Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias / Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks

INTRODUCCIÓN: El deterioro cognitivo es una entidad clínica en la que las funciones intelectuales están parcial o totalmente alteradas y supone un problema de salud pública y un reto para los servicios sanitarios y sociales. El objetivo de este trabajo es estimar la prevalencia de estos trastornos en la población mayor de 65 años que consulta en atención primaria en 5 redes centinelas sanitarias. MÉTODO: Se realizó el test Mini-Cog de cribado de deterioro cognitivo en una muestra de pacientes que acudieron a su médico de familia en 4 días seleccionados al azar. La confirmación se hizo con el test Mini-Mental y el Alzheimer's Questionnaire. Se estimaron tasas brutas y ajustadas por las variables demográficas y sociales. RESULTADOS: Se estudiaron 4.624 pacientes, que representan a una población de 1.723.216 personas de 5 comunidades autónomas. La prevalencia ajustada para el conjunto de la población estudiada fue del 18,5% (IC 95% 17,3-19,7), con diferencias entre las redes centinelas. Las mujeres presentan tasas ajustadas significativamente más elevadas que los hombres: 18,5 y 14,3%, respectivamente. La prevalencia por grupo de edad alcanza el 45,3% por encima de los 85 años y presenta diferencias por nivel de estudios alcanzado y tipo de convivencia. CONCLUSIONES: El deterioro cognitivo es un motivo de consulta frecuente en atención primaria. Es mayor en mujeres y aumenta exponencialmente con la edad. Tanto la sospecha como la confirmación del deterioro cognitivo pueden realizarse por el médico de familia con instrumentos sensibles y validados, lo que permite iniciar un tratamiento precoz

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7), with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients

Prevalence of cognitive impairment in Spain: The Gómez de Caso study in health sentinel networks. / Prevalencia de deterioro cognitivo en España. Estudio Gómez de Caso en redes centinelas sanitarias.

INTRODUCTION: Cognitive impairment, a clinical entity causing complete or partial intellectual dysfunction, is a major public health concern that poses a challenge for health and social services. The purpose of this study is to estimate the prevalence of this disorder in people aged 65 and older visiting the primary care physician in 5 health sentinel networks. METHOD: A sample of patients visiting their primary care doctor on 4 randomly selected days completed the Mini-Cog screening test. Diagnosis of cognitive impairment was confirmed with the Mini-Mental State Examination and the Alzheimer's Questionnaire. We estimated raw and adjusted rates using demographic and social variables. RESULTS: We included 4,624 patients from 5 autonomous communities and representing a population of 1,723,216 inhabitants. The adjusted prevalence rate was 18.5% (95% CI 17.3-19.7], with differences between sentinel networks. Women showed higher adjusted rates than men: 18.5 vs. 14.3%. The highest prevalence rate was observed in people aged 85 and older (45.3%); prevalence rates vary depending on education level and marital status. CONCLUSIONS: Cognitive impairment is a frequent reason for consultations in primary care. Its prevalence is higher in women and increases exponentially with age. A number of sensitive, validated tools have been proven useful in screening for and confirming cognitive impairment. Using these tools in primary care settings enables early treatment of these patients.

Los consultorios de Nador y Zoco El Had en 1912-1913. Los inicios de la labor sanitaria española en esta zona de Marruecos / The Health Assistance Offices of Nador and Zoco El Had en 1912-1913. The beginning of the Spanish health labour in this zone of Morocco

Se describe, a través de los médicos que iniciaron las tareas asistenciales en los Consultorios/Dispensarios Indígenas de Nador y Zoco el Had durante los primeros años del Protectorado Español en Marruecos (1912-1913), la importante labor que realizaron en medio del profundo atraso e ignorancia médico-sanitaria de sus habitantes. Con el fin de elucidar cómo pudieron ser las tareas asistenciales, en qué circunstancias desarrollaron su trabajo, cómo era la Sanidad de la época, a qué tipo de enfermedades se enfrentaron, es por lo que he tomado como muestra de este trabajo a dichos Consultorios. Dicha labor, que calificaría como heroica, nos ayuda a comprender mejor la época, las bases del posterior desarrollo sanitario de la zona e incluso de las actuales misiones sanitarias españolas por todo el mundo. Eran médicos sin un renombre especial que les hiciese merecedores de portadas en las grandes revistas médicas. Sin embargo, fueron capaces de comenzar a colocar las primeras piedras del desarrollo sanitario de esta zona. Unas breves pinceladas nos ayudan a ubicarnos en el contexto histórico de la época, para pasar a exponer a continuación las vivencias personales y profesionales de estos médicos en Marruecos (Jóvenes médicos militares que afrontaron aquí sus primeros destinos, ilusiones, trabajos, penalidades y que nos legaron una memoria escrita de todo aquello). Posiblemente fue el espíritu que los animaba, al igual que el de otras gestas de nuestra historia, lo que hizo posible que casi 100 años después el panorama que nos describían haya cambiado. En algo contribuyeron (AU)

It is shown, through the doctors initiating assistance duties in the natives clinics/outpatients’ of Nador and Zoco El Had during the first years of the Spanish Protectorate at Morocco (1912-1913), the notorious labour within the deep backwardness and health-medical ignorance of their inhabitants. Trying to elucidate how the assistance tasks could be, as the circumstances in which their jobs were done, how was the health assistance of this time, the diseases they had to deal with, is why I selected this health facilities up noted, as the sample for my revision. This labour that I could qualify as heroic, help us for a better understanding of the age studied, the basis for later sanitary development of the zone, and so the Spanish recent sanitary missions around the world. They were not famous doctors, without covers of great medical magazines. However the were able to put the «first stones» for «building» the sanitary development of the zone. Some brief sequences help us to understand the atmosphere of the historical context of the time, carrying on with the personal and professional experiences of these doctors in Morocco (young military doctors that faced up here their first postings, hopes, jobs, undergoes and that they handed down to us like a written memory of all those experiences). Perhaps the spirit that encouraged them, like other feats of our history, made possible that close to 100 years later the outlook they described has changed. Some contribution for it is due to them (AU)