good correlation with respect to the full questionnaire. The combination of the 2 questions maintained the correlation and significantly increased the NPV to 97%.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Question 5 (“How old are you?”) and question 6 (“When were you born?”) had the highest PPV (91% and 93%, respectively) and had a good correlation with respect to the full questionnaire. The combination of the 2 questions maintained the correlation but did not, however, increase the PPV of the questions when considered individually.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The main result of this study was the high NPV reached with the combination of questions 1 and 10 (97%) on the SPMSQ, such that both may be used as screening for cognitive impairment in polypathological patients. Questions 5 and 6 had high PPV (91% and 93%, respectively), although their combination did not improve the diagnostic validity indices. A possible practical approach for the diagnosis of cognitive impairment in polypathological patients is outlined in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The results of this study should be interpreted within the context of its limitations. As with all simplified screening tests, negativity (answering the 3 questions correctly) safely rules out the presence of cognitive impairment. Positivity (incorrect answer to the date of birth or “What is the date today?” and/or “Count backwards by threes from 20“) requires the confirmation of the cognitive impairment or dementia with more specific tests.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, the combination of 2 questions on the SPMSQ (“What is the date today?” and “Count backwards by threes from 20”) achieved a high NPV in the screening of cognitive impairment in polypathological patients, while the question regarding the date of birth achieved a high PPV. These findings should be validated in an independent cohort of patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study was funded by the Institute of Health Carlos III (ISCIII, FIS 07/0047), Ministry of Health and Consumer Affairs, Spain</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres875311" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec863506" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres875310" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec863505" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-29" "fechaAceptado" => "2017-03-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec863506" "palabras" => array:5 [ 0 => "Polypathology" 1 => "Cognitive impairment" 2 => "Screening" 3 => "Pfeiffer questionnaire" 4 => "SPMSQ" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec863505" "palabras" => array:5 [ 0 => "Pluripatología" 1 => "Deterioro cognitivo" 2 => "Cribado" 3 => "Cuestionario de Pfeiffer" 4 => "SPMSQ" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the correlation, sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each question on the Pfeiffer questionnaire (SPMSQ) compared with the full questionnaire for polypathological patients (PPPs).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Multicentre cross-sectional study. An SPMSQ score is considered pathological if 3 or more errors are recorded. For each question and combination of 2 questions, we calculated the correlation (kappa index), sensitivity, specificity and predictive values compared with the full SPMSQ.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 1632 PPPs included (mean age, 77.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.8 years, 53% men), 1434 performed the SPMSQ (the remaining presented delirium); 39% of the PPPs were pathological. The question “What day is it today?” and the command “Count backwards by 3s from 20” obtained good correlation and NPV (85 and 89%, respectively); the combination of both increased the NPV to 97%. The question “When were you born?’ achieved good correlation and greater PPV (93%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The combination of the question “What day is it today?” and the command “Count backwards by 3s from 20” achieved a high NPV. The question related to the date of birth achieved the highest PPV.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la concordancia, sensibilidad, especificidad y valores predictivos positivo (VPP) y negativo (VPN) de cada pregunta del cuestionario de Pfeiffer (SPMSQ) con respecto al cuestionario completo en pacientes pluripatológicos (PPP).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multicéntrico. El SPMSQ se consideró patológico si se registraban 3 o más errores. Para cada pregunta y combinaciones de 2 preguntas se calcularon la concordancia (índice <span class="elsevierStyleItalic">kappa</span>), sensibilidad, especificidad y valores predictivos con respecto al SPMSQ completo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 1.632 pacientes pluripatológicos incluidos (edad media 77,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9,8 años, 53% varones), se realizó el SPMSQ a 1.434 (los restantes presentaban <span class="elsevierStyleItalic">delirium</span>) y resultó patológico en el 39%. Las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvieron buena concordancia y VPN (85% y 89%, respectivamente); la combinación de ambas aumentó el VPN al 97%. La pregunta «¿cuándo nació?» alcanzó buena concordancia y el mayor VPP (93%).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La combinación de las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvo un VPN elevado, y la relacionada con la fecha de nacimiento fue la que consiguió el mayor VPP.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">More information about the members of the PROFUND Project can be found in <a class="elsevierStyleCrossRef" href="#sec0030">Appendix 1</a>.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Bernabeu-Wittel M, Nieto Martín D, Moreno-Gaviño L, Ollero-Baturone M, on behalf of researchers from the Proyecto Profund. Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos. Rev Clin Esp. 2017;217:320–324.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0050" class="elsevierStylePara elsevierViewall">Máximo Bernabeu-Wittel, Manuel Ollero-Baturone, Javier Galindo-Ocaña, M. Dolores Nieto-Martín, Lourdes Moreno-Gaviño, Nieves Ramírez-Duque, Manuel Cassani-Garza, Manuel Rincón-Gómez; Hospital Virgen del Rocío, Sevilla.</p> <p id="par0055" class="elsevierStylePara elsevierViewall">Aurelio Fuertes-Martín, Ignacio Novo Valeiro, Guillermo Ternavasio, Cristina de la Calle-Cabrera, Hernán Llorente-Cancho, Sandra Gómez-Lesmes, María Sanchez-Ledesma; University Hospital, Salamanca.</p> <p id="par0060" class="elsevierStylePara elsevierViewall">Bosco Barón-Franco, Alberto Escalera-Zalvide, Tomás Martínez; Hospital Juan Ramón Jiménez, Huelva.</p> <p id="par0065" class="elsevierStylePara elsevierViewall">José Murcia-Zaragoza; General Hospital of Alicante.</p> <p id="par0070" class="elsevierStylePara elsevierViewall">Carmen Ramos-Cantos, Carlos Sanromán; Hospital de la Axarquía, Malaga.</p> <p id="par0075" class="elsevierStylePara elsevierViewall">Antonio Alemán; Hospital Morales Meseguer, Murcia.</p> <p id="par0080" class="elsevierStylePara elsevierViewall">Antonio Fernández-Moyano; Hospital San Juan de Dios del Aljarafe, Seville.</p> <p id="par0085" class="elsevierStylePara elsevierViewall">Antonia Mora-Rufete; General Hospital of Elche.</p> <p id="par0090" class="elsevierStylePara elsevierViewall">José Barbé Gil-Ortega, Antonio Sanjosé-Laporte; Hospital Vall d’Hebrón, Barcelona.</p> <p id="par0095" class="elsevierStylePara elsevierViewall">Virginia Rodríguez-Martínez, Felipe Díez; Hospital of Torrecárdenas, Almeria.</p> <p id="par0100" class="elsevierStylePara elsevierViewall">Carolina Luque-Amado, María Maiz-Jiménez, Montserrat Godoy, Alberto Ruiz-Cantero; Hospital de la Serranía, Malaga.</p> <p id="par0105" class="elsevierStylePara elsevierViewall">Manuel Romero-Jiménez; Hospital Infanta Elena, Huelva.</p> <p id="par0110" class="elsevierStylePara elsevierViewall">M. Ángeles Soria-López; Clinic Virgen de la Vega, Murcia.</p> <p id="par0115" class="elsevierStylePara elsevierViewall">Francisco Martínez, Mariano Aguayo-Canela; Hospital Virgen Macarena, Seville.</p> <p id="par0120" class="elsevierStylePara elsevierViewall">Jesús Medina; Hospital 12 de Octubre, Madrid</p> <p id="par0125" class="elsevierStylePara elsevierViewall">Pilar Giner; Hospital San Cecilio, Granada.</p> <p id="par0130" class="elsevierStylePara elsevierViewall">Beatriz Massa; Hospital of Villajoyosa, Alicante.</p> <p id="par0135" class="elsevierStylePara elsevierViewall">Manuel Francisco Fernández-Miera; Hospital Marqués de Valdecilla, Santander.</p> <p id="par0140" class="elsevierStylePara elsevierViewall">Sixto Ruiz; Hospital of Inca, Mallorca.</p> <p id="par0145" class="elsevierStylePara elsevierViewall">José Manuel Machín-Lázaro; Hospital of Guadalajara</p> <p id="par0150" class="elsevierStylePara elsevierViewall">Jordi Aligué, Clotilde Morales; Hospital of Manresa, Barcelona.</p> <p id="par0155" class="elsevierStylePara elsevierViewall">Luis Feliu-Mazaria; General Hospital of Palma, Mallorca.</p> <p id="par0160" class="elsevierStylePara elsevierViewall">Francesc Formiga; Hospital of Bellvitge, Barcelona.</p> <p id="par0165" class="elsevierStylePara elsevierViewall">Emilio Sacanella; Clinic Hospital, Barcelona.</p> <p id="par0170" class="elsevierStylePara elsevierViewall">M. Luisa Rodríguez-Benedito; General Hospital of Requena, Valencia.</p> <p id="par0175" class="elsevierStylePara elsevierViewall">Manuela Castillo-Blasco, Pedro Tenllado-Doblas; Hospital Dr Moliner, Valencia.</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Manuel Montero Pérez-Barquero; Hospital Reina Sofía, Cordoba.</p> <p id="par0185" class="elsevierStylePara elsevierViewall">Eulalia Villegas-Bruguera; Hospital Dos de Maig, Barcelona.</p> <p id="par0190" class="elsevierStylePara elsevierViewall">Blanca Pinilla; Hospital Gregorio Marañón, Madrid.</p> <p id="par0195" class="elsevierStylePara elsevierViewall">Lucy Abella-Vázquez, Alicia Tejera-Concepción; Hospital Nuestra Sra. de la Candelaria, Tenerife.</p> <p id="par0200" class="elsevierStylePara elsevierViewall">Jordy Forteza-Rey; Hospital Son Dureta, Mallorca.</p> <p id="par0205" class="elsevierStylePara elsevierViewall">Jesús Díez-Manglano; Hospital Royo Villanova, Zaragoza.</p> <p id="par0210" class="elsevierStylePara elsevierViewall">Francisco Medrano-González; Hospital of Albacete.</p> <p id="par0215" class="elsevierStylePara elsevierViewall">Francisco Martos; Hospital of Benalmádena, Malaga.</p> <p id="par0220" class="elsevierStylePara elsevierViewall">Alberto Muela-Molinero; Hospital of León.</p> <p id="par0225" class="elsevierStylePara elsevierViewall">Mónica Albert-Coll; Hospital of Manacor, Mallorca.</p>" "etiqueta" => "Appendix 1" "titulo" => "Project PROFUND Researchers" "identificador" => "sec0030" ] ] ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1445 "Ancho" => 2093 "Tamanyo" => 179408 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Proposal for a practical approach for screening cognitive impairment in polypathological patients.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">95% confidence interval between brackets.</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Question 1: “What is the date today? (day, month and year)”; Question 2: “What day of the week is it today?”; Question 3: “What is the name of this location?”; Question 4: “What is your telephone number?” (if the patient does not have a telephone, ask them their address); Question 5: “How old are you?”; Question 6: “When were you born?”; Question 7: “Who is the current head of the government?”; Question 8: “Who was the previous head?”; Question 9: “What is your mother's maiden name?”; Question 10: “Count backwards by threes from 20”.</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: Kappa, index of agreement; S, sensitivity; Sp, specificity; PPV, positive predictive value; NPV, negative predictive value.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Questions \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">kappa</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">S \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sp \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 [0.63–0.7] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78% [75–81%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88% [85–90%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82% [79–85%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85% [82–87%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 [0.52–0.6] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58% [54–62%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95% [93–96%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% [86–92%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76% [74–78%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 [0.32–0.43] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37% [34–41%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [95–98%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% [85–93%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68% [66–71%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.66 [0.62–0.7] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71% [67–74%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93% [91–94%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87% [84–90%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82% [79–84%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 [0.34–0.44] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38% [35–42%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [96–98%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91% [87–94%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69% [66–71%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 [0.52–0.6] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47% [43–51%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [96–98%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93% [89–95%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72% [69–74%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 [0.56–0.64] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64% [60–68%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94% [92–95%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88% [85–90%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78% [76–81%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.67 [0.63–0.7] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% [71–78%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91% [89–93%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85% [82–88%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84% [81–86%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 [0.36–0.46] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41% [37–45%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [95–99%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% [86–93%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69% [67–72%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Question 10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 [0.51–0.59] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88% [85–90%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69% [66–72%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67% [64–71%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89% [86–91%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Questions 1 and/or 10<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 [0.53–0.62] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98% [96–99%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64% [60–69%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66% [63–69%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [96–98%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Questions 1 and/or 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71 [0.7–0.75] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84% [81–87%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87% [85–89%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82% [79–85%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88% [86–90%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Questions 5 and/or 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 [0.53–0.6] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57% [53–61%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97% [96–98%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93% [90–95%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76% [73–78%] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Questions 2 and/or 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 [0.65–0.73] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72% [69–76%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95% [93–96%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90% [88–93%] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83% [80–85%] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1477427.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The answer is considered in error if the patient answers 1 or 2 questions incorrectly.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Statistical analysis of each question on the Pfeiffer questionnaire (incorrect answer) and their combinations in a sample of 1632 polypathological patients, considering the reference standard of cognitive impairment to be 3 or more incorrect answers in the questionnaire.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características clínicas, funcionales, mentales y sociales de pacientes pluripatológicos. 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