A path analysis of patient dependence and caregiver burden in Alzheimer's disease.

BACKGROUND: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. METHODS: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. RESULTS: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. CONCLUSIONS: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Practical application of brief cognitive tests.

INTRODUCTION: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations for use. DEVELOPMENT: Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20 min. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results. CONCLUSION: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT], test of verbal fluency [TVF]) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI. The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce - but never substitute - clinical judgment, patient-doctor communication, and inter-professional dialogue.

Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).

OBJECTIVE: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. METHODS: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. RESULTS: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. CONCLUSIONS: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

Dopaminergic dysregulation, artistic expressiveness, and Parkinson's disease.

BACKGROUND: The most frequent behavioral manifestations in Parkinson's disease (PD) are attributed to the dopaminergic dysregulation syndrome (DDS), which is considered to be secondary to the iatrogenic effects of the drugs that replace dopamine. Over the past few years some cases of patients improving their creative abilities after starting treatment with dopaminergic pharmaceuticals have been reported. These effects have not been clearly associated to DDS, but a relationship has been pointed out. METHODS: Case study of a patient with PD. The evolution of her paintings along medication changes and disease advance has been analyzed. RESULTS: The patient showed a compulsive increase of pictorial production after the diagnosis of PD was made. She made her best paintings when treated with cabergolide, and while painting, she reported a feeling of well-being, with loss of awareness of the disease and reduction of physical limitations. CONCLUSIONS: Dopaminergic antagonists (DA) trigger a dopaminergic dysfunction that alters artistic creativity in patients having a predisposition for it. The development of these skills might be due to the dopaminergic overstimulation due to the therapy with DA, which causes a neurophysiological alteration that globally determines DDS.

[Clinical and demographic characteristics of the cases of dementia diagnosed in the Health District of Girona throughout the period 2007-2010: data from the Girona Dementia Registry (ReDeGi)]. / Caracteristicas clinicas y demograficas de los casos de demencia diagnosticados en la Region Sanitaria de Girona durante el periodo 2007-2010: datos del Registro de Demencias de Girona (ReDeGi).

INTRODUCTION: The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District. AIM: To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia. PATIENTS AND METHODS: The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010. RESULTS: A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases. CONCLUSIONS: The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.

Prevalence and European comparison of dementia in a ≥75-year-old composite population in Spain.

OBJECTIVES: To estimate dementia prevalence in Spain. MATERIALS AND METHODS: Nine probabilistic and geographically defined samples participated. A screening design based on the MMSE was implemented. Positively screened individuals underwent clinical evaluation. The total number of cases in Spain was estimated. Prevalence was confronted to that of other European countries. RESULTS: Five hundred and forty-six persons aged ≥75 participated, 49 had dementia (35 with Alzheimer's disease [AD], 10 with vascular dementia [VD], 4 other; 25 first diagnosed in the study). Age- and sex-adjusted prevalence and estimated nationwide cases were 7.5% (95% CI 5.4-9.7), 5.6 (95% CI 3.7-7.5) and 1.4 (95% CI 0.5-2.3), and 290,000 (95% CI 208,000-372,000), 214,000 (95% CI 141,000-288,000) and 54,000 (95% CI 20,000-88,000) for dementia, AD and VD, respectively. CONCLUSIONS: Dementia prevalence in Spain is comparable to other European populations, while a high number of undiagnosed cases live in the community. The potential impact of Mediterranean diet, hypertension control and decreasing vascular risk factors is discussed.

[The effect of donepezil in comparison with conventional treatment on cognitive functioning and the performance of the patient in a prospective cohort of patients with Alzheimer's disease treated in routine clinical practice in Spain]. / Efecto del donepecilo comparado con el tratamiento convencional en la funcion cognitiva y el rendimiento del paciente en una cohorte prospectiva de pacientes con enfermedad de Alzheimer tratados en la practica clinica habitual en Espana.

AIMS: Our aim was to perform a secondary analysis of a 12-month-long, non-blind, multi-centre prospective cost-of-illness study. The analysis assessed the effect of donepezil on cognitive functioning and the performance of patients with possible or probable Alzheimer's disease, compared to that of other drugs for dementia. PATIENTS AND METHODS: A sample of 700 patients took part in the study (76.8 ± 6.6 years of age, 67.3% females): 600 (31.4% drug-naive) received donepezil and 100 (9% drug-naive) were given other drugs for dementia. RESULTS: The mean variations corrected by the baseline values and the centre of the total scores on the Folstein minimental test, the clinical dementia rating and Blessed dementia rating scales at 12 months were significantly lower in patients treated with donepezil: -1.23 ± 3.41 versus -2.26 ± 3.07 (p = 0.006), 0.20 ± 0.68 versus 0.39 ± 1.03 (p = 0.014) and 1.28 ± 3.31 versus 2.04 ± 2.84 (p = 0.027), respectively. CONCLUSIONS: This secondary analysis shows that the deterioration in the cognitive functioning and performance of patients with the passage of time is slower with donepezil than with other drugs for dementia in routine medical practice. Since these results were observed in a post hoc analysis, formal prospective clinical trials should be conducted to confirm these findings.

[Drug consumption and cognitive function in non-institutionalized elderly: a population-based study]. / Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada.

BACKGROUND: Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption. METHODS: This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants' medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. RESULTS: A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD=2.9) and 5.2 (SD=3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD=2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P=0.003) and nervous system (P=0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P <0.05). CONCLUSIONS: Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption.

Incidence and subtypes of early-onset dementia in a geographically defined general population.

OBJECTIVE: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. METHODS: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km(2) and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. RESULTS: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30-64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3-15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. CONCLUSIONS: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30-49 years; in the age group 50-64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase.

Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers.

BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.

[Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona]. / Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona.

AIM: To perform a descriptive analysis of the outpatient activity in a neurological department in terms of the frequency and type of neurological diseases that were attended. PATIENTS AND METHODS: A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerised hospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the International Classification of Diseases, 10th edition (CIE-10). RESULTS: The mean age was 60.6 +/- 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year 2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The most common diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies. CONCLUSIONS: The frequency of visits increases with age and the order, in terms of frequency, was: episodic and paroxysmal, degenerative and demyelinating, psychotic and behavioural disorders, and extrapyramidal syndromes.

[A longitudinal study of apathy in patients with Alzheimer's disease]. / Estudio longitudinal de la apatía en pacientes con enfermedad de Alzheimer.

INTRODUCTION: Apathy is the most common behavioral symptom in Alzheimer's disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months. PATIENTS AND METHODS: Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathy NPI score was taken in to account in the study when it was equal or more than 4. RESULTS: The sample size consisted of 155 subjects with a mean age of 77.1 +/- 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores. CONCLUSION: The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI total score was observed when an increased apathy NPI score is observed.

[Prevalence and evolution of delirium in a community population of 70 years and older]. / Prevalencia y evolución del delirium en una muestra comunitaria de 70 años y más.

INTRODUCTION: There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. METHOD: Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. RESULTS: 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. CONCLUSION: The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period.

[Factorial distribution of the burden on caregivers of patients with Alzheimer's disease]. / Distribución factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Care of patients with Alzheimer's disease (AD) is so demanding that it can trigger states of physical, emotional and psychological distress among caregivers. The aims of this study were to determine the factorial structure of the Zarit Burden Scale (BS), to establish the differences among the factors according to the characteristics of patients and caregivers, and to determine the effect of the course of the disease on the factors on the BS over a period of two years. SUBJECTS AND METHODS: We conducted a prospective, longitudinal study on non-professional caregivers of patients with AD. The study involved 463 patients with a diagnosis of probable AD. The mean age was 75.2 years. All the subjects were administered the study protocol on a six-monthly basis over a period of 24 months. The patient's cognitive and functional capacity and the presence of psychological and behavioural symptoms were evaluated. The main caregiver was asked to complete the Zarit BS. RESULTS: The 21 items on the BS were distributed into five factors that accounted for 59.7% of the total variance of the score. A multivariate analysis identified aggressiveness, apathy, irritability, the caregiver's age and his or her relation to the family as the main causes of distress. CONCLUSIONS: This study confirms the multidimensional structure of the BS and offers information about the effect exerted on burden by the different clinical variables of the patients and the sociodemographic variables of the caregivers.

[Differences among dementias according to onset age: study based on dementia registry data]. / Diferencias entre las demencias según la edad de inicio: estudio a partir de los datos de un registro de demencias.

INTRODUCTION: To know cognitive, functional and sociodemographical features as risk factors in order to differentiate dementias based on onset age of illness. METHODS: Cross-sectional and analytical study based on 670 cases of a pilot program for dementia from the Gerona Hospital Registry for dementias. The cases were standardized and registered consecutively during the 2004-2005 biennium. RESULTS: A total of 10.3% (n=69) of patients who were included in the registry showed the first symptoms of dementia before they were 66 years old. The distribution of the dementia diagnoses differed according to age at onset of illness, with greater frequency of frontotemporal dementia in the early-onset dementia group. Patients with early-onset dementia showed less functional and cognitive impairment than patients with late-onset dementia. They also had more behavioral and psychological disorders than the late onset cases as well as a greater number of family backgrounds of Down's syndrome and personal background of depression. No vascular risk factors differences between late-and-early-onset dementias were found. CONCLUSIONS: Early-onset dementias showed different clinical manifestations, risk factors and diagnostic distributions versus the later onset ones. The registry program for dementia is a useful tool to study low prevalence characteristics of diseases leading to the dementia condition.

[Mortality rates in patients with Alzheimer's disease treated with atypical neuroleptic drugs]. / Mortalidad en pacientes con enfermedad de Alzheimer tratados con neurolepticos atipicos.

AIM: To evaluate the influence of metabolic syndrome (MS) and a history of heart disease on increased mortality rates among patients with Alzheimer's disease (AD) who have been treated with cholinesterase inhibitors or memantine and who received risperidone or olanzapine therapy during the time under study. PATIENTS AND METHODS: Our study involved a sample of 751 patients diagnosed with AD and treated with anti-dementia drugs. Of the total number, 10.2% (n = 77) and 7.7% (n = 58) had been treated with risperidone and olanzapine, respectively, at some time during the follow-up. Twelve (1.6%) had received both substances in different periods of time. RESULTS: Mean follow-up time was 27.52 +/- 12.15 months. Mortality rate stood at 14% (n = 105). The mean maximum dose of olanzapine was 4.3 mg/day (standard deviation, SD = 2.55; range = 2.5-15) and 1.36 mg/day (SD = 0.67; range = 0.25-3.5) in the case of risperidone. Treatment lasted 519.12 (SD = 285.2; range = 90-1045) and 481.68 (SD = 345.22; range = 1-1650) days, respectively. If age, sex, conduct disorders on the Blessed scale, the cumulative heart disease index and the global deterioration scale are included in the model, both olanzapine (relative risk, RR = 8.95; confidence interval, CI 95% = 2.856-28.046) and risperidone (RR = 4.526; CI 95% = 1.816-11.281) increase the risk of death. An interaction between a history of heart disease and risperidone is recorded, which suggests a possible protection of the drug in this group. No evidence was found of an interaction between the two drugs and MS. CONCLUSIONS: Neither the presence of cardiac disorders nor MS allow us to explain the increased mortality rate in patients with dementia who are treated with olanzapine or risperidone.

[Metabolic syndrome in Alzheimer's disease: clinical and developmental influences]. / Síndrome metabólico en la enfermedad de Alzheimer:influencias clínicas y evolutivas.

INTRODUCTION: Metabolic syndrome (MS) results in an increased risk of developing Alzheimer's disease (AD), but its implications when the disease is already well established remain unknown. AIM. To assess the influence of MS in the clinical manifestations and its effect on mortality among AD patients treated with anti-Alzheimer drugs. PATIENTS AND METHODS: We conducted a retrospective cohort study with 751 outpatients from a dementia clinic who were diagnosed with AD and who had been prescribed cholinesterase inhibitors and/or memantine. Data was collected in a standardised manner from the patients' medical records. RESULTS: The mean follow-up time was 27.52 +/- 12.15 months. Frequency of MS was 24.6% (n = 185). The mortality rate throughout the period of study was 14.0% (n = 105). Patients with MS are younger and present lower degrees of cognitive and functional impairment, with greater organic comorbidity at the expense of heart diseases. They take more medicines and are given fewer atypical antipsychotics at the expense of olanzapine, above all. When age, sex, the basic activities of daily living and conduct disorders subscales from the Blessed scale (BDRS), the Cumulative Illness Rating Scale (CIRS) for heart disease and the Folstein Mini-Mental State Examination (MMSE) were included in the model, MS did not increase the risk of mortality. CONCLUSIONS: Patients with MS are diagnosed with AD at an earlier age despite having a lower degree of cognitive and functional impairment. MS does not give rise to an increase in the mortality rate of patients with AD.

[Characterisation and prevalence of the psychological and behavioural symptoms in patients with dementia]. / Caracterización y prevalencia de los síntomas psicológicos y conductuales en pacientes con demencia.

AIM: To assess the prevalence of behavioural and psychological symptoms (BPS's) in patients with dementia in Spain and their dementia-specific characteristics. PATIENTS AND METHODS: A cross-sectional and retrospective study of 1025 patients from 52 specialized dementia care units using the Neuropsychiatric Inventory (NPI). Patients with a probable diagnosis of Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease and dementia (PDD) were selected for BPS's characterisation. RESULTS: The global prevalence of BPS's was 66.7% (684 patients; 95% CI = 63.8-69.6%). BPS's were under-diagnosed in one third of cases. A total of 668 patients with NPI of 4 or superior and a diagnosis of AD (n = 380; 56.8%), DLB (n = 156; 23.3%) and PDD (n = 132; 19.7%) had a NPI mean of 21.1 (SD = 14.7), 25.6 (SD = 13.9) and 21.8 (SD = 14.2), respectively. Apathy, depression and anxiety were the most common BPS's. Delusions and hallucinations were significantly more prevalent in DLB. Dementia severity was correlated with the global NPI value and with all the sub-items, but anxiety and euphoria. The presence of agitation, euphoria or lability was associated with a deficient therapeutic fulfillment. CONCLUSION: A high prevalence of non-diagnosed BPS's was observed in the studied population. This has serious negative consequences for the quality of life of patients and their social environment. Therefore we propose an active search and subsequent correct treatment of BPS's in all patients with dementia.

[Clinical heterogeneity of Alzheimer's disease according to the age of onset]. / Heterogeneidad clinica de la enfermedad de Alzheimer segun la edad de inicio.

INTRODUCTION: The age of onset of Alzheimer's disease (AD) has been linked to the degree of clinical heterogeneity. Some studies have suggested that the presenile and senile forms may be different conditions. AIM: To describe the clinical and developmental characteristics of patients with AD according to the age of onset. PATIENTS AND METHODS: A clinical sample of AD patients was evaluated by means of the Cambridge Examination for Mental Disorders of the Elderly protocol together with other tests and clinical scales (Trail Making Test, Neuropsychiatric Inventory, Rapid-Disability Rating Scale-2 and Zarit Burden Interview). Patients were reassessed at 12 months. RESULTS: Of the 492 participants, 419 (85.2%) were cases of late-onset AD and 73 cases (14.8%) had early-onset AD. For this latter group, the time between onset of the first symptoms and diagnosis of the disease was higher (3.85 versus 2.5 years) and there was a higher frequency of family histories of dementia (35.6%) and personal histories of psychiatric disorders (13.7%). This group also presented better scores on the functional evaluation scales and on the neuropsychological tests, as well as more frequent and severe symptoms of depression. At 12 months no clinical differences were recorded between the two groups, except for an increase in the frequency and severity of apathy. CONCLUSIONS: From the differences found between early-onset and late-onset AD we cannot consider them to be two different conditions from the clinical and/or neuropsychological point of view.