[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: 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: 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). RESULTS. 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%). CONCLUSIONS. 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. · 1.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective
Fibromyalgia (FM) is characterized by a heterogeneous group of clinical symptoms that are evaluated using a wide variety of instruments. This study sought to develop and validate a new scale, the Comprehensive Rating Scale for Fibromyalgia Symptomatology (CRSFS), to facilitate the joint evaluation of the most frequent symptoms in patients with FM.
CRSFS items were based on a literature review and a focus group composed of patients and healthcare professionals. Four samples of patients (FM, non-FM rheumatic pain, depression, and healthy volunteers) were used to study the reliability and validity of the CRSFS. The factor structure of the CRSFS was determined through exploratory and confirmatory factor analyses. The test–retest and inter-examiner reliabilities were evaluated in a subsample of participants with FM. The criterion and convergent construct validity were compared using valid and reliable instruments to assess the impact of FM on quality of life, pain, fatigue, mood, and quality of sleep. The capacity to differentiate groups of patients was examined by comparing the CRSFS scores of the four samples to each other and using receiver operating characteristics curves.
The sample was composed of 240 participants, the mean age was 49.1years (SD=10.4), and 97.5% of them were women. The factor analyses, as well as the tests of reliability and validity, were positive. The final version of the CRSFS consisted of 20 symptoms evaluated using 60 items.
The CRSFS is a valid and reliable 4-factor scale that evaluates the most frequent clinical symptoms of patients with FM.
Journal of Psychosomatic Research 02/2013; · 3.27 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Stroop Color and Word Test (SCWT) is a short test that is widely used in neuropsychological assessment to evaluate the executive aspects of attention control, information processing speed, selective attention, cognitive flexibility, and executive function in terms of the ability to inhibit a usual response in favor of an unusual response. The aim of this study was to create normative data from the SCWT adjusted for age, sex, and educational level for its clinical use in a population of 55 years of age and above. The SCWT was administered to a population-based sample of 2,151 participants aged 55 or older, and the effect of sex, age, and educational level was determined in the SCWT by means of linear regression models. Normative tables were created following the traditional method based on the stratification by relevant variables and on regression models.
Archives of Clinical Neuropsychology 02/2013; · 2.00 Impact Factor
[show abstract][hide abstract] ABSTRACT: The objective of this paper was to assess the prevalence, incidence, persistence, and risk and mortality factors for Apathy Syndrome in Alzheimer's disease (ASAD) in a clinical sample. This was a cohort study of 491 patients with probable Alzheimer's disease (AD). The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), the Neuropsychiatric Inventory (NPI), the Rapid Disability Rating Scale (RDRS-2), and the Zarit Burden Interview (ZBI) were administered, and all patients were reevaluated after 12 months. Baseline ASAD diagnosis was made using specific diagnostic criteria. ASAD prevalence and incidence/year were 21.0% and 10.6%, respectively. After one year, ASAD persisted in 61.2% of patients. At baseline, patients with ASAD scored lower on the CAMCOG and higher on the Blessed, RDRS-2, and ZBI. Antipsychotic use was the only risk factor for ASAD (RR = 3.159; 95% CI: 1.247-8.003). ASAD was related to an increased functional disability, but no relationship with cognitive impairment or increased caregiver burden was detected. Finally, ASAD was associated with an increased risk of mortality (HR = 1.987; 95% CI: 1.145-3.450; p = 0.014). ASAD suggests a more severe AD clinical profile, with poorer functional progression and increased mortality risk. Antipsychotic use seems to be the only risk factor for ASAD.
[show abstract][hide abstract] ABSTRACT: Abstract Background: Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia. Methods: We used a cross-sectional design using 1,186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical (ATC) classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used. Results: Analgesics were prescribed to 78.6% (95% CI: 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI: 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI: 14.4-19.3) following step 2, and 2.6% (95% CI: 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia. Conclusions: The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.
The International journal of neuroscience 12/2012; · 0.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: PURPOSE: To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. METHODS: Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. RESULTS: The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). CONCLUSIONS: Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.
European Journal of Clinical Pharmacology 11/2012; · 2.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVES:: To establish the prevalence, incidence, persistence, risk factors, and mortality risk increase of psychosis of Alzheimer disease (PoAD) in a clinical sample. DESIGN, PARTICIPANTS, AND MEASUREMENTS:: Cross-sectional, observational study of 491 patients with probable AD who, at baseline visit, were evaluated with the Cambridge Examination for Mental Disorders of the Elderly, the Neuropsychiatric Inventory-10, the Rapid Disability Rating Scale-2, and the Zarit Burden Interview. All participants were reevaluated at 6, 12, 18, and 24 months. PoAD diagnoses were made using specific criteria. RESULTS:: PoAD prevalence was 7.3%, and the cumulative incidence at 6, 12, 18, and 24 months was 5.8%, 10.6%, 13.5%, and 15.1%, respectively. After 1 year, psychotic symptoms persisted in 68.7% of the patients with initial PoAD. At baseline, patients with PoAD scored lower in the Cambridge Cognitive Examination and Mini-Mental State Examination and higher in the Rapid Disability Rating Scale-2 and Zarit Burden Interview tests. Both low scores in the Cambridge Cognitive Examination subscale of learning memory (hazard ratio [HR] = 0.874; 95% CI: 0.788-0.969; Wald χ = 6.515; df = 1) and perception (HR = 0.743; 95% CI: 0.610-0.904; Wald χ = 8.778; df = 1), and high scores in expressive language (HR = 1.179; 95% CI: 1.024-1.358; Wald χ = 5.261; df = 1) and calculation skills (HR = 1.763; 95% CI: 1.067-2.913; Wald χ = 4.905; df = 1) were found to be associated with PoAD. PoAD leads to a faster functional impairment, and it increases mortality risk (HR = 2.191; 95% CI: 1.136-4.228; Wald χ = 5.471; df = 1) after controlling for age, gender, cognitive and functional disability, general health status, and antipsychotic treatment. CONCLUSIONS:: PoAD seems to define a phenotype of AD of greater severity, with worsened functional progression and increased mortality risk.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 09/2012; · 3.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: Limited information exists regarding the consumption of psychopharmaceuticals for non-Alzheimer's degenerative dementias (n-ADDs), despite the fact that the treatment of neuropsychiatric symptoms of these diseases is an important challenge for clinicians.
The aim of this study was to describe sociodemographic and clinical data from 235 patients with various subtypes of n-ADD, together with the level of consumption of pharmaceuticals with central nervous system activity.
A descriptive, observational, cross-sectional study was conducted using the data registered by the Registry of Dementias of Girona, northeast Catalunya, Spain. All drugs were categorized according to the Anatomical Therapeutic Chemical Classification System.
The results showed a high level of psychopharmaceutical prescription: 48.9 % of the n-ADD patients used acetylcholinesterase inhibitors and 9.8 % used memantine. Antipsychotics and benzodiazepines were prescribed to 45.5 and 46.8 % of the patients, respectively. Antidepressants were consumed by 70.2 % of the registered cases.
High levels of psychopharmaceutical prescribing were observed in our study and many of these prescriptions lacked specific indications for n-ADDs. It is necessary to consider the risk-benefit relationship before prescribing pharmaceuticals. Specific training programmes will be necessary to improve the use of pharmaceuticals in n-ADD patients.
[show abstract][hide abstract] ABSTRACT: The most frequent behavioral manifestations in Parkinson's disease (PD) are attributed to the dopaminergic dysregulation syndrome (DDS), which is considered to be secondary to the iatrogenic effects of the drugs that replace dopamine. Over the past few years some cases of patients improving their creative abilities after starting treatment with dopaminergic pharmaceuticals have been reported. These effects have not been clearly associated to DDS, but a relationship has been pointed out.
Case study of a patient with PD. The evolution of her paintings along medication changes and disease advance has been analyzed.
The patient showed a compulsive increase of pictorial production after the diagnosis of PD was made. She made her best paintings when treated with cabergolide, and while painting, she reported a feeling of well-being, with loss of awareness of the disease and reduction of physical limitations.
Dopaminergic antagonists (DA) trigger a dopaminergic dysfunction that alters artistic creativity in patients having a predisposition for it. The development of these skills might be due to the dopaminergic overstimulation due to the therapy with DA, which causes a neurophysiological alteration that globally determines DDS.
[show abstract][hide abstract] ABSTRACT: The Computerised Support System for the Diagnosis of Dementia in Primary Care (SISDDAP, in Spanish) is an asynchronous telemedicine programme that establishes protocols for the screening and diagnosis of dementia, thereby enabling primary care (PC) and specialised care (SC) professionals to reach shared diagnoses of dementia.
To determine the feasibility and degree of implementation of an asynchronous telemedicine programme and to evaluate the rate of agreement between the cognitive and functional measures taken by professionals from two different levels of healthcare.
The study examines the use of the SISDDAP programme by professionals from four basic areas of healthcare (BAH) in which the programme was introduced on a voluntary basis. The absolute and relative frequency of use of the SISDDAP programme and the number of variables registered were calculated, together with the intra-class correlation coefficient among the scores obtained by PC and SC professionals on the different psychometric instruments, including the SISDDAP diagnostic module (Mini-Mental State Examination, Blessed Dementia Rating Scale and Patient Health Questionnaire 9).
The four BAH that incorporated the SISDDAP referred 215 (45.3%) applications via the telemedicine programme, and 82.2% of these applications had a maximum of two data items missing. The intra-class correlation coefficient was above 0.70 among all the instruments evaluated.
The SISDDAP is an asynchronous telemedicine programme that is well accepted among PC professionals. After suitable training, the level of agreement among the psychometric instruments is acceptable.
Revista de neurologia 09/2012; 55(5):263-9. · 1.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the relationship between quality of life (QOL) and environmental factors of temperature, noise, and lighting in nursing home residents with severe dementia.
Cross-sectional, observational, analytical.
Eight public, long-term care nursing homes in the province of Girona, Spain.
Random sample of 160 nursing home residents with severe dementia.
Functional and cognitive impairment, pain, neuropsychiatric disturbances, and QOL were determined using standardized instruments. Temperature, noise, and lighting in bedrooms, dining rooms, and living rooms were measured in the morning and afternoon using a multifunction environment meter in a standardized manner.
Adjusted multivariate linear regression models demonstrated that environmental measures were independently associated with QOL and related factors. High temperature in the bedroom was associated with lower QOL (standardized β = 0.184), high noise levels in the living room were associated with low behavioral signs of social interactions (β = 0.196), and low lighting levels in the bedroom were associated with number of signs of negative affective mood (β = -0.135).
The QOL of nursing home residents with severe dementia was related to environmental factors such as temperature, noise, and lighting. The monitoring of these environmental factors may improve these individuals' QOL.
Journal of the American Geriatrics Society 06/2012; 60(7):1230-6. · 3.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: Clinical evidence indicates that acetylcholinesterase inhibitors (AChEIs) are not efficacious to treat frontotemporal lobar degeneration (FTLD). The British Association for Psychopharmacology recommends avoiding the use of AChEI and memantine in patients with FTLD.
Cross-sectional design using 1092 cases with Alzheimer's disease (AD) and 64 cases with FTLD registered by the Registry of Dementias of Girona. Bivariate analyses were performed, and binary logistic regressions were used to detect variables associated with antidementia drugs consumption.
The AChEIs were consumed by 57.6% and 42.2% of the patients with AD and FTLD, respectively. Memantine was used by 17.2% and 10.9% of patients with AD and FTLD, respectively. Binary logistic regressions yielded no associations with antidementia drugs consumption.
There is a discrepancy regarding clinical practice and the recommendations based upon clinical evidence. The increased central nervous system drug use detected in FTLD requires multicentric studies aiming at finding the best means to treat these patients.
American Journal of Alzheimer s Disease and Other Dementias 05/2012; 27(4):260-6. · 1.52 Impact Factor