Assessment of an electronic system for research ethics committees document management: An observational study.

Since 1 January 2020, the Central Research Ethics Committee of the Health Ministry implemented PRIISA.BA, an in-house developed electronic system for online submission of health research applications to the 63 public and private research ethics committees (RECs) of Buenos Aires City, Argentina. This study though to compare the times to first review and the time to approval among applications submitted prior to PRIISA.BA and thereafter, across public RECs. All public RECs of the city were invited to participate. Overall, 453 applications from 10 RECs (242 pre- and 211 post-PRIISA.BA) were available for the analyses. There was a decrease in the time to first review and an increase in the time to approval after PRIISA.BA implementation. The increase in time to approval was transient and limited to the first three months. The results were consistent with analyses limited to non-COVID applications. Our results show an increase in the times to approval after the implementation of an electronic system for online submission of health research applications that, although transient, was significant. These data could be relevant to other RECs implementing this technology since it emphasizes the need of monitoring potential unnecessary delays in reviews during the critical initial period.

Associations Among Loneliness, Purpose in Life and Subjective Cognitive Decline in Ethnoracially Diverse Older Adults Living in the United States.

Subjective cognitive decline (SCD), which precedes Mild Cognitive Impairment and dementia, may be affected by purpose in life (PiL) and loneliness in older adults. We investigated associations among PiL, loneliness, and SCD in US Latino (n = 126), Black (n = 74), Asian (n = 33), and White (n = 637) adults. Higher PiL predicted lower SCD in all groups (p-values < .012), except Black participants. Lower loneliness predicted lower SCD in Latino and White groups (p-values < .05), and PiL moderated this association in White adults. PiL and loneliness may play important roles in cognitive decline. Differential predictors of SCD suggest differential targets for preventing cognitive decline and dementia across ethnoracial groups.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America.

BACKGROUND: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. METHODS: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. FINDINGS: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. INTERPRETATION: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact. FUNDING: Massachusetts General Hospital Department of Psychiatry.

Impact of Social Isolation on People with Dementia and Their Family Caregivers.

BACKGROUND: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. OBJECTIVE: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. METHODS: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. RESULTS: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. CONCLUSION: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.

The impact of SARS-CoV-2 in dementia across Latin America: A call for an urgent regional plan and coordinated response.

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.

The power of knowledge about dementia in Latin America across health professionals working on aging.

INTRODUCTION: Expert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known. METHODS: We investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location. RESULTS: Experts specified low public policy knowledge (X2  = 41.27, P < .001), high levels of stigma (X2  = 2636.37, P < .001), almost absent BI knowledge (X2  = 56.58, P < .001), and needs for regional diagnostic manuals (X2  = 2893.63, df = 3, P < .001) and data-sharing platforms (X2 = 1267.5, df = 3, P < .001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts. DISCUSSION: Our findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs' dementia knowledge.

Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly.

The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. OBJECTIVE: To validate the MoCA in the elderly and study its usefulness in MCI and MD. METHODS: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. RESULTS: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD ​​100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. CONCLUSION: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.

O MoCA é um teste breve e útil para diagnosticar comprometimento cognitivo leve (CCL) e demência leve. Até o momento, nenhuma validação argentina com adaptação transcultural da versão em espanhol havia sido relatada. OBJETIVO: Validar o MoCA em idosos e estudar sua utilidade no CCL e demência leve. MÉTODOS: Este estudo incluiu 399 indivíduos acima de 60 anos avaliados no departamento cognitivo-comportamental (2017-2018). Foram excluídos pacientes com menos de 3 anos de escolaridade, com distúrbios sensoriais, distúrbios psiquiátricos e demência moderada a grave. O grupo controle foi cognitivamente normal. Eles foram classificados de acordo com a avaliação neuropsicológica e os critérios clínicos padrão em Controles, MCI e demência leve. A versão adaptada do MoCA (MOCA-A) foi administrado aos pacientes e controles. RESULTADOS: Média de escolaridade: 10,34 anos (DP: 3,5). O escore MoCA-A foi significativamente diferente entre os grupos (p<0,0001). O MoCA-A correlacionou-se com a escolaridade (r=0,406 p<0,00001). Com uma pontuação de corte ≥25 (IY=0,55), a sensibilidade para CCL foi de 84,8% e para demência leve 100%, com especificidade de 69,7%. Adicionando um ponto único à pontuação em pacientes com menos de 12 anos de escolaridade, a especificidade do teste atingiu 81%. CONCLUSÃO: O MoCA-A é um teste de rastreamento preciso e confiável para MCI e demência leve na Argentina.

Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly / Validação da versão argentina do teste montreal cognitive assessment test (moca): um instrumento de triagem para comprometimento cognitivo leve e demência leve em idosos

ABSTRACT. The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. Objective: To validate the MoCA in the elderly and study its usefulness in MCI and MD. Methods: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. Results: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD ​​100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. Conclusion: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.

RESUMO. O MoCA é um teste breve e útil para diagnosticar comprometimento cognitivo leve (CCL) e demência leve. Até o momento, nenhuma validação argentina com adaptação transcultural da versão em espanhol havia sido relatada. Objetivo: Validar o MoCA em idosos e estudar sua utilidade no CCL e demência leve. Métodos: Este estudo incluiu 399 indivíduos acima de 60 anos avaliados no departamento cognitivo-comportamental (2017-2018). Foram excluídos pacientes com menos de 3 anos de escolaridade, com distúrbios sensoriais, distúrbios psiquiátricos e demência moderada a grave. O grupo controle foi cognitivamente normal. Eles foram classificados de acordo com a avaliação neuropsicológica e os critérios clínicos padrão em Controles, MCI e demência leve. A versão adaptada do MoCA (MOCA-A) foi administrado aos pacientes e controles. Resultados: Média de escolaridade: 10,34 anos (DP: 3,5). O escore MoCA-A foi significativamente diferente entre os grupos (p<0,0001). O MoCA-A correlacionou-se com a escolaridade (r=0,406 p<0,00001). Com uma pontuação de corte ≥25 (IY=0,55), a sensibilidade para CCL foi de 84,8% e para demência leve 100%, com especificidade de 69,7%. Adicionando um ponto único à pontuação em pacientes com menos de 12 anos de escolaridade, a especificidade do teste atingiu 81%. Conclusão: O MoCA-A é um teste de rastreamento preciso e confiável para MCI e demência leve na Argentina.

Relación entre actividades de tiempo libre y cognición en adultos mayores: una revisión de estudios argentinos e iberoamericanos / Relationship between leisure activities and cognition in elderly adults: a review of argentine and Iberoamerican studies

El envejecimiento poblacional implica un desafío para la salud pública por las patologías cuyos casos aumentan con la extensión de la vida. Se ha propuesto que ciertas actividades de la vida diaria (AVDs) avanzadas de tiempo libre poseen un efecto bené+co en la cognición de los adultos mayores. El objetivo de este trabajo fue relevar estudios empíricos presentando evidencia respecto a la relación entre dichas actividades y el funcionamiento cognitivo, para países iberoamericanos. Se incluyeron trabajos escritos en español, portugués e inglés, de enero de 2012 a mayo de 2017, involucrando a adultos de 60 y más años de edad no institucionalizados. Se hallaron 15 trabajos. Considerados en su conjunto, existiría evidencia de una relación entre las mencionadas actividades y el rendimiento cognitivo. Los trabajos de diseño prospectivo y los de intervención indicarían que la realización de dichas actividades avanzadas incide bene+ciosamente en el funcionamiento cognitivo.

Population aging implies a challenge to public health for the pathologies whose cases increase with the extension of life. It has been proposed that certain leisure advanced activities of daily living (ATLs) have a bene+cial effect on the cognition of the elderly. The objective of this work was to relieve empirical studies presenting evidence regarding the relationship between these activities and cognitive functioning, for Iberoamerican countries. Works written in Spanish, Portuguese and English were included from January 2012 to May 2017, involving non-institutionalized adults aged 60 and over. Fifteen papers were found. Considered as a whole, there would be evidence of a relationship between these activities and cognitive performance. Prospective design and interventional studies would indicate that such advanced activities has a bene+cial impact on cognitive functioning.

[A survey on biomarkers and early diagnosis in Alzheimer's disease]. / Una encuesta sobre biomarcadores y diagnóstico precoz de la enfermedad de Alzheimer.

Given the potential use of biomarkers in the diagnosis of Alzheimer's disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.

Una encuesta sobre biomarcadores y diagnóstico precoz de la enfermedad de Alzheimer / A survey on biomarkers and early diagnosis in Alzheimer's disease

Ante el uso potencial de biomarcadores para el diagnóstico temprano de la enfermedad de Alzheimer (EA), nuevos dilemas éticos y de comunicación aparecen en la práctica clínica cotidiana. El objetivo de este trabajo fue conocer la opinión de profesionales de la salud (PS) y del público en general (PG) sobre la realización de técnicas diagnósticas tempranas en la EA utilizando marcadores biológicos, aun a sabiendas que hasta ahora la enfermedad es incurable. Se confeccionó una encuesta en Internet con respuesta múltiple en dos versiones: una para PS y otra para el PG. Se invitó a participar a los encuestados a través de un sistema legal de envíos masivos de correo electrónico, utilizando direcciones recolectadas en la base de datos del CEMIC. Se analizaron 1503 respuestas: 807 grupo PS y 696 grupo PG. La mayoría de los encuestados (84.7%) prefirió la opción de realizar el diagnóstico temprano de la EA aun conociendo la falta de tratamiento curativo. El 45.1% del grupo PG vs. el 26.8% del grupo PS respondió que no cree que se genere un dilema de comunicación ni ético en los médicos al informar el diagnóstico de la enfermedad. El grupo PS mostró mayor divergencia en las opiniones que el PG. Estos resultados podrían indicar una nueva dinámica en la relación médico-paciente, mostrando al PG con una posición activa y favorable frente al uso de los biomarcadores para el diagnóstico temprano de la EA.

Given the potential use of biomarkers in the diagnosis of Alzheimer’s disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.

[Ethical considerations regarding the communication of diagnosis of prodromal Alzheimer's disease]. / Consideraciones éticas de la comunicación diagnóstica en la enfermedad de Alzheimer prodrómica.

Population aging has increased age-related diseases such as dementia, Alzheimer's disease (AD) being the most common in older adults (50%-60%). It is one of the most feared conditions for its irreversible and incurable, by its chronicity and it consists of a long process of depersonalization. The clinical diagnosis is mainly based on DSM-IV and NINCDS-ADRDA. Definitive diagnosis is post-mortem, as it requires histopathological confirmation. However, there have been new diagnostic criteria based EA biomarkers, which can be done in life, anticipating the course of several years before dementia. Thus, physicians are increasingly exposed to AD patients in early stages, having to face the dilemma of communicating the diagnosis to a patient with cognitive failures and disease awareness, with the implications that generates about him and his family. The objectives of this paper will analyze the ethical problem of communication of clinical diagnosis of AD in prodromal stages (pre-dementia) in our country, based on the analysis of ethical principles (autonomy and non maleficence) involved in decision making.

Consideraciones éticas de la comunicación diagnóstica en la enfermedad de Alzheimer prodrómica / [Ethical considerations regarding the communication of diagnosis of prodromal Alzheimer’s disease].

Population aging has increased age-related diseases such as dementia, Alzheimer’s disease (AD) being the most common in older adults (50

). It is one of the most feared conditions for its irreversible and incurable, by its chronicity and it consists of a long process of depersonalization. The clinical diagnosis is mainly based on DSM-IV and NINCDS-ADRDA. Definitive diagnosis is post-mortem, as it requires histopathological confirmation. However, there have been new diagnostic criteria based EA biomarkers, which can be done in life, anticipating the course of several years before dementia. Thus, physicians are increasingly exposed to AD patients in early stages, having to face the dilemma of communicating the diagnosis to a patient with cognitive failures and disease awareness, with the implications that generates about him and his family. The objectives of this paper will analyze the ethical problem of communication of clinical diagnosis of AD in prodromal stages (pre-dementia) in our country, based on the analysis of ethical principles (autonomy and non maleficence) involved in decision making.

Consideraciones éticas de la comunicación diagnóstica en la enfermedad de Alzheimer prodrómica. / [Ethical considerations regarding the communication of diagnosis of prodromal Alzheimers disease].

Population aging has increased age-related diseases such as dementia, Alzheimers disease (AD) being the most common in older adults (50

-60

). It is one of the most feared conditions for its irreversible and incurable, by its chronicity and it consists of a long process of depersonalization. The clinical diagnosis is mainly based on DSM-IV and NINCDS-ADRDA. Definitive diagnosis is post-mortem, as it requires histopathological confirmation. However, there have been new diagnostic criteria based EA biomarkers, which can be done in life, anticipating the course of several years before dementia. Thus, physicians are increasingly exposed to AD patients in early stages, having to face the dilemma of communicating the diagnosis to a patient with cognitive failures and disease awareness, with the implications that generates about him and his family. The objectives of this paper will analyze the ethical problem of communication of clinical diagnosis of AD in prodromal stages (pre-dementia) in our country, based on the analysis of ethical principles (autonomy and non maleficence) involved in decision making.

Deterioro cognitivo leve: riesgo de demencia según subtipos / Mild cognitive Impairment: Risk of Dementia according to Subtypes

El deterioro cognitivo leve (DCL) presenta 3 subtipos clínicos: amnésico (DCLa), múltiples dominios (DCLmd) y dominio único no amnésico (DCLduna), cuya evolutividad a demencia no ha sido extensamente estudiada. El objetivo de este trabajo es evaluar la conversión a demencia de los diferentes subtipos de DCL y determinar los factores de riesgo asociados a la misma. Métodos: Se reclutaron 127 pacientes con Deterioro Cognitivo Leve (edad 70,21; DS 13,17) fueron evaluados conuna batería neuropsicológica y neuropsiquiátrica y clasificados en 3 grupos: DCLa (n=20), DCLmd (n=98) y DCLduna (n=9). Diecisiete controles normales (edad 74,59; DE 10,63) fueron incluidos. Resultados: El 27,1% de los pacientes con DCL desarrolló demencia tipo Alzheimer (promedio 11,12 meses, DE=0,183).Ninguno de los controles convirtió a demencia. El 35% (n=7) del grupo con DCLa convirtió a Demencia: un 20% (n=4) a6 meses y un 15% (n=3) a 12 meses; 11,1% (n=1) del grupo con DCLduna convirtió a demencia en 6 meses. El 31,6%(n=31) de DCLmd rotó a demencia: el 15,3% (n=15) en 6meses y un 16,3% (n=16) al año. La edad (p<0,05, β=1,03) aumentó la probabilidad de conversión a demencia. El grupo de DCLmd fue el más frecuente, sin embargo fue mayor la conversión a demencia en el DCLa, siendo la edad y la jubilación las variables que aumentaron la probabilidad de conversión (AU)

Mild cognitive impairment (MCI) has 3 clinical subtypes: amnestic (aMCI), multiple domains (mdMCI) and non-amnestic single domain (na-SD-MCI) whose evolutive possibility to dementia has not been profoundly studied. Objective: This paper aims to determine the conversion to dementia of the different subtypes of MCI and determine risk factors associated to conversion to dementia. Methods: A total of 127 patients diagnosed with MCI (age=70.21; SD=13.17) were evaluated with a neuropsychological and neuropsychiatric battery. They were classified into 3 groups: amnestic MCI (n=20), multiple domain MCI (n=98), non-amnestic MCI (n=9). Seventeen normal subjects (age=74.59; SD=10.63) were included. Results: Of those included, 27.1% developed Alzheimer’s type dementia [average time for conversion to Alzheimer’s dementia (AD) 11.12 months (SD=0.183)]. None of the controls developed dementia. Thirty-five percent (n=7) of amnestic MCI converted to AD: 20% (n=4) at 6 months and15% (n=3) at 12 months); 11.1% (n=1) of the non-amnestic single domain MCI converted to AD at 6 months. It was found that 31.6% (n=31) of multiple domain MCI rotated to AD: 15.3% (n=15) at 6 months and 16.3% (n=16) at 12months. Age (p<0.05, β=1.03) increased the likelihood of rotation to AD. Multi-domain MCI subtype was the most frequent. However, the conversion to dementia in amnestic subtype was the highest, age and retirement being the variables that increased the likelihood of conversion to Dementia (AU)

Mild cognitive impairment: risk of dementia according to subtypes.

UNLABELLED: Mild cognitive impairment (MCI) has 3 clinical subtypes: amnestic (aMCI), multiple domains (mdMCI) and non-amnestic single domain (na-SD-MCI) whose evolutive possibility to dementia has not been profoundly studied. OBJECTIVE: This paper aims to determine the conversion to dementia of the different subtypes of MCI and determine risk factors associated to conversion to dementia. METHODS: A total of 127 patients diagnosed with MCI (age=70.21; SD=13.17) were evaluated with a neuropsychological and neuropsychiatric battery. They were classified into 3 groups: amnestic MCI (n=20), multiple-domain MCI (n=98), non-amnestic MCI (n=9). Seventeen normal subjects (age=74.59; SD=10.63) were included. RESULTS: Of those included, 27.1% developed Alzheimer's type dementia [average time for conversion to Alzheimer's dementia (AD) 11.12 months (SD=0.183)]. None of the controls developed dementia. Thirty-five percent (n=7) of amnestic MCI converted to AD: 20% (n=4) at 6 months and 15% (n=3) at 12 months); 11.1% (n=1) of the non-amnestic single domain MCI converted to AD at 6 months. It was found that 31.6% (n=31) of multiple domain MCI rotated to AD: 15.3% (n=15) at 6 months and 16.3% (n=16) at 12 months. Age (p<0.05, ß=1.03) increased the likelihood of rotation to AD. Multi-domain MCI subtype was the most frequent. However, the conversion to dementia in amnestic subtype was the highest, age and retirement being the variables that increased the likelihood of conversion to Dementia.

Behavioral symptoms related to cognitive impairment.

Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct 'MBI' and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer's disease and frontotemporal lobar degeneration.

Efficacy of a cognitive intervention program in patients with mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia. Identifying this condition would allow early interventions that may reduce the rate of progression to Alzheimer's disease (AD). We examined the efficacy of a six-month cognitive intervention program (CIP) in patients with MCI and to assess patients' condition at one-year follow-up. METHODS: Forty-six MCI participants assessed with neuropsychological, neurological, neuropsychiatry, and functional procedures were included in this study and followed up during a year. The sample was randomized into two subgroups: 24 participants (the "trained group") underwent the CIP during six months while 22 (control group) received no treatment. Sixteen participants dropped out of the study. The intervention focused on teaching cognitive strategies, cognitive training, and use of external aids, in sessions of two hours, twice per week for six months. Cognitive and functional measures were used as primary outcome and all were followed up at one year. RESULTS: The intervention effect (mean change from baseline) was significant (p < 0.05) on the Mini-Mental State Examination (1.74), the Clinical Dementia Rating Scale (0.14), the Boston Naming Test (2.92), block design (-13.66), matrix reasoning (-3.07), and semantic fluency (-3.071) tasks. Four patients (one trained and three controls) progressed to dementia after one year of follow-up. CONCLUSIONS: These results suggest that persons with MCI can improve their performance on cognitive and functional measures when provided with early cognitive training and it could persist in a long-term follow-up.

[Review of recommendations and new diagnosis criteria for mild cognitive impairment due to Alzheimer's disease]. / Revisión de los nuevos criterios y recomendaciones para el diagnóstico de Deterioro Cognitivo Leve debido a Enfermedad de Alzheimer.

The symptomatic predementia phase of Alzheimer's disease (AD), known as mild cognitive impairment (MCI) is a clinical and neuropsychological condition which defines the transitional state between normal aging and dementia, and is used as a clinical description of people at risk of developing AD. A review of the diagnostic criteria of MCI due to Alzheimer's disease was recently published by the Alzheimer's Association and the National Institute on Aging of the U.S. in order to ensure early diagnosis of the disease, useful for both clinical practice and clinical trials. The objectives of this paper are to review and analyze the revised diagnostic criteria for MCI due to Alzheimer's disease recently proposed, to compare with criteria for MCI available and to establish current strengths and limitations of the new proposal in clinical practice. The new diagnostic criteria for MCI due to AD have a radical importance since they are potentially applicable in the clinical or research protocols and in all clinical settings where such markers are available. They provide a useful, consistent and valuable tool to homogenize the subgroup of patients with MCI who already has AD in a predementia phase with inexorable progression to dementia by AD over the years.

Clinical manifestations of geriatric depression in a memory clinic: toward a proposed subtyping of geriatric depression.

BACKGROUND: As the older population increases so does the number of older psychiatric patients. Elderly psychiatric patients manifest certain specific and unique characteristics. Different subtypes of depressive syndromes exist in late-life depression, and many of these are associated with cognitive impairment. MATERIALS AND METHODS: A total of 109 depressive patients and 30 normal subjects matched by age and educational level were evaluated using a neuropsychiatric interview and an extensive neuropsychological battery. Depressive patients were classified into four different groups by SCAN 2.1 (schedules for clinical assessment in Neuropsychiatry): major depression disorder (n: 34), dysthymia disorder (n: 29), subsyndromal depression (n: 28), and depression due to mild dementia of Alzheimer's type (n: 18). RESULTS: We found significant associations (p<.05) between depressive status and demographic or clinical factors that include marital status (OR: 3.4, CI: 1.2-9.6), level of daily activity (OR: 5.3, CI: 2-14), heart disease (OR: 12.5, CI: 1.6-96.3), and high blood cholesterol levels (p:.032). Neuropsychological differences were observed among the four depressive groups and also between depressive patients and controls. Significant differences were observed in daily life activities and caregivers' burden between depressive patients and normal subjects. CONCLUSION: Geriatric depression is associated with heart disease, high cholesterol blood levels, marital status, and daily inactivity. Different subtypes of geriatric depression have particular clinical features, such as cognitive profiles, daily life activities, and caregivers' burden, that can help to differentiate among them. LIMITATIONS: The cohort referred to a memory clinic with memory complaints is a biased sample, and the results cannot be generalized to other non-memory symptomatic cohorts.