CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015.

OBJECTIVE: To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. MATERIALS AND METHODS: It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios. RESULTS: The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). CONCLUSIONS: The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.

Estudio MESGI50: descripción de una cohorte sobre la madurez y el envejecimiento satisfactorio / Mesgi50 study: description of a cohort on maturity and satisfactory ageing

Objetivo: Describir las principales características demográficas, de salud y socioeconómicas de los participantes en el Estudio sobre la Madurez y el Envejecimiento Satisfactorio en Girona (estudio MESGI50). Métodos: Estudio epidemiológico poblacional vinculado a la Survey of Health, Ageing, and Retirement in Europe (SHARE). La población de referencia fueron los habitantes de la provincia de Girona de 50 y más años de edad. Se utilizó un muestreo probabilístico por conglomerados bietápico estratificado según el número de habitantes y el grado de envejecimiento de la población. Resultados: Se seleccionaron aleatoriamente 28 municipios según su tipo (demográficamente envejecidos o jóvenes) y estratificados según el número de habitantes. La tasa de respuesta fue del 65%, con una media de 1,7 sujetos elegibles por hogar y una muestra final de 2065 hogares y 3331 participantes. El efecto del diseño fue de 1,27. El 52,9% eran mujeres y la media de edad era de 66,9 años (desviación estándar: 11,5). La salud autorreferida, la fuerza de agarre manual, la limitación en las actividades de la vida diaria y la sintomatología depresiva aumentaron con la edad y de forma más acusada en las mujeres. Se observaron diferencias en el consumo de alcohol y en los patrones de alimentación según el ámbito de residencia. Conclusiones: Las características demográficas, de salud y socioeconómicas durante el proceso de envejecimiento son distintas según los grupos de edad, el sexo y el ámbito de residencia (AU)

Objective: To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study). Methods: Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used. Results: Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD=11.5). The self-rated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence. Conclusions: The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence (AU)

A Path Analysis of Dependence and Quality of Life in Alzheimer's Disease.

OBJECTIVE: To determine the direct and indirect relationships of cognitive, functional, and behavioral factors and other medical comorbidities with the quality of life (QoL) of patients with Alzheimer's disease (AD) according to the theoretical model of dependence. METHODS: Observational and cross-sectional study. Cognitive and functional status, behavior, dependence, medical comorbidities, and QoL were assessed by using standardized instruments. A path analysis was used to model the direct and indirect relationships among clinical indicators according to the theoretically based model of dependence. RESULTS: The sample consisted of 343 patients with AD (32.1% mild, 36.7% moderate, and 31.2% severe). Medical comorbidities, disease severity, and dependence level had a direct relationship with QoL. The functional disability and the behavior disturbances were indirectly related to QoL via dependence level, and the cognitive impairment was indirectly related to QoL via severity level. CONCLUSION: Direct and indirect effects exist between clinical indicators, dependence, and QoL.

[MESGI50 study: description of a cohort on Maturity and Satisfactory Ageing]. / Estudio MESGI50: descripción de una cohorte sobre la madurez y el envejecimiento satisfactorio.

OBJECTIVE: To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study). METHODS: Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used. RESULTS: Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD=11.5). The self-rated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence. CONCLUSIONS: The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence.

The Trail Making Test.

The Trail Making Test (TMT) is used as an indicator of visual scanning, graphomotor speed, and executive function. The aim of this study was to examine the TMT relationships with several neuropsychological measures and to provide normative data in community-dwelling participants of 55 years and older. A population-based Spanish-speaking sample of 2,564 participants was used. The TMT, Symbol Digit Test, Stroop Color-Word Test, Digit Span Test, Verbal Fluency tests, and the MacQuarrie Test for Mechanical Ability tapping subtest were administered. Exploratory factor analyses and regression lineal models were used. Normative data for the TMT scores were obtained. A total of 1,923 participants (76.3%) participated, 52.4% were women, and the mean age was 66.5 years (Digit Span = 8.0). The Symbol Digit Test, MacQuarrie Test for Mechanical Ability tapping subtest, Stroop Color-Word Test, and Digit Span Test scores were associated in the performance of most TMT scores, but the contribution of each measure was different depending on the TMT score. Normative tables according to significant factors such as age, education level, and sex were created. Measures of visual scanning, graphomotor speed, and visuomotor processing speed were more related to the performance of the TMT-A score, while working memory and inhibition control were mainly associated with the TMT-B and derived TMT scores.

Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi).

The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer's disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03-3.84) for VaD, and 2.15 (1.97-2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39-0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.

Gender differences in depression and pain: A two year follow-up study of the Survey of Health, Ageing and Retirement in Europe.

BACKGROUND: The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries. METHODS: The study population was taken from waves 4-5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence. RESULTS: Prevalences of depression, pain, and depression-pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9-2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2-1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2-2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3-2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1-1.7; treated OR=2.0; 95% CI=1.5-2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1-1.7; men OR=1.8; 95% CI=1.3-2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1-1.6). LIMITATIONS: We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred. CONCLUSIONS: Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.

Sense of Well-Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest-A Pilot Study.

Background and Objective. Most patients with fibromyalgia benefit from different forms of physical exercise. Studies show that exercise can help restore the body's neurochemical balance and that it triggers a positive emotional state. So, regular exercise can help reduce anxiety, stress, and depression. The aim of this study was to analyze the benefits of moderate aerobic exercise when walking in two types of forests, young and mature, and to assess anxiety, sleep, pain, and well-being in patients with fibromyalgia. Secondary objectives included assessing (i) whether there were differences in temperature, sound, and moisture, (ii) whether there was an improvement in emotional control, and (iii) whether there was an improvement in health (reduction in pain) and in physical and mental relaxation. Patients and Methods. A study involving walking through two types of forests (mature and young) was performed. A total of 30 patients were randomly assigned to two groups, mature and young forests. The participants were administered the following tests: the Spanish version of the Revised Fibromyalgia Impact Questionnaire (FIQR) at baseline and the end-point of the study, the State-Trait Anxiety Inventory (STAI) after each walk, and a series of questions regarding symptomatic evolution. Several physiological parameters were registered. Results. FIQR baseline and end-point scores indicated a significant decrease in the symptomatic subscale of the FIQ (SD = 21.7; z = -2.4; p = 0.041). The within-group analysis revealed that differences were significant with respect to days of intense pain, insomnia, and days of well-being only in the group assigned to the mature forest, not in the group assigned to the young forest. No differences were found with respect to anxiety. Conclusions. Although the main aim of this research was not achieved, as the results revealed no differences between the groups in the two forest types, authors could confirm that an aerobic exercise program consisting of walking through a mature forest can provide the subjective perception of having less days of pain and insomnia and more days of wellness, in patients with fibromyalgia.

Marble-burying is enhanced in 3xTg-AD mice, can be reversed by risperidone and it is modulable by handling.

Translational research on behavioural and psychological symptoms of dementia (BPSD) is relevant to the study the neuropsychiatric symptoms that strongly affect the quality of life of the human Alzheimer's disease (AD) patient and caregivers, frequently leading to early institutionalization. Among the ethological behavioural tests for rodents, marble burying is considered to model the spectrum of anxiety, psychotic and obsessive-compulsive like symptoms. The present work was aimed to study the behavioural interactions of 12 month-old male 3xTg-AD mice with small objects using the marble-burying test, as compared to the response elicited in age-matched non-transgenic (NTg) mice. The distinction of the classical 'number of buried marbles' but also those left 'intact' and those 'changed' of position of marbles or partially buried (the transitional level of interaction) provided new insights into the modelling of BPSD-like alterations in this AD model. The analysis revealed genotype differences in the behavioural patterns and predominant behaviors. In the NTg mice, predominance was shown in the 'changed or partially buried', while interactions with marble were enhanced in 3xTg-AD mice resulting in an increase of marble burying. Besides, genotype-dependent meaningful correlations were found, with the marble test pattern of 3xTg-AD mice being directly related to neophobia in the corner tests. In both genotypes, the increase of burying was reversed by chronic treatment with risperidone (1mg/kg, s.c.). In 3xTg-AD mice, the repetitive handling of animals during the treatment also exerted modulatory effects. These distinct patterns further characterize the modelling of BPSD-like symptoms in the 3xTg-AD mice, and provide another behavioural tool to assess the benefits of preventive and/or therapeutic strategies, as well as the potential action of risk factors for AD, in this animal model.

Rate of dementia diagnoses according to the degree of aging of the population.

BACKGROUND: There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities. METHODS: We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007-2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared. RESULTS: The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia. CONCLUSIONS: The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.

Dependence scale for Alzheimer's disease: relationship with other clinical indicators and psychometric properties.

The objective of this cross-sectional and multicenter study was to evaluate the psychometric properties of the Spanish version of the Dependence Scale (DS) and to assess the relationship between dependence and clinical measures according to disease severity. Medical comorbidities, cognitive status and functional status, behavior, dependence, caregiver burden, and medical and social resources were assessed using standardized instruments. The sample consisted of 343 patients (32.1% mild, 36.7% moderate, and 31.2% severe), the mean age was 78.9 years (standard deviation=7.4), and 67.0% were women. Criterion and construct validity index of DS were appropriate. The DS standard error of measurement was ±1.23. The explained variance in DS ranged between 0.598 and 0.731, and the relative contribution of clinical measures depended on disease severity. Current findings confirm that the Spanish version of the DS has appropriate psychometric indices and suggest that clinical indicators have different contribution to dependence according to disease severity.

Prevalencia de anosognosia en la enfermedad de Alzheimer / Prevalence of anosognosia in Alzheimer's disease

Fundamento y objetivo: La anosognosia es un trastorno que afecta a la presentación clínica de la enfermedad de Alzheimer (EA), incrementándose su frecuencia con la evolución de la misma. El objetivo fue determinar la prevalencia de anosognosia y analizar los factores asociados y predictores. Pacientes y método: Estudio multicéntrico transversal, observacional y analítico de 345 pacientes con EA. La anosognosia se evaluó mediante la Anosognosia Questionnaire-Dementia y el estadio evolutivo con la Global Deterioration Scale (GDS). Se utilizaron los tests Mini-Mental State Examination, Disability Assessment for Dementia y Neuropsychiatric Inventory para valorar la cognición, el estado funcional y los síntomas neuropsiquiátricos, respectivamente. Se ajustaron modelos de regresión lineal para determinar las variables asociadas y de regresión logística binaria (RLog) para analizar los factores predictores de la anosognosia. Resultados: La prevalencia global de la anosognosia fue del 46,7% (intervalo de confianza del 95% [IC 95%] 41,3-52,1). La prevalencia en los estadios fue de 28,4% (GDS 4), 64,6% (GDS 5) y 91,4% (GDS 6). La RLog identificó como variables predictoras la mayor edad (odds ratio [OR] 1,04; IC 95% 1,01-1,09), la menor capacidad funcional (OR 0,96; IC 95% 0,93-0,98), el menor nivel cognitivo (OR 0,9; IC 95% 0,88-0,99), y la mayor apatía (OR 1,1; IC 95% 1,03-1,18), desinhibición (OR 1,2; IC 95% 1,09-1,50), irritabilidad (OR 1,1; IC 95% 1,09-1,50) y trastornos motores (OR 1,2; IC 95% 1,09-1,50). Conclusiones: La anosognosia se incrementa con el mayor deterioro. En los pacientes en fase leve las variables predictoras fueron la apatía, la desinhibición y los trastornos motores (AU)

Three-year trajectories of caregiver burden in Alzheimer's disease.

Although numerous studies have examined caregiver burden in the context of Alzheimer's disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer's disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89-13.47), as were sole caregivers (OR 3.51; 95% CI 1.98-6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance.

Abridged scale for the screening anosognosia in patients with dementia.

The objective of this cross-sectional study was to validate an abridged version of the Anosognosia Questionnaire--Dementia (AQ-D) for screening anosognosia in daily practice. The authors reduce the AQ-D from 30 items to 9, with a large sample (n = 352) of patients with Alzheimer disease (AD). The Cronbach α was .793 and an area under the receiver-operating characteristic curve was 0.946. The κ index between new abridged AQ-D (AAQ) and original AQ-D was .800. The AAQ presents good validity and reliability indicators and kept concordance with the original scale. It is quick and easy to administer and it can simplify the clinical screening of anosognosia in patients with AD.

Psychotropic drugs in patients with Alzheimer's Disease: a longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain.

OBJECTIVES: Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. METHODS: Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. RESULTS: Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). CONCLUSIONS: Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.

¿Demencia o trastorno neurocognitivo mayor? / No disponible

No disponible

[Prevalence of anosognosia in Alzheimer's disease]. / Prevalencia de anosognosia en la enfermedad de Alzheimer.

BACKGROUND AND OBJECTIVE: Anosognosia is a disorder that affects the clinical presentation of Alzheimer's disease (AD), increasing in frequency with the evolution of AD. The objective was to determine the prevalence of anosognosia and analyze the associated factors and predictors. PATIENTS AND METHOD: Multicenter transversal and observational study of 345 AD patients. Anosognosia was assessed by Anosognosia Questionnaire-Dementia and the evolutionary stage with the Global Deterioration Scale (GDS). Tests used were Mini-Mental State Examination, Disability Assessment for Dementia and Neuropsychiatric Inventory to assess cognition, functional status and neuropsychiatric symptoms, respectively. We adjusted linear regression models to determine the associated variables and binary logistic regression (RLog) to identify predictors of anosognosia. RESULTS: The overall prevalence of anosognosia was 46.7% (95% confidence interval [95% CI] 41.3 to 52.1). The prevalence in stages was 28.4% (GDS 4), 64.6% (GDS 5) and 91.4% (GDS 6). The RLog identified as predictors older age (odds ratio [OR] 1.04; 95% CI 1.01-1.09), lower functional capacity (OR 0.96; 95% CI 0.93-0.98), lower cognitive level (OR 0.9; 95% CI 0.88-0.99), and greater apathy (OR 1.1; 95% CI 1.03-1.18), disinhibition (OR 1.2; 95% CI 1.09-1.50), irritability (OR 1.1; 95% CI 1.09-1.50) and motor disorders (OR 1.2; 95% CI 1.09-1.50). CONCLUSIONS: Anosognosia increases with further deterioration. In patients with a mild impairment, predictor variables were apathy, disinhibition and motor disorders.

Discrepancies regarding the quality of life of patients with Alzheimer's disease: a three-year longitudinal study.

Cross-sectional studies report notable discrepancies between patient and caregiver ratings of the quality of life of patients (QoL-p) with Alzheimer's disease (AD). This study aimed to identify the factors associated with any changes in QoL-p ratings and any discrepancies between patient and caregiver ratings of QoL-p. Three-year follow-up of a cohort of non-institutionalized patients (n = 119). QoL-p was assessed by the Quality of Life in AD (QoL-AD) scale. We analyzed the influence of functional and cognitive status and behavioral problems in patients, and burden and mental health in caregivers. Repeated measures analysis was applied to the scores of patients and caregivers on the QoL-AD, and to the discrepancies between them. Generally, patients' own ratings remained stable over time (F3,116 = 0.9, p = 0.439), whereas caregiver ratings showed a decline (F3,116 = 9.4, p < 0.001). In the analysis of discrepancies, patients with anosognosia gave higher ratings (F1,117 = 11.9, p = 0.001), whereas caregiver ratings were lower when the patient showed greater agitation (F1,117 = 13.0, p < 0.001), apathy (F1,117 = 15.4, p < 0.001), and disabilities (F1,117 = 17.1, p < 0.001), and when the caregiver experienced greater burden (F1,117 = 9.0, p = 0.003) and worse mental health (F1,117 = 10.1, p = 0.003). Patient ratings of QoL-p remain generally stable over time, whereas those of caregivers show a decline, there being significant discrepancies in relation to specific patient and caregiver factors.

Perfiles neuropsicológicos en la enfermedad de alzheimer con y sin depresión / No disponible

INTRODUCCIÓN: Los estudios epidemiológicos demuestran que existe una estrecha asociación con sentido bidireccional entre deterioro cognitivo y depresión. Pacientes con depresión, presentan déficits cognitivos y es un factor de riesgo de demencia, y la prevalencia de depresiones en la demencia es muy elevada. OBJETIVOS: A partir de una muestra clínica de pacientes con enfermedad de Alzheimer (eA) pretendemos conocer los perfiles cognitivos de pacientes con y sin depresión. Población. Pacientes ambulatorios diagnosticados de eA de una intensidad leve/moderada y en tratamiento con colinesterásicos con intención de tratar. MATERIAL Y MÉTODO: A través del cAMDeX y el NPi se estableció un diagnóstico de Depresión en la enfermedad de Alzheimer (DeeA) según criterios específicos. Se comprobó la asociación entre las subescalas del cAMcoG y DeeA. RESULTADOS: Participaron en el presente estudio 783 pacientes con una media de edad de 76,24 (DS 5 6,83) y de los que el 21,5 % fueron diagnosticados de DeeA. La memoria de aprendizaje (or 5 1,245; ic 95 %: 1,011-1,533; p 5 0,039) y el cálculo (0,779; ic 95 %: 0,645-0,941; p 5 0,010) se integraron en un modelo controlado por edad, sexo, antecedentes psiquiátricos personales, subescalas de apatía y delirios del NPi, y el componente vascular medido por la escala de demencia multinfártica integrada en el cAMDeX. CONCLUSIONES: existe un perfil neuropsicológico específico de DeeA. Al-gunas funciones neuropsicológicas como la memoria de aprendizaje requieren de cierta preservación para asociarse con DeeA, mientras que en otras, como el cálculo, se requiere un deterioro. No se observa asociación entre DeeA y patología vascular

INTRODUCTION: A bidirectional association between depression and cognitive impairment has been described by epidemiological studies. on one hand, patients with depression, which is a risk factor for dementia, present with cognitive decline. And, on the other hand, there is a high prevalence of depression in dementia. AIMS: to describe the cognitive profiles of patients with Alzheimer's disease (AD) presenting with and without dementia using a clinical sample. Population. outpatients with a diagnosis of mild/moderate AD, receiving anticholinesterases. MATERIAL AND METHODS: Depression in Alzheimer's disease (DeAD) was diagnosed following specific criteria using cAMDeX and NPi. the association between cAMcoG subscales and DeAD was checked out.Results. this study was performed with 753 patients who had a mean age of 76,24 (DS 5 6,83) years. Almost one out of every five AD patients (21,5 %) was diagnosed with DeAD. Learning memory (or 5 1,245; ic95 %: 1,011-1,533; p 5 0,039) and calculation (or 5 0,779; ic 95 %: 0,645-0,941; p 5 0,010) were associated with DeAD in a model controlled by age, sex, psychiatric personal history, NPi's apathy and delusion subscales, and the vascular component measured using the multi-infarct dementia scale integrated within the cAMDeX. CONCLUSIONS: there is a specific neu ropsychological profile related to the DeeA. thus, developing depression in AD requires a quite preserved learning memory, and deteriorated calculation skills. No association has been detected between vascular pathology and DeAD

[Cognitive decline in Alzheimer's disease. A follow three or more years of a sample of patients]. / Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.

INTRODUCTION: The rates of cognitive decline in patients with Alzheimer's disease show variations due to various factors. AIM. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline. PATIENTS AND METHODS: Retrospective study of a sample of 383 patients with Alzheimer's disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final). RESULTS: The younger age (beta = -0.23; p < 0.001), more educated (beta = 0.26; p < 0.001) and the greater deterioration of ADL (beta = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (beta = -0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%). CONCLUSIONS: The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD.

TITLE: Declive cognitivo en la enfermedad de Alzheimer. Seguimiento de mas de tres años de una muestra de pacientes.Introduccion. Las tasas de declive cognitivo en los pacientes con enfermedad de Alzheimer presentan variaciones debido a diversos factores. Objetivo. Determinar la influencia de la edad, escolaridad, genero, actividades de la vida diaria (AVD) e inhibidores de la acetilcolinesterasa (IAChE) y memantina en el ritmo y tasas de declive cognitivo. Pacientes y metodos. Estudio retrospectivo de una muestra de 383 pacientes con enfermedad de Alzheimer, con evaluaciones neuropsicologicas durante un periodo superior a tres años. Se utilizo como medida cognitiva el Cambridge Cognitive Examination (CAMCOG). Se agruparon los pacientes segun su tasa de declive anual (TDA) y se realizaron analisis bivariante y de regresion lineal multivariante utilizando como variable dependiente la diferencia de puntuaciones en el CAMCOG (basal-final). Resultados. La menor edad (beta = ­0,23; p < 0,001), la mayor escolaridad (beta = 0,26; p < 0,001) y el mayor deterioro de las AVD (beta = 0,24; p < 0,001) estuvieron asociados a un mayor declive en todos los pacientes. Los farmacos tuvieron un efecto benefico (beta = ­0,18; p = 0,011) en el grupo con menor y mas lento declive (TDA < 5%). Conclusiones. La menor edad, la mayor escolaridad y el deterioro de las AVD se relacionan con un mayor declive cognitivo. Los IAChE y la memantina tuvieron un efecto benefico, enlenteciendo el declive en el grupo de pacientes con menor TDA.