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.

[Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild Alzheimer s disease over a six-month period]. / Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses.

INTRODUCTION: At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. PATIENTS AND METHODS: We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6 month period. RESULTS: The sample was made up of 175 patients, of which 134 began therapy with 5 10 mg/day of donepezil and 41 with 6 12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. CONCLUSIONS: The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine.

Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses / Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild alzheimer's disease over a six-month period

Introducción. Actualmente, en el tratamiento del deterioro cognitivo asociado a la enfermedad de Alzheimer (EA) se utilizan los inhibidores de la acetilcolinesterasa (iACh). Los efectos secundariosde estos fármacos se asocian al aumento de acetilcolina, lo que limita su efectividad, y se debe ajustar al paciente hasta la dosis máxima tolerada . Pacientes y métodos. Se realiza un estudio comparativoretrospectivo de la tolerancia y de los acontecimientos adversos (AA) de dos iACh en un grupo de pacientes con EA probable de gravedad mínima y leve durante un período de 6 meses. Resultados. La muestra la formaban 175 pacientes, de los cuales 134 iniciaron tratamiento con donepecilo en 5-10 mg/día y 41 con rivastigmina en 6-12 mg/día. El 20 por ciento de los pacientes presentaron AA y el 8 por ciento abandonó el tratamiento. Los trastornos gastrointestinales (TGI) fueron el principal AA observado (57,1 por ciento). El 6 por ciento de los pacientes tratados con donepecilo abandonaron el tratamiento a causa de los AA frente al 14,6 por ciento de los pacientes tratados con rivastigmina. Los pacientes tratados con rivastigmina presentaron una mayor incidencia de TGI y el riesgo relativo de presentar TGI fue 4,4 veces superior que en los pacientestratados con donepecilo. Conclusiones. Los TGI asociados al tratamiento con iACh son el principal motivo de abandono del tratamiento y se producen con mayor frecuencia en pacientes tratados con rivastigmina (AU)

Introduction. At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer’s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. Patients and methods. We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6-month period. Results. The sample was made up of 175 patients, of which 134 began therapy with 5-10 mg/day of donepezil and 41 with 6-12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. Conclusions. The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine (AU)

[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.

[The clinical incidence of frontal dementia]. / Incidencia clínica de la demencia frontal.

INTRODUCTION AND OBJECTIVES: Although the neuropathology of Pick s disease and the frontal lobe dementias has been well defined, the complexity of the clinical diagnosis makes epidemiological studies difficult. The objective of this study was to determine the annual clinical incidence of fronto temporal dementia. PATIENTS AND METHODS: A retrospective observational study was made of the diagnoses of all persons attended in UVAMID during the period 1999 2000. Clinical evaluation was standardized following a protocol of the UVAMID. This included a clinical history obtained by interviewing the patient and a reliable informant, general medical and neurological examination, neuropsychological examination and a battery of complementary tests. RESULTS: In clinical practice the incidence of the different types of dementia varies between 93/100,000 in Alzheimer type dementia and 14/100,000 in DFT f. When age groups are considered, there is a progressive increase in the incidence of DFT f with 12/100,000 in the age group 46 69 years and 57/100,000 in the group of 75 79 years. CONCLUSIONS: The results of this study show that cases of DFT f form 2.7% of the new cases occurring annually. The main limitation of this study is that since these patients were referred for consultation from primary care centres, they form a non representative clinically biased sample which limits extrapolation of the results.

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

Objetivo. Determinar el efecto de la sintomatología depresiva de los pacientes en la carga percibida por el cuidador, valorar la evolución de la carga según la desaparición, persistencia y emergencia de los síntomas depresivos a los 12 meses y conocer qué factores se asocian con el aumento o disminución de la carga del cuidador a los 12 meses. Pacientes y métodos. Estudio prospectivo observable a 12 meses de una muestra de 150 pacientes con diagnóstico clínico de enfermedad de Alzheimer probable, según criterios NINDCS-ADDRA. Se recogieron los datos sociodemográficos del cuidador y se administraron las escalas siguientes: CAMDEX, CAMCOG, NPI, RDRS-2 y Burden Interview (BI), en el momento basal y a los 12 meses. Resultados. La presencia de depresión en el momento basal se asociaba a mayor carga (puntuación de BI de 22,76 frente a 15,79), a mayor aparición de sintomatología no cognitiva (puntuación de NPI de 16,23 frente a 5,94) y a mayor discapacidad funcional (puntuación RDRS-2 de 27,89 frente a 25,53). La carga aumenta en el grupo de pacientes en los que persistió la sintomatología depresiva y en aquellos en que emergió a los 12 meses. Conclusión. Los datos sugieren que los síntomas depresivos aumentan la discapacidad funcional y que se asocian a una mayor presencia de síntomas no cognitivos; a su vez, la discapacidad funcional y los síntomas no cognitivos aumentan la carga del cuidador (AU)

Incidencia clínica de la demencia frontal / The clinical incidence of frontal dementia

Introducción y objetivos. A pesar de que la neuropatología de la enfermedad de Pick y de las demencias del lóbulo frontal está bien definida, la complejidad del diagnóstico clínico dificulta los estudios epidemiológicos. El objetivo del presente trabajo es determinar la incidencia clínica anual de la demencia frontotemporal. Pacientes y métodos. Estudio restrospectivo observacional del diagnóstico de todos los sujetos que acudieron a la UVAMID entre los años 1999 y 2000. La valoración clínica se realizó de modo estandarizado siguiendo el protocolo de la UVAMID, que incluye la historia clínica realizada a través de una entrevista al paciente y a un informador fiable, un examen médico general y neurológico, una exploración neuropsicológica y un conjunto de pruebas complementarias. Resultados. La incidencia en la práctica clínica de los diversos tipos de demencia varía entre 93/100.000 para la demencia tipo Alzheimer y 14/ 100.000 para la DFT-f. Por grupos de edad, se observa un aumento progresivo de la incidencia de la DFT-f, 12/100.000 para el grupo de entre 46 y 69 años y 57/100.000 para el grupo de 75-79 años. Conclusiones. Los resultados del presente estudio señalan que los casos de DFT-f representaron el 2,7 por ciento del total de casos nuevos anuales. La principal limitación del presente trabajo es que los pacientes, al ser remitidos a consulta desde los centros de atención primaria, forman una muestra no representativa, clínicamente sesgada, que limita la extrapolación de los resultados (AU)

[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)