A path analysis of patient dependence and caregiver burden in Alzheimer's disease.

BACKGROUND: The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants. METHODS: Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence. RESULTS: The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress. CONCLUSIONS: Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Pharmaceutical consumption and cost in patients with dementia: A longitudinal study by the Registry of Dementias of Girona (ReDeGi) in Catalonia (Spain).

OBJECTIVE: Drug spending increases exponentially from the age of 65-70 years, and dementia is one of the diseases significantly contributing to this increase. Our aim was to describe pharmaceutical consumption and cost in patients with dementia, using the Anatomical Therapeutic Chemical (ATC) classification system. We also assessed the evolution of costs and consumption, and the variables associated to this evolution during three years. METHODS: Three years prospective cohort study using data from the ReDeGi and the Health Region of Girona (HRG) Pharmacy Unit database from the Public Catalan Healthcare Service (PCHS). Frequency of consumption and costs of ATC categories of drugs were calculated. RESULTS: Sample of 869 patients with dementia, most of them with a diagnosis of degenerative dementia (72.6%), and in a mild stage of the disease (68.2%). Central nervous system (CNS) drugs had the highest consumption rate (97.2%), followed by metabolic system drugs (80.1%), and cardiovascular system drugs (75.4%). Total pharmaceutical cost was of 2124.8 € per patient/year (standard deviation (SD)=1018.5 €), and spending on CNS drugs was 55.5% of the total cost. After 36 months, pharmaceutical cost increased in 694.9 € (SD=1741.9), which was associated with dementia severity and institutionalization at baseline. CONCLUSIONS: Pharmaceutical consumption and costs are high in patients with dementia, and they increase with time, showing an association with baseline dementia severity and institutionalization. CNS drugs are the pharmaceuticals with highest prescription rates and associated costs.

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.

Evaluación de la anosognosia en la enfermedad de Alzheimer / Evaluation of anosognosia in Alzheimer’s disease

Objetivos. Comparar la prevalencia de anosognosia en pacientes con enfermedad de Alzheimer (EA) a partir de dos metodologías de evaluación diferentes, analizar el grado de discrepancia entre ambas y determinar las variables asociadasa esta discrepancia. Pacientes y métodos. Estudio transversal y observacional en pacientes con EA. Se administraron el Anosognosia Questionnaire- Dementia (AQ-D) y la Experimenter Rating Scale (ERS). Se registró información clínica y sociodemográfica del pacientey de su cuidador mediante instrumentos estandarizados. Se determinó la prevalencia con cada instrumento y el grado de concordancia entre ambos. Se creó una variable denominada ‘concordancia/no concordancia’ y se ajustó un modelo de regresión logística para determinar las variables asociadas a la discrepancia.Resultados. La prevalencia de anosognosia en los casos leves fue del 13,6% (intervalo de confianza del 95%, IC 95% = 5,5- 21,7) y del 17,3% (IC 95% = 8,4-26,1) y del 44,2% (IC 95% = 28,2-60,2) y 55,8% (IC 95% = 38,8-71,8) en los casos moderados, según la ERS y el AQ-D, respectivamente. El grado de concordancia entre ambas medidas obtuvo un valor kappa de 0,7. El modelo de regresión con la discrepancia entre la ERS y el AQ-D como variable dependiente se asoció a una menor capacidad funcional (odds ratio = -0,080; IC 95% = 0,855-0,997; p = 0,042). Conclusiones. Los datos mostraron un incremento de la prevalencia de anosognosia asociada a la gravedad y una discordancia en su evaluación con dos métodos diferentes cuanto mayor fue el grado de discapacidad funcional del enfermo (AU)

Aims. To compare the prevalence of anosognosia in patients with Alzheimer’s disease (AD) using two different evaluationmethodologies, to analyse the discrepancy between them and to determine the variables associated with this discrepancy. Patients and methods. The methodology involved a cross-sectional, observational study conducted in patients with AD.The Anosognosia Questionnaire-Dementia (AQ-D) and the Experimenter Rating Scale (ERS) were administered. Clinicaland sociodemographic information was recorded about both the patient and his/her caregiver by means of standardised instruments. Prevalence was determined with each instrument and the degree of agreement between them was thenestablished. A variable called ‘agreement/non-agreement’ was created and a logistic regression model was adjusted to determine the variables associated to the discrepancy. Results. The prevalence of anosognosia in the mild cases was 13.6% (95% confidence interval, 95% CI = 5.5-21.7) and17.3% (95% CI = 8.4-26.1), and 44.2% (95% CI = 28.2-60.2) and 55.8% (95% CI = 38.8-71.8) in the moderate cases, according to the ERS and the AQ-D, respectively. The degree of agreement between the two measurements yielded akappa-value of 0.7. The regression model with the discrepancy between the ERS and the AQ-D as the dependent variable was associated to a lower functional capacity (odds ratio = 0.080; 95% CI = 0.855-0.997; p = 0.042). Conclusions. The data from the study showed an increase in the prevalence of anosognosia linked to the severity and a higher disagreement in its evaluation with two different methods as the degree of the patient’s functional disabilityincreased (AU)

[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)

Quality of life of patients with Alzheimer's disease: differential perceptions between spouse and adult child caregivers.

BACKGROUND/AIMS: Little research has been conducted into differences in the perceived quality of life of patients (QoL-p) when comparing spouse and adult child caregivers of people with Alzheimer's disease (AD). The aim of this study was to identify the differential variables in perceived QoL-p between patients and carers, distinguishing between spouse and adult child caregivers. METHOD: Cross-sectional analytic study of 251 patients and their carers (spouses: 112; adult children: 139) using the QoL-AD scale and sociodemographic and clinical data. RESULTS: The more positive perception of spouses was associated with higher educational levels of the caregiver and greater functional autonomy in the patient. The more negative perception of adult children was associated with greater caregiver burden and higher levels of depression in the patient. The perception of daughter caregivers showed the strongest association with mental health and burden. CONCLUSIONS: Spouse caregivers have a more positive perception of the patient's quality of life than adult child caregivers.

[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)

Síndrome de Klüver-Bucy por lesión frontal / No disponible

No disponible

Prevalencia y evolución del delirium en una muestra comunitaria de 70 años y más / Prevalence and evolution of delirium in a community population of 70 years and older

Introducción. Existen numerosos estudios sobre el delirium con muestras clínicas e institucionalizadas, pero son escasos con muestras comunitarias. El objetivo del estudio fue determinar la prevalencia de delirium en una muestra comunitaria y la supervivencia en un período de 5 años. Método. Estudio de casos y controles y de supervivencia a partir de los datos de un estudio epidemiológico para determinar la prevalencia de demencia y su incidencia tras 5 años en ocho municipios de la provincia de Girona. Se aplicaron criterios DSM-IV para identificar los casos de delirium en el estudio de prevalencia a partir de la información recogida mediante el Cambridge Mental Disorders of the Elderly Examination. Se aplicaron técnicas de contraste de hipótesis para comparar las características de los participantes según la presencia o ausencia de delirium. Se utilizó la técnica de Kaplan- Meier para estimar la supervivencia de los participantes y un modelo de regresión multivariante de Cox para determinar el efecto del delirium sobre la mortalidad a los 5 años. Resultados. Participaron 1.460 habitantes mayores de 69 años y se detectaron 14 casos de delirium que representaron una prevalencia del 0,96 % (intervalo de confianza [IC] 95%: 0,43-1,49). La supervivencia media para los participantes con delirium fue de 3 años (IC 95%: 1,9-4,1) y fue significativamente inferior a la de los controles sanos. La presencia de delirium incrementó en 2,65 el riesgo de mortalidad a los 5 años. Conclusiones. La prevalencia de delirium en muestras comunitarias es baja y la mayoría de los casos está superpuesto a una demencia. Los pacientes con delirium tienen un mayor riesgo de mortalidad a los 5 años (AU)

Introduction. There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. Method. Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. Results. 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. Conclusion. The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period (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

[Prevalence and evolution of delirium in a community population of 70 years and older]. / Prevalencia y evolución del delirium en una muestra comunitaria de 70 años y más.

INTRODUCTION: There are many studies on delirium in clinical populations and nursing home patients but not in community populations. This study has aimed to know the prevalence of delirium in a community population and to know the survival rate during a five-year period. METHOD: Case-control and survival study based on data from an epidemiological study to measure the prevalence and incidence of dementia in eight rural villages in Girona. According to the Diagnostic and Statistical Manual of Mental Disorders, delirium was identified for the prevalence study using the information obtained from the Cambridge Mental Disorders of the Elderly Examination. A hypothesis contrast method was used in order to compare all clinical features of the subjects according the presence or the absence of delirium. The Kaplan-Meier technique was used to estimate survival of the subjects, and a multivariate Cox regression analysis was done to know the effect of delirium on mortality over the five-year period. RESULTS: 1,460 subjects older than 69 participated in the study. A prevalence of 0.96% (95% confidence interval [CI]: 0.43-1.49) was detected (14 cases of delirium). Mean survival for subjects with delirium was 3 years (CI 95%: 1.9-4.1) and it was slightly lower than for heal - thy controls. The presence of delirium increased the risk of death in five years by 2.65. CONCLUSION: The prevalence of delirium in community populations is low and most of the times it is superimposed on dementia. Patients with delirium have a higher risk of mortality at the end of a five-year period.

[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

Diferencias entre las demencias según la edad de inicio: estudio a partir de los datos de un registro de demencias / ferences among dementias according to onset age: study based on dementia registry data

Introducción. Se trata de conocer aspectos sociodemográficos,cognitivos, funcionales y factores de riesgo quepermitan diferenciar las demencias según la edad de inicio.Métodos. Estudio transversal y analítico a partir de los670 casos que forman el estudio piloto del Registro Hospitalariode Demencias de Girona. Los casos fueron registradosde forma consecutiva y estandarizada durante el bienio2004-2005.Resultados. El 10,31% (n=69) de los pacientes que formaronparte del registro manifestaron los primeros síntomasde demencia antes de los 66 años. La distribución de losdiagnósticos de demencia fue diferente según la edad deinicio, con una mayor frecuencia de demencia frontotemporalen el grupo de demencias de inicio precoz. Los pacientescon alguna demencia de inicio precoz presentaron menordeterioro cognitivo y funcional y mayor número dealteraciones conductuales en el momento del diagnósticoque los casos tardíos. También mostraron un mayor númerode antecedentes familiares de síndrome de Down y personalesde depresión. No se observaron diferencias en los factoresde riesgo vascular entre ambos grupos.Conclusiones. Las demencias de inicio precoz muestrandiferencias clínicas, diagnósticas y de factores de riesgo conrespecto a las que se inician más tardíamente. Los registrosson una herramienta útil para estudiar características debaja prevalencia en el contexto de las enfermedades que inducenun proceso de demencia (AU)

Introduction. To know cognitive, functional and sociodemographicalfeatures as risk factors in order to differentiatedementias based on onset age of illness.Methods. Cross-sectional and analytical study basedon 670 cases of a pilot program for dementia from theGerona Hospital Registry for dementias. The cases werestandardized and registered consecutively during the2004-2005 biennium.Results. A total of 10.3% (n= 69) of patients whowere included in the registry showed the first symptomsof dementia before they were 66 years old. The distributionof the dementia diagnoses differed according to ageat onset of illness, with greater frequency of frontotemporaldementia in the early-onset dementia group. Patientswith early-onset dementia showed less functionaland cognitive impairment than patients with late-onsetdementia. They also had more behavioral and psychologicaldisorders than the late onset cases as well as a greaternumber of family backgrounds of Down’s syndromeand personal background of depression. No vascular riskfactors differences between late-and-early-onset dementiaswere found.Conclusions. Early-onset dementias showed differentclinical manifestations, risk factors and diagnosticdistributions versus the later onset ones. The registryprogram for dementia is a useful tool to study low prevalencecharacteristics of diseases leading to the dementiacondition (AU)

[Differences among dementias according to onset age: study based on dementia registry data]. / Diferencias entre las demencias según la edad de inicio: estudio a partir de los datos de un registro de demencias.

INTRODUCTION: To know cognitive, functional and sociodemographical features as risk factors in order to differentiate dementias based on onset age of illness. METHODS: Cross-sectional and analytical study based on 670 cases of a pilot program for dementia from the Gerona Hospital Registry for dementias. The cases were standardized and registered consecutively during the 2004-2005 biennium. RESULTS: A total of 10.3% (n=69) of patients who were included in the registry showed the first symptoms of dementia before they were 66 years old. The distribution of the dementia diagnoses differed according to age at onset of illness, with greater frequency of frontotemporal dementia in the early-onset dementia group. Patients with early-onset dementia showed less functional and cognitive impairment than patients with late-onset dementia. They also had more behavioral and psychological disorders than the late onset cases as well as a greater number of family backgrounds of Down's syndrome and personal background of depression. No vascular risk factors differences between late-and-early-onset dementias were found. CONCLUSIONS: Early-onset dementias showed different clinical manifestations, risk factors and diagnostic distributions versus the later onset ones. The registry program for dementia is a useful tool to study low prevalence characteristics of diseases leading to the dementia condition.

[Mortality rates in patients with Alzheimer's disease treated with atypical neuroleptic drugs]. / Mortalidad en pacientes con enfermedad de Alzheimer tratados con neurolepticos atipicos.

AIM: To evaluate the influence of metabolic syndrome (MS) and a history of heart disease on increased mortality rates among patients with Alzheimer's disease (AD) who have been treated with cholinesterase inhibitors or memantine and who received risperidone or olanzapine therapy during the time under study. PATIENTS AND METHODS: Our study involved a sample of 751 patients diagnosed with AD and treated with anti-dementia drugs. Of the total number, 10.2% (n = 77) and 7.7% (n = 58) had been treated with risperidone and olanzapine, respectively, at some time during the follow-up. Twelve (1.6%) had received both substances in different periods of time. RESULTS: Mean follow-up time was 27.52 +/- 12.15 months. Mortality rate stood at 14% (n = 105). The mean maximum dose of olanzapine was 4.3 mg/day (standard deviation, SD = 2.55; range = 2.5-15) and 1.36 mg/day (SD = 0.67; range = 0.25-3.5) in the case of risperidone. Treatment lasted 519.12 (SD = 285.2; range = 90-1045) and 481.68 (SD = 345.22; range = 1-1650) days, respectively. If age, sex, conduct disorders on the Blessed scale, the cumulative heart disease index and the global deterioration scale are included in the model, both olanzapine (relative risk, RR = 8.95; confidence interval, CI 95% = 2.856-28.046) and risperidone (RR = 4.526; CI 95% = 1.816-11.281) increase the risk of death. An interaction between a history of heart disease and risperidone is recorded, which suggests a possible protection of the drug in this group. No evidence was found of an interaction between the two drugs and MS. CONCLUSIONS: Neither the presence of cardiac disorders nor MS allow us to explain the increased mortality rate in patients with dementia who are treated with olanzapine or risperidone.