Características clínicas de los casos de demencia diagnosticados en la Clínica de Memoria del Hospital Nacional de Geriatría y Gerontología / Clinical aspects of dementia cases diagnosed at the Memory Clinic of the National Geriatric and Gerontology Hospital

Antecedentes: la demencia es una entidad clínica cada vez más prevalente en nuestro medio, cuya incidencia aumenta con la edad. El objetivo del presente estudio es identificar los principales tipos de demencia atendidos en una unidad de trastornos de memoria. Métodos: registro consecutivo y estandarizado de pacientes diagnosticados con demencia en la Unidad de Trastornos de Memoria y Conducta, del Hospital Nacional de Geriatría y Gerontología. Resultados: se evaluó 1659 casos, de los cuales el 65,8% reunió criterios de demencia. El 42,9% correspondió a enfermedad de Alzheimer, el 28,5% a demencia secundaria a patología vascular, el 17,1% a formas mixtas, y el 11,5% a tipos varios. La edad media fue de 79,6 + 6,7 años, y el 66,2% fueron mujeres. La escolaridad promedio fue 4,95 + 4,09 años; el 41,7% estaba casado; el 47,3% tenía un hijo como cuidador; el tiempo promedio entre la aparición de los síntomas y el diagnóstico clínico fue de 3,18 + 2,6 años. La puntuación media del test Minimental fue de 18,35 + 5,9 puntos; en el test de dibujo del reloj fue de 3,4 + 2,5, y el Clinical Dementia Rating fue de 1,7 + 0,7; el 45,2% de los casos correspondió a CDR de 1. El 24% de los casos tenía antecedente familiar de demencia, y el 95,7% presentaba uno o más factores de riesgo cardiovascular, siendo la HTA el más frecuente, en un 70,2%. El 27,1% de los casos fue demencias leves; el 31,9%, moderadas; el 39,3% moderadas-severas, y el 1,7%, severas. El 90% de los casos presentó uno o más trastornos neuroconductuales. Conclusiones: la determinación de los principales tipos de demencia en la población adulta mayor y sus principales características, ha permitido registrar gran cantidad de información que se desconocía y que será de útil para la gestión y planificación de estrategias de atención en salud pública.

Background: Dementia is an increasingly prevalent clinical entity in the medical field, whose incidence increases with age. The purpose of this study is to identify the main types of dementia treated in a memory-disorders unit. Methodology: A consecutive and standardized register of patients diagnosed with dementia at the Memory Disorders Unit of the National Geriatrics and Gerontology Hospital. Results: 1659 cases were evaluated, 65.8% met criteria for dementia. 42.9% of the cases were Alzheimer’s disease, 28.5% secondary vascular dementia pathology, mixed forms represented 17.1% and 11.5% were diverse types. The mean age was 79.6 + 6.7 years and 66.2% were women. Average schooling was 4.95+ 4.09 years, 41.7% were married, 47.3% had a child as a caregiver, the average time between onset of symptoms and the clinical diagnosis was 3.18 + 2.6 years. The mean Minimental test score was 18.35 + 5.9 points, in the clock drawing test it was 3.4 + 2.5 and the Clinical Dementia Rating was 1.7 + 0.7; 45.2% of cases were CDR 1. 24% of cases had a family history of dementia and 95.7% had one or more cardiovascular risk factors, with AHT being the most common in 70.2%. 27.1% of dementia cases were mild, 31.9% moderate, 39.3% moderatesevere and 1.7% were severe. 90% of patients had one or more neurobehavioral disorders. Conclusions: The determination of the main types of dementia in the elderly population and their main features has allowed the registry of abundant information that was unknown and that will be useful for the management and strategic planning of public health care.

Memory clinic experience under a social security health system in Costa Rica / Experiência de uma clínica de memória do sistema social de saúde da Costa Rica

Dementia and mild cognitive impairment (MCI) are an increasingly prevalent clinical entity in our , showing an increasing incidence with age. Objective: The purpose of this study was to identify the main types of dementia and MCI treated in a memory disorders unit in Costa Rica. Methods: A consecutive and standardized register of patients diagnosedwith dementia and MCI at the memory disorders unit of the National Geriatrics and Gerontology Hospital (NGGH) was analyzed. Results: Dementia was diagnosed in 63.5% of the 3572 cases, whereas 10.6% met criteria for MCI. The most frequent type of dementia was Alzheimers disease (47.1%), followed by vascular pathology (28.9%), mixed forms (17.2%) and other types (6.8%). In MCI, 69.5% were of amnestic multiple domain type and 14.3% were non-amnestic multiple domain, while 41.3% were of vascular and 35.8% of neurodegenerative etiology. Mean age was 79.6±6.7 years and 64.7% were women in dementia cases whereas mean age was 76.4±6.9 years and 62.1% were women in MCI. Mean years of schooling was 4.95±4.09 years and 6.87±4.71, while mean time between onset of symptoms and clinical diagnosis was 3.2±2.6 years and 2.67±2.69 years, in dementia and MCI, respectively. Conclusion: The determination of the main types of dementia and MCI in Costa Rica and their main features has allowed the registration of comprehensive, hitherto unavailable information that will be useful for the management and strategic planning of public health care.

Demência e transtorno cognitivo leve (CCL) é uma entidade clínica cada vez mais prevalente, mostrando uma incidência crescente com a idade. Objetivo: O objetivo deste estudo foi o de identificar os principais tipos de demência e CCL tratados em uma unidade de transtornos da memória de Costa Rica. Métodos: Um registo consecutivo e padronizado de pacientes com diagnóstico de demência e CCL na unidade de transtorno de memória do Hospital Geral de Geriatria e Gerontologia. Resultados: Demência foi diagnosticada em 63,5% dos 3.572 casos, enquanto 10,6% tiveram diagnóstico de CCL. O tipo mais frequente de demência foi a doença de Alzheimer (47,1%), seguido de doença vascular (28,9%), formas mistas (17,2%) e outros tipos (6,8%). No CCL, 69,5% eram de tipo amnéstico de múltiplos domínios e 14,3% eram não amnésticos de múltiplos domínios, enquanto 41,3% eram de etiologia vascular e 35,8% de etiologia neurodegenerativa. A média de idade foi de 79,6±6,7 anos e 64,7% eram mulheres em casos de demência ao passo que a média de idade foi de 76,4±6,9 anos e 62,1% eram mulheres nos casos de CCL. A média de anos de estudo foi de 4,95±4,09 anos e 6,87±4,71, o tempo entre o início dos sintomas e o diagnóstico clínico médio foi de 3,2±2,6 anos e 2,67±2,69 anos em demência e CCL, respectivamente. Conclusão: A determinação dos principais tipos de demência e CCL na Costa Rica e as suas principais características permitiu o registro de informação abundante que era desconhecida e que será útil para a gestão e planejamento estratégico da saúde pública.