Paraoxonase-1 inhibits oxidized low-density lipoprotein-induced metabolic alterations and apoptosis in endothelial cells: a nondirected metabolomic study.

We studied the influence of PON1 on metabolic alterations induced by oxidized LDL when incubated with endothelial cells. HUVEC cells were incubated with native LDL, oxidized LDL, oxidized LDL plus HDL from wild type mice, and oxidized LDL plus HDL from PON1-deficient mice. Results showed alterations in carbohydrate and phospholipid metabolism and increased apoptosis in cells incubated with oxidized LDL. These changes were partially prevented by wild type mouse HDL, but the effects were less effective with HDL from PON1-deficient mice. Our results suggest that PON1 may play a significant role in endothelial cell survival by protecting cells from alterations in the respiratory chain induced by oxidized LDL. These results extend current knowledge on the protective role of HDL and PON1 against oxidation and apoptosis in endothelial cells.

Lower Barthel Index scores predict less prescription of pharmacological therapy in elderly patients with Alzheimer disease.

AIMS: To determine the factors associated with receiving specific treatment (cholinesterase inhibitors or/and memantine) for Alzheimer disease (AD) in elderly patients. METHODS: An observational study carried out in 289 consecutive outpatients aged >64 years with dementia. We collected data on specific AD therapy, sociodemographic variables, Barthel Index (BI), Lawton and Brody Index (LI), Mini Mental State Examination, Global Deterioration Scale (GDS), Charlson Index and the total number of drugs chronically prescribed. Patients receiving specific therapy for dementia were compared with the rest. RESULTS: Two hundred and thirty-three (80.6%) patients were receiving specific treatment for dementia, with 197 (84.5%) receiving monotherapy and the rest (15.4%) combined therapy. The bivariate analysis showed that age, marital status, place of residence, BI and LI, cognitive status and disease severity (GDS) were factors associated with receiving specific dementia therapy. Multiple stepwise logistic regression analysis showed that a lower BI (beta = -0.25; odds ratio 0.976, 95% confidence interval = 0.966-0.986; p < 0.0001) was the only factor independently associated with not receiving specific therapy for AD. CONCLUSIONS: Of the possible factors related to elderly patients receiving specific therapy for AD, a poor BI score was the most important factor associated with not receiving treatment.

[High prevalence of neuroleptic drug use in elderly people with dementia]. / Alta prevalencia de consumo de neurolépticos en las personas ancianas con demencia.

BACKGROUND AND OBJECTIVES: The management of psychological and behavioural symptoms associated with dementia frequently requires the use of neuroleptic drugs. The objective of this study was to determine the prevalence, characteristics and possible differential factors of people aged > or = 65 years with dementia who take or not neuroleptic drugs. The subgroup with Alzheimer disease was analysed. PATIENTS AND METHODS: Five-hundred and fifteen patients aged > or = 65 years with dementia were prospectively evaluated. Data were collected on sociodemographic variables, type of dementia, Barthel Index (BI), Lawton Index (LI), Mini Mental State Exam (MMSE), Charlson Index, treatment with neuroleptic, antidepressants, benzodiazepines and non-benzodiazepine hypnotic-sedatives drugs, specific dementia treatments, vascular risk factors and comorbidities. The stage and severity of dementia were evaluated by the Global Deterioration Scale (GDS), creating two groups: Mild-moderate (GDS 3, 4 and 5) and severe (GDS 6 and 7) disease. RESULTS: There were 364 women (70%) and 151 men, with a mean age of 81+/-6 years, of whom 10.1% were institutionalized. Two hundred and seventy patients (52.5%) had mild-moderate disease and 245 had severe disease (47.5%). Neuroleptic drugs were being taken by 233 (45.2%) patients. In the multivariate analysis, neuroleptic drug use was associated with male gender, institutionalization, worse LI scores, more severe dementia and not having heart failure. The subgroup with Alzheimer disease was associated with worse IB and not having arterial hypertension. CONCLUSION: A high percentage of elderly patients with dementia are treated with neuroleptic drugs. There are significant differences in the prescription of neuroleptic drugs according to patient sociodemographic characteristics, severity of dementia and comorbidities.

[Dementia, a progressive disease: severe dementia. Identification of end-stage dementia]. / Demencia, una enfermedad evolutiva: demencia severa. Identificación de demencia terminal.

Because of the aging population, the incidence and prevalence of dementia has increased. The most common form of dementia is Alzheimer's disease. The present review focuses on the progression and prognosis of this disease, although many of the issues discussed can be extrapolated to other types of dementia. Despite public education efforts in recent years, dementia continues to have a tremendous impact on the patient, the primary caregiver and/or family and society in general. A diagnosis of dementia shortens life expectancy. Mean survival time is generally about 10 years but varies from person to person, depending on several factors. Through various scales, such as the Global Deterioration Scale (GDS), complemented by Functional Assessment Staging (FAST), disease progression can be monitored and patients who are terminally ill can be identified in the absence of factors of poor outcome. Thus, the correct measures can be implemented to ensure an appropriate end of life in patients with dementia.

[Pharmacological treatment of dementia: when, how and for how long. Recommendations of the Working Group on Dementia of the Catalan Society of Geriatrics and Gerontology]. / Tratamiento farmacológico de la demencia: cuándo, cómo y hasta cuándo. Recomendaciones del Grupo de Trabajo de Demencias de la Sociedad Catalana de Geriatría y Gerontología.

Dementia in general--and Alzheimer's disease (AD) in particular--are bound to loom large among the most acute healthcare, social, and public health problems of the 21st century. AD shows a degenerative progression that can be slowed down--yet not halted--by today's most widely accepted specific treatments (those based on cholinesterase inhibitors as well as those using memantine). There is enough evidence to consider these treatments advisable for the mild, moderate and severe phases of the illness. However, in the final stage of the disease, a decision has to be made on whether to withdraw such treatment or not. In this paper, the Working Group on Dementia for the Catalan Society of Geriatrics and Gerontology reviews the use of these specific pharmacological treatments for AD, and, drawing on the scientific evidence thus gathered, makes a series of recommendations on when, how, and for how long, the currently existing specific pharmacological treatments should be used.

[Informing of the diagnosis in dementia]. / La información del diagnóstico en la demencia.

Dementia is a syndrome characterized by a progressive deterioration of cognitive functions, accompanied by psychiatric symptoms and behavioral disturbances that produce a progressive and irreversible disability. The way it should communicate the diagnosis of dementia is a key discussion point on which there is no unanimous agreement so far. The communicating of the diagnosis of dementia is a complex issue that affects not only, the patient but also to caregivers and health professionals who care and must conform to the ethical principles governing medical practice (autonomy, nonmaleficence, beneficence, and justice). Therefore, from the Dementia Working Group of the Catalan Geriatric Society (Grupo de Trabajo de Demencia de la Sociedad Catalana de Geriatría) arises the need to review the issue and propose a course of action for the disclosure of diagnosis.

Tratamiento farmacológico de la demencia: cuándo, cómo y hasta cuándo. Recomendaciones del Grupo de Trabajo de Demencias de la Sociedad Catalana de Geriatría y Gerontología / Pharmacological treatment of dementia: When, how and for how long. Recommendations of the Working Group on Dementia of the Catalan Society of Geriatrics and Gerontology

La demencia en general y la enfermedad de Alzheimer (EA) en particular, están llamadas a ser uno de los principales problemas sanitarios, sociales y de salud pública en el siglo xxi . La EA tiene un curso progresivo que el tratamiento específico adecuado puede enlentecer pero no detener. Existe evidencia suficiente para recomendar este tratamiento en las fases leves, moderadas y moderadamente graves. En la fase final de la enfermedad habrá que tomar decisiones en cuanto a la retirada de dicho tratamiento. En el presente artículo, el Grupo de Trabajo de Demencias de la Sociedad Catalana de Geriatría y Gerontología, revisa la utilización del tratamiento farmacológico especifico para la EA y basándose en la evidencia científica, realiza recomendaciones de cuando, como y hasta cuando se debe utilizar el tratamiento farmacológico específico existente en la actualidad (tanto los inhibidores de la acetil colinesterasa como la memantina)(AU)

Dementia in general −and Alzheimer's disease (AD) in particular− are bound to loom large among the most acute healthcare, social, and public health problems of the 21st century. AD shows a degenerative progression that can be slowed down −yet not halted− by today's most widely accepted specific treatments (those based on cholinesterase inhibitors as well as those using memantine). There is enough evidence to consider these treatments advisable for the mild, moderate and severe phases of the illness. However, in the final stage of the disease, a decision has to be made on whether to withdraw such treatment or not. In this paper, the Working Group on Dementia for the Catalan Society of Geriatrics and Gerontology reviews the use of these specific pharmacological treatments for AD, and, drawing on the scientific evidence thus gathered, makes a series of recommendations on when, how, and for how long, the currently existing specific pharmacological treatments should be used(AU)

La información del diagnóstico en la demencia / Informing of the diagnosis in dementia

La demencia es un síndrome caracterizado por un deterioro progresivo de las funciones cognitivas, acompañado de síntomas psiquiátrico y alteraciones comportamentales que provocan una discapacidad progresiva e irreversible. El modo en que se debe comunicar el diagnóstico en la demencia constituye un punto de debate clave, sobre el cual no existe un acuerdo unánime hasta el momento. La comunicación del diagnóstico de demencia es un tema complejo que afecta no sólo al paciente sino también, a los cuidadores y a los profesionales sanitarios que lo atienden, y que se debe ajustar a los principios éticos que rigen la práctica médica (autonomía, no maleficencia, beneficencia y justicia). Por todo ello, desde el Grupo de Trabajo de Demencia de la Sociedad Catalana de Geriatría surge la necesidad de realizar una revisión del tema y de proponer unas pautas de actuación frente a la revelación del diagnóstico(AU)

Dementia is a syndrome characterized by a progressive deterioration of cognitive functions, accompanied by psychiatric symptoms and behavioral disturbances that produce a progressive and irreversible disability. The way it should communicate the diagnosis of dementia is a key discussion point on which there is no unanimous agreement so far. The communicating of the diagnosis of dementia is a complex issue that affects not only, the patient but also to caregivers and health professionals who care and must conform to the ethical principles governing medical practice (autonomy, nonmaleficence, beneficence, and justice). Therefore, from the Dementia Working Group of the Catalan Geriatric Society (Grupo de Trabajo de Demencia de la Sociedad Catalana de Geriatría) arises the need to review the issue and propose a course of action for the disclosure of diagnosis(AU)

Demencia, una enfermedad evolutiva: demencia severa. Identificación de demencia terminal / Dementia, a progressive disease: severe dementia. Identification of end-stage dementia

El envejecimiento de la población determina un aumento de la prevalencia e incidencia de las personas afectadas de demencia. La enfermedad de Alzheimer es la demencia más frecuente y en la presente revisión nos referimos a ella cuando se evalúa el curso evolutivo y el pronóstico de ésta, a pesar de que muchos aspectos pueden ser extrapolables a otros tipos de demencia. A pesar del gran despliegue en los últimos años de educación pública sobre la demencia, ésta continúa siendo responsable de un gran impacto sobre el paciente, el cuidador principal y/o familia y la sociedad en general. El diagnóstico de demencia acorta la esperanza de vida. Si bien en general se estima que el tiempo medio de supervivencia se sitúa alrededor de los 10 años, éste varía de una persona a otra en función de diferentes factores. A través de diferentes escalas, como la Global Deterioration Scale (GDS), complementada con la Functional Assessment Staging (FAST), es posible monitorizar la progresión de la enfermedad e identificar aquellos pacientes que se encuentran en fase terminal, en ausencia de factores pronósticos de mala evolución, a fin de aplicar todos aquellos cuidados que aseguren un adecuado final de vida en pacientes con demencia (AU)

Because of the aging population, the incidence and prevalence of dementia has increased. The most common form of dementia is Alzheimer's disease. The present review focusses on the progression and prognosis of this disease, although many of the issues discussed can be extrapolated to other types of dementia. Despite public education efforts in recent years, dementia continues to have a tremendous impact on the patient, the primary caregiver and/or family and society in general. A diagnosis of dementia shortens life expectancy. Mean survival time is generally about 10 years but varies from person to person, depending on several factors. Through various scales, such as the Global Deterioration Scale (GDS), complemented by Functional Assessment Staging (FAST), disease progression can be monitored and patients who are terminally ill can be identified in the absence of factors of poor outcome. Thus, the correct measures can be implemented to ensure an appropriate end of life in patients with dementia (AU)