[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.

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

Introducción. Uno de los trastornos conductuales más frecuentes en la enfermedad de Alzheimer (EA) es la apatía. El objetivo de este estudio fue determinar la prevalencia de apatía en pacientes con EA en fases iniciales y su evolución tras 12 meses de seguimiento. Pacientes y métodos. Estudio observacional longitudinal en pacientes con EA. Se administró el Cambridge-Cognitive Revised (CAMCOG-R), la Disability Assessment in Dementia (DAD) y el inventario neuropsiquiátrico (NPI), y se recogieron de manera estructurada las características sociodemográficas. Se valoró la presencia de apatía en pacientes con una puntuación en la subescala del NPI mayor o igual a 4 puntos. Resultados. La muestra estuvo formada por 155 pacientes,con una media de edad de 77,1 ± 6,7 años, y un 67,7% fueron mujeres. La prevalencia de apatía fue del 18,7%; a los 12 meses, la persistencia fue del 51,7% y la remisión, del 48,3%. La incidencia fue del 21,4%. Se observaron diferencias en el momento basal entre los pacientes con y sin apatía en el CAMCOG-R (p = 0,001), en la DAD (p < 0,001) y en el NPI (p < 0,001). Al año no se observaron diferencias según edad ni sexo. Según los índices de variación porcentual, a los 12 meses se observaron diferencias en la iniciativa y ejecución funcional y en el NPI. Conclusiones. La apatía aumenta con la evolución de la EA, a la vez que se asocia a mayor discapacidad funcional, sobre todo en iniciativa y capacidad ejecutiva. Se observó un aumentode la puntuación de las otras subescalas del NPI asociado al incremento de la apatía

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 apathyNPI 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 totalscore was observed when an increased apathy NPI score is observed

Differential efficacy of treatment with acetylcholinesterase inhibitors in patients with mild and moderate Alzheimer's disease over a 6-month period.

There are various anticholinesterase inhibitors (AChEIs) for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). All AChEIs have shown greater efficacy than placebo in randomized, double-blind, parallel-group clinical trials. No differential studies have yet been made of the efficacy between all AChEIs. The study aims to determine the differential efficacy of the AChEIs with respect to a historical sample of patients with AD that were not treated with AChEIs. An open-label, prospective, observational study with a retrospective control group was undertaken to examine the evolution of the cognitive function over a 6-month period. The patients were assessed with the Mini-Mental State Examination (MMSE) at study entry and at 6 months. A general linear model was applied for repeated measurements with the MMSE score as the dependent variable, treatment type as an independent variable and the severity of the deterioration, age and the MMSE baseline score as covariables. Of the sample of 147 patients, 40 initiated treatment with donepezil, 32 with galantamine, 30 with rivastigmine and 45 were part of a historical sample of the memory clinic patients between 1991 and 1996 that had not been treated with AChEIs. The average age was 73.7 years (SD = 6.9; range = 52-86), 67.3% were women, 78.2% of the cases were mild and the MMSE baseline score was 18.1 points (range = 11-27). No significant intergroup differences were observed in these variables. The average doses of donepezil, galantamine and rivastigmine were 5.87 mg/day (SD = 1.92), 14.81 mg/day (SD = 6.25) and 6.41 mg/day (SD = 1.82), respectively. At 6 months, the difference in the MMSE score with respect to the untreated group was 1.6 points for donepezil (95% CI 0.79-2.37; p < 0.001), 0.99 points for galantamine (95% CI 0.14-1.85; p = 0.01) and 0.90 points for rivastigmine (95% CI 0.05-1.74; p = 0.03). No significant differences were observed in the efficacy among the groups treated with AChEIs (p > 0.05). Treatment with AChEIs significantly delays the global cognitive impairment associated with AD for at least 6 months. Our study found no significant differences in efficacy between donepezil, galantamine and rivastigmine. Further studies in the context of daily clinical practice will determine the clinical significance of the changes observed. An important variability of the response to the treatment was observed in treated patients.

Neuropsychological profile of Alzheimer's disease in women: moderate and moderately severe cognitive decline.

INTRODUCTION: Alzheimer's disease (AD) is characterised by progressive cognitive and functional decline. There is evidence that AD is more prevalent in women. This study aims at identifying the clinical and sociodemographic variables associated with the cognitive functions and the pattern of decline in women with moderate to moderately severe AD. METHODS: Cross-sectional observational study of 165 women with dementia of the AD type according to NINCDS-ADRDA criteria. The cognitive functions were assessed using the Cambridge Cognitive Examination (CAMCOG). The sociodemographic and clinical data were collected from the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) interview, and the Neuropsychiatric Inventory (NPI) was administrated to the caregiver. RESULTS: The number of years of schooling and the score on the CAMDEX depression scale were the variables associated with the CAMCOG score. The effect of these variables was not homogenous for all the CAMCOG subtests. CONCLUSIONS: The number of years of schooling and the presence of depressive symptomatology influence the results of the neuropsychological exploration, but the effect is moderate and not homogenous for all the CAMCOG subtests. The differences in cognitive profile between moderate and moderately severe are characterised by a greater effect on temporal orientation, calculation and perception.

Evolution of depressive symptoms in Alzheimer disease: one-year follow-up.

The current longitudinal study analyzes the natural course of depressive symptoms in patients with Alzheimer disease (AD). The goals were to identify the clinical and sociodemographic variables related to depressive symptoms, to assess the effect of depressive symptoms on the course of cognitive and functional impairment and on associated neuropsychiatric disorders, and to identify which factors are associated with remission, persistence, and emergence of depressive symptoms at 12 months. A sample of 150 patients with mild or moderate severity was assessed at baseline and at 12 months using the neuropsychologic battery Cambridge Cognitive Examination. The Neuropsychiatric Inventory and Rapid Disability Rating Scale were administered to the caregiver. Prevalence, persistence, and emergence of depressive symptoms at baseline were 51%, 55%, and 20%, respectively. Remission of depressive symptoms at 12 months leads to a decreased frequency of other noncognitive disorders and to a slight improvement in the assessment of global function. The presence of depressive symptoms does not affect the course of cognitive impairment at 12 months, and a psychiatric history of the patient and the number of depressive symptoms at baseline are risk factors for the emergence and persistence of depressive symptoms at 12 months.

[Clinical incidence of dementia with Lewy bodies]. / Incidencia clínica de la demencia por cuerpos de Lewy.

INTRODUCTION AND AIMS: Dementia with Lewy bodies (DLB) has only relatively recently been acknowledged as an independent neurodegenerative entity. Until now few epidemiological prevalence studies have been carried out that include DLB and there are no studies about its incidence. The aim of this study is to determine the annual clinical incidence of DLB. PATIENTS AND METHODS: We performed an observational retrospective study of the diagnosis of all the individuals who were attended at the UVAMID (Memory and Dementia Assessment Unit) between 1999 and 2001. The clinical assessment was performed in a standardised manner following the UVAMID protocol, which includes the medical history, obtained by interviewing the patient and a reliable informant, a general medical and neurological check up, neuropsychological exploration and a set of complementary tests. RESULTS: The incidence of DLB in clinical practice was found to be 26/100,000 cases per year. By age groups, a progressive increase in incidence was seen until the 80 84 year old bracket and 63% of the cases of DLB were males. CONCLUSIONS: The results of this study show that cases of DLB made up 2% of the total number of new annual cases. The main limitation of this study lies in the fact that, because patients were referred to clinic from primary health care centres, they do not constitute a representative sample that is clinically unbiased, and this imposes restraints on the extrapolation of results.

Incidencia clínica de la demencia por cuerpos de Lewy / Clinical incidence of dementia with Lewy bodies

Introducción y objetivos. El reconocimiento de la demencia por cuerpos de Lewy (DCL) como una entidad neurodegenerativa independiente es relativamente reciente. Aún se han realizado pocos estudios epidemiológicos de prevalencia que incluyan la DCL y no existen estudios de incidencia. El objetivo del presente trabajo es de terminar la incidencia clínica anual de la DCL. Pacientes y métodos. Estudio retrospectivo observacional del diagnóstico de todos los sujetos que acudieron a la UVAMID entre los años 1999 y 2001. La valoración clínica se realizó de modo estandarizado según el protocolo de la UVAMID, que incluye la historia clínica realizada a través de una entrevista al paciente y a un informador fiable, un examen médico general y neurológico, una exploración neuropsicológica y un conjunto de pruebas complementarias. Resultados. La incidencia en la práctica clínica de la DCL fue de 26/100.000 casos anuales. Por grupos de edad, se observó un aumento progresivo de la incidencia hasta el intervalo de 80-84 años y el 63 por ciento de los casos de DCL fueron hombres. Conclusiones. Los resultados del presente estudio señalan que los casos de DCL representaron el 2 por ciento del total de casos nuevos anuales. La principal limitación del presente trabajo es que los pacientes, al remitirse a consulta desde los centros de atención primaria, forman una muestra no representativa, clínicamente sesgada, que limita la extrapolación de los resultados (AU)

Introduction and aims. Dementia with Lewy bodies (DLB) has only relatively recently been acknowledged as an independent neurodegenerative entity. Until now few epidemiological prevalence studies have been carried out that include DLB and there are no studies about its incidence. The aim of this study is to determine the annual clinical incidence of DLB. Patients and methods. We performed an observational retrospective study of the diagnosis of all the individuals who were attended at the UVAMID (Memory and Dementia Assessment Unit) between 1999 and 2001. The clinical assessment was performed in a standardised manner following the UVAMID protocol, which includes the medical history, obtained by interviewing the patient and a reliable informant, a general medical and neurological check-up, neuropsychological exploration and a set of complementary tests. Results. The incidence of DLB in clinical practice was found to be 26/100,000 cases per year. By age groups, a progressive increase in incidence was seen until the 80-84 year old bracket and 63% of the cases of DLB were males. Conclusions. The results of this study show that cases of DLB made up 2% of the total number of new annual cases. The main limitation of this study lies in the fact that, because patients were referred to clinic from primary health care centres, they do not constitute a representative sample that is clinically unbiased, and this imposes restraints on the extrapolation of results (AU)

[Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild Alzheimer s disease over a six-month period]. / Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses.

INTRODUCTION: At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. PATIENTS AND METHODS: We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6 month period. RESULTS: The sample was made up of 175 patients, of which 134 began therapy with 5 10 mg/day of donepezil and 41 with 6 12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. CONCLUSIONS: The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine.

Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses / Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild alzheimer's disease over a six-month period

Introducción. Actualmente, en el tratamiento del deterioro cognitivo asociado a la enfermedad de Alzheimer (EA) se utilizan los inhibidores de la acetilcolinesterasa (iACh). Los efectos secundariosde estos fármacos se asocian al aumento de acetilcolina, lo que limita su efectividad, y se debe ajustar al paciente hasta la dosis máxima tolerada . Pacientes y métodos. Se realiza un estudio comparativoretrospectivo de la tolerancia y de los acontecimientos adversos (AA) de dos iACh en un grupo de pacientes con EA probable de gravedad mínima y leve durante un período de 6 meses. Resultados. La muestra la formaban 175 pacientes, de los cuales 134 iniciaron tratamiento con donepecilo en 5-10 mg/día y 41 con rivastigmina en 6-12 mg/día. El 20 por ciento de los pacientes presentaron AA y el 8 por ciento abandonó el tratamiento. Los trastornos gastrointestinales (TGI) fueron el principal AA observado (57,1 por ciento). El 6 por ciento de los pacientes tratados con donepecilo abandonaron el tratamiento a causa de los AA frente al 14,6 por ciento de los pacientes tratados con rivastigmina. Los pacientes tratados con rivastigmina presentaron una mayor incidencia de TGI y el riesgo relativo de presentar TGI fue 4,4 veces superior que en los pacientestratados con donepecilo. Conclusiones. Los TGI asociados al tratamiento con iACh son el principal motivo de abandono del tratamiento y se producen con mayor frecuencia en pacientes tratados con rivastigmina (AU)

Introduction. At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer’s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. Patients and methods. We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6-month period. Results. The sample was made up of 175 patients, of which 134 began therapy with 5-10 mg/day of donepezil and 41 with 6-12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. Conclusions. The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine (AU)

[Carer's burden and depressive symptoms in patients with Alzheimer s disease. State after twelve months]. / Carga del cuidador y síntomas depresivos en pacientes con enfermedad de Alzheimer. Evolución a los 12 meses.

OBJECTIVE: The objective of this study is to determine the effect of depressive symptoms of patients in the burden perceived by the carer, evaluate the course of this burden in relation to the disappearance, persistence or appearance of depressive symptoms after twelve months and find which factors are associated with a rise or fall in the carer s load after twelve months. PATIENTS AND METHODS: A prospective observational study for 12 months of a sample of 150 patients with the clinical diagnosis of probable Alzheimer s disease on the criteria of NINDCS ADDRA: The sociodemographic data of their carers were collected and tested on the following scales: CAMDEX, CAMCOG, NPI, RDRS 2 and Burden Interview (BI) initially and twelve months later. RESULTS: The existence of depression initially was associated with an increased burden (score of BI of 22.76 compared with 15.79), increased non cognitive symptoms (NPI score of 16.23 compared with 5.94) and greater functional disability (RDRS 2 score of 27.89 compared with 25.53). The burden increased in the group of patients whose depressive symptoms persisted and in those in whom they appeared after twelve months. CONCLUSION: The data suggest that depressive symptoms increase functional disability and are associated with an increase in non cognitive symptoms. At the same time the functional disability and non cognitive symptoms increase the carer's burden.

[The clinical incidence of frontal dementia]. / Incidencia clínica de la demencia frontal.

INTRODUCTION AND OBJECTIVES: Although the neuropathology of Pick s disease and the frontal lobe dementias has been well defined, the complexity of the clinical diagnosis makes epidemiological studies difficult. The objective of this study was to determine the annual clinical incidence of fronto temporal dementia. PATIENTS AND METHODS: A retrospective observational study was made of the diagnoses of all persons attended in UVAMID during the period 1999 2000. Clinical evaluation was standardized following a protocol of the UVAMID. This included a clinical history obtained by interviewing the patient and a reliable informant, general medical and neurological examination, neuropsychological examination and a battery of complementary tests. RESULTS: In clinical practice the incidence of the different types of dementia varies between 93/100,000 in Alzheimer type dementia and 14/100,000 in DFT f. When age groups are considered, there is a progressive increase in the incidence of DFT f with 12/100,000 in the age group 46 69 years and 57/100,000 in the group of 75 79 years. CONCLUSIONS: The results of this study show that cases of DFT f form 2.7% of the new cases occurring annually. The main limitation of this study is that since these patients were referred for consultation from primary care centres, they form a non representative clinically biased sample which limits extrapolation of the results.

Carga del cuidador y síntomas depresivos en pacientes con enfermedad de Alzheimer. Evolución a los 12 meses / Carer's burden and depressive symptoms in patients with Alzheimer's disease. State after twelve months

Objetivo. Determinar el efecto de la sintomatología depresiva de los pacientes en la carga percibida por el cuidador, valorar la evolución de la carga según la desaparición, persistencia y emergencia de los síntomas depresivos a los 12 meses y conocer qué factores se asocian con el aumento o disminución de la carga del cuidador a los 12 meses. Pacientes y métodos. Estudio prospectivo observable a 12 meses de una muestra de 150 pacientes con diagnóstico clínico de enfermedad de Alzheimer probable, según criterios NINDCS-ADDRA. Se recogieron los datos sociodemográficos del cuidador y se administraron las escalas siguientes: CAMDEX, CAMCOG, NPI, RDRS-2 y Burden Interview (BI), en el momento basal y a los 12 meses. Resultados. La presencia de depresión en el momento basal se asociaba a mayor carga (puntuación de BI de 22,76 frente a 15,79), a mayor aparición de sintomatología no cognitiva (puntuación de NPI de 16,23 frente a 5,94) y a mayor discapacidad funcional (puntuación RDRS-2 de 27,89 frente a 25,53). La carga aumenta en el grupo de pacientes en los que persistió la sintomatología depresiva y en aquellos en que emergió a los 12 meses. Conclusión. Los datos sugieren que los síntomas depresivos aumentan la discapacidad funcional y que se asocian a una mayor presencia de síntomas no cognitivos; a su vez, la discapacidad funcional y los síntomas no cognitivos aumentan la carga del cuidador (AU)

Incidencia clínica de la demencia frontal / The clinical incidence of frontal dementia

Introducción y objetivos. A pesar de que la neuropatología de la enfermedad de Pick y de las demencias del lóbulo frontal está bien definida, la complejidad del diagnóstico clínico dificulta los estudios epidemiológicos. El objetivo del presente trabajo es determinar la incidencia clínica anual de la demencia frontotemporal. Pacientes y métodos. Estudio restrospectivo observacional del diagnóstico de todos los sujetos que acudieron a la UVAMID entre los años 1999 y 2000. La valoración clínica se realizó de modo estandarizado siguiendo el protocolo de la UVAMID, que incluye la historia clínica realizada a través de una entrevista al paciente y a un informador fiable, un examen médico general y neurológico, una exploración neuropsicológica y un conjunto de pruebas complementarias. Resultados. La incidencia en la práctica clínica de los diversos tipos de demencia varía entre 93/100.000 para la demencia tipo Alzheimer y 14/ 100.000 para la DFT-f. Por grupos de edad, se observa un aumento progresivo de la incidencia de la DFT-f, 12/100.000 para el grupo de entre 46 y 69 años y 57/100.000 para el grupo de 75-79 años. Conclusiones. Los resultados del presente estudio señalan que los casos de DFT-f representaron el 2,7 por ciento del total de casos nuevos anuales. La principal limitación del presente trabajo es que los pacientes, al ser remitidos a consulta desde los centros de atención primaria, forman una muestra no representativa, clínicamente sesgada, que limita la extrapolación de los resultados (AU)

[Effectiveness of donepezil on several cognitive functions in patients with Alzheimer's disease over 12 months]. / Eficacia del donepezilo sobre diversas funciones cognitivas durante 12 meses en pacientes con enfermedad de Alzheimer.

OBJECTIVES: The efficacy of donepezil for the treatment of cognitive dysfuntion in Alzheimer's disease has been demonstrated. The objective [corrected] of this study was to evaluate the effectiveness of donepezil in different neuropsychological areas of mild or moderate AD patients over a period of twelve months compared with data from untreated patients (historical control). METHODS: This was an open-label study where 100 patients received donepezil 5mg or 10 mg/day for twelve months. Because the study was uncontrolled, data were compared with historical data from 81 patients who had not received anticholinesterase inhibitors. The CAMCOG neuropsychological battery was used in both groups at baseline and at month 12. RESULTS: A hundred patients (30% male and 70% female) were enrolled in the study receiving donepezil 5 or 10 mg/day (average age: 74.3 6.1 years). The historical control group consisted of 81 people (average age 72.9 6.5 years), 29.6% of whom were men. There were no significant differences with respect to age, sex and CAMCOG score at baseline. The differences within the groups were significant in the following neuropsychological areas: recent, remote and learning memory, attention, calculation and abstract verbal thinking. Differences in expressive language and learning memory between both groups were confirmed by the multivariative analysis of baseline. CONCLUSION: The rate of cognitive deterioration observed in mild to moderate AD patients receiving open-label donepezil treatment was less than expected if this cohort had not been treated. The cognitive beneficial effects observed during one year treatment with donepezil were mainly focused on memory and verbal expression.

Eficacia del donepezilo sobre diversas funciones cognitivas durante 12 meses en pacientes con enfermedad de Alzheimer / Effectiveness of donepezil on several cognitive functions in patients with Alzheiner's disease over 12 months

FUNDAMENTO Y OBJETIVO: El donepezilo ha demostrado su eficacia clínica en el tratamiento del deterioro cognitivo en pacientes con enfermedad de Alzheimer (EA). El presente estudio pretende comprobar el efecto a los 12 meses del donepezilo en diferentes áreas neuropsicológicas en un grupo de pacientes con enfermedad de Alzheimer de grado leve y moderado frente a un grupo control (muestra histórica). PACIENTES Y MÉTODO: Se trata de un estudio abierto en que 100 pacientes recibieron donepezilo en dosis de 5-10 mg/día, mientras que la muestra histórica no había sido tratada con ningún inhibidor de la acetilcolinesterasa. En ambos grupos se administró la batería neuropsicológica CAMCOG en el momento basal y a los 12 meses. RESULTADOS: El grupo con donepezilo estaba formado por 100 pacientes (edad media: 74,3 ñ 6,1 años), de los cuales el 30 por ciento eran varones, y el grupo control (muestra histórica) estaba formado por 81 pacientes (edad media: 72,9 ñ 6,5 años), con un 29,6 por ciento de varones. No existían diferencias significativas entre los dos grupos respecto a la edad, el sexo, la puntuación global del CAMCOG ni en el tiempo transcurrido entre las dos valoraciones. Las diferencias intragrupo en ambas evaluaciones fueron significativas en las siguientes áreas neuropsicológicas: memoria remota, reciente y de aprendizaje, atención, cálculo y razonamiento verbal abstracto. El análisis multivariante de la variación de puntuación basal respecto a los 12 meses entre ambos grupos confirma las diferencias en el lenguaje expresivo y la memoria de aprendizaje. CONCLUSIONES: Los pacientes con donepezilo presentan un deterioro cognitivo global al año de tratamiento significativamente menor al del grupo control. La eficacia clínica observada a lo largo del año se centró principalmente en las áreas de memoria de aprendizaje y lenguaje expresivo (AU)

[Burden and quality of life in carers of patients with Alzheimer type dementia]. / Carga y calidad de vida en cuidadores de pacientes con demencia tipo Alzheimer.

OBJECTIVE: To analyze the factors which affect the burden and quality of life in carers of patients with Alzheimer's disease. MATERIAL AND METHODS: From a sample of 234 carers of patients in the Unit for Assessment of Memory and Dementia with a diagnosis of probable Alzheimer's disease, according to the scale of National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA), and of minimal or slight severity, according to the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) criteria, we obtained sociodemographic variables and administered the following questionnaires: Neuropsychiatric Inventory (NPI), Rapid Disability Rating Scale (RDRS-2), Quality of Life Questionnaire (QLQ) and Burden Interview (BI). RESULTS: The sex of the carers, the hours of attention to the basic activities of daily life (BADL) and the Cambridge Cognitive Examination (CAMCOQ), Minimental State Examination (MMSE), QLQ, NPI and RDRS-2 scores were related to the BI score. Multiple regression accepted the scoring for NPI, RDRS-2 and QLQ in the model. The QLQ score was associated with male sex of the patient, the age of the carer, employment status, whether or not he lived with the patient, with the family relationship, the hours of attention to the BADL and the scores on CAMCOG, MMSE, RDRS-2, NPI and BI. The multiple regression model included the age of the carer, the BI score and the hours of attention to the BADL. CONCLUSION: The non-cognitive symptoms, functional disability and poor perception of quality of life are factors affecting the burden and age of the carer, the hours of attention to the BADL and the burden affecting quality of life.

Efectividad a los seis meses del donepecilo en el tratamientodel deterioro cognitivo en pacientes con demencia tipo Alzheimer / The effectiveness of six months of donepezil in the treatment of cognitive deterioration in patients with Alzheimer-type dementia

Introducción. Se comparan dos grupos de pacientes con deterioro cognitivo secundario a enfermedad de Alzheimer (EA) de gravedad mínima y ligera (criterios CAMDEX), uno tratado con donepecilo y otro sin este fármaco (muestra histórica) en un período de seis meses. Pacientes y métodos. En ambos grupos se administró la batería neuropsicológica CAMCOG en el momento basal y a los seis meses. Resultados. La muestra clínica que recibió tratamiento con donepecilo (5-10 mg/día) estaba formada por 91 pacientes (edad media: 75,25; desviación estándar: 6,01), de los cuales el 28,6 por ciento eran varones, y el grupo control que no recibió anticolinesterásicos (muestra histórica) estaba compuesto por 84 pacientes (edad media: 75,98; desviación estándar: 5,01) con un 29,8 por ciento de varones. No existían diferencias significativas en la edad, sexo, puntuación basal del CAMCOG, ni en el tiempo transcurrido entre las dos mediciones. La media de las diferencias entre el CAMCOG basal y a los seis meses en ambos grupos es estadísticamente significativa (-1,5275 ñ 7,8458 frente a -6,7143 ñ 6,1234; p< 0,001). El análisis multivariante de medidas repetidas corrobora estos hallazgos al encontrar diferencias significativas (p< 0,001) en los resultados del CAMCOG a los seis meses entre los dos grupos. Conclusión. El donepecilo se mostró eficaz en cuanto a que es capaz de retrasar el deterioro cognitivo a los seis meses en los pacientes con EA de intensidad mínima y ligera (AU)

[CAMDEX-R in the clinical evaluation of dementias]. / El CAMDEX-R en la evaluación clínica de las demencias.

CAMDEX has been very useful both for clinical use as epidemiological enquiries about dementia. However, the knowledge evolution about means that nowadays this schedule shows several shortcoming. A new version, CAMDEX-R, has adapted and introduced enough items to satisfy the actual requirements. The present article describes the changes and new contributions accomplished on the schedule.

[Integrated program of psychogeriatric care]. / Programa integral de atención psicogeriátrica.

INTRODUCTION: At the present time there is considerable controversy over the course to follow in attention to patients with psychogeriatric disorders. Rapid diagnosis and maintaining the patients in their homes are the basic objectives of the policy of sharing responsibility among those involved. DEVELOPMENT: We review the bibliography and suggest a form of attention based on experience acquired in the dementia evaluation unit of the Programme Vida als Anys of the Generalitat de Catalunya. The model described is based on making the diagnosis in the patient's home, giving support to the family and integrating the patient into a follow-up unit, with a person responsible for evaluating and resolving the needs of both patient and family as they arise. In order to carry out this programme, the attention must be given by multidiscliplinary units with the necessary resources.

Programa integral de atención psicogeriátrica / Integral programme of psychogeriatric healthcare

Introducción. Actualmente, existe una gran controversia sobre la política sanitaria a seguir en la asistencia de pacientes con trastornos psicogeriátricos. El diagnóstico rápido y la contención de los pacientes en el domicilio son los objetivos fundamentales dentro de una política de responsabilidad compartida entre diversos estamentos. Desarrollo. Se lleva a cabo una revisión de la bibliografía y se lanza una propuesta asistencial basada en la experiencia acumulada en la unidad de valoración de las demencias del Programa Vida als Anys de la Generalitat de Catalunya. El modelo expuesto se basa en la realización del diagnóstico a domicilio, apoyo a la familia e integración del paciente dentro de una unidad de seguimiento, con un responsable que valorará y dará soluciones a las necesidades puntuales del paciente y la familia a lo largo de la evolución de la enfermedad. Para que el programa pueda realizarse es preciso que la asistencia sea realizada por unidades multidisciplinarias y se disponga de los medios de soporte necesarios (AU)