Search

Background: Acetylcholinesterase inhibitors (AChEIs) and the N-methyl D-aspartate-antagonist memantine are indicated for the symptomatic treatment of Alzheimer's disease (AD)., Objectives: Our aims were to describe the baseline characteristics of patients with AD according to prescription of these treatments after the diagnostic work-up to describe long-term trends in the use of these medications and to identify baseline characteristics associated with the frequency of use of each treatment., Methods: This was a cohort study with a sample of 2992 patients with AD recorded in the Registry of Dementias of Girona (ReDeGi) between 2007 and 2014. Consumption of AChEIs and memantine was assessed using the Pharmacy Unit database from the Public Catalan Healthcare Service. We used generalized estimating equation analyses to identify the baseline characteristics associated with the consumption of AChEIs and memantine over time., Results: Most of the patients (70.4%; 95% confidence interval [CI] 68.7-72.0) were prescribed antidementia medication at the time of diagnosis. Of these, 75.0% (95% CI 73.1-76.8) were prescribed AChEIs, 14.7% (95% CI 13.2-16.3) were prescribed an AChEI plus memantine, and 10.3% (95% CI 9.0-11.6) were prescribed memantine. Advanced age reduced the likelihood of AChEI consumption. Mild dementia severity increased the use of AChEIs, and moderate-advanced dementia increased the likelihood of memantine consumption. After diagnosis, the likelihood of AChEI consumption decreased from the first year until the fifth, whereas the likelihood of memantine consumption, either alone or in combination with AChEIs, increased., Conclusions: Antidementia drug use in this study showed the initial use of AChEIs alone with later use of AChEIs in combination with memantine and memantine alone in older patients with severe AD. Our findings are in agreement with current clinical practice guidelines for the pharmacological treatment of AD.

Introduction: The rates of cognitive decline in patients with Alzheimer's disease show variations due to various factors. AIM. To determine the influence of age, education, gender, activities of daily living (ADL) and acetylcholinesterase inhibitors (IAChE) and memantine in the rhythm and rate of cognitive decline., Patients and Methods: Retrospective study of a sample of 383 patients with Alzheimer's disease, with neuropsychological assessments over three years. Cognitive measure was used as the Cambridge Cognitive Examination (CAMCOG). Patients were grouped according to their rate of annual decline (RAD) and performed a bivariate and multivariate regression analysis using as dependent variable the difference in scores on the CAMCOG (baseline-final)., Results: The younger age (beta = -0.23; p < 0.001), more educated (beta = 0.26; p < 0.001) and the greater deterioration of ADL (beta = 0.24; p < 0.001) were associated with a greater decline in all patients. The drugs had a beneficial effect (beta = -0.18; p = 0.011) in the group with lower and slower decline (RAD < 5%)., Conclusions: The lower age, higher education and the deterioration of ADL are associated with a greater cognitive decline. The IAChE and memantine had a beneficial effect, slowing the decline in the group of patients with lower RAD.

Background: There are discrepant findings regarding which subscales of the Cambridge Cognitive Examination (CAMCOG) are able to predict cognitive decline. The study aimed to identify the baseline CAMCOG subscales that can discriminate between patients and predict cognitive decline in Alzheimer's disease (AD) and mild cognitive impairment (MCI)., Methods: This was a five-year case-control study of patients with cognitive impairment and a control group. Participants were grouped into AD (n = 121), MCI converted to dementia (MCI-Ad, n = 43), MCI-stable (MCI-St, n = 66), and controls (CTR, n = 112). Differences in the mean scores obtained by the four groups were examined. Receiver operating characteristic curves were used to compare subscale scores in the AD and MCI-Ad groups with those of controls. The influence of age, gender, schooling, and depression on baseline subscale scores was assessed., Results: Of the CAMCOG subscales, Orientation and Memory (learning and recent) (OR + MEM) showed the highest discriminant capacity in the baseline analysis of the four groups. This baseline analysis indicated that OR + MEM was the best predictor of conversion to AD in the MCI-Ad group (area under the curve, AUC = 0.81), whereas the predictive capacity of the global MMSE and CAMCOG scores was poor (AUC = 0.59 and 0.53, respectively)., Conclusions: In the baseline analysis, the Orientation and Memory (learning and recent) subscales showed the highest discriminant and predictive capacity as regards both cognitive decline in the AD group and conversion to AD among MCI-Ad patients. This was not affected by age, gender, schooling, or depression.

Introduction: The indirect cost associated with the care of patients with Alzheimer's disease is taken on primarily by the family., Aim: To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden., Subjects and Methods: Non-institutionalized patients diagnosed with Alzheimer's disease who are managed on an out-patient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient's clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver's dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded., Results: Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 euro/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 euro/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers., Conclusions: Care has a mean indirect cost of 6364.2 euro/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver.

Objectives: To identify patient groups with Alzheimer disease (AD) according to the presence of psychological and behavioral syndromes and to determine the clinical differences among these groups., Methods: Cross-sectional and observational study of 491 patients with probable AD whom were administered the Neuropsychiatric Inventory (NPI) at the baseline visit and reevaluated after 12 months., Results: Principal component analysis (PCA) of baseline NPI data revealed three factors, including a psychosis factor (delusions, hallucinations, and aberrant motor behavior), a depressive factor (depression, anxiety, irritability, agitation, and apathy) and a hypomanic factor (euphoria and disinhibition). Cluster analysis of factor scores indicated the presence of three patient groups: one group was characterized by low scores in factors, a second group including patients with high scores in the depressive factor, and a third group that included patients with high scores in the three factors. The PCA of the NPI scores carried out after 1 year showed the persistence of the three factors. The cluster analysis of their factor scores also showed the presence of the same three patient groups but with a few differences in certain symptoms. A higher frequency of personal psychiatric history but no family history was observed in the cluster with depressive symptoms., Conclusions: Three neuropsychiatric syndromes have been identified, which have made it possible to classify patients with AD in three distinct large groups. A temporal stability is evidenced among the group with low symptoms. Patients with high scores in depressive factor or in three factors showed greater temporal instability. Certain differences among the groups suggest that different physiopathogenic mechanisms may be involved in neuropsychiatric syndromes.

Introduction: Apathy is the most common behavioral symptom in Alzheimer's disease (AD). The aim of this study was to establish the prevalence of apathy in patients with mild AD and at 12 months., Patients and Methods: Longitudinal study in patients with AD assessed with Cambridge-Cognitive Revised (CAMCOG-R), Disability Assessment in Dementia (DAD) and Neuropsychiatric Inventory (NPI). Sociodemographic variables were collected using a structured interview. The apathy NPI score was taken in to account in the study when it was equal or more than 4., Results: The sample size consisted of 155 subjects with a mean age of 77.1 +/- 6.7 years, and there were more women than men (67.7% vs. 32.3%). The prevalence of apathy was 18.7%. After 12 months persistence was 51.7% and remission was 48.3%. The emergence was 21.4%. Significant differences were seen in CAMCOG-R (p = 0,001), DAD (p < 0,001) and NPI (p < 0,001) between patients with or without apathy. The presence of apathy symptoms was not associated with age or gender but it affects to the course of initiative and executive functions and the NPI total scores., Conclusion: The apathy increases with the severity of the AD, and it has been associated with a poorer initiative and executive function ability. With respect to the baseline visit, an increased of NPI total score was observed when an increased apathy NPI score is observed.

Objective: Data in the literature show different estimates of the prevalence of depression in patients with Alzheimer disease (AD) when different classification systems are used. This study describes the prevalence and clinical features of depression in AD based on five different depression classification systems., Methods: This was a cross-sectional, observational study of 491 patients with probable AD. Depression was diagnosed using five classification systems (International Classification of Diseases, 10th Revision [ICD-10], Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], Cambridge Examination for Mental Disorder of the Elderly [CAMDEX], Provisional Diagnostic Criteria for depression in AD [PDC-dAD], Neuropsychiatric Inventory [NPI])., Results: The prevalence of depression was 4.9% (95% confidence interval [CI]: 3.2-7.1) according to ICD-10 criteria; 9.8% (95% CI: 7.3-12.6) according to CAMDEX; 13.4% (95% CI: 10.6-16.6) according to DSM-IV; 27.4% (95% CI: 23.6-31.5) according to PDC-dAD criteria; and 43.7% (95% CI: 39.4-48.2) when using the screening questions from the NPI depression subscale. The level of agreement between the classification systems was low to moderate (kappa <0.52). The characteristics associated with the most diagnostic disagreement were loss of confidence or self-esteem and irritability., Conclusions: This study shows that there is a high variability in the prevalence rates of depression in AD depending on the diagnostic criteria used and that there is a low rate of agreement among the diagnostic criteria analyzed. The results suggest that the use of generic diagnostic criteria such as the ICD-10, the CAMDEX, or DSM-IV provides low prevalence rates of depression in patients with AD compared with specific diagnostic criteria such as the PDC-dAD.

Background and Objective: This study aims to identify the relationship between costs of medical and social attention in patients with dementia of Alzheimer disease (AD) type and clinical and sociodemographic data of patients and their caregivers., Patients and Method: It was an analytic observational study in a cohort of patients diagnosed with Alzheimer's disease who received ambulatory attention. Information about the use of health-related resources was collected and costs were estimated from a societal perspective. Indirect costs were calculated using a replacement cost approach. Patients and caregivers were examined with the Mini-Mental State Examination (MMSE), the Rapid Disability Rating Scale (RDRS-2), the Neuropsychiatric Inventory (NPI), the Burden Interview (BI) and the Resource Utilization in Dementia (RUD). Patients were grouped taking into account the score obtained in the MMSE., Results: A cohort of 417 patients, mean age (SD) 75.2 (6.6) years, 71% females, was studied. Disease severity levels were distributed as follows: MMSE, 26% for MMSE > 19, 66% for MMSE = 19-11, and 8% for MMSE < 11. 69% of caregivers were women, with a mean age of 57.1 (15.8) years. The cost per patient and per month was estimated to be 419.3 Euro for MMSE > 19, 641.9 Euro for MMSE = 19-11, and 1150.6 Euro for MMSE < 11., Conclusions: The societal cost of AD increases dramatically with increasing disease severity. Caregiver burden and sex as well as the marital status of patients are associated with the cost of the disease.

Introduction and Aims: Dementia with Lewy bodies (DLB) has only relatively recently been acknowledged as an independent neurodegenerative entity. Until now few epidemiological prevalence studies have been carried out that include DLB and there are no studies about its incidence. The aim of this study is to determine the annual clinical incidence of DLB., Patients and Methods: We performed an observational retrospective study of the diagnosis of all the individuals who were attended at the UVAMID (Memory and Dementia Assessment Unit) between 1999 and 2001. The clinical assessment was performed in a standardised manner following the UVAMID protocol, which includes the medical history, obtained by interviewing the patient and a reliable informant, a general medical and neurological check up, neuropsychological exploration and a set of complementary tests., Results: The incidence of DLB in clinical practice was found to be 26/100,000 cases per year. By age groups, a progressive increase in incidence was seen until the 80 84 year old bracket and 63% of the cases of DLB were males., Conclusions: The results of this study show that cases of DLB made up 2% of the total number of new annual cases. The main limitation of this study lies in the fact that, because patients were referred to clinic from primary health care centres, they do not constitute a representative sample that is clinically unbiased, and this imposes restraints on the extrapolation of results.

Introduction: At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose., Patients and Methods: We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6 month period., Results: The sample was made up of 175 patients, of which 134 began therapy with 5 10 mg/day of donepezil and 41 with 6 12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil., Conclusions: The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine.

Objective: The objective of this study is to determine the effect of depressive symptoms of patients in the burden perceived by the carer, evaluate the course of this burden in relation to the disappearance, persistence or appearance of depressive symptoms after twelve months and find which factors are associated with a rise or fall in the carer s load after twelve months., Patients and Methods: A prospective observational study for 12 months of a sample of 150 patients with the clinical diagnosis of probable Alzheimer s disease on the criteria of NINDCS ADDRA: The sociodemographic data of their carers were collected and tested on the following scales: CAMDEX, CAMCOG, NPI, RDRS 2 and Burden Interview (BI) initially and twelve months later., Results: The existence of depression initially was associated with an increased burden (score of BI of 22.76 compared with 15.79), increased non cognitive symptoms (NPI score of 16.23 compared with 5.94) and greater functional disability (RDRS 2 score of 27.89 compared with 25.53). The burden increased in the group of patients whose depressive symptoms persisted and in those in whom they appeared after twelve months., Conclusion: The data suggest that depressive symptoms increase functional disability and are associated with an increase in non cognitive symptoms. At the same time the functional disability and non cognitive symptoms increase the carer's burden.

Introduction and Objectives: Although the neuropathology of Pick s disease and the frontal lobe dementias has been well defined, the complexity of the clinical diagnosis makes epidemiological studies difficult. The objective of this study was to determine the annual clinical incidence of fronto temporal dementia., Patients and Methods: A retrospective observational study was made of the diagnoses of all persons attended in UVAMID during the period 1999 2000. Clinical evaluation was standardized following a protocol of the UVAMID. This included a clinical history obtained by interviewing the patient and a reliable informant, general medical and neurological examination, neuropsychological examination and a battery of complementary tests., Results: In clinical practice the incidence of the different types of dementia varies between 93/100,000 in Alzheimer type dementia and 14/100,000 in DFT f. When age groups are considered, there is a progressive increase in the incidence of DFT f with 12/100,000 in the age group 46 69 years and 57/100,000 in the group of 75 79 years., Conclusions: The results of this study show that cases of DFT f form 2.7% of the new cases occurring annually. The main limitation of this study is that since these patients were referred for consultation from primary care centres, they form a non representative clinically biased sample which limits extrapolation of the results.

Objectives: The efficacy of donepezil for the treatment of cognitive dysfuntion in Alzheimer's disease has been demonstrated. The objective [corrected] of this study was to evaluate the effectiveness of donepezil in different neuropsychological areas of mild or moderate AD patients over a period of twelve months compared with data from untreated patients (historical control)., Methods: This was an open-label study where 100 patients received donepezil 5mg or 10 mg/day for twelve months. Because the study was uncontrolled, data were compared with historical data from 81 patients who had not received anticholinesterase inhibitors. The CAMCOG neuropsychological battery was used in both groups at baseline and at month 12., Results: A hundred patients (30% male and 70% female) were enrolled in the study receiving donepezil 5 or 10 mg/day (average age: 74.3 6.1 years). The historical control group consisted of 81 people (average age 72.9 6.5 years), 29.6% of whom were men. There were no significant differences with respect to age, sex and CAMCOG score at baseline. The differences within the groups were significant in the following neuropsychological areas: recent, remote and learning memory, attention, calculation and abstract verbal thinking. Differences in expressive language and learning memory between both groups were confirmed by the multivariative analysis of baseline., Conclusion: The rate of cognitive deterioration observed in mild to moderate AD patients receiving open-label donepezil treatment was less than expected if this cohort had not been treated. The cognitive beneficial effects observed during one year treatment with donepezil were mainly focused on memory and verbal expression.

Objective: To analyze the factors which affect the burden and quality of life in carers of patients with Alzheimer's disease., Material and Methods: From a sample of 234 carers of patients in the Unit for Assessment of Memory and Dementia with a diagnosis of probable Alzheimer's disease, according to the scale of National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCS-ADRDA), and of minimal or slight severity, according to the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) criteria, we obtained sociodemographic variables and administered the following questionnaires: Neuropsychiatric Inventory (NPI), Rapid Disability Rating Scale (RDRS-2), Quality of Life Questionnaire (QLQ) and Burden Interview (BI)., Results: The sex of the carers, the hours of attention to the basic activities of daily life (BADL) and the Cambridge Cognitive Examination (CAMCOQ), Minimental State Examination (MMSE), QLQ, NPI and RDRS-2 scores were related to the BI score. Multiple regression accepted the scoring for NPI, RDRS-2 and QLQ in the model. The QLQ score was associated with male sex of the patient, the age of the carer, employment status, whether or not he lived with the patient, with the family relationship, the hours of attention to the BADL and the scores on CAMCOG, MMSE, RDRS-2, NPI and BI. The multiple regression model included the age of the carer, the BI score and the hours of attention to the BADL., Conclusion: The non-cognitive symptoms, functional disability and poor perception of quality of life are factors affecting the burden and age of the carer, the hours of attention to the BADL and the burden affecting quality of life.

Introduction: At the present time there is considerable controversy over the course to follow in attention to patients with psychogeriatric disorders. Rapid diagnosis and maintaining the patients in their homes are the basic objectives of the policy of sharing responsibility among those involved., Development: We review the bibliography and suggest a form of attention based on experience acquired in the dementia evaluation unit of the Programme Vida als Anys of the Generalitat de Catalunya. The model described is based on making the diagnosis in the patient's home, giving support to the family and integrating the patient into a follow-up unit, with a person responsible for evaluating and resolving the needs of both patient and family as they arise. In order to carry out this programme, the attention must be given by multidiscliplinary units with the necessary resources.