Cardiovascular risk in subjects over 55 years of age and cognitive performance after five years. NEDICES2-RISK study. Study protocol.

BACKGROUND: Cognitive impairment and dementia have a high prevalence among the elderly and cause significant socio-economic impact. Any progress in their prevention can benefit millions of people. Current data indicate that cardiovascular risk (CVR) factors increase the risk of developing cognitive impairment and dementia. Using models to calculate CVR specific for the Spanish population can be useful for estimating the risk of cognitive deterioration since research on this topic is limited and predicting this risk is mainly based on outcomes in the Anglo-Saxon population. The aim of this study is to assess the relationship between CVR in the Spanish population, as calculated using the FRESCO (Función de Riesgo Española de acontecimientos Coronarios y Otros) and REGICOR (Registre Gironí del Cor) CVR tables, and the change in cognitive performance at a 5-year follow-up. METHODS: Design: Observational, analytic, prospective cohort study, with a 5-year follow-up. Ambit: Population. Population: Subjects 55 to 74 years of age, included in the NEDICES2 (2014-2017) cohort, who did not present dementia and had undergone the neuropsychological evaluation (N = 962). Variables: Exposure factors (CVR factors and estimated risk according to the CVR predictors by REGICOR and FRESCO), dependent variables (change in the score of the brief neuropsychological test in the study NEDICES2 five years after the first evaluation), and clinical and socio-demographic variables. Statistical analysis: Analysis of data quality. Descriptive analysis: socio-demographic and clinical variables of subjects. Bivariate analysis: relationship between basal CVR and change in neuropsychological tests. Multivariate analysis: relationship between basal CVR and change in neuropsychological tests adjusted by co-variables. Analysis and comparison of the reliable change in independent samples. DISCUSSION: The Spanish population can benefit from determining if individuals with high CVR, which is commonly detected in usual clinical practice, will present decreased cognitive performance compared to subjects with lower CVR. This study can affect how to address CVR factors and the design of effective prevention strategies for cognitive deterioration. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03925844.

Is milk and dairy intake a preventive factor for elderly cognition (dementia and Alzheimer's)? A quality review of cohort surveys.

Milk and dairy (M&D) is a longstanding human food with widespread use. Many studies showed the preventive capacity of M&D in several human health disorders, but its utility in others is under discussion. Aging has been associated to elderly cognitive decline including dementia-Alzheimer syndrome (Dem-AD). The absence of a therapy to impede or postpone Dem-AD determines the need for its prevention, including nutritional factors. To evaluate the preventive capacity of M&D consumption in elderly Dem-AD we performed a systematic review in the main biomedical databases and information resources, but we present this study as a narrative review to discuss better the complexity of this subject. The elderly Dem-AD has a long pre-symptomatic period and the M&D intake has a widespread use. These determinants and the quality flaws of published studies impeach us to answer whether M&D consumption is preventive for Dem-AD. Moreover, two long Japanese cohorts suggest that M&D intake could prevent Dem-AD. Prospective cohorts beginning in midlife (or early life) could answer this question in the future.

Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study.

BACKGROUND: The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. OBJECTIVE: The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. METHODS: A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. RESULTS: In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. CONCLUSIONS: Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals.

BACKGROUND: Burnout syndrome is an important health problem that affects many professionals and must be addressed globally, with both organizational measures and personal interventions. Burnout of health professionals can be prevented in order to avoid personal, familial, and social consequences, as well as repercussions for patients. METHODS/DESIGN: This work describes a protocol for a controlled, pragmatic, randomized clinical trial in 2 parallel groups: intervention and control. All health professionals from 7 health care centers will form the intervention group, and all health professionals from 7 different health care centers will form the control group. The intervention group will receive 16 hours of training at their work place. The Maslach's burnout inventory, the Cuestionario de Desgaste Profesional Médico or the Cuestionario de Desgaste Profesional de Enfermería, and the 28-item Goldberg's General Health Questionnaire, validated for our setting, will be used as measurement tools. Change in the average scores from the Maslach's burnout inventory emotional exhaustion scale will be compared between the intervention and control groups, measured as intention-to-treat, and the intervention will be considered effective if a minimum decrease of 20% is achieved. DISCUSSION: Due to the deleterious consequences of burnout syndrome for people suffering from it and for the organization where they work, it is necessary to evaluate the effectiveness of certain interventions for its prevention. Organizational measures are important for preventing burnout syndrome, but so is providing professionals with coping strategies, as this group intervention intends to do. TRIAL REGISTRATION: ClinicalTrials.gov processed this record on June 10, 2013. ClinicalTrials.gov Identifier: NCT01870154.

El Fototest en el cribado de demencia en atención primaria. Réplica / The use of the Fototest in screening for dementia in primary care. Reply

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El cribado de la demencia en atención primaria. Revisión crítica / Dementia screening in primary care: critical review

Introducción. Los profesionales de atención primaria necesitan herramientas útiles y sencillas que permitan detectar, de manera precoz, el deterioro cognitivo en sujetos bajo sospecha clínica de demencia. Objetivo. Esta revisión crítica persigue analizar las características psicométricas de los test de cribado cognitivo, comúnmente empleados en el cribado de la demencia en atención primaria, que hayan sido adaptados para la población de habla española en la Península Ibérica. Desarrollo. Se ha puesto especial énfasis en aquellos instrumentos que reunían las siguientes características: sencillez en la corrección y tiempo de aplicación breve (menor o igual a 10 min). Se detallan aspectos como la fiabilidad, la validez y, más concretamente, la capacidad de discriminación del instrumento (ancianos con demencia y ancianos sanos). Conclusión. El futuro de la evaluación cognitiva breve en atención primaria requiere la adaptación y validación de nuevos instrumentos con población española, la mejora de la sensibilidad de los test en pacientes con deterioro cognitivo leve y la búsqueda de medidas que tengan una validez transcultural adecuada (AU)

Introduction. Primary care professionals need useful and simple tools to detect early cognitive impairment in patients with any clinical suspicion of dementia. Aim. This critical review attempts to analyze the psychometric properties of cognitive screening tests, commonly used for screening dementia in primary care setting, which have been adapted for Spanish speaking population in the Iberian Peninsula. Development. Special emphasis has been placed on those instruments which met the following criteria: easy correction and short-term application (less than or equal to 10 minuts). Properties such as reliability, validity and especially the discriminating power of the instrument (older people with dementia vs. healthy older adults) have been detailed. Conclusion. The future of brief cognitive assessment in primary care setting requires the adaptation and validation of new tests for the Spanish population, improving the sensitivity of the tests in patients with mild cognitive impairment and searching for measures with an adequate cross-cultural validity (AU)

[Dementia screening in primary care: critical review]. / El cribado de la demencia en atención primaria. Revisión crítica.

INTRODUCTION: Primary care professionals need useful and simple tools to detect early cognitive impairment in patients with any clinical suspicion of dementia. AIM. This critical review attempts to analyze the psychometric properties of cognitive screening tests, commonly used for screening dementia in primary care setting, which have been adapted for Spanish speaking population in the Iberian Peninsula. DEVELOPMENT: Special emphasis has been placed on those instruments which met the following criteria: easy correction and short-term application (less than or equal to 10 minutes). Properties such as reliability, validity and especially the discriminating power of the instrument (older people with dementia vs. healthy older adults) have been detailed. CONCLUSION: The future of brief cognitive assessment in primary care setting requires the adaptation and validation of new tests for the Spanish population, improving the sensitivity of the tests in patients with mild cognitive impairment and searching for measures with an adequate cross-cultural validity.