Comparison of mortality rate in older adults with and without functional awareness: the Neurological Disorders in Central Spain (NEDICES) population-based study.

OBJECTIVES: The main aim of the study was to compare the rates of mortality in older adults with and without functional unawareness (FU). We also tested a possible interaction effect between levels of awareness and education, as a single cognitive reserve proxy, on mortality. STUDY DESIGN: The study design is a longitudinal population-based cohort study. METHODS: The Neurological Disorders in Central Spain is epidemiological study to detect main age-associated conditions in people aged 65 years and older. Participants were collected from updated population-based registers of residents in three areas of central Spain. Awareness of functional limitations was established in accordance with the discrepancy between two sources of information on functional impairments: reliable informants versus the participants themselves. Three mutually exclusive groups were formed, namely, Functional Limitation Complaints (FCs), FU, and Functional Awareness (FA). Cox's regression models, adjusted by different covariates, were used to calculate the risk of mortality for each group at 5-year follow-up (vs. reference group without limitations). RESULTS: Of 1818 selected individuals, 229 (12.5%) showed FA, 254 (13.9%) showed FC, and 96 (5%) were classified as FU. All these groups showed an increased risk of mortality at 5-year follow-up [adjusted hazard ratio (HR) for FC < FU < FA]. However, the association of FU with mortality remained significant only for highly educated individuals. CONCLUSIONS: Functional impairment was associated with increased mortality rates, regardless of the presence of unawareness. This study extends the role of education in modulating the symptoms and prognosis of individuals at very mild or preclinical dementia stages.

Cognition in non-demented Parkinson's disease vs essential tremor: A population-based study.

OBJECTIVES: Patients with Parkinson's disease (PD) and essential tremor (ET) have a higher risk of cognitive impairment than age-matched controls. Only a few small studies (11-18 subjects per group) have directly compared the cognitive profile of these conditions. Our aim was to compare the cognitive profile of patients with these two conditions to each other and to healthy individuals in a population-based study of non-demented participants. MATERIALS AND METHODS: This investigation was part of the NEDICES study, a survey of the elderly in which 2438 dementia-free participants underwent a short neuropsychological battery. We used nonparametric techniques to evaluate whether there are differences and/or a gradient of impairment across the groups (PD, ET, and controls). Also, we performed a head-to-head comparison of ET and PD, adjusting for age and education. RESULTS: Patients with PD (N=46) and ET (N=180) had poorer cognition than controls (N=2212). An impaired gradient of performance was evident. PD scored lower than ET, and then each of these lower than controls, in memory (P<.05) and verbal fluency (P<.001) tasks. When we compared PD and ET, the former had lower scores in verbal fluency (P<.05), whereas the later had a poorer cognitive processing speed (P<.05). CONCLUSIONS: This large population-based study demonstrates that both conditions influence cognitive performance, that a continuum exists from normal controls to ET to PD (most severe), and that although deficits are in many of the same cognitive domains, the affected cognitive domains do not overlap completely.

The 37 item Version of the Mini-Mental State Examination: Normative Data in a Population-Based Cohort of Older Spanish Adults (NEDICES).

The 37-item version of the Mini-Mental State Examination (MMSE-37) is an extended version of the original test for individuals with low education, which was adapted for different cultures. Despite its favorable psychometric properties, there is a lack of normative data for this instrument. We provide normative data for the MMSE-37 stratified by age, sex, and education in a large population-based cohort of older Spanish adults. The sample consisted of 3,777 participants without dementia (age range: 65-97 years) from different socioeconomic areas of central Spain. Normative data are presented in percentile ranks and divided into nine overlapping age tables with different midpoints, using the overlapping cell procedure. A hierarchical regression was performed to evaluate the effects of sociodemographic variables on MMSE-37 performance. Results showed that age, sex, and education affect test score. The norms presented herein are important for the correct interpretation of MMSE-37 scores when assessing older adults in Spain.

[Spanish versions of the Minimental State Examination (MMSE). Questions for their use in clinical practice]. / Versiones en español del Minimental State Examination (MMSE). Cuestiones para su uso en la practica clinica.

The Minimental State Examination (MMSE), created in 1975 as a tool for briefly evaluating the patient's mental state, has been widely used and is the most frequently cited cognitive test on Medline, as well as being the one with the most versions in different languages (over 70). Through a review of the Medline database, this paper aims to analyse its virtues and shortcomings, in addition to determining its current clinical usefulness, in both the original version and any of its modifications, although here we are mainly concerned with its Spanish adaptations. The MMSE (original or versions) is the most commonly used test for standardised cognitive assessment in the clinical setting, especially in the case of the elderly. It is the test with the most data for screening, staging and monitoring dementias. Yet, because filling it in may take over 10 minutes, it has to compete with shorter, more specific screening tests in the primary care and community setting. In the hospital and specialised setting, there is a need for broader standardised neuropsychological tests that make it possible to detect subtle cognitive disorders in patients with incipient dementia or mild cognitive impairment, as well as to establish a cognitive profile of the different subtypes of dementia. This study proposes a series of recommendations on the clinical use of the Spanish versions of the MMSE in different contexts of application.

TITLE: Versiones en español del Minimental State Examination (MMSE). Cuestiones para su uso en la practica clinica.El Minimental State Examination (MMSE), creado en 1975 como instrumento para la evaluacion breve del estado mental, ha tenido una gran difusion, y es el test cognitivo mas citado en Medline y con mayor numero de versiones idiomaticas (superiores a 70). Este articulo pretende, mediante una revision en la base de datos Medline, analizar sus virtudes y limitaciones, ademas de precisar su utilidad clinica actual, tanto de la version original como de sus modificaciones, principalmente de las adaptaciones al español. El MMSE (original o versiones) es el test mas utilizado para la evaluacion cognitiva estandarizada en el ambito clinico, sobre todo en el anciano. Es el que dispone de mas datos para el cribado, estadiaje y seguimiento de las demencias. Sin embargo, dado que su cumplimentacion puede requerir mas de 10 minutos, ha de competir con tests de cribado mas cortos y especificos en atencion primaria y el medio comunitario. En el ambito hospitalario y especializado, se precisan evaluaciones neuropsicologicas estandarizadas mas amplias que permitan detectar alteraciones cognitivas sutiles en pacientes con demencia incipiente o alteracion cognitiva leve, ademas de establecer un perfil cognitivo de los diferentes subtipos de demencias. Este trabajo realiza una serie de recomendaciones sobre el uso clinico de las versiones españolas del MMSE en diferentes contextos de aplicacion.

Cause of death in mild cognitive impairment: a prospective study (NEDICES).

BACKGROUND AND PURPOSE: Previous studies have reported the occurrence of increased mortality rates among individuals with mild cognitive impairment (MCI), but possible links between MCI subtypes and cause-specific mortality need to be explored. To examine short-term mortality (5 years), long-term mortality (13 years) and cause-specific mortality of individuals over 65 years of age suffering from MCI compared with cognitively unimpaired individuals in the Neurological Disorders in Central Spain (NEDICES) cohort. METHODS: Mild cognitive impairment was classified using standardized psychometric and functional assessment in accordance with diagnostic convention. Cox's proportional hazards models, adjusted by sociodemographics and comorbidity factors, were used to assess the risk of death at 5 and 13 years of MCI subtypes compared with a reference group of older people without cognitive impairment (N = 2329). Causes of death were obtained from the National Population Register of Spain. RESULTS: There were 1484 deceased individuals at 13 years. MCI subtypes were defined as amnestic single domain (N = 259), amnestic multiple domain (N = 197) and non-amnestic (N = 641). After adjusting for covariates, only the amnestic multiple domain MCI subtype showed an increased hazard ratio (HR) for mortality at 5 years versus the reference group. However, the HR for mortality at 13 years was increased for all MCI subtypes. The HR by MCI subtype was 1.19 in the non-amnestic subtype (95% CI 1.05-1.36), 1.31 in the amnestic single domain subtype (95% CI 1.10-1.56) and 1.67 in the amnestic multiple domain subtype (95% CI 1.38-2.02). In terms of cause-specific mortality, the chance of death from dementia was statistically higher in all MCI subtypes. CONCLUSION: Amnestic multiple domain MCI showed the greatest risk of mortality in comparison with other MCI subtypes at different intervals. Dementia was the only cause-specific mortality that was increased in MCI individuals.

El cribado de la demencia en atención primaria. Revisión crítica / Dementia screening in primary care: critical review

Introducción. Los profesionales de atención primaria necesitan herramientas útiles y sencillas que permitan detectar, de manera precoz, el deterioro cognitivo en sujetos bajo sospecha clínica de demencia. Objetivo. Esta revisión crítica persigue analizar las características psicométricas de los test de cribado cognitivo, comúnmente empleados en el cribado de la demencia en atención primaria, que hayan sido adaptados para la población de habla española en la Península Ibérica. Desarrollo. Se ha puesto especial énfasis en aquellos instrumentos que reunían las siguientes características: sencillez en la corrección y tiempo de aplicación breve (menor o igual a 10 min). Se detallan aspectos como la fiabilidad, la validez y, más concretamente, la capacidad de discriminación del instrumento (ancianos con demencia y ancianos sanos). Conclusión. El futuro de la evaluación cognitiva breve en atención primaria requiere la adaptación y validación de nuevos instrumentos con población española, la mejora de la sensibilidad de los test en pacientes con deterioro cognitivo leve y la búsqueda de medidas que tengan una validez transcultural adecuada (AU)

Introduction. Primary care professionals need useful and simple tools to detect early cognitive impairment in patients with any clinical suspicion of dementia. Aim. This critical review attempts to analyze the psychometric properties of cognitive screening tests, commonly used for screening dementia in primary care setting, which have been adapted for Spanish speaking population in the Iberian Peninsula. Development. Special emphasis has been placed on those instruments which met the following criteria: easy correction and short-term application (less than or equal to 10 minuts). Properties such as reliability, validity and especially the discriminating power of the instrument (older people with dementia vs. healthy older adults) have been detailed. Conclusion. The future of brief cognitive assessment in primary care setting requires the adaptation and validation of new tests for the Spanish population, improving the sensitivity of the tests in patients with mild cognitive impairment and searching for measures with an adequate cross-cultural validity (AU)

Depresión en la demencia tipo Alzheimer: ¿existe algún efecto sobre la memoria? / Depression in Alzheimer type-dementia: Is there any efect on memory performance?

Introducción. La depresión es uno de los trastornos neuropsiquiátricos más frecuentes en la enfermedad de Alzheimer (EA). Objetivo. Analizar si la depresión incrementa el deterioro cognitivo de la memoria verbal y no verbal en pacientes con EA temprana. Sujetos y métodos. El estudio comparó el rendimiento de 23 pacientes diagnosticados de EA con y sin depresión, 15 pacientes con depresión mayor unipolar (D) y 20 sujetos control sanos (SC) en tareas de memoria (recuerdo y reconocimiento) para palabras, dibujos sin sentido y posición. El grupo con EA fue estratificado, por la presencia o ausencia de depresión, en dos grupos bien equiparados en cuanto a las características clínicas y sociodemográficas. Resultados. Los pacientes con EA rindieron significativamente peor que los grupos SC y D en las medidas de memoria verbal. Sin embargo, la única medida de memoria no verbal que discriminó entre los pacientes con EA y el grupo D fue el reconocimiento. Los grupos de EA (con y sin depresión) no mostraron diferencias significativas en ninguna de las medidas de memoria estudiadas. Conclusiones. La depresión está asociada con un deterioro significativo de la memoria en pacientes sin demencia. La presencia de la depresión no agrava el deterioro de la memoria en pacientes con EA (AU)

Introduction. Depression is one of the most common neuropsyquiatric disorders in Alzheimer’s disease (AD). Aim. To evaluate whether depression exacerbates verbal and non-verbal memory impairment in early AD patients. Subjects and methods. The study compared the performance of 23 patients who received a diagnosis of AD, with or without depression, 15 patients with unipolar major depression (UD) and 20 healthy control subjects (HS) on memory tasks (recall and recognition) for words, abstract designs and position. AD patients were stratified into two groups, according to the presence or absence of depression, well matched on clinical and sociodemographic characteristics. Results. Patients with AD scored significantly lower than HS and UD groups on verbal memory measures. However, the recognition was the only non-verbal memory measure that discriminated significantly between AD and UD groups. The AD groups (with or without depression) did not show any significant differences on memory performance. Conclusions. Depression is associated with significant memory impairment in non-demented patients. The presence of depression did not increase memory impairment in AD patients (AU)

Meningitis bacteriana recurrente / Recurrent bacterial meningitis

Se revisaron retrospectivamente 524 registros clínicos de pacientes que ingresaron a un hospital metropolitano de Santiago por meningitis bacteriana aguda entre enero de 1983 y diciembre de 1992, con el objeto de identificar a los que sufrieron meningitis aguda bacteriana recurrente, describir la proporción de casos en que ésta ocurre y las causas o factores predisponentes o condicionantes del fenómeno. Se identificaron once pacientes (2,09 por ciento de los ingresados por meningitis aguda bacteriana) con una o mas recurrencias y 25 episodios en total. Todos los afectados fueron citados para evaluarles prospectivamente con exámenes clínicos, radiológicos y de laboratorio, con especial énfasis en los aspectos neurológico, otorrinológico e inmunológico. Un paciente no respondió al llamado, en otro la investigación realizada no permitió identificar un trastorno de base que explicase la reiteración de la infección meníngea. En los nueve restantes se encontraron cuatro casos de defectos de la inmunidad, dos fístulas congénitas del líquido cefalorraquídeo y tres fístulas causadas por traumatismos encefalocraneanos. Las recurrencias pueden evitarse en estos pacientes si se buscan cuidadosamente antecedentes de factores predisponentes en la historia y el examen físico de todo niño con meningitis aguda bacteriana. La investigación, en caso de mas de un episodio, debe incluir evaluaciones neurológica, otorrinológica y de la inmunidad, empleando métodos clínicos, instrumentales (en particular de imágenes simples y contrastadas) y de laboratorio