RESUMO
Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.
RESUMO
OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.
Assuntos
Doenças do Sistema Nervoso Central , Comunicação Interdisciplinar , Neurologia , Psiquiatria , Adulto , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Objetivo: Las enfermedades cerebrales condicionan con frecuencia alteraciones mentales y conductuales. Para analizar el área de interfase entre la neurología y la psiquiatría, analizamos todas las interconsultas neuropsiquiátricas realizadas en los servicios de Neurología, Neurocirugía, Terapia Intensiva Neurológica y Urgencias Neurológicas, en el Instituto Nacional de Neurología y Neurocirugía de México (2007-2009). Resultados: En 506 casos, la edad promedio fue 44.24 años (DE 17 años); 240 fueron mujeres (47.4 %). Las patologías neurológicas que generaron más interconsultas fueron neoplasias del sistema nervioso central (14.2 %), encefalitis viral (8.7 %), enfermedad vascular cerebral isquémica (7.1 %), epilepsia (6.5 %) y enfermedad vascular cerebral hemorrágica (4.7 %). Los trastornos mentales más frecuentes (de acuerdo con el DSM-IV) fueron delirium (38.5 %), trastorno depresivo (15 %), demencia (7.7 %), deterioro cognoscitivo, sin criterios de demencia (6.5 %), trastorno de ansiedad (6.9 %). El delirium fue la condición neuropsiquiátrica más frecuente independientemente de las categorías etiológicas. En las infecciones cerebrales hubo mayor frecuencia del síndrome catatónico (p < 0.001). En pacientes con enfermedad vascular cerebral se manifiesta más frecuentemente la risa y el llanto patológico (p = 0.012). Conclusiones: Este estudio muestra la relevancia clínica del delirium, la depresión, la ansiedad, la demencia, los síndromes frontales y la catatonia en pacientes hospitalizados con enfermedades neurológicas y psiquiátricas.
OBJECTIVE: Brain pathologies are frequent sources of mental and behavioral disorders. In order to analyze the boundary between neurology and psychiatry, we analyzed all neuropsychiatric consultations seen at the inpatient Neurology, Neurosurgery, Critical Medicine and Neurological Emergencies clinics of the National Institute of Neurology and Neurosurgery of Mexico between 2007 and 2009. RESULTS: A total of 506 neuropsychiatric visits were included, patient mean age was 44.2 years (SD 17 years) 240 patients were female (47.4%). The main neurological disorders for which patients sought medical care at the neuropsychiatry service, were: brain tumors (14.2%), viral encephalitis (8.7%), ischaemic cerebrovascular disorders (7.1%), epilepsy (6.5%) and haemorragic cerebrovascular disorders (4.7%). The most common DSM-IV psychiatric diagnoses included: delirium (38.5%), depressive disorders (15%), dementia (7.7%), cognitive decline, without fulfilling criteria for dementia (6.5%), and anxiety disorders (6.9%). Delirium was the most common neuropsychiatric condition among the etiological groups. Catatonic syndrome was more frequent among patients with brain infections (p < 0.001), and pathological laughter and crying were more frequent among atients with cerebrovascular disorders (p = 0.012). CONCLUSIONS: Our study highlights the clinical relevance of delirium, depression, anxiety, dementia, frontal syndromes and catatonia among neurologic and neurosurgical in-patients attending a tertiary care reference center in Mexico.
