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Background: Alzheimer's disease (AD) is the most common cause of cognitive impairment and dementia. The objective of this work is to describe the pharmacological management of AD and the opinion on future pharmacological therapies in Argentina. Method: A cross‐sectional, descriptive study was carried out. An opinion anonymous survey about pharmacological treatments was designed. The survey was distributed electronically by the Argentine Neurology Society (ANS) to physicians who assessment patients with cognitive disorders (CD). Answers of specialists in CD (SCD) and non‐specialists in CD (NSCD) about recommended treatments (RT), non‐recommended treatments (NRT) and off‐label therapies were analyzed. Physicians who would indicate or were hesitant to indicate anti‐monoclonal beta amyloid protein antibodies (MABs) therapy were considered as potential MABs prescribers. A descriptive statistical and frequency assessment were performed. Result: 155 physicians (10,3% of the total to whom the questionnaire was directed) were surveyed. A 19,35% indicated at least one NRT for dementia and 78,06% prescribed at least one off‐label therapy or a NRT for mild cognitive impairment (MCI). A 31% would indicate MABs. For the management of psychotic symptoms, the most selected drug was quetiapine (88.4%) and for apathy, escitalopram (32,3%). One hundred physicians (64,5% of the total) were considered potential MABs indicators. Nevertheless, 42% of them were unaware of the adverse effects of MABs. Also, 70% would request biomarkers for brain beta amyloid in the initial assessment. There were significant differences in the responses of the SCD and the NSCD regarding indicating MABs (52.17% vs. 23.08, p<0.05) and considering knowledge of its adverse effects (76.09% vs. 38.46%, p<0.05). There were no significant differences between SCD and NSCD in the prescription for RT, NRT, and off‐label therapies. Conclusion: In the real life, our study shows that two‐thirds of the respondents would be potential MABs prescribers. At the same time, we identified a high rate of NRTs and off‐label medications indications for patients with CD. These results highlight the need for continuous medical education, particularly in low‐income countries such as Argentina considering the cost of biomarkers and the new therapies like MABs for AD and its impact on public health policies. [ABSTRACT FROM AUTHOR]

Background: Vitamin B12 deficiency is associated with cognitive‐behavioral disorders, which may be potentially reversible. No specific associated cognitive domain has been established and alterations in episodic memory, verbal fluency, attention and executive functions, praxia and visuoconstruction have been described. The objective of this work is to evaluate and describe the cognitive domains affected in patients with cognitive impairment associated with vitamin B12 deficiency. Method: Cross‐sectional observational study conducted at the Trinidad Mitre sanatorium of Buenos Aires City. Patients with cognitive impairment and vitamin B12 deficiency were analyzed. Information was collected on the cognitive domain affected (taking as altered value the Z score ≤‐1.5 according to age and educational level, obtained in the neurocognitive evaluations), cognitive profile, magnetic resonance imaging features and mean consultation‐supplementation time. Result: 25 patients with vitamin B12 deficiency and cognitive complaint were analyzed, with a mean age of 68.5 years. 83% presented multidomain mild cognitive impairment being 60% with subcortical pattern. Memory and attention were the most affected domains in 80% of the sample, followed by executive functions with 52%. The most deficient tests were the direct digit test (68%), serial memory (56%), deferred logical memory (52%) and Trail Making B (52%). Nearly 52% presented mild depressive symptomatology. A 56% of the sample presented with severe B12 deficiency with 32% elevation of plasma homocysteine. Supplementation was performed intramuscularly in 68% of the patients with a mean symptomatology‐supplementation onset time of 10.8 months. 92% of the patients presented subjective improvement after supplementation, 32% had control global test evaluation with improvement in all of them and 50% of this group presented control cognitive evaluation with improvement in previously deficient domains. Conclusion: According to our findings we conclude that these patients with vitamin B12 deficiency present a multidomain pattern with special affectation of memory, attention and executive functions; of mild degree and potentially reversible. The reversibility of the picture could be related to high doses of B12 and early supplementation, using control cognitive assessments as an objective measure of improvement. References Reynolds E. Lancet Neurol. 2006 Nov;5(11):949‐60. Eastley R. Int J Geriatr Psychiatry. 2000 Mar;15(3):226‐33. Robins Wahlin. Biol Psychol. 2001 Jun;56(3):247‐65. [ABSTRACT FROM AUTHOR]

Background: Burnout syndrome (BOS) is frequently described in physicians, being characterized by exhaustion and long‐term loss of interest generally at work. It is associated with lower effectiveness, lower job satisfaction, and a decrease in commitment to work. It's been recently hypothesized that BOS could lead to cognitive impairment (CI), leading to serious consequences for health care professionals. Primary objective: to determine the impact that BOS has on subjective memory (SM) in physicians compared to general population in other occupations (OthOcc). Secondary objective: to compare how BOS is linked to anxiety, depression and SM impact in physicians and OthOcc. Method: We performed an observational multicenter cross‐sectional study using a custom‐made survey (using Maslach Burnout Inventory [MBI], Hospital Anxiety and Depression Scale, and a SM scale of our own elaboration), sent digitally, distributed nationally. Risk of BOS (BOS‐R) was defined when 1‐2/3 MBI subscales were altered and BOS when all 3 were. Statistical analysis was performed with parametric and non‐parametric tests. Result: We obtained 215 responses (111 physicians and 104 OthOcc). The average age of the physicians, was 34.23 years, women were 62.16% (n=69). In physicians, prevalence of BOS‐R was 62.16% (n=69) and of BOS was 20.72% (n=23); 33.33% (n=37) presented anxiety; and 9.91% (n=11), depression. We found a relationship between BOS‐R/BOS and lower SM scores (p=0.011). Physicians had worse SM scores when compared to OthOcc, being the mean for physicians with BOS‐R 11.32 (SD 6.36) and for OthOcc 9.75 (SD 6.54); for physicians with BOS 11.52 (SD 6.56) and for OthOcc 8.23 (SD 4). Physicians with BOS‐R/BOS presented anxiety (p<0.001) and depression (p=0.001), OthOcc also presented anxiety (p=0.019) and depression (p=0.001). Conclusion: The impact of BOS in physicians is alarming, and is associated with cognitive impairment and anxiety/depression. It has serious personal consequences, negatively affecting health care quality. We believe physicians are suffering what has been coined as 'moral injury', something beyond BOS, that is also affecting our health care system and our patients. [ABSTRACT FROM AUTHOR]