[Cognitive impairment in very elderly patients: a retrospective study in a neurology service]. / Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurologia.

INTRODUCTION: A considerable proportion of very elderly patients with cognitive impairment are attended in the general neurology offices. There are few studies about the clinical characteristics of these patients. AIM: To describe the background and clinical features of very elderly patients who come to the general neurology clinic due to cognitive complaints or suspected cognitive impairment. PATIENTS AND METHODS: We retrospectively studied 336 patients (296 patients < 85 years vs. 40 patients >= 85 years of age) who had been mostly referred by primary care physicians. Cognitive performance was measured by the Mini-Mental State Examination and the overall (i.e., cognitive and functional) clinical situation was measured by the Clinical Dementia Rating scale. RESULTS: Older patients had more frequently cognitive impairment (mild cognitive impairment or dementia), both at the first visit and at the one-year follow-up visit (p < 0.0005). No differences were found in symptom duration (2.0 ± 2.1 vs. 1.5 ± 1.4 years), type of symptoms, or comorbidity. Alzheimer's disease was the most frequent etiological diagnosis in both age groups (82.4% vs. 75.0%; p > 0.05). CONCLUSIONS: Very elderly patients studied in the neurology office have a higher risk of presenting cognitive impairment, despite being comparable in terms of symptoms and time of evolution. These results could be explained from the hypotheses of brain reserve and combined brain pathology.

TITLE: Deterioro cognitivo en el paciente muy anciano: estudio retrospectivo en una consulta de neurologia.Introduccion. Una considerable proporcion de pacientes muy ancianos con deterioro cognitivo son atendidos en las consultas generales de neurologia, pero existen pocos estudios acerca de las caracteristicas clinicas de estos pacientes. Objetivo. Describir los antecedentes y rasgos clinicos de los pacientes muy ancianos que acuden a consulta general de neurologia por quejas o sospecha de deterioro cognitivo. Pacientes y metodos. Se estudio retrospectivamente a 336 pacientes (296 pacientes < 85 años frente a 40 pacientes >= 85 años) que habian sido remitidos en su mayoria desde la atencion primaria. El rendimiento cognitivo se midio mediante el test minimental de Folstein, y la situacion clinica global (cognitiva y funcional), mediante la escala de estadificacion clinica de la demencia. Resultados. Los pacientes de mas edad presentaban con mayor frecuencia deterioro cognitivo (alteracion cognitiva leve o demencia), tanto en la primera visita como en la visita de seguimiento al cabo de un año (p < 0,0005). No se encontraron diferencias en el tiempo desde el inicio de los sintomas (2,0 ± 2,1 frente a 1,5 ± 1,4 años), el tipo de sintomas ni la comorbilidad. La enfermedad de Alzheimer fue el diagnostico etiologico final mas frecuente en los dos grupos de edad (82,4% frente a 75%; p > 0,05). Conclusiones. Los pacientes muy ancianos estudiados en la consulta de neurologia presentan con mayor frecuencia deterioro cognitivo, a pesar de tener un tiempo de evolucion y una sintomatologia similares. Estos resultados podrian explicarse desde la hipotesis de la reserva cerebral y de la patologia cerebral combinada.

[Influence of depression on the initial diagnosis and the evolution of cognitive impairment]. / Influencia de la depresion en el diagnostico inicial y evolutivo del deterioro cognitivo.

INTRODUCTION: Depression and cognitive impairment maintain a close and complex relationship, which could be modified by pharmacological treatment. AIM: To analyze the influence of depression and antidepressive medication on the initial diagnosis and the evolution of cognitive impairment. PATIENTS AND METHODS: All the patients derived to a Neurology clinic due to complaints or suspicion of cognitive impairment, during a period of nine years, were studied. The influence of demographic and depression-related variables on initial cognitive diagnosis, cognitive-functional situation and 1-year evolution were analyzed. RESULTS: A total of 582 patients were included (mean age: 77.6 ± 7.0; 64.9% women). Frequency of current and past depression were, respectively, 25.4% and 17.2%. In addition, 20.6% of the patients were taking antidepressant medication and 31.2% were on anxiolytic/hypnotic treatment. One-year follow-up visit was available in 320 (59.8%) of patients. In the adjusted analysis, anxiolytic/hypnotic treatment was associated with a worse cognitive-functional situation in the initial visit, while past depression and presence of dystimia were associated with a favorable evolution (p < 0.05). CONCLUSIONS: Past or current depression are not associated with bad prognosis in patients derived to neurologist due to possible cognitive impairment.

TITLE: Influencia de la depresion en el diagnostico inicial y evolutivo del deterioro cognitivo.Introduccion. La depresion y el deterioro cognitivo mantienen una estrecha y compleja relacion, que podria verse alterada por el tratamiento antidepresivo. Objetivo. Analizar la influencia de la depresion y del tratamiento antidepresivo en el diagnostico cognitivo inicial y evolutivo de los pacientes remitidos a neurologia por quejas o sospecha de deterioro cognitivo. Pacientes y metodos. Se estudio a todos los pacientes remitidos a una consulta de neurologia por quejas o sospecha de deterioro cognitivo durante un periodo de nueve años. Se analizo la influencia de las variables demograficas y de las variables relacionadas con la depresion en el diagnostico cognitivo y en la situacion cognitivo-funcional inicial y tras un año de seguimiento. Resultados. Se incluyo a 582 pacientes (edad media: 77,6 ± 7 años; mujeres, 64,9%). La frecuencia de depresion actual o en el pasado era, respectivamente, del 25,4% y 17,2%. El 20,6% de los pacientes recibia tratamiento con farmacos antidepresivos y el 31,2% tomaba ansioliticos/hipnoticos. Se dispuso de seguimiento al cabo de un año en 320 pacientes (59,8%). En el analisis ajustado, el tratamiento ansiolitico/hipnotico se asocio a una peor situacion cognitiva y funcional inicial, mientras que la depresion en el pasado y la presencia de distimia en la visita inicial se asociaron a una evolucion favorable (p < 0,05). Conclusiones. La depresion pasada o actual no es un factor de mal pronostico en los pacientes remitidos al neurologo por posible deterioro cognitivo.

No hay razones científicas para jubilar al MMSE / There is no scientific basis for retiring the MMSE

No disponible

[Psychological and behavioural symptoms of dementia: prevention, diagnosis and treatment]. / Sintomas psicologicos y conductuales de la demencia: prevencion, diagnostico y tratamiento.

INTRODUCTION: The psychological and behavioural symptoms of dementia (BPSD) [corrected] give rise to personal suffering, are the cause of added deterioration and worsen the economic and social cost of dementias. AIM: To offer a systematic approach to the prevention, diagnosis and treatment of BPSD. [corrected]. DEVELOPMENT: The study adopts a global perspective that takes into account biological, psychological and social factors in an attempt to avoid both excessive medicalisation and a purely psychology-based attitude. Satisfying basic needs, treating medical and psychiatric comorbidity, the adaptation of the setting, and the specific pharmacological treatment of dementia, as well as offering patients and their caregivers the counselling and support they need, all contribute to prevent the onset of BPSD. [corrected]. The diagnosis of BPSD [corrected] is based on the patient's medical history and on observation. It is useful to identify a primary or destabilising BPSD [corrected] on which to deploy hypotheses and specific treatments based on modifying the environment, drugs, non-pharmacological therapies and continuous assessment. Any action taken must be integrated within a person-focused care plan aimed at accomplishing the patients' and their caregivers' welfare and quality of life. CONCLUSIONS: BPSD [corrected] are the result of biological, psychological and social factors. In the present scenario, in which there are no curative treatments in most cases of dementia, a systematic and multidisciplinary approach aimed at preventing and treating BPSD [corrected] is a highly cost-effective therapeutic opportunity in both personal and social terms.

Asistencia sanitaria en las demencias: satisfacción y necesidades del cuidador / Health care in dementia: satisfaction and needs of the caregiver

Introducción: La atención primaria (AP) y las consultas de neurología general (CN) asumen la principal carga en la asistencia sanitaria de los pacientes con demencia. Apenas se dispone de estudios acerca de la satisfacción del cuidador con estos ámbitos asistenciales. Métodos: Se diseñó y administró una encuesta a 75 cuidadores de pacientes con demencia que acudieron a revisión a una CN y que habían sido remitidos desde la AP. La encuesta incluía cuestiones relacionadas con los cuidados, la utilización de servicios y la satisfacción. Se recogieron, además, variables sociodemográficas y clínicas, se describieron los resultados de la encuesta y se realizó un análisis de correlaciones simples (r de Spearman) para explorar los factores asociados a la satisfacción. Resultados: Los cuidadores fueron mayoritariamente hijas/os (60%) o cónyuges (31%). El 73% eran mujeres. El servicio más utilizado fue la ayuda en el domicilio (36%), pero el 41% de los pacientes no disponía de ningún servicio. La satisfacción fue alta (84% bastante o muy satisfechos con la AP, 97% bastante o muy satisfechos con la CN, p<0,01). Un mayor número de años cuidando se asoció a una menor satisfacción con la AP (r=−0,37, p<0,005), mientras que la institucionalización se asoció a una menor satisfacción con la CN (r=-0,30, p<0,01). Conclusiones: En un contexto de escasez de recursos, la satisfacción de los cuidadores de pacientes con demencia respecto de la asistencia sanitaria fue alta, posiblemente debido a la motivación de los profesionales y a la actitud positiva de los cuidadores (AU)

Introduction: Primary care (PC) and general neurology clinics (NC) assume the leading role in the health care of patients with dementia. There are hardly any studies on the satisfaction of the caregiver at these settings of health care. Methods: A questionnaire was designed and distributed to 75 caregivers of patients with dementia who were reviewed in an NC and who had been referred from PC. The questionnaire included questions associated with the care, the use of services, and satisfaction. Sociodemographic and clinical variables were also collected. The results of the questionnaire are described and a simple correlation analysis (Spearman r) was performed to determine the factors associated with satisfaction.Results: The majority of carers were sons or daughters (60%) or spouses (31%), of which 73% were women. The service most used was home help (36%), but 41% of patients had no services available. Satisfaction was high (84% quite or very satisfied with PC, 97% quite or very satisfied with the NC, P < .01). A greater number of years giving care was associated with a lower satisfaction with PC ((r=−0.37, P<.005), while institutionalisation was associated with a lower satisfaction with the NC (r=−0.30, P<.01).Conclusions: In a context of a scarcity of resources, the satisfaction of the caregivers of patients with dementia, as regards health care, was high, possibly due to the motivation of the health professionals and the positive attitude of the caregivers themselves (AU)

[Health care in dementia: satisfaction and needs of the caregiver]. / Asistencia sanitaria en las demencias: satisfacción y necesidades del cuidador.

INTRODUCTION: Primary care (PC) and general neurology clinics (NC) assume the leading role in the health care of patients with dementia. There are hardly any studies on the satisfaction of the caregiver at these settings of health care. METHODS: A questionnaire was designed and distributed to 75 caregivers of patients with dementia who were reviewed in an NC and who had been referred from PC. The questionnaire included questions associated with the care, the use of services, and satisfaction. Sociodemographic and clinical variables were also collected. The results of the questionnaire are described and a simple correlation analysis (Spearman r) was performed to determine the factors associated with satisfaction. RESULTS: The majority of carers were sons or daughters (60%) or spouses (31%), of which 73% were women. The service most used was home help (36%), but 41% of patients had no services available. Satisfaction was high (84% quite or very satisfied with PC, 97% quite or very satisfied with the NC, P<.01). A greater number of years giving care was associated with a lower satisfaction with PC ((r=-0.37, P<.005), while institutionalisation was associated with a lower satisfaction with the NC (r=-0.30, P<.01). CONCLUSIONS: In a context of a scarcity of resources, the satisfaction of the caregivers of patients with dementia, as regards health care, was high, possibly due to the motivation of the health professionals and the positive attitude of the caregivers themselves.

[The NEDICES cohort of the elderly. Methodology and main neurological findings]. / La cohorte de ancianos NEDICES. Metodología y principales hallazgos neurológicos.

AIM: To summarise the methodological aspects and main findings of the NEDICES (Neurological Disorders in Central Spain) cohort study of the elderly population, with over 5000 participants. DEVELOPMENT: The article outlines the findings concerning the following chronic neurological diseases (CND): dementia, Parkinson's disease and Parkinsonisms, stroke and essential, or senile, tremor. The NEDICES study examined the health, mortality and a series of sociological aspects of the cohort that are not discussed here. The paper does describe, however, the objectives, methods, population and development, with the baseline (1994) and incidence (1997) cut-off points, and the main findings regarding the CND under study are discussed. CONCLUSIONS: The prevalence and incidence of the CND are comparable to those of other Spanish and European population-based studies, but with certain peculiarities, such as the fact that incidence of senile tremor is the highest of those reported in the literature and that this CND is associated with dementia. Over half the cases of Parkinson's disease were reported de novo with the study and Alzheimer's disease was associated with vascular risk factors.

La cohorte de ancianos NEDICES. Metodología y principales hallazgos neurológicos / The nedices cohort of the elderly methodology and main neurological findings

Resumir los aspectos metodológicos y principales hallazgos del estudio de cohorte poblacional de ancianosNEDICES (Neurological Disorders in Central Spain) integrada por más de 5.000 participantes. Desarrollo. Se sintetizan los hallazgos en enfermedades neurológicas crónicas (ENC): demencia, enfermedad de Parkinson y parkinsonismos, ictus y temblor senil. El estudio NEDICES investigó la salud, la mortalidad y los diversos aspectos sociológicos de la cohorte, que nose discuten. Sí se describen los objetivos, métodos, población y desarrollo con los cortes, basal (año 1994) y de incidencia (año 1997), y se comentan los principales hallazgos en las ENC investigadas. Conclusión. La prevalencia e incidencia de lasENC son análogas a las de otros estudios poblacionales españoles y europeos, aunque con peculiaridades: la incidencia de temblor senil es la más elevada de la bibliografía y esta ENC se asocia con demencia. Más de la mitad de los casos de enfermedad de Parkinson se describieron de novo con el estudio, y la enfermedad de Alzheimer se asoció con factores de riesgovasculares

To summarise the methodological aspects and main findings of the NEDICES (Neurological Disorders inCentral Spain) cohort study of the elderly population, with over 5000 participants. Development. The article outlines the findings concerning the following chronic neurological diseases (CND): dementia, Parkinson’s disease and Parkinsonisms, stroke and essential, or senile, tremor. The NEDICES study examined the health, mortality and a series of sociological aspectsof the cohort that are not discussed here. The paper does describe, however, the objectives, methods, population and development, with the baseline (1994) and incidence (1997) cut-off points, and the main findings regarding the CND under study are discussed. Conclusions. The prevalence and incidence of the CND are comparable to those of other Spanish andEuropean population-based studies, but with certain peculiarities, such as the fact that incidence of senile tremor is the highest of those reported in the literature and that this CND is associated with dementia. Over half the cases of Parkinson’sdisease were reported de novo with the study and Alzheimer’s disease was associated with vascular risk factors

[Changing the anticholinesterase in Alzheimer's disease]. / Cambio de anticolinesterásico en la enfermedad de Alzheimer.

AIM: To review the available information related to the switch of one cholinesterase inhibitor (CEI) by other CEI in Alzheimer's disease. DEVELOPMENT AND CONCLUSIONS: The distinct pharmacological profile of CEI supports the switch, which can be considered in three scenarios: poor tolerability, lack of efficacy at the beginning of the treatment and long-term loss of efficacy. A poor tolerability to one CEI predisposes to not tolerating a second CEI, but this is not so much when a washout period is kept. Under these circumstances, the switch can be performed if the adverse events are minor and do not represent a risk for the patient. Switching the CEI is also advisable in case of lack of efficacy at the beginning of treatment. In this situation, some observational studies have shown a response to rivastigmine in approximately half of patients who had not responded to donepezil. Switching in other directions is also reasonable, but has been less investigated. As for the third scenario, i.e. long-term loss of efficacy, there are not sufficient available data to indicate the switch. This practice should be kept for research purposes only.

Cambio de anticolinesterásico en la enfermedad de Alzheimer / Changing the anticholinesterase in alzheimer´s disease

Aim. To review the available information related to the switch of one cholinesterase inhibitor (CEI) by other CEI in Alzheimer’s disease. Development and conclusions. The distinct pharmacological profile of CEI supports the switch, which can be considered in three scenarios: poor tolerability, lack of efficacy at the beginning of the treatment and long-term loss of efficacy. A poor tolerability to one CEI predisposes to not tolerating a second CEI, but this is not so much when a washout period is kept. Under these circumstances, the switch can be performed if the adverse events are minor and do not represent a risk for the patient. Switching the CEI is also advisable in case of lack of efficacy at the beginning of treatment. In this situation, some observational studies have shown a response to rivastigmine in approximately half of patients who had not responded to donepezil. Switching in other directions is also reasonable, but has been less investigated. As for the third scenario, i.e. long-term loss of efficacy, there are not sufficient available data to indicate the switch. This practice should be kept for research purposes only (AU)

Objetivo. Revisar la información disponible en relación con el cambio de un inhibidor de la colinesterasa (ICE) por otro ICE en la enfermedad de Alzheimer. Desarrollo y conclusiones. El diferente perfil farmacológico de los ICE apoya el cambio, que puede plantearse en tres situaciones: mala tolerancia, falta de eficacia al inicio del tratamiento y pérdida de efecto a largo plazo. La mala tolerancia a un primer ICE predispone a no tolerar un segundo ICE, pero este riesgo disminuye si se realiza un período de ‘lavado’. En esta situación, el cambio está justificado en caso de efectos adversos menores, que no conlleven riesgo para el paciente. También es aconsejable el cambio de ICE ante la falta de eficacia al inicio del tratamiento. En esta situación, los estudios observacionales han demostrado una respuesta a la rivastigmina aproximadamente en la mitad de los pacientes que no respondieron al donepecilo. Cambios en otras direcciones también son razonables, pero han sido menos estudiados. En el tercer supuesto, la pérdida de efecto a largo plazo, no existen datos suficientes para aconsejar el cambio de ICE. Esta práctica debería reservarse para el ámbito de la investigación (AU)

[Donepezil therapy in patients with vascular and post-traumatic cognitive impairment: some clinical observations]. / Tratamiento con donepecilo en pacientes con deterioro cognitivo vascular y postraumático: observaciones clínicas.

INTRODUCTION: Donepezil is a procholinergic drug that slows down cognitive and functional impairment in patients with Alzheimer's disease. Little research has been carried out to study its effect in other types of neurobehavioural disorders. AIMS: The purpose of this study was to describe the response to donepezil therapy in patients with neurobehavioural disorders due to vascular and post-traumatic causes. CASE REPORTS: Donepezil was administered to four patients with mild cognitive impairment due to vascular causes, to two patients with vascular dementia and to two patients with post-traumatic dementia. Following an average time of four months, the effects exerted on the cognitive, functional and behavioural areas were evaluated. One patient did not tolerate the drug and another suffered an episode of congestive heart failure that gave rise to a moderate neurobehavioural exacerbation. Two patients underwent a moderate improvement, three patients showed a slight improvement and no changes were observed in one patient. In general, memory, attention, depression, apathy and psychotic traits tended to improve. Aggressiveness/irritability tended to get worse. The functional repercussions of these changes were negligible or inexistent. CONCLUSIONS: Treatment with donepezil improved cognition and conduct in patients with neurobehavioural disorders due to vascular or post-traumatic causes. These results will have to be confirmed and expanded by means of controlled studies, and research must continue into the characteristics of responding patients and the relevance of their responses.

Tratamiento con donepecilo en pacientes con deterioro cognitivo vascular y postraumático: observaciones clínicas / Donepezil therapy in patients with vascular and post-traumatic cognitive impairment: some clinical observations

Introducción. El donepecilo es un fármaco procolinérgico que atenúa el deterioro cognitivo y funcional en los pacientes con enfermedad de Alzheimer. Su efecto en otro tipo de trastornos neuroconductuales no se ha estudiado lo suficiente. Objetivo. Describir la respuesta al tratamiento con donepecilo en pacientes con alteraciones neuroconductuales de causa vascular y postraumática. Casos clínicos. Se pautó el donepecilo a cuatro pacientes con deterioro cognitivo ligero de causa vascular, a dos pacientes con demencia vascular y a dos pacientes con demencia postraumática. Tras un tiempo medio de cuatro meses, se evaluaron los efectos en las áreas cognitiva, funcional y conductual. Un paciente no toleró el fármaco y otro paciente desarrolló un episodio de insuficiencia cardíaca congestiva que provocó un empeoramiento neuroconductual moderado. Dos pacientes experimentaron una mejoría moderada, tres pacientes tuvieron una mejoría ligera y en un paciente no se observaron cambios. En general, se apreció una tendencia a la mejoría en la memoria, la atención, la depresión, la apatía y los rasgos psicóticos. La agresividad / irritabilidad tendió a empeorar. La repercusión funcional de estos cambios fue mínima o nula. Conclusiones. El tratamiento con donepecilo mejora la cognición y la conducta en pacientes con alteraciones neuroconductuales de causa vascular o postraumática. Se precisa confirmar y ampliar estos resultados mediante estudios controlados, así como seguir investigando en torno a las características de los pacientes respondedores, y a la relevancia de la respuesta (AU)

Introduction. Donepezil is a procholinergic drug that slows down cognitive and functional impairment in patients with Alzheimer’s disease. Little research has been carried out to study its effect in other types of neurobehavioural disorders. Aims. The purpose of this study was to describe the response to donepezil therapy in patients with neurobehavioural disorders due to vascular and post-traumatic causes. Case reports. Donepezil was administered to four patients with mild cognitive impairment due to vascular causes, to two patients with vascular dementia and to two patients with post-traumatic dementia. Following an average time of four months, the effects exerted on the cognitive, functional and behavioural areas were evaluated. One patient did not tolerate the drug and another suffered an episode of congestive heart failure that gave rise to a moderate neurobehavioural exacerbation. Two patients underwent a moderate improvement, three patients showed a slight improvement and no changes were observed in one patient. In general, memory, attention, depression, apathy and psychotic traits tended to improve. Aggressiveness/irritability tended to get worse. The functional repercussions of these changes were negligible or inexistent. Conclusions. Treatment with donepezil improved cognition and conduct in patients with neurobehavioural disorders due to vascular or post-traumatic causes. These results will have to be confirmed and expanded by means of controlled studies, and research must continue into the characteristics of responding patients and the relevance of their responses (AU)

[The advantages of a programme for training carers of persons with dementia: a pilot study by specialised nurses]. / Beneficios de un programa de formación del cuidador en la demencia: experiencia piloto desde la enfermería especializada.

INTRODUCTION: The care of patients with dementia usually has to be undertaken by persons with no formal training. However, the chances of treatment being effective depends on them. Specialist non hospital nurses, who are accessible and close to these patients, are in a privileged position to develop programmes to train carers. In our country no studies have been done to evaluate the efficacy of such programmes. OBJECTIVES: To evaluate the efficacy of a programme for training carers of patients with irreversible dementia. The programme was designed and carried out by specialist nurses, based on a neurology clinic outside the hospital. PATIENTS AND METHODS: Ten carers who came consecutively to the clinic were invited to participate in the programme. Before and after the programme we evaluated cognitive, functional behaviour and affective aspects of the patient and/or carer. RESULTS: As far as the patient was concerned no changes were found in either cognitive or functional aspects. Although the behaviour problems were reduced, they caused less stress to the carer after the training sessions. At the same time the affectivity of the patients improved. CONCLUSIONS: It is possible to carry out effective training programmes for carers of demented patients, with relatively little expense. Affectivity, both of the patient and the carer is the aspect most improved by this training. Large scale trials are necessary to show improvement of other aspects, and to compare different types of training programmes.

Apoyo a los cuidadores de pacientes con enfermedad de Alzheimer: un programa desde la enfermería de atención especializada / Support for the carers of patients with Alzheimer’s disease

No disponible

No disponible

Beneficios de un programa de formación del cuidador en la demencia: experiencia piloto desde la enfermería especializada / The advantages of a programme for training carers of persons with dementia: a pilot study by specialised nurses

Introducción. El cuidado de los pacientes con demencia recae en la mayoría de los casos en personas que no han recibido una preparación formal. Ellos son, sin embargo, la garantía para que cualquier intervención terapéutica resulte eficaz. La enfermería especializada extrahospitalaria, por su cercanía y accesibilidad, ocupa una posición privilegiada para desarrollar programas de formación dirigidos a cuidadores. En este ámbito, no existen en nuestro país experiencias cuya eficacia haya sido evaluada. Objetivo. Valorar la eficacia de un programa de formación del cuidador en pacientes con demencia irreversible. Programa diseñado y ejecutado por personal de enfermería especializado, y realizado desde una consulta de neurología extrahospitalaria. Pacientes y métodos. Se ofreció el programa a 10 cuidadores que acudieron de forma consecutiva a la consulta. Se valoraron, antes y después de la intervención, aspectos cognitivos, funcionales, conductuales y afectivos, en el paciente y/o en el cuidador. Resultados. Respecto al paciente no se apreciaron cambios en la esfera cognitiva ni en la funcional. Aunque los problemas de conducta no disminuyeron, éstos generaban menos estrés en el cuidador después de la intervención. Asimismo se observó una mejoría en la afectividad de los pacientes. Conclusiones. Es posible llevar a cabo programas eficaces de formación del cuidador en la demencia, con relativa economía de medios. La afectividad, tanto del paciente como del cuidador, es el área más sensible a este tipo de intervenciones. Es preciso realizar experiencias a mayor escala, con el fin de demostrar beneficios a otros niveles, y de comparar distintos tipos de intervenciones (AU)