Management of suspected Alzheimer's disease patients by specialist physicians at the first visit in Spain: First Consultation Study.

OBJECTIVE: To assess the management of suspected Alzheimer's disease (AD) patients at the first visit by Spanish specialist physicians. MATERIALS & METHODS: Epidemiological, cross-sectional and multicenter study. A total of 200 specialists (neurologists, psychiatrists and geriatricians) from hospitals and specialized centers across Spain included a total of 1851 patients of both sexes older than 18 years suspected to be suffering from AD. Data of clinical and demographic characteristics, methods of diagnosis, treatments and follow-up were collected in one visit. RESULTS: The mean age of the population was 75.2 ± 7.9 years. The most frequent symptoms were difficulty in performing familiar tasks (76.7%), memory loss (76.0%) and misplacing items (72.7%). The assessment of suspected AD subjects included: neurological examination (walk apraxia [10.8%] and extrapyramidal signs [10.7%]), evaluation of cognition (mean of the Mini-Mental State Examination score was 19.9 ± 5.2 [mild AD]), function and behavior, and supplementary diagnostic tests (blood test [90%] and computerized axial tomography [66.8%]). In total, 69.5% of the patients were diagnosed with AD according to Spanish Society of Neurology criteria. Principal treatment was cholinesterase inhibitors (87.8%). The mean time for follow-up visit: 4 ± 2.4 months; with the same physician (95.5%), neurologist (68.2%), psychiatrist (19%) and geriatrician (11.7%). CONCLUSIONS: Several possible areas are amenable to improvement by means of reducing the time to diagnosis, increasing the number of patients treated with nonpharmacological therapy, and providing more information on the benefits of treatment, care and providing the best therapeutic options available. In this study, almost half of the patients took 1-3 years to visit a physician after appearance of the first symptoms. Significant differences were observed between the medical specialty and treatments provided; nevertheless, the majority of physicians used cholinesterase inhibitors (87.8%) as the principal treatment.

Validation of the Spanish Personal and Social Performance scale (PSP) in outpatients with stable and unstable schizophrenia.

INTRODUCTION: The main long-term therapeutic goals of schizophrenia should go beyond the symptoms and include the improvement of patients' psychosocial functioning and quality of life. The aim of this study was to validate the Personal and Social Performance (PSP) scale in Spanish outpatients with schizophrenia. MATERIALS AND METHODS: Naturalistic, 6-month follow-up, multicentre study. 244 patients and 76 controls were evaluated using the PSP, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Clinical Global Impression - Severity (CGI-S) and Change (CGI-C) scales. RESULTS: Internal reliability=0.87. Test-retest reliability=0.98. Construct validity=1 component that explained 73.2% of the variance. Convergent validity: Pearson correlation coefficient between PSP and SOFAS=0.95 (p<0.0001), between PSP and CGI-S=-0.88 (p<0.0001). Discriminant validity: the PSP discriminates between patients and controls [50.3 versus 91.9, p<0.0001] and among patients with mild, moderate, and severe schizophrenia according to CGI-S scores [73 versus 56.6 versus 37.5, p<0.0001]. Area under the curve=0.986. A cut-off point of 79 on the PSP scale provided good sensitivity (94.3%) and specificity (96.1%) for identifying patients and controls according to their level of functioning. At month 6 significant improvements (p<0.0001) were seen in PSP, SOFAS, and CGI-C scores. The PSP was sensitive to improvement; a score of very much improved in the CGI-C corresponds to a improvement of 34 points in the PSP. CONCLUSION: The Spanish PSP is a reliable, valid and sensitive instrument for measuring functioning in outpatients with schizophrenia. As a brief, clinician-rated instrument, the PSP scale seems to be appropriate for use in everyday clinical practice as a mean of identifying and monitoring changes in patient's functioning.

Management of Patients With Unclassified Epileptic Seizures in Outpatient Clinics in Spain. Results of the RETO Study.

PURPOSE: The objective of this study was to determine the approach and management of specialists in patients with unclassified epileptic seizures in outpatient clinics in Spain. METHODS: Observational, multicenter, and cross-sectional study. Ninety-three neurologists or neuropediatricians documented consecutive patients with a history of at least two difficult to classify or unclassified epileptic seizures. Patient demographics, quality of life (QOLIE-10-P), disease characteristics, and anticonvulsant treatment were captured. Physicians were asked about their therapeutic approach for the selection of an antiepileptic drug and underlying reasons. RESULTS: A total of 725 patients were included. At the time of the survey, 81% were treated (69% with monotherapy). Most frequently given reasons for starting antiepileptic therapy were ([mean] on a scale of 1­5) efficacy, (3.9), safety (3.61), and broad-spectrum effectiveness (3.5). Reasons given for switching therapy (226/725) included need for broader spectrum of action: 70 (31.0%); simpler dosing regimen: 25 (11.1%); quality of life considerations: 24 (10.6%); lack of adherence to therapy: 24 (10.6%); comorbidities: 13 (5.8%); drug interactions: 12 (5.3%); and possibility of pregnancy 6 (2.7%). CONCLUSIONS: When deciding on starting or switching therapy for patients with difficult to classify or unclassified epilepsy, the most important consideration for the specialists included efficacy, safety, and broad-spectrum efficacy.

[Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)]. / La migraña crónica vista por el neurologo y el paciente: resultados del proyecto CIEN-mig (III).

INTRODUCTION: Data on the reality of chronic migraine in our clinics are scarce. AIM. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. SUBJECTS AND METHODS: A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. RESULTS: A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. CONCLUSIONS: Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feed-back with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology.

[Satisfaction of the migraine patient attending neurology clinics: results of CIEN-mig project (II)]. / Satisfacción del paciente con migraña que acude a consultas de neurología: resultados del proyecto CIEN-mig (II).

INTRODUCTION: Migraine is the most common neurological consultation in our country. AIM. To analyse the satisfaction level of the patient with migraine attending our clinics. PATIENTS AND METHODS: A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. RESULTS: The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. CONCLUSIONS: The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients' opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment.

La migraña crónica vista por el neurólogo y el paciente: resultados del proyecto CIEN-mig (III) / Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)

Introducción. Existen pocos datos acerca de la realidad de la migraña crónica en nuestras consultas. Objetivo. Conocer la carga asistencial y la actitud del neurólogo frente a la migraña crónica y la opinión del paciente con esta patología. Sujetos y métodos. Un total de 145 neurólogos contestaron por vía electrónica dos cuestionarios. El primero iba encaminado a caracterizar el impacto de la migraña crónica y su actitud en la práctica habitual. El segundo había de ser respondido por tres pacientes consecutivos. Resultados. Un 4,1% consultó por migraña crónica, mayoritariamente mujeres en la quinta década. El tiempo medio hasta el diagnóstico fue de 28,7 meses. Todos los neurólogos recomendaron tratamiento preventivo desde el inicio. Más de una cuarta parte lo mantenía más de un año y utilizaba combinaciones de fármacos. Sólo la mitad pensaba que el abuso de analgésicos era la causa de la migraña crónica y la mayoría se decantó por permitir antiinflamatorios no esteroideos y triptanes de forma restringida. Sólo la mitad de los pacientes sabía que tenía migraña crónica. En su opinión, la herencia y la ausencia de un tratamiento reglado y precoz podrían contribuir al desarrollo de migraña crónica. Conclusiones. Casi un paciente al día consulta por migraña crónica, lo que da idea de su impacto asistencial. La coordinación con atención primaria es necesaria, si tenemos en cuenta que el retraso en el diagnóstico es de más de dos años. La mayoría de los neurólogos sigue las recomendaciones de tratamiento del Grupo de Cefaleas de la Sociedad Española de Neurología (AU)

Introduction. Data on the reality of chronic migraine in our clinics are scarce. Aim. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. Subjects and methods. A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. Results. A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. Conclusions. Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feedback with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology (AU)

Satisfacción del paciente con migraña que acude a consultas de neurología: resultados del proyecto CIEN-mig (II) / Satisfaction of the migraine patient attending neurology clinics: results of CIEN-mig project (II)

Introducción. La migraña es el motivo neurológico más frecuente de consulta en nuestro país. Objetivo. Analizar el grado de satisfacción del paciente migrañoso que acude a consultas de neurología de nuestro país. Pacientes y métodos. Un total de 160 neurólogos españoles pasó un cuestionario de satisfacción a 10 pacientes consecutivos con migraña que acudieron a consulta. Resultados. Un total de 1.330 pacientes contestaron el cuestionario. Los factores que los pacientes consideraban más importantes por parte de neurólogo fueron la experiencia profesional y la amabilidad. Los pacientes pensaban que deberíamos mejorar sobre todo en el tiempo en explicar el tratamiento y en la facilidad de acceso a la consulta. Casi el 90% de los pacientes pensaba que los tratamientos frente a la migraña habían mejorado, pero casi la mitad de los pacientes no estaba satisfecha con la atención en la atención primaria. Los pacientes se mostraban más satisfechos con el tratamiento sintomático (69,1%) que con el tratamiento preventivo (50,4%). A algo más de la mitad de los pacientes se les había realizado un estudio de neuroimagen para analizar sus cefaleas. Sólo la mitad pensaba que llevar a cabo un estudio de neuroimagen mejoraría su satisfacción. Conclusiones. La satisfacción de los pacientes con migraña que acuden a consultas de neurología ha mejorado los últimos años. En su opinión, los aspectos susceptibles de mejora serían la explicación de esta afección y su tratamiento, la facilidad de acceso a la consulta y el tratamiento preventivo (AU)

Introduction. Migraine is the most common neurological consultation in our country. Aim. To analyse the satisfaction level of the patient with migraine attending our clinics. Patients and methods. A total of 160 neurologists asked 10 consecutive migraine patients to fill in a satisfaction questionnaire. Results. The questionnaire was answered by 1330 patients. The most important factors they considered for their neurologists were professional experience and kindness. Patients thought neurologist should improve in time to explain treatment and accessibility. Almost 90% of patients considered that treatments for migraine had improved, but almost half of them were not satisfied with the management in primary care setting. Patients were more satisfied with symptomatic treatment (69.1%) than with preventatives (50.4%). More than half had a neuroimaging study due to their headaches. Only half thought that such an study would improve their satisfaction. Conclusions. The level of satisfaction of the migraine patient attending our clinics has improved in the last years. In patients’ opinion the aspects which should be improved are the time to explain migraine and its treatment, accessibility and preventive treatment (AU)

La migraña crónica vista por el neurólogo y el paciente: resultados del proyecto CIEN-mig (III) / Chronic migraine as seen by neurologists and patients: results of the CIEN-mig project (III)

Introducción. Existen pocos datos acerca de la realidad de la migraña crónica en nuestras consultas. Objetivo. Conocer la carga asistencial y la actitud del neurólogo frente a la migraña crónica y la opinión del paciente con esta patología. Sujetos y métodos. Un total de 145 neurólogos contestaron por vía electrónica dos cuestionarios. El primero iba encaminado a caracterizar el impacto de la migraña crónica y su actitud en la práctica habitual. El segundo había de ser respondido por tres pacientes consecutivos. Resultados. Un 4,1% consultó por migraña crónica, mayoritariamente mujeres en la quinta década. El tiempo medio hasta el diagnóstico fue de 28,7 meses. Todos los neurólogos recomendaron tratamiento preventivo desde el inicio. Más de una cuarta parte lo mantenía más de un año y utilizaba combinaciones de fármacos. Sólo la mitad pensaba que el abuso de analgésicos era la causa de la migraña crónica y la mayoría se decantó por permitir antiinflamatorios no esteroideos y triptanes de forma restringida. Sólo la mitad de los pacientes sabía que tenía migraña crónica. En su opinión, la herencia y la ausencia de un tratamiento reglado y precoz podrían contribuir al desarrollo de migraña crónica. Conclusiones. Casi un paciente al día consulta por migraña crónica, lo que da idea de su impacto asistencial. La coordinación con atención primaria es necesaria, si tenemos en cuenta que el retraso en el diagnóstico es de más de dos años. La mayoría de los neurólogos sigue las recomendaciones de tratamiento del Grupo de Cefaleas de la Sociedad Española de Neurología (AU)

Introduction. Data on the reality of chronic migraine in our clinics are scarce. Aim. To know the frequency of consultation and attitude of the neurologist regarding chronic migraine, and the opinion of patients with this condition. Subjects and methods. A total of 145 neurologists consulted electronically two questionnaires. The first tested the impact of chronic migraine and their approach in the daily practice. The second was filled in by the consecutive patients. Results. A total of 4.1% of patients consulted due to chronic migraine, mostly women in their forties. The average time for diagnosis was 28.7 months. All neurologists recommended preventive treatment from the beginning. More than a quarter kept this treatment for more than a year and used drug combinations. Only half thought that overuse was the reason for chronic migraine and the majority allowed non-steroidal anti-inflammatories and triptans at restricted doses. Only half of the patients knew they had chronic migraine. In their opinion, heredity and the absence of an early and serious treatment could contribute for chronic migraine development. Conclusions. Almost one patient per day consults due to chronic migraine, which gives an idea of its impact. A better feedback with primary care level is necessary, if we consider that the delay in the diagnosis is longer than two years. The majority of neurologists follows the current recommendations of the Headache Group of the Spanish Society of Neurology (AU)

[Approach of neurologists in Spain to migraine: results of the CIEN-mig project (I)]. / Actitud del neurólogo español frente a la migraña: resultados del proyecto CIEN-mig (I).

INTRODUCTION: Headache is the most frequent neurological reason for consultation in our country. AIM: To obtain descriptive data on the approach and satisfaction of the neurologist regarding the diagnosis, burden and management of headaches, and migraine in particular, together with the relationship with primary care physicians (PCP). SUBJECTS AND METHODS: A total of 160 neurologists participated and answered electronically five questionnaires during one year. The results for patients were obtained in a standard clinic day and for the first 10 patients. RESULTS: The mean number of patients/day was 20.7. Thirty-six percent consulted due to headache, most under 50 and women. Half had migraine; in 70% daily activities were moderate-severely affected. Almost half had missed at least one work day due to migraine in the previous month. Neurologist considered that headache background of PCP should improve, mainly regarding preventive treatment. Complementary studies were asked in a rather low proportion of patients; CT (35%) being the most frequent. The majority indicated triptans, and in the mild phase of pain, and neuromodulators or beta-blockers for the preventive treatment. CONCLUSIONS: Migraine is the first reason for consultation in the Neurology Services of our country and impacts negatively in the quality of life of our patients, usually women below 50. Its management should be improved with a better feedback with PCP and the use of the most efficacious treatments.

Actitud del neurólogo español frente a la migraña: resultados del proyecto CIEN-mig (I) / Approach of neurologists in Spain to migraine: results of the CIEN-mig project (I)

Introducción. La cefalea es el motivo neurológico más frecuente de consulta en nuestro país. Objetivo. Obtener datos descriptivos de la actitud y satisfacción del neurólogo en cuanto al diagnóstico, repercusión y manejo de las cefaleas, y de la migraña en particular, y de las relaciones con la atención primaria. Sujetos y métodos. Participaron un total de 160 especialistas que contestaron por vía electrónica cinco cuestionarios durante un año. Los resultados de pacientes se obtuvieron un día estándar de consulta para los 10 primeros pacientes. Resultados. El número medio de pacientes por día fue de 20,7. Un 36% consultó por cefalea, la mayoría menores de 50 años y mujeres. La mitad padecía migraña, de los que el 70% tenía afectación moderada-grave de sus actividades. Casi la mitad había faltado al menos un día al trabajo por este motivo el mes anterior. Los neurólogos consideran que los médicos de atención primaria tienen una formación en cefaleas mejorable, sobre todo en el tratamiento preventivo. Se solicitaron estudios complementarios a un porcentaje relativamente bajo de pacientes, siendo la tomografía computarizada de cráneo (35%) el estudio más frecuente. La mayoría utilizó triptanes en la fase leve del dolor, y neuromoduladores o betabloqueantes para el tratamiento preventivo. Conclusiones. La migraña es la primera causa de consulta a nuestros servicios de neurología e impacta negativamente en la calidad de vida de los pacientes, mayoritariamente mujeres menores de 50 años. Su manejo es claramente mejorable, y es necesaria una mayor coordinación entre atención primaria-especializada y un mayor uso de los fármacos más eficaces (AU)

Introduction. Headache is the most frequent neurological reason for consultation in our country. Aim. To obtain descriptive data on the approach and satisfaction of the neurologist regarding the diagnosis, burden and management of headaches, and migraine in particular, together with the relationship with primary care physicians (PCP). Subjects and methods. A total of 160 neurologists participated and answered electronically five questionnaires during one year. The results for patients were obtained in a standard clinic day and for the first 10 patients. Results. The mean number of patients/day was 20.7. Thirty-six percent consulted due to headache, most under 50 and women. Half had migraine; in 70% daily activities were moderate-severely affected. Almost half had missed at least one work day due to migraine in the previous month. Neurologist considered that headache background of PCP should improve, mainly regarding preventive treatment. Complementary studies were asked in a rather low proportion of patients; CT (35%) being the most frequent. The majority indicated triptans, and in the mild phase of pain, and neuromodulators or beta-blockers for the preventive treatment. Conclusions. Migraine is the first reason for consultation in the Neurology Services of our country and impacts negatively in the quality of life of our patients, usually women below 50. Its management should be improved with a better feedback with PCP and the use of the most efficacious treatments (AU)