Valor diagnóstico y correlaciones funcionales de la escala ADAS-Cog en la enfermedad de Alzheimer: datos del proyecto NORMACODEM / Diagnostic value and functional correlations of the ADAS-Cog scale in Alzheimer's disease: data on NORMACODEM project

Introducción. El objetivo es estudiar la validez de criterio de la Alzheimer's Disease Assessment Scale (ADAS) y de su subescala cognitiva ADAS-Cog para el diagnóstico de la enfermedad de Alzheimer (EA) y determinar diferentes puntos de corte obteniendo la sensibilidad y especificidad diagnósticas respectivas. Además se pretenden estudiar las correlaciones de las puntuaciones de la escala ADAS con medidas funcionales.Métodos. Se estudiaron 451 sujetos (254 controles sanos,86 casos con deterioro cognitivo sin demencia y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de la escala ADAS-total. La puntuación global es la resultante de la suma de dos subtests: la subescala cognitiva (ADAS-Cog) y la subescala no cognitiva (ADAS-Nocog). Se aplicaron ajustes por edad y escolaridad correspondientes para cada sujeto. A fin de poder establecer la correlación con medidas funcionalesse administraron la Rapid Disability Rating Scale-2(RDRS-2), la Blessed Dementia Rating Scale (BDRS) y la escala Interview for Detererioration of Daily Living in Dementia (IDDD). El estudio estadístico se realizó mediante las curvas ROC y el coeficiente de correlación de Pearson. Resultados. El punto de corte más equilibrado para la ADAS-total ajustado por edad y escolaridad fue de >= 17 (sensibilidad: 90,09 %, y especificidad: 85,88%). El punto de corte más equilibrado del ADAS-Cog ajustado por edad y escolaridad fue de >= 12 (sensibilidad: 89,19 %, y especificidad: 88,53%). El área bajo la curva ROC fue, respectivamente, 0,95 y 0,94. La escala ADAS-total y ADAS-Cog presentan buenas correlaciones con las escalas funcionales estudiadas. Conclusiones. Tanto la ADAS-total como la ADAS-Cog presentan una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo. Asimismo existe una buena correlación entre el deterioro funcional estudiado en los pacientes con EA y la puntuación obtenida en ambas escalas

Introduction. The aims of this study were to assessthe criterion validity of Alzheimer's Disease AssessmentScale (ADAS) and its cognitive subscale (ADAS-Cog) forthe diagnosis of Alzheimer’s disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted tostudy the possible correlations between cognitive scores(ADAS) and functional measures. Methods. 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). Statistical analysis: ROC curves and Pearson correlation coefficient. Results. ADAS best cut-off score for dementia was >=17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was >= 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. Conclusions. Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog

[Diagnostic value and functional correlations of the ADAS-Cog scale in Alzheimer's disease: data on NORMACODEM project]. / Valor diagnóstico y correlaciones funcionales de la escala ADAS-Cog en la enfermedad de Alzheimer: datos del proyecto NORMACODEM.

INTRODUCTION: The aims of this study were to assess the criterion validity of Alzheimer's Disease Assessment Scale (ADAS) and its cognitive subscale (ADAS-Cog) for the diagnosis of Alzheimer's disease (AD), and to determine their different cut-off scores and sensitivity and specificity values. In addition, we also attempted to study the possible correlations between cognitive scores (ADAS) and functional measures. METHODS: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with AD). ADAS total score was obtained by adding the cognitive (ADAS-Cog) and non-cognitive (ADAS-Nocog) scales. Scores were adjusted for age and formal education. For assessing the possible correlation between cognitive and functional measures, the following instruments were administered: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) and the Interview for the Deterioration of Daily Living in Dementia (IDDD). STATISTICAL ANALYSIS: ROC curves and Pearson correlation coefficient. RESULTS: ADAS best cut-off score for dementia was > or = 17 providing sensitivity and specificity values of 90.09% and 85.88 % respectively, while for the ADAS-Cog best cut-off score was > or = 12 with sensitivity and specificity values of 89.19 % and 88.53 % respectively. In both cases scores were adjusted for age and formal education. The area under the ROC curve was 0.95 and 0.94 respectively. Highly significant correlations were found for ADAS and 19 ADAS-Cog with the functional scales studied. CONCLUSIONS: Both, ADAS and ADAS-Cog report good validity in terms of sensitivity, specificity and as predictive value for AD. Moreover, significant correlations were found between the functional impairment observed in patients with AD and the overall scores achieved in the ADAS and ADAS-Cog.

[Rapid Disability Rating Scale-2 in Alzheimer's disease: NORMACODEM project data]. / Estudio de la Escala de Evaluación Rápida de Discapacidad-2 (Rapid Disability Rating Scale-2) en la enfermedad de Alzheimer: datos del proyecto NORMACODEM.

INTRODUCTION: The study aimed to investigate the Rapid Disability Rating Scale-2 (RDRS-2) in Alzheimer's disease (AD). Test retest reliability, internal consistency, data of discriminant validity of the scale, correlations with other functional and cognitive measures were analyzed. MATERIAL AND METHODS: 451 subjects were assessed: 254 healthy controls, 86 with cognitive impairment but no dementia (CIND) and 111 subjects diagnosed of AD. Total and subscales scores of the RDRS-2 were obtained. The total score is the sum of three subscales: activities of daily living, disability, and special problems. To establish its correlation with other functional scales and cognitive instruments, the following tools were applied: Blessed Dementia Rating Scale (BDRS), Interview for the Deterioration of Daily Living in Dementia (IDDD), Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and the Mini-Mental State Examination (MMSE). STATISTICAL ANALYSIS: lineal multivariate regression analysis. Crossvalidation. ROC curves. Intraclass coefficient. Cronbach's alpha and Pearson's Correlation coefficient. RESULTS: RDRS-2 scores by group were the following (mean and SD): Controls (18.95; 1.64), CIND (20.61; 2.88), and AD (28.96; 9.07). Results from regression analysis 282 demonstrated absence of influence of sociocultural variables such as age and education in RDRS-2 scores. Correlations with other instruments were as following: BDRS, r=0.820; IDDD, r=0.882; ADAS-Cog, r=0.762, and MMSE, r=0.742. Intraclass coefficient was 0.86 and Cronbach's alpha was 0.91. For the RDRS-2 the best cutoff score was 21 (82.88% sensitivity and 88.8% specificity). Area under the ROC curve was 0.92. CONCLUSIONS: The Spanish adaptation of the RDRS-2 is free of sociocultural influence, and shows very adequate data on internal consistency and stability. Although not specifically designed for its use in AD it correlates highly and significantly with other functional scales as well as with the degree of cognitive impairment in AD.

Demencia tipo Alzheimer, estudios de correlación cognitivo-funcional y memoria de trabajo. Respuesta / Dementia of Alzheimer type, studies of clinico-functional correlation and working memory. Reply

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[Diagnostic value and test-retest reliability of the Blessed Dementia Rating Scale for Alzheimer's disease: data from the NORMACODEM project]. / Valor diagnóstico y fiabilidad test-retest de la Escala de demencia de Blessed (BDRS) para la enfermedad de Alzheimer: datos del proyecto NORMACODEM.

INTRODUCTION: This study aims to discover the criterion validity of the Blessed Dementia Rating Scale (BDRS) for the diagnosis of Alzheimer's disease. Different cut-off scores and corresponding diagnostic sensitivities and specificities were established. Test-retest reliability and internal consistency of the BDRS were also analyzed. SAMPLE: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with Alzheimer's disease). INSTRUMENTS: scores from different sections of the Blessed score were obtained. The global score (BBRS-Total) is the result of the sum of the three sections, A (changes in every day activities), B (changes in habits) and C (changes in personality). The sum of parts A and B (BDRS-Mod) were also quantified. STATISTICS: ROC curves, intraclass correlation coefficient and Cronbach's alpha. RESULTS: The best cut-off score for the BDRS-Total was 3.5 (sensitivity: 87.39%, and specificity: 90%). For the BDRS-Mod, the best cut-off score was 1.5 (sensitivity: 90%, and specificity: 89%). Area under the ROC curve was 0.964 and 0.963 respectively. Intraclass correlation coefficient was 0.98 and Cronbach's alpha was 0.925. CONCLUSIONS: The BDRS has good discriminative validity in terms of sensitivity, specificity and predictive value. It also has good test-retest reliability and internal consistency.

Valor diagnóstico y fiabilidad test-retest de la Escala de demencia de Blessed (BDRS) para la enfermedad de Alzheimer: datos del proyecto NORMACODEM / Diagnostic value and test-retest reliability of the Blessed Dementia Rating Scale for Alzheimer's disease: data from the NORMACODEM project

Introducción. El objetivo es establecer la validez de criterio de la Blessed Dementia Rating Scale (BDRS) para el diagnóstico de la enfermedad de Alzheimer (EA), estableciendo diferentes puntos de corte y obteniendo la sensibilidad y especificidad respectiva. Además se analiza la fiabilidad test-retest y la consistencia interna de la escala. Métodos. Se estudiaron 451 sujetos (254 controles sanos, 86 casos con trastorno cognitivo leve y 111 sujetos afectos de EA). Se obtuvieron las puntuaciones de los diversos apartados de la escala de Blessed. La puntuación global (BDRS-Total) es la suma resultante de los tres apartados: A (cambios en las actividades de la vida diaria), B (cambios en hábitos) y C (cambios en personalidad). Se cuantificó asimismo la puntuación obtenida de la suma resultante de los apartados A y B (BDRS Mod). Estudio estadístico: curvas ROC, coeficiente de correlación intraclase, alfa de Cronbach. Resultados. El punto de corte más equilibrado de la BDRS-Total es 3,5 (sensibilidad: 87,39 %, Y especificidad: 90 %). El punto de corte más equilibrado de la BDRS-Mod es 1,5 (sensibilidad: 90%, y especificidad: 89%). El área bajo la curva ROC es de 0,964 y 0,963, respectivamente. El coeficiente de correlación intraclase fue de 0,98. El coeficiente alfa de Cronbach fue de 0,925. Conclusiones. La BDRS presenta una buena validez discriminativa en términos de sensibilidad, especificidad y valor predictivo, así como adecuada fiabilidad test-retest

Introduction. This study aims to discover the criterion validity of the Blessed Dementia Rating Scale (BDRS) for the diagnosis of Alzheimer's disease. Different cut-off scores and corresponding diagnostic sensitivities and specificities were established. Test-retest reliability and internal consistency of the BDRS were also analyzed. Methods. Sample: 451 subjects were studied (254 controls, 86 subjects with mild cognitive impairment and 111 patients with Alzheimer's disease). Instruments: scores fram different sections of the Blessed score were obtained. The global score (BBRS- Total) is the result of the sum of the three sections, A (changes in every day activities), B (changes in habits) and C (changes in personality). The sum of parts A and B (BDRS-Mod) were also quantified. Statistics: ROC curves, intraclass correlation coefficient and Cronbach's alpha. Results. The best cut-off score for the BDRS-Total was 3.5 (sensitivity: 87.39 %, and specificity: 90 %). For the BDRS-Mod, the best cut-off score was 1.5 (sensitivity: 90 %, and specificity: 89 %). Area under the ROC curve was 0.964 and 0.963 respectively. Intraclass correlation coefficient was 0.98 and Cronbach's alpha was 0.925. Conclusions. The BDRS has good discriminative validity in terms of sensitivity, specificity and predictive value. It also has good test-retest reliability and internal consistency

[Correlations between cognition and function in Alzheimer's disease: based on the abbreviated Barcelona Test (a-BT)]. / Correlación cognitivo-funcional en la demencia tipo Alzheimer: a propósito del Test Barcelona Abreviado.

INTRODUCTION: The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. METHODS: A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer's disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson's correlation coefficient. RESULTS: The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). DISCUSSION: The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer's disease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer's disease pathology evaluated.

Correlación cognitivo-funcional en la demencia tipo Alzheimer: a propósito del test Barcelona abreviado / Correlation between cognition and function in Alzheimer's disease: based on abbreviated Barcelona test

Introducción. El objetivo del presente trabajo es establecer el grado de las posibles correlaciones de las puntuaciones globales del Test Barcelona Abreviado (TB-A) con escalas funcionales de la vida diaria. Métodos. Se estudiaron 107 sujetos (42 controles sanos, 19 casos de trastorno cognitivo leve y 46 sujetos afectos de enfermedad de Alzheimer). Se obtuvieron las puntuaciones del Test Barcelona y de las escalas funcionales siguientes: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) e Interview for Deterioration of Daily Living in Dementia (IDDD). En el estudio estadístico se estableció el grado de correlación mediante el coeficiente de Pearson. Resultados. Todas las correlaciones obtenidas fueron significativas (p < 0,0001) y altas, con una variación desde 0,72 a 0,80. Las puntuaciones estandarizadas del TB-A tienen un rango menor de correlación en relación con las puntuaciones brutas en el caso de la RDRS-2 y la BDRS y superior en caso de la IDDD. Discusión. Este trabajo establece la existencia de una buena correlación funcional de las puntuaciones globales del TB-A y las actividades de la vida diaria, al menos en los casos del deterioro cognitivo propio de los trastornos leves sin demencia y los grados discretos a moderados-graves de la enfermedad de Alzheimer. El TB-A permite predecir el estado funcional de los sujetos

Introduction. The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. Methods. A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer’s disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson’s correlation coefficient. Results. The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). Discussion. The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer’s diasease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer’s diasease pathology evaluated

Allelic polymorphism -491A/T in apo E gene modulates the lipid-lowering response in combined hyperlipidemia treatment.

BACKGROUND: Combined hyperlipidemia (CHL) is one of the dyslipidemias more frequently found in clinical practice, and lipid-lowering drugs are often necessary in its management. Some genetic loci have been associated with CHL expression, and some studies have shown modulation of drugs efficiency in the treatment of dyslipidemias by genetic polymorphisms. We have investigated whether common polymorphisms and mutations in the apolipoprotein (apo) E, lipoprotein lipase (LPL), and apo CIII genes influence atorvastatin or bezafibrate responses in patients with CHL. DESIGN: One hundred and sixteen subjects participating in the ATOMIX study (Atorvastatin in Mixed dyslipidemia) were randomized to treatment with either atorvastatin or bezafibrate. Apolipoprotein E genotype and common -491A/T and -219T/G polymorphisms in the apo E gene promoter region, Sst I polymorphism in the apo CIII gene (3238C/G), and D9N and N291S common mutations in the LPL gene were determined by polymerase chain reaction (PCR) and restriction enzyme digestion. RESULTS: Statistical analysis showed the influence of the -491A/T polymorphism in atorvastatin and bezafibrate treatments. Subjects carrying the -491T allele showed an increased LDL-cholesterol-lowering effect with atorvastatin compared with -491T allele noncarriers (-35% vs. -27%, P = 0.037). Subjects carrying the -491T allele, when on bezafibrate treatment, showed a lower triglyceride reduction compared with -491T allele noncarriers (-23% vs. -39%, P = 0.05). CONCLUSIONS: In our study, the -491A/T polymorphism in the apo E gene promoter region modulated the lipid-lowering efficiency of atorvastatin and bezafibrate in CHL patients. Such influence might explain some of the interindividual response variabilities observed for the two drugs, and could help in CHL management.

Adaptation and standardization of the geriatric evaluation of relative's rating instrument (GERRI) for Spain.

BACKGROUND: The Geriatric Evaluation of Relative's Rating Instrument (GERRI) is a scale that evaluates the frequencies of alterations in behavior and functional capacity over a two-week period prior to exploration. The scale depends on the observations done by a relative o first caregiver of the studied subject. AIM: To adapt and standardize the GERRI for the use in the Spanish population as a part of a general project to standardized cognitive and functional tests. METHOD: The scale was administered to 444 subjects: 249 controls, 85 mild memory-cognitive disorders without dementia subjects (DWD) and 110 patients with Alzheimer-type dementia (ATD). An across-sectional statistical study was conducted in our samples stratified by age, gender and education. We evaluated the reliability of repeatability of the test, the internal reliability and the age, sex and education effects on the score of the different subscales. We also took into account the diagnostical validity in the Alzheimer disease and finally we correlated this test results with Mini mental test. RESULTS: The demographic variables age and schooling were found to affect the GERRI subscales differently. Gender did not reach significance. Internal consistency for the GERRI-Social, -Mood and -Cognitive were 0.8620, 0.7647 and 0.9259, respectively. CONCLUSION: The Spanish version of the GERRI may be applied to Spanish clinical series because of its reliable internal consistency and reproducibility.

Adaptación para España y normalización del Instrumento de evaluación geriátrica por puntuaciones del informador (GERRI) / Adaptation and standardization of the Geriatric Evaluation of Relative's Rating Instrument (GERRI) for Spain

FUNDAMENTO: El Instrumento de evaluación geriátrica por puntuaciones del informador (GERRI) es una escala que evalúa la frecuencia de las alteraciones de conducta y la capacidad funcional, durante un período de 2 semanas previas a la exploración. OBJETIVO: Adaptar y normalizar el GERRI para su uso en la población española como parte de un proyecto general para normalizar pruebas cognitivas y funcionales. MÉTODOS: La escala fue administrada a 444 sujetos (249 controles, 85 pacientes con pérdida de memoria leve-alteraciones cognitivas sin demencia y 110 pacientes con demencia tipo Alzheimer). Se realizó un estudio estadístico transeccional en una población estratificada por edad, sexo y educación. Valoramos la fiabilidad en la reproducción de la prueba, la fiabilidad interna y los efectos de la edad, el sexo y la educación en la puntuación de las diferentes subescalas. Valoramos también la validez diagnóstica en la enfermedad de Alzheimer y, finalmente, correlacionamos los resultados de esta prueba con el Mini Mental State Examination. RESULTADOS: Las variables demográficas edad y escolarización afectan a las subescalas del GERRI de forma diferente. Sin embargo el sexo no las afecta de forma significativa. Las consistencias internas para el GERRI social, del humor y cognitivo fueron, respectivamente, de 0,8620, 0,7647 y 0,9259. CONCLUSIONES: La versión española del GERRI puede ser aplicada a series clínicas españolas por que es fiable, consistente y reproducible. (AU)

Clinical validity of the 'mini-mental state' for Spanish speaking communities.

The Mini-Mental State (MMS) is a brief structured test of cognitive function. The purpose of this study was to adapt and normalise MMS for the Spanish population. The test was administered to 450 subjects (253 control volunteers, 86 mild memory/cognitive impairment without dementia subjects - CIWD and 111 Alzheimer's Disease patients - AD). A cross-sectional statistical study in a population stratified by age and education was conducted. A more accurate diagnosis is provided by scores that have been adjusted for age and level of education. The recommended cut-off in our study was 24/25 (non-demented above 24). The adaptation and normalisation of MMS provides the Spanish population with a highly valuable screening tool.

Chitotriosidase genotype and serum activity in subjects with combined hyperlipidemia: effect of the lipid-lowering agents, atorvastatin and bezafibrate.

Chitotriosidase, an enzyme involved in the degradation of chitin-containing pathogens with unclear function in humans, has been proposed as a marker of lipid accumulation in macrophages in different lipid-storage diseases, including atherosclerosis. To evaluate (1) if lipid-lowering treatment could modify serum chitotriosidase activity and (2) be useful in monitoring lipid-lowering treatment, we have analyzed this enzyme activity in the participants in the Atozvastatin Versus Bezafibrate in Mixed Hyperlipidemia (ATOMIX) study, a double-blind, comparative, and randomized study comparing the efficacy of atorvastatin and bezafibrate in mixed hyperlipidemia. Because a common genetic deficiency of chitotriosidase modifies serum quitotriosidase activity, this genetic variation was also studied. Seven subjects of 116 (6.03%) were homozygous, and 46 (39.6%) were heterozygous for the defective allele. Mean serum quitotriosidase activity correlated with allele dosage, as it was found to be of 0, 59.8 +/- 52.6 and 81.2 +/- 41.6 nmol/mL/h, in homozygotes for the defective allele, heterozygotes, and homozygotes for the wild-type allele, respectively (P =.0011 for the difference between the last 2 groups). However, this enzyme activity was not found to correlate with lipid levels before and after treatment with either atorvastatin or bezafibrate, and neither with the intensity of the lipid lowering. These results do not support the use of serum chitotriosidase activity as a biologic marker of atherosclerotic plaque modification related to hypolipidemic treatment.

[Gabapentin used in 559 patients with partial seizures. A multicenter observation study. Spanish Gabapentin Work Group]. / Gabapentina asociada en 559 pacientes con epilepsias parciales. Estudio observacional multicéntrico. Grupo Español Colaborativo de Gabapentina.

INTRODUCTION: Gabapentin (GBP) is a new antiepileptic drug whose efficacy and tolerability have been evaluated in clinical trials, although there is little data on its use in everyday clinical practice. OBJECTIVES: To evaluate the characteristics of GBP in an observational study when used in patients with uncontrolled partial seizures. PATIENTS AND METHODS: An open multicentric study in which GBP was used in 559 patients of over 12 years of age with uncontrolled partial crises in whom the efficacy, tolerability and quality of life (QOLIE-10) over a period of 6 months were analysed. RESULTS: The response rate (> 50% reduction in seizures) was 71% with 35.3% seizure-free patients. There were no differences related to age, aetiology, previous frequency of seizures or duration of the epilepsy. In 18.8% there were adverse effects (somnolence, dizziness, headache, blurred vision, diplopia and nausea), which were generally well-tolerated, but in 4.5% of the patients led to the drug being suspended. In the 65 patients in whom quality of life was evaluated there was improvement, both overall and in each aspect studied. CONCLUSION: Under normal conditions of everyday clinical practice, GBP is an effective drug which is well tolerated by adults and adolescents with refractory partial seizures.

Efficacy and Safety of Quinapril 40mg Once Daily as Monotherapy for Patients with Poorly Controlled Hypertension : The EUREKA Study.

OBJECTIVE: We assessed the efficacy and safety of quinapril 40mg once daily for treating essential hypertension in patients with poorly controlled hypertension who were using other angiotensin-converting enzyme (ACE) inhibitors, or in those who needed to take more than one tablet a day of the ACE inhibitor to lower blood pressure, or in those who needed to start antihypertensive therapy with maximum doses of other drugs because of the severity of hypertension. DESIGN: Prospective, observational, noncomparative, open-label. METHODS: A total of 6082 patients of both genders, aged ≥40 years, received a single daily oral dose of quinapril 40mg for a period of 8 weeks. The primary end-point parameter of efficacy was the percentage of patients with adequate control of blood pressure, which was defined as systolic blood pressure (SBP) ≤140mm Hg and diastolic blood pressure (DBP) ≤90mm Hg. For the diabetic group the definition was 130/85mm Hg. Tolerability and safety of antihypertensive drugs was assessed by physical examination and detection of adverse effects potentially related to antihypertensive medication. RESULTS: At the end of the 8-week treatment period with quinapril, adequate control of DBP, SBP and both was found in 90, 56 and 54% of patients, respectively, with a mean difference of 25mm Hg for SBP and of 15mm Hg for DBP as compared with baseline. In hypertensive patients with diabetes mellitus (n = 1269) and in patients previously treated with other ACE inhibitors (n = 2083), quinapril therapy was also associated with statistically significant decreases in mean DBP and SBP (p < 0.0001). A total of 42 adverse events were recorded. No patient failed to complete the study because of adverse events. CONCLUSIONS: Quinapril 40mg significantly lowered blood pressure, achieving adequate control of DBP in up to 90% of patients with moderate essential hypertension previously unsuccessfully controlled.

Randomized crossover study of gemfibrozil versus lovastatin in familial combined hyperlipidemia: additive effects of combination treatment on lipid regulation.

The most appropriate therapy for combined hyperlipidemia remains to be determined. We compared the lipid-regulating effects of gemfibrozil and lovastatin in 30 patients with familial combined hyperlipidemia (FCHL) in a randomized, double-blind, placebo-controlled crossover study including 8-week courses of one drug followed by a washout period and a crossover phase to the alternate drug. After completion of the trial, open-label combination therapy was given for up to 12 months. Lovastatin was more efficacious than gemfibrozil in the reduction of total cholesterol (23% v. 9%, P<.001) and low-density lipoprotein (LDL) cholesterol (28% v. 2%, P<.001), whereas gemfibrozil surpassed lovastatin in the reduction of triglycerides (48% v. 0%, P<.001) and very-low-density lipoprotein (VLDL) cholesterol (50% v. 19%, P = .005) and the increase of high-density lipoprotein (HDL) cholesterol (18% v. 4%, P = .005). Lovastatin caused a greater decline in total apolipoprotein B (apo B) and LDL apo B than gemfibrozil, whereas VLDL apo B decreased only after gemfibrozil therapy. Drug-induced changes in lipoprotein composition indicated that gemfibrozil reduced both the number and size of VLDL particles and lovastatin decreased the number of LDL particles. Combined treatment was safe and had additive effects on lipids, causing significant (P<.001) reductions in total cholesterol (32%), triglycerides (51%), LDL cholesterol (34%), and apo B (26%) and an increase in HDL cholesterol (19%). Target LDL cholesterol levels were achieved only in 11% of patients given gemfibrozil alone and triglycerides decreased to target levels in 22% after lovastatin alone, whereas combined therapy normalized both lipid fractions in 96% of patients. Thus, in FCHL, gemfibrozil has no effect on LDL cholesterol levels but favorably influences the putative atherogenic alterations of lipoprotein composition that are related to hypertriglyceridemia. Conversely, lovastatin markedly decreases LDL cholesterol but has little effect on triglyceride-rich lipoproteins. Combination treatment safely corrects all of the lipid abnormalities in most patients.

Clinical validity and utility of the interview for deterioration of daily living in dementia for Spanish-speaking communities NORMACODEM Group.

The assessment of activities of daily living is a central procedure in the diagnosis of dementia. Few instruments in the field allow for early detection of functional decline because the items they use refer mainly to basic activities of daily living (BADL), which do not become compromised until later in the disease process. The Interview for Deterioration of Daily Living in Dementia (IDDD) may be a valuable tool for early detection of functional decline because it includes, apart from a BADL subscale, another subscale containing a variety of instrumental activities of daily living (LADL), which are the first to be affected in dementing processes. We present an adaptation and validation of the IDDD for Spanish-speaking communities (S-IDDD). A total of 254 control subjects (CONT), 86 patients with mild memory/cognitive impairment with no dementia (CIND), and 111 patients diagnosed with probable dementia of the Alzheimer type (DAT) participated in this project. IDDD total scores (mean and SD) were as follow: CONT: 33.1 (0.4); CIND: 35.2 (3.4); DAT: 54.3 (18.6). The present validation showed no sociodemographic effects on the IDDD total scores. The IDDD demonstrated great internal consistency (alpha = .985) and reproducibility (intraclass correlation coefficient = .94). Correlations were high (r = .81; p < .1) when they took into account the whole sample, but decreased significantly when the groups were separated by pathologic condition. The scale showed significant differences between DAT versus CIND and CONT. The IADL subscale differentiated all three groups, which makes it extremely valuable for early detection of functional decline. The present study shows that the S-IDDD is a reliable adaptation of the original IDDD scale and may be used successfully in Spanish populations for staging and follow-up of subjects with dementia.

[Normalization of cognitive and functional assessment instruments for dementia (NORMACODEM) (I): objectives, content and population]. / Normalización de instrumentos cognitivos y funcionales para la evaluación de la demencia (NORMACODEM) (I): objectivos, contenidos y población.

UNLABELLED: To adequately evaluate patients with 4 neuropsychological deficits a project for norming cognitive and functional instruments that assess dementia (NORMACODEM) was designed. Four hundred fifty-one subjects in three groups: 254 controls, 86 patients with minor memory/cognitive deficits without dementia (DWD) and 111 patients with probable Alzheimer-type dementia (ATD) according to the NINCDS/ADRDA criteria. Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale (ADAS), Abbreviated Barcelona Test (ABT), Global Dementia Staging (GDS), Functional Assessment Staging (FAST), Clinical Dementia Rating (CDR), Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), Interview for Deterioration in Daily life in Dementia (IDDD), Geriatric Evaluation by Relatives Rating Instrument (GERRI), Geriatric Depression Scale (GDS), Zung Self-Rating Anxiety Scale (ZSRAS). Descriptive statistics and analysis of variance. The characteristics of the sample were as follows. CONTROLS: 99 men, 155 women. Mean (SD) age: 64.6 (10.9) years. Mean (SD) educational level: 9.1 (4.9) years. DWD: 42 men, 44 women. Mean (SD) age: 65.8 (8.7) years. Men (SD) educational level: 8.4 (4.4) years. ATD: 48 mean, 63 women. Mean (SD) age: 68.3 (8.0) years. Mean (SD) educational level: 6.2 (4.3) years. The ATD patients were significantly older than the controls. Mean educational level was significantly lower in the ATD group than in the other two.

[Adaptation and normalization of the Alzheimer's disease Assessment Scale for Spain (NORMACODEM) (II)]. / Adaptación y normalización españolas de la Alzheimer's Disease Assessment Scale (ADAS) (NORMACODEM) (y II).

UNLABELLED: This report is part of a project for norming cognitive and functional instruments that assess dementia (NORMACODEM). To adapt and norm the Alzheimer's Disease Assessment Scale (ADAS) for use in Spain. Two hundred fifty-four controls, 86 patients with minor memory/cognitive disorders without dementia (deterioration without dementia, DWD), 111 patients with Alzheimer-type dementia (ATD). Statistical description. Multivariate linear regression. Crossed validation. Internal consistency and test-retest (n = 48). The mean scores (SD) obtained were as follows. CONTROLS: ADAS-Cog = 8.0 (3.4), ADAS-Noncog = 2.9 (2.9), ADAS-Tot = 10.9 (4.6). DWD: ADAS-Cog = 11.37 (5.1), ADAS-Noncog = 4.9 (4.3), ADAS-Tot = 16.2 (7.0). ATD: ADAS-Cog = 31.8 (5.1), ADAS-Noncog = 10.3 (4.3), ADAS-Tot = 42.2 (20.7). Multiple regression analysis revealed that educational level and age were significantly associated with the ADAS-Cog score. The internal consistency of the ADAS-Cog was 0.963. The test-retest procedure yielded linear correlation, coefficients of 0.93 for the ADAS-Cog, 0.86 for the ADAS-Noncog and 0.95 for the ADAS-Tot. Age and educational level/schooling are associated to the earned on the ADAS-Cog instrument. The present Spanish version of the ADAS has high internal consistency and reproducibility. The instruments can be use for assessment in Spanish populations.