[Depressive symptoms and burden in family caregivers in Alzheimer's disease: a model of structural equations]. / Sintomas depresivos y sobrecarga en los familiares cuidadores en la enfermedad de Alzheimer: un modelo de ecuaciones estructurales.

INTRODUCTION: The care of patients with Alzheimer's disease increases the burden and depression of the main caregiver, although the relationship between the two is not clearly defined. AIMS: To explore the factors associated with depressive symptomatology and burden in the main caregiver and to apply a model of structural equations to identify the relationship between them. SUBJECTS AND METHODS: The sample consisted of 127 family caregivers of people with Alzheimer's disease, with a follow-up of 24 months. Multivariate regression analyses were performed to identify the characteristics of patients and caregivers associated with burden and depression of the main caregiver, and a model of structural equations was designed to analyse the relationship between the variables. RESULTS: In the model of structural equations, the burden had a direct effect on depression, both in the baseline assessment and at 24 months. The variables associated with burden were: schooling and the lower mental health of the main caregiver; and the behavioral alterations and the functional dependency of the patient. The lower cognitive level of the patient and the lower mental health of the main caregiver were associated with depression. The correlation between burden and depression increased from baseline to two years (r = 0.470 vs. r = 0.613). CONCLUSIONS: The deterioration of the patient and caregiver burden are risk factors for depression in the main caregiver. Interventions would be necessary to reduce the burden and prevent related depression.

TITLE: Sintomas depresivos y sobrecarga en los familiares cuidadores en la enfermedad de Alzheimer: un modelo de ecuaciones estructurales.Introduccion. El cuidado de los pacientes con enfermedad de Alzheimer incrementa la sobrecarga y la depresion del cuidador principal, aunque la relacion entre ambas no esta claramente definida. Objetivos. Explorar los factores asociados a la sintomatologia depresiva y la sobrecarga en el cuidador principal y aplicar un modelo de ecuaciones estructurales para identificar la relacion entre ellas. Sujetos y metodos. La muestra estuvo formada por 127 cuidadores familiares de personas con enfermedad de Alzheimer, con un seguimiento de 24 meses. Se realizaron analisis de regresion multivariante para identificar las caracteristicas de pacientes y cuidadores asociadas a la sobrecarga y la depresion del cuidador principal, y se diseño un modelo de ecuaciones estructurales para analizar la relacion entre las variables. Resultados. En el modelo de ecuaciones estructurales, la sobrecarga tuvo un efecto directo sobre la depresion, tanto en la evaluacion basal como a los 24 meses. Las variables asociadas a la sobrecarga fueron: la escolaridad y la menor salud mental del cuidador principal, y las alteraciones conductuales y la dependencia funcional del paciente. El menor nivel cognitivo del paciente y la menor salud mental del cuidador principal estuvieron asociados a la depresion. La correlacion entre sobrecarga y depresion aumento desde la evaluacion basal hasta los dos años (r = 0,47 frente a r = 0,613). Conclusiones. El deterioro del paciente y la sobrecarga son factores de riesgo para la depresion en el cuidador principal. Serian necesarias intervenciones para reducir la carga y poder prevenir la depresion relacionada.

Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano / Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS)

Introducción: La Frontotemporal Dementia Rating Scale (FTD-FRS) es una escala diseñada para facilitar la estadificación clínica y la evaluación de la progresión de pacientes con demencia frontotemporal (DFT). Objetivo: Realizar un estudio multicéntrico de adaptación y validación al castellano de la FTD-FRS. Metodología: La adaptación se realizó mediante 2 procesos de traducción y retrotraducción inglés-español español-inglés y se verificó con los autores originales. El proceso de validación se llevó a cabo en una muestra consecutiva de pacientes diagnosticados de DFT. Se evaluó la consistencia interna, se determinó la unidimensionalidad con el método Rasch, se analizaron la validez de constructo y la validez discriminante, y se calculó el grado de acuerdo entre la Clinical Dementia Rating scale y la FTD-FRS para los casos con DFT. Resultados: Se incluyeron 60 pacientes con DFT. La puntuación media de la FTD-FRS fue de 12,1 puntos (DE = 6,5; rango = 2-25) mostrando diferencias intergrupos (F = 120,3; gl = 3; p < 0,001). El α de Cronbach = 0,897, el análisis de componentes principales de los residuos produjo un aceptable autovalor para 5 contrastes (1,6-2,7) y una varianza respecto al origen del 36,1%. La FTD-FRS correlacionó con el Mini-mental test (r = 0,572; p < 0,001) y capacidad funcional (DAD; r = 0,790; p < 0,001). La FTD-FRS correlacionó significativamente con la Clinical Dementia Rating scale (r = −0,641; p < 0,001) pero se observó variabilidad entre la distribución de la gravedad, siendo valorados como más leves según la Clinical Dementia Rating scale que con la FTD-FRS (kappa = 0,055). Conclusiones: El estudio de traducción y validación al español mostró resultados de validez y unidimensionalidad (gravedad) satisfactorios para el uso de la FTD-FRS en el estudio de la gravedad en pacientes con DFT (AU)

Introduction: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). Objective: Present a multicentre adaptation and validation study of a Spanish version of the FRS. Methodology: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. Results: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD = 6.5; range, 2-25) with inter-group differences (F = 120.3; df = 3; P < .001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r = 0.572; P < .001) and functional capacity (DAD; r = 0.790; P < .001). FTD-FRS also showed a significant correlation with CDR (r = −0.641; P < .001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa = 0.055). Conclusions: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD (AU)

Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS). / Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano.

INTRODUCTION: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). OBJECTIVE: Present a multicentre adaptation and validation study of a Spanish version of the FRS. METHODOLOGY: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. RESULTS: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD=6.5; range, 2-25) with inter-group differences (F=120.3; df=3; P<.001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r=0.572; P<.001) and functional capacity (DAD; r=0.790; P<.001). FTD-FRS also showed a significant correlation with CDR (r=-0.641; P<.001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa=0.055). CONCLUSIONS: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD.

A path analysis of patient dependence and caregiver burden in Alzheimer's disease.

BACKGROUND: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. METHODS: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. RESULTS: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. CONCLUSIONS: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).

OBJECTIVE: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. METHODS: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. RESULTS: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. CONCLUSIONS: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

[Clinical and demographic characteristics of the cases of dementia diagnosed in the Health District of Girona throughout the period 2007-2010: data from the Girona Dementia Registry (ReDeGi)]. / Caracteristicas clinicas y demograficas de los casos de demencia diagnosticados en la Region Sanitaria de Girona durante el periodo 2007-2010: datos del Registro de Demencias de Girona (ReDeGi).

INTRODUCTION: The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District. AIM: To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia. PATIENTS AND METHODS: The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010. RESULTS: A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases. CONCLUSIONS: The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.

Evaluación de la anosognosia en la enfermedad de Alzheimer / Evaluation of anosognosia in Alzheimer’s disease

Objetivos. Comparar la prevalencia de anosognosia en pacientes con enfermedad de Alzheimer (EA) a partir de dos metodologías de evaluación diferentes, analizar el grado de discrepancia entre ambas y determinar las variables asociadasa esta discrepancia. Pacientes y métodos. Estudio transversal y observacional en pacientes con EA. Se administraron el Anosognosia Questionnaire- Dementia (AQ-D) y la Experimenter Rating Scale (ERS). Se registró información clínica y sociodemográfica del pacientey de su cuidador mediante instrumentos estandarizados. Se determinó la prevalencia con cada instrumento y el grado de concordancia entre ambos. Se creó una variable denominada ‘concordancia/no concordancia’ y se ajustó un modelo de regresión logística para determinar las variables asociadas a la discrepancia.Resultados. La prevalencia de anosognosia en los casos leves fue del 13,6% (intervalo de confianza del 95%, IC 95% = 5,5- 21,7) y del 17,3% (IC 95% = 8,4-26,1) y del 44,2% (IC 95% = 28,2-60,2) y 55,8% (IC 95% = 38,8-71,8) en los casos moderados, según la ERS y el AQ-D, respectivamente. El grado de concordancia entre ambas medidas obtuvo un valor kappa de 0,7. El modelo de regresión con la discrepancia entre la ERS y el AQ-D como variable dependiente se asoció a una menor capacidad funcional (odds ratio = -0,080; IC 95% = 0,855-0,997; p = 0,042). Conclusiones. Los datos mostraron un incremento de la prevalencia de anosognosia asociada a la gravedad y una discordancia en su evaluación con dos métodos diferentes cuanto mayor fue el grado de discapacidad funcional del enfermo (AU)

Aims. To compare the prevalence of anosognosia in patients with Alzheimer’s disease (AD) using two different evaluationmethodologies, to analyse the discrepancy between them and to determine the variables associated with this discrepancy. Patients and methods. The methodology involved a cross-sectional, observational study conducted in patients with AD.The Anosognosia Questionnaire-Dementia (AQ-D) and the Experimenter Rating Scale (ERS) were administered. Clinicaland sociodemographic information was recorded about both the patient and his/her caregiver by means of standardised instruments. Prevalence was determined with each instrument and the degree of agreement between them was thenestablished. A variable called ‘agreement/non-agreement’ was created and a logistic regression model was adjusted to determine the variables associated to the discrepancy. Results. The prevalence of anosognosia in the mild cases was 13.6% (95% confidence interval, 95% CI = 5.5-21.7) and17.3% (95% CI = 8.4-26.1), and 44.2% (95% CI = 28.2-60.2) and 55.8% (95% CI = 38.8-71.8) in the moderate cases, according to the ERS and the AQ-D, respectively. The degree of agreement between the two measurements yielded akappa-value of 0.7. The regression model with the discrepancy between the ERS and the AQ-D as the dependent variable was associated to a lower functional capacity (odds ratio = 0.080; 95% CI = 0.855-0.997; p = 0.042). Conclusions. The data from the study showed an increase in the prevalence of anosognosia linked to the severity and a higher disagreement in its evaluation with two different methods as the degree of the patient’s functional disabilityincreased (AU)

Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers.

BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.

[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)

[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

[Factorial distribution of the burden on caregivers of patients with Alzheimer's disease]. / Distribución factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Care of patients with Alzheimer's disease (AD) is so demanding that it can trigger states of physical, emotional and psychological distress among caregivers. The aims of this study were to determine the factorial structure of the Zarit Burden Scale (BS), to establish the differences among the factors according to the characteristics of patients and caregivers, and to determine the effect of the course of the disease on the factors on the BS over a period of two years. SUBJECTS AND METHODS: We conducted a prospective, longitudinal study on non-professional caregivers of patients with AD. The study involved 463 patients with a diagnosis of probable AD. The mean age was 75.2 years. All the subjects were administered the study protocol on a six-monthly basis over a period of 24 months. The patient's cognitive and functional capacity and the presence of psychological and behavioural symptoms were evaluated. The main caregiver was asked to complete the Zarit BS. RESULTS: The 21 items on the BS were distributed into five factors that accounted for 59.7% of the total variance of the score. A multivariate analysis identified aggressiveness, apathy, irritability, the caregiver's age and his or her relation to the family as the main causes of distress. CONCLUSIONS: This study confirms the multidimensional structure of the BS and offers information about the effect exerted on burden by the different clinical variables of the patients and the sociodemographic variables of the caregivers.

Distribución factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer / Factorial distribution of the burden on caregivers of patients with alsheimer’s disease

La enfermedad de Alzheimer (EA) provoca una necesidad de asistencia a los pacientes que puedeprovocar estados de carga física, emocional y psicológica en los cuidadores. Los objetivos de este estudio fueron determinar la estructura factorial de la escala de carga de Zarit (EC), establecer las diferencias entre los factores según las característicasde pacientes y cuidadores y determinar el efecto de la evolución de la enfermedad sobre los factores de la EC durante un período de dos años. Sujetos y métodos. Estudio prospectivo y longitudinal en cuidadores no formales de pacientes con EA. Participaron 463 pacientes diagnosticados de EA probable. La media de edad fue de 75,2 años. A todos los sujetos se les administróel protocolo de estudio semestralmente durante un período de 24 meses. Se evaluó la capacidad cognitiva y funcional del paciente y la presencia de síntomas psicológicos y conductuales. Al cuidador principal se le administró la EC de Zarit. Resultados. Los 21 ítems de la EC se distribuyeron en cinco factores que explicaron el 59,7% de la varianza total de lapuntuación. El análisis multivariante identificó la agresividad, la apatía, la irritabilidad, la edad del cuidador y su relación familiar como los principales causantes de la carga. Conclusiones. Este estudio confirma la estructura multidimensional dela EC y aporta información sobre el efecto que las distintas variables clínicas de los pacientes y sociodemográficas de los cuidadores provocan sobre la carga

Care of patients with Alzheimer’s disease (AD) is so demanding that it can trigger states of physical,emotional and psychological distress among caregivers. The aims of this study were to determine the factorial structure of the Zarit Burden Scale (BS), to establish the differences among the factors according to the characteristics of patients and caregivers, and to determine the effect of the course of the disease on the factors on the BS over a period of two years. Subjectsand methods. We conducted a prospective, longitudinal study on non-professional caregivers of patients with AD. The study involved 463 patients with a diagnosis of probable AD. The mean age was 75.2 years. All the subjects were administered the study protocol on a six-monthly basis over a period of 24 months. The patient’s cognitive and functional capacity and thepresence of psychological and behavioural symptoms were evaluated. The main caregiver was asked to complete the Zarit BS. Results. The 21 items on the BS were distributed into five factors that accounted for 59.7% of the total variance of the score.A multivariate analysis identified aggressiveness, apathy, irritability, the caregiver's age and his or her relation to the family as the main causes of distress. Conclusions. This study confirms the multidimensional structure of the BS and offers informationabout the effect exerted on burden by the different clinical variables of the patients and the sociodemographic variables of the caregivers