Perea-Bartolome et al. BMC Public Health 2011, 11:504 http://www.biomedcentral.com/1471-2458/11/504 - the sum of the scores representing the Charlson comorbidity index (CCI). In order to calculate the age- adjusted Charlson comorbidity index (ACCI), we add one point to the CCI for each decade above 50 years of age. The values obtained will be grouped into four cate- gories: 1-2, 3-4, 5-7 or ≥ 8. 4. Need for help in daily life activities Use will be made of the Barthel index [45] for the eva- luation of basic daily life activities and of the Lawton and Brody index [46] for the evaluation of instrumental daily life activities. The short version informant test (IQCODE) will be applied [47,48]. This is a question- naire to be completed by a relative or person close to the patient. Following a series of short instructions, and in very little time, the informant is asked to recall how the patient was 10 years ago, and how he or she has changed since then, based on a 5-point Likert scale. The short version comprises 17 questions. 5. Neuropsychological assessment protocol a) Cognitive screening: The Folstein Mini-Mental Test, MMSE [49], and the 7 Minute Screen [50,51], are cogni- tive screening tests that explore a number of cognitive areas which are particularly affected in an early stage in Alzheimer-type dementia and in other dementias. b) Evaluation of the premorbid situation: The word accentuation test [52] allows us to quickly estimate the premorbid intellectual level of the subject. It consists of 30 infrequent words that are presented to the subject (without accentuations), and which he or she must read correctly (phonetic accent). c) Attention-concentration: This is a digit subtest to the right and reverse [53]. It assesses attention, as well as storage and immediate recall of a series of numbers. d) Speech: The Boston vocabulary test [54] explores denomination capacity based on the visual confrontation of 60 images. Semantic - phonetic generation [55], comprising two subtests. The first, names of animals, evaluates semantic verbal fluency. The subject is asked to name animals as quickly as possible and in one minute. The score is the number of words evoked by the patient. The second subtest is words that begin with the letter “p”, and evalu- ates phonologic verbal fluency. The subject is asked to name words that begin with the letter “p”. The score is the number of words evoked by the patient in a period of one minute. e) Logical memory: Babcock story [56], immediate and delayed. The explorer reads a story to the subject, who in turn is required to recall it immediately, thereby assessing retention memory and immediate recall corresponding to logical structured verbal mate- rial. After non-mnesic interference (approximately 15 minutes), the subject is instructed to repeat what he or she remembers about the story (delayed logical Page 5 of 8 verbal memory). The story consists of 21 information units. f) Visuoconstruction memory: Rey complex figure test [57]. This test involves two phases: copy and memory. Memory reproduction informs us of the visual memory of the subject, as well as of his or her visuoconstruction capacity. Subject performance is evaluated according to the number of correct units conforming the complete figure (the maximum score being 36), the type of execu- tion of the subject, and the time (in seconds) used to construct the figure. h) Visual memory: The Benton visual retention test will be used [58]. We will apply form C, Administration A. This involves presentation of each of the sheets, dur- ing 10 seconds, followed by immediate memory repro- duction or recall by the subject. This test evaluates the visuospatial perception of the subject, as well as visual memory, visuoconstruction skills and visual conceptuali- zation. Subject performance is evaluated according to the number of correct reproductions (the maximum score being 10) and error assessment (taking into account the specific type of error made by the subject: omission, distortion, displacement, perseverance, rota- tion, size and whether located to left or right). i) Executive function: Abbreviated Frontal Assessment Battery (FAB)[59]. This test evaluates frontal lobe func- tions based on 6 tasks: similarities (formation of con- cepts), verbal fluency (mental flexibility), motor series (programming), interference (execution of conflictive instructions), control (response inhibition) and auton- omy (environmental independence). The action-verb flu- ency test [60] in turn requires the subject to evoke the largest possible number of words designating an action (verbs), in 60 seconds. The score in this task is the total number of words correctly evoked within the limited time interval. g) Visuoconstruction skills: the Rey complex figure test [57]. Copying of the figure evaluates subject visual perception, practical-constructive skills, visuospatial ana- lytical capacity, and right-left orientation. The assess- ment is the same as commented above in the memory figure reproduction phase. h) Cognitive impairment: classification of the severity of cognitive impairment in 7 global stages ranging from normal to severe impairment, based on the Global Dete- rioration Scale (GDS) [61]. Procedure All participants will be informed of the purpose of the study by telephone and conventional mail, and will be asked to give written informed consent to participation. Once consent has been obtained, all subjects will receive a card stating the place, date and exact time of the eva- luation. One day before the study the subjects will be