Sense of Well-Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest-A Pilot Study.

Background and Objective. Most patients with fibromyalgia benefit from different forms of physical exercise. Studies show that exercise can help restore the body's neurochemical balance and that it triggers a positive emotional state. So, regular exercise can help reduce anxiety, stress, and depression. The aim of this study was to analyze the benefits of moderate aerobic exercise when walking in two types of forests, young and mature, and to assess anxiety, sleep, pain, and well-being in patients with fibromyalgia. Secondary objectives included assessing (i) whether there were differences in temperature, sound, and moisture, (ii) whether there was an improvement in emotional control, and (iii) whether there was an improvement in health (reduction in pain) and in physical and mental relaxation. Patients and Methods. A study involving walking through two types of forests (mature and young) was performed. A total of 30 patients were randomly assigned to two groups, mature and young forests. The participants were administered the following tests: the Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR) at baseline and the end-point of the study, the State-Trait Anxiety Inventory (STAI) after each walk, and a series of questions regarding symptomatic evolution. Several physiological parameters were registered. Results. FIQR baseline and end-point scores indicated a significant decrease in the symptomatic subscale of the FIQ (SD = 21.7; z = -2.4; p = 0.041). The within-group analysis revealed that differences were significant with respect to days of intense pain, insomnia, and days of well-being only in the group assigned to the mature forest, not in the group assigned to the young forest. No differences were found with respect to anxiety. Conclusions. Although the main aim of this research was not achieved, as the results revealed no differences between the groups in the two forest types, authors could confirm that an aerobic exercise program consisting of walking through a mature forest can provide the subjective perception of having less days of pain and insomnia and more days of wellness, in patients with fibromyalgia.

Dependence scale for Alzheimer's disease: relationship with other clinical indicators and psychometric properties.

The objective of this cross-sectional and multicenter study was to evaluate the psychometric properties of the Spanish version of the Dependence Scale (DS) and to assess the relationship between dependence and clinical measures according to disease severity. Medical comorbidities, cognitive status and functional status, behavior, dependence, caregiver burden, and medical and social resources were assessed using standardized instruments. The sample consisted of 343 patients (32.1% mild, 36.7% moderate, and 31.2% severe), the mean age was 78.9 years (standard deviation=7.4), and 67.0% were women. Criterion and construct validity index of DS were appropriate. The DS standard error of measurement was ±1.23. The explained variance in DS ranged between 0.598 and 0.731, and the relative contribution of clinical measures depended on disease severity. Current findings confirm that the Spanish version of the DS has appropriate psychometric indices and suggest that clinical indicators have different contribution to dependence according to disease severity.

Valor económico anual de la asistencia informal en la enfermedad de Alzheimer / Annual economic cost of informal care in Alzheimer’s disease

Introducción. El coste indirecto asociado a la atención de los pacientes con enfermedad de Alzheimer (EA) lo asume principalmente la familia. Objetivo. Describir el coste asociado al tiempo de dedicación, su evolución anual, las características y la carga del cuidador asociada. Sujetos y métodos. Pacientes diagnosticados de EA no institucionalizados, seguidos ambulatoriamente en una unidad de diagnóstico y sus cuidadores principales. Estudio prospectivo y observacional de 12 meses de evolución. Se evaluaron las características clínicas del paciente a través del Cambrigde Cognitive Examination Revised, para la capacidad cognitiva; el Disability Assessment in Dementia, para la capacidad funcional, y el inventario neuropsiquiátrico, para los trastornos no cognitivos. Se recogieron los datos sociodemográficos a través del Cambridge Examination for Mental Disorders of the Elderly Revised. Se registró la dedicación del cuidador, sus características sociodemográficas y la carga (a través de la escala de Zarit). Resultados. La muestra estuvo formada por 169 pacientes y 169 cuidadores. El coste en el momento basal fue de 6.364,8 €/año, asociado principalmente al apoyo en actividades instrumentales. A los 12 meses se observó un incremento global del 29% (1.846,8 €/año). El incremento del coste se asoció a la discapacidad física (F = 25,2; gl = 1; p < 0,001), el deterioro cognitivo (F = 8,5; gl = 1; p = 0,004), la edad del paciente (F = 9,2; gl = 1; p = 0,003) y si el cuidador era o no el único (F = 20,4; gl = 1; p < 0,001). El coste de la asistencia explicó el 6,7% de la varianza total de la carga percibida por los cuidadores. Conclusiones. El coste indirecto medio de la atención fue de 6.364,8 €/año, con un incremento del 29% anual que se asoció a la discapacidad física y cognitiva, a la edad del paciente y a tener un solo cuidador (AU)

Introduction. The indirect cost associated with the care of patients with Alzheimer’s disease is taken on primarily by the family. Aim. To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. Subjects and methods. Non-institutionalized patients diagnosed with Alzheimer’s disease who are managed on an outpatient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient’s clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver’s dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. Results. Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 €/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 €/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. Conclusions. Care has a mean indirect cost of 6364.2 €/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver (AU)

[Annual economic cost of informal care in Alzheimer's disease]. / Valor económico anual de la asistencia informal en la enfermedad de Alzheimer.

INTRODUCTION: The indirect cost associated with the care of patients with Alzheimer's disease is taken on primarily by the family. AIM: To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. SUBJECTS AND METHODS: Non-institutionalized patients diagnosed with Alzheimer's disease who are managed on an out-patient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient's clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver's dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. RESULTS: Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 euro/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 euro/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. CONCLUSIONS: Care has a mean indirect cost of 6364.2 euro/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver.

[Adaptation and convergent validity of a telephone-based Mini-Mental State Examination]. / Adaptación y validez convergente de una versión telefónica del Mini-Mental State Examination.

BACKGROUND AND OBJECTIVE: To adapt to Spanish and to determine the convergent validity of a Telephone Mini-Mental State Examination (t-MMSE) in order to assess the cognitive functions in Alzheimer's disease (AD) patients. PATIENTS AND METHOD: Prospective and observational study of a clinical sample consisting of patients with dementia from a memory clinic. Consecutive sampling of participants was used and convergent validity of the t-MMSE and MMSE scores was determined using several statistics measures. Patients were randomly assigned depending on the administration of the in-person/telephone test (MMSE and t-MMSE) or telephone/in-person (t-MMSE and MMSE) test within a 1- to 7-day interval. The effect of the confusion variables (age, gender, years of education, dementia severity, presence or absence of hearing impairment and administration order) on the concordance between the in-person and telephone MMSE versions was analysed. RESULTS: After translating and retranslating the t-MMSE, of 141 participants, 77.47% subjects completed the protocol of the study. For the total score, the statistics for the convergent validity suggested a high consistency, independently of the order of test administration (intraclass correlation coefficient = 0.87, Spearman's rho = 0.77); for the all subscores, it suggested moderate and good correlations. The difference between subscores did not range more than 1 point in any case. Confusion variables did not affect the variability of the performance scores between t-MMSE and MMSE. CONCLUSIONS: The t-MMSE can be used as a good tool to estimate the MMSE score of patients with dementia.

Adaptación y validez convergente de una versión telefónica del Mini-Mental State Examination / Adaptation and convergent validity of a telephone-based Mini-Mental State Examination

Fundamento y objetivo: Adaptar al castellano y determinar la validez convergente de una versión telefónica del Mini-Mental State Examination (t-MMSE) para valorar las funciones cognoscitivas de los pacientes con demencia. Pacientes y método: Estudio observacional y prospectivo de pacientes con demencia seleccionados mediante muestreo consecutivo de las consultas ambulatorias de una unidad hospitalaria. Se evaluó la validez convergente de las puntuaciones del t-MMSE respecto a las puntuaciones del MMSE mediante diversos indicadores. Los participantes fueron aleatorizados a la aplicación de los tests, en el intervalo de 1 semana, presencial-telefónica (MMSE y t-MMSE) y telefónica- presencial (t-MMSE y MMSE). Se analizó el efecto de variables de confusión (edad, sexo, escolaridad, gravedad de la demencia, déficit auditivo y orden de aplicación) en el grado de concordancia entre el t-MMSE y el MMSE. Resultados: Tras el proceso de traducción directa e inversa del t-MMSE, fue posible aplicar el protocolo de estudio al 77,47% de los candidatos a participar (n=141). Para la puntuación total, los indicadores de validez convergente fueron elevados independientemente del orden de aplicación (coeficiente de correlación intraclase = 0,87; rho de Spearman = 0,77). Los indicadores de validez de las subpuntuaciones presentaron valores entre moderados y buenos. Las diferencias entre las subpuntuaciones no fueron superiores a 1 punto en ningún caso. No se observó ningún efecto de las variables de confusión en la variación de las puntuaciones entre el t-MMSE y el MMSE. Conclusiones: El t-MMSE puede ser utilizado de forma válida para estimar la puntuación del MMSE en pacientes con demencia

Background and objective: To adapt to Spanish and to determine the convergent validity of a Telephone Mini-Mental State Examination (t-MMSE) in order to assess the cognitive functions in Alzheimer's disease (AD) patients. Patients and method: Prospective and observational study of a clinical sample consisting of patients with dementia from a memory clinic. Consecutive sampling of participants was used and convergent validity of the t-MMSE and MMSE scores was determined using several statistics measures. Patients were randomly assigned depending on the administration of the in-person/telephone test (MMSE and t-MMSE) or telephone/in-person (t-MMSE and MMSE) test within a 1- to 7-day interval. The effect of the confusion variables (age, gender, years of education, dementia severity, presence or absence of hearing impairment and administration order) on the concordance between the in-person and telephone MMSE versions was analysed. Results: After translating and retranslating the t-MMSE, of 141 participants, 77.47% subjects completed the protocol of the study. For the total score, the statistics for the convergent validity suggested a high consistency, independently of the order of test administration (intraclass correlation coefficient = 0.87, Spearman's rho = 0.77); for the all subscores, it suggested moderate and good correlations. The difference between subscores did not range more than 1 point in any case. Confusion variables did not affect the variability of the performance scores between t-MMSE and MMSE. Conclusions: The t-MMSE can be used as a good tool to estimate the MMSE score of patients with dementia