Functional, Clinical, and Sociodemographic Variables Associated with Risk of In-Hospital Mortality by COVID-19 in People over 80 Years Old.

OBJECTIVES: The objective is to assess the role of functional, clinical, and analytic parameters in predicting mortality in older patients hospitalized due to COVID-19. DESIGN: Cohort study with a mean follow-up of 12.8 days. SETTING: Public university hospital (Madrid, Spain). PARTICIPANTS: 499 patients 80 and above consecutively admitted to a Spanish public university hospital between 4 March 2020 and 16 May 2020. MEASUREMENTS: Mortality was the main outcome. Data of sociodemographic variables (age, sex, living), comorbidities, polypharmacy, functional status, date of hospital admission and length of stay was recorded. Clinical symptoms, laboratory and X-ray findings were collected at time of admission. For multivariant analysis, logistic regressions were performed to identify risk factors for death. RESULTS: Mean age was 86.7±4.4 with 37% of death. Mortality was associated with male gender [odds ratio (OR) 1.50; 95% confidence interval (CI) 1.01-2.24], with a 5-points increase on Barthel Index [OR 1.01 (95%CI 1.00-1.02)], higher Charlson Index score [OR 1.13 (95%CI 1.02-1.26)] and comorbidities [OR 1.28 (95%CI 1.06-1.53)], hyperpolipharmacy [OR 2.00 (95%CI 1.04-3.82)], unilateral pneumonia [OR 1.83 (95%CI 1.01-3.30)], higher levels of C-reactive protein [OR 1.09 (95%CI 1.06-1.12)] and creatine [OR 1.48 (95%CI 1.15-1.89)]. Higher oxygen levels were a protective factor [OR 0.92 (95%CI 0.89-0.95)]. CONCLUSIONS: Functional status, being male, a higher burden of comorbidities, hyperpolipharmacy, unilateral pneumonia and some laboratory parameters predict in-hospital mortality in this older population. The knowledge of these mortality risk factors should be used to improve the survival of older hospitalized patients.

Programa de intervención en pacientes mayores frágiles dados de alta desde urgencias / Intervention programme for elderly frail patients discharged from the emergency department

No disponible

Microhemorragias cerebrales: epidemiología e implicaciones clínicas / Brain microbleeds: Epidemiology and clinical implications

INTRODUCCIÓN: Las microhemorragias cerebrales (MHC) son depósitos de hemosiderina, fagocitados por macrófagos, que se visualizan como imágenes hipointensas en determinadas secuencias de adquisición T2 de resonancia magnética cerebral. Existen muchas incógnitas acerca de su fisiopatología y significado clínico. DESARROLLO: Revisión bibliográfica de los principales estudios epidemiológicos, clínicos y anatomopatológicos de MHC en la población general, en pacientes con enfermedad o riesgo vascular y en pacientes con deterioro cognitivo. Descripción de la prevalencia, factores de riesgo, mecanismos fisiopatológicos y posibles implicaciones clínicas de las MHC. CONCLUSIONES: La prevalencia de las MHC es muy variable (3-27% en la población general, 6-80% en pacientes con enfermedad o riesgo vascular, 16-45% en pacientes con deterioro cognitivo). Las MHC se asocian a la edad, a la enfermedad de Alzheimer y, en particular, a la enfermedad vascular (hemorrágica o isquémica) cerebral. El sustrato patológico es la lipohialinosis (MHC subcorticales) o la angiopatía amiloide cerebral (MHC lobulares). Las MHC contribuyen al deterioro cognitivo, posiblemente a través de una desconexión córtico-subcortical e intracortical, y se asocian a una mayor mortalidad, especialmente de causa vascular. Las MHC aumentan el riesgo de sufrir hemorragia cerebral, especialmente en pacientes con múltiples MHC lobulares (probable angiopatía amiloide cerebral), por lo que el tratamiento anticoagulante podría estar contraindicado en estos pacientes. En pacientes con menor riesgo de sangrado, los nuevos anticoagulantes orales y la realización de un seguimiento combinado -clínico y mediante resonancia magnética- podrían ser útiles en la toma de decisiones

INTRODUCTION: Brain microbleeds (BMB) are haemosiderin deposits contained within macrophages, which are displayed as hypointense images in some T2-weighted magnetic resonance imaging sequences. There are still many questions to be answered about the pathophysiology and clinical relevance of BMB. DEVELOPMENT: We conducted a literature review of the main epidemiological, clinical, and anatomical pathology studies of BMB performed in the general population, in patients at risk of or already suffering from a vascular disease, and in patients with cognitive impairment. We analysed the prevalence of BMB, risk factors, and potential pathophysiological mechanisms and clinical implications. CONCLUSIONS: The prevalence of BMB is highly variable (3%-27% in the general population, 6%-80% in patients with vascular risk factors or vascular disease, and 16%-45% in patients with cognitive impairment). BMB are associated with ageing, Alzheimer disease (AD), and in particular haemorrhagic or ischaemic cerebrovascular disease. The pathological substrate of BMB is either lipohyalinosis (subcortical BMB) or cerebral amyloid angiopathy (lobar BMB). BMB exacerbate cognitive impairment, possibly through cortical-subcortical and intracortical disconnection, and increase the risk of death, mostly due to vascular causes. BMB also increase the risk of cerebral haemorrhage, particularly in patients with multiple lobar BMB (probable erebral amyloid angiopathy). Therefore, anticoagulant treatment may be contraindicated in these patients. In patients with lower risk of bleeding, the new oral anticoagulants and the combination of clinical and magnetic resonance imaging follow-up could be helpful in the decision-making process

Intervención multidimensional que mejora el pronóstico a corto plazo entre los ancianos frágiles dados de alta desde una unidad de corta estancia: estudio cuasiexperimental / Multidimensional intervention to improve the short-term prognosis of frail elderly patients discharged from a short-stay unit: A quasiexperimental study

Objetivo. Estudiar el efecto de una intervención multidimensional en el pronóstico a 30 días en los ancianos frágiles dados de alta desde una unidad de corta estancia. Material y método. Estudio cuasiexperimental con una cohorte de control histórica. Se incluyeron pacientes frágiles (Identification of Senior at Risk≥2), de≥75 años, dados de alta desde la unidad de corta estancia durante 2 meses en 2013 (grupo control) y un año (2016; grupo de intervención). Se realizó una intervención basada en la activación de recursos, en función de los déficits detectados tras una valoración geriátrica abreviada, más la coordinación con Atención Primaria. La variable de resultado principal fue la presencia de algún resultado adverso (muerte o reingreso por cualquier causa o deterioro funcional grave) a los 30 días del alta. Resultados. Se incluyeron 137 (62,8%) pacientes en el grupo de intervención y 81 (37,2%) en el control. Dieciocho (13,1%) pacientes en el grupo de intervención y 29 (35,8%) en el control presentaron algún evento adverso a los 30 días. Tras un análisis multivariable, se demostró que la realización de una intervención multidimensional fue un factor de protección para la presentación de algún evento adverso a los 30 días tras el alta (RR ajustado 0,40; IC 95% 0,23-0,68; p=0,001). Conclusiones. La realización de un plan de atención individualizado, basado en la activación de recursos, en función de los déficits detectados tras una valoración geriátrica abreviada, y la coordinación con Atención Primaria, entre los pacientes ancianos frágiles podría mejorar los resultados a los 30 días tras el alta desde una UCE

Objective. To study the effect of a multidimensional intervention on the prognosis at 30 days for frail elderly patients discharged from a short-stay unit. Material and method. A quasiexperimental study was conducted with a historical control cohort. We included frail patients (Identification of Seniors at Risk score≥2) 75 years of age or older, discharged from an short-stay unit over 2 months in 2013 (control group) and in 2016 (intervention group). An intervention was conducted based on the activation of resources, based on the deficiencies detected after an abbreviated geriatric assessment, in conjunction with Primary Care. The main endpoint was the presence of an adverse result (death or readmission for any cause or severe functional impairment) at 30 days of discharge. Results. We included 137 (62.8%) patients in the intervention group and 81 (37.2%) in the control group. Eighteen (13.1%) patients in the intervention group and 29 (35.8%) in the control group presented an adverse event at 30 days. A multivariate analysis showed that the implementation of a multidimensional intervention was a protective factor for presenting an adverse event at 30 days of discharge (adjusted RR 0.40; 95% CI 0.23-0.68; P=.001). Conclusions. The implementation of an individual care plan for frail elderly patients, based on the activation of resources according to the deficiencies detected after an abbreviated geriatric assessment and in conjunction with Primary Care, could improve the results at 30 days of discharge from an short-stay unit

Multidimensional intervention to improve the short-term prognosis of frail elderly patients discharged from a short-stay unit: A quasiexperimental study. / Intervención multidimensional que mejora el pronóstico a corto plazo entre los ancianos frágiles dados de alta desde una unidad de corta estancia: estudio cuasiexperimental.

OBJECTIVE: To study the effect of a multidimensional intervention on the prognosis at 30 days for frail elderly patients discharged from a short-stay unit. MATERIAL AND METHOD: A quasiexperimental study was conducted with a historical control cohort. We included frail patients (Identification of Seniors at Risk score≥2) 75 years of age or older, discharged from an short-stay unit over 2 months in 2013 (control group) and in 2016 (intervention group). An intervention was conducted based on the activation of resources, based on the deficiencies detected after an abbreviated geriatric assessment, in conjunction with Primary Care. The main endpoint was the presence of an adverse result (death or readmission for any cause or severe functional impairment) at 30 days of discharge. RESULTS: We included 137 (62.8%) patients in the intervention group and 81 (37.2%) in the control group. Eighteen (13.1%) patients in the intervention group and 29 (35.8%) in the control group presented an adverse event at 30 days. A multivariate analysis showed that the implementation of a multidimensional intervention was a protective factor for presenting an adverse event at 30 days of discharge (adjusted RR 0.40; 95% CI 0.23-0.68; P=.001). CONCLUSIONS: The implementation of an individual care plan for frail elderly patients, based on the activation of resources according to the deficiencies detected after an abbreviated geriatric assessment and in conjunction with Primary Care, could improve the results at 30 days of discharge from an short-stay unit.

Brain microbleeds: Epidemiology and clinical implications. / Microhemorragias cerebrales: epidemiología e implicaciones clínicas.

INTRODUCTION: Brain microbleeds (BMB) are haemosiderin deposits contained within macrophages, which are displayed as hypointense images in some T2-weighted magnetic resonance imaging sequences. There are still many questions to be answered about the pathophysiology and clinical relevance of BMB. DEVELOPMENT: We conducted a literature review of the main epidemiological, clinical, and anatomical pathology studies of BMB performed in the general population, in patients at risk of or already suffering from a vascular disease, and in patients with cognitive impairment. We analysed the prevalence of BMB, risk factors, and potential pathophysiological mechanisms and clinical implications. CONCLUSIONS: The prevalence of BMB is highly variable (3%-27% in the general population, 6%-80% in patients with vascular risk factors or vascular disease, and 16%-45% in patients with cognitive impairment). BMB are associated with ageing, Alzheimer disease (AD), and in particular haemorrhagic or ischaemic cerebrovascular disease. The pathological substrate of BMB is either lipohyalinosis (subcortical BMB) or cerebral amyloid angiopathy (lobar BMB). BMB exacerbate cognitive impairment, possibly through cortical-subcortical and intracortical disconnection, and increase the risk of death, mostly due to vascular causes. BMB also increase the risk of cerebral haemorrhage, particularly in patients with multiple lobar BMB (probable erebral amyloid angiopathy). Therefore, anticoagulant treatment may be contraindicated in these patients. In patients with lower risk of bleeding, the new oral anticoagulants and the combination of clinical and magnetic resonance imaging follow-up could be helpful in the decision-making process.

In-hospital mortality risk score for very old patients hospitalized with decompensated chronic heart failure.

OBJECTIVE: To derive a risk score to predict in-hospital mortality for very old patients with decompensated chronic heart failure (DCHF). METHODOLOGY: Retrospective cohort study that included patients ≥ 80 years admitted to a Geriatric Acute Care Unit with DCHF between January 2012 and December 2014. We analyzed 70 candidate risk factors and in-hospital mortality. We derived a risk model using multivariate logistic regression model and constructed a scale for scoring risk. We used bootstrapping techniques for the internal validation. RESULTS: We included 629 patients with mean age of 90 (SD5) years, 470 (73.1%) being women. Eighty-six (13.7%) patients died during the hospitalization. Factors included in the final risk model were NYHA class III-IV, severe functional dependence (Katz activities of daily living index < 2), infection as cause of exacerbation of heart failure, number of medications ≥ 8, albumin < 3 mg/dL, glomerular filtration rate < 60 mL/min, level of potassium in blood > 5.5 mEq/L and red blood cell distribution width (RDW) > 17%. In-hospital mortality in risk groups was 3.0, 4.6, 9.5, 15.1 and 36.3%, respectively. The area under ROC curve risk for score after bootstrapping was 0.77 (95%: CI 0.70-0.83). CONCLUSION: This risk score could be useful for stratifying risk for in-hospital mortality among very old patients admitted to hospital for DCHF.

[Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update]. / Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017.

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding anti-pneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved.

Resumen del Consenso sobre la Vacunación Antineumocócica en el Adulto por Riesgo de Edad y Patología de Base. Actualización 2017 / No disponible

En el año 2013 algunas de las Sociedades Científicas más directamente relacionadas con los grupos de riesgo para padecer enfermedad neumocócica publicamos un documento de Consenso con una serie de recomendaciones basadas en las evidencias científicas respecto a la vacunación antineumocócica en el adulto con condiciones especiales y patología de base. Se estableció un compromiso de discusión y actualización ante la aparición de nuevas evidencias. Fruto de este trabajo de revisión, en abril de 2017 se ha publicado una actualización del anterior documento junto a 4 nuevas Sociedades Científicas donde destaca, entre otras novedades, la recomendación de vacunación por criterio de edad. Se resumen algunas de las principales novedades que presenta la actualización del documento de Consenso

In the year 2013 some of the most directly related to groups of risk of presenting IPD Scientific Societies published a series of vaccine recommendations based on scientific evidence regarding anti-pneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. In april 2017 an exhaustive revision over the previous document was published focusing mainly in recommendation by age. We review some of the main changes in the new Consensus document

Recomendaciones de bebida e hidrataciónpara la población española / Spanish guidelines for hydration

El agua contenida en los alimentos junto con la que bebemos y el resto de los líquidos que ingerimos, tienen que garantizar nuestra correcta hidratación en todas las edades y circunstancias vitales. En consecuencia, es muy importante que su consumo tenga asegurada la calidad y la cantidad. La ingestión adecuada de agua total se ha establecido para prevenir los efectos deletéreos de la deshidratación que incluyen trastornos funcionales y metabólicos. Es conocido como el grado de hidratación puede influir sobre la salud y el bienestar de las personas. En la mujer embarazada, una parte importante del aumento de su peso se produce a expensas del incremento del volumen plasmático. En el caso de la lactancia, resulta obvia la importancia de mantener una ingesta hídrica adecuada si queremos preservar localidad y cantidad de la leche y, por lo tanto, el estado nutricional del niño y de la madre. En el caso del niño, su balance hídrico tiene que estar equilibrado a través de aportaciones cotidianas suficientes. Las necesidades basales de líquidos en los mayores se cifran en torno a 30-35 mL por Kilogramo de peso y día. Hay circunstancias que incrementan las necesidades de líquidos del organismo como el estrés, la actividad y el ejercicio físico, el aumento de la temperatura ambiental ,la fiebre, las pérdidas de líquidos por vómitos y/o diarreas, la diabetes descompensada, las quemaduras, etc. Los factores que condicionan el ejercicio en relación con la hidratación son: las características del ejercicio, las condiciones ambientales, las características individuales, el acostumbramiento a las condiciones climáticas externas, el entrenamiento, el umbral y la capacidad de sudoración. Todo ello hace que resulte muy conveniente instaurar unas Guías directrices que puedan orientar a los consumidores, así como a los distintos profesionales dela salud, sobre lo que resulta más adecuado beber o aconsejar beber en cada momento (AU)

Water is a natural resource essential to life and essential in our daily food. The water contained in food which along with liquids we drink and the rest we eat, we have to ensure proper hydration in all ages and life circumstances. It is very important that its consumption has ensured the quality and quantity. The adequate intake of total water has been established to prevent the deleterious effects of dehydration (especially acute effects) that include functional and metabolic disorders. It is known that the degree of hydration can influence the health and welfare of people, including his mental concentration and other cognitive aspects, their physical performance and heat tolerance. In pregnant women, an important part of its increasing weight occurs at the expense of the volume plasma increase. In the case of breastfeeding, if we consider that approximately 87-90% the composition of milk is water, it is obvious the importance of maintaining an adequate water intake if we want to preserve the quality and quantity of milk and, hence, the nutritional status of children and mothers. In the case of children, their water balance has to be balanced through sufficient contributions every day, especially in the early stages of life where they are most vulnerable to fluids and electrolytes imbalances. Children -especially infants and those who start walking-are at increased risk, even deadly, dehydration than adults. The factors that determine the exercise in relation to the hydration are the characteristics of the exercise, environmental conditions, individual characteristics, accustomed to external weather conditions, training, and capacity threshold of sweating. In recent years, besides the traditional beverages, a wide range of new drinks that often have a significant caloric value, have proliferated in the marketplace for. This makes it highly desirable to establish some guidelines (AU)

Increased biomagnetic activity in the ventral pathway in mild cognitive impairment.

OBJECTIVE: Mild cognitive impairment (MCI) patients represent an intermediary state between healthy aging and dementia. MCI activation profiles, recorded during a memory task, have been studied either through high spatial resolution or high temporal resolution techniques. However, little is known about the benefit of combining both dimensions. Here, we investigate, by means of magnetoencephalography (MEG), whether spatio-temporal profiles of neuromagnetic activity could differentiate between MCI and age-matched elderly participants. METHODS: Taking the advantage of the high temporal resolution and good spatial resolution of MEG, neuromagnetic activity from 15 elderly MCI patients and 20 age-matched controls was recorded during the performance of a modified version of the Sternberg paradigm. RESULTS: Behavioral performance was similar in both groups. A between group analysis revealed that MCI patients showed bilateral higher activity in the ventral pathway, in both the target and the non-target stimuli. A within-group analysis of the target stimuli, indicates a lack of asymmetry through all late latency windows in both groups. CONCLUSIONS: MCI patients showed a compensatory mechanism represented by an increased bilateral activity of the ventral pathway in order to achieve a behavioral performance similar to the control group. SIGNIFICANCE: This spatio-temporal pattern of activity could be another tool to differentiate between healthy aging and MCI patients.

[Pain management in elderly people in primary care (ADA Study)]. / Manejo del dolor del anciano en Atención Primaria (Estudio ADA).

OBJECTIVE: The main purpose of this study is to obtain information concerning type, clinical evaluation and therapeutic management of pain in elderly people in a Primary Care setting. METHODOLOGY: Observational prospective study, conducted in the Primary Care setting in elderly patients, who were attended in the doctor's office with pain as main or secondary symptom. A total of 213 physicians and 1120 patients have participated in the study. Demographic data and clinical characteristics, pain intensity (as measured by Visual Analogical Scale -VAS-), diagnostic methods, treatments and sanitary resources used have been collected. RESULTS: Pain was the main reason for visiting the physician in 86.2% of patients. The main characteristics of pain were: nociceptive pain (80.8%), lower limbs location (43.5%), degenerative etiology (71.8%) and chronic (67,7%). Pain intensity, as measured by VAS, was 7.1 +/- 1.3. Degree of satisfaction with previous analgesic treatments was good/very good in 30% of patients. The analgesics most frequently prescribed in this study were paracetamol (87.4%) and NSAID (51.2%). DISCUSSION: Chronic nociceptive pain of degenerative etiology, and not very satisfactory response with previous treatments are the main characteristics of the elderly patient with pain that were attended by the Primary Care physician.

Manejo del dolor del anciano en Atención Primaria (Estudio ADA) / Pain management in elderly people in primary care (ADA Study)

Objetivo. El objetivo de este estudio es conocer la tipología, la valoración clínica, el abordaje diagnóstico y el manejo terapéutico del dolor que los médicos de atención primaria realizan en población anciana. Metodología. Estudio prospectivo observacional realizado en atención primaria sobre pacientes ancianos que acuden a la consulta con dolor como motivo principal o acompañante. En el estudio participan un total de 213 médicos que aportan datos sobre 1.120 pacientes. Se recogen datos demográficos, clínicos, intensidad del dolor mediante la escala analógica visual, métodos diagnósticos, tratamientos y recursos sanitarios utilizados. Resultados. El dolor como motivo principal de consulta aparece en el 86,2% de los casos. Las características más frecuentes del dolor son: tipo nociceptivo (80,8%), de localización en miembros inferiores (43,5%), de etiología degenerativa (71,8%) y de evolución crónica (67,7%). La intensidad del dolor mediante la escala analógica visual era de 7,1 ± 1,3. El grado de satisfacción con tratamientos analgésicos previos fue bueno/muy bueno en el 30% de los pacientes. Los fármacos más utilizados en el presente estudio han sido paracetamol (87,4%) y antiinflamatorios no esteroideos (51,2%). Discusión. El dolor crónico, de tipo nociceptivo, de etiología degenerativa y con una respuesta no muy satisfactoria a los tratamientos previos, configuran el perfil del paciente anciano con dolor que acude a la consulta del médico de atención primaria (AU)

Pain management in elderly people in primary care (ADA Study) Objective. The main purpose of this study is to obtain information concerning type, clinical evaluation and therapeutic management of pain in elderly people in a Primary Care setting. Methodology. Observational prospective study, conducted in the Primary Care setting in elderly patients, who were attended in the doctor's office with pain as main or secondary symptom. A total of 213 physicians and 1120 patients have participated in the study. Demographic data and clinical characteristics, pain intensity (as measured by Visual Analogical Scale -VAS-), diagnostic methods, treatments and sanitary resources used have been collected. Results. Pain was the main reason for visiting the physician in 86.2% of patients. The main characteristics of pain were: nociceptive pain (80.8%), lower limbs location (43.5%), degenerative etiology (71.8%) and chronic (67,7%). Pain intensity, as measured by VAS, was 7.1 ± 1.3. Degree of satisfaction with previous analgesic treatments was good/very good in 30% of patients. The analgesics most frequently prescribed in this study were paracetamol (87.4%) and NSAID (51.2%). Discussion. Chronic nociceptive pain of degenerative etiology, and not very satisfactory response with previous treatments are the main characteristics of the elderly patient with pain that were attended by the Primary Care physician (AU)

Medial temporal lobe neuromagnetic hypoactivation and risk for developing cognitive decline in elderly population: a 2-year follow-up study.

Cognition declines as a function of age. However, some elders could develop more severe status such as mild cognitive impairment (MCI). The aim of this study was the early detection of neurophysiological patterns of brain activity that may predict the possibility of certain subjects to develop MCI. Brain magnetic activity was recorded from 15 healthy subjects during a memory task by means of magnetoencephalography. None of the participants could be considered as MCI at the time of the first clinical evaluation. After 2-year follow-up, five subjects developed MCI and 10 maintained their cognitive status across time. The subjects who developed cognitive decline showed a lower number of activity sources in the left medial temporal lobe between 400 and 800 ms after stimulus onset, as compared to the non-cognitive decline group. These findings may help with the early identification of elderly subjects at high risk of cognitive decline, allowing the possibility of neuropsychological or pharmaceutical treatment that delay or prevent the progression of the cognitive impairment.

Evidence of biochemical and biomagnetic interactions in Alzheimer's disease: an MEG and MR spectroscopy study.

BACKGROUND: Several neuroimaging studies have shown reliable differences between Alzheimer's disease (AD) patients and age-matched controls. However, few studies have demonstrated the interactions between neuroimaging methods for the diagnoses of AD. OBJECTIVE: In this study, we try to elucidate the complementary nature of magnetoencephalography (MEG) and magnetic resonance spectroscopy (MRS) examinations in the assessmentof AD. METHODS: Ten patients fulfilling the NINCDS-ADRDA criteria of probable AD, and 10 elderly individuals with no history of neurological or psychiatric illness serving as age-matched controls participated in the study. All patients and controls received an MRS, MEG and neuropsychological assessment. MEG data were obtained in the context of a working memory task, previously utilized in a similar sample of patients. RESULTS: The AD group showed a reduced number of activity sources over left temporoparietal areas during the late portion of the evoked magnetic field (between 400-800 ms), as well as a bilateral temporoparietal increase in creatine and myoinositol concentrations, and in the myoinositol/N-acetyl-aspartate ratio. The combination of the variables 'number of dipoles during the late portion of the evoked magnetic field' and 'myoinositol/N-acetyl-aspartate ratio' accounted for 65% of the variance of the Mini Mental State Examination scores. CONCLUSIONS: These results highlight the importance of assessing the complex brain pathology underlying AD by utilizing multiple brain examination modalities in a coordinate approach.

La reciente controversia sobre el uso de neurolépticos en el anciano con demencia / The recent controversy on the use of neuroleptics in the elderly with dementia

Recientemente se ha planteado un debate sobre los riesgos de utilizar determinados neurolépticos en los pacientes mayores con demencia. Se revisan en este comentario los datos disponibles sobre la relación entre los neurolépticos, la mortalidad y los sucesos cardiovasculares y también las áreas aún abiertas a debate. Dada la frecuencia y gravedad de los síntomas de conducta de la demencia no parece aceptable el nihilismo terapéutico. Con la evidencia actual, los neurolépticos atípicos siguen siendo preferibles al haloperidol y otros fármacos en aquellos pacientes en quienes fracasan las medidas no farmacológicas

Dementia and Nutrition. Intervention study in institutionalized patients with Alzheimer disease.

OBJECTIVES: To know nutritional status of a group of institutionalized patients with moderate Alzheimer's Disease (AD), and to ascertain the effects of an intervention with nutritional supplements on morbidity and mortality after one year follow-up. PATIENTS AND METHODS: 99 patients (mean age: 86.5 years), 80 women, with a diagnosis of AD according with NINCDS/ADRDA criteria, were recruited from 8 nursing-homes. 25 were included in an intervention group and received a nutritional supplements along 12 months. Evolution was evaluated according to the Functional Assessment Staging Test (FAST). Patients with FAST levels 5-6 were included. General clinical variables as well as variables reflecting cognitive state and nutritional status: anthropometric, biochemical data and Mini Nutritional Assessment (MNA) were analysed. Statistical analysis was carry out with the SPSS 10.0 package. RESULTS: Mean time since diagnosis was 49 months, with a 20.2 months duration of institutionalization. Mean value of MNA was 20.1 3.5. 16.5% of patients had a BMI equal o lower than 21. After one year the intervention group showed higher levels of albumin (P=05), pre-albumin (P=05), iron (P=01), zinc (P=05), and beta-carotene (P=05) than the control group. The same response in BMI (P=05), MNA (P=05), and triceps skinfold (P=01). Mortality was lower (16% vs. 22.7%), without statistical significance, in the intervention group, as it was the number of infectious events (47% vs. 66% P=05), and the days in bed (7.5 2.1 vs. 17.3 5.6 P=05). CONCLUSION: Nutritional supplements applied to a group of patients with AD living in nursing-homes can reduce morbidity and mortality after one year follow-up.

Do cognitive patterns of brain magnetic activity correlate with hippocampal atrophy in Alzheimer's disease?

BACKGROUND: Many reports support the clinical validity of volumetric MRI measurements in Alzheimer's disease. OBJECTIVE: To integrate functional brain imaging data derived from magnetoencephalography (MEG) and volumetric data in patients with Alzheimer's disease and in age matched controls. METHODS: MEG data were obtained in the context of a probe-letter memory task. Volumetric measurements were obtained for lateral and mesial temporal lobe regions. RESULTS: As expected, Alzheimer's disease patients showed greater hippocampal atrophy than controls bilaterally. MEG derived indices of the degree of activation in left parietal and temporal lobe areas, occurring after 400 ms from stimulus onset, correlated significantly with the relative volume of lateral and mesial temporal regions. In addition, the size of the right hippocampus accounted for a significant portion of the variance in cognitive scores independently of brain activity measures. CONCLUSIONS: These data support the view that there is a relation between hippocampal atrophy and the degree of neurophysiological activity in the left temporal lobe.