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.

[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.

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

Objetivo. Análisis descriptivo de la actividad ambulatoria en un servicio de neurología en relación con la frecuenciay tipo de enfermedades neurológicas atendidas. Pacientes y métodos. Estudio retrospectivo y trasversal de los pacientesremitidos a la consulta ambulatoria de neurología. Se registraron consecutivamente los casos visitados por primera vez durantelos años 2006 y 2007. Se evaluó la documentación médica a partir de los registros hospitalarios informatizados, recogiéndose:zona de salud de referencia, fecha de visita, edad, sexo y diagnóstico según la Clasificación Internacional de Enfermedades,9.ª edición, modificación clínica (CIE-9-MC), reconvertida a la Clasificación Internacional de Enfermedades, 10.ªedición (CIE-10). Resultados. La media de edad fue de 60,6 ± 20,9 años (rango: 4-95 años) y el 61,4% fueron mujeres. El índicede frecuentación fue de 4,3 solicitudes/1.000 habitantes para el año 2006 y de 3,9 para el año 2007, y se observó unincremento con la edad para las enfermedades neurodegenerativas. Respecto a la CIE-10, las enfermedades se clasificaroncomo episódicas y paroxísticas (25%), degenerativas y desmielinizantes (18,6%), trastornos mentales orgánicos (14,7%), síndromesextrapiramidales (10,5%), enfermedades de la circulación cerebral (3,5%), trastornos relacionados con el estrés y somatomorfos(3,5%) y enfermedades del oído interno (3,3%). Las demás patologías no alcanzaron el 3%. El 61% de los pacientespresentó enfermedades del sistema nervioso central y el 20,3%, trastornos psiquiátricos. Las enfermedades más frecuentesfueron los trastornos cognitivos (31,5%), las cefaleas (18,6%) y los trastornos del movimiento (11,7%), seguidas delas enfermedades psiquiátricas, epilepsias, enfermedades cerebrovasculares y neuropatías(AU)

Aim. To perform a descriptive analysis of the outpatient activity in a neurological department in terms of thefrequency 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 computerisedhospital 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 InternationalClassification 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 year2007; 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 mostcommon diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies(AU)

Síndrome de Klüver-Bucy por lesión frontal / No disponible

No disponible

[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

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

Introducción. Se trata de conocer aspectos sociodemográficos,cognitivos, funcionales y factores de riesgo quepermitan diferenciar las demencias según la edad de inicio.Métodos. Estudio transversal y analítico a partir de los670 casos que forman el estudio piloto del Registro Hospitalariode Demencias de Girona. Los casos fueron registradosde forma consecutiva y estandarizada durante el bienio2004-2005.Resultados. El 10,31% (n=69) de los pacientes que formaronparte del registro manifestaron los primeros síntomasde demencia antes de los 66 años. La distribución de losdiagnósticos de demencia fue diferente según la edad deinicio, con una mayor frecuencia de demencia frontotemporalen el grupo de demencias de inicio precoz. Los pacientescon alguna demencia de inicio precoz presentaron menordeterioro cognitivo y funcional y mayor número dealteraciones conductuales en el momento del diagnósticoque los casos tardíos. También mostraron un mayor númerode antecedentes familiares de síndrome de Down y personalesde depresión. No se observaron diferencias en los factoresde riesgo vascular entre ambos grupos.Conclusiones. Las demencias de inicio precoz muestrandiferencias clínicas, diagnósticas y de factores de riesgo conrespecto a las que se inician más tardíamente. Los registrosson una herramienta útil para estudiar características debaja prevalencia en el contexto de las enfermedades que inducenun proceso de demencia (AU)

Introduction. To know cognitive, functional and sociodemographicalfeatures as risk factors in order to differentiatedementias based on onset age of illness.Methods. Cross-sectional and analytical study basedon 670 cases of a pilot program for dementia from theGerona Hospital Registry for dementias. The cases werestandardized and registered consecutively during the2004-2005 biennium.Results. A total of 10.3% (n= 69) of patients whowere included in the registry showed the first symptomsof dementia before they were 66 years old. The distributionof the dementia diagnoses differed according to ageat onset of illness, with greater frequency of frontotemporaldementia in the early-onset dementia group. Patientswith early-onset dementia showed less functionaland cognitive impairment than patients with late-onsetdementia. They also had more behavioral and psychologicaldisorders than the late onset cases as well as a greaternumber of family backgrounds of Down’s syndromeand personal background of depression. No vascular riskfactors differences between late-and-early-onset dementiaswere found.Conclusions. Early-onset dementias showed differentclinical manifestations, risk factors and diagnosticdistributions versus the later onset ones. The registryprogram for dementia is a useful tool to study low prevalencecharacteristics of diseases leading to the dementiacondition (AU)

[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.

Mortalidad en pacientes con enfermedad de Alzheimer tratados con neurolépticos atípicos / Mortality rates in patients with alzheimer’s disease treated with atypical neuroleptic drugs

Valorar la influencia del síndrome metabólico (SM) y de los antecedentes de enfermedad cardíaca en elincremento de la mortalidad en pacientes con enfermedad de Alzheimer (EA) tratados con inhibidores de la colinesterasa o memantina y que durante el tiempo en estudio hayan recibido tratamiento con risperidona u olanzapina. Pacientes y métodos.751 pacientes diagnosticados de EA y tratados con fármacos antidemencia. Un 10,2% (n = 77) y un 7,7% (n = 58) habían recibido tratamiento con risperidona y olanzapina, respectivamente, en algún momento del seguimiento. Doce (1,6%) habían recibido ambas sustancias en diferentes períodos. Resultados. El tiempo medio de seguimiento es de 27,52 ± 12,15 meses. Lamortalidad se sitúa en el 14% (n = 105). La dosis máxima media de olanzapina fue de 4,3 mg/día (desviación estándar, DE = 2,55; rango = 2,5-15) y de 1,36 mg/día (DE = 0,67; rango = 0,25-3,5) para la risperidona. La duración del tratamiento fue, respectivamente, de 519,12 (DE = 285,2; rango = 90-1.045) y 481,68 (DE = 345,22; rango = 1-1.650) días. Incluyendo en elmodelo la edad, el sexo, los trastornos de conducta de la escala Blessed, el índice acumulativo de enfermedad-corazón y la escala de deterioro global, tanto la olanzapina (razón de riesgo, RR = 8,95; intervalo de confianza, IC, 95% = 2,856-28,046) como la risperidona (RR = 4,526; IC 95% = 1,816-11,281) incrementan el riesgo de muerte. Se registra una interacción entre antecedentes de enfermedad cardíaca y risperidona, lo que sugiere un efecto diferencial en la supervivencia del fármaco en este grupo. No se evidencia ninguna interacción entre los dos fármacos y el SM. Conclusiones. Ni la presencia de trastornoscardíacos ni el SM permiten explicar el incremento de mortalidad en pacientes con demencia tratados con olanzapina o risperidona

To evaluate the influence of metabolic syndrome (MS) and a history of heart disease on increased mortalityrates 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) and7.7% (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.

Síndrome metabólico en la enfermedad de Alzheimer: influencias clínicas y evolutivas / Metabolic syndrome in alzheimer’s disease: clinical and developmental influences

El síndrome metabólico (SM) comporta un incremento del riesgo para desarrollar la enfermedad deAlzheimer (EA), pero se desconocen las implicaciones que comporta su presencia cuando la enfermedad ya está establecida.Objetivo. Valorar la influencia del SM en las manifestaciones clínicas y sus efectos sobre la mortalidad en pacientes con EA tratadoscon fármacos contra el Alzheimer. Pacientes y métodos. Estudio de cohorte retrospectivo con 751 pacientes ambulatorios de un servicio de demencias que fueron diagnosticados de EA y a los que se les prescribió inhibidores de la colinesterasa y/o memantina.Se efectúa una recogida estandarizada de los datos de la historia clínica de los pacientes. Resultados. El tiempo medio de seguimiento es de 27,52 ± 12,15 meses. La frecuencia del SM es del 24,6% (n = 185). La mortalidad durante el período de estudio fue del 14,0% (n = 105). Los pacientes con SM son más jóvenes, presentan un menor deterioro cognitivo y funcional, una mayor comorbilidad orgánica a expensas de enfermedades cardíacas, consumen más fármacos y reciben con menor frecuenciaantipsicóticos atípicos a expensas sobre todo de la olanzapina. Incluyendo en el modelo la edad, el sexo, las subescalas de actividades básicas de la vida diaria y trastornos de la conducta de la escala de Blessed (BDRS), el índice acumulativo de enfermedad(CIRS)-corazón y el test minimental de Folstein (MMSE), el SM no incrementa el riesgo de mortalidad. Conclusiones.Los pacientes con SM son diagnosticados de EA en una edad más joven a pesar de un menor deterioro cognitivo y funcional. El SM no comporta un incremento de la mortalidad de los pacientes con EA

Metabolic syndrome (MS) results in an increased risk of developing Alzheimer’s disease (AD), but itsimplications 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 hadbeen 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 degreesof 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

[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.

Heterogeneidad clínica de la enfermedad de Alzheimer según la edad de inicio / Clinical heterogeneity of Alzheimer´s disease according to the age of onset

Introducción. La edad de inicio de la enfermedad de Alzheimer (EA) se ha asociado con la heterogeneidad clínica. Hay estudios que han planteado la posibilidad de que las formas preseniles y las seniles sean entidades distintas. Objetivo. Describir las características clínicas y evolutivas de pacientes con EA según la edad de inicio. Pacientes y métodos. Una muestra clínica de pacientes con EA fue valorada mediante el protocolo del Cambridge Examination for Mental Disorders of the Elderly y otros tests y escalas clínicas (Trail Making Test, Neuropsychiatric Inventory, Rapid-Disabity Rating Scale-2 y Zarit Burden Interview). Los pacientes fueron revalorados a los 12 meses. Resultados. De los 492 participantes, 419 (85,2%) fueron casos de EA de inicio tardío y 73 casos (14,8%) de EA de inicio precoz. Para este último grupo, el tiempo transcurrido entre el inicio de los primeros síntomas y el diagnóstico de la enfermedad fue superior (3,85 frente a 2,5 años), y se observó una mayor frecuencia de antecedentes familiares de demencia (35,6%) y personales de trastorno psiquiátrico (13,7%). Este grupo también presentó mejores rendimientos en las escalas de valoración funcional y en las pruebas neuropsicológicas, y mayor frecuencia y gravedad de la sintomatología depresiva. A los 12 meses no se registraron diferencias clínicas entre ambos grupos, a excepción de un incremento de la frecuencia y gravedad de la apatía. Conclusión. Las diferencias halladas entre la EA de inicio precoz y la de inicio tardío no permiten considerarlas como dos entidades diferentes desde el punto de vista clínico y/o neuropsicológico

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 lateonset 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

[The feasibility of a registry of dementias: clinical features and diagnostic coverage]. / Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica.

INTRODUCTION AND AIM: Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. MATERIALS AND METHODS: Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. RESULTS: 670 new cases of dementia, of which 74% corresponded to Alzheimer's disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative's home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit's reference territorial area. The diagnostic coverage for the health region of Girona was 38%. CONCLUSIONS: The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona.

Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica / The fiability of a registry of dementias: clinical features and diagnostic coverage

Introducción y objetivo. Los estudios epidemiológicos clásicos no permiten conocer la realidad de los patrones de derivación y diagnóstico de demencia en la práctica clínica habitual de un territorio definido. Esta información es fundamental para la planificación y distribución de los recursos sanitarios y sociales a medio y largo plazo. Se presentan los resultados de un programa piloto de registro de casos de demencia basado en los fundamentos de la vigilancia epidemiológica. Materiales y métodos. Registro consecutivo y estandarizado de los diagnósticos incidentes de demencia de una unidad especializada durante el bienio 2004-2005. Resultados. Se registraron 670 nuevos casos de demencia, de los cuales el 74% correspondió a la enfermedad de Alzheimer. Las demencias preseniles representaron el 10,3% de los casos. El tiempo medio entre el inicio de los síntomas y el diagnóstico clínico fue de 2,4 años y la gravedad de la demencia fue leve en el 60%. El 90,1% de los casos residía en su domicilio o en el de un familiar. La hipertensión arterial, la diabetes mellitus y los antecedentes de trastorno depresivo fueron los antecedentes patológicos más frecuentes (> 20%). La cobertura diagnóstica sobre la base de los casos de demencia esperados para el área de referencia de la unidad especializada fue del 75% y para el conjunto de las comarcas de Girona fue del 38%. Conclusiones. Los datos registrados muestran la viabilidad y validez del sistema de registro de casos propuesto y su capacidad actual para ampliar la cobertura del registro a la región sanitaria de Girona

Introduction and aim. Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. Materials and methods. Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. Results. 670 new cases of dementia, of which 74% corresponded to Alzheimer’s disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative’s home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit’s reference territorial area. The diagnostic coverage for the health region of Girona was 38%. Conclusions. The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona

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.