ES2742574A1 - Exploration set of sequence establishment in dementia with Lewy bodies (Machine-translation by Google Translate, not legally binding) - Google Patents

Abstract

Exploration set of sequence establishment in dementia with Lewy bodies. Exploration set of sequence establishment in dementia with Lewy bodies. (Machine-translation by Google Translate, not legally binding)

Description

DESCRIPTION

Exploration set of sequence establishment in dementia with Lewy bodies.

Technical sector

The invention is part of a field that relates psychology to optometry to understand, through vision, problems that are generated in the daily activity of an adult with possible dementia with Lewy bodies and that suffers deficit in the resulting mental activity of problems in the planning and sequencing functions, typical of the executive functions of the individual.

Background of the invention

In 1912, Friedrich Lewy first described the cytoplasmic inclusions that are currently known as Lewy bodies (CL) in the black substance. Specifically, he discovered them in Parkinson's disease. In fact, Parkinson's disease dementia and Lewy body disease dementia are taken together as Lewy Body Dementias (DCL). This type of dementia is the second type of degenerative dementia diagnosed in people over 65 years.

The clinical characteristics of these pathologies are similar and include hallucinations, cognitive fluctuations and dementia in the context of motor disorders characteristic of parkinsonism. In general, there is a predominance of executive and visospatial deficits in the first phase, without seriously altering the mnesic function at first.

The difference between the two variants of the DCL pathology lies only in the latency that is observed in the diagnosis of cognitive deficit with respect to the motor, being the latency of one year in the case of dementia of Parkinson's disease, and being the latency less than a year and even simultaneous in the case of dementia of Lewy body disease.

The prevalence of the disorder is between 4.2% and 7.5% and the incidence is between 31.6 and 112 per 100 000 people over 65 (Walker, Z., Possin, KL, Boeve, BF & Aarsland, D. (2015) Lewy body dementias, The Lancet, 386 (10004), 1683-1697).

In any case, it is worth noting that, together, the DCLs seem to be underestimated in the clinic (Mok, W., Chow, TW, Zheng, L., Mack, WJ & Miller, C. (2004). Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians, American Journal of Alzheimer's Disease & Other Dementias, 19 (3), 161-165; Toledo, JB, Cairns, NJ, Da, X., Chen, K., Carter, D., Fleisher, A. (...) & Eisen, P. (2013) Clinical and multimodal biomarker correlates of ADNI neuropathological findings Acta neuropathologica Communications, 1 (1), 65).

As in many types of dementia, there are two clearly differentiated phases: one prodromal, characterized by being the pre-dementia stage where clues can be collected for its probable diagnosis; and a stage of dementia where the disease manifests itself with all its consequences and there is already a clear loss of brain function.

Prodromal stage: in this phase some degree of functional deficit is observed. Specifically, in the case of DCL, deficits are usually observed at visospatial and visosconstructive levels to a greater extent than in any other type of dementia. In addition, the presence of serious deficits in this regard strongly predicts a rapid decline and the development of hallucinations.

Dementia stage: at this point, although memory can also be affected, the most striking are visual hallucinations (present in more than 80% of patients and referring to living beings with locomotion, preferably) cognitive fluctuations (affecting the orientation and language) and parkinsonism (slow movement, tremor, stiffness, loss of balance).

In the perceptual-visual field, the most commonly used tests to detect visospatial deficit in DCLs are the Test Battery for Visual Perception of Objects and Space (VOSP) and the orientation judgment test of the Benton line (Benton) , AL, Hamsher, K., Varney, NR and Spreen, O. (1983). Contributions to neuropsychological assessment. New York: Oxford University Press). The first test consists of the evaluation of the perception of objects with various disadvantages (gradients, unusual perspectives, rotated, or with distractors) and the spatial perception of a number of elements (cubes or points) or the identification of the position of the objects. same.

The second test consists of the assessment of the recognition of certain lines presented between a set of lines, according to the degrees of their angle with the horizontal.

On the other hand, the most used objects to test the performance in the copy of the subjects with possible DCL are: cubes, classic clocks and complex figures. It also points to the difficulty that this type of affected has in drawing and determining the angles of a rectangle (Cagnin, A., Bussé, C., Jelcic, N., Gnoato, F., Mitolo, M. & Caffarra , P. (2015)). High specificity of MMSE pentagon scoring for diagnosis of prodromal dementia with Lewy bodies. Parkinsonism & related disorders, 21 (3), (303-305).

In addition to the perceptual aspect, another mental aspect affected in the previous prodromal phase of the DCL is the establishment of sequences, which is the ability to sequence operations or events to achieve a goal. There is empirical evidence that order information is processed in parallel or in addition to the item information. Precisely, the tasks that involve order information (sequence establishment) usually take more time to resolve and contain more errors when performed by someone affected by a frontal deficit or executive functions, as occurs in the DCL. This is especially more significant when the sequences are novel, such as a script of steps to open an aesthetic center in front of the script of a more usual activity, for example, the visit to a restaurant.

One of the most recognized attempts to assess the function of sequence establishment using a perceptual component is the Wisconsin Card Classification Test, popularized by Heaton, R.K. in 1981 (Heaton, RK (1981). Wisconsin Card Sorting Test Manuel. Odessa (FL). (Psychological Assessment Resource Inc.) and published with different variations by multiple authors. Its purpose is to evaluate the ability of abstraction, concept formation and the change of cognitive strategies as changes occur in the disposition of the cards.

To perform this test, there are two sets of 64 cards each; The letters are characterized by combining three types of distinctive characters: shape (triangle, star, cross and circle), color (red, blue, green and yellow) and number of elements (one, two, three or four). The test consists of distributing the cards following a certain criterion, for example, the color. When the subject, responds correctly consecutively ten times, gets a category. From the last correct answer, the classification criterion is changed without prior notice; If you continue to classify the cards with the criteria of the previous category, the perseverative errors are noted.

This test is widely used, especially: in education, for help in the diagnosis of attention deficit hyperactivity disorders; in the field of addictions, to evaluate pathological players and impulsivity problems; and in the field of neuropsychology, especially with regard to brain injuries acquired by accident in adulthood with frontal damage.

However, the test does not have an equally effective application in older people, given its complexity and the abstraction of its rules.

On the other hand, currently, there is no equipment or device that measures this dementia optometrically.

Explanation of the invention.

Exploration set of sequence establishment in Lewy Bodies Dementia.

The present invention relates to a set of components that allow to evaluate, in a prodromal stage, visual defects whose detection serves to identify sequencing problems that may indicate the existence of dementia with Lewy bodies.

One aspect of the present invention relates to a set of at least 48 cards that include 16 geometric elements of which 6 are a triangle, a five-pointed star, a four-pointed star, a circle, a rhombus and a square; and the remaining 10 configure a basic representation of an everyday object such as a truck, a car, a bus, a locomotive, an animal, etc. by means of straight lines and / or flat geometric figures selected from the group consisting of: rectangles, squares, rhombuses, triangles, pentagons, hexagons, trapezoids (any of them with straight or rounded corners), ovals and / or circles. In the 48, or more, cards of the set, the represented everyday object is the same. It is essential that the represented object is daily and basic, a simplified symbolic image, since the people with whom the set of cards will be used have visospatial and visoconstructive deficits, even to a greater extent than in any other type of dementia, Therefore, the use of complex figures would not be useful because they were not identifiable by patients for whom the objects to be recognized pose an added difficulty.

In each of the cards included in the set, at least one of the geometric elements included is drawn folded or duplicated, in two complementary colors, so that each of the two parts that compose it is one color and can be seen with anaglyphic glasses, providing that folded geometric element the ability to be seen in relief (these are glasses that have filters with two complementary colors to each other and with the two colors of the geometric elements represented on the card). This relief effect is achieved by the ability of binocular vision that the human being must have to achieve the flat fusion, first, and then the stereopsis of those objects that are located in a different plane at the cortical level. Set cards are made in 3 different levels; The difference in levels refers to the separation between the two parts that make up the folded geometric element in the sense that this separation can have three different distances, each distance being correlated with a level. The greater the distance between the two parts, the more prominent the geometric element is. This characteristic is used to determine if the problems in the establishment of sequences that a person suffers are due to dementia or optometric issues, so that, by increasing the difficulty in visually identifying objects, the level of ability to sequence cards Of the cards included in the set, for each level a third is made of the cards. In that third of cards that are made for each level, there are at least 16 cards:

1 card with 1 duplicate item,

1 card with 2 duplicate elements,

1 card with 3 duplicate elements,

1 card with 4 duplicate elements,

1 card with 5 duplicate elements,

1 card with 6 duplicate elements,

1 card with 7 duplicate elements,

1 card with 8 duplicate elements,

1 card with 9 duplicate elements,

1 card with 10 duplicate elements,

1 card with 11 duplicate elements,

1 card with 12 duplicate elements,

1 card with 13 duplicate elements,

1 card with 14 duplicate elements,

1 card with 15 duplicate elements,

1 card with 16 duplicate elements.

In addition, it can include more cards with between 1 and 15 duplicate elements different from those that are duplicated in this first third of cards, so that, if necessary, several options can be available to analyze the patient's capabilities.

The set also includes 16 additional cards with a geometric element represented in 3 dimensions in a real way, without the use of anaglyphs, in each of them, to use these cards as shown in the explanation of the test to the individuals who are going to perform. At the time of the test, the sequence of these sample cards is not the same as that used with the evaluation cards. The evaluation cards also do not have the same sequence between levels.

In the method of performing the optometric measurement, for a more correct psychological interpretation of the results, it is essential to put the glasses in front of the patient's eyes so that he cannot see the unfolded images before starting the evaluation. The measure is to present all cards of the same level by placing the cards in the correct order. The patient must put the cards in the precise sequence that consists in ordering them according to the number of geometric elements that he sees in relief. On each card there is only an exact number of folded geometric elements that are therefore embossed. Once the first sequence is finished, the tests with levels 2 and 3 are repeated and The specialist records the results by identifying the errors and the suitability of the sequence established by the patient.

If it is a patient with binocular vision problems, the sample cards can be used to rule out sequencing problems at level 1 and, in this case, a second set of components can be used for the same evaluation, but for patients with visual problems In this case, in the cards the geometric elements are included directly in relief so that the patient can identify them.

In a preferred embodiment, the cards are made of a light and rigid polyethylene terephthalate (PET) plastic and the sample cards or the second set of components (for patients with binocular vision problems) can be elaborate by printing by 3D printer, which can reduce the cost of the set and facilitate the manufacture of variations at any time.

In addition, the set may include a support with slits to place the cards in the proper order during the test. Preferably, said support is a case in which all the components of the assembly can be stored and transported and which includes, once opened, the support in which the cards can be placed.

It is important to understand binocular vision as an element of assessing the state of vision of a patient that can directly or indirectly affect sequencing. As the human being has frontal vision, with an association of two images of a single object that is perceived by both eyes and merged at the cortical level, the object is perceived in relief.

A measure of this binocular vision is achieved with filters complementary to each other and using an image bent or duplicated in two or three colors (either the two colors complementary to each other, or, using a third color that is not complementary to any of the two others to make a flat element in the context used and the two complementary colors to be seen in relief.A relief image is achieved with the fusion of the folded image thanks to duplicating that object in two complementary colors.

With a binocular vision test two evaluation elements can be achieved: the first one that is intended to be achieved with the relief images is to sequence according to the number of relief images that are observed; and secondly, if the relief images are not detected because the patient has binocular vision problems, it allows us to distinguish which patients have problems of fusion, convergence and / or accommodation, associated or not with Lewy Bodies Dementia.

Brief description of the drawings

The accompanying drawings show, for illustrative and non-limiting purposes, the first evaluation cards of each level and their reverse:

Figure 1. Level 1 card with 1 folded geometric element.

Figure 2. Level 2 card with 1 folded geometric element.

Figure 3. Level 3 card with 1 folded geometric element.

Figure 4. Reverse of the cards with design identifiers in barcode (14) and QR code (15).

Preferred Embodiment of the Invention

The present invention is further illustrated by the following examples, which are not intended to be limiting in scope.

64 rectangular 70x40 mm and 0.5 mm thick cards were manufactured in PET. Drawing in print in black ink on the plastic material, the figure of a truck was made with its main elements assimilated to geometric elements: the cabin (1) of 2.2x1.4 mm, like a rectangle of rounded corners; the truck box (2) of 4x1.6 mm and the chassis (3) of 5.3x0.5 mm, as two rectangles; and 4 wheels (4) in the form of circles with a diameter of 0.9 mm plus a rectangle for the driver's window (5), 1x0.7 mm; two lines for the steering wheel (6) of 0.7 mm each, an oval for the headlight (7) of 0.5x0.3 mm and 5 figures of decoration of the truck box: a triangle (8) of 1, 5 mm base and 1.5 height, a 5-pointed star (9) of 0.7x0.7 mm, a 4-pointed star (10) of 0.7x0.7 mm, a circle (11) of 0 , 5 mm in diameter, a rhombus (12) of 0.5 mm side and a square (13) of 0.5 mm side, all adjusted to the size of the card and in 48 coded cards, to know the precise measurements , on the back with barcode (14) and QR code (15).

In each of the cards, with two complementary colored inks (red and green) instead of black ink, between 1 and 16 of the represented geometric elements were folded, so that a card with 1 folded element was manufactured , another card with 2 folded elements, another card with 3 folded elements, and so on until completing 16 cards.

In figure 1, the separation of 1 mm between the two parts of the geometric element constituted by a triangle can be seen: part 8 and part 81. In figure 2, part 82 is more separated from part 8 (2 mm) than part 81, represented in figure 1, of its corresponding part 8. And, in figure 3, part 83 is more separated from part 8 (3 mm) than part 82 of part 8, in figure 2 With regard to the separation of the two parts of the geometric elements represented, in Figures 1-3 3 different levels of relief are shown on the cards, which represent 3 different levels of binocularity or relief vision, therefore, optometrically.

An aluminum case with exterior dimensions of 700x350 mm and a height of 100 mm was also manufactured. It was lined with PET and included a 20mm thick inner foam cover, adjusted to the inside size of the case to protect the cards. On the inside of the lid, holes of the size of the cards were printed in a total of 16 holes to arrange the cards of each level in the proper sequence. To hold the cards inside the case, the appropriate holes and jaws of plastic material were arranged for proper fastening.

Claims (7)

1. Set of exploration of the establishment of sequences in Dementia with Lewy Bodies that includes a set of at least 48 cards each of which contains 16 geometric elements of which 6 are: - a triangle, - a five-pointed star, - a four-pointed star, - a circle, - a rhombus, and - a square; and the other 10 geometric elements configure an object by means of straight lines and / or flat geometric figures selected from the group consisting of: rectangles, squares, rhombuses, triangles, pentagons, hexagons, trapezoids (any of them with straight or rounded corners), ovals and / or circles; where, in each card, at least one of the geometric elements is folded or duplicated, each of the two parts of the folded element has a complementary color to that of the other part of the same geometric element and the separation between said two parts may have 3 different distances configuring 3 relief levels. 2. Sequence set scanning set according to claim 1 wherein there are at least 16 cards for each level of relief: 1 card with 1 duplicate item, 1 card with 2 duplicate elements, 1 card with 3 duplicate elements, 1 card with 4 duplicate elements, 1 card with 5 duplicate elements, 1 card with 6 duplicate elements, 1 card with 7 duplicate elements, 1 card with 8 duplicate elements, 1 card with 9 duplicate elements, 1 card with 10 duplicate elements, 1 card with 11 duplicate elements, 1 card with 12 duplicate elements, 1 card with 13 duplicate elements, 1 card with 14 duplicate elements, 1 card with 15 duplicate elements, 1 card with 16 duplicate elements. 3. Sequence set exploration set according to any of the preceding claims wherein the object formed by 10 geometric elements is selected from the group consisting of: a truck, a car, a bus, a locomotive and / or an animal. 4. Sequence set exploration set according to any one of the preceding claims which includes 16 sample cards each of which includes an embossed geometric element. 5. Sequence set scanning set according to any of the preceding claims which includes a holder with slits to place the cards therein in the appropriate order. 6. Scanning set of the sequence establishment according to claim 5 wherein the slit holder is included in a case in which all components of the scanning set for storage and transport are accommodated. 7. Sequence set exploration set according to any of the preceding claims, wherein the cards are made of polyethylene terephthalate plastic (PET).