Diagnostic criteria in dementing illness. What's new? / Criterios diagnósticos en la enfermedad demencial ¿Qué hay de nuevo?

The spectrum of neurodegenerative diseases that primarily affect cognition and behaviorspreads from asymptomatic preclinical disease to very mild cognitive impairment to frank dementia. Alzheimer's disease (AD) is the most common cause of a decline in cognitive ability. Also, it is a devastating condition that affects patients and their entirefamilies of caregivers, exacting tremendous financial hardships. Diagnosis may be complicated by other forms of dementia that have symptoms and pathologies similar to AD. Knowing the key features and pathology of each type of dementia can help in the accurate diagnosis of patients, so they will receive the treatment and support services appropriate for their condition and maintain the highest possible functioning in daily life and quality of life. Differentiate, based on clinical criteria, neuropathology, and biomarkers, AD and its atypical variants from other common dementias including Dementia with Lewy Bodies, Vascular Cognitive Impairment, Frontotemporal Degeneration, and less frequent cognitive disorders. The importance of getting an accurate and early diagnosis of dementiais now increasingly significant to make important decisions about treatment, support, and care. Nonpharmacological as well as pharmacological interventions should be initiated once the diagnosis is obtained. Biochemical markers to identify Alzheimer's disease play a central role in the new diagnostic criteria for the disease and in the recent biological definition of AD. This review article presents up-to-date data regarding the recent diagnostic criteria of Alzheimer´s disease and related disorders, emphasizing its usefulness in routine clinical practice.

El espectro de enfermedades neurodegenerativas que afectan principalmente a la cognición y el comportamiento abarca desde la enfermedad preclínica asintomática hasta el deterioro cognitivo muy leve y la demencia franca. La enfermedad de Alzheimer (EA) es la causa más común de deterioro de la capacidad cognitiva. Es una enfermedad devastadora que afecta a los pacientes y a toda su familia de cuidadores, lo que supone enormes dificultades socioeconómicas y psicoemocionales. El diagnóstico puede complicarse debido a otras formas de demencia que presentan síntomas y patologías similares a la EA. Los marcadores bioquímicos para identificar la enfermedad de Alzheimer desempeñan un papel central en los nuevos criterios diagnósticos de la enfermedad y en la reciente definición biológica de la EA. Conocer las características claves y la patología de cada tipo de demencia puede ayudar en el diagnóstico preciso de los pacientes, a fin de que reciban el tratamiento y los servicios de apoyo adecuados a su condición y mantengan el mayor funcionamiento posible en la vida diaria y la calidad de vida. Por lo tanto es prioritario diferenciar, basándose en criterios clínicos, neuropatología y biomarcadores, la EA y sus variantes atípicas de otras demencias comunes como el Deterioro Cognitivo Vascular, la Degeneración Fronto- temporal entre otras, y los trastornos cognitivos menos frecuentes. Este artículo de revisión presenta datos actualizados relativos a los recientes criterios diagnósticos de algunas formas de demencia haciendo hincapié en su utilidad en la práctica clínica habitual. Se exponen los criterios de EA, de Demencia Vascular (DV), de la demencia Fronto-temporal (DFT) y de una forma rara de demencia, descripta en los últimos años, que se evidencia en pacientes muy añosos con un perfil similar a la EA. Se trata de la encefalopatía predominantemente límbica por tdp- 43 relacionada a la edad (LATE).

Delivering the diagnosis of Alzheimer's disease: bioethical considerations / Comunicación del diagnóstico de enfermedad de Alzheimer: reflexiones bioéticas.

Delivering the diagnosis of Alzheimer's disease to the patient can cause situations that do not meet the necessary ethical professional standards. We present two cases in which the rash way such a diagnosis was delivered did not respect the principle of nonmaleficence. In both cases the revelation worsened the situation prior to the consultation, causing unfortunate distress to the patient and family. The blunt use of the term "Alzheimer", together with the insufficient information on the characteristics of the affection, seems to have been the main factor that produced a negative emotional impact, revealing an arrogant professional attitude of 'absolute' and unquestionable knowledge, without the necessary equity. A diagnosis of Alzheimer´s should be not only truthful but delivered with caution, above all things avoiding a further damage than that already brought about by the disease.

Al comunicar al paciente el diagnóstico de enfermedad de Alzheimer, pueden originarse situaciones no acordes con la necesaria conducta ética profesional. Presentamos dos casos en los que, al actuarse con imprudencia, no se respetó el requisito de no maleficencia, En ambos casos la revelación diagnóstica empeoró la situación previa a la consulta, provocando en el paciente y su familia decisiones y consecuencias desafortunadas. El uso abrupto y cortante del término "Alzheimer", junto a la información insuficiente sobre las características de la afección, parece haber sido el factor principal de un impacto emotivo negativo, mostrando una actitud profesional dueña de un saber "absoluto" e inapelable, en un vínculo sin equidad. El acto de comunicar un diagnóstico debe ajustarse al criterio de prudencia, y no solamente al de veracidad o exactitud, evitando por sobre todas las cosas provocar un daño mayor al ya causado por la enfermedad.

[Cognitive profile in hypertensive patients. Usefulness of the Clock Drawing Test]. / Perfiles cognitivos en pacientes hipertensos. Utilidad del test del reloj.

INTRODUCTION: Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. METHODS: We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. RESULTS: The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. CONCLUSION: The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.

[Longitudinal follow-up of a population with cognitive complaint: characteristics and progression profile]. / Seguimiento longitudinal de pacientes con queja cognitiva: características y perfiles de progresión.

Cognitive complaint is a common cause of consultation among older adults at the primary care level and it may be the first symptom of cognitive impairment, thus its assessment and follow-up are essential for an early diagnosis. AIM: to describe the baseline neurocognitive profile and evolution of patients with cognitive complaint evaluated at the geriatric assessment unit of the Hospital Italiano de Buenos Aires. METHODS: observational study of a retrospective cohort of 518 patients with cognitive complaint who underwent a comprehensive geriatric evaluation and cognitive impairment screening tests at the first visit and follow-up visits. Patients diagnosed with dementia at baseline were excluded. RESULTS: 323 (62.36%) subjects were diagnosed with mild cognitive impairment at the first visit and 195 (37.64%) had no cognitive impairment. Of the all the patients, 216 (41.7%) subjects showed worsening of their baseline cognitive status. They had an older age at baseline evaluation, a lower educational level and a worse outcome at Mini Mental State Examination and at memory, executive and language tests than those who remained stable. CONCLUSION: in this follow-up study of a cohort with cognitive complaint we verify the impact of age, educational level and poor outcomes on memory, executive function and language domains as variables associated with progression of cognitive impairment.

[Cognitive impairment during the COVID-19- social isolation period]. / Restricción cognitiva durante la cuarentena por COVID-19.

The COVID-19 social isolation period entailed changes in daily habits and routines, testing the adjustment abilities of the population to address unusual situations. Given that the activities of daily living require a normally functioning cognitive system, the study of cognitive-functional interaction under social isolation is relevant. The object of this work was to obtain information on the cognitive-functional impact of social isolation, analyze the changes induced in daily routines and habits, and assess the cognitive adjustment of the adult population to the isolation requirements. We carried out an online adult population survey, that combined multiple choice or binary questions following a Likert ordinal scale, performing a percentage analysis as well as a principal component analysis of the results. We surveyed 1095 subjects, 68% of which were residents of the Buenos Aires Metropolitan Area (AMBA), of an average age of 52.7 ± 12.8 years, and 15.6 ± 2.2 years of education. All age groups reported attention and memory impairment, more significant in lower age groups and women. The principal component analysis showed an associated correlation of the functional challenge brought about by social isolation on the executive system, with the negative impact on cognitive functions such as attention and memory. Social isolation significantly impacted on the attentional, mnesic and executive cognitive systems, ratifying the role of cognitive abilities in the generation of means and strategies to overcome unusual situations, and highlighting the importance of cognitive-functional interaction.

El período de aislamiento social por COVID-19 generó cambios en los hábitos y rutinas, poniendo a prueba capacidades adaptativas para resolver situaciones infrecuentes. Dado que el sistema cognitivo es el sustrato de las actividades funcionales cotidianas, nuestro objetivo fue conocer el impacto cognitivofuncional del aislamiento, obtener información acerca de los cambios de hábitos y rutinas diarias y evaluar la modalidad de adaptación de la población adulta a la cuarentena. En el marco del Instituto de Salud Pública y Medicina Preventiva de la UBA, realizamos una encuesta online donde se incluyeron preguntas con respuesta de elección según escala ordinal Likert, de tipo binario y de elección múltiple. Se realizó un análisis porcentual de los resultados y un análisis de componentes principales. Encuestamos 1095 sujetos, el 68% fueron residentes en el Área metropolitana de Buenos Aires, edad 52.7 ± 12.8 años y 15.6 ± 2.2 años de instrucción. Todos los grupos de edad refirieron empeoramiento de la atención y memoria, siendo más significativo en las franjas de menor edad y en el género femenino. El análisis de componentes principales mostró una correlación asociada al efecto negativo de factores cognitivos previos como la memoria y la atención con la dificultad durante la cuarentena en el dominio ejecutivo. El aislamiento social impactó en el sistema atencional, mnésico y de funciones ejecutivas. Resultó corroborado el importante rol de las capacidades cognitivas en la generación de recursos y la aplicación de estrategias para adaptarse a situaciones poco habituales, poniendo de manifiesto la interacción cognitivo-funcional.

Restricción cognitiva durante la cuarentena por COVID-19 / Cognitive impairment during the COVID-19- social isolation period

Resumen El período de aislamiento social por COVID-19 generó cambios en los hábitos y rutinas, poniendo a prueba capacidades adaptativas para resolver situaciones infrecuentes. Dado que el sistema cog nitivo es el sustrato de las actividades funcionales cotidianas, nuestro objetivo fue conocer el impacto cognitivo-funcional del aislamiento, obtener información acerca de los cambios de hábitos y rutinas diarias y evaluar la modalidad de adaptación de la población adulta a la cuarentena. En el marco del Instituto de Salud Pública y Medicina Preventiva de la UBA, realizamos una encuesta online donde se incluyeron preguntas con respuesta de elección según escala ordinal Likert, de tipo binario y de elección múltiple. Se realizó un análisis porcentual de los resultados y un análisis de componentes principales. Encuestamos 1095 sujetos, el 68% fueron residentes en el Área metropolitana de Buenos Aires, edad 52.7 ± 12.8 años y 15.6 ± 2.2 años de instrucción. Todos los grupos de edad refirieron empeoramiento de la atención y memoria, siendo más significativo en las franjas de menor edad y en el género femenino. El análisis de componentes principales mostró una correlación asociada al efecto negativo de factores cognitivos previos como la memoria y la atención con la dificultad durante la cua rentena en el dominio ejecutivo. El aislamiento social impactó en el sistema atencional, mnésico y de funciones ejecutivas. Resultó corroborado el importante rol de las capacidades cognitivas en la generación de recursos y la aplicación de estrategias para adaptarse a situaciones poco habituales, poniendo de manifiesto la interacción cognitivo-funcional.

Abstract The COVID-19 social isolation period entailed changes in daily habits and routines, testing the adjustment abilities of the popula tion to address unusual situations. Given that the activities of daily living require a normally functioning cognitive system, the study of cognitive-functional interaction under social isolation is relevant. The object of this work was to obtain information on the cognitive-functional impact of social isolation, analyze the changes induced in daily routines and habits, and assess the cognitive adjustment of the adult population to the isolation requirements. We carried out an online adult population survey, that combined multiple choice or binary questions following a Likert ordinal scale, performing a percentage analysis as well as a principal component analysis of the results. We surveyed 1095 subjects, 68% of which were residents of the Buenos Aires Metropolitan Area (AMBA), of an average age of 52.7 ± 12.8 years, and 15.6 ± 2.2 years of education. All age groups reported attention and memory impairment, more significant in lower age groups and women. The principal component analysis showed an associated correlation of the functional challenge brought about by social isolation on the executive system, with the negative impact on cognitive functions such as attention and memory. Social isolation significantly impacted on the attentional, mnesic and executive cognitive systems, ratifying the role of cognitive abilities in the generation of means and strategies to overcome unusual situations, and highlighting the importance of cognitive-functional interaction.

[Study of the performance of complex activities of daily living in a population of patients with mild cognitive impairment. Mild functional impairment: A new clinical entity?] / Estudio del desempeño de las actividades complejas de la vida diaria en una población de pacientes con Deterioro Cognitivo Leve. Deterioro Funcional Leve: ¿una nueva entidad clínica?

Several papers describe functional changes in the aging population, and its relevance in the early cognitive impairment detection. Alterations in instrumental activities would constitute a diagnostic marker of MCI and predict the progression to Dementia. In order to count on a tool to evaluate the performance in the use of new technologies we have designed a new protocol, Complex Functional Study (CFS), that quantifies performance and functional changes Related to previous states. OBJECTIVES: To compare CFS scores in patients with MCI with a control group without cognitive impairment (CD) and verify their diagnostic performance to detect complex function alterations in reference too the functional scales, Instrumental Activities of Daily Living (AVDI) and Disability Assessment for Dementia (DAD). METHODS: Patients with MCI and controls were included. All subjects were evaluated with a neurocognitive battery, and functional scales (EFE).STATA software version 14.2 was used for data analysis. RESULTS: 269 recruited patients older than 65 years old, 173 with diagnosis of MCI and 96 controls. The MCI patients obtained significantly higher EFE scores tan subjects without DC (p < 0,001).The EFE presented a greater sensitivity to detect the functional alteration (EFE 81.5%, AVDI 25.9%, DAD 18.5%). CONCLUSIONS: The EFE is an instrument of optimal clinical value, with good sensitivity to identify the alteration of the complex activities of daily life in patients with MCI. The results allow to characterize a profile compatible with Light Functional Impairment.

[New predictors in prodromal Alzheimer: Deferred phase in word recall of MIS test]. / Nuevos predictores en Alzheimer prodrómico: fase diferida en el test MIS de recuerdo de palabras.

BACKGROUND: The Memory Impairment Screen (MIS-A) is a validated test to detect Alzheimer's Disease (AD) and other dementias. We have modified this test to suit a Spanish speaking population and added a new component, delayed recall (MIS-D). OBJECTIVES: 1) To test a Spanish version of MIS-A and MIS-D. 2) To assess the discriminative validity of MIS-D as a screening tool for the amnestic variant of Mild Cognitive Impairment (aMCI). METHODS: A case-control study of a cohort of 739 aged 65 years old and over, of whom 436 were healthy controls and 303 had a diagnosis of aMCI. The MCI group was patients from the Geriatric Unit for the Elderly at the Italian Hospital of Buenos Aires staffed by geriatricians. MEASUREMENTS: ANOVA test and test t de Student mean comparison. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) were estimated for MIS-D and MIS-A. RESULTS: Normative values for MIS-A and MIS-D were obtained from the control population. Both age and education significantly affected these values (p<0.0001). The cut-off for MIS-A should be 7.5 and for MIS-D, 5.5. Comparison between control population and aMCI population using ROC curve gave a result of 5.5 in MIS-D, with 97% specificity and 76% sensitivity. CONCLUSION: MIS-D was positively predictive of Amci. An extension of the sample in other health care contexts would enable us to verify its clinical validity for other populations.