[Paradoxical lucidity and personal identity in patients with advanced dementia: change of paradigm?] / Lucidez paradójica e identidad personal en pacientes con demencia avanzada: ¿cambio de paradigma?

In this article we approach the concept of paradoxical lucidity (LP) (an unexpected, spontaneous, significant and relevant episode of communication or connection) in persons with advanced dementia. The existence of LP could change the paradigm of dementia as a degenerative, chronic, progressive and irreversible disease (where neuronal death plays the leading role), towards a model where functional deficits of neuronal networks acquire importance, which raises new potentially reversible therapeutic and rehabilitative possibilities. We analyze the ethical consequences that these episodes may have with respect to the implicated persons (patients, caregivers and professionals in charge of their care) and try to answer the following question: Do persons with advanced dementia continue to maintain their personal identity despite suffering cognitive impairment so severe?. The LP indicates that this is possible. In this work we make a transversal outline of the different concepts and theories of personal identity in these patients, from different areas of knowledge (philosophy, psychology, neuroscience).

The Genetic Research in Alzheimer Disease (GERALD) Initiative Finds rs9320913 as a Neural eQTL of lincRNA AL589740.1.

Alzheimer's disease is the most common cause of dementia worldwide, and longitudinal studies are crucial to find the factors affecting disease development. Here, we describe a novel initiative from southern Spain designed to contribute in the identification of the genetic component of the cognitive decline of Alzheimer's disease patients. The germline variant rs9320913 is a C>A substitution mapping within a gene desert. Although it has been previously associated to a higher educational achievement and increased fluid intelligence, its role on Alzheimer's disease risk and progression remains elusive. A total of 407 subjects were included in the study, comprising 153 Alzheimer disease patients and 254 healthy controls. We have explored the rs9320913 contribution to both Alzheimer disease risk and progression according to the Mini-Mental State Exams. We found that rs9320913 maps within a central nervous system lincRNA AL589740.1. eQTL results show that rs9320913 correlated with the brain-frontal cortex (beta = -0.15, p value = 0.057) and brain-spinal cord (beta of -0.23, p value = 0.037). We did not find rs9320913 to be associated to AD risk, although AA patients seemed to exhibit a less pronounced Mini-Mental State Exam score decline.

Demencia en las personas mayores: complejidad, envejecimiento y fragilidad. Síndrome geriátrico / Dementia in the elderly: complexity, ageing and frailty. Geriatric syndrome

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Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen / Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin

Objetivos: Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP). Diseño: Estudio transversal en una muestra de conveniencia. Emplazamiento: Seis centros de AP en España. Participantes: Los criterios de inclusión fueron: pacientes entre 16 y 65años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes. Intervención: Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión. Mediciones principales: Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI. Resultados: Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada. Conclusiones: Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP (AU)

Objectives: To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). Design: Cross-sectional study in a convenience sample.Location: Six PC centers in Spain. Participants: The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. Intervention: HIV serology was offered to all patients who met the inclusion criteria. Main measurements: Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. Results: A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. Conclusions: Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC (AU)

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]. / Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen.

OBJECTIVES: To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). DESIGN: Cross-sectional study in a convenience sample. LOCATION: Six PC centers in Spain. PARTICIPANTS: The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. INTERVENTION: HIV serology was offered to all patients who met the inclusion criteria. MAIN MEASUREMENTS: Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. RESULTS: A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. CONCLUSIONS: Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC.

Vivir positivamente con demencia ¿y si ampliamos la mirada? / Living positively with dementia is it possible to widen the horizon?

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Actitudes, dudas y conocimientos de los colectivos implicados en la atención del paciente con Alzheimer: resultados de la encuesta del proyecto kNOW Alzheimer / Attitudes, uncertainties and knowledge among the different parties involved in alzheimer’s patients care: findings from the kNOW Alzheimer project survey study

Introducción: La enfermedad de Alzheimer (EA) involucra a colectivos diversos de profesionales y cuidadores. Las actitudes y necesidades de formación en diagnóstico temprano, tratamiento, síntomas conductuales, recursos sociosanitarios y aspectos legales o éticos son desconocidas. Métodos: Estudio observacional transversal tipo encuesta dentro del proyecto kNOW Alzheimer, iniciativa de la SEN, SEGG, SEMERGEN, SEFAC y CEAFA mediante cuestionarios específicos. Cada sociedad invitó a todos sus miembros a cumplimentarlos a través de www.knowalzheimer.com. Resultados: Participaron 114 neurólogos, 113 geriatras, 275 médicos de atención primaria, 328 farmacéuticos y 858 cuidadores. Los retrasos en el diagnóstico se originan en pacientes y cuidadores, el sistema y en los profesionales, que carecen de medios o malinterpretan síntomas tempranos. Persiste el uso del término 'demencia senil'. Profesionales y cuidadores perciben buena eficacia del tratamiento. Se apuesta por el diagnóstico y tratamiento en fase pre-demencia. Hay déficit de formación en el manejo de la conducta. Los profesionales afirman que informan pero los cuidadores se sienten desinformados. Los cuidadores desean conocer cuanto antes si ellos o un familiar padecen Alzheimer. Los síntomas conductuales y la necesidad de restringir actividades son fuentes de sobrecarga. Los farmacéuticos pueden contribuir a la detección y manejo, pero precisan de formación amplia. Hay necesidad de formación en aspectos legales, bioéticos, recursos y acceso a la investigación. Conclusiones: Este proyecto ha permitido obtener información sobre actitudes y dudas de los colectivos involucrados en la atención a la EA, necesidades de formación y puntos de mejora (AU)

Background: Alzheimer’s disease (AD) involves different groups of professionals and caregivers. Their attitudes and needs of training in early diagnosis, treatment, behavioral symptoms, resources, social and legal or ethical aspects are unknown. Methods: Survey study within the project 'kNOW Alzheimer', a SEN, SEGG, SEMERGEN SEFAC and CEAFA initiative, through specific questionnaires. Each Society invited all its members to complete them through www.knowalzheimer.com. Results: Participants were 114 neurologists, geriatricians 113, 275 primary care physicians, 328 pharmacists and 858 caregivers. Delays in diagnosis arise in patients and caregivers, the system and the professionals, who lack the means or misinterpreted early symptoms. The term 'senile dementia' is still in use. Professionals and caregivers perceived good efficacy of treatment. Professionals advocate for diagnosis and treatment in the pre-dementia stage. There is a need for training in behavior management. Practitioners claim they inform but caregivers feel uninformed. Caregivers want to know as soon as possible if they or a family member suffers from AD. Behavioral symptoms and the need to restrict activities are sources of overload. Pharmacists can contribute to detection and management, but require extensive training. There is a need for training on legal aspects, bioethics, resources and access to research. Conclusions: This project has yielded information on attitudes and doubts of the collectives involved in AD care, their training needs and points of improvement (AU)

Demencia de inicio en edades avanzadas: aspectos clínicos y fisiopatológicos diferenciales / Late onset dementia: specific clinical and pathophysiological features

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Dolor y síntomas no expresados: la otra demencia / Pain and unexpressed symptoms: The other dementia

Los pacientes con demencia en estadio avanzado presentan una gran vulnerabilidad biológica, social y personal. Sus cuidados representan un importante reto, tanto por sus aspectos cuantitativos como cualitativos (necesidad de abordajes específicos y adaptados). El deterioro severo del lenguaje, la pérdida de la movilidad y las alteraciones de la alimentación y de la nutrición (en los pacientes con gran deterioro cognitivo y funcional) caracterizan las fases avanzadas de la demencia. Los problemas de reconocimiento y de expresión verbal de las propias sensaciones que presentan estos pacientes condicionan la sintomatología y dificultan el abordaje diagnóstico y terapéutico. A lo largo del artículo se repasan, someramente, las características y las peculiaridades clínicas de síntomas y síndromes frecuentes en estos pacientes (dolor, agitación, delirium y epilepsia), y se enfatizan los principios generales sobre los que asientan los planes de prevención e intervención (AU)

Patients with advanced dementia are biologically, socially and personally highly vulnerable. The care of these patients is a challenge in terms of both the quantity of care required and qualitative aspects (the need for specific and adapted approaches). The advanced phases of dementia are characterized by severe speech impairment, loss of mobility, and feeding and nutritional alterations (in patients with severe cognitive and functional impairment). Problems of recognition and verbal expression of sensations hampers the diagnostic and therapeutic approach. This article briefly reviews the clinical characteristics of the symptoms and syndromes prevalent in these patients (pain, neuropsychiatric symptoms, delirium, epilepsy) and emphasizes the general principles for prevention and therapeutic approaches (AU)

[Pain and unexpressed symptoms: the other dementia]. / Dolor y síntomas no expresados: la otra demencia.

Patients with advanced dementia are biologically, socially and personally highly vulnerable. The care of these patients is a challenge in terms of both the quantity of care required and qualitative aspects (the need for specific and adapted approaches). The advanced phases of dementia are characterized by severe speech impairment, loss of mobility, and feeding and nutritional alterations (in patients with severe cognitive and functional impairment). Problems of recognition and verbal expression of sensations hampers the diagnostic and therapeutic approach. This article briefly reviews the clinical characteristics of the symptoms and syndromes prevalent in these patients (pain, neuropsychiatric symptoms, delirium, epilepsy) and emphasizes the general principles for prevention and therapeutic approaches.

Delirium y demencia / Delirium and dementia

Delirium y demencia son síndromes neurocognitivos de alta prevalencia en el anciano. Son definidos por criterios clínicos de consenso y se diferencian por la afectación o no de la conciencia, el perfil temporal, la potencial de reversibilidad, etc. En las personas mayores, ambos cuadros coinciden con frecuencia en un mismo paciente y comparten aspectos clínicos, epidemiológicos, patogénicos, etc., que son repasados en este artículo. No disponemos de evidencias científicas sólidas que expliquen las relaciones entre ambos síndromes. Se aboga por un cambio de paradigma en la aproximación diagnóstica, preventiva y terapéutica al delirium en el anciano que recoja la complejidad inherente a este síndrome geriátrico y, lejos de posturas dicotómicas, explore las interrelaciones entre delirium y demencia. El delirium se postula como un modelo de investigación importante en el entendimiento de los trastornos cognitivos y las demencias (AU)

Delirium and dementia are highly prevalent neurocognitive syndromes in the elderly. These syndromes are defined by level of consciousness, clinical onset, and potential reversibility, etc. Frequently, both syndromes coincide in the elderly patient and share many epidemiologic, pathogenic and clinical features, which are reviewed in this article. There is no solid scientific evidence that explains the association between delirium and dementia. The present article proposes a change of paradigm in the diagnostic, preventive and therapeutic approach to delirium in the elderly that recognizes the inherent complexity of this geriatric syndrome and, unlike dichotomic models, explores the complex interrelations between both geriatric syndromes. Delirium is viewed as an important model to investigate cognitive disorders and dementia (AU)

[Delirium and dementia]. / Delirium y demencia.

Delirium and dementia are highly prevalent neurocognitive syndromes in the elderly. These syndromes are defined by level of consciousness, clinical onset, and potential reversibility, etc. Frequently, both syndromes coincide in the elderly patient and share many epidemiologic, pathogenic and clinical features, which are reviewed in this article. There is no solid scientific evidence that explains the association between delirium and dementia. The present article proposes a change of paradigm in the diagnostic, preventive and therapeutic approach to delirium in the elderly that recognizes the inherent complexity of this geriatric syndrome and, unlike dichotomic models, explores the complex interrelations between both geriatric syndromes. Delirium is viewed as an important model to investigate cognitive disorders and dementia.