Neuroinflammation in obesity: circulating lipopolysaccharide-binding protein associates with brain structure and cognitive performance.

BACKGROUND/OBJECTIVES: Growing evidence implicates neuroinflammation in the pathogenesis of diet-induced obesity and cognitive dysfunction in rodent models. Obesity is associated with reduced white matter integrity and cognitive decline. Circulating lipopolysaccharide binding protein (LBP) concentration is known to be increased in patients with obesity. Here, we aimed to evaluate whether circulating LBP is associated longitudinally with white matter structure and cognitive performance according to obesity status. SUBJECTS/METHODS: This longitudinal study analyzed circulating LBP (ELISA), DTI-metrics (axial diffusivity (L1), fractional anisotropy (FA) and radial diffusivity (RD)) in specific regions of the white matter of 24 consecutive middle-aged obese subjects (13 women) and 20 healthy volunteers (10 women) at baseline and two years later. Digit Span Test (DST) was used as a measure of working memory/short-term verbal memory. RESULTS: Circulating LBP concentration was associated with FA and L1 values of several white matter regions both at baseline and follow-up. The associations remained significant after controlling for age, BMI, fat mass and plasma high sensitivity C-reactive protein. Importantly, the increase in LBP over time impacted negatively on FA and L1 values and on DST performance. CONCLUSIONS: Circulating LBP associates with brain white matter integrity and working memory/short-term verbal memory in both obese and non-obese subjects.

Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS). / Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano.

INTRODUCTION: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). OBJECTIVE: Present a multicentre adaptation and validation study of a Spanish version of the FRS. METHODOLOGY: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. RESULTS: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD=6.5; range, 2-25) with inter-group differences (F=120.3; df=3; P<.001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r=0.572; P<.001) and functional capacity (DAD; r=0.790; P<.001). FTD-FRS also showed a significant correlation with CDR (r=-0.641; P<.001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa=0.055). CONCLUSIONS: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD.

A path analysis of patient dependence and caregiver burden in Alzheimer's disease.

BACKGROUND: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. METHODS: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. RESULTS: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. CONCLUSIONS: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers.

BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.

[Epidemiology of Alzheimer's disease and other dementias]. / Epidemiologia de la enfermedad de Alzheimer y otras demencias.

INTRODUCTION: Dementia is a clinical syndrome resulting from a number of causations and which is usually accompanied by progressive and diffuse brain dysfunction. The different subtypes are characterised by a clinical picture with common symptoms that differ in terms of their aetiology, age, clinical presentation, clinical course and associated disorders. AIM: To present an update on the information available about the descriptive epidemiology of dementia and its main subtypes. DEVELOPMENT: The main data on prevalence, incidence and mortality were extracted from a literature review. Alzheimer's disease is the most frequent subtype and accounts for 60-80% of all the cases, followed by vascular dementia and other neurodegenerative dementias, such as dementia due to Lewy bodies, the dementia-Parkinson complex and frontotemporal dementia. Other subtypes of dementias present frequencies below 1%, and the epidemiological indicators available are not very robust. CONCLUSIONS: The prevalence and incidence of dementia increase exponentially from the age of 65 onwards. As a consequence of the progressive ageing of the population and the increase in life expectancy, the number of cases of dementia will rise in the coming decades. Recent studies point to a slight drop in the accumulated risk of dementia adjusted by age groups and sex over the last few decades in some countries. It is possible that by means of primary prevention strategies implemented upon the known risk factors for dementia the burden of dementia on public health will diminish in the future.

TITLE: Epidemiologia de la enfermedad de Alzheimer y otras demencias.Introduccion. La demencia es un sindrome clinico causado por multiples etiologias y que cursa habitualmente con disfuncion cerebral progresiva y difusa. Los distintos subtipos se caracterizan por un cuadro clinico con sintomas comunes que difieren en su etiologia, edad, forma de presentacion, curso clinico y trastornos asociados. Objetivo. Presentar una actualizacion de la informacion disponible de la epidemiologia descriptiva de la demencia y de sus principales subtipos. Desarrollo. A partir de una revision de la bibliografia, se extraen los principales datos de prevalencia, incidencia y mortalidad. La enfermedad de Alzheimer es el subtipo mas frecuente y representa el 60-80% de todos los casos, seguida de la demencia vascular y de otras demencias neurodegenerativas, como la demencia por cuerpos de Lewy, el complejo demencia-Parkinson y la demencia frontotemporal. Otros subtipos de demencias presentan frecuencias inferiores al 1%, y se dispone de indicadores epidemiologicos poco robustos. Conclusiones. La prevalencia e incidencia de demencia se incrementa a partir de los 65 años de forma exponencial. Como consecuencia del progresivo envejecimiento poblacional y el incremento de la esperanza de vida, el numero de casos de demencia aumentara durante las proximas decadas. Estudios recientes señalan una ligera disminucion del riesgo acumulado de demencia ajustado por grupos de edad y sexo durante las ultimas decadas en algunos paises. Es posible que mediante estrategias de prevencion primaria sobre los factores de riesgo de demencia conocidos en un futuro disminuya la carga de la demencia sobre la salud publica.

[Galanthamine versus donepezil in the treatment of Alzheimer's disease]. / Galantamina frente a donepecilo en el tratamiento de la enfermedad de Alzheimer.

AIM: To use comparative studies on the utilisation of the acetylcholinesterase inhibitors (AchE), galanthamine and donepezil, to evaluate the effectiveness and tolerance of the two drugs in the treatment of the symptoms of Alzheimer's disease (AD). DEVELOPMENT: A search was conducted on Medline for papers dealing with galanthamine and donepezil that had been published up to February 2007. Six comparative studies involving galanthamine and donepezil were found, although there are other studies that compare them together with other AchE inhibitors. CONCLUSIONS: Both drugs are moderately effective in the treatment of AD. Nevertheless, whereas in the case of donepezil there seems to be a positive relation between the maximum dosage and response, for galanthamine doses above 24 mg/day do not seem to offer any improvement. In general, treatment was well tolerated in all the studies. Maximum recommended doses (24 mg/day for galanthamine versus 10 mg/day for donepezil) were more often reached in patients treated with donepezil. The five most common side effects were, in order of frequency of presentation: nausea, agitation, vomiting, headache and fainting. In the long term, the most frequent side effects from anticholinesterases are, generally speaking, muscle cramps, tremors, nightmares, nausea, vomiting, fatigue, vertigo and loss of weight. The studies analysed show limitations in the design, duration, sample sizes and the titration schemes of the drugs.

[The feasibility of a registry of dementias: clinical features and diagnostic coverage]. / Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica.

INTRODUCTION AND AIM: Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. MATERIALS AND METHODS: Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. RESULTS: 670 new cases of dementia, of which 74% corresponded to Alzheimer's disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative's home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit's reference territorial area. The diagnostic coverage for the health region of Girona was 38%. CONCLUSIONS: The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona.

[Telemedicine and dementia: a need for the 21st century]. / Telemedicina y demencia: una necesidad para el siglo XXI.

INTRODUCTION: The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. DEVELOPMENT: Telemedicine's applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. CONCLUSIONS: Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services.

[Characterisation and prevalence of the psychological and behavioural symptoms in patients with dementia]. / Caracterización y prevalencia de los síntomas psicológicos y conductuales en pacientes con demencia.

AIM: To assess the prevalence of behavioural and psychological symptoms (BPS's) in patients with dementia in Spain and their dementia-specific characteristics. PATIENTS AND METHODS: A cross-sectional and retrospective study of 1025 patients from 52 specialized dementia care units using the Neuropsychiatric Inventory (NPI). Patients with a probable diagnosis of Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease and dementia (PDD) were selected for BPS's characterisation. RESULTS: The global prevalence of BPS's was 66.7% (684 patients; 95% CI = 63.8-69.6%). BPS's were under-diagnosed in one third of cases. A total of 668 patients with NPI of 4 or superior and a diagnosis of AD (n = 380; 56.8%), DLB (n = 156; 23.3%) and PDD (n = 132; 19.7%) had a NPI mean of 21.1 (SD = 14.7), 25.6 (SD = 13.9) and 21.8 (SD = 14.2), respectively. Apathy, depression and anxiety were the most common BPS's. Delusions and hallucinations were significantly more prevalent in DLB. Dementia severity was correlated with the global NPI value and with all the sub-items, but anxiety and euphoria. The presence of agitation, euphoria or lability was associated with a deficient therapeutic fulfillment. CONCLUSION: A high prevalence of non-diagnosed BPS's was observed in the studied population. This has serious negative consequences for the quality of life of patients and their social environment. Therefore we propose an active search and subsequent correct treatment of BPS's in all patients with dementia.

[Clinical heterogeneity of Alzheimer's disease according to the age of onset]. / Heterogeneidad clinica de la enfermedad de Alzheimer segun la edad de inicio.

INTRODUCTION: The age of onset of Alzheimer's disease (AD) has been linked to the degree of clinical heterogeneity. Some studies have suggested that the presenile and senile forms may be different conditions. AIM: To describe the clinical and developmental characteristics of patients with AD according to the age of onset. PATIENTS AND METHODS: A clinical sample of AD patients was evaluated by means of the Cambridge Examination for Mental Disorders of the Elderly protocol together with other tests and clinical scales (Trail Making Test, Neuropsychiatric Inventory, Rapid-Disability Rating Scale-2 and Zarit Burden Interview). Patients were reassessed at 12 months. RESULTS: Of the 492 participants, 419 (85.2%) were cases of late-onset AD and 73 cases (14.8%) had early-onset AD. For this latter group, the time between onset of the first symptoms and diagnosis of the disease was higher (3.85 versus 2.5 years) and there was a higher frequency of family histories of dementia (35.6%) and personal histories of psychiatric disorders (13.7%). This group also presented better scores on the functional evaluation scales and on the neuropsychological tests, as well as more frequent and severe symptoms of depression. At 12 months no clinical differences were recorded between the two groups, except for an increase in the frequency and severity of apathy. CONCLUSIONS: From the differences found between early-onset and late-onset AD we cannot consider them to be two different conditions from the clinical and/or neuropsychological point of view.

[A proposal for a clinical registry of dementias]. / Propuesta para un registro clinico de demencias.

AIMS: We outline a proposal for the structural and functional features needed to develop a registry of dementias which can be used to collect standardised information that is both reliable and valid concerning cases of dementia in the specialised health care centres within a particular geographical area. DEVELOPMENT: Due to the shortage of information about aspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns of detection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequential implementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identify the cases and sources of information; second, a system for collecting data must be developed that allows information to be gathered in a standardised manner while at the same time making it possible to work in close collaboration with the specialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all the functions and activities of the registry. CONCLUSIONS: Epidemiological surveillance is an essential instrument for planning, managing and distributing community health resources, for following up the natural history of chronic diseases and for assessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry of dementias meets all the basic requirements of epidemiological surveillance.

Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).

OBJECTIVE: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. METHODS: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. RESULTS: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. CONCLUSIONS: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

[The clinical incidence of frontal dementia]. / Incidencia clínica de la demencia frontal.

INTRODUCTION AND OBJECTIVES: Although the neuropathology of Pick s disease and the frontal lobe dementias has been well defined, the complexity of the clinical diagnosis makes epidemiological studies difficult. The objective of this study was to determine the annual clinical incidence of fronto temporal dementia. PATIENTS AND METHODS: A retrospective observational study was made of the diagnoses of all persons attended in UVAMID during the period 1999 2000. Clinical evaluation was standardized following a protocol of the UVAMID. This included a clinical history obtained by interviewing the patient and a reliable informant, general medical and neurological examination, neuropsychological examination and a battery of complementary tests. RESULTS: In clinical practice the incidence of the different types of dementia varies between 93/100,000 in Alzheimer type dementia and 14/100,000 in DFT f. When age groups are considered, there is a progressive increase in the incidence of DFT f with 12/100,000 in the age group 46 69 years and 57/100,000 in the group of 75 79 years. CONCLUSIONS: The results of this study show that cases of DFT f form 2.7% of the new cases occurring annually. The main limitation of this study is that since these patients were referred for consultation from primary care centres, they form a non representative clinically biased sample which limits extrapolation of the results.

[Burden and quality of life in carers of patients with Alzheimer type dementia]. / Carga y calidad de vida en cuidadores de pacientes con demencia tipo Alzheimer.

OBJECTIVE: To analyze the factors which affect the burden and quality of life in carers of patients with Alzheimer's disease. MATERIAL AND METHODS: From a sample of 234 carers of patients in the Unit for Assessment of Memory and Dementia with a diagnosis of probable Alzheimer's disease, according to the scale of National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA), and of minimal or slight severity, according to the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) criteria, we obtained sociodemographic variables and administered the following questionnaires: Neuropsychiatric Inventory (NPI), Rapid Disability Rating Scale (RDRS-2), Quality of Life Questionnaire (QLQ) and Burden Interview (BI). RESULTS: The sex of the carers, the hours of attention to the basic activities of daily life (BADL) and the Cambridge Cognitive Examination (CAMCOQ), Minimental State Examination (MMSE), QLQ, NPI and RDRS-2 scores were related to the BI score. Multiple regression accepted the scoring for NPI, RDRS-2 and QLQ in the model. The QLQ score was associated with male sex of the patient, the age of the carer, employment status, whether or not he lived with the patient, with the family relationship, the hours of attention to the BADL and the scores on CAMCOG, MMSE, RDRS-2, NPI and BI. The multiple regression model included the age of the carer, the BI score and the hours of attention to the BADL. CONCLUSION: The non-cognitive symptoms, functional disability and poor perception of quality of life are factors affecting the burden and age of the carer, the hours of attention to the BADL and the burden affecting quality of life.

[Effectiveness of donepezil at six months in the treatment of cognition deterioration in patients with Alzheimer-type dementia]. / Efectividad a los seis meses del donepecilo en el tratamiento del deterioro cognitivo en pacientes con demencia tipo Alzheimer.

INTRODUCTION: We compared two groups of patients with cognitive deterioration secondary to Alzheimer's disease (AD) of minimal and slight degree (CAMDEX criteria), one treated with donepezil and the other without this drug (a case history sample) over a period of six months. PATIENTS AND METHODS: Both groups received the CAMCOG battery of neuropsychological tests at basal (pretreatment) time and six months later. RESULTS: Those in the study sample who received donepezil (5-10 mg/day) were 91 patients (average age: 75.25, standard deviation = 6.01) of whom 28.6% were men. The control group, who did not receive anticholinesterase drugs (case history sample) consisted of 84 persons (average age: 75.98, standard deviation = 5.01) with 29.8% men. There were no significant differences with regard to age, sex, basal CAMCOG score or period of time between the two CAMCOG determinations. The averages of the differences between the basal CAMCOG scores and those six months later in the two groups was statistically significant (-1.5275 +/- 7.8458 against -6.7143 +/- 6.1234; p < 0.001). Multivariate analysis of repeat measurements corroborates these findings since significant differences were found between the two groups (p < 0.001) in the results of CAMCOG after six months. CONCLUSION: Donepezil was seen to be effective in that it delayed cognitive deterioration after six months in patients with minimal and slight degrees of AD.

[Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild Alzheimer s disease over a six-month period]. / Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses.

INTRODUCTION: At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. PATIENTS AND METHODS: We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6 month period. RESULTS: The sample was made up of 175 patients, of which 134 began therapy with 5 10 mg/day of donepezil and 41 with 6 12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. CONCLUSIONS: The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine.

[Clinical incidence of dementia with Lewy bodies]. / Incidencia clínica de la demencia por cuerpos de Lewy.

INTRODUCTION AND AIMS: Dementia with Lewy bodies (DLB) has only relatively recently been acknowledged as an independent neurodegenerative entity. Until now few epidemiological prevalence studies have been carried out that include DLB and there are no studies about its incidence. The aim of this study is to determine the annual clinical incidence of DLB. PATIENTS AND METHODS: We performed an observational retrospective study of the diagnosis of all the individuals who were attended at the UVAMID (Memory and Dementia Assessment Unit) between 1999 and 2001. The clinical assessment was performed in a standardised manner following the UVAMID protocol, which includes the medical history, obtained by interviewing the patient and a reliable informant, a general medical and neurological check up, neuropsychological exploration and a set of complementary tests. RESULTS: The incidence of DLB in clinical practice was found to be 26/100,000 cases per year. By age groups, a progressive increase in incidence was seen until the 80 84 year old bracket and 63% of the cases of DLB were males. CONCLUSIONS: The results of this study show that cases of DLB made up 2% of the total number of new annual cases. The main limitation of this study lies in the fact that, because patients were referred to clinic from primary health care centres, they do not constitute a representative sample that is clinically unbiased, and this imposes restraints on the extrapolation of results.

[Carer's burden and depressive symptoms in patients with Alzheimer s disease. State after twelve months]. / Carga del cuidador y síntomas depresivos en pacientes con enfermedad de Alzheimer. Evolución a los 12 meses.

OBJECTIVE: The objective of this study is to determine the effect of depressive symptoms of patients in the burden perceived by the carer, evaluate the course of this burden in relation to the disappearance, persistence or appearance of depressive symptoms after twelve months and find which factors are associated with a rise or fall in the carer s load after twelve months. PATIENTS AND METHODS: A prospective observational study for 12 months of a sample of 150 patients with the clinical diagnosis of probable Alzheimer s disease on the criteria of NINDCS ADDRA: The sociodemographic data of their carers were collected and tested on the following scales: CAMDEX, CAMCOG, NPI, RDRS 2 and Burden Interview (BI) initially and twelve months later. RESULTS: The existence of depression initially was associated with an increased burden (score of BI of 22.76 compared with 15.79), increased non cognitive symptoms (NPI score of 16.23 compared with 5.94) and greater functional disability (RDRS 2 score of 27.89 compared with 25.53). The burden increased in the group of patients whose depressive symptoms persisted and in those in whom they appeared after twelve months. CONCLUSION: The data suggest that depressive symptoms increase functional disability and are associated with an increase in non cognitive symptoms. At the same time the functional disability and non cognitive symptoms increase the carer's burden.

[Integrated program of psychogeriatric care]. / Programa integral de atención psicogeriátrica.

INTRODUCTION: At the present time there is considerable controversy over the course to follow in attention to patients with psychogeriatric disorders. Rapid diagnosis and maintaining the patients in their homes are the basic objectives of the policy of sharing responsibility among those involved. DEVELOPMENT: We review the bibliography and suggest a form of attention based on experience acquired in the dementia evaluation unit of the Programme Vida als Anys of the Generalitat de Catalunya. The model described is based on making the diagnosis in the patient's home, giving support to the family and integrating the patient into a follow-up unit, with a person responsible for evaluating and resolving the needs of both patient and family as they arise. In order to carry out this programme, the attention must be given by multidiscliplinary units with the necessary resources.

[Clinical and demographic characteristics of the cases of dementia diagnosed in the Health District of Girona throughout the period 2007-2010: data from the Girona Dementia Registry (ReDeGi)]. / Caracteristicas clinicas y demograficas de los casos de demencia diagnosticados en la Region Sanitaria de Girona durante el periodo 2007-2010: datos del Registro de Demencias de Girona (ReDeGi).

INTRODUCTION: The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District. AIM: To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia. PATIENTS AND METHODS: The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010. RESULTS: A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases. CONCLUSIONS: The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.