[Study of the performance of complex activities of daily living in a population of patients with mild cognitive impairment. Mild functional impairment: A new clinical entity?] / Estudio del desempeño de las actividades complejas de la vida diaria en una población de pacientes con Deterioro Cognitivo Leve. Deterioro Funcional Leve: ¿una nueva entidad clínica?

Several papers describe functional changes in the aging population, and its relevance in the early cognitive impairment detection. Alterations in instrumental activities would constitute a diagnostic marker of MCI and predict the progression to Dementia. In order to count on a tool to evaluate the performance in the use of new technologies we have designed a new protocol, Complex Functional Study (CFS), that quantifies performance and functional changes Related to previous states. OBJECTIVES: To compare CFS scores in patients with MCI with a control group without cognitive impairment (CD) and verify their diagnostic performance to detect complex function alterations in reference too the functional scales, Instrumental Activities of Daily Living (AVDI) and Disability Assessment for Dementia (DAD). METHODS: Patients with MCI and controls were included. All subjects were evaluated with a neurocognitive battery, and functional scales (EFE).STATA software version 14.2 was used for data analysis. RESULTS: 269 recruited patients older than 65 years old, 173 with diagnosis of MCI and 96 controls. The MCI patients obtained significantly higher EFE scores tan subjects without DC (p < 0,001).The EFE presented a greater sensitivity to detect the functional alteration (EFE 81.5%, AVDI 25.9%, DAD 18.5%). CONCLUSIONS: The EFE is an instrument of optimal clinical value, with good sensitivity to identify the alteration of the complex activities of daily life in patients with MCI. The results allow to characterize a profile compatible with Light Functional Impairment.

[New predictors in prodromal Alzheimer: Deferred phase in word recall of MIS test]. / Nuevos predictores en Alzheimer prodrómico: fase diferida en el test MIS de recuerdo de palabras.

BACKGROUND: The Memory Impairment Screen (MIS-A) is a validated test to detect Alzheimer's Disease (AD) and other dementias. We have modified this test to suit a Spanish speaking population and added a new component, delayed recall (MIS-D). OBJECTIVES: 1) To test a Spanish version of MIS-A and MIS-D. 2) To assess the discriminative validity of MIS-D as a screening tool for the amnestic variant of Mild Cognitive Impairment (aMCI). METHODS: A case-control study of a cohort of 739 aged 65 years old and over, of whom 436 were healthy controls and 303 had a diagnosis of aMCI. The MCI group was patients from the Geriatric Unit for the Elderly at the Italian Hospital of Buenos Aires staffed by geriatricians. MEASUREMENTS: ANOVA test and test t de Student mean comparison. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) were estimated for MIS-D and MIS-A. RESULTS: Normative values for MIS-A and MIS-D were obtained from the control population. Both age and education significantly affected these values (p<0.0001). The cut-off for MIS-A should be 7.5 and for MIS-D, 5.5. Comparison between control population and aMCI population using ROC curve gave a result of 5.5 in MIS-D, with 97% specificity and 76% sensitivity. CONCLUSION: MIS-D was positively predictive of Amci. An extension of the sample in other health care contexts would enable us to verify its clinical validity for other populations.

Spanish Revised Memory and Behavior Problems Checklist Scale (SpRMBPC): trans-cultural adaptation and validation of the RMBPC questionnaire.

BACKGROUND: The use of standardized scales is critical for monitoring the interventions within and between different populations, but the current Spanish tools are dispersed in several scales. A simple tool for simultaneously and exhaustively evaluating patient's symptoms and caregiver's distress in Spanish-speaking groups is needed. METHODS: RMBPC was translated into Spanish by cross-cultural adaptation. Comprehensibility and easiness of SpRMBPC were evaluated with 92 patient-caregiver dyads. Reliability, stability and scale structure were evaluated by Cronbach's α, test-retest and factor analysis respectively. Concurrent and discriminant validity were assessed by correlation with validated tools for measuring stage of dementia; memory, disruptive behaviors and depression symptoms of the patients; and anxiety, depression and burden of the caregivers (CDR, MMSE, NPIq, NPI disruption, NPI depression, HADS-A; HADS-D and Zarit Burden Interview respectively). RESULTS: Almost all caregivers completed the questionnaire (97% completeness; 7.5% missing data). Both the frequency of Patient's Symptoms and Caregiver Reaction scores and subscores displayed high stability and reliability. All of these scores correlated positively with their respective validated tools as predicted, except with MMSE. The patients' subscores for Disruptive Behaviors and Memory Impairment displayed their highest correlation with the disruptive symptoms and level of dementia validated tools. CONCLUSIONS: SpRMBPC is a validated tool for assessing the dementia stage and the psychiatric morbidity of patients and caregivers. The Frequency Disruption and Memory subscales assess specifically patient's disruptive symptoms and dementia stages. These tools can be applied to analyze the burden of the patient's disease and the caregiver's distress in Spanish-speaking populations.

Narrowing the gap in hypertension: effectiveness of a complex antihypertensive program in the elderly.

Hypertension control is a difficult goal to achieve in common practice even when its benefits have been widely proved. We assessed the effectiveness of a Complex Antihypertensive Intervention Program in the Elderly (CAPE). A program trial of 500 elderly hypertensive patients was conducted. 250 were followed by primary care physicians and intervened by the CAPE and 250 received usual care. The program included an organizational change with the addition of an office where patients had their blood pressure measured, were appointed to join educational sessions and received verbal and printed advice before medical attendance. Data was systematically recorded in the electronic medical record which functioned as a physician reminder during the visit. Differences in systolic blood pressure level and in percentage of well-controlled (<140/90 mm Hg) patients between groups were measured after 12 months of follow-up. The difference of mean change in systolic blood pressure between groups was 7.1 mm Hg (95% confidence interval, 4-10 mm Hg). Sixty-seven percent of patients in the intervention group were well-controlled, as were 51% of patients in the control group (p < 0.001). Patients who attended educational sessions showed the lowest odd ratio (0.25; 95% confidence interval, 0.11-0.54) for blood pressure above 140/90 mm Hg in multivariate analysis after adjusting for age, sex, initial systolic blood pressure level, and changes in antihypertensive treatment. These results support the effectiveness of our complex intervention program. Routine clinical care of hypertension can be improved with simple strategies that go beyond pharmacotherapy, tending to overcome clinical inertia.

La intervención con programas específicos disminuye la utilización de recursos médicos en pacientes policonsultadores / The intervention with specific programs decrease health care utilization in high utilizer patients

Introducción: entre el 10 y el 25 por ciento de los pacientes de un servicio de salud consumen alrededor del 60 por ciento de sus recursos. Algunas estrategias como la incorporación de un médico de cabecera han logrado disminuir su utilización. Ojetivos: evaluar el efecto de un grupo interdisciplinario de salud en la utilización de recursos por pacientes policonsultadores. Diseño: ensayo clínico controlado aleatorizado simple de 6 meses de duración (febrero-julio 1999). Pacientes y métodos: de 65200 pacientes residentes en Capital Federal afiliados al sistema de salud prepago (SP), se seleccionaron los 800 pacientes con mayor número de consultas antre agosto y diciembre de 1998. Fueron aleatorizados en: 400 grupo intervención (GI) (recibieron la intervención), y 400: grupo control (GC). Intervención: contacto por el médico de cabecera (M de C) y una secretaria. Línea telefónica sin cargo para turnos y autorizaciones, visita en domicilio de una enfermera con control telefónico posterior y consultas a una asistente social. Resultados medidos: internaciones, consultas médicas, consumo de fármacos y prácticas. Resultados: los pacientes del GI tuvieron significativamente menor número de internaciones (26 vs. 55; RR: 0,47 IC 95 por ciento: 0,30-0,74) y duración de las mismas (146 vs. 280 días; P<0,05) que el GC y menor número de prácticas [media/ prácticas/ paciente/ mes (DS): GI: 0,43 (0,54); GC: 0,54 (070) p<0,05]. No hubo diferencias significativas en el número de consultas y consumo de fármacos. Conclusiones: un grupo multidisciplinario de salud, en apoyo a los médicos de cabecera, fue de utilidad para disminuir el número y duración de las internaciones y el número de prácticas en un grupo de pacientes policonsultadores en un sistema de salud prepago

La intervención con programas específicos disminuye la utilización de recursos médicos en pacientes policonsultadores / The intervention with specific programs decrease health care utilization in high utilizer patients

Introducción: entre el 10 y el 25 por ciento de los pacientes de un servicio de salud consumen alrededor del 60 por ciento de sus recursos. Algunas estrategias como la incorporación de un médico de cabecera han logrado disminuir su utilización. Ojetivos: evaluar el efecto de un grupo interdisciplinario de salud en la utilización de recursos por pacientes policonsultadores. Diseño: ensayo clínico controlado aleatorizado simple de 6 meses de duración (febrero-julio 1999). Pacientes y métodos: de 65200 pacientes residentes en Capital Federal afiliados al sistema de salud prepago (SP), se seleccionaron los 800 pacientes con mayor número de consultas antre agosto y diciembre de 1998. Fueron aleatorizados en: 400 grupo intervención (GI) (recibieron la intervención), y 400: grupo control (GC). Intervención: contacto por el médico de cabecera (M de C) y una secretaria. Línea telefónica sin cargo para turnos y autorizaciones, visita en domicilio de una enfermera con control telefónico posterior y consultas a una asistente social. Resultados medidos: internaciones, consultas médicas, consumo de fármacos y prácticas. Resultados: los pacientes del GI tuvieron significativamente menor número de internaciones (26 vs. 55; RR: 0,47 IC 95 por ciento: 0,30-0,74) y duración de las mismas (146 vs. 280 días; P<0,05) que el GC y menor número de prácticas [media/ prácticas/ paciente/ mes (DS): GI: 0,43 (0,54); GC: 0,54 (070) p<0,05]. No hubo diferencias significativas en el número de consultas y consumo de fármacos. Conclusiones: un grupo multidisciplinario de salud, en apoyo a los médicos de cabecera, fue de utilidad para disminuir el número y duración de las internaciones y el número de prácticas en un grupo de pacientes policonsultadores en un sistema de salud prepago