Search

Alzheimer's disease is the most frequent cause of cognitive disorders and dementia in older adults and is considered a new epi- demic. Due to its different cognitive, behavioral and functional manifestations, the detection, and diagnosis of patients with Alzheimer's Disease Dementia can represent a challenge. In this Clinical Practice Recommendation, management are given with levels based on the best scientific evidence available. Likewise, indications for study, or referral to a higher level of sanitary assistance are presented, according to the complexity of each clinical case. In this way, a set of practical recommendations of support is provided for decision making by health professionals at each sanitary level, from primary care to medical specialists. Through an operational and dynamic approach, this recommendations propose a global strategy based on evidence for patients, family members and health agents involved in this pathology, of great social relevance.

Due to the phenomenon of ageing population, cognitive impairment has become more prevalent, and any marker able to improve its detection becomes of significant importance. With that objective in mind, a prospective observational study was performed in a medical consultation related to cognitive impairment. 150 subjects (58% women) were included with an average age of 76 years (SD 8.6). The Head Turn sign was positive for 32 subjects with a sensitivity of 41.7% for dementia, a specificity of 93.7% and a negative predictive value of 64.4%. This study shows the semiologic value of a simple clinical sign, easy to spot in the daily practice and most helpful to alert physicians about a likely dementia diagnosis.

Sedative drugs use has been associated with more cognitive impairment and increased mortality. Sedative load refers to cumulative exposure to multiple drugs with sedative properties., Objective: Describe the use of psychotropic drugs and sedative load in older adults with and without dementia., Material and Methods: We conducted a cross-sectional study from 2014-2015 (Sanatorio Trinidad Mitre), in hospitalized patients older than 65 years old. Drugs were classified according to the WHO ATC system. The sedative load of drugs was calculated using the Linjakumpu model., Results: 152 PsD and 35 PcD patients were registered, mean age 80.8±8.42. Polypharmacy was present in 44.39% being higher in patients with dementia than without dementia (62.80% vs 40.13%, p=0.0147). In 40.64% at least one psychotropic/sedative medication was used, greater in PcD (60% vs 36.18%, p=0.0097). The CS was: 1.32±1.59; 2.14 in PcD and 1.13 in PsD (p<0.001). Atypical antipsychotics and benzodiazepines were the most common (51.43 and 40% respectively) in patients without dementias., Conclusion: we evidenced a high level of prescription psychotropic or sedative drugs, mostly in patients with dementia. In those, the sedative load was greater. This finding highlights the importance of implementing strategies to optimize sedative drug use among older people.

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.

Cognitive impairment and dementia treatment costs are significant for health systems. According to national and international guidelines, recommended drugs for treatment of dementias are cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine. Despite these guidelines recommendations, other nootropics, vasodilators and antioxidants are often used in Argentina. The purpose of this study was to describe and compare the prescription pattern of commonly used drugs for the treatment of cognitive disorders and dementia in different regions of Argentina. An observational, retrospective study of 1814108 recipes prescribed to National Institute of Social Services for Retired and Pensioners outpatients during the during the second half of 2008 and the first and second half of 2009 was performed, taking in count the whole country and also different Argentina's regions. Demographic variables, quantity and rate of prescriptions, dosage forms and strengths were analyzed. Considering the entire country, memantine was the most prescribed drug in these periods (570893 packages). An increase in the memantine, donepezil, rivastigmine and idebenone rates of prescription was observed. Prescription rate of memantine increased in the North-West and North-East regions, that of idebenone in the North-East region and Patagonia and donepezil in the North-East region. Non recommended drugs were highly prescribed in all the analyzed regions. Some of them were indicated to young and middle-aged patients.

Introduction: Irrational use of drugs for the treatment of cognitive impairment can increase health costs in developing countries., Objective: to analyze the pattern of drug prescription related to the treatment of patients with dementia and to compare them with the income of patients., Patients: 313 community-based outpatients that seeked medical advice for memory problems, in the Memory Center of Zubizarreta General Hospital (Buenos Aires, Argentina), were prospectively assessed during a period of a year., Results: Patients' mean income was 502.81 "Pesos Argentinos" which is equivalent to US$152 per month (2007). Fourty one point fifty five percent (41.55%) of the patients had dementia, 15.65% psychiatric diseases, 15.01% mild cognitive impairment and 27.79% were normal. Patients received an average of 2.84 drugs/day, 20% of the patients took at least one drug for cognitive impairment (9.85% memantine, 6.38% donepezil and 4% nootropics, cerebral vasodilators or antioxidants), and 39.3% received psychotropic medication (28.11% benzodiazepines and 9.26 % atypical antipsychotics). Twelve point seventy six percent (12.76%) of the patients with mild cognitive impairment were treated with antidementials, 5.74% of normal subjects received antidementials. 4% of patients were exclusively treated with free samples., Conclusion: In our sample irrational degree of using antidemential drugs and psychotropic agents was found.

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]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) 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.)

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]