Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU9

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU)

Differentiation between mild cognitive impairment and Alzheimer's disease using the FMLL mini-battery.

AIM: To construct and validate a mini-battery to discriminate between Alzheimer's disease (AD) and mild cognitive impairment (MCI) in patients seen at a hospital memory clinic. METHODS: In a cohort of 310 subjects (137 with MCI and 173 with AD), the area under the receiver operating curve (AUC) was used to select the neuropsychologic diagnostic test battery subtests with the best overall performance, namely, the Mini-Mental State Examination (MMSE, 0.715), Logical Memory II (LMII, 0.721), Verbal Fluency Test (0.747), and Lawton index (0.742). A mini-battery test was constructed with the following formulation: FMLL = [(Fluency Test/17 + MMSE/30 + LMII/32 + Lawton/8)/4] x 100. Another cohort of 87 subjects with MCI and 100 with AD was used to validate the mini-battery and to calculate the psychometric properties. RESULTS: The concurrent validity with Reisberg's Global Deterioration Scale was r = 0.792 (p < 0.001). Cronbach's alpha internal consistency was 0.6358. The AUC to diagnose MCI or AD was 0.879 (95% CI: 0.832-0.927; p < 0.001). Specificity for MCI diagnosis was 0.9 when FMLL scores were above 59% and 1 when scores were above 76%. CONCLUSION: The FMLL mini-examination is a useful tool to differentiate between MCI and AD in patients seen in a memory clinic.

[Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease]. / Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer.

INTRODUCTION: To describe the neuropsychiatric symptoms (NPS) in elderly patients with either mild cognitive impairment (MCI) or Alzheimer's disease (AD) and their relevance in the differential diagnosis between the two entities. MATERIAL AND METHODS: A total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities. RESULTS: Sixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4-5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3-18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3-4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5-6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7-23.4; p<0.01). CONCLUSIONS: NPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities.