[Epidemiology of Alzheimer's disease and other dementias]. / Epidemiologia de la enfermedad de Alzheimer y otras demencias.

INTRODUCTION: Dementia is a clinical syndrome resulting from a number of causations and which is usually accompanied by progressive and diffuse brain dysfunction. The different subtypes are characterised by a clinical picture with common symptoms that differ in terms of their aetiology, age, clinical presentation, clinical course and associated disorders. AIM: To present an update on the information available about the descriptive epidemiology of dementia and its main subtypes. DEVELOPMENT: The main data on prevalence, incidence and mortality were extracted from a literature review. Alzheimer's disease is the most frequent subtype and accounts for 60-80% of all the cases, followed by vascular dementia and other neurodegenerative dementias, such as dementia due to Lewy bodies, the dementia-Parkinson complex and frontotemporal dementia. Other subtypes of dementias present frequencies below 1%, and the epidemiological indicators available are not very robust. CONCLUSIONS: The prevalence and incidence of dementia increase exponentially from the age of 65 onwards. As a consequence of the progressive ageing of the population and the increase in life expectancy, the number of cases of dementia will rise in the coming decades. Recent studies point to a slight drop in the accumulated risk of dementia adjusted by age groups and sex over the last few decades in some countries. It is possible that by means of primary prevention strategies implemented upon the known risk factors for dementia the burden of dementia on public health will diminish in the future.

TITLE: Epidemiologia de la enfermedad de Alzheimer y otras demencias.Introduccion. La demencia es un sindrome clinico causado por multiples etiologias y que cursa habitualmente con disfuncion cerebral progresiva y difusa. Los distintos subtipos se caracterizan por un cuadro clinico con sintomas comunes que difieren en su etiologia, edad, forma de presentacion, curso clinico y trastornos asociados. Objetivo. Presentar una actualizacion de la informacion disponible de la epidemiologia descriptiva de la demencia y de sus principales subtipos. Desarrollo. A partir de una revision de la bibliografia, se extraen los principales datos de prevalencia, incidencia y mortalidad. La enfermedad de Alzheimer es el subtipo mas frecuente y representa el 60-80% de todos los casos, seguida de la demencia vascular y de otras demencias neurodegenerativas, como la demencia por cuerpos de Lewy, el complejo demencia-Parkinson y la demencia frontotemporal. Otros subtipos de demencias presentan frecuencias inferiores al 1%, y se dispone de indicadores epidemiologicos poco robustos. Conclusiones. La prevalencia e incidencia de demencia se incrementa a partir de los 65 años de forma exponencial. Como consecuencia del progresivo envejecimiento poblacional y el incremento de la esperanza de vida, el numero de casos de demencia aumentara durante las proximas decadas. Estudios recientes señalan una ligera disminucion del riesgo acumulado de demencia ajustado por grupos de edad y sexo durante las ultimas decadas en algunos paises. Es posible que mediante estrategias de prevencion primaria sobre los factores de riesgo de demencia conocidos en un futuro disminuya la carga de la demencia sobre la salud publica.

Neuroinflammation in obesity: circulating lipopolysaccharide-binding protein associates with brain structure and cognitive performance.

BACKGROUND/OBJECTIVES: Growing evidence implicates neuroinflammation in the pathogenesis of diet-induced obesity and cognitive dysfunction in rodent models. Obesity is associated with reduced white matter integrity and cognitive decline. Circulating lipopolysaccharide binding protein (LBP) concentration is known to be increased in patients with obesity. Here, we aimed to evaluate whether circulating LBP is associated longitudinally with white matter structure and cognitive performance according to obesity status. SUBJECTS/METHODS: This longitudinal study analyzed circulating LBP (ELISA), DTI-metrics (axial diffusivity (L1), fractional anisotropy (FA) and radial diffusivity (RD)) in specific regions of the white matter of 24 consecutive middle-aged obese subjects (13 women) and 20 healthy volunteers (10 women) at baseline and two years later. Digit Span Test (DST) was used as a measure of working memory/short-term verbal memory. RESULTS: Circulating LBP concentration was associated with FA and L1 values of several white matter regions both at baseline and follow-up. The associations remained significant after controlling for age, BMI, fat mass and plasma high sensitivity C-reactive protein. Importantly, the increase in LBP over time impacted negatively on FA and L1 values and on DST performance. CONCLUSIONS: Circulating LBP associates with brain white matter integrity and working memory/short-term verbal memory in both obese and non-obese subjects.

Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano / Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS)

Introducción: La Frontotemporal Dementia Rating Scale (FTD-FRS) es una escala diseñada para facilitar la estadificación clínica y la evaluación de la progresión de pacientes con demencia frontotemporal (DFT). Objetivo: Realizar un estudio multicéntrico de adaptación y validación al castellano de la FTD-FRS. Metodología: La adaptación se realizó mediante 2 procesos de traducción y retrotraducción inglés-español español-inglés y se verificó con los autores originales. El proceso de validación se llevó a cabo en una muestra consecutiva de pacientes diagnosticados de DFT. Se evaluó la consistencia interna, se determinó la unidimensionalidad con el método Rasch, se analizaron la validez de constructo y la validez discriminante, y se calculó el grado de acuerdo entre la Clinical Dementia Rating scale y la FTD-FRS para los casos con DFT. Resultados: Se incluyeron 60 pacientes con DFT. La puntuación media de la FTD-FRS fue de 12,1 puntos (DE = 6,5; rango = 2-25) mostrando diferencias intergrupos (F = 120,3; gl = 3; p < 0,001). El α de Cronbach = 0,897, el análisis de componentes principales de los residuos produjo un aceptable autovalor para 5 contrastes (1,6-2,7) y una varianza respecto al origen del 36,1%. La FTD-FRS correlacionó con el Mini-mental test (r = 0,572; p < 0,001) y capacidad funcional (DAD; r = 0,790; p < 0,001). La FTD-FRS correlacionó significativamente con la Clinical Dementia Rating scale (r = −0,641; p < 0,001) pero se observó variabilidad entre la distribución de la gravedad, siendo valorados como más leves según la Clinical Dementia Rating scale que con la FTD-FRS (kappa = 0,055). Conclusiones: El estudio de traducción y validación al español mostró resultados de validez y unidimensionalidad (gravedad) satisfactorios para el uso de la FTD-FRS en el estudio de la gravedad en pacientes con DFT (AU)

Introduction: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). Objective: Present a multicentre adaptation and validation study of a Spanish version of the FRS. Methodology: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. Results: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD = 6.5; range, 2-25) with inter-group differences (F = 120.3; df = 3; P < .001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r = 0.572; P < .001) and functional capacity (DAD; r = 0.790; P < .001). FTD-FRS also showed a significant correlation with CDR (r = −0.641; P < .001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa = 0.055). Conclusions: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD (AU)

Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS). / Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano.

INTRODUCTION: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). OBJECTIVE: Present a multicentre adaptation and validation study of a Spanish version of the FRS. METHODOLOGY: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. RESULTS: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD=6.5; range, 2-25) with inter-group differences (F=120.3; df=3; P<.001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r=0.572; P<.001) and functional capacity (DAD; r=0.790; P<.001). FTD-FRS also showed a significant correlation with CDR (r=-0.641; P<.001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa=0.055). CONCLUSIONS: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD.

A path analysis of patient dependence and caregiver burden in Alzheimer's disease.

BACKGROUND: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. METHODS: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. RESULTS: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. CONCLUSIONS: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).

OBJECTIVE: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. METHODS: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. RESULTS: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. CONCLUSIONS: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

[Clinical and demographic characteristics of the cases of dementia diagnosed in the Health District of Girona throughout the period 2007-2010: data from the Girona Dementia Registry (ReDeGi)]. / Caracteristicas clinicas y demograficas de los casos de demencia diagnosticados en la Region Sanitaria de Girona durante el periodo 2007-2010: datos del Registro de Demencias de Girona (ReDeGi).

INTRODUCTION: The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District. AIM: To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia. PATIENTS AND METHODS: The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010. RESULTS: A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases. CONCLUSIONS: The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.

Evaluación de la anosognosia en la enfermedad de Alzheimer / Evaluation of anosognosia in Alzheimer’s disease

Objetivos. Comparar la prevalencia de anosognosia en pacientes con enfermedad de Alzheimer (EA) a partir de dos metodologías de evaluación diferentes, analizar el grado de discrepancia entre ambas y determinar las variables asociadasa esta discrepancia. Pacientes y métodos. Estudio transversal y observacional en pacientes con EA. Se administraron el Anosognosia Questionnaire- Dementia (AQ-D) y la Experimenter Rating Scale (ERS). Se registró información clínica y sociodemográfica del pacientey de su cuidador mediante instrumentos estandarizados. Se determinó la prevalencia con cada instrumento y el grado de concordancia entre ambos. Se creó una variable denominada ‘concordancia/no concordancia’ y se ajustó un modelo de regresión logística para determinar las variables asociadas a la discrepancia.Resultados. La prevalencia de anosognosia en los casos leves fue del 13,6% (intervalo de confianza del 95%, IC 95% = 5,5- 21,7) y del 17,3% (IC 95% = 8,4-26,1) y del 44,2% (IC 95% = 28,2-60,2) y 55,8% (IC 95% = 38,8-71,8) en los casos moderados, según la ERS y el AQ-D, respectivamente. El grado de concordancia entre ambas medidas obtuvo un valor kappa de 0,7. El modelo de regresión con la discrepancia entre la ERS y el AQ-D como variable dependiente se asoció a una menor capacidad funcional (odds ratio = -0,080; IC 95% = 0,855-0,997; p = 0,042). Conclusiones. Los datos mostraron un incremento de la prevalencia de anosognosia asociada a la gravedad y una discordancia en su evaluación con dos métodos diferentes cuanto mayor fue el grado de discapacidad funcional del enfermo (AU)

Aims. To compare the prevalence of anosognosia in patients with Alzheimer’s disease (AD) using two different evaluationmethodologies, to analyse the discrepancy between them and to determine the variables associated with this discrepancy. Patients and methods. The methodology involved a cross-sectional, observational study conducted in patients with AD.The Anosognosia Questionnaire-Dementia (AQ-D) and the Experimenter Rating Scale (ERS) were administered. Clinicaland sociodemographic information was recorded about both the patient and his/her caregiver by means of standardised instruments. Prevalence was determined with each instrument and the degree of agreement between them was thenestablished. A variable called ‘agreement/non-agreement’ was created and a logistic regression model was adjusted to determine the variables associated to the discrepancy. Results. The prevalence of anosognosia in the mild cases was 13.6% (95% confidence interval, 95% CI = 5.5-21.7) and17.3% (95% CI = 8.4-26.1), and 44.2% (95% CI = 28.2-60.2) and 55.8% (95% CI = 38.8-71.8) in the moderate cases, according to the ERS and the AQ-D, respectively. The degree of agreement between the two measurements yielded akappa-value of 0.7. The regression model with the discrepancy between the ERS and the AQ-D as the dependent variable was associated to a lower functional capacity (odds ratio = 0.080; 95% CI = 0.855-0.997; p = 0.042). Conclusions. The data from the study showed an increase in the prevalence of anosognosia linked to the severity and a higher disagreement in its evaluation with two different methods as the degree of the patient’s functional disabilityincreased (AU)

[Drug consumption and cognitive function in non-institutionalized elderly: a population-based study]. / Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada.

BACKGROUND: Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption. METHODS: This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants' medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. RESULTS: A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD=2.9) and 5.2 (SD=3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD=2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P=0.003) and nervous system (P=0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P <0.05). CONCLUSIONS: Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption.

Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada / Drug consumption and cognitive function in non-institutionalized elderly: A population-based study

Introducción: El consumo de fármacos en la población general se concentra en las personas de edad avanzada. El objetivo del presente estudio fue valorar el perfil farmacológico en ancianos de 75 años y mayores, estimar la relación con la función cognoscitiva y las variables asociadas al consumo farmacológico. Métodos: Estudio epidemiológico transversal y poblacional puerta a puerta de una muestra de población rural no institucionalizada representativa de los habitantes mayores de 74 años del Área Básica de Salud de Anglès (Girona). La prescripción farmacológica se registró a partir de los medicamentos presentes en el domicilio de los participantes. La función cognoscitiva se evaluó mediante el Mini-Mental State Examination. Resultados: Participaron 875 individuos (82%). Los participantes con deterioro cognoscitivo leve y moderado consumían una media de 4,6 (DE=2,9) y 5,2 (DE=3,2) fármacos, superior a los 4 (DE=2,7) fármacos de media consumidos por los que no sufrían deterioro cognoscitivo (p < 0,05). En el análisis bivariante, según el grado de deterioro cognoscitivo existía una variación en el consumo de fármacos del aparato digestivo y metabolismo (p=0,003) y del sistema nervioso (p=0,001). El análisis multivariante identificó cuatro variables asociadas al consumo de fármacos del sistema nervioso: edad, sexo, comorbilidad y sospecha de depresión (p<0,05).Conclusiones: Los participantes con deterioro cognoscitivo grave presentaron una mayor frecuencia de consumo de antipsicóticos y otros antidepresivos. Sin embargo, el análisis multivariante señala que son la edad avanzada, el sexo femenino y la sospecha de depresión las variables asociadas a un mayor consumo de fármacos del sistema nervioso (AU)

Background: Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption.Methods: This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants’ medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. Results: A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD=2.9) and 5.2 (SD=3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD=2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P=0.003) and nervous system (P=0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P <0.05).Conclusions: Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption (AU)

Incidence and subtypes of early-onset dementia in a geographically defined general population.

OBJECTIVE: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. METHODS: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km(2) and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. RESULTS: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30-64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3-15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. CONCLUSIONS: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30-49 years; in the age group 50-64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase.

Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers.

BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.

Ejercicio físico y calidad de vida autopercibida en el anciano hipertenso / Physical exercise and quality of self-perceived life in the hypertensive elderly subject

Objetivo. Determinar la relación entre el ejercicio físico y la calidad de vida (CdV) autopercibida en pacientes hipertensos mayores de 70 años.DiseñoEstudio transversal y analítico de una muestra de pacientes ambulatorios que acudieron a las consultas de atención primaria de los investigadores.Material y métodoSe incluyeron pacientes de 70 años de edad o mayores, diagnosticados de hipertensión arterial (HTA). Se excluyeron los pacientes institucionalizados o los que no cumplían los criterios del estudio. A todos los participantes se les efectuó analítica, valoración de la comorbilidad y exploración física básica que incluyó la medida de la presión arterial estandarizada. La actividad física se cuantificó en metabolic equivalents (METS) semanales mediante un cuestionario validado. La CdV se midió mediante el cuestionario de autopercepción de la salud de 12 ítems (SF-12).ResultadosSe incluyeron 191 pacientes (edad 77,8 años; el 58,1% mujeres). Media de 1.837 METS semanales (DE: 1.906,5). La CdV según el cuestionario SF-12, 43,2 para la dimensión fisica y 52,4 para la psíquica. La puntuación de la CdV fue inferior en los pacientes situados en los cuartiles inferiores de ejercicio físico (p<0,02). El ejercicio físico a partir de 1.635 METS por semana y la comorbilidad se asociaron de forma independiente con el componente físico de la CdV, mientras que el ejercicio físico a partir de 840 METS semanales, el sexo, la comorbilidad, el HDL colesterol y la diabetes tipo 2 lo hicieron con el componente psíquico de la CdV.ConclusionesExiste una asociación independiente entre la práctica de ejercicio físico y la CdV autopercibida en los pacientes hipertensos mayores de 70 años. El nivel de ejercicio que recomienda la Guía Europea de HTA se asocia a una mejor percepción del componente psíquico de la CdV, mientras que para el componente físico es necesario un nivel más elevado de ejercicio(AU)

Objective. Determine the relationship between physical exercise and self-perceived quality of life in hypertensive patients over 70 years of age.DesignCross-sectional and analytic study of a sample of out-patients who came to the investigators’ primary care medical offices.Material and methodPatients of 70 years or older diagnosed of arterial hypertension were included. Those institutionalized or who did not meet the study criteria were excluded. All the participants underwent laboratory analysis, evaluation of comorbidity, basic physical examination that included measurement of standardized blood pressure. Physical activity was quantified in metabolic equivalents (METS) per week using a validated questionnaire. Quality of life was measured with the SF-12 questionnaire.ResultsA total of 191 patients (age 77.8 y; 58.1% women) were included. Mean of 1837 METS per week (SD:1906.5) .Quality of life SF-12, 43.2 for the physical dimension and 52.4 for the psychic one. Quality of life score was lower in the patients located in the lower quartiles of physical exercise (p<0.02). Physical exercise after 1635 METS per week and comorbidity were associated independently with the physical component of quality of life while physical exercise after 840 METS per week, gender, comorbidity, HDL cholesterol and type 2 diabetes did so with the psychic component of quality of life.ConclusionsThere is an independent association between the practice of physical exercise and self-perceived quality of life in hypertensive patients over 70 years. The exercise level recommended by the European Guide of AHT is associated with a better perception of the psychic component of quality of life while a higher exercise level is necessary for the physical one(AU)

[Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona]. / Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona.

AIM: To perform a descriptive analysis of the outpatient activity in a neurological department in terms of the frequency and type of neurological diseases that were attended. PATIENTS AND METHODS: A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerised hospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the International Classification of Diseases, 10th edition (CIE-10). RESULTS: The mean age was 60.6 +/- 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year 2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The most common diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies. CONCLUSIONS: The frequency of visits increases with age and the order, in terms of frequency, was: episodic and paroxysmal, degenerative and demyelinating, psychotic and behavioural disorders, and extrapyramidal syndromes.

Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona / Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona

Objetivo. Análisis descriptivo de la actividad ambulatoria en un servicio de neurología en relación con la frecuenciay tipo de enfermedades neurológicas atendidas. Pacientes y métodos. Estudio retrospectivo y trasversal de los pacientesremitidos a la consulta ambulatoria de neurología. Se registraron consecutivamente los casos visitados por primera vez durantelos años 2006 y 2007. Se evaluó la documentación médica a partir de los registros hospitalarios informatizados, recogiéndose:zona de salud de referencia, fecha de visita, edad, sexo y diagnóstico según la Clasificación Internacional de Enfermedades,9.ª edición, modificación clínica (CIE-9-MC), reconvertida a la Clasificación Internacional de Enfermedades, 10.ªedición (CIE-10). Resultados. La media de edad fue de 60,6 ± 20,9 años (rango: 4-95 años) y el 61,4% fueron mujeres. El índicede frecuentación fue de 4,3 solicitudes/1.000 habitantes para el año 2006 y de 3,9 para el año 2007, y se observó unincremento con la edad para las enfermedades neurodegenerativas. Respecto a la CIE-10, las enfermedades se clasificaroncomo episódicas y paroxísticas (25%), degenerativas y desmielinizantes (18,6%), trastornos mentales orgánicos (14,7%), síndromesextrapiramidales (10,5%), enfermedades de la circulación cerebral (3,5%), trastornos relacionados con el estrés y somatomorfos(3,5%) y enfermedades del oído interno (3,3%). Las demás patologías no alcanzaron el 3%. El 61% de los pacientespresentó enfermedades del sistema nervioso central y el 20,3%, trastornos psiquiátricos. Las enfermedades más frecuentesfueron los trastornos cognitivos (31,5%), las cefaleas (18,6%) y los trastornos del movimiento (11,7%), seguidas delas enfermedades psiquiátricas, epilepsias, enfermedades cerebrovasculares y neuropatías(AU)

Aim. To perform a descriptive analysis of the outpatient activity in a neurological department in terms of thefrequency and type of neurological diseases that were attended. Patients and methods. A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerisedhospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the InternationalClassification of Diseases, 10th edition (CIE-10). Results. The mean age was 60.6 ± 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The mostcommon diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies(AU)

Prevalencia y evolución del delirium en una muestra comunitaria de 70 años y más / Prevalence and evolution of delirium in a community population of 70 years and older

Introducción. Existen numerosos estudios sobre el delirium con muestras clínicas e institucionalizadas, pero son escasos con muestras comunitarias. El objetivo del estudio fue determinar la prevalencia de delirium en una muestra comunitaria y la supervivencia en un período de 5 años. Método. Estudio de casos y controles y de supervivencia a partir de los datos de un estudio epidemiológico para determinar la prevalencia de demencia y su incidencia tras 5 años en ocho municipios de la provincia de Girona. Se aplicaron criterios DSM-IV para identificar los casos de delirium en el estudio de prevalencia a partir de la información recogida mediante el Cambridge Mental Disorders of the Elderly Examination. Se aplicaron técnicas de contraste de hipótesis para comparar las características de los participantes según la presencia o ausencia de delirium. Se utilizó la técnica de Kaplan- Meier para estimar la supervivencia de los participantes y un modelo de regresión multivariante de Cox para determinar el efecto del delirium sobre la mortalidad a los 5 años. Resultados. Participaron 1.460 habitantes mayores de 69 años y se detectaron 14 casos de delirium que representaron una prevalencia del 0,96 % (intervalo de confianza [IC] 95%: 0,43-1,49). La supervivencia media para los participantes con delirium fue de 3 años (IC 95%: 1,9-4,1) y fue significativamente inferior a la de los controles sanos. La presencia de delirium incrementó en 2,65 el riesgo de mortalidad a los 5 años. Conclusiones. La prevalencia de delirium en muestras comunitarias es baja y la mayoría de los casos está superpuesto a una demencia. Los pacientes con delirium tienen un mayor riesgo de mortalidad a los 5 años (AU)

Introduction. There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. Method. Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. Results. 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. Conclusion. The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period (AU)

[A longitudinal study of apathy in patients with Alzheimer's disease]. / Estudio longitudinal de la apatía en pacientes con enfermedad de Alzheimer.

INTRODUCTION: Apathy is the most common behavioral symptom in Alzheimer's disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months. PATIENTS AND METHODS: Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathy NPI score was taken in to account in the study when it was equal or more than 4. RESULTS: The sample size consisted of 155 subjects with a mean age of 77.1 +/- 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores. CONCLUSION: The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI total score was observed when an increased apathy NPI score is observed.

Estudio longitudinal de la apatía en pacientes con enfermedad de Alzheimer / A longitudinal study of apathy in patients with alzheimer's disease

Introducción. Uno de los trastornos conductuales más frecuentes en la enfermedad de Alzheimer (EA) es la apatía. El objetivo de este estudio fue determinar la prevalencia de apatía en pacientes con EA en fases iniciales y su evolución tras 12 meses de seguimiento. Pacientes y métodos. Estudio observacional longitudinal en pacientes con EA. Se administró el Cambridge-Cognitive Revised (CAMCOG-R), la Disability Assessment in Dementia (DAD) y el inventario neuropsiquiátrico (NPI), y se recogieron de manera estructurada las características sociodemográficas. Se valoró la presencia de apatía en pacientes con una puntuación en la subescala del NPI mayor o igual a 4 puntos. Resultados. La muestra estuvo formada por 155 pacientes,con una media de edad de 77,1 ± 6,7 años, y un 67,7% fueron mujeres. La prevalencia de apatía fue del 18,7%; a los 12 meses, la persistencia fue del 51,7% y la remisión, del 48,3%. La incidencia fue del 21,4%. Se observaron diferencias en el momento basal entre los pacientes con y sin apatía en el CAMCOG-R (p = 0,001), en la DAD (p < 0,001) y en el NPI (p < 0,001). Al año no se observaron diferencias según edad ni sexo. Según los índices de variación porcentual, a los 12 meses se observaron diferencias en la iniciativa y ejecución funcional y en el NPI. Conclusiones. La apatía aumenta con la evolución de la EA, a la vez que se asocia a mayor discapacidad funcional, sobre todo en iniciativa y capacidad ejecutiva. Se observó un aumentode la puntuación de las otras subescalas del NPI asociado al incremento de la apatía

Introduction. Apathy is the most common behavioral symptom in Alzheimer’s disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months. Patients and methods. Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathyNPI score was taken in to account in the study when it was equal or more than 4. Results. The sample size consisted of 155 subjects with a mean age of 77.1 ± 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores. Conclusion. The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI totalscore was observed when an increased apathy NPI score is observed

[Prevalence and evolution of delirium in a community population of 70 years and older]. / Prevalencia y evolución del delirium en una muestra comunitaria de 70 años y más.

INTRODUCTION: There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. METHOD: Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. RESULTS: 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. CONCLUSION: The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period.