Impact of Chronic Risperidone Use on Behavior and Survival of 3xTg-AD Mice Model of Alzheimer's Disease and Mice With Normal Aging.

Psychosis and/or aggression are common problems in dementia, and when severe or persistent, cause considerable patient distress and disability, caregiver stress, and early institutionalization. In 2005, the Food and Drug Administration (FDA) determined that atypical antipsychotics were associated with a significantly greater mortality risk compared to placebo, which prompted the addition of an FDA black-box warning. The American College of Neuropsychopharmacology (ACNP) White Paper, 2008, reviewed this issue and made clinical and research recommendations regarding the use of antipsychotics in dementia patients with psychosis and/or agitation. Increased mortality risk has also been described in cerebrovascular adverse events in elderly users of antipsychotics. In the present work, at the translational level, we used male 3xTg-AD mice (PS1M146V, APPSwe, tauP301L) at advanced stages of the disease reported to have worse survival than females, to study the behavioral effects of a low chronic dose of risperidone (0.1 mg/kg, s.c., 90 days, from 13 to 16 months of age) and its impact on long-term survival, as compared to mice with normal aging. Animals were behaviorally assessed for cognitive and BPSD (behavioral and psychological symptoms of dementia)-like symptoms in naturalistic and experimental conditions (open-field test, T-maze, social interaction, Morris water maze, and marble test) before and after treatment. Weight, basal glucose levels, and IPGTT (i.p. glucose tolerance test) were also recorded. Neophobia in the corner test was used for behavioral monitoring. Survival curves were recorded throughout the experiment until natural death. The benefits of risperidone were limited, both at cognitive and BPSD-like level, and mostly restricted to burying, agitation/vibrating tail, and other social behaviors. However, the work warns about a clear early mortality risk window during the treatment and long-lasting impact on survival. Reduced life expectancy and life span were observed in the 3xTg-AD mice, but total lifespan (36 months) recorded in C57BL/6 × 129Sv counterparts with normal aging was also truncated to 28 months in those with treatment. Sarcopenia at time of death was found in all groups, but was more severe in wild-type animals treated with risperidone. Therefore, the 3xTg-AD mice and their non-transgenic counterparts can be useful to delimitate critical time windows and for studying the physio-pathogenic factors and underlying causal events involved in this topic of considerable public health significance.

Percepción, actitudes y necesidades de los profesionales de atención primaria con relación al paciente con demencia / Perception, attitudes and needs of Primary Care professionals as regards the patient with dementia

ObjetivoConocer la percepción, las actitudes y las necesidades expresadas por los profesionales de atención primaria de nuestro medio, con relación al diagnóstico y el seguimiento de los pacientes con trastornos cognitivos.DiseñoEstudio transversal en 26 Áreas Básicas de Salud (ABS) de Girona.EmplazamientoABS de la Región Sanitaria de Girona.ParticipantesMédicos y diplomados en enfermería (DUE).MedicionesCuestionario autoadministrado por los propios profesionales en el contexto de las reuniones periódicas de los equipos.ResultadosRespondieron la encuesta 218 profesionales (108 médicos y 110 diplomados de enfermería [DUE]) de 19 ABS (73% del total). El 98,6% de los participantes creyó necesario realizar formación en demencias pero el 49,1% de médicos y el 74,5% de DUE refirió no haber realizado nunca formación específica o no en los últimos 5 años. El 88,7% de los médicos refiere no realizar el diagnóstico de demencia de forma habitual y solamente en el 25,5% de los casos se efectúa en las fases leves de demencia. Las principales barreras referidas por los médicos para el diagnóstico de demencia fueron la poca confianza en el diagnóstico (32,6%) y la falta de tiempo en la consulta (31,4%). El 87% de los médicos refirió dificultades en el seguimiento y control de estos enfermos.ConclusionesEste estudio aporta información útil para los agentes implicados en la atención a la demencia. Identifica aspectos de formación prioritarios y las barreras y dificultades para el diagnóstico, tratamiento y seguimiento de estos enfermos en el ámbito de la atención primaria(AU)

ObjectiveTo find out the perception, attitudes and needs expressed by primary care professionals in the Girona (Spain) health area as regards the diagnosis and monitoring of patients with cognitive disorders.DesignCross sectional study conducted in 26 primary healthcare areas (ABS) in Girona.SettingPrimary healthcare areas (ABS) in Girona.ParticipantsPhysicians and primary nursing care (PNC).Main measuramentsSelf-administered questionnaire by the professionals in the centres. In the context of regular meetings of the teams.ResultsA total 218 practitioners from 19 ABS (73% of total) responded to the questionnaire (108 physicians and 110 primary nursing care-PNC-). Almost all (98.6%) of participants thought they needed training in dementia, but 49.1% of physicians and 74.5% of PNC mentioned never having any specific training or not in the last 5 years. A total of 88.7% of doctors do not make a diagnosis of dementia on a regular basis, and only in 25.5% of cases do they make one in the mild stages of dementia. The main barriers reported by physicians in the diagnosis of dementia were the lack of confidence in diagnosis (32.6%) and lack of consultation time (31.4%). The great majority (87%) of physicians mentioned difficulties in monitoring and control of these patients.ConclusionsThis study provides useful information for those involved in the care of dementia. It identifies priority training issues, and barriers and difficulties in the diagnosis, treatment and monitoring of these patients in the field of primary care(AU)

[Perception, attitudes and needs of Primary Care professionals as regards the patient with dementia]. / Percepción, actitudes y necesidades de los profesionales de atención primaria con relación al paciente con demencia.

OBJECTIVE: To find out the perception, attitudes and needs expressed by primary care professionals in the Girona (Spain) health area as regards the diagnosis and monitoring of patients with cognitive disorders. DESIGN: Cross sectional study conducted in 26 primary healthcare areas (ABS) in Girona. SETTING: Primary healthcare areas (ABS) in Girona. PARTICIPANTS: Physicians and primary nursing care (PNC). MAIN MEASURAMENTS: Self-administered questionnaire by the professionals in the centres. In the context of regular meetings of the teams. RESULTS: A total 218 practitioners from 19 ABS (73% of total) responded to the questionnaire (108 physicians and 110 primary nursing care-PNC-). Almost all (98.6%) of participants thought they needed training in dementia, but 49.1% of physicians and 74.5% of PNC mentioned never having any specific training or not in the last 5 years. A total of 88.7% of doctors do not make a diagnosis of dementia on a regular basis, and only in 25.5% of cases do they make one in the mild stages of dementia. The main barriers reported by physicians in the diagnosis of dementia were the lack of confidence in diagnosis (32.6%) and lack of consultation time (31.4%). The great majority (87%) of physicians mentioned difficulties in monitoring and control of these patients. CONCLUSIONS: This study provides useful information for those involved in the care of dementia. It identifies priority training issues, and barriers and difficulties in the diagnosis, treatment and monitoring of these patients in the field of primary care.

Perfil cognitivo en la fibromialgia. Comparación con un grupo con deterioro cognitivo leve / Cognitive profile in fibromyalgia. Comparison with a mild cognitive impairment group

Objetivo: Los objetivos de este trabajo fueron realizar una evaluación neuropsicológica de pacientes con fibromialgia (FM) con quejas subjetivas de pérdida de memoria y compararlos con un grupo de deterioro cognitivo leve (DCL) sin FM. Material y método: Estudio retrospectivo. Se evaluó a 32 pacientes con FM y 86 pacientes con DCL sin FM. Se administró una batería neuropsicológica. Se comparó el grupo con FM con un grupo control con DCL (n=86) sin FM. Resultados: Se evidenció un deterioro cognitivo leve en 29 de las 32 mujeres con FM y el patrón neuropsicológico mostró una afectación en atención, memoria y función ejecutiva. Cuando comparamos el perfil neuropsicológico con el grupo con DCL sin FM, observamos que la muestra con FM presenta una mayor afectación en memoria, en función ejecutiva, y una menor afectación en función premotora. Conclusión: La exploración neuropsicológica evidenció una alteración cognitiva leve en la mayoría de las mujeres con FM con quejas subjetivas de pérdida de memoria (90,5%). El patrón neuropsicológico obtenido es de predominio subcortical, con afectación de la memoria y de la función ejecutiva. La muestra con FM presenta unos resultados cognitivos similares al grupo con DCL (AU)

Objective: The neuropsychological assessment of patients with fibromyalgia (FM) and with subjective cognitive complaints was analyzed. The group was compared with a mild cognitive impairment (MCI) group without FM. Material and method: Retrospective study of 32 patients with FM were evaluated and 86 patients with MCI without FM. A neuropsychological test battery was administered. Results were compared with a control group of MCI (n=86) without FM. Results: Evidence of MCI was observed in 29 of 32 women with FM, and the neuropsychological pattern showed a major impairment on attention, memory and executive function. When the neuropsychological pattern was compared with the MCI group without FM, we found that patients with FM presented a higher rate of impairment of memory and executive function, and less impairment of the premotor function. Conclusions: The neuropsychological evaluation showed an MCI in the majority of women with FM with a subjective complaint of memory loss (90,5%). The neuropsychological pattern was predominantly subcortical with impairment of memory and executive function. The sample of patients with FM presented cognitive results similar to the MCI group (AU)

[Cognitive profile in fibromyalgia. Comparison with a mild cognitive impairment group]. / Perfil cognitivo en la fibromialgia. Comparación con un grupo con deterioro cognitivo leve.

OBJECTIVE: The neuropsychological assessment of patients with fibromyalgia (FM) and with subjective cognitive complaints was analyzed. The group was compared with a mild cognitive impairment (MCI) group without FM. MATERIAL AND METHOD: Retrospective study of 32 patients with FM were evaluated and 86 patients with MCI without FM. A neuropsychological test battery was administered. Results were compared with a control group of MCI (n=86) without FM. RESULTS: Evidence of MCI was observed in 29 of 32 women with FM, and the neuropsychological pattern showed a major impairment on attention, memory and executive function. When the neuropsychological pattern was compared with the MCI group without FM, we found that patients with FM presented a higher rate of impairment of memory and executive function, and less impairment of the premotor function. CONCLUSIONS: The neuropsychological evaluation showed an MCI in the majority of women with FM with a subjective complaint of memory loss (90,5%). The neuropsychological pattern was predominantly subcortical with impairment of memory and executive function. The sample of patients with FM presented cognitive results similar to the MCI group.

A clinical registry of dementia based on the principle of epidemiological surveillance.

BACKGROUND: Traditional epidemiological studies do not allow elucidating the reality of referral and diagnosis patterns of dementia in routine clinical practice within a defined territory. This information is useful and necessary in order to plan and allocate healthcare resources. This paper presents the results from a dementia case registry based on epidemiological surveillance fundamentals. METHODS: Standardised registry of dementia diagnoses made in 2007 by specialised care centres in the Health Region of Girona (RSG) (Spain), which encompasses an area of 5,517 sq. km and a reference population of 690,207 inhabitants. RESULTS: 577 cases of dementia were registered, of which 60.7% corresponded to cases of Alzheimer's disease. Presenile dementia accounted for 9.3% of the cases. Mean time between the onset of symptoms and clinical diagnosis was 2.4 years and the severity of the dementia was mild in 60.7% of the cases. High blood pressure, a family history of dementia, dislipidemia, and a past history of depression were the most common conditions prior to the onset of the disease (>20%). CONCLUSION: The ReDeGi is a viable epidemiological surveillance device that provides information about the clinical and demographic characteristics of patients diagnosed with dementia in a defined geographical area.