Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. OBJECTIVES: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. METHODS: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. RESULTS: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. CONCLUSIONS: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver's quality of life.

A blood-based, 7-metabolite signature for the early diagnosis of Alzheimer's disease.

Accurate blood-based biomarkers of Alzheimer's disease (AD) could constitute simple, inexpensive, and non-invasive tools for the early diagnosis and treatment of this devastating neurodegenerative disease. We sought to develop a robust AD biomarker panel by identifying alterations in plasma metabolites that persist throughout the continuum of AD pathophysiology. Using a multicenter, cross-sectional study design, we based our analysis on metabolites whose levels were altered both in AD patients and in patients with amnestic mild cognitive impairment (aMCI), the earliest identifiable stage of AD. UPLC coupled to mass spectrometry was used to independently compare the levels of 495 plasma metabolites in aMCI (n = 58) and AD (n = 100) patients with those of normal cognition controls (NC, n = 93). Metabolite alterations common to both aMCI and AD patients were used to generate a logistic regression model that accurately distinguished AD from NC patients. The final panel consisted of seven metabolites: three amino acids (glutamic acid, alanine, and aspartic acid), one non-esterified fatty acid (22:6n-3, DHA), one bile acid (deoxycholic acid), one phosphatidylethanolamine [PE(36:4)], and one sphingomyelin [SM(39:1)]. Detailed analysis ruled out the influence of potential confounding variables, including comorbidities and treatments, on each of the seven biomarkers. The final model accurately distinguished AD from NC patients (AUC, 0.918). Importantly, the model also distinguished aMCI from NC patients (AUC, 0.826), indicating its potential diagnostic utility in early disease stages. These findings describe a sensitive biomarker panel that may facilitate the specific detection of early-stage AD through the analysis of plasma samples.

La verdadera eficiencia de las Unidades de Memoria. ¿Qué falla? / Alzheimer disease and the delay of its diagnosis

Introducción: El deterioro cognitivo es un problema de salud pública extraordinariamente prevalente en la población general. Las Unidades de Memoria son necesarias dada la necesidad de llevar a cabo una aproximación holística tanto a pacientes como a cuidadores. Sin embargo, los datos disponibles son controvertidos tanto respecto a la demora en el diagnóstico como al tratamiento de nuestros pacientes. Pacientes y métodos: Llevamos a cabo un estudio epidemiológico retrospectivo en la Unidad de Estudio de la Cognición y la Conducta, en el Servicio de Neurología del Hospital Clínico San Carlos de Madrid. Se revisaron 620 historias clínicas y se seleccionaron aquellos pacientes con enfermedad de Alzheimer (EA) según criterios NINCSADRDA, desde 2008 a 2011. Se analizaron variables como la edad, el sexo, la dominancia manual, el nivel educativo, la presencia de un cuidador, GDS (Global Deterioration Scale) y meses transcurridos desde los primeros síntomas hasta el diagnóstico. El análisis estadístico se llevó a cabo mediante SPSS versión 19. Describimos la correlación entre variables como la edad, el sexo, el nivel educativo y la presencia de un cuidador con el GDS y los meses de demora diagnóstica. Resultados: Evaluamos 229 personas con EA (67,7 % mujeres, 32,3 % hombres). La distribución de GDS fue: GDS 4: 45,4 %; GDS 5: 28,4 %; GDS 6: 21,0 %; GDS 7: 5,2 %. La mediana de edad fue de 81 años (hombres, 80; mujeres, 81). La mediana de nivel educativo fue de 5 años (hombres, 7; mujeres, 5).El 87,8 % tenían un cuidador (GDS 4: 35,7 %, GDS 5: 67,9 %, GDS 6: 96,4 %, GDS7: 100 %). La mediana de meses de demora diagnóstica fue de 36 en hombres y de 30 en mujeres (GDS 4: 24, GDS 5: 36, GDS 6: 48 y GDS 7: 51 meses). Teniendo en cuenta la situación social, la mediana de meses de demora diagnóstica fue de 24 en aquellos pacientes que vivían solos y de 36 en pacientes con cuidador. No hubo diferencias entre personas con más de 6 años de nivel educativo o con menos de 6 (mediana de meses: 36, en ambos casos). Con clu - siones: Las Unidades de Memoria son necesarias para la realización de un diagnóstico precoz y el inicio de un tratamiento óptimo. Sin embargo, hoy en día existe un gran retraso en el área a la hora de poder llevar a cabo estos objetivos. El diagnóstico de EA se realiza tarde en los hombres y en pacientes con mejor soporte social en nuestro medio(AU)

Background: Cognitive impairment is a prevalent public health problem in general population. Memory Clinics are necessary in order to implement a holistic approach to patients and caregivers. However, data report many controversial aspects about the delay of diagnosis and treatment of our patients. Methods: retrospective epidemiological study was carried out. We reviewed 620 medical histories selecting those patients diagnosed of Alzheimer disease (AD) (NINCS-ADRDA criteria) in BCU-HCSC from 2008 to 2011. We analyzed age, sex, handness, educational level, caregiver, GDS and time (months) from first symptoms till diagnosis. We made a statistical analysis using SPSS 19 version. We describe the correlation between factors like age, sex, educational level and caregiver presence with GDS and months from first symptoms at the time of diagnosis. Results:We evaluated 229 AD (67.7% women, 32.3 % men). The distribution of GDS score was: GDS 4: 45.4 %, GDS 5: 28.4 %, GDS 6: 21.0 %, GDS 7: 5.2 %. The median age was 81(men 80, women 81) The median of educational level was 5 years (men 7, women 5). 87.8 % had a caregiver (GDS 4: 35.7 %, GDS 5: 67.9 %, GDS 6: 96.4%, GDS7: 100 %). The median of months from first symptoms to diagnosis was 36 in men and 30 in women (GDS4: 24, GDS 5: 36, GDS 6: 48 and GDS 7: 51 months). Regarding the social situation, the median of months from first symptoms till diagnosis was 24 for patients who live alone and 36 for patients with caregiver. There was no diference between people with more than 6 years of educational level and less of six years (median of 36 months in both cases). Conclusions: Memory clinics are necessary in order to make an early diagnosis and implement an optimal treatment for AD patients. However, nowadays there is a great delay in our area in order to make an optimal medical approach of these patients. Alzheimer diagnosis is made later in men and patients with better social support(AU)