Dopaminergic dysregulation, artistic expressiveness, and Parkinson's disease.

BACKGROUND: The most frequent behavioral manifestations in Parkinson's disease (PD) are attributed to the dopaminergic dysregulation syndrome (DDS), which is considered to be secondary to the iatrogenic effects of the drugs that replace dopamine. Over the past few years some cases of patients improving their creative abilities after starting treatment with dopaminergic pharmaceuticals have been reported. These effects have not been clearly associated to DDS, but a relationship has been pointed out. METHODS: Case study of a patient with PD. The evolution of her paintings along medication changes and disease advance has been analyzed. RESULTS: The patient showed a compulsive increase of pictorial production after the diagnosis of PD was made. She made her best paintings when treated with cabergolide, and while painting, she reported a feeling of well-being, with loss of awareness of the disease and reduction of physical limitations. CONCLUSIONS: Dopaminergic antagonists (DA) trigger a dopaminergic dysfunction that alters artistic creativity in patients having a predisposition for it. The development of these skills might be due to the dopaminergic overstimulation due to the therapy with DA, which causes a neurophysiological alteration that globally determines DDS.

[Drug consumption and cognitive function in non-institutionalized elderly: a population-based study]. / Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada.

BACKGROUND: Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption. METHODS: This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants' medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. RESULTS: A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD=2.9) and 5.2 (SD=3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD=2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P=0.003) and nervous system (P=0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P <0.05). CONCLUSIONS: Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption.

Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada / Drug consumption and cognitive function in non-institutionalized elderly: A population-based study

Introducción: El consumo de fármacos en la población general se concentra en las personas de edad avanzada. El objetivo del presente estudio fue valorar el perfil farmacológico en ancianos de 75 años y mayores, estimar la relación con la función cognoscitiva y las variables asociadas al consumo farmacológico. Métodos: Estudio epidemiológico transversal y poblacional puerta a puerta de una muestra de población rural no institucionalizada representativa de los habitantes mayores de 74 años del Área Básica de Salud de Anglès (Girona). La prescripción farmacológica se registró a partir de los medicamentos presentes en el domicilio de los participantes. La función cognoscitiva se evaluó mediante el Mini-Mental State Examination. Resultados: Participaron 875 individuos (82%). Los participantes con deterioro cognoscitivo leve y moderado consumían una media de 4,6 (DE=2,9) y 5,2 (DE=3,2) fármacos, superior a los 4 (DE=2,7) fármacos de media consumidos por los que no sufrían deterioro cognoscitivo (p < 0,05). En el análisis bivariante, según el grado de deterioro cognoscitivo existía una variación en el consumo de fármacos del aparato digestivo y metabolismo (p=0,003) y del sistema nervioso (p=0,001). El análisis multivariante identificó cuatro variables asociadas al consumo de fármacos del sistema nervioso: edad, sexo, comorbilidad y sospecha de depresión (p<0,05).Conclusiones: Los participantes con deterioro cognoscitivo grave presentaron una mayor frecuencia de consumo de antipsicóticos y otros antidepresivos. Sin embargo, el análisis multivariante señala que son la edad avanzada, el sexo femenino y la sospecha de depresión las variables asociadas a un mayor consumo de fármacos del sistema nervioso (AU)

Background: Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption.Methods: This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants’ medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. Results: A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD=2.9) and 5.2 (SD=3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD=2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P=0.003) and nervous system (P=0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P <0.05).Conclusions: Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption (AU)

[Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona]. / Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona.

AIM: To perform a descriptive analysis of the outpatient activity in a neurological department in terms of the frequency and type of neurological diseases that were attended. PATIENTS AND METHODS: A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerised hospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the International Classification of Diseases, 10th edition (CIE-10). RESULTS: The mean age was 60.6 +/- 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year 2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The most common diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies. CONCLUSIONS: The frequency of visits increases with age and the order, in terms of frequency, was: episodic and paroxysmal, degenerative and demyelinating, psychotic and behavioural disorders, and extrapyramidal syndromes.

Análisis de la demanda asistencial neurológica generada por la atención primaria en una área geográfica de las comarcas de Girona / Analysis of the demand for neurological health care generated by primary care in a geographical area within the districts of Girona

Objetivo. Análisis descriptivo de la actividad ambulatoria en un servicio de neurología en relación con la frecuenciay tipo de enfermedades neurológicas atendidas. Pacientes y métodos. Estudio retrospectivo y trasversal de los pacientesremitidos a la consulta ambulatoria de neurología. Se registraron consecutivamente los casos visitados por primera vez durantelos años 2006 y 2007. Se evaluó la documentación médica a partir de los registros hospitalarios informatizados, recogiéndose:zona de salud de referencia, fecha de visita, edad, sexo y diagnóstico según la Clasificación Internacional de Enfermedades,9.ª edición, modificación clínica (CIE-9-MC), reconvertida a la Clasificación Internacional de Enfermedades, 10.ªedición (CIE-10). Resultados. La media de edad fue de 60,6 ± 20,9 años (rango: 4-95 años) y el 61,4% fueron mujeres. El índicede frecuentación fue de 4,3 solicitudes/1.000 habitantes para el año 2006 y de 3,9 para el año 2007, y se observó unincremento con la edad para las enfermedades neurodegenerativas. Respecto a la CIE-10, las enfermedades se clasificaroncomo episódicas y paroxísticas (25%), degenerativas y desmielinizantes (18,6%), trastornos mentales orgánicos (14,7%), síndromesextrapiramidales (10,5%), enfermedades de la circulación cerebral (3,5%), trastornos relacionados con el estrés y somatomorfos(3,5%) y enfermedades del oído interno (3,3%). Las demás patologías no alcanzaron el 3%. El 61% de los pacientespresentó enfermedades del sistema nervioso central y el 20,3%, trastornos psiquiátricos. Las enfermedades más frecuentesfueron los trastornos cognitivos (31,5%), las cefaleas (18,6%) y los trastornos del movimiento (11,7%), seguidas delas enfermedades psiquiátricas, epilepsias, enfermedades cerebrovasculares y neuropatías(AU)

Aim. To perform a descriptive analysis of the outpatient activity in a neurological department in terms of thefrequency and type of neurological diseases that were attended. Patients and methods. A retrospective and cross-sectional study was conducted involving patients referred to the neurology outpatients department. The cases that visited for the first time during the years 2006 and 2007 were recorded consecutively. Medical information was evaluated based on computerisedhospital registers and the following data were collected: health referral area, date of visit, age, sex and diagnosis according to the International Classification of Diseases, 9th edition, clinical modification (CIE-9-MC), reconverted into the InternationalClassification of Diseases, 10th edition (CIE-10). Results. The mean age was 60.6 ± 20.9 years (range: 4-95 years) and 61.4% were females. The rate of frequency of visits was 4.3 requests/1000 inhabitants for the year 2006 and 3.9 for the year2007; an increase was observed with age for the neurodegenerative diseases. As far as the CIE-10 is concerned, the diseases were classified as episodic and paroxysmal (25%), degenerative and demyelinating (18.6%), organic mental disorders (14.7%), extrapyramidal syndromes (10.5%), diseases affecting cerebral circulation (3.5%), stress-related disorders and somatomorphs (3.5%) and diseases of the inner ear (3.3%). The remaining pathologies did not reach 3% of the total. Diseases of the central nervous system were observed in 61% of the patients and psychiatric disorders were found in 20.3%. The mostcommon diseases were cognitive disorders (31.5%), headaches (18.6%) and movement disorders (11.7%), followed by psychiatric diseases, epilepsies, cerebrovascular diseases and neuropathies(AU)

[A longitudinal study of apathy in patients with Alzheimer's disease]. / Estudio longitudinal de la apatía en pacientes con enfermedad de Alzheimer.

INTRODUCTION: Apathy is the most common behavioral symptom in Alzheimer's disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months. PATIENTS AND METHODS: Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathy NPI score was taken in to account in the study when it was equal or more than 4. RESULTS: The sample size consisted of 155 subjects with a mean age of 77.1 +/- 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores. CONCLUSION: The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI total score was observed when an increased apathy NPI score is observed.

Estudio longitudinal de la apatía en pacientes con enfermedad de Alzheimer / A longitudinal study of apathy in patients with alzheimer's disease

Introducción. Uno de los trastornos conductuales más frecuentes en la enfermedad de Alzheimer (EA) es la apatía. El objetivo de este estudio fue determinar la prevalencia de apatía en pacientes con EA en fases iniciales y su evolución tras 12 meses de seguimiento. Pacientes y métodos. Estudio observacional longitudinal en pacientes con EA. Se administró el Cambridge-Cognitive Revised (CAMCOG-R), la Disability Assessment in Dementia (DAD) y el inventario neuropsiquiátrico (NPI), y se recogieron de manera estructurada las características sociodemográficas. Se valoró la presencia de apatía en pacientes con una puntuación en la subescala del NPI mayor o igual a 4 puntos. Resultados. La muestra estuvo formada por 155 pacientes,con una media de edad de 77,1 ± 6,7 años, y un 67,7% fueron mujeres. La prevalencia de apatía fue del 18,7%; a los 12 meses, la persistencia fue del 51,7% y la remisión, del 48,3%. La incidencia fue del 21,4%. Se observaron diferencias en el momento basal entre los pacientes con y sin apatía en el CAMCOG-R (p = 0,001), en la DAD (p < 0,001) y en el NPI (p < 0,001). Al año no se observaron diferencias según edad ni sexo. Según los índices de variación porcentual, a los 12 meses se observaron diferencias en la iniciativa y ejecución funcional y en el NPI. Conclusiones. La apatía aumenta con la evolución de la EA, a la vez que se asocia a mayor discapacidad funcional, sobre todo en iniciativa y capacidad ejecutiva. Se observó un aumentode la puntuación de las otras subescalas del NPI asociado al incremento de la apatía

Introduction. Apathy is the most common behavioral symptom in Alzheimer’s disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months. Patients and methods. Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathyNPI score was taken in to account in the study when it was equal or more than 4. Results. The sample size consisted of 155 subjects with a mean age of 77.1 ± 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores. Conclusion. The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI totalscore was observed when an increased apathy NPI score is observed

[Factorial distribution of the burden on caregivers of patients with Alzheimer's disease]. / Distribución factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Care of patients with Alzheimer's disease (AD) is so demanding that it can trigger states of physical, emotional and psychological distress among caregivers. The aims of this study were to determine the factorial structure of the Zarit Burden Scale (BS), to establish the differences among the factors according to the characteristics of patients and caregivers, and to determine the effect of the course of the disease on the factors on the BS over a period of two years. SUBJECTS AND METHODS: We conducted a prospective, longitudinal study on non-professional caregivers of patients with AD. The study involved 463 patients with a diagnosis of probable AD. The mean age was 75.2 years. All the subjects were administered the study protocol on a six-monthly basis over a period of 24 months. The patient's cognitive and functional capacity and the presence of psychological and behavioural symptoms were evaluated. The main caregiver was asked to complete the Zarit BS. RESULTS: The 21 items on the BS were distributed into five factors that accounted for 59.7% of the total variance of the score. A multivariate analysis identified aggressiveness, apathy, irritability, the caregiver's age and his or her relation to the family as the main causes of distress. CONCLUSIONS: This study confirms the multidimensional structure of the BS and offers information about the effect exerted on burden by the different clinical variables of the patients and the sociodemographic variables of the caregivers.

Distribución factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer / Factorial distribution of the burden on caregivers of patients with alsheimer’s disease

La enfermedad de Alzheimer (EA) provoca una necesidad de asistencia a los pacientes que puedeprovocar estados de carga física, emocional y psicológica en los cuidadores. Los objetivos de este estudio fueron determinar la estructura factorial de la escala de carga de Zarit (EC), establecer las diferencias entre los factores según las característicasde pacientes y cuidadores y determinar el efecto de la evolución de la enfermedad sobre los factores de la EC durante un período de dos años. Sujetos y métodos. Estudio prospectivo y longitudinal en cuidadores no formales de pacientes con EA. Participaron 463 pacientes diagnosticados de EA probable. La media de edad fue de 75,2 años. A todos los sujetos se les administróel protocolo de estudio semestralmente durante un período de 24 meses. Se evaluó la capacidad cognitiva y funcional del paciente y la presencia de síntomas psicológicos y conductuales. Al cuidador principal se le administró la EC de Zarit. Resultados. Los 21 ítems de la EC se distribuyeron en cinco factores que explicaron el 59,7% de la varianza total de lapuntuación. El análisis multivariante identificó la agresividad, la apatía, la irritabilidad, la edad del cuidador y su relación familiar como los principales causantes de la carga. Conclusiones. Este estudio confirma la estructura multidimensional dela EC y aporta información sobre el efecto que las distintas variables clínicas de los pacientes y sociodemográficas de los cuidadores provocan sobre la carga

Care of patients with Alzheimer’s disease (AD) is so demanding that it can trigger states of physical,emotional and psychological distress among caregivers. The aims of this study were to determine the factorial structure of the Zarit Burden Scale (BS), to establish the differences among the factors according to the characteristics of patients and caregivers, and to determine the effect of the course of the disease on the factors on the BS over a period of two years. Subjectsand methods. We conducted a prospective, longitudinal study on non-professional caregivers of patients with AD. The study involved 463 patients with a diagnosis of probable AD. The mean age was 75.2 years. All the subjects were administered the study protocol on a six-monthly basis over a period of 24 months. The patient’s cognitive and functional capacity and thepresence of psychological and behavioural symptoms were evaluated. The main caregiver was asked to complete the Zarit BS. Results. The 21 items on the BS were distributed into five factors that accounted for 59.7% of the total variance of the score.A multivariate analysis identified aggressiveness, apathy, irritability, the caregiver's age and his or her relation to the family as the main causes of distress. Conclusions. This study confirms the multidimensional structure of the BS and offers informationabout the effect exerted on burden by the different clinical variables of the patients and the sociodemographic variables of the caregivers

[Telemedicine and dementia: a need for the 21st century]. / Telemedicina y demencia: una necesidad para el siglo XXI.

INTRODUCTION: The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. DEVELOPMENT: Telemedicine's applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. CONCLUSIONS: Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services.

Telemedicina y demencia: una necesidad para el siglo XXI / Telemedicine and dementia: a need for the 21st century

Introducción. La incorporación de las tecnologías de la información y comunicación en los servicios de salud implica un cambio en la concepción, organización y gestión de estos servicios. La telemedicina es un método de trabajo que permite al profesional sanitario explorar y/o tratar a un paciente a distancia. En esta revisión se realiza un recorrido histórico sobre la telemedicina y su evolución bibliométrica, y se valora su aplicación en el campo de las demencias. Desarrollo. Las aplicaciones de la telemedicina se han desarrollado con la intención de acercar los recursos de salud a los pacientes más alejados de ellos. La revisión del impacto bibliométrico muestra un incremento de las referencias bibliográficas relacionadas con la telemedicina a partir de 1995. Durante los últimos años en España se ha producido un incremento en la investigación y el desarrollo de programas de telemedicina, y actualmente existen programas en todas las comunidades autónomas. Aunque algunas de las necesidades que presentan los pacientes con demencia no son propicias para la utilización de las tecnologías de la información y comunicación, su aplicación puede dar un valor añadido a la asistencia sanitaria. No pretende sustituir la consulta médica presencial, sino evitar algunas de las dificultades que presentan estos pacientes y mejorar su calidad de vida en el proceso asistencial. Conclusiones. Las demencias podrían ser un modelo adecuado para la implantación de diversos programas de telemedicina que mejorarían la asistencia al paciente y ahorrarían en costes y gestión sociosanitaria

Introduction. The ongoing process of information and communication technologies in health services implies a change in the conception, organization and management of these services. Telemedicine is a working method that allows health professionals to explore and/or treat a patient from an off-site location. In this review we provide a historical background on telemedicine, the evolution of its bibliometric impact, and its application for people with dementia. Development. Telemedicine’s applications have been developed in order to provide greater availability and easier access to healthcare to underserved people. The bibliometric study of telemedicine literature shows an increase in the number of bibliographic references related to telemedicine since 1995. During the last few years in Spain the research and development of telemedicine programs have increased significantly and at present there are telemedicine programs in all regions of the country. Although some of the needs of the patients with dementia may be unsuitable for communication and information technologies, their application could offer an added value to health services. This technology does not attempt to replace face-to-face medical consultations but rather to prevent some difficulties this kind of patients can present and improve their quality of life. Conclusions. Dementia could be an appropriate field in order to implement some telemedicine programs that may improve patient medical care, and reduce medical and management expenses for social and healthcare services

[The feasibility of a registry of dementias: clinical features and diagnostic coverage]. / Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica.

INTRODUCTION AND AIM: Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. MATERIALS AND METHODS: Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. RESULTS: 670 new cases of dementia, of which 74% corresponded to Alzheimer's disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative's home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit's reference territorial area. The diagnostic coverage for the health region of Girona was 38%. CONCLUSIONS: The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona.

Viabilidad de un registro de demencias: características clínicas y cobertura diagnóstica / The fiability of a registry of dementias: clinical features and diagnostic coverage

Introducción y objetivo. Los estudios epidemiológicos clásicos no permiten conocer la realidad de los patrones de derivación y diagnóstico de demencia en la práctica clínica habitual de un territorio definido. Esta información es fundamental para la planificación y distribución de los recursos sanitarios y sociales a medio y largo plazo. Se presentan los resultados de un programa piloto de registro de casos de demencia basado en los fundamentos de la vigilancia epidemiológica. Materiales y métodos. Registro consecutivo y estandarizado de los diagnósticos incidentes de demencia de una unidad especializada durante el bienio 2004-2005. Resultados. Se registraron 670 nuevos casos de demencia, de los cuales el 74% correspondió a la enfermedad de Alzheimer. Las demencias preseniles representaron el 10,3% de los casos. El tiempo medio entre el inicio de los síntomas y el diagnóstico clínico fue de 2,4 años y la gravedad de la demencia fue leve en el 60%. El 90,1% de los casos residía en su domicilio o en el de un familiar. La hipertensión arterial, la diabetes mellitus y los antecedentes de trastorno depresivo fueron los antecedentes patológicos más frecuentes (> 20%). La cobertura diagnóstica sobre la base de los casos de demencia esperados para el área de referencia de la unidad especializada fue del 75% y para el conjunto de las comarcas de Girona fue del 38%. Conclusiones. Los datos registrados muestran la viabilidad y validez del sistema de registro de casos propuesto y su capacidad actual para ampliar la cobertura del registro a la región sanitaria de Girona

Introduction and aim. Classic epidemiological studies do not allow to know the dementia patterns of derivation and diagnosis in a defined territory. This information is fundamental for the planning and distribution of the sanitary and social resources to a medium-to-long term. The results of a pilot-registry program for dementia cases based on the population surveillance principles is presented. Materials and methods. Consecutive and standardized registry of the incident dementia diagnoses of a memory unit during biennium 2004-2005. Results. 670 new cases of dementia, of which 74% corresponded to Alzheimer’s disease, were registered. The presenile dementias were 10.3% of the cases. The mean time between the beginning of the symptoms and the clinical diagnosis was of 2.4 years and the severity of the dementia was mild in 60.0%. 90.1% of the cases lived in their homes or in a relative’s home. The hypertension, the diabetes mellitus and the antecedents of depressive disease were the more frequent pathological antecedents (> 20%). The diagnostic coverage based on the estimated dementia cases was 75% for the memory unit’s reference territorial area. The diagnostic coverage for the health region of Girona was 38%. Conclusions. The registered data show the viability and validity of the proposed registry program for dementia cases. Nowadays the registry program is able to extend the diagnostic coverage all over the health region of Girona

Propuesta para un registro clínico de demencias / A proposal for a clinical registry of dementias

Objetivo. Se presenta una propuesta de las característicasestructurales y funcionales necesarias para desarrollar un registrode demencias que permita recoger con garantías de fiabilidady validez la información estandarizada de los casos diagnosticadosde demencia en los centros sanitarios de atención especializada deun área geográfica definida. Desarrollo. Debido a la falta de informaciónsobre los aspectos relativos al impacto de las demenciassobre el sistema sanitario, en términos de utilización de recursos yen patrones de detección, derivación, diagnóstico y tratamiento enla práctica clínica habitual por parte de atención primaria y secundaria,se propone una implementación secuencial del registro paraadaptarse a cada territorio o región sanitaria. En primer lugar, sedeberían identificar los casos y las fuentes de información; en segundolugar, desarrollar un sistema de recogida de datos que permitaadoptar de forma estandarizada la recogida de información yestablecer una estrecha colaboración con los especialistas que llevena cabo el diagnóstico de demencia; y, en tercer lugar, aportar alregistro una estructura logística y de personal que centralice todaslas funciones y actividades del registro. Conclusiones. La vigilanciaepidemiológica es un instrumento fundamental para la planificación,gestión y distribución de los recursos sociosanitarios, para elseguimiento de la evolución natural de enfermedades crónicas asícomo para evaluar el impacto de programas preventivos. En estesentido, y desde un punto de vista funcional, la propuesta de unregistro de demencias cumple todos los requisitos básicos de la vigilanciaepidemiológica

Aims. We outline a proposal for the structural and functional features needed to develop a registry of dementiaswhich can be used to collect standardised information that is both reliable and valid concerning cases of dementia in thespecialised health care centres within a particular geographical area. Development. Due to the shortage of information aboutaspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns ofdetection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequentialimplementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identifythe cases and sources of information; second, a system for collecting data must be developed that allows information to begathered in a standardised manner while at the same time making it possible to work in close collaboration with thespecialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all thefunctions and activities of the registry. Conclusions. Epidemiological surveillance is an essential instrument for planning,managing and distributing community health resources, for following up the natural history of chronic diseases and forassessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry ofdementias meets all the basic requirements of epidemiological surveillance

[A proposal for a clinical registry of dementias]. / Propuesta para un registro clinico de demencias.

AIMS: We outline a proposal for the structural and functional features needed to develop a registry of dementias which can be used to collect standardised information that is both reliable and valid concerning cases of dementia in the specialised health care centres within a particular geographical area. DEVELOPMENT: Due to the shortage of information about aspects concerning the impact of dementias on the health care system (in terms of the usage of resources and patterns of detection, referral, diagnosis and treatment in usual clinical practice in primary and secondary care), a sequential implementation of the registry is proposed so that it can be adapted to each health district or region. The first step is to identify the cases and sources of information; second, a system for collecting data must be developed that allows information to be gathered in a standardised manner while at the same time making it possible to work in close collaboration with the specialists who diagnose dementia; and, third, it must be set up with the logistics and staff needed to centralise all the functions and activities of the registry. CONCLUSIONS: Epidemiological surveillance is an essential instrument for planning, managing and distributing community health resources, for following up the natural history of chronic diseases and for assessing the impact of programmes of prevention. In this respect, and from a functional point of view, the proposed registry of dementias meets all the basic requirements of epidemiological surveillance.