Estadio evolutivo de los pacientes con enfermedad de Alzheimer que acuden a la consulta especializada en España. Estudio EACE / Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study

Introducción: Estamos asistiendo a un cambio en el paradigma del diagnóstico de la enfermedad de Alzheimer (EA), de modo que tiende a realizarse en fases más precoces de la evolución, incluso antes de la aparición del síndrome completo de demencia. En nuestro entorno no se conoce en qué situación clínica se está realizando el diagnóstico de la EA. Por ese motivo, se ha llevado a cabo este estudio, para describir el estadio evolutivo de los pacientes con EA en el momento del diagnóstico. Métodos: Estudio multicéntrico, observacional y transversal. Se incluyeron pacientes que cumplían criterios NINCDS-ARDRA de EA probable, atendidos en consultas de Atención Especializada en España. Se recogieron los datos sobre los tiempos asistenciales y de evolución de la EA según el MMSE, el cuestionario NPI y la escala CDR. Resultados: Participaron 437 especialistas de todas las Comunidades Autónomas, que incluyeron un total de 1.707 pacientes, de los cuales 1.694 fueron incluidos en el análisis. La puntuación media del MMSE fue de 17,6±4,8 (IC 95%: 17,4-17,9). El 64% de los pacientes presentaban deterioro cognitivo moderado (MMSE entre 10 y 20) y el 6% grave (MMSE < 10). El tiempo medio desde los primeros síntomas hasta la primera consulta a Atención Primaria fue de 10,9±17,2 meses (IC 95%: 9,9-11,8), y hasta el diagnóstico de la EA fue de 28,4±21,3 meses. Conclusiones: Los resultados del EACE ponen de manifiesto que en nuestro entorno la mayor parte de los pacientes con EA acuden a Atención especializada en un estado evolutivo moderado (AU)

Introduction: The diagnostic paradigm of Alzheimer disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. Methods: Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). Results: Participants in this study included 437 specialists representing all of Spain’s autonomous communities and a total of 1,707 patients, of whom 1,694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI: 17.4-17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSE<10) in 6%. The mean interval between symptom onset and the initial primary care visit was 10.9±17.2 months (95% CI: 9.9-11.8), and the interval between symptom onset and diagnosis with AD was 28.4±21.3 months. Conclusions: Results from the EACE show that most AD patients in our are area have reached a moderate clinical stage by the time they are evaluated in a specialist clinic (AU)

[Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study]. / Estadio evolutivo de los pacientes con enfermedad de Alzheimer que acuden a la consulta especializada en España. Estudio EACE.

INTRODUCTION: The diagnostic paradigm of Alzheimer disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. METHODS: Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). RESULTS: Participants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1,707 patients, of whom 1,694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI:17.4-17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSE<10) in 6%. The mean interval between symptom onset and the initial primary care visit was 10.9±17.2 months (95% CI:9.9-11.8), and the interval between symptom onset and diagnosis with AD was 28.4±21.3 months. CONCLUSIONS: Results from the EACE show that most AD patients in our area have reached a moderate clinical stage by the time they are evaluated in a specialist clinic.

[An analysis of avoidable admissions to a neurology service]. / Análisis de los ingresos evitables en un servicio de neurología.

INTRODUCTION: Inappropriate admissions to a hospital service generate unnecessary costs for our health care service. Most admissions to a hospital service come from the emergency department. The presence of a neurologist to attend hospital emergencies would be an important factor allowing admission criteria to be streamlined. AIMS: To determine the number of avoidable admissions (AA) in a neurology service, and to define their characteristics. PATIENTS AND METHODS: We conducted a prospective, descriptive study of the admissions that took place in the Neurology Service of the Hospital General Universitario de Elche (Alicante) over a period of three months. The neurologist determines whether admission is indicated or not. We collected demographic data concerning the patient, the admission diagnosis, neurological diagnosis, the reason for appropriateness and the reason for AA. RESULTS: A total of 250 admissions were attended; 65 were considered to be AA (26%). The most frequent diagnoses in the cases of AA were non-neurological (32.3%), clinical findings (15.4%), neuropathies (10.8%) and epilepsy (10.8%). The reasons leading to AA were non-neurological and transfer to another service (30.8%), follow-up by neurology outpatient department (NOD) (29.2%), NOD study (21.5%), non-neurological and discharge (16.9%) and not specified (1.5%). The mean length of stay in the case of AA was 4.3 days. CONCLUSIONS: The number of AA in our service is higher than that found in other studies. On-duty neurologists, streamlining outpatient diagnostic testing and the design of flexible schedules for outpatient care would reduce the amount of resources that are used, while at the same time increasing the quality of the health service.

Análisis de los ingresos evitables en un servicio de neurología / An analysis of avoidable admissions to a neurology service

Introducción. Los ingresos inadecuados a un servicio hospitalariogeneran costes innecesarios a nuestro sistema de salud.La mayoría de ingresos en un servicio hospitalario procede delárea de urgencias. La presencia de un neurólogo que atienda lasurgencias hospitalarias constituiría un factor importante pararacionalizar los criterios de hospitalización. Objetivos. Determinarel número de ingresos evitables (IE) en un servicio de neurologíaasí como definir las características de éstos. Pacientes y métodos.Estudio descriptivo prospectivo de los ingresos realizados enel Servicio de Neurología del Hospital General Universitario deElche (Alicante) durante tres meses. El neurólogo determina laindicación de ingreso. Se recogen los datos de filiación del paciente,el diagnóstico del ingreso, el diagnóstico del neurólogo, el motivode adecuación y el motivo de IE. Resultados. Se atendieron untotal de 250 ingresos; 65 se consideraron IE (26%). Los diagnósticosmás frecuentes de los IE fueron: no neurológico (32,3%), síntomasy signos (15,4%), neuropatías (10,8%) y epilepsia (10,8%).Los motivos de IE fueron: no neurológico y traslado de servicio(30,8%), seguimiento en consultas externas de neurología (CEN)(29,2%), estudio en CEN (21,5%), no neurológico y alta (16,9%) yno consta (1,5%). Los IE tuvieron una estancia media de 4,3 días.Conclusiones. El número de IE en nuestro servicio es más elevadoque en otros estudios. La disponibilidad de guardias de neurología,la agilización de la realización ambulatoria de pruebasdiagnósticas y el diseño de agendas flexibles de asistencia ambulatoriasupondrían una reducción en la utilización de recursos, yaumentaría la calidad del servicio asistencial

Introduction. Inappropriate admissions to a hospital service generate unnecessary costs for our health care service.Most admissions to a hospital service come from the emergency department. The presence of a neurologist to attend hospitalemergencies would be an important factor allowing admission criteria to be streamlined. Aims. To determine the number ofavoidable admissions (AA) in a neurology service, and to define their characteristics. Patients and methods. We conducted aprospective, descriptive study of the admissions that took place in the Neurology Service of the Hospital General Universitariode Elche (Alicante) over a period of three months. The neurologist determines whether admission is indicated or not. Wecollected demographic data concerning the patient, the admission diagnosis, neurological diagnosis, the reason for appropriatenessand the reason for AA. Results. A total of 250 admissions were attended; 65 were considered to be AA (26%). The mostfrequent diagnoses in the cases of AA were non-neurological (32.3%), clinical findings (15.4%), neuropathies (10.8%) andepilepsy (10.8%). The reasons leading to AA were non-neurological and transfer to another service (30.8%), follow-up byneurology outpatient department (NOD) (29.2%), NOD study (21.5%), non-neurological and discharge (16.9%) and notspecified (1.5%). The mean length of stay in the case of AA was 4.3 days. Conclusions. The number of AA in our service ishigher than that found in other studies. On-duty neurologists, streamlining outpatient diagnostic testing and the design offlexible schedules for outpatient care would reduce the amount of resources that are used, while at the same time increasingthe quality of the health service

[A descriptive study of intrahospital consultation to a neurological department]. / Estudio descriptivo de las interconsultas realizadas a un servicio de neurología.

INTRODUCTION: Intrahospital consultation (IC) is a little analyzed activity within daily neurologist hospital care. It entails an extra investment of time and resources. This study aims to describe the number and characteristics of the IC to a neurological department in our setting and to emphasize its importance within daily neurological health care. METHODS: We performed an eighteen-month retrospective study of the requests for consultations received during this period in the Neurology Service of the Hospital General Universitario. The following variables were analyzed: demographic information, number and type of IC, time of response, syndromic diagnosis, complementary tests requested and resolution of patients. RESULTS: 224 IC in 210 patients were seen. The average time of response was 1.57 days, although it was modified because of type of IC (normal: 1.7 days; for preference: 1.5 days; urgent: 0.2 days). The specialities that requested most consultations were cardiology (12.9%) and internal medicine (12.5 %). The most frequent reasons for consultation were: signs and symptoms (27.2%), focal neurological deficit (22.8%) and cognitive impairment (17.9%). CT scan and MRI were the most common complementary tests. A total of 25.4% of patients were referred to neurology outpatient clinic for follow-up. CONCLUSIONS: IC is an infrastudied activity in the literature. We consider it necessary to analyze this kind of care in every hospital in order to improve the organization and the planning of the day-to-day hospital activity

Estudio descriptivo de las interconsultas realizadas a un servicio de neurología / A descriptive study of intrahospital consultation to a neurological department

Introducción. Las interconsultas (IC) son una actividad poco analizada dentro del quehacer diario del neurólogo que desempeña su actividad en el hospital. Supone una inversión «extra» de tiempo y recursos. Nuestro objetivo es el de describir en nuestro medio el número y las características de las IC atendidas y destacar la importancia de las mismas en la labor asistencial diaria del servicio. Métodos. Realizamos un estudio descriptivo retrospectivo de las IC atendidas en el Hospital General durante un período de 18 meses. Se recogieron las variables demográficas, número de IC, tipo de IC, la demora de respuesta y datos de los pacientes referentes a patologías atendidas, pruebas solicitadas y destino de los mismos. Resultados. Se realizaron 224 IC pertenecientes a 210 pacientes. El tiempo medio de respuesta fue de 1,57 días, aunque éste fue variable en función de la urgencia de la solicitud (normal: 1,7 días; preferente: 1,5 días; urgente: 0,2 días). Las especialidades más consultoras fueron cardiología (12,9%) y medicina interna (12,5%). Los motivos de consulta más frecuentes fueron: síntomas y signos (27,2%), focalidad neurológica (22,8 %) y trastorno cognitivo (17,9 %). La prueba más solicitada fue la tomografía computarizada craneal seguida de la resonancia magnética cerebral. Tras la IC, el 25,4% de los pacientes fueron remitidos a consultas externas para seguimiento. Conclusiones. La actividad de las IC es un tema poco tratado en la literatura. Consideramos necesario analizar en cada ámbito este tipo de actividad de modo que se consiga una mejor planificación del trabajo asistencial hospitalario (AU)

Introduction: Intrahospital consultation (IC) is a little analyzed activity within daily neurologist hospital care. It entails an extra investment of time and resources. This study aims to describe the number and characteristics of the IC to a neurological department in our setting and to emphasize its importance within daily neurological health care. Methods: We performed an eighteen-month retrospective study of the requests for consultations received during this period in the Neurology Service of the Hospital General Universitario. The following variables were analyzed: demographic information, number and type of IC, time of response, syndromic diagnosis, complementary tests requested and resolution of patients. Results: 224 IC in 210 patients were seen. The average time of response was 1.57 days, although it was modified because of type of IC (normal: 1.7 days; for preference: 1.5 days; urgent: 0.2 days). The specialities that requested most consultations were cardiology (12.9%) and internal medicine (12.5 %). The most frequent reasons for consultation were: signs and symptoms (27.2%), focal neurological deficit (22.8%) and cognitive impairment (17.9%). CT scan and MRI were the most common complementary tests. A total of 25.4% of patients were referred to neurology outpatient clinic for follow-up. Conclusions: IC is an infrastudied activity in the literature. We consider it necessary to analyze this kind of care in every hospital in order to improve the organization and the planning of the day-to-day hospital activity (AU)

[Optic atrophy, sensorineural deafness and sensory neuropathy]. / Atrofia óptica, sordera neurosensorial y neuropatía sensitiva.

We present a patient with slowly progressing optic atrophy, sensorineural deafness and sensory neuropathy. Clinical examination and testing revealed the exclusively sensorineural nature of this syndrome. Nerve biopsy pointed to primary degeneration. Our review of the literature indicates that this syndrome is categorized as heredo-degenerative.