Treatment of Alzheimer's Disease in the New Era of Monoclonal Antibodies Against Cerebral Amyloid-ß: Pharmacological Prescription and Knowledge in Argentina.

Background: Alzheimer's disease (AD) presents a significant global health challenge. Understanding the current and upcoming treatment landscape is crucial for effectively managing patients. Objective: The aim of this study was to assess the pattern of prescription and knowledge about new therapies by physicians who treat AD patients in Argentina. Methods: A cross- sectional and analytic study was conducted. A survey was elaborated about pharmacological treatment in AD. Statistical analysis of answers of specialists in cognitive disorders (SCD), non-specialists in cognitive disorders (NSCD), recommended treatment, non-recommended treatment (NRT), and off-label treatment was performed. Results: 155 physicians answered the survey. A 19.35%prescribed at least one NRT for dementia. 78.06%prescribed at least an off-label treatment or an NRT for mild cognitive impairment (MCI). 31%would prescribe monoclonal antibodies (MABs) against cerebral amyloid-ß (Aß) to AD patients, and 42.6%responded that they were not aware of any adverse effect of these. Quetiapine was the most frequent treatment for psychotic symptoms (88.4%) and escitalopram (32.3%) for apathy. A 70%of potential prescribers of MABs (n = 100) would request biomarkers of cerebral Aß in the initial assessment. There were significant differences between the responses of SCD and NSCD regarding the prescription of MABs (52.17%versus 23.08, respectively) and knowledge about adverse events (76.09%versus 38.46%, respectively). Conclusions: A considerable percentage of physicians indicated NRT and off-label medication in MCI and dementia. In Argentina, there are many physicians who would indicate a MABs for AD, but many are not completely aware of its safety profile.

[Spanish Norms for Mini-SEA (Mini Social Cognition and Emotional Assessment) in adults in Buenos Aires]. / Baremos en español del Mini-SEA (Mini Social Cognition and Emotional Assessment) en adultos normales de Buenos Aires.

INTRODUCTION AND OBJECTIVE: The Mini-SEA is a quick and brief cognitive assessment test developed to study social cognition. It consists of a modified version of the faux pas Test and an emotional recognition test based on Ekman's faces. The objective of this work was to obtain the first Spanish Speaking norms for the Mini-SEA test. MATERIAL AND METHODS: 64 healthy volunteers, between 35 and 80 years old, were recruited and evaluated with the Mini-SEA by specialized neuropsychologists from the Cities of Buenos Aires and La Plata, both in the Province of Buenos Aires, Argentina. RESULTS: The total mean (M) of the Mini-SEA was 25 +/- 4. The M of the faux pas Score was 12.5 +/- 2.4 and the M of the Emotional Recognition Score was 12.8 +/- 1.5. The sample was divided into 4 age groups: Group 1 (<50 years), Group 2 (50-59 years), Group 3 (60-69 years) and Group 4 (more than 70 years). Differences were found in the age continuum in the Emotional Recognition score between group 1 and 4 (p <0.05) and between group 3 and 4 (p <0.01), but not in the Faux Pas Score. CONCLUSION: This study presents the first normative values of the Mini-SEA Social Cognition test for a Spanish-speaking population. The Mini-SEA, being a quick and easy to administer test, allows the study of social cognition in an adequate and precise way, especially in prodromal stages of neurodegenerative diseases.

What is happening with not recommended drugs for dementia in Argentina? Prescription patterns and direct costs analysis.

OBJECTIVES: The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP. MATERIALS: This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages. RESULTS: A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD. CONCLUSION: Inappropriate drug use increases health costs in developing countries. We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias.

[Practice recommendations for the detection and diagnosis of patients with Alzheimer's disease dementia in the City of Buenos Aires]. / Recomendaciones para la detección y diagnóstico de pacientes con demencia debida a Enfermedad de Alzheimer en la Ciudad de Buenos Aires.

Alzheimer's disease is the most frequent cause of cognitive disorders and dementia in older adults and is considered a new epi- demic. Due to its different cognitive, behavioral and functional manifestations, the detection, and diagnosis of patients with Alzheimer's Disease Dementia can represent a challenge. In this Clinical Practice Recommendation, management are given with levels based on the best scientific evidence available. Likewise, indications for study, or referral to a higher level of sanitary assistance are presented, according to the complexity of each clinical case. In this way, a set of practical recommendations of support is provided for decision making by health professionals at each sanitary level, from primary care to medical specialists. Through an operational and dynamic approach, this recommendations propose a global strategy based on evidence for patients, family members and health agents involved in this pathology, of great social relevance.

[Review of recommendations and new diagnosis criteria for mild cognitive impairment due to Alzheimer's disease]. / Revisión de los nuevos criterios y recomendaciones para el diagnóstico de Deterioro Cognitivo Leve debido a Enfermedad de Alzheimer.

The symptomatic predementia phase of Alzheimer's disease (AD), known as mild cognitive impairment (MCI) is a clinical and neuropsychological condition which defines the transitional state between normal aging and dementia, and is used as a clinical description of people at risk of developing AD. A review of the diagnostic criteria of MCI due to Alzheimer's disease was recently published by the Alzheimer's Association and the National Institute on Aging of the U.S. in order to ensure early diagnosis of the disease, useful for both clinical practice and clinical trials. The objectives of this paper are to review and analyze the revised diagnostic criteria for MCI due to Alzheimer's disease recently proposed, to compare with criteria for MCI available and to establish current strengths and limitations of the new proposal in clinical practice. The new diagnostic criteria for MCI due to AD have a radical importance since they are potentially applicable in the clinical or research protocols and in all clinical settings where such markers are available. They provide a useful, consistent and valuable tool to homogenize the subgroup of patients with MCI who already has AD in a predementia phase with inexorable progression to dementia by AD over the years.

Role of cognitive reserve in progression from mild cognitive Impairment to dementia / Papel da reserva cognitiva na progressão de comprometimento cognitivo leve para demência

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. Objetivos: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. Métodos: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1 anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). Resultados: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). Conclusões: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Role of cognitive reserve in progression from mild cognitive impairment to dementia.

Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. OBJECTIVES: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. METHODS: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). RESULTS: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). CONCLUSIONS: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. OBJETIVOS: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. MÉTODOS: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). RESULTADOS: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). CONCLUSÕES: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Mild behavioral impairment and risk of dementia: a prospective cohort study of 358 patients.

BACKGROUND: Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia, at least for some patients. Behavioral symptoms in MCI are associated with a higher risk of dementia, but their association with dementia risk in patients without MCI is unknown. Mild behavioral impairment (MBI) refers to a late-life syndrome with prominent psychiatric and related behavioral symptoms in the absence of prominent cognitive symptoms that may also be a dementia prodrome. This study sought to compare MCI and MBI patients and to estimate the risk of dementia development in these 2 groups. METHOD: Between January 2001 and January 2006, a consecutive series of 358 elderly (>or= 65 years old) patients (239 with MCI and 119 with MBI) presenting to an outpatient general hospital specialty clinic were followed for up to 5 years until conversion to dementia or censoring. RESULTS: Thirty-four percent of MCI patients and over 70% of patients with MBI developed dementia (log-rank p = .011). MBI patients without cognitive symptoms were more likely to develop dementia (log-rank p < .001). MBI patients were more likely to develop frontotemporal dementia (FTD) than dementia of the Alzheimer's type (DAT). CONCLUSION: MBI appears to be a transitional state between normal aging and dementia. MBI (specifically in those without cognitive symptoms) may confer a higher risk for dementia than MCI, and it is very likely an FTD prodrome in many cases. These findings have implications for the early detection, prevention, and treatment of patients with dementia in late life, by focusing the attention of researchers on the emergence of new behavioral symptoms.

[Cognitive performance in schizophrenia (paranoid vs residual subtype)]. / Estudio de los rendimientos cognitivos en pacientes esquizofrénicos (forma paranoide vs residual).

INTRODUCTION: Several studies refer to the relationship between schizophrenia and cognitive dysfunctions. The most frequent disturbances accepted are the deficits in the executive, memory and verbal tests. However, there are few comparative data about the cognitive functioning of the different subtypes of schizophrenia. OBJECTIVE: Analyze and compare the neuropsychological disturbances present in patients with paranoid and residual schizophrenia. MATERIALS AND METHOD: Eleven patients with paranoid schizophrenia, eleven patients with residual schizophrenia (DSM-IV criteria), and thirty one normal subjects matched by age, educational level, and general cognitive level (Mini Mental State Examination (Folstein, 1975), were assessed with a semistructured psychiatric examination and an extensive neuropsychological battery. RESULTS: Significant differences were found in memory, language, and executive functions when schizophrenics were compared with normal subjects. Differences in similarities were found between paranoid and residual schizophrenics. Residual schizophrenics had more disturbances in neuropsychological tests in comparison with paranoid schizophrenics. CONCLUSION: Schizophrenics demonstrated disturbances in memory, language, executive functions and attention. Residual schizophrenics had more impairment in neuropsychological tests than paranoid schizophrenics.

Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-type dementia in Argentina.

BACKGROUND: There is no previous information about economic costs of Alzheimer's disease (AD) in South America. The objective of this study was to evaluate the costs of AD in Argentina. METHODS: Eighty community-dwelling patients, 20 institutionalized AD patients and their respective primary caregivers, and 25 healthy elderly subjects participated in this study. The cognitive and neuropsychiatric impairments and severity of dementia were assessed with the Mini-mental State Examination, Neuropsychiatric Inventory and Clinical Dementia Rating, respectively. A structured interview about health and health-care resources used during the past 3 months was administered to family caregivers. The time devoted by carers to looking after the patients and the caregiver burden (Zarit's Burden Interview) were recorded. RESULTS: The annual direct costs of the disease increased with cognitive deterioration from US$3420.40 in mild to US$9657.60 in severe AD, and with institutionalization (US$3189.20 outpatient vs. US$14,447.68 institutionalized). Most direct costs were paid for by the family. CONCLUSIONS: With the projected increase in the number of persons at risk for developing AD in emerging countries, the family cost of the disease will be significant. Dementia costs should be a matter of analysis when health policies are being designed in developing countries.

Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease.

AIMS: Patients with Alzheimer's disease need assistance and supervision of their daily activities. They survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient's death. The present study addressed the predictive value of behavior-related burden on Alzheimer's disease caregivers. PARTICIPANTS: 82 patients with probable Alzheimer's (73.7 +/- 8.1 years), and their primary caregivers (59.6 +/- 14.8 years, 81.5% women), were assessed. METHODS: Cognitive impairment, neuropsychiatric symptoms, and dementia severity were assessed with Mini Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR), respectively. Caregivers were given Zarit's Burden Interview and Carer Activity Inventory. RESULTS: Neuropsychiatric symptoms like delusions, hallucinations, restlessness, anxiety, euphoria, disinhibition, unusual motor behavior, sleep disturbances, and appetite alterations were the best caregiver burden predictors (NPI r = 0.482, p < 0.001). No correlation with cognition, disease stage, or negative neuropsychiatric symptoms (depression and apathy) was found. CONCLUSION: Increased caregiver burden was related to increased levels of patient behavioral disturbance. Of these symptoms, hallucinations, unusual (motor) behavior, and abnormal behavior at nighttime were the most significant. No correlation with neuropsychiatric symptoms such as apathy and depression was found. This may have relevance to appropriate interventions for caregivers.