[Show abstract][Hide abstract] ABSTRACT: Introduction: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in theclinical setting. Several BCT have been developed and/or validated in our country, but we lackspecific recommendations for use.
Development: Review of studies on the diagnostic accuracy of BCT for CI, using studies conduc-ted in Spain with BCT which take less than 20 min. We provide recommendations of use basedon expert consensus and established on the basis of BCT characteristics and study results.
Conclusion: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Exa-mination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT],test of verbal fluency [TVF]) may also be administered in cases of negative results with persis-tent suspected CI or concern (stepwise approach). In the specialised care setting, a systematicassessment of the different cognitive domains should be conducted using the Montreal Cogni-tive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke’sCognitive Examination, or by means of a stepwise or combined approach involving more sim-ple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informantquestionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI.The choice of instruments will depend on the patient’s characteristics, the clinician’s expe-rience, and available time. The BCT and IQ must reinforce —– but never substitute —– clinicaljudgment, patient-doctor communication, and inter-professional dialogue.
[Show abstract][Hide abstract] ABSTRACT: Los cuestionarios al informador, en sentido estricto, están pensados para ser administrados a un informador, habitualmente el cuidador principal, y tienen como finalidad más inmediata la evaluación cognitiva de los pacientes con deterioro cognitivo y/o demencia. Suelen ser breves e incluyen preguntas sobre las capacidades cognitivas y funcionales del estado actual, en relación a su situación previa. Pueden ser utilizados como instrumento de cribado o complementarios a la evaluación clínica. Como ejemplo de ellos estarían el Blessed Dementia Scale (BDRS)1, el Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)2 y el Ascertain Disease-8 (AD8)3.
Un segundo grupo de instrumentos son aquellos que, aplicados directamente al paciente, permiten un análisis del estado global del paciente, aunque incluyen una parte específica dirigida al informador. El Clinical Dementia Rating (CDR)4 y el General Practitioner Assessment of Cognition (GPCOC)5 serían ejemplos de este tipo de cuestionarios.
Existe un tercer grupo de instrumentos, también para ser administrados al informador, que tienen como objetivo proporcionar información acerca de algún aspecto específico de la situación del paciente: capacidades funcionales, síntomas psicológicos y conductuales, dependencia, etc. En este grupo se encontrarán cuestionarios como el Functional Activities Questionnaire (FAQ)6 o el Neuropsychiatric Inventory (NPI)7.
Los motivos para la elaboración de los cuestionarios específicos al informador son varios, el más importante se refiere a la dificultad que puede presentar la evaluación del paciente en algunos casos: incapacidad, enfermedad, negativa a la evaluación, anosognosia, etc. Así mismo ayudan a obtener información sistemática con pruebas más simples y de fácil aplicación para la detección del deterioro cognitivo, siendo especialmente útiles en la atención Primaria. La mayoría de los instrumentos de este tipo obtienen unos valores de sensibilidad y especificidad superiores a los logrados con el Mini Mental State Examination (MMSE) en la detección del deterioro cognitivo. Jorm (1996)8 plantea varias ventajas de los cuestionarios: el conocimiento diario del informador, el no requerir la presencia del paciente, la aplicación en pacientes no testables, la facilidad para responder por teléfono o por e-mail y la perspectiva longitudinal que puede aportar el informador. Por el contrario el inconveniente principal de los cuestionarios al informador es el de poder acceder a un informador fiable, o bien que en algunos informadores pueden producirse valoraciones sesgadas.
TESTS COGNITIVOS BREVES, Edited by C. Carnero-Pardo, 03/2015: chapter 2. Los cuestionarios al informador: pages 19-52; Sociedad Española de Neurología., ISBN: 978-84-942661-6-4
[Show abstract][Hide abstract] ABSTRACT: The objective of this cross-sectional and multicenter study was to evaluate the psychometric properties of the Spanish version of the Dependence Scale (DS) and to assess the relationship between dependence and clinical measures according to disease severity. Medical comorbidities, cognitive status and functional status, behavior, dependence, caregiver burden, and medical and social resources were assessed using standardized instruments. The sample consisted of 343 patients (32.1% mild, 36.7% moderate, and 31.2% severe), the mean age was 78.9 years (standard deviation = 7.4), and 67.0% were women. Criterion and construct validity index of DS were appropriate. The DS standard error of measurement was ±1.23. The explained variance in DS ranged between 0.598 and 0.731, and the relative contribution of clinical measures depended on disease severity. Current findings confirm that the Spanish version of the DS has appropriate psychometric indices and suggest that clinical indicators have different contribution to dependence according to disease severity.
Journal of Geriatric Psychiatry and Neurology 10/2014; 28(2). DOI:10.1177/0891988714554711 · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities.
We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007-2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared.
The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia.
The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.
International Psychogeriatrics 10/2014; 27(2):1-9. DOI:10.1017/S1041610214002130 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although numerous studies have examined caregiver burden in the context of Alzheimer’s disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer’s disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89–13.47), as were sole caregivers (OR 3.51; 95% CI 1.98–6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance.
[Show abstract][Hide abstract] ABSTRACT: Background and objective: The presence of anosognosia is a disorder that affects the clinical presentation of Alzheimer's disease (AD), increasing in frequency with the evolution of AD. The objective was to determine the prevalence of anosognosia and analyze the associated factors and predictors.
Patient and Method: Multicenter transversal and observational study of 345 AD patients. Anosognosia was assessed by Anosognosia Questionnaire in Dementia (AQ-D) and the evolutionary stage with the Global Deterioration Scale (GDS). Tests were used MMSE, DAD and NPI to assess cognition, functional status and neuropsychiatric symptoms, respectively. We adjusted linear regression models to determine the associated variables and binary logistic regression (RLog) to identify predictors of anosognosia.
Results: The overall prevalence of anosognosia was 46.7% (confidence interval 95% [95% CI] 41.3 to 52.1). The prevalence in stages was 28.4% (GDS 4), 64.6% (GDS 5) and 91.4% (GDS 6). The RLog identified as predictors older age (odds ratio [OR] 1.04; IC 95% 1.01-1.09), lower functional capacity (OR 0.96; IC 95% 0.93-0.98), lower cognitive level (OR 0.9; IC 95% 0.88-0.99), and greater apathy (OR 1.1; IC 95% 1.03-1.18), disinhibition (OR 1.2; IC 95% 1.09-1.50), irritability (OR 1.1; IC 95% 1.09-1.50) and motor disorders (OR 1.2; IC 95% 1.09-1.50).
Conclusions: Anosognosia increases with further deterioration. In patients undergoing mild predictor variables were apathy, disinhibition and motor disorders.
[Show abstract][Hide abstract] ABSTRACT: The objective of this cross-sectional study was to validate an abridged version of the Anosognosia Questionnaire—dementia (AQ-D) for screening anosognosia in daily practice. The authors reduce the AQ-D from 30 items to 9, with a large simple (n = 352) of patients with Alzheimer disease (AD). The Cronbach a was .793 and an area under the receiver–operating characteristic curve was 0.946. The k index between new abridged AQ-D (AAQ) and original AQ-D was .800. The AAQ presents good validity and reliability indicators and kept concordance with the original scale. It is quick and easy to administer and it can simplify the clinical screening of anosognosia in patients with AD.
Journal of Geriatric Psychiatry and Neurology 04/2014; 27(3):220-226. DOI:10.1177/0891988714527515. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables.
Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics.
Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2).
Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.
Journal of the American Medical Directors Association 03/2014; 15(7). DOI:10.1016/j.jamda.2014.02.003 · 4.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cross-sectional studies report notable discrepancies between patient and caregiver ratings of the quality of life of patients (QoL-p) with Alzheimer’s disease (AD). This study aimed to identify the factors associated with any changes in QoL-p ratings and any discrepancies between patient and caregiver ratings of QoL-p. Three-year follow-up of a cohort of non-institutionalized patients (n = 119). QoL-p was assessed by the Quality of Life in AD (QoL-AD) scale. We analyzed the influence of functional and cognitive status and behavioral problems in patients, and burden and mental health in caregivers. Repeated measures analysis was applied to the scores of patients and caregivers on the QoL-AD, and to the discrepancies between them. Generally, patients’ own ratings remained stable over time (F 3,116 = 0.9, p = 0.439), whereas caregiver ratings showed a decline (F 3,116 = 9.4, p < 0.001). In the analysis of discrepancies, patients with anosognosia gave higher ratings (F 1,117 = 11.9, p = 0.001), whereas caregiver ratings were lower when the patient showed greater agitation (F 1,117 = 13.0, p < 0.001), apathy (F 1,117 = 15.4, p < 0.001), and disabilities (F 1,117 = 17.1, p < 0.001), and when the caregiver experienced greater burden (F 1,117 = 9.0, p = 0.003) and worse mental health (F 1,117 = 10.1, p = 0.003). Patient ratings of QoL-p remain generally stable over time, whereas those of caregivers show a decline, there being significant discrepancies in relation to specific patient and caregiver factors.
[Show abstract][Hide abstract] ABSTRACT: Introduction:
The rates of cognitive decline in patients with Alzheimer's disease show variations due to various factors. AIM. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline.
Patients and methods:
Retrospective study of a sample of 383 patients with Alzheimer's disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final).
The younger age (beta = -0.23; p < 0.001), more educated (beta = 0.26; p < 0.001) and the greater deterioration of ADL (beta = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (beta = -0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%).
The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD.
Revista de neurologia 06/2013; 56(12):593-600. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to estimate several subtypes of depressive disorders as risk factors for dementia and Alzheimer disease (AD) specifically.
This is a population-based cohort study using a sample of 451 non-demented older people. Adjusted Cox proportional hazard models were calculated to determine the association of depression with dementia or AD development after 5 years. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination (CAMDEX). Depressive disorders (major episode [MD] and minor depressive disorders [MDDIS]) were assessed following DSM-IV criteria and further classified according to the age at onset (early versus late onset). In turn, all late-onset depressions were grouped as with or without depression-executive dysfunction syndrome (DEDS). Dementia (and dementia subtypes) diagnoses were made using the CAMDEX. When the patients were deceased, the Retrospective Collateral Dementia Interview was used.
Late-onset depressions (both MD and MDDIS) were associated with increased dementia (hazard ratio [HR] = 2.635; 95% CI = 1.153–6.023; and HR = 2.517; 95% CI = 1.200–5.280, respectively), and AD (HR = 6.262; 95% CI = 2.017–19.446; and HR = 4.208; 95% CI = 1.828–9.685, respectively) after adjustment by age, gender, marital status, education, cognitive impairment, executive function and stroke history. A second model revealed that only late-onset depressions with DEDS increased the risk for both dementia (late-onset MD with DEDS: HR = 6.262; 95% CI = 2.017–19.446; late-onset MDDIS with DEDS: HR = 4.208; 95% CI = 1.828–9.685) and AD (late-onset MD with DEDS: HR = 7.807; 95% CI = 1.567–38.894; late-onset MDDIS with DEDS: HR = 6.099; 95% CI = 2.123–17.524).
Late-onset depressive episodes with DEDS are risk factors for dementia and AD development, regardless of the severity of the depression. Copyright
International Journal of Geriatric Psychiatry 04/2013; 28(4). DOI:10.1002/gps.3826 · 2.87 Impact Factor