Intelligent digital tools for screening of brain connectivity and dementia risk estimation in people affected by mild cognitive impairment: the AI-Mind clinical study protocol.

More than 10 million Europeans show signs of mild cognitive impairment (MCI), a transitional stage between normal brain aging and dementia stage memory disorder. The path MCI takes can be divergent; while some maintain stability or even revert to cognitive norms, alarmingly, up to half of the cases progress to dementia within 5 years. Current diagnostic practice lacks the necessary screening tools to identify those at risk of progression. The European patient experience often involves a long journey from the initial signs of MCI to the eventual diagnosis of dementia. The trajectory is far from ideal. Here, we introduce the AI-Mind project, a pioneering initiative with an innovative approach to early risk assessment through the implementation of advanced artificial intelligence (AI) on multimodal data. The cutting-edge AI-based tools developed in the project aim not only to accelerate the diagnostic process but also to deliver highly accurate predictions regarding an individual's risk of developing dementia when prevention and intervention may still be possible. AI-Mind is a European Research and Innovation Action (RIA H2020-SC1-BHC-06-2020, No. 964220) financed between 2021 and 2026. First, the AI-Mind Connector identifies dysfunctional brain networks based on high-density magneto- and electroencephalography (M/EEG) recordings. Second, the AI-Mind Predictor predicts dementia risk using data from the Connector, enriched with computerized cognitive tests, genetic and protein biomarkers, as well as sociodemographic and clinical variables. AI-Mind is integrated within a network of major European initiatives, including The Virtual Brain, The Virtual Epileptic Patient, and EBRAINS AISBL service for sensitive data, HealthDataCloud, where big patient data are generated for advancing digital and virtual twin technology development. AI-Mind's innovation lies not only in its early prediction of dementia risk, but it also enables a virtual laboratory scenario for hypothesis-driven personalized intervention research. This article introduces the background of the AI-Mind project and its clinical study protocol, setting the stage for future scientific contributions.

Anticoagulantes orales en pacientes frágiles con fibrilación auricular: moviéndose en la incertidumbre en la práctica clínica diaria / Oral anticoagulants in frail patients with atrial fibrillation: moving in the uncertainty of daily clinical practice

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[Oral anticoagulation therapy in the elderly population with atrial fibrillation. A review article]. / Anticoagulación en población anciana con fibrilación auricular no valvular. Artículo de revisión.

Aging is an important risk factor for patients with atrial fibrillation. The estimated prevalence of atrial fibrillation in patients aged ≥80 years is 9-10%, and is associated with a four to five fold increased risk of embolic stroke, and with an estimated increased stroke risk of 1.45-fold per decade in aging. Older age is also associated with an increased risk of major bleeding with oral anticoagulant therapy. This review will focus on the role of oral anticoagulation with new oral anticoagulants, non-vitamin K antagonist in populations with common comorbid conditions, including age, chronic kidney disease, coronary artery disease, on multiple medication, and frailty. In patients 75 years and older, randomised trials have shown new oral anticoagulants to be as effective as warfarin, or in some cases superior, with an overall better safety profile, consistently reducing rates of intracranial haemorrhages. Prior to considering oral anticoagulant therapy in an elderly frail patient, a comprehensive assessment should be performed to include the risks and benefits, stroke risk, baseline kidney function, cognitive status, mobility and fall risk, multiple medication, nutritional status assessment, and life expectancy.

Dolor irruptivo oncológico en el anciano / Breakthrough cancer pain in the elderly

El dolor irruptivo se define como una exacerbación aguda del dolor de rápida aparición, corta duración y de intensidad moderada o elevada, que ocurre de forma espontánea o en relación con un evento predecible o no predecible a pesar de existir un dolor basal estabilizado y controlado. Sin embargo, existen dudas sobre la definición, terminología, epidemiología y valoración del dolor irruptivo sin una clara contestación y consenso, especialmente en la población anciana. En esta revisión no sistematizada se intentarán sintetizar y resumir los aspectos más relevantes del dolor irruptivo en los ancianos en base a las escasas publicaciones existentes en dicho grupo poblacional (AU)

Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group (AU)

Evaluación clínica y herramientas diagnósticas / Clinical assessment and diagnostic tools

La presencia de deterioro cognitivo genera cambios importantes tanto para el paciente como para su familia y para el personal sanitario que debe prestar cuidados adecuados. Un reconocimiento precoz de esta alteración va a permitir un diagnóstico y tratamiento adecuado, un apoyo psicosocial y educativo, así como la posibilidad de establecer unos planes de cuidados, de proyecto vital y económico. La abundancia de criterios y de clasificaciones pone de manifiesto el interés que despierta en la comunidad científica el problema de las alteraciones cognitivas observadas en el envejecimiento. Es obvio que se precisa unificación de criterios y la puesta en marcha de estudios longitudinales para llegar a conclusiones fiables. La valoración clínica de los diferentes dominios cognitivos debe incluir una cuidadosa historia clínica y la utilización de baterías neuropsicológicas diagnósticas. Podemos establecer, en primer lugar, que un instrumento de screening ideal debería ser aquel que se pudiese administrar en pocos minutos, además debe tener un punto de corte para identificar aquellos que precisen una valoración más completa para establecer un diagnóstico adecuado. La utilización de biomarcadores dinámicos se basa en la hipótesis de que estos marcadores tienen un modelo específico dependiente del tiempo. En primer lugar destaca la presencia de marcadores de amiloidosis y en un segundo paso los marcadores de neurodegeneración. La fragilidad cognitiva es un término emergente e inspirado en un potencial paralelo con el síndrome de fragilidad física. Se ha establecido que un subgrupo de pacientes con deterioro cognitivo presenta reducción en la capacidad de recuperación y un declinar funcional que interacciona con la fragilidad física. La evidencia sugiere que el estado cognitivo representa una importante dimensión del síndrome de fragilidad (AU)

The presence of cognitive impairment generates important changes in both affected individuals and their families and the health staff who must provide adequate care. Early identification of this alteration allows appropriate diagnosis and treatment and psychosocial and educational support, as well as the possibility of establishing care, life and financial plans. The interest of the scientific community in age-related cognitive alterations is demonstrated by the abundance of criteria and classifications. Obviously, there is a need to unify these criteria and implement longitudinal studies in order to reach reliable conclusions. Clinical assessment of the distinct cognitive domains should include careful history-taking and the use of diagnostic neuropsychological batteries. First, the ideal screening test would be one that could be administered in a few minutes, with a cut-off point that would identify patients requiring further assessment for correct diagnosis. The use of dynamic biomarkers is based on the hypothesis that they have a specific time-dependent model. These biomarkers include, firstly, markers of amyloidosis and, secondly, markers of neurodegeneration. Cognitive frailty is an emerging term inspired by a potential parallel with physical frailty syndrome. A subgroup of patients with cognitive impairment show a reduced capacity for recovery and functional decline that interact with physical frailty. The evidence suggests that cognitive status represents an important dimension of frailty syndrome (AU)

Algoritmo terapéutico / No disponible

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Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017 / Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update

La enfermedad neumocócica invasiva (ENI) y la neumonía neumocócica (NN) suponen un grave problema de salud entre los adultos de mayor edad y aquellos con determinadas condiciones y patologías de base, entre los que destacan los inmunodeprimidos y algunos inmunocompetentes, que les hacen más susceptibles a la infección y favorecen cuadros de mayor gravedad y peor evolución. Entre las estrategias para prevenir la ENI y la NN se encuentra la vacunación, aunque las coberturas vacunales son más bajas de lo deseable. Actualmente, existen 2 vacunas disponibles para el adulto. La vacuna polisacárida (VNP23), que se emplea en mayores de 2 años de edad desde hace décadas, es la que mayor número de serotipos (23) incluye, pero no genera memoria inmunitaria, los niveles de anticuerpos disminuyen con el tiempo, provoca un fenómeno de tolerancia inmunitaria y no actúa sobre la colonización nasofaríngea. La vacuna conjugada (VNC13) puede emplearse a cualquier edad de la vida a partir de las 6 semanas de vida y genera una respuesta inmunitaria más potente que la VNP23 frente a la mayoría de los 13 serotipos en ella incluidos. En el año 2013 las 16 Sociedades Científicas más directamente relacionadas con los grupos de riesgo para padecer ENI publicamos un documento de Consenso con una serie de recomendaciones basadas en las evidencias científicas respecto a la vacunación antineumocócica en el adulto con condiciones especiales y patología de base. Se estableció un compromiso de discusión y actualización ante la aparición de nuevas evidencias. Fruto de este trabajo de revisión, presentamos una actualización del anterior documento junto a otras nuevas Sociedades Científicas donde destaca la recomendación por edad (AU)

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding antipneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved (AU)

[Clinical assessment and diagnostic tools]. / Evaluación clínica y herramientas diagnósticas.

The presence of cognitive impairment generates important changes in both affected individuals and their families and the health staff who must provide adequate care. Early identification of this alteration allows appropriate diagnosis and treatment and psychosocial and educational support, as well as the possibility of establishing care, life and financial plans. The interest of the scientific community in age-related cognitive alterations is demonstrated by the abundance of criteria and classifications. Obviously, there is a need to unify these criteria and implement longitudinal studies in order to reach reliable conclusions. Clinical assessment of the distinct cognitive domains should include careful history-taking and the use of diagnostic neuropsychological batteries. First, the ideal screening test would be one that could be administered in a few minutes, with a cut-off point that would identify patients requiring further assessment for correct diagnosis. The use of dynamic biomarkers is based on the hypothesis that they have a specific time-dependent model. These biomarkers include, firstly, markers of amyloidosis and, secondly, markers of neurodegeneration. Cognitive frailty is an emerging term inspired by a potential parallel with physical frailty syndrome. A subgroup of patients with cognitive impairment show a reduced capacity for recovery and functional decline that interact with physical frailty. The evidence suggests that cognitive status represents an important dimension of frailty syndrome.

[Breakthrough cancer pain in the elderly]. / Dolor irruptivo oncológico en el anciano.

Breakthrough pain is defined as an acute exacerbation of pain with rapid onset, short duration and moderate or high intensity, which occurs spontaneously or in connection with a predictable or unpredictable event despite there being stabilised and controlled baseline pain. However, there are doubts about the definition, terminology, epidemiology, and assessment of breakthrough pain, with no clear answers or consensus, especially in the elderly population. This non-systematic review summarises the most important aspects of breakthrough pain in the elderly, based on the limited publications there are in that population group.

La fragilidad en el anciano con enfermedad renal crónica / Frailty in elderly people with chronic kidney disease

En los últimos años el concepto de fragilidad como «estado de prediscapacidad» se ha extendido de forma amplia en todos los que trabajamos en beneficio de la persona mayor. Su importancia radica no solo en su elevada prevalencia —superior al 25% en mayores de 85 años—, sino a que es considerada un factor de riesgo independiente, que confiere a los ancianos que lo presentan un riesgo elevado de discapacidad, institucionalización y mortalidad. El estudio de la función renal es relevante en pacientes que soportan gran carga de comorbilidad, habiéndose encontrado una importante asociación entre la enfermedad renal crónica y el desarrollo de eventos clínicos adversos como la enfermedad cardiovascular, la insuficiencia cardiaca, la enfermedad renal terminal, el incremento de la susceptibilidad a infecciones y el mayor deterioro funcional. La fragilidad puede ser una situación reversible, por lo que su estudio en el paciente con enfermedad renal crónica es de especial interés. Este artículo tiene por objeto describir las interrelaciones existentes entre envejecimiento, fragilidad y enfermedad renal crónica a la luz de la bibliografía pertinente más relevante y reciente publicada (AU)

In recent years, the concept of frailty as a ‘state of pre-disability’ has been widely accepted by those involved in the care of the elderly. Its importance lies not only in its high prevalence - more than 25% in people over 85 years of age - but it is also considered an independent risk factor of disability, institutionalisation and mortality amongst the elderly. The study of renal function is relevant in patients with major comorbidities. Studies have shown a significant association between chronic kidney disease and the development of adverse clinical outcomes such as heart disease, heart failure, end-stage renal disease, increased susceptibility to infections and greater functional impairment. Frailty can be reversed, which is why a study of frailty in patients with chronic kidney disease is of particular interest. This article aims to describe the association between ageing, frailty and chronic kidney disease in light of the most recent and relevant scientific publications (AU)

[Diagnostic criteria. Benefits of early diagnosis]. / Criterios diagnósticos. Beneficios del diagnóstico precoz.

Almost 36 million persons live with dementia worldwide. This figure is set to double by 2030, with 66 million patients, and by 2050 there will be 116 million affected persons. Dementia has an economic impact on individuals and health services and affects the global economy. It is important to evaluate costs to plan social services and healthcare and to provide information on the cost-effectiveness of treatments. The economic cost of dementia was around 604 billion dollars in 2010 and estimates are obviously set to rise.

Reflexiones en torno a la anticoagulación en el anciano / Thoughts about anticoagulation in older patients

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Perfil clínico y mortalidad a 90 días de los pacientes centenarios atendidos en servicios de urgencias hospitalarios / Clinical profile and 90-day mortality in centenarian patients attended in emergency departments

Objetivos. Determinar el perfil clínico de los pacientes centenarios y desarrollar un modelo predictivo de muerte a los 90 días tras ser atendidos en un servicio de urgencias hospitalario (SUH). Metodología. Estudio observacional de cohortes retrospectivo multicéntrico que incluyó a pacientes > 99 años atendidos en 5 SUH de la Comunidad de Madrid, de enero a diciembre de 2012. Se recogieron variables demográficas, comorbilidad, situación basal cognitiva, funcional y social, síndromes geriátricos, datos del episodio agudo y del consumo de recursos hospitalarios y sociales, y la mortalidad global a los 90 días. Resultados. Se incluyeron 209 pacientes con una edad media de 101 años (DE 1,7), 161 (77,0%) de los cuales fueron mujeres. Sesenta y cuatro (32,5%) tenían comorbilidad grave (índice de Charlson ≥ 3); 101 (49,8%) ≥ 5 fármacos; 100 (52,6%) deterioro cognitivo; 82 (42,3%) dependencia grave; 85 (40,7%) estaban institucionalizados y 190 (94,5%) presentaron algún síndrome geriátrico. Los motivos de consulta más frecuentes fueron la disnea (26,8%) seguido de las caídas (12,4%). Ciento dieciocho (56,5%) ingresaron y 58 de 174 (33,3%) fallecieron a los 90 días. El modelo predictivo de mortalidad global a 90 días incluyó: sexo hombre (OR 2,42 IC 95% = 0,97-6,04; p = 0,059), visita a urgencias en 3 meses previos (OR 4,08 IC 95% = 1,26-13,16; p = 0,019) y la toma de decisión de ingreso (OR 8,63 IC 95% = 3,25-22,9; p < 0,001), y tuvo un área bajo la curva de 0,776 (IC 95% = 0,70-0,85; p < 0,001). Conclusiones. Los pacientes centenarios atendidos en los SUH presentan una importante fragilidad, falleciendo 1 de cada 3 a los 90 días, lo cual está asociado con el sexo, la atención en urgencias en los 3 meses previos y la hospitalización (AU)

Objectives. To determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED). Methodology. This was an observational, retrospective, multicentre cohort study including patients > 99 years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality. Results. The study included 209 patients aged 101 years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index ≥ 3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90 days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI = 0.97-6.04; P = .059), emergency care in the previous 3 months (OR 4.08 95% CI = 1.26-13.16; P = .019) and the hospitalization by index event (OR 8.63 95% CI = 3.25-22.9; P < .001) and this model had an area under ROC curve of 0.776 (95% CI = 0.70-0.85; P < .001). Conclusions. Centenarian patients attended in ED had a significant frailty and one in three cases died in the first 90 days after being attended, and this was associated with male sex, emergency care in the previous 3 months, and hospitalisation (AU)

Frailty in elderly people with chronic kidney disease. / La fragilidad en el anciano con enfermedad renal crónica.

In recent years, the concept of frailty as a "state of pre-disability" has been widely accepted by those involved in the care of the elderly. Its importance lies not only in its high prevalence - more than 25% in people over 85 years of age - but it is also considered an independent risk factor of disability, institutionalisation and mortality amongst the elderly. The study of renal function is relevant in patients with major comorbidities. Studies have shown a significant association between chronic kidney disease and the development of adverse clinical outcomes such as heart disease, heart failure, end-stage renal disease, increased susceptibility to infections and greater functional impairment. Frailty can be reversed, which is why a study of frailty in patients with chronic kidney disease is of particular interest. This article aims to describe the association between ageing, frailty and chronic kidney disease in light of the most recent and relevant scientific publications.

Criterios diagnósticos. Beneficios del diagnóstico precoz / Diagnostic criteria. Benefits of early diagnosis

A nivel mundial, cerca de 36 millones de personas viven con demencia; esta cifra se va a duplicar para el año 2030 con 66 millones de pacientes y para el año 2050 las previsiones alcanzan la cifra de 116 millones de personas con demencia. La demencia tiene un impacto económico sobre los individuos, sobre los servicios de atención de la salud y afecta a la economía global. Es importante evaluar los costes, para planificar los servicios sociales y la atención en salud, y para informar sobre modelos de rentabilidad de los tratamientos. El coste económico de esta entidad se sitúa en 604 billones de dólares en el año 2010 y las estimaciones, lógicamente, son al alza (AU)

Almost 36 million persons live with dementia worldwide. This figure is set to double by 2030, with 66 million patients, and by 2050 there will be 116 million affected persons. Dementia has an economic impact on individuals and health services and affects the global economy. It is important to evaluate costs to plan social services and healthcare and to provide information on the cost-effectiveness of treatments. The economic cost of dementia was around 604 billion dollars in 2010 and estimates are obviously set to rise (AU)

[Clinical profile and 90-day mortality in centenarian patients attended in emergency departments]. / Perfil clínico y mortalidad a 90días de los pacientes centenarios atendidos en servicios de urgencias hospitalarios.

OBJECTIVES: To determine the clinical profile and to develop a model to predict 90-day mortality in centenarian patients attended in emergency departments (ED). METHODOLOGY: This was an observational, retrospective, multicentre cohort study including patients >99years attended in 5 ED in the Community of Madrid from January to December 2012. Demographic variables were recorded, as well as, comorbidities, cognitive, functional, social basal status, geriatric syndromes, acute episode, and hospital and social resources use, and 90-day mortality. RESULTS: The study included 209patients aged 101years (SD 1.7) of whom 161 (77.0%) were female. Sixty four (32.5%) had severe comorbidity (Charlson index≥3), 101 (49.8%) on multiple medication, 100 (52.6%) had cognitive impairment, 82 (42.3%) had severe functional dependence, 85 (40.7%) were institutionalised, and 190 (94.5%) had a geriatric syndrome. Dyspnoea (26.8%), followed by falls (12.4%) were the most common causes of attendance. One hundred and eighteen (56.5%) were admitted, and 58 out of 174 (33.3%) died in the first 90days. The model to predict 90-day overall mortality included male sex (OR 2.42 95% CI=0.97-6.04; P=.059), emergency care in the previous 3months (OR 4.08 95% CI=1.26-13.16; P=.019) and the hospitalization by index event (OR 8.63 95% CI=3.25-22.9; P<.001) and this model had an area under ROC curve of 0.776 (95% CI=0.70-0.85; P<.001). CONCLUSIONS: Centenarian patients attended in ED had a significant frailty and one in three cases died in the first 90days after being attended, and this was associated with male sex, emergency care in the previous 3months, and hospitalisation.

Actualización del dolor oncológico en el anciano / Update on oncological pain in the elderly

El dolor es un síntoma muy prevalente en los pacientes geriátricos oncológicos, apareciendo hasta en el 90% en las fases finales de la enfermedad. Requiere de un manejo multidimensional, con un alto porcentaje de valoración y tratamiento inadecuado. El dolor no reconocido o tratado deficientemente en la población geriátrica, y especialmente en los pacientes oncológicos, conlleva la aparición de síntomas invalidantes como depresión, ansiedad, aislamiento, alteraciones del sueño y del apetito, y muy especialmente pérdida de la capacidad funcional y de la calidad de vida. En esta revisión pretendemos analizar los estudios más relevantes sobre el diagnóstico y manejo del dolor en población de edad avanzada con patología oncológica (AU)

Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population (AU)

[Update on oncological pain in the elderly]. / Actualización del dolor oncológico en el anciano.

Pain is a prevalent symptom in cancer geriatric patients, appearing in up to 90% of patients with terminal cancer. This requires a multidimensional approach, as there is a high percentage of inappropriate assessments and treatments. Unrecognized or poorly treated pain in the geriatric population, especially in cancer patients, leads to the development of disabling symptoms such as depression, anxiety, isolation, sleep disturbances, and appetite, and very especially, loss of functional capacity and quality of life. In this review an analysis is made on the most relevant studies on the diagnosis and management of cancer pain in the geriatric population.