ES2742598A1 - Device for the exploration of the mechanism of attention in dementia with lewy bodies - Google Patents

Abstract

Device for exploring the mechanism of attention in dementia with Lewy bodies. The present invention relates to a device for screening Lewy body dementia in its prodromal stage. It includes a collar (1) to which a landscape disk (2) is attached, which serves as a support for an interchangeable disk (3) in which an urban or rural landscape is represented, with at least one characteristic figure unfolded with polarized inks. complementary to each other that, when observed with polarized glasses, appear in relief. The interchangeable disc (3), independently or together with the landscape disc, rotates around the patient's neck, who has to identify the figures in relief to assess their attention span. The device is used for early detection of alterations in attention, in psychologists' and optometrists' offices, and with application in educational centers to health care.

Description

DESCRIPTION

Device for exploring the mechanism of attention 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 who suffer deficits in the mechanism of Attention.

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 should be noted 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 (influencing orientation and language) and parkinsonism (slowness of movement, tremor, stiffness, loss of balance).

In the perceptual-visual field, the most commonly used tests to detect visuospatial deficit in DCLs are the Test Battery for Visual Perception of Objects and Space (VOSP) and the Benton line orientation test (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 attention, which is defined as the ability to select certain information to process it carefully, and prevent other information from being further processed. Subjects with MCI show a severe attention deficit compared to subjects suffering from other dementias such as Alzheimer's disease, being assessed in multiple ways, with a selective attention test or visual search.

One of the most recognized tests currently to assess the state of the mechanism of care in these patients is the "Trail Making Test" (TMT), originally included as part of the Halstead-Reitan battery, to classify cognitive skills of soldiers It is a test of visual search speed, attention, mental flexibility and motor function.The test consists of two parts, a part A and a second part B of greater complexity and its main measure is the time of completion.

In the first part, part A, there is a series of consecutive numbers, disordered along the entire work surface, each surrounded by a circle, and with a random distribution; the subject is explained that he must draw lines of union between the circles following the natural order expressed by the numbers.

In part B, there are also circles with messy numbers that must be joined by lines, but the task of joining the circles that include those numbers with other circles that include letters that will have to be sorted in alphabetical order is incorporated. In this way, the subject begins its path at 1, traces a line to A, continues to draw a line to 2 and from there continues to B, this process being recurring until the numbers and letters provided on the submitted cards are finished.

It should be noted that, although this test is simple, it is of high application and has been conveniently used with a population affected by DCL. However, too many indices can be extracted from their scores, which contributes to creating some confusion as to the meaning of the measurements. Likewise, it is not a pure test for attention, but it also explores in an intermingled way executive functions such as: cognitive flexibility, inhibitory control and working memory, which adds difficulty to the precise measurement of the mechanism of Attention. Finally, the TMT test lacks an optometric basis that can help in the discrimination of different types of dementias or different measures according to the visual health of the patients. It is considered that this optometric base is fundamental to formulate equipment for detecting the variable attention within the sensory modality of vision.

Explanation of the invention.

Device for exploring the mechanism of attention in Dementia with Lewy Bodies.

The present invention relates to a collar assembly with a landscape disc that allows to evaluate, in a prodromal stage, defects in attention, visually analyzing the subject to refer him to the specialist if necessary, in order to rule out Dementia with Lewy bodies.

For this, the device for exploration includes: a circular collar that fits around the neck and serves to attach a landscape disk formed by a circular crown. By collar, in this specification is meant a collar-shaped element that surrounds the neck; and by circular crown, a flat geometric figure is defined delimited by two concentric circumferences and of different radius. A third element is placed on the landscape disk: an interchangeable disk, equipped with the necessary elements to rotate around the collar. Alternatively, instead of rotating the interchangeable disc on the landscape disc, it may be the landscape disc itself that rotates around the collar. Both the internal diameter and the external diameter of the landscape disk may vary; the first, depending on the circumference of the neck of the person, or group of people, whose attention is to be explored; the second, depending on the width that you want to give to the interchangeable disk that fits over it.

The device includes, at least, an interchangeable disk with the shape of a circular crown and size suitable for coupling on the landscape disk. Each interchangeable disc has a landscape drawn, which can be urban or rural, so that the drawing is understood as a set. Among the drawn landscape, one or several characteristic figures of said landscape are included that are drawn unfolded with two complementary polarized paintings. Using polarized glasses, the unfolded characteristic figures are embossed, protruding from the rest of the landscape.

This 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 that objects that are located in a different plane at the cortical level. The number of interchangeable discs that a device for exploring the mechanism of attention in Lewy Dementia with Bodies is not limited. The unfolded figures must be characteristic of the concrete landscape drawn on each interchangeable disk. That is, if it is the landscape of a city, the characteristic figures could be traffic lights, trees, police, etc. In each interchangeable disk there is at least one unfolded characteristic figure. There may also be more than one unfolded characteristic figure and, in this case, the unfolded figures may be homogeneous or heterogeneous, such that they are homogeneous when all the characteristic figures that are seen in relief represent the same object, and heterogeneous when the figures Embossed features reproduce two or more different objects. The complexity of the landscapes designed for each interchangeable disk depends on the level of assessment of the disease that you want to perform.

The invention uses the three-dimensional effects that are achieved by combining certain elements in glasses with the complementary elements in the material used for the exploration and evaluation of visual problems, which allow to achieve the last phase of binocular vision or stereoscopic vision. This means that the patient can perceive an image that stands out from the rest whenever he uses polarized lenses in two normal directions with each other and unfolded images in polarized printing in the two directions corresponding to the filters of the polarized glasses.

Under these conditions, depending on the separation in the unfolded object, it allows to see the image in relief when viewed with both eyes open, with the polarized glasses on and within limits of frontal vision, provided that the patient does not have binocular vision problems or problems of optometric refraction that do not allow you to see sharp and simple images that are formed when you see the unfolded object fused at the cortical level. With this image (or several images) in relief among all the objects drawn on a surface, the patient's attention is activated in such a way that, if there is no visual problem, when you see the relief image you must indicate that you identify it.

In the present invention, visual simulation is associated with the measurement of care in a patient with dementia problems with Lewy bodies to assess if loss of attention occurs, once it has been proven that there is no visual problem. This loss of attention should be associated with the rest of the symptoms, but it can be calibrated and measured with the present invention and subsequently linked to other signs of the disease.

The collar is made so that it can be kept around the neck free of restraints, except for the anatomical ones. In order to adapt its size to the size of the patient's neck, a preferred option is the use of sailboat closures. Once the collar is closed, you can rotate the landscape disk that is attached. To rotate, the movement printed by the optometrist / psychologist who is performing the test may be sufficient. Another option is to include a speed adjustable motor that rotates the landscape disk.

Both the landscape disc, as the interchangeable disc (s) and even the collar, can be plasticized. The landscape disk is coupled to the collar by any available means and, on the landscape disk, the chosen interchangeable disk is coupled to be able to show, in the patient's frontal visual field, the characteristic figures of the landscape drawn, whether urban or rural, that allow to understand the drawing as a set and simulate on this disc certain characteristic figures of that landscape that do not confuse the patient in the search for the relief figures that he will see on the surface of the interchangeable disc. Preferably, the color of the landscape disk is white.

In the method of performing the optometric measurement for a more correct psychological interpretation of the results it is essential to put the polarized glasses in front of the patient's eyes before he can see the landscape of the interchangeable disc with which he will work, so that he does not can see the unfolded images before starting the evaluation. The measure consists in presenting the interchangeable disc with the chosen landscape and with a certain number of objects presented in relief (number that determines the level of work); the set is rotated, and the patient is asked to indicate by voice where he sees those characteristic figures in relief. On the first level, only one type of characteristic figure is highlighted; at the following levels, the number of distinct characteristic figures that the patient should look for while rotating the interchangeable disk around it (accompanied or not accompanied by the landscape disk) is increased. Either the interchangeable disc alone or the sum of the landscape disc and the interchangeable disc can be rotated as many times as the specialist needs to do so to ensure the level of attention achieved to score, by number of characteristic figures in relief perceived and turned, how many He has detected. Another element of measurement may be the time needed to perform the evaluation exercise. Depending on the number of objects that you have seen in relief, the errors and the suitability of the attention given are identified. If it is a patient with Binocular vision problems can use the same equipment without polarized glasses and now the unfolded figures (which would not be seen in relief) would be sought. There is an option to attach LED lights to allow evaluation measurement in other lighting conditions (photopic, mesopic and / or scotopic).

In a preferred embodiment, the collar assembly, the landscape disk coupled to the collar and the interchangeable disk (s) are made of a light and rigid polyethylene terephthalate (PET) plastic. On the other hand, the inner face of the collar, which is in contact with the patient's skin, can carry a foam or soft tissue to prevent rashes and discomfort in the patient's neck, to protect the neck.

It is a simple device, but with many possibilities of variation through interchangeable discs, with which reliable data can be obtained on the care mechanisms of subjects with possible Dementia with Lewy Bodies in the early stages of the disease.

Brief description of the drawings

Various aspects of the device are shown in the accompanying drawings, for illustrative and non-limiting purposes.

Figure 1. Collar (1) with landscape disk (2) attached. Top and side view.

Figure 2. Interchangeable disk (3) with a landscape drawing.

Figure 3. Arrangement of collar closure (1) by sailboat.

Preferred Embodiment of the Invention

An interchangeable disk (3) was constructed drawing an urban landscape with buildings of different shapes and sizes and with traffic lights, on a plastic material, of PET. The traffic lights were drawn in print in two polarized inks complementary to each other: an ink polarized at 45 ° and the second at 135 °, so that both polarizations are normal to each other and combined give a black color.

On the other hand, another 4 interchangeable discs (3) were elaborated in which the number of characteristic figures drawn with the two polarized inks complementary to each other was increased: traffic lights plus buildings with square section; traffic lights more buildings with square section, more buildings with circular section; traffic lights more buildings with square section, more buildings with circular section, more buildings with rectangular section; and traffic lights more buildings with square section, more buildings with circular section, more buildings with rectangular section, more buildings with pentagonal section.

Each interchangeable disc (3) was made with 140 mm inside diameter and 400 mm outside diameter, just like the landscape disc (2) where the interchangeable discs (3) are coupled under pressure. For this, a circular groove was performed on the upper face of the landscape disk and a protruding circumference on the lower face of each interchangeable disk (3), so that the protruding circumference of the interchangeable disk (3) is coupled to the groove of the landscape disc (2) and interchangeable discs (3) can rotate on the landscape disc (2) freely.

The diameter of the inner face of the collar (1) was designed so that it can vary from 120 to 200 mm and the height of the collar is 50 mm.

To close the collar (1) around the patient's neck, a sailboat (100x30 mm) with polyamide tape closure and consisting of two parts was used: female part (loop) (4) and male part (hook) (5 ) it being possible to reduce or increase the size of the collar (1) depending on the size of the patient's neck. To do this, they adhered along the outer surface of the collar (1) and the female part (4) passes over the male part (5) in the length necessary to adapt the length of the inner face of the collar (1 ) to the patient's neck. In addition, a foam with a thickness of 15 mm and a length of 200 mm and a height of 45 mm was included in the inner face of the collar (1).

To keep the landscape disk (2) coupled to the collar (1) and prevent it from wobbling excessively, the lower part of the collar (1) includes a flange which, in this example, was made 50 mm high. The landscape disk (2) is based on the interchangeable disk (3), both made of the same material as the collar (1). The interchangeable disc has printed the landscape chosen by the specialist to do the exploration.

Claims (8)

1. Device for the exploration of the mechanism of attention in Dementia with Lewy Bodies that includes: - a collar (1), - a landscape disk (2) in the shape of a circular crown that attaches to the collar (1), - at least one interchangeable disk (3) with the shape of a circular crown, suitable size to fit on the landscape disk, and the drawing of a landscape in which at least one characteristic figure of said landscape is drawn unfolded with two polarized paintings complementary to each other, in which either the interchangeable disc (3) or the landscape disc (2) together with the interchangeable disc (3) can rotate around the collar (1). 2. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to claim 1 wherein the drawing of the interchangeable disk (3) includes more than one unfolded characteristic figure and all unfolded characteristic figures represent the same object . 3. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to claim 1 wherein the drawing of the interchangeable disk (3) includes more than one unfolded characteristic figure and the unfolded characteristic figures represent two or more objects different. 4. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to any of the preceding claims wherein the inner face of the collar (1) includes foam or a soft fabric. 5. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to any of the preceding claims wherein the landscape disk (2) and / or the interchangeable disk (3) revolve around the collar (1) driven by a person. 6. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to any of the preceding claims in which the landscape disk (2) rotates around the collar (1) driven by a rotation motor with regulator of speed. 7. Device for exploring the mechanism of attention in Lewy Bodies Dementia according to any of the preceding claims that includes LED lights. 8. Set for the exploration of the attention mechanism in Lewy Bodies Dementia that includes a device as defined in any of the preceding claims and glasses with polarized lenses in two normal directions to each other corresponding to the unfolded images of the interchangeable disc / s (3).