Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013).

PURPOSE: We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS: Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS: Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS: Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.

Utilidad de las baterías neuropsicológicas estandarizadas en sujetos adultos con síndrome de Down y demencia / The Usefulness of standard neuropsychological testing for adults with Down syndrome and dementia

(SD) tienen un riesgo aumentado de desarrollar la enfermedad de Alzheimer (EA). Puesto que en el SD se parte de un nivel intelectual menor que en la población general, a veces resulta difícil objetivar si existe o no, en el envejecimiento, una reducción de sus capacidades para cumplir los criterios diagnósticos de EA. El «Mini-MentalState Examination» (MMSE) y el «Severe ImpairmentBattery» (SIB) son pruebas cognitivas estandarizadas ampliamente utilizadas para detectar demencia en la población general. Escasos estudios han utilizado el MMSE y la SIB en sujetos con SD con sospecha de demencia. El objetivo del presente estudio consistió en analizar la utilidad del MMSE y la SIB en la valoración de las funciones cognitivas de sujetos con SD. Método: Se administró el MMSE y la SIB a 45 sujetos con SD (16 con EA y 29 sin demencia) y el cuestionario «Dementia Questionnaire for Mentally Retarded Persons» (DMR) a sus cuidadores. Resultados: Los sujetos con SD y demencia mostraron una mayor alteración que los sujetos con SD sin demencia en la DMR-social y DMR-total, pero no se hallaron diferencias significativas entre ambos grupos en el rendimiento de la SIB, MMSE ni DMR-cognitivo. Las puntuaciones en la SIB correlacionaron significativamente con las del MMSE, DMR-total, DMR-cognitivo y DMR-social. El rendimiento en el MMSE correlacionó significativamente con el del DMR-total, DMR-cognitivo y SIB. Conclusiones: El MMSE y la SIB son herramientas útiles para el seguimiento de las funciones cognitivas en sujetos con SD y deterioro cognitivo o demencia (AU)

Background: Subjects with Down syndrome (DS) have an increased risk of Alzheimer’s disease (AD). As intellectual ability is lower in DS subjects than among the general population, it is difficult to determine whether cognition has deteriorated with age to the point of fulfilling AD diagnostic criteria. The Mini-Mental State Examination (MMSE) and the Severe Impairment Battery (SIB) are standard cognitive tests widely used to assess dementia in the general population. There are few studies using the MMSE and the SIB on subjects with DS where dementia is suspected. The aim of the present study was to analyse the appropriateness of the SIB and the MMSE in the cognitive assessment of aging subjects with DS. Methods: The SIB and the MMSE were administered to 45 subjects with DS (16 with Alzheimer’s disease and 29 without dementia), and the DMR questionnaire was given to their caregivers. Results: DS subjects with dementia had higher impairment levels than DS subjects without dementia in their social and total DMR scores, but no significant differences were found between the two groups in the SIB and MMSE scores or in cognitive DMR performance. Overall, SIB scores correlated significantly with MMSE results, total DMR, cognitive DMR, and social DMR. MMSE performance correlated significantly with total and cognitive DMR scores as well as SIB score. Conclusion: The SIB and the MMSE are useful assessment tools in monitoring cognitive function among subjects with DS and cognitive loss or dementia (AU)