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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]

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Background and Objectives: In Argentina, government has established lockdown on 19 March 2020 to decrease SARS‐COV‐2 infection. The study aim was to understand how mandatory quarantine imposed due to COVID‐19 pandemic has affected quality of life, mood, and cognitive performance of older adults with cognitive impairment. Design: Longitudinal descriptive–observational study. Participants: Patients with cognitive impairment attending to online cognitive training sessions. Measurements: Participants have completed by themselves Quality of Life in Alzheimer's Disease scale (QOL‐AD), Beck Depression Inventory (BDI‐II), Test your Memory (TYM), and an attention and executive task created by our institution. Same assessments were done at the beginning of the lockdown and 7 months later. Results: Fifty‐one adults were included. An increase in BDI‐II score (p = 0.049) and worse performance in one of the executive attention tests (p = 0.012) have been found. No significant differences in QOL‐AD, TYM, verbal fluency, or memory tests total scores have been observed. Reviewing scales subitems, differences in changes in sleep habits (p = 0.021), energy level decrease (p = 0.004), worse subjective record of memory capacity (p = 0.028), and decrease in ability to do housework (p = 0.007) have been shown. In those who lived alone, BDI and TYM higher scores in BDI‐II (p = 0.030) (p = 0.022) have been found. Conclusion: Mandatory quarantine imposed due to COVID‐19 pandemic was associated with worsening of mood, some quality‐of‐life variables, and decrease in attention in older adults with cognitive impairment in Argentina. Key points: These results provide evidence of the negative impact of social isolation in the emotional and cognitive sphere of patients with cognitive impairment [ABSTRACT FROM AUTHOR]

The objective of this paper is to evaluate available evidence for each step in autoimmune encephalitis management and provide expert opinion when evidence is lacking. The paper approaches autoimmune encephalitis as a broad category rather than focusing on individual antibody syndromes. Core authors from the Autoimmune Encephalitis Alliance Clinicians Network reviewed literature and developed the first draft. Where evidence was lacking or controversial, an electronic survey was distributed to all members to solicit individual responses. Sixty-eight members from 17 countries answered the survey. The most popular bridging therapy was oral prednisone taper chosen by 38% of responders while rituximab was the most popular maintenance therapy chosen by 46%. Most responders considered maintenance immunosuppression after a second relapse in patients with neuronal surface antibodies (70%) or seronegative autoimmune encephalitis (61%) as opposed to those with onconeuronal antibodies (29%). Most responders opted to cancer screening for 4 years in patients with neuronal surface antibodies (49%) or limbic encephalitis (46%) as opposed to non-limbic seronegative autoimmune encephalitis (36%). Detailed survey results are presented in the manuscript and a summary of the diagnostic and therapeutic recommendations is presented at the conclusion. [ABSTRACT FROM AUTHOR]

The objective of this paper is to evaluate available evidence for each step in autoimmune encephalitis management and provide expert opinion when evidence is lacking. The paper approaches autoimmune encephalitis as a broad category rather than focusing on individual antibody syndromes. Core authors from the Autoimmune Encephalitis Alliance Clinicians Network reviewed literature and developed the first draft. Where evidence was lacking or controversial, an electronic survey was distributed to all members to solicit individual responses. Sixty-eight members from 17 countries answered the survey. Corticosteroids alone or combined with other agents (intravenous IG or plasmapheresis) were selected as a first-line therapy by 84% of responders for patients with a general presentation, 74% for patients presenting with faciobrachial dystonic seizures, 63% for NMDAR-IgG encephalitis and 48.5% for classical paraneoplastic encephalitis. Half the responders indicated they would add a second-line agent only if there was no response to more than one first-line agent, 32% indicated adding a second-line agent if there was no response to one first-line agent, while only 15% indicated using a second-line agent in all patients. As for the preferred second-line agent, 80% of responders chose rituximab while only 10% chose cyclophosphamide in a clinical scenario with unknown antibodies. Detailed survey results are presented in the manuscript and a summary of the diagnostic and therapeutic recommendations is presented at the conclusion. [ABSTRACT FROM AUTHOR]

Objectives: The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP.Materials: This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages.Results: A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD.Conclusion: Inappropriate drug use increases health costs in developing countries. We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias. [ABSTRACT FROM AUTHOR]

Background: Aging is the main risk factor for neurodegenerative diseases, such as Alzheimer's disease (AD) dementia. Yerba mate (YM) tea or mate Ilex paraguariensis is an infusion widely consumed in Argentina and other South American countries such as Brazil, Paraguay, and Uruguay. Experimental studies suggest a YM antioxidant and protective effect against amyloid deposition in AD. Previously, our group and others identified an inverse association between YM consumption and Parkinson's Disease. The aim of this project is to evaluate a potential association between YM consumption and the risk of cognitive impairment development. Method: Two different stages were designed. Stage I is a descriptive study designed. Adult patients fulfilling mild cognitive impairment criteria (MCI) evaluated at the Sanatorio de la Trinidad Mitre between January 2021 and December 2022 will be included. Each participant or their caregiver will be invited to complete a survey about lifestyle and nutritional information, including YM consumption. Stage II is a case‐control study. Patients with MCI will be distributed by severity and subtypes of MCI. The control group will be constituted by individuals with normal cognitive evaluations matched by age, sex and educational level who agree to answer the afore mentioned survey. All data will be recorded in an anonymized electronic database and statistical analysis will be carried out. Project duration is estimated at 12 months for each stage. Result: Results from stage I will describe epidemiological and clinical characteristics of patients with MCI and the frequency and duration of YM consumption in this group of patients, as well as any potential correlation between neuropsychological tests and YM consumption. Results from stage II are expected to identify an inverse association between the magnitude of YM consumption and MCI. Conclusion: Observational evidence of the association between YM consumption and MCI might be the first step to develop experimental studies using Ilex paraguariensis in neurodegenerative cognitive disorders. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary objective: To examine the effect of cognitive rehabilitation therapy (CRT) on psychosocial outcomes in Argentinean patients with acquired brain injury (ABI), in connection with the time elapsed between injury and treatment initiation. Research design: Self-reported data from patients in a naturalistic setting was collected before and after CRT. Methods and procedure: An outpatient sample of 75 Spanish-speaking patients with cognitive disturbances secondary to ABI (49 male/26 female, age: 50.2 ± 20.1 years; education 14.3 ± 3.2 years) completed a set of scales on their daily living activities, memory self-perception, quality-of-life and mood. Single and multi-group analyses were conducted, considering pre- and post- responses and the time elapsed between injury and treatment initiation. The influence of socio-demographic moderators was controlled during comparisons. Main results: Results suggest an improvement in several psychosocial indicators after treatment. Additionally, correlations and group comparisons showed greater improvement in subjective memory and quality-of-life self-reports in patients who began treatment earlier than those who began treatment after a longer time period. Conclusions: Overall, results suggest that CRT is associated with positive results in different areas of the psychosocial domain and that post-injury time can mediate this effect. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia. Identifying this condition would allow early interventions that may reduce the rate of progression to Alzheimer's disease (AD). We examined the efficacy of a six-month cognitive intervention program (CIP) in patients with MCI and to assess patients’ condition at one-year follow-up.Methods: Forty-six MCI participants assessed with neuropsychological, neurological, neuropsychiatry, and functional procedures were included in this study and followed up during a year. The sample was randomized into two subgroups: 24 participants (the “trained group”) underwent the CIP during six months while 22 (control group) received no treatment. Sixteen participants dropped out of the study. The intervention focused on teaching cognitive strategies, cognitive training, and use of external aids, in sessions of two hours, twice per week for six months. Cognitive and functional measures were used as primary outcome and all were followed up at one year.Results: The intervention effect (mean change from baseline) was significant (p < 0.05) on the Mini-Mental State Examination (1.74), the Clinical Dementia Rating Scale (0.14), the Boston Naming Test (2.92), block design (−13.66), matrix reasoning (−3.07), and semantic fluency (−3.071) tasks. Four patients (one trained and three controls) progressed to dementia after one year of follow-up.Conclusions: These results suggest that persons with MCI can improve their performance on cognitive and functional measures when provided with early cognitive training and it could persist in a long-term follow-up. [ABSTRACT FROM AUTHOR]

Background: The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs.Methods: Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008.Results: 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US$4625 for DAT, US$4924 for FTD, and US$5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76).Conclusions: The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living. [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]

Background: Rapidly progressive dementia (RPD) is a syndrome caused by different disease entities. Accurate diagnosis is crucial as numerous proportions of these diseases are highly treatable. There are few RPD series published in South America. Knowing regional data may be useful to establish specific diagnostic guidelines based on local information. The main study objectives are to describe the etiological diagnosis of patients with RPD in Argentina and to compare the clinical characteristics and data obtained from complementary studies among patients with Autoimmune Encephalitis (AE), Prion Diseases (PD), Neurodegenerative Diseases (ND) and Other Causes (OC). Method: A multicenter observational cross‐sectional study was performed with the information obtained from patients referred to the neurology department of the participant centers. Patients with RPD criteria (developing dementia in less than 24 months) were retrospectively included between Dec‐2001 and Jun‐2019. Based on International diagnostic criteria, patients were divided into: AE, PD, ND and OC. We compared baseline clinical data, complementary exams, MRI and serologic characteristics between groups. Parametric or non‐parametric statistic and multivariate analysis was used according to the sample distribution of the available data. Result: On a sample of 328 patients with a diagnosis of RPD, 54.87% were men (n=180) with a mean age of 60.78±5.57 years at admission. The diagnosis time for dementia was 4.06 (0.83–23.6) months. The three most frequent causes were AE 23.17% (n=76), ND 22.86% (n=75) and PD 15.85% (n = 52). In 15.85% of the patients the diagnosis remained unknown. When comparing AE, ND, PD and OC, statistically significant differences were observed in age (younger age for AE, p=0.0001), higher mortality for PD (p=0.0001) and larger time of evolution in ND (p=0.0001). In the PD group more behavioral symptoms (p = 0.002) and pathological electroencephalogram (p=0.001) were found. Conclusion: In accordance with similar series, autoimmune etiology was the more frequent cause. This is the first South American RPD multicentric study. These results might supply valuable data for the healthcare system and future epidemiological investigations more focused diagnostic guidelines. [ABSTRACT FROM AUTHOR]