Incidence of early-onset dementia in Mar del Plata.

INTRODUCTION: Early-onset dementia (EOD) is defined as dementia with onset before the age of 65 years. EOD is increasingly recognised as an important clinical and social problem with devastating consequences for patients and caregivers. OBJECTIVE: Determine the annual crude incidence rate and the specific incidence rates by sex and age in patients with EOD, and the standardised rate using the last national census of the population of Argentina (NCPA), from 2010. MATERIALS AND METHODS: Hospital Privado de Comunidad, Mar del Plata, Argentina, attends a closed population and is the sole healthcare provider for 17 614 people. Using the database pertaining to the Geriatric Care department, we identified all patients diagnosed with EOD between 1 January, 2005 and 31 December, 2011. EOD was defined as dementia diagnosed in patients younger than 65. RESULTS: The study period yielded 14 patients diagnosed with EOD out of a total of 287 patients evaluated for memory concerns. The crude annual incidence of EOD was 11 per 100 000/year (CI 95%: 6.25-19.1): 17 per 100 000 (CI 95%: 7.2-33.1) in men and 8 per 100 000 (CI 95%: 3.4-17.2) in women. We observed a statistically significant increase when comparing incidence rates between patients aged 21 to <55 years and ≥ 55 to <65 years (3 vs 22 per 100 000, P=.0014). The rate adjusted by NCPA census data was 5.8 cases of EOD habitants/year. CONCLUSION: This study, conducted in a closed population, yielded an EOD incidence rate of 11 per 100 000 inhabitants/year. To the best of our knowledge, this is the first prospective epidemiological study in Argentina and in Latin America.

Outcome of newly-diagnosed epilepsy in older patients.

INTRODUCTION: The annual incidence of seizure disorders rises sharply after the age of 60. Treatment is complicated by the normal physiological changes of aging, comorbid diseases, and polypharmacy. Despite this, approximately 80% of the patients become seizure-free. OBJECTIVES: The objectives of this study were to (1) analyze the outcome of a cohort of patients with newly-diagnosed epilepsy over the age of 65, (2) describe epilepsy etiology and seizure type, and (3) classify the outcome according to the latest ILAE classification proposal for drug-resistant epilepsy (2010). METHODS: All patients with newly-diagnosed epilepsy over the age of 65 who were evaluated in two different institutions were included. Seizures and epilepsy syndromes were classified according to the International League Against Epilepsy proposal (2010). Epilepsy outcomes were also analyzed according to the proposal of the ILAE Commission on Therapeutic Strategies (2010). RESULTS: One hundred and twenty-two patients were included with a median follow-up time of 15 months. Median age of diagnosis was 78 years. Seventy-seven patients (55%) had epilepsy of unknown cause, and 55 (45%) had structural-metabolic epilepsy. The proportions of seizure-free patients at 6, 12, 18, and 24 months were 90%, 77%, 74%, and 67%, respectively. Thirty percent of patients experienced adverse effects (AEs). We found a statistically significant trend toward a higher frequency of AEs as the number of concomitant medications rose and in younger patients. According to the 2010 ILAE classification proposal for drug-resistant epilepsy criteria, 55.8% of the patients were seizure-free, 12.3% had treatment failure, and 32% had undetermined seizure outcome. CONCLUSION: Patients with newly-diagnosed epilepsy after the age of 65 have very good chances of achieving seizure control with AED treatment. It seems that fulfilling the ILAE classification proposal for drug-resistant epilepsy (2010) criteria for seizure freedom was more difficult in our cohort. Older patients also seem to be more prone to suffering from AEs.

[Minimally invasive treatment of chronic subdural hematoma in adults. Results in 116 patients]. / Tratamiento mínimamente invasivo del hematoma subdural crónico del adulto. Resultados en 116 pacientes.

INTRODUCTION: Chronic subdural hematoma in adults (CSDH) has a global crude incidence of 14.1/100,000 per year in our institution captive population. There is no single treatment protocol. In our hospital we choose a minimal invasive technique (trans-marrow puncture) without general anaesthesia due to the age of the population. A descriptive study of patients with CSDH and treatment results, including a laterality analysis, is presented. MATERIAL AND METHODS: We retrospectively searched patients with (CSDH) between January 1998 and May 2009. The diagnosis was made by neuroimaging techniques in all patients. The preferred treatment was trans-marrow puncture; exceptionally some patients were treated by burr holes or craniotomy. RESULTS: We found 127 patients. Age, gender, midline displacement, hospitalisation days, and number of procedures, were not a predictive factor of mortality in the first month. A slight majority (55%) of CSDH were on the left side, with no statistically significant difference. There were 6 (4.7%) deaths during hospitalisation. In our series cumulative mortality at six months was 11.8%. Markwalder scale at admission was not a predictive factor of statistically significant mortality. An 80% of the patients received trans-marrow puncture as single procedure was performed on 80% of the patients. CONCLUSIONS: The results of our study suggest that trans-marrow puncture is an acceptable procedure, with low mortality, and less hospitalisation days and complications. Mortality, associated mechanisms, age, gender, midline displacement are no different than in others previous publications. We found a higher frequency of hematomas to the left, as in other series. Meta-analysis studied need to be performed to determine more accurately the frequency of this dominance.

[Chronic and subacute subdural haematoma. An epidemiological study in a captive population]. / Hematoma subdural crónico y subagudo. Estudio epidemiológico en una población cautiva.

INTRODUCTION: Although chronic and subacute subdural haematomas (CSSH) are amongst the commonest neurosurgical conditions, there are few studies on their incidence in the general population. OBJECTIVES: To determine the overall annual rate, the specific rates according to age and sex based on the Official Argentinian National Census of 1991 (OANC 91) for CSSH. PATIENTS AND METHODS: The Hospital Privado de Comunidad de Mar del Plata attends a captive population of 89,500 persons from the Instituto Nacional de Servicios Sociales de Jubilados y Pensionados (INSSJP) and the Prepaid Medical Schemes (PMP) of our institution. We studied the patients of INSSJP and PMP who had CSSH between 1992 and 1996. We determined the annual overall rate and the specific rates according to age and sex, and fitted to the OANC 91. RESULTS: 1. Annual overall rate: 14.1 CSSH/100,000 persons/year. 2. Specific rate for women: 11.6 CSSH/100,000 persons/year. 3. Specific rate for men: 18.1 CSSH/100,000 persons/year. 4. Specific rate 71-80 years old: 18.8 CSSH/100,000 persons/year. 5. Rate fitted to OANC9: 3.1 CSSH/100,000 persons/year. CONCLUSIONS: Our overall rate is higher, and the specific rate for the age group 71-80 years is intermediate, with regard to the rates found in other studies. Neuroepidemiological investigation should be stimulated so that more clinical studies are made regarding the results and costs based on the population.

[First episode non-traumatic subarachnoid haemorrhage. An epidemiological study of incidence and of arterial hypertension as a risk factor]. / Primer episodio de hemorragia subaracnoidea no traumática. Estudio epidemiológico de su incidencia y de la hipertensión arterial como un factor de riesgo.

AIMS: Our aim was to conduct an epidemiological study of the incidence of non-traumatic subarachnoid haemorrhage (NTSAH) and to evaluate a history of arterial hypertension (AHT) as a risk factor (RF). We also sought to determine the gross annual rate (GAR) and specific rates, by sex and age, of first episode non-traumatic subarachnoid haemorrhage (FENTSAH) adjusted to the Censo Nacional de Población de la Argentina (CNPA), and to carry out a population-based case-control study about the history of AHT as a RF in an Argentine community. PATIENTS AND METHODS: Our institution, the Hospital Privado de Comunidad de Mar del Plata, Argentina, attends a population of about 89,500 individuals exclusively and completely. There is a single filing system of case histories with all the diagnoses in a database. Patients who suffered a FENTSAH between the years 1992 and 1996 (n=62) were investigated to determine the specific GAR by sex and age and adjusted to the 1991 CNPA. The population was compared at random with two controls per case for the study of a history of AHT as a RF, and was then stratified according to sex and age. RESULTS: 1. GAR: 13.6/100,000 inhab./year; 2. Specific rate for males: 10.5/100,000 inhab./year; 3. Specific rate for females: 15.9/100,000 inhab./year; 4. CNPA adjusted rate: 7.3/100,000 inhab./year; 5. A significantly important number of patients with FENTSAH presented a history of hypertension as compared to controls subjects (odds ratio: 4.73; CI 95%: 2.39 9.34). CONCLUSIONS: Our rates are not substantially different from the rates found in other western countries and our findings indicate that a history of AHT is a RF for FENTSAH.

[Mild cognitive impairment: the neuropsychological characteristics of the different subtypes]. / Deterioro cognitivo leve: caracteristicas neuropsicologicas de los distintos subtipos.

AIM: To evaluate the frequency of mild cognitive impairment (MCI) subtypes and their neuropsychological characteristics in our population, and estimate the change in this frequency according to the extension of the neuropsychological examination. PATIENTS AND METHODS: Patients with diagnostic of MCI were included from 01/01/2003 to 31/12/2007. MCI was classified as MCI-amnestic type (MCI-AT), MCI-multiple domain type (MCI-MDT) and MCI-single domain non amnestic (MCI-MNOA). A neuropsychological test was considered abnormal if its result was equal or less than 1.5 standard deviations from what expected for age and educational level. The cohort was divided in short evaluation (less than 14 test, from 2003-2005) and basic-extended evaluation (equal or more than 14 test, from 2006-2007). RESULTS: Out of 204 patients included, 51 (26%) were classified as MCI-AT, 11 (5,4%) as MCI-MNOA and 142 (69,9%) as MCI-MDT. A higher educational level was associated with an increase in the number of MCI-MDT. The longer the evaluation, the greater was the proportion of MCI-MDT and MCI-MNOA and the lower the proportion of MCI-AT, without statistical significance. CONCLUSIONS: The most frequent MCI subtype was MCI-MDT. A more extended evaluation would allow a better classification of MCI subtypes and increase the number of MCI-MDT and MCI-MNOA at the expense of MCI-AT.

Deterioro cognitivo leve: características neuropsicológicas de los distintos subtipos / Mild Cognitive impairment: The Neuropsychological characteristics of the different sybtypes

Resumen. Objetivo. Evaluar, en nuestra población, la frecuencia de los subtipos de deterioro cognitivo leve (DCL) y sus características neuropsicológicas, y estimar la variación de esta frecuencia según la extensión de la evaluación. Pacientes y métodos. Se incluyeron pacientes con diagnóstico de DCL entre el 1 de enero de 2003 y el 31 de diciembre de 2007. Los subtipos de DCL se clasificaron como DCL amnésico (DCL-a), DCL monodominio no amnésico (DCL-mnoa) y DCL multidominio (DCL-mult). Se consideró una prueba neuropsicológica afectada cuando el resultado correspondía a igual o menos de 1,5 desviaciones estándares ajustadas a la edad y nivel educacional. Se dividió la cohorte de pacientes en evaluación menor a la básica (menos de 14 pruebas, del 2003 al 2005) y evaluación básica-ampliada (igual o más de 14 pruebas, del 2006 al 2007). Resultados. Del total de 204 pacientes, 51 (26%) correspondieron a DCL-a, 11 (5,4%) a DCL-mnoa y 142 (69,6%) a DCL-mult. Se observó una tendencia hacia una mayor proporción de DCL-mult a mayor nivel educativo. A mayor extensión de la evaluación neuropsicológica, se halló una mayor proporción de DCL-mult y DCL-mnoa, a expensas de una disminución del número de DCL-a, sin alcanzar una significancia estadística. Conclusiones. El subtipo más frecuente fue el DCL-mult. La extensión de la evaluación redundaría en una mejor clasificación de los subtipos y, posiblemente, en un aumento del número de DCL-mult y DCL-mnoa, a expensas de DCL-a. (AU)

Summary. Aim. To evaluate the frequency of mild cognitive impairment (MCI) subtypes and their neuropsychological characteristics in our population, and estimate the change in this frequency according to the extension of the neuropsychological examination. Patients and methods. Patients with diagnostic of MCI were included from 01/01/2003 to 31/12/2007. MCI was classified as MCI-amnestic type (MCI-AT), MCI-multiple domain type (MCI-MDT) and MCI-single domain non amnestic (MCI-MNOA). A neuropsychological test was considered abnormal if its result was equal or less than 1.5 standard deviations from what expected for age and educational level. The cohort was divided in short evaluation (less than 14 test, from 2003-2005) and basic-extended evaluation (equal or more than 14 test, from 2006-2007). Results. Out of 204 patients included, 51 (26%) were classified as MCI-AT, 11 (5,4%) as MCI-MNOA and 142 (69,9%) as MCI-MDT. A higher educational level was associated with an increase in the number of MCI-MDT. The longer the evaluation, the greater was the proportion of MCI-MDT and MCI-MNOA and the lower the proportion of MCI-AT, without statistical significance. Conclusions. The most frequent MCI subtype was MCI-MDT. A more extended evaluation would allow a better classification of MCI subtypes and increase the number of MCI-MDT and MCI-MNOA at the expense of MCI-AT (AU)

Hematoma subdural crónico y subagudo. Estudio epidemiológico en una población cautiva / Chronic and subacute subdural haematoma. An epidemiological study in a captive population

Introducción. A pesar de ser una de las enfermedades neuroquirúrgicas más frecuentes, son escasos los trabajos sobre la incidencia poblacional de los hematomas subdurales crónicos o subagudos (HSCS). Objetivos. Determinar las tasas brutas anuales, específicas por sexo y edad, y ajustadas al Censo Nacional de la Población Argentina de 1991 (CNPA91) de los HSCS. Pacientes y métodos. En el Hospital Privado de Comunidad de Mar del Plata se atiende a una población cautiva de 89.500 individuos con historia clínica única pertenecientes al Instituto Nacional de Servicios Sociales de Jubilados y Pensionados (INSSJP) y a los Planes de Medicina Prepaga de nuestra institución (PMP). Se investigaron los pacientes pertenecientes al INSSJP y PMP que padecieron un HSCS entre los años 1992 y 1996, ambos inclusive; se determinaron las tasas brutas anuales y específicas por sexo y edad, y se ajustaron al CNPA91.Resultados. 1. Tasa bruta anual: 14,1 HSCS/100.000 habitantes/ año; 2. Tasa específica para mujeres: 11,6 HSCS/100.000 habitantes/año; 3. Tasa específica para varones: 18,1 HSCS/100.000 habitantes/año; 4. Tasa específica de 71-80 años: 18,8 HSCS/100.000 habitantes/año, y 5. Tasa ajustada al CNPA91: 3,1 HSCS/100.000 habitantes/año. Conclusiones. Nuestra tasa bruta global es mayor y la específica para la edad de 71-80 años es intermedia con respecto a las de otros estudios. Es necesario estimular la investigación neuroepidemiológica a efectos de realizar estudios clínicos, de resultados y de costes basados en la población (AU)