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

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

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

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

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

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

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

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

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

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

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

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

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

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