Executive functions in patients with Alzheimer's disease, type 2 diabetes mellitus patients and cognitively healthy older adults.

OBJECTIVES: The present study investigated whether the performance on executive function tasks of patients with type 2 diabetes mellitus (T2DM) is as impaired as that of Alzheimer's disease (AD) patients and to compare their performance with that of a group of cognitively healthy older adults. We also investigated whether glycosylated hemoglobin levels (HbA1c, a measure of glucose regulation) are related to performance on executive control tasks. METHODS: Three groups of participants (AD, T2DM, and healthy older adults) completed medical and psychological evaluations and performed a series of computerized tasks, including processing speed (simple and choice reaction time) tasks, verbal and visuospatial working memory (WM) updating (n-back) tasks, and the Wisconsin Card Sorting Test (WCST), to assess processing speed and executive functioning. RESULTS: As expected, the results showed that AD patients performed significantly worse than the healthy older adult group in all tasks. Executive functions deteriorated in the two groups of patients but more in the AD group. The T2DM group differed from healthy older controls but not from AD patients in the percentage of perseverations and the percentage of perseverative errors (WCST). CONCLUSIONS: These findings revealed working memory (updating and maintenance) and executive control declines in the T2DM compared to healthy older controls but smaller than that suffered by the AD patients. The impairment of executive processing of T2DM patients despite the glycosylated hemoglobin control suggests that these patients are at risk of developing AD.

Word-stem priming and recognition in type 2 diabetes mellitus, Alzheimer's disease patients and healthy older adults.

The present study investigated (a) whether the pattern of performance on implicit and explicit memory of patients with type 2 diabetes mellitus (DM2) is more similar to those of patients with Alzheimer's disease (AD) or to cognitively normal older adults and (b) whether glycosylated hemoglobin levels (a measure of glucose regulation) are related to performance on the two memory tasks, implicit word-stem completion and "old-new" recognition. The procedures of both memory tasks included encoding and memory test phases separated by a short delay. Three groups of participants (healthy older adults, DM2 patients and AD patients) completed medical and psychological assessments and performed both memory tasks on a computer. The results of the word-stem completion task showed similar implicit memory in the three groups. By contrast, explicit recognition of the three groups differed. Implicit memory was not affected by either normal or pathological aging, but explicit memory deteriorated in the two groups of patients, especially in AD patients, showing a severe impairment compared to the cognitively healthy older adults. Importantly, glycosylated hemoglobin levels were not related to performance on either implicit or explicit memory tasks. These findings revealed a clear dissociation between explicit and implicit memory tasks in normal and pathological aging. Neuropsychologists and clinicians working with TM2 patients should be aware that the decline of voluntary, long-term explicit memory could have a negative impact on their treatment management. By contrast, the intact implicit memory of the two clinical groups could be used in rehabilitation.

Tamaño del cupo e importe, intensidad y calidad de la prescripción de los médicos de familia / Patient workload and costs, intensity and quality of family doctor prescriptions

ObjetivosConocer la relación entre algunas características de la prescripción (importe, intensidad y calidad) de los médicos de familia de un departamento de salud y el tamaño de sus cupos, y se controla por eventuales confusores. Analizar la intensidad prescriptora de determinados grupos terapéuticos según el tamaño del cupo.DiseñoEstudio cuantitativo de consumo de medicamentos.EmplazamientoDepartamento de Salud N.o 20 de la Agencia Valenciana de Salud.ParticipantesTodos cupos de médicos de familia (n=122) del modelo reformado de atención primaria del departamento en 2007.Mediciones y resultadosSe analiza toda la prescripción en receta oficial del SNS en los 122 cupos en 2007. Se definen variables referidas al cupo y al importe, a la intensidad y a la calidad de la prescripción. Se analiza la relación entre el tamaño del cupo y las características de la prescripción y se ajusta por posibles confusores. Se analiza la intensidad de la prescripción de los 35 grupos terapéuticos más representativos (el 81% de la prescripción) según el tamaño del cupo. De forma estadísticamente significativa, en los pacientes activos de los cupos más numerosos se detecta un menor importe de la prescripción por persona (β=–0,22) y por receta (β=–0,26), y una menor intensidad prescriptora de algunos grupos terapéuticos, como antihipertensivos (r=–0,23), antidiabéticos (r=–0,29) y antiagregantes plaquetarios (r=–0,19).ConclusionesSe plantea la hipótesis de que los pacientes activos de los cupos más numerosos estarían infradiagnosticados o infratratados de determinados procesos como la hipertensión, la diabetes o la prevención del riesgo cardiovascular, lo que contribuye a un menor importe de la prescripción en estos cupos(AU)

ObjectivesTo determine the relationship between some characteristics (cost, intensity, quality) of prescriptions issued by general practitioners in a health district and their patient loads, controlling for possible confounders. To analyze the intensity of prescription of certain groups of therapeutic drugs according to the patient load.DesignQuantitative study of consumption of medicines.SettingHealth District n° 20 of the Valencian Health Agency.ParticipantsAll patients on the lists of general practitioners (n=122) in the reformed model of primary healthcare in the Health District in 2007.Measurements and resultsAll official prescriptions issued in 2007 to patients on the 122 lists were analysed. We defined variables relating to the patient load and the cost, intensity and quality of the prescription. The relationship between patient load and prescription characteristics was analysed, adjusting for possible confounders. The intensity of prescription of the 35 most representative groups of therapeutic drugs (81% of prescriptions) was analysed according to patient load. With statistical significance, a lower prescription cost by person (beta=−0,22) and by prescription (beta=−0,26),was found in active patients of the largest patient loads and a lower intensity of prescription of some drugs groups such as antihypertensives (r=−0.23), antidiabetics (r=−0.29) and antiaggregates (r=−0.19).ConclusionsWe put forward the hypothesis that the active patients in the largest patient loads may be under-diagnosed or undertreated for certain disorders, such as hypertension, diabetes mellitus, or the prevention of cardiovascular risk, thereby contributing to the lower prescription cost in such patient loads(AU)

[Patient workload and costs, intensity and quality of family doctor prescriptions]. / Tamaño del cupo e importe, intensidad y calidad de la prescripción de los médicos de familia.

OBJECTIVES: To determine the relationship between some characteristics (cost, intensity, quality) of prescriptions issued by general practitioners in a health district and their patient loads, controlling for possible confounders. To analyze the intensity of prescription of certain groups of therapeutic drugs according to the patient load. DESIGN: Quantitative study of consumption of medicines. SETTING: Health District n° 20 of the Valencian Health Agency. PARTICIPANTS: All patients on the lists of general practitioners (n=122) in the reformed model of primary healthcare in the Health District in 2007. MEASUREMENTS AND RESULTS: All official prescriptions issued in 2007 to patients on the 122 lists were analysed. We defined variables relating to the patient load and the cost, intensity and quality of the prescription. The relationship between patient load and prescription characteristics was analysed, adjusting for possible confounders. The intensity of prescription of the 35 most representative groups of therapeutic drugs (81% of prescriptions) was analysed according to patient load. With statistical significance, a lower prescription cost by person (beta=-0,22) and by prescription (beta=-0,26),was found in active patients of the largest patient loads and a lower intensity of prescription of some drugs groups such as antihypertensives (r=-0.23), antidiabetics (r=-0.29) and antiaggregates (r=-0.19). CONCLUSIONS: We put forward the hypothesis that the active patients in the largest patient loads may be under-diagnosed or undertreated for certain disorders, such as hypertension, diabetes mellitus, or the prevention of cardiovascular risk, thereby contributing to the lower prescription cost in such patient loads.