Does Your Loved One With Cognitive Symptoms Need to See a Doctor? Check It Online.

Widespread access to emerging information and communication technologies (ICT) allows its use for the screening of diseases in the general population. At the initiative of the Spanish Confederation of Associations of Families of People with Alzheimer's disease and other dementias (CEAFA), a website (http://www.problemasmemoria.com) has been created that provides information about Alzheimer's disease and includes questionnaires to be completed by family or friends concerned about memory problems of a relative. A cross-sectional, randomized, multicenter study was performed to evaluate feasibility, validity, and user satisfaction with an electronic method of completion vs. the current method of paper-based questionnaires for clinically dementia screening completed by the informants: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Alzheimer's disease-8 screening test (AD8). A total of 111 pairs were recruited by seven memory clinics. Informants completed IQCODE and AD8 questionnaires both in their paper and electronic versions. The correlation between paper and electronic versions was significantly positive for IQCODE (r = 0.98; p < 0.001) and AD8 (r = 0.96; p < 0.001). The execution time did not differ significantly, and participants considered their use equally easy. This study shows that an electronic version of the IQCODE and AD8 questionnaires is suitable for its online use via the internet and achieves the same results as the traditional paper versions.

Evaluación del tratamiento antitrombótico en pacientes geriátricos institucionalizados con fibrilación auricular no valvular / Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes institucionalizados con fibrilación auricular no valvular y evaluar el grado de controlanticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en siete centros gerontológicos durante el año 2016, valorandoen aquellos residentes con fibrilación auricular no valvular la terapiaantitrombótica establecida y las incidencias embólicas, hemorrágicasy la mortalidad. En los residentes anticoagulados con antivitamina K semidió el control de la anticoagulación, estimándose un mal control si elmétodo de Rosendaal fuese < 65% o el tiempo en rango terapéuticodirecto < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían undiagnóstico de fibrilación auricular no valvular, con una edad media de85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El 50%estaban anticoagulados, principalmente con antivitamina K, de los cualesal menos el 56% no se encontraban dentro del rango terapéutico. Un16% de los residentes no tenían prescrita terapia antitrombótica, destacando en éstos una mayor dependencia funcional, cognitiva y edad más avanzada. Se encontró una mayor frecuencia de ingresos hospitalarios de causa cardiovascular y de sangrados en aquellos residentes anticoagulados, aunque no hubo diferencias significativas. (AU)

Objective: The goals of this study were to analyze the type of antithrombotic treatment administered to institutionalized patients with nonvalvularatrial fibrillation (and any ensuing complications) and to evaluate thedegree of anticoagulation control achieved with vitamin K antagonists.Method: This was a prospective observational follow-up study carriedout in seven elderly care facilities during 2016. Patients with nonvalvular atrial fibrillation were evaluated for their antithrombotic therapy andany embolic or hemorrhagic events, as well as for mortality. Subjects onanticoagulation treatment with VKAs were evaluated for anticoagulationcontrol, with control considered poor if the mean time in therapeutic rangewas < 65% when measured with Rosendaal’s method or < 60% whendetermined by the direct method.Results: Of the 699 residents evaluated, 20.6% had a diagnosis ofNVAF. Average age was 85.83 years. Both the cardioembolic (meanCHA2DS2-VASc score: 4.79), and the hemorrhagic (mean HAS-BLEDscore: 3.04) risk were high. Fifty percent received anticoagulationtreatment, mainly with vitamin K antagonists, of whom at least 56% werenot within the therapeutic range. Sixteen percent of the residents, theoldest and most functionally and cognitively dependent ones, had notbeen prescribed any antithrombotic therapy. A higher frequency of hospital admissions induced by cardiovascular and bleeding events was found in these residents, although differences were not statistically significant. (AU)

Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation.

OBJECTIVE: The goals of this study were to analyze the type of  ntithrombotic treatment administered to institutionalized patients with  nonvalvular atrial fibrillation (and any ensuing complications) and to  evaluate the degree of anticoagulation control achieved with vitamin K  antagonists. Method: This was a prospective observational follow-up study  carried out in seven elderly care facilities during 2016. Patients with  nonvalvular atrial fibrillation were evaluated for their antithrombotic  therapy and any embolic or hemorrhagic events, as well as for mortality.  Subjects on anticoagulation treatment with VKAs were evaluated for  anticoagulation control, with control considered poor if the mean time in  therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method. RESULTS: Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF.  Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2- VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04)  risk were high. Fifty percent received anticoagulation treatment, mainly  with vitamin K antagonists, of whom at least 56% were not within the  therapeutic range. Sixteen percent of the residents, the oldest and most  functionally and cognitively dependent ones, had not been prescribed any  antithrombotic therapy. A higher frequency of hospital admissions induced  by cardiovascular and bleeding events was  found in these residents,  although differences were not statistically significant. CONCLUSIONS: Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet  therapy, and some without any antithrombotic treatment. This study  howed that as functionality decreases, treatment strategies are  increasingly aimed at therapeutic deintensification. Given that the degree  of anticoagulation control with vitamin K antagonists is inadequate in 56%  of cases, it is essential to monitor the time in therapeutic range to  optimize treatment as needed.

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes  institucionalizados con fibrilación auricular no valvular y evaluar el grado  de control anticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en  siete centros gerontológicos durante el año 2016, valorando en aquellos  residentes con fibrilación auricular no valvular la terapia antitrombótica  establecida y las incidencias embólicas, hemorrágicas y la mortalidad. En  los residentes anticoagulados con antivitamina K se midió el control de la  anticoagulación, estimándose un mal control si el método de Rosendaal  fuese < 65% o el tiempo en rango terapéutico directo < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían un diagnóstico de fibrilación auricular no valvular, con una edad media de 85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio 4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El  50% estaban anticoagulados, principalmente con antivitamina K, de los  cuales al menos el 56% no se encontraban dentro del rango terapéutico.  Un 16% de los residentes no tenían prescrita terapia antitrombótica,  destacando en éstos una mayor dependencia funcional, cognitiva y edad  más avanzada. Se encontró una mayor frecuencia de ingresos  hospitalarios  de causa cardiovascular y de sangrados en aquellos  residentes anticoagulados, aunque no hubo diferencias significativas.Conclusiones: La mitad de los pacientes geriátricos institucionalizados con fibrilación auricular no valvular están  anticoagulados, un tercio antiagregados y algunos sin tratamiento  antitrombótico, observando que a medida que disminuye la funcionalidad  las estrategias van en la línea de una desintensificación terapéutica. El  grado de control anticoagulante con antivitamina K es inadecuado en el  56% de los casos, por lo que es imprescindible monitorizar el tiempo en  rango terapéutico para optimizar el tratamiento cuando sea necesario.

Intervención terapéutica farmacológica del deterioro cognitivo leve / Pharmacological therapeutic intervention in mild cognitive impairment

El deterioro cognitivo leve es un síndrome en el que, además de sintomatología cognitiva, se pueden encontrar sintomatología afectiva y conductual y diferentes subtipos. Se trata de una entidad clínica heterogénea, que tiene heterogeneidad etiológica (degenerativa, vascular, psiquiátrica, patología no neurológica), sintomatología clínica heterogénea y heterogeneidad en el curso clínico. La etiología es múltiple y, por lo mismo, el tratamiento también lo es y se debe combinar con el no farmacológico. Se describen las intervenciones farmacológicas tanto preventivas como terapéuticas: control de factores de riesgo vascular, evitar la iatrogenia, uso de suplementos nutracéuticos, la CDP-colina, el Ginkgo biloba EGb 761(R) y la mejora de órganos de los sentidos (AU)

Mild cognitive impairment (MCI) is a syndrome encompassing affective and behavioural symptoms and various subtypes. MCI is a heterogeneous clinical entity with varied causes (degenerative, vascular, psychiatric, non-neurological disorders), and there is wide variation in symptoms and clinical course. There are multiple causes and consequently various treatments can be applied and should be combined with non-pharmacological measures. This article describes both preventive and therapeutic pharmacological interventions: control of vascular risk factors, avoidance of iatrogeny, use of nutraceuticals, CDP-choline, and Ginkgo biloba EGb 761(R), and improvement in sense organs (AU)

[Pharmacological therapeutic intervention in mild cognitive impairment]. / Intervención terapéutica farmacológica del deterioro cognitivo leve.

Mild cognitive impairment (MCI) is a syndrome encompassing affective and behavioural symptoms and various subtypes. MCI is a heterogeneous clinical entity with varied causes (degenerative, vascular, psychiatric, non-neurological disorders), and there is wide variation in symptoms and clinical course. There are multiple causes and consequently various treatments can be applied and should be combined with non-pharmacological measures. This article describes both preventive and therapeutic pharmacological interventions: control of vascular risk factors, avoidance of iatrogeny, use of nutraceuticals, CDP-choline, and Ginkgo biloba EGb 761®, and improvement in sense organs.

[Pharmacological treatment]. / Terapias farmacológicas.

Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made.

Terapias farmacológicas / Pharmacological treatment

La enfermedad de Alzheimer es un proceso degenerativo e inflamatorio crónico que conduce a una disfunción sináptica y a la muerte neuronal. Se realiza una revisión sobre las alternativas terapéuticas farmacológicas: los inhibidores de la acetilcolinesterasa, la memantina, un suplemento alimenticio: Souvenaid y la Ginkgo biloba. Se hace un especial hincapié en la Ginkgo biloba dadas las controversias sobre su uso y la aprobación por parte de la European Medicines Agency (AU)

Alzheimer’s disease (AD) is a chronic degenerative and inflammatory process leading to synaptic dysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made (AU)

Actitudes, dudas y conocimientos de los colectivos implicados en la atención del paciente con Alzheimer: resultados de la encuesta del proyecto kNOW Alzheimer / Attitudes, uncertainties and knowledge among the different parties involved in alzheimer’s patients care: findings from the kNOW Alzheimer project survey study

Introducción: La enfermedad de Alzheimer (EA) involucra a colectivos diversos de profesionales y cuidadores. Las actitudes y necesidades de formación en diagnóstico temprano, tratamiento, síntomas conductuales, recursos sociosanitarios y aspectos legales o éticos son desconocidas. Métodos: Estudio observacional transversal tipo encuesta dentro del proyecto kNOW Alzheimer, iniciativa de la SEN, SEGG, SEMERGEN, SEFAC y CEAFA mediante cuestionarios específicos. Cada sociedad invitó a todos sus miembros a cumplimentarlos a través de www.knowalzheimer.com. Resultados: Participaron 114 neurólogos, 113 geriatras, 275 médicos de atención primaria, 328 farmacéuticos y 858 cuidadores. Los retrasos en el diagnóstico se originan en pacientes y cuidadores, el sistema y en los profesionales, que carecen de medios o malinterpretan síntomas tempranos. Persiste el uso del término 'demencia senil'. Profesionales y cuidadores perciben buena eficacia del tratamiento. Se apuesta por el diagnóstico y tratamiento en fase pre-demencia. Hay déficit de formación en el manejo de la conducta. Los profesionales afirman que informan pero los cuidadores se sienten desinformados. Los cuidadores desean conocer cuanto antes si ellos o un familiar padecen Alzheimer. Los síntomas conductuales y la necesidad de restringir actividades son fuentes de sobrecarga. Los farmacéuticos pueden contribuir a la detección y manejo, pero precisan de formación amplia. Hay necesidad de formación en aspectos legales, bioéticos, recursos y acceso a la investigación. Conclusiones: Este proyecto ha permitido obtener información sobre actitudes y dudas de los colectivos involucrados en la atención a la EA, necesidades de formación y puntos de mejora (AU)

Background: Alzheimer’s disease (AD) involves different groups of professionals and caregivers. Their attitudes and needs of training in early diagnosis, treatment, behavioral symptoms, resources, social and legal or ethical aspects are unknown. Methods: Survey study within the project 'kNOW Alzheimer', a SEN, SEGG, SEMERGEN SEFAC and CEAFA initiative, through specific questionnaires. Each Society invited all its members to complete them through www.knowalzheimer.com. Results: Participants were 114 neurologists, geriatricians 113, 275 primary care physicians, 328 pharmacists and 858 caregivers. Delays in diagnosis arise in patients and caregivers, the system and the professionals, who lack the means or misinterpreted early symptoms. The term 'senile dementia' is still in use. Professionals and caregivers perceived good efficacy of treatment. Professionals advocate for diagnosis and treatment in the pre-dementia stage. There is a need for training in behavior management. Practitioners claim they inform but caregivers feel uninformed. Caregivers want to know as soon as possible if they or a family member suffers from AD. Behavioral symptoms and the need to restrict activities are sources of overload. Pharmacists can contribute to detection and management, but require extensive training. There is a need for training on legal aspects, bioethics, resources and access to research. Conclusions: This project has yielded information on attitudes and doubts of the collectives involved in AD care, their training needs and points of improvement (AU)

La enfermedad de Alzheimer antes de la demencia: Introducción / No disponible

No disponible

Epidemiología infecciosa en centros gerontológicos / Infection epidemiology in gerontology centres

Introducción. Los procesos infecciosos en centros gerontológicos (CG) constituyen una de las causas importantes de mortalidad y descompensación de patologías crónicas concomitantes. Para conocer su magnitud y distribución, se inició un sistema de vigilancia epidemiológica. Material y métodos. Durante los años 2006-2009 se realizó un estudio de prevalencia en 4 CG de Fundación Matia. Se midió la prevalencia realizando un corte anual, recogiendo: tipo de infección, datos demográficos, factores de riesgo y uso de antibióticos. La incidencia se midió en un CG como centro piloto durante 2 años, recogiendo: tipo de infección y uso de antibióticos. Resultados. La prevalencia en los CG osciló entre el 4,80 y el 6,44%. La densidad de incidencia de infección en el estudio piloto estuvo entre 3,45-5,77 infecciones por 1.000 residentes-día. La localización infecciosa más frecuente, y en este orden, fue la respiratoria, la urinaria y la cutánea. La incidencia de infección respiratoria es mayor de manera estadísticamente significativa ante la presencia de disfagia, malnutrición y enfermedad pulmonar obstructiva crónica. Sin embargo, en la incidencia infección urinaria no se aprecia relación significativa con los diferentes factores de riesgo analizados. Conclusiones. La frecuencia y las repercusiones de las infecciones nosocomiales en este tipo de centros pone de relieve la necesidad de controles epidemiológicos periódicos para adaptar planes de intervención y desarrollar medidas preventivas adecuadas(AU)

Introduction. Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. Material and methods. A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. Results. The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. Conclusions. The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures(AU)

[Infection epidemiology in gerontology centres]. / Epidemiología infecciosa en centros gerontológicos.

INTRODUCTION: Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. MATERIAL AND METHODS: A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. RESULTS: The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. CONCLUSIONS: The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.

Presencia de especialista en geriatría en los centros que atienden a pacientes con demencia / Presence of a geriatrics specialist in centres dealing with patients suffering from senile dementia

No disponible