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Aims To analyze the incidence of type 2 diabetes (T2D) in Central Spain and its association with the socioeconomic status (SES), educational level, and other risk factors (RF) in the elderly population of three communities. Methods Data for 5278 elderly participants (≥65 years old) were obtained using a census population-based survey. There was a first and a second survey three years later. The association between SES, educational level, RF, and T2D incidence was analyzed. Results The incidence rate for T2D was 9.8/1000 person-years without gender differences. Incident T2D was associated with low SES and lower educational levels. Baseline and follow-up BMI were also the main RFs for T2D. Communities’ incidence rates were: (1) Margarita, working-class area: 11.3/1000 person-years; (2) Arévalo, agricultural region: 10.1/1000 person-years and; (3) Lista, professional high-income class area: 7.6/1000 person-years. Conclusion We found an incidence rate of 9.8/1000 person-years of T2D in the elderly population. The risk of T2D was associated with a lower income and educational level. An increase in BMI may mediate this association. Our results emphasize the necessity of strategies for the prevention of diabetes that includes an approach to SES, educational levels, and other RF among older individuals in Spanish community settings.

The causes of the dementia decrease in affluent countries are not well known but health amelioration could probably play a major role. Nevertheless, although many vascular and systemic disorders in adult life are well-known risk factors (RF) for dementia and Alzheimer disease (AD), health status is rarely considered as a single RF.To analyse whether the health status and the self-perceived health (SPH) could be RF for dementia and AD and to discuss its biological basis.We analysed different objective health measures and SPH as RF for dementia and AD incidence in 4569 participants of the NEDICES cohort by means of Cox-regression models. The mean follow-up period was 3.2 (range: 0.03-6.6) years.Ageing, low education, history of stroke, and "poor" SPH were the main RF for dementia and AD incidence, whereas physical activity was protective. "Poor" SPH had a hazard ratio = 1.66 (95% CI 1.17-2.46; p = 0.012) after controlling for different confounders.According to data from NEDICES cohort, SPH is a better predictor of dementia and AD than other more objective health status proxies. SPH should be considered a holistic and biologically rooted indicator of health status, which can predict future development of dementia and AD in older adults.Our data indicate that it is worthwhile to include the SPH status as a RF in the studies of dementia and AD incidence and to explore the effect of its improvement in the evolution of this incidence.

Background Predementia is a heuristic umbrella concept to classify older adults with cognitive impairment who do not suffer dementia. Many diagnostic entities have been proposed to address this concept, but most of them have not had widespread acceptance. Aims To review clinical definitions, epidemiologic data (prevalence, incidence) and rate of conversion to dementia of the main predementia constructs, with special interest in the two most frequently used: mild cognitive impairment (MCI) and minor neurocognitive disorder (miNCD). Methods We have selected in three databases (MEDLINE, Web of Science and Google scholar) the references from inception to 31 December 2019 of relevant reviews, population and community-based surveys, and clinical series with >500 participants and >3 years follow-up as the best source of evidence. Main results The history of predementia constructs shows that MCI is the most referred entity. It is widely recognized as a clinical syndrome harbinger of dementia of several etiologies, mainly MCI due to Alzheimer's disease. The operational definition of MCI has shortcomings: vagueness of its requirement of "preserved independence in functional abilities" and others. The recent miNCD construct presents analogous difficulties. Current data indicate that it is a stricter predementia condition, with lower prevalence than MCI, less sensitivity to cognitive decline and, possibly, higher conversion rate to dementia. Conclusions MCI is a widely employed research and clinical entity. Preliminary data indicate that the clinical use of miNCD instead of MCI requires more scientific evidence. Both approaches have common limitations that need to be addressed.

Background: Cardiovascular risk estimation in people over 70 years is problematic. Most scores have been derived from cohorts of middle-aged people, with older persons under-represented. The predictive power of classical cardiovascular risk factors reduce with age. The aim is to develop a specific score for the elderly populationMethods: Population-based cohort established in 1995. Setting: Three geographical areas of Spain (Madrid, Ávila and Lugo). Participants: 3,729 people older than 64 years, free of any cardiovascular diseases (CVD), at baseline. Measurements: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were yearly investigated and confirmed using the WHO-MONICA criteria. All participants were followed until the occurrence of the first CVD event, until death or until December 31th 2015 if alive.Results: Age was the strongest predictor of 10-year CVD both in men and women. In men, variables associated to CVD were high blood pressure treatment (HR: 1,35; 95% CI: 1,067 , 1,710), diabetes (HR: 1,359; 95% CI: 0,997 , 1,852) and smoking (HR:1,207; 95%CI: 0,945 , 1,541), and in women smoking (HR: 1,881 95%CI: 1,356 , 2,609) and diabetes (HR:1,285; 95%CI:0,967 , 1,707). Total-cholesterol did not increased the risk of CVD either in males or females. However, total-cholesterol level (>200mg/dl) were negatively associated both in men and women.Conclusions: In old Spanish men, 10-year total CVD is significantly increased by age, diabetes and antihypertensive treatment, and in old women by diabetes and smoking. Total-cholesterol levels did not increased the risk of CVD either in males or females.

Alzheimer disease (AD) mortality risk in a large cohort of subjects treated or not with non-steroidal anti-inflammatory drugs (NSAIDs) is unknown. Our objective was to determine whether NSAIDs use is associated with decreased risk of AD mortality. In this prospective, population-based study (Neurological Disorders in Central Spain [NEDICES]) of 5,072 people without AD (aged 65 years and older), sociodemographic, comorbidity factors, and current medications were recorded at baseline. Community-dwelling older adults were followed for a median of 12.7 years, after which the death certificates of deceased participants were examined. 2,672 (52.7%) of 5,072 participants died, including 504 (18.9%) NSAIDs users and 2,168 (81.1%) non-users. Of the 2,672 deceased participants, 113 (4.2%) had AD as a cause of death (8 [1.6%] among NSAIDs users and 105 [4.8%] among non-users, chi-square = 10.70, p = 0.001). In an unadjusted Cox model, risk of AD mortality was decreased in NSAIDs users (hazard ratio [HR] for AD mortality = 0.35, 95% confidence interval [CI] 0.17–0.72, p = 0.004) when compared to non-users. After adjusting for numerous demographic factors and co-morbidities, the HR for AD mortality in NSAIDs users was 0.29, 95% CI 0.12–0.73, p = 0.009. Stratified analyses showed a significantly decreased risk of AD mortality with aspirin, whereas non-aspirin NSAIDs only showed a statistical trend toward significance in the adjusted Cox regression models. NSAIDs use was associated with 71% decreased risk of AD mortality in older adults. Our results support the hypothesis that NSAIDs use is a protective factor of developing AD.

Background The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. Objective The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. Methods A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. Results In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. Conclusions Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection)., Our thanks to all collaborators in this feasibility pilot study, the Instituto de Salud Carlos III and the Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), and the two hospital computer experts (Victoria Garcia Baquero and Teresa Garcia Morales), who created the website (http://nedices2.ciberned.com/estudio-de-salud-nedices-2/). We would also like to thank Miss Jennifer Gates for the editing and proofreading of the manuscript.

BACKGROUND The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. OBJECTIVE The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. METHODS A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. RESULTS In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. CONCLUSIONS Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection).

Objective We investigated the mortality rates of three subtypes of disability and their specific explanatory factors in older adults. Methods Our data come from NEDICES, a population-based longitudinal cohort study of Spanish older adults. We examined 3816 participants without dementia who completed the Pfeffer's Functional Activities Questionnaire (FAQ) and an assessment of self-perceived functional limitations (SFL) associated with health conditions. Subjects were classified into mutually exclusive subtypes of disability: subtype 1 (SFL), subtype 2 (impaired FAQ), and subtype 3 (impaired FAQ plus SFL). Factors related to all disability subtypes were analyzed using a multinomial logistic regression (MLR), whereas Cox regression (CR) models adjusted by covariates were applied to compare survival rates between groups at the 5-year follow up. Results The CR models indicated that SFL and FAQ scores were associated with higher risk of mortality at 5-years. After stratifying by subtypes of disability, mortality was significantly higher in subtype 3 than in subtypes 1 and 2. All models were consistent after adjusting by different covariates. The MLR showed that subtype 1 was specifically associated with the number of comorbidities, whereas subtype 2 was associated with lower MMSE scores depression and living in nursing homes. Conclusions Our results show that the combination of impaired FAQ plus SFL have an increased differential predictive utility for mortality than approaches based on unique measures. They also indicate that both measures of disability are associated with different explanatory factors.

Background: Little information is available on the potential association between polypharmacy and risk of mortality. Objective: To determine in a population-based study whether polypharmacy is associated with increased risk of mortality in elderly persons. Methods: In this population-based, prospective study of 5,052 people aged 65 years and older (Neurological Disorders in Central Spain), current medications were recorded. Cox proportional hazards models, adjusted for sociodemographics and comorbidity factors, were used to assess the risk of death up to 13.3 years later, comparing the polypharmacy group (≥6 drugs) to those who were taking 1-5 drugs and those in a nonmedicated group (0 drugs). Results: Out of 5,052 participants, 2,550 (50.5%) died over a median follow-up of 6.5 years, including 361 (28.8%) deaths among 931 nonmedicated participants, 1,946 (51.4%) deaths among 3,787 participants taking 1-5 drugs daily, and 243 (72.8%) among 334 participants on polypharmacy. In an unadjusted Cox model, risk of mortality was increased in participants on polypharmacy [hazard ratio (HR) = 2.78, 95% confidence interval [CI]: 2.36-3.27, p < 0.001) and in those taking between 1 and 5 drugs (HR = 1.47, 95% CI: 1.31-1.64, p < 0.001) versus those who were nonmedicated (reference group). In a Cox model that adjusted for a variety of demographic factors and comorbidities, HR remained increased in participants on polypharmacy (HR = 1.83, 95% CI: 1.51-2.21, p < 0.001). Conclusion: This study provides evidence that polypharmacy is associated with increased risk of mortality in elderly people. The extent to which polypharmacy is the proximate cause rather than a marker of this increase risk remains to be determined.

Tens of glycemic variability (GV) indices are available in the literature to characterize the dynamic properties of glucose concentration profiles from continuous glucose monitoring (CGM) sensors. However, how to exploit the plethora of GV indices for classifying subjects is still controversial. For instance, the basic problem of using GV indices to automatically determine if the subject is healthy rather than affected by impaired glucose tolerance (IGT) or type 2 diabetes (T2D), is still unaddressed. Here, we analyzed the feasibility of using CGM-based GV indices to distinguish healthy from IGTT2D and IGT from T2D subjects by means of a machine-learning approach.The data set consists of 102 subjects belonging to three different classes: 34 healthy, 39 IGT, and 29 T2D subjects. Each subject was monitored for a few days by a CGM sensor that produced a glucose profile from which we extracted 25 GV indices. We used a two-step binary logistic regression model to classify subjects. The first step distinguishes healthy subjects from IGTT2D, the second step classifies subjects into either IGT or T2D.Healthy subjects are distinguished from subjects with diabetes (IGTT2D) with 91.4% accuracy. Subjects are further subdivided into IGT or T2D classes with 79.5% accuracy. Globally, the classification into the three classes shows 86.6% accuracy.Even with a basic classification strategy, CGM-based GV indices show good accuracy in classifying healthy and subjects with diabetes. The classification into IGT or T2D seems, not surprisingly, more critical, but results encourage further investigation of the present research.

BACKGROUND: Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders. METHODS: A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity). RESULTS: High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29-0.87) and dependence (OR = 0.33; 95% CI = 0.19-0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22-0.70 and OR = 0.39; 95%CI = 0.21-0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence. CONCLUSIONS: Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain. This project was partially funded by a research contract in support of the project “Epidemiological Study of Dementia in Spain” signed by the Pfizer Foundation and Carlos III Institute of Health. The funding agency had no influence in the scientific process including study design, data collection, data analysis, interpretation of results, and writing of the manuscript. Sí

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We aimed to investigate the prevalence of metabolic syndrome in rural and urban areas in the province of Segovia, Spain, and its relationship to lifestyle habits, cardiovascular risk, and serum adiponectin concentrations.The study had a cross-sectional design and included 888 individual residents in the province of Segovia, Autonomous Community of Castilla-León.The age/sex standardized prevalence of the metabolic syndrome was by: (1) American Heart Association/National Heart Lung and Blood Institute criteria (AHA/NHLBI), 17%; (2) International Diabetes Federation (IDF), 24.3%; and (3) Consensus Societies/Joint Interim Statement (CS), 27.8%. A high correlation was found between the different criteria. No formal education [odds ratio (OR) 6.9 (2.4-20.2)] and primary education [6.7 (2.8-15.9)] were independently associated with metabolic syndrome. An inverse association with metabolic syndrome was found for subjects doing a high level of exercise during work [0.4 (0.2-0.7)] as well as those who were mild drinkers [alcohol intake of less than 15 grams/daily, 0.4 (0.3-0.8)]. Among subjects with low estimated cardiovascular risk, adiponectin levels are higher in those who do not meet criteria of metabolic syndrome. A total of 29.7% of subjects meeting CS criteria had20% 10-year predicted risk of cardiovascular disease (CVD) by the Framingham risk score criteria [4.5 (2.4-8.5)].Our results show: (1) A higher estimated prevalence of metabolic syndrome according to IDF and CS criteria. (2) Low educational level was independently associated with metabolic syndrome. A high level of physical activity and a daily alcohol intake of less than 15 grams/day were inversely associated with metabolic syndrome. (3) Metabolic syndrome increases the predicted CVD risk. (4) Adiponectin levels are not inversely related to insulin resistance in subjects with high cardiovascular risk and metabolic syndrome.

Background Environmental correlates for essential tremor (ET) are largely unexplored. The search for such environmental factors has involved the study of a number of neurotoxins. Harmane (1-methyl-9H-pyrido[3,4- b ]indole) is a potent tremor-producing toxin. In two prior case–control studies in New York, we demonstrated that blood harmane concentration was elevated in ET patients vs. controls, and especially in familial ET cases. These findings, however, have been derived from a study of cases ascertained through a single tertiary referral center in New York. Objective Our objective was to determine whether blood harmane concentrations are elevated in familial and sporadic ET cases, ascertained from central Spain, compared to controls without ET. Methods Blood harmane concentrations were quantified by a well-established high performance liquid chromatography method. Results The median harmane concentrations were: 2.09 g −10 /ml (138 controls), 2.41 g −10 /ml (68 sporadic ET), and 2.90 g −10 /ml (62 familial ET). In an unadjusted logistic regression analysis, log blood harmane concentration was not significantly associated with diagnosis (familial ET vs. control): odds ratio = 1.56, p = 0.26. In a logistic regression analysis that adjusted for evaluation start time, which was an important confounding variable, the odds ratio increased to 2.35, p = 0.049. Conclusions Blood harmane levels were slightly elevated in a group of familial ET cases compared to a group of controls in Spain. These data seem to further extend our observations from New York to a second cohort of ET cases in Spain. This neurotoxin continues to be a source of interest for future confirmatory research.

7.5% (95% CI 5.4–9.7), 5.6 (95% CI 3.7–7.5) and 1.4 (95% CI 0.5– 2.3), and 290,000 (95% CI 208,000–372,000), 214,000 (95% CI 141,000–288,000) and 54,000 (95% CI 20,000–88,000) for dementia, AD and VD, respectively. Conclusions – Dementia prevalence in Spain is comparable to other European populations, while a high number of undiagnosed cases live in the community. The potential impact of Mediterranean diet, hypertension control and decreasing vascular risk factors is discussed.

Background and purpose: Essential tremor (ET), one of the most prevalent neurological diseases, has been associated with a variety of comorbidities and, in some studies, a modest increase in risk of mortality. The mechanisms underlying this possible increased mortality have yet to be explored, although one possibility is increased frailty. Frailty has not been studied in ET, and our objective was to address this gap in knowledge. We hypothesized that frailty would be greater in ET cases than in controls. Methods: A 20-item frailty score assessed comorbid conditions, number of medications, and functional activity. The frailty score was compared in 237 non-demented elderly ET cases and 3903 non-demented age-matched controls from a population-based study in central Spain. Results: The frailty score was higher in ET cases than in controls (8.6 ± 5.2 vs. 6.8 ± 4.6, P

Objective To evaluate whether memory impairment detected in the three-word delayed recall task of the Mini-Mental State Examination (MMSE) increases the risk of mortality. Methods The NEDICES (Neurological Diseases in Central Spain) cohort study, is a population census-based study, aimed at detecting age-associated neurological diseases in people aged 65 and over, living in one rural and two urban communities in central Spain. Participants with dementia or without MMSE evaluation at baseline were excluded. Mortality was evaluated 10.67 years after enrolment. Cox's proportional hazards regression models were used to evaluate the hazard of death according to performance in the three-word delayed recall task included in the MMSE (score 0–3), adjusting for potential covariates (sex, age, level of education, and comorbidity). Survival was estimated using Kaplan–Meier method. Results The final study population comprised 3778 non-demented elderly subjects. After adjusting for confounding covariates, mortality was 52% greater in persons with the lowest memory score (0) vs. persons with the highest score (3). Hazard ratios (HR) showed a tendency to an increase in mortality from the highest to the lowest memory score, which was statistically significant for the groups with none (HR = 1.52; CI = 1.27–1.80) or one (HR = 1.24; CI = 1.04–1.48) word recall. Older age, male sex, and comorbidity were also associated with mortality, but level of education was not. Conclusions Memory impairment in the three-word delayed free recall, a very simple task used by physicians worldwide, increases the risk of mortality at 10 years in non-demented elderly. Copyright © 2010 John Wiley & Sons, Ltd.

In a 2009 Cochrane review, the authors concluded that there is good evidence that statins, given in late life to people at risk of vascular disease, have no effect in preventing Alzheimer's disease or dementia. A related issue, which remains unclear, is whether statins improve cognitive function. While some studies have shown a beneficial effect of statins on cognitive function, others have observed mild detrimental effects on cognition. Our aim was to assess cognitive function in community-dwelling elderly participants treated with statins compared with their untreated counterparts (i.e., controls) living in the same population. 137 population-dwelling participants who were receiving statins and 411 matched controls age ⩾ 65 years (median=72 years) in central Spain (the Neurological Disorders in Central Spain [NEDICES] study) underwent a neuropsychological assessment, including tests of global cognitive performance, frontal-executive function, verbal fluency, and memory. Median duration of statin treatment was 2 years. Of 137 participants receiving statins, 53 (38.7%) were taking pravastatin, 38 (27.7%) simvastatin, 37 (27.0%) lovastatin, 6 (4.4%) fluvastatin, and 3 (2.2%) atorvastatin. Although initial univariate analyses indicated some differences, after adjusting for age, gender, education, depressive symptoms, premorbid intelligence, medications that potentially affect cognitive function, and blood cholesterol levels, statin users and controls performed similarly on all neuropsychological tests. In this population-based sample, elderly participants treated with statins and untreated controls performed similarly in all tested cognitive areas. These results do not support a positive benefit of statins on cognition.

Background: Mild cognitive deficits have been reported in essential tremor (ET). However, these cognitive deficits have been assessed in cross-sectional rather than longitudinal analyses. Objective: To determine whether decline in cognitive test scores occurs at a faster rate in ET cases than controls. Methods: In a population-based study of older people (≥ 65 years) in central Spain (Neurological Disorders in Central Spain, NEDICES), non-demented ET cases and controls were followed prospectively. Participants with baseline or incident Parkinson’s disease or dementia were excluded as were participants who developed incident ET. At baseline (1994–1995) and at follow-up (1997–1998), a 37-item version of the mini-mental state examination (37-MMSE) was administered. Results: A total of 2319 participants (72.4 ± 5.8 years) included 135 prevalent ET cases and 2184 controls. At baseline, the mean 37-MMSE in cases was 28.8 ± 5.8 vs. 30.2 ± 4.8 in controls (P = 0.02). During the 3-year follow-up period, the 37-MMSE declined by 0.70 ± 3.2 points in cases vs. 0.11 ± 3.8 points in controls (P = 0.03). In analyses that adjusted for age, education, and other potential confounders, the case–control difference remained robust. Discussion: In this population-based, prospective study of non-demented elders, baseline cognitive test scores were lower in ET cases than controls; moreover, during the 3-year follow-up period, these scores declined at a rate that was seven-times faster in ET cases. This study provides evidence that cognitive deficits in ET are not static, and they appear to be progressing at a faster rate than in elders without this disease.

Background: Few longitudinal studies have verified the clinical diagnosis of dementia based on clinical examinations. We evaluated the consistency of the clinical diagnosis of dementia over a period of 3 years of follow-up in a population-based, cohort study of older people in central Spain. Methods: Individuals (N = 5278) were evaluated at baseline (1994-1995) and at follow-up (1997-1998). The evaluation included a screening questionnaire for dementia and a neurological assessment. Results: Dementia screening consisted of a 37-item version of the Mini-Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (FAQ). Study neurologists investigated those participants who screened positively (N = 713) as well as 843 who had screened negatively to test the sensitivity of the screening instruments or because they had a positive screening for other chronic neurological diseases. We detected 295 patients among those who screened positive and 13 among those who screened negatively. Three years follow-up evaluation demonstrated 14 diagnostic errors at baseline (4.5%) leading to a final number of 306 patients with dementia. The corrected prevalence of dementia was 5.8% (95% confidence interval [CI] 5.2-6.5). Conclusions: The diagnosis of dementia was highly accurate in this population-based, Spanish cohort study, and our prevalence figures agree with other European surveys. Given the high cost and difficulties of population rescreening and its relatively low yield, we conclude that a single 2-phase investigation (screening followed by clinical examination) provides accurate information for most population-based prevalence studies of dementia.

Background Studies investigating the association between hypercholesterolemia in the elderly and cognitive decline report discrepant outcomes. We determined in a prospective population-based cohort (NEDICES) in elders whether hypercholesterolemia was associated with slower cognitive decline. Methods Participants were evaluated at baseline and 3 years later. Baseline demographic variables were recorded. Hypercholesterolemia was defined by total cholesterol of > 200 mg/dl or current use of lipid-lowering drugs. At baseline and at follow-up, a 37-item version of the Mini-Mental State Examination (37-MMSE) was administered. Results The final sample, 2015 participants (72.9 ± 6.1 years), comprised 1166 (57.9%) hypercholesterolemic and 849 (42.1%) non-hypercholesterolemic participants (reference category). The mean follow-up was 3.4 ± 0.5 years. During the three year follow-up period, the 37-MMSE declined by 0.7 ± 4.3 points (median = 0 point) in non-hypercholesterolemic participants vs. 0.3 ± 3.9 points in hypercholesterolemic participants (median = 0 points) (Mann–Whitney test, p = 0.007). In analyses adjusted for baseline age and other potential confounders, this difference remained robust. We also assessed the cognitive decline per unit time (i.e., the rate of cognitive decline). The rate of cognitive decline was 0.2 ± 1.3 (median = 0.0) points/year for non-hypercholesterolemic participants and 0.1 ± 1.2 (median = 0.0) points/year for hypercholesterolemic participants (Mann–Whitney test, p = 0.028). Conclusions In this prospective population-based cohort study, cognitive test scores among hypercholesterolemic elders declined more slowly than observed in their non-hypercholesterolemic counterparts. Additional studies are needed to confirm these results.

Objective To determine whether selective memory impairment (SMI) on an adapted Mini-Mental State Examination (aMMSE) test increases risk of future dementia in a population-based survey of central Spain. Background SMI is a strong predictor of dementia in the elderly. However, most approaches have used extensive memory batteries, which are not always suitable for screening purposes. Methods The basal cohort consisted of 2982 poorly educated individuals aged 65 or over. Dementia, stroke and parkinsonism cases were previously excluded. At entry, participants received a structured interview including an aMMSE. Two groups were created according to basal cognitive performance, namely: (1) aMMSE > 23 and no word remembered on the aMMSE delayed-recall task (SMI group); and (2) aMMSE > 23 and at least one word remembered on the delayed-recall task (control group). In a three-year follow-up wave, conversion rate to dementia was calculated and logistic regression was performed. Results Of a total of 2507 subjects who completed the two evaluations, 280 qualified for SMI at entry. In the SMI group, 25 subjects (8.9%) developed dementia vs 26 subjects (1.2%) in the control group. Taking the two groups together, and once demographic and medical variables had been controlled, a low delayed-recall score increased dementia conversion rate (OR 0.47, 95% CI 0.34–0.64). Alzheimer's disease was the main cause of dementia (79.8%). Conclusions Memory impairment is a risk factor for future dementia in the neurologically-healthy elderly. This can be observed in a subgroup of subjects with SMI defined on the aMMSE delayed-recall subscore. Some other measurements should be added to the SMI construct to improve its predictive validity. Copyright © 2004 John Wiley & Sons, Ltd.

Background: A two-phase investigation method (screening followed by detailed examination) is the most accurate epidemiologic approach to estimate the epidemiology of Parkinson disease (PD) and secondary parkinsonism. The scarcity of statistics on the incidence of PD and other types of parkinsonism using this methodology led the authors to estimate them in three elderly populations. Methods: A Spanish elderly parkinsonism-free cohort was followed for an average of 3 years. At the end of the follow-up, the cohort survivors were contacted by way of screening and clinical examination. Results: The cohort consisted of 5,160 subjects (ages 65 to 85 and over): Eight hundred twenty-eight died before the examination, 3,685 completed the screening procedure, and 647 could not be screened because they refused (108) or were unreachable (539). Sixty-eight incident cases of parkinsonism were found: 30 PD (44.1%), 22 drug-induced parkinsonism (32.3%), 8 parkinsonism with associated features (11.7%), and 3 vascular parkinsonism (4.4%). The remaining five cases (7.3%) were classified as unspecified parkinsonism. Average annual incidence rate (per 100,000 person-years) in the population aged 65 to 85 and over years, adjusted to the standard European population, was 409.9 (95% CI 299.0 to 520.8) for parkinsonism and 186.8 (95% CI 110.4 to 263.2) for PD. Incidence rates of parkinsonism increased with advancing age. For PD, incidence rates increased with age in men but decreased beyond the age of 79 in women. Age-adjusted relative risk in men compared with women was 1.56 (95% CI 0.97 to 2.51) for parkinsonism and 2.55 (95% CI 1.21 to 5.37) for PD. Sixteen (53.3%) patients with PD were detected through the screening and had not been diagnosed previously. Conclusions: Incidence estimates of PD based on two-phase investigation methodology are higher than those based on other approaches. Men had a risk of developing PD that was twice that of women. A large proportion of PD patients may never seek neurologic attention.

Fundamento y objetivo Estimar la prevalencia de dislipemia en sujetos mayores de 65 anos no institucionalizados de medios urbano y rural espanoles y describir el perfil lipidico: concentraciones de colesterol total (CT), colesterol ligado a lipoproteinas de baja densidad (cLDL), colesterol ligado a lipoproteinas de alta densidad (cHDL) y trigliceridos, por edad, sexo y zonas geograficas Pacientes y metodo Estudio epidemiologico, transversal y multicentrico de la poblacion anciana (edad mayor o igual a 65 anos) no institucionalizada en 3 areas geograficas: Arevalo (Avila), Begonte (Lugo) y area urbana de Lista (Madrid). Se obtuvo una muestra aleatoria estratificada por edad y sexo a partir de los padrones de cada zona. La tasa de participacion fue del 84,6%. En la fase I se realizo una entrevista domiciliaria (n = 4.522) con examen fisico y determinacion de CT en sangre capilar (Reflotron®). En la fase 2, a un tercio de la muestra elegido al azar (n = 1.907), se le realizo una determinacion centralizada de CT, cHDL, cLDL y trigliceridos Resultados La media (DE) de CT en el total de la poblacion fue 230,3 (46,8) mg/dl. Las cifras de CT descendieron significativamente con la edad (p Conclusiones La prevalencia de dislipemia es superior a las estimaciones realizadas por la Sociedad Espanola de Arteriosclerosis para la poblacion anciana europea (50%), mayor en mujeres y en grupos de menor edad (65–69 anos). El grado de conocimiento, tratamiento y control de la hipercolesterolemia es muy escaso entre la poblacion anciana espanola

Although essential tremor (ET) is considered the most prevalent adult movement disorder, the available information on its prevalence and distribution worldwide is not completely understood. We investigated the prevalence and distribution of ET in three elderly Spanish populations using a door-to-door, two-phase approach. A brief screening instrument was administered on May 1, 1994 to subjects over 64 years old taken from the census of one urban municipality of Greater Madrid (quarter of Margaritas, Getafe), one urban district of Madrid (Lista), and one rural site (Arevalo county, Avila) (N = 5,278). Study subjects were limited to those who screened positively (N = 472). To increase reliability, each patient was examined by 3 experienced neurologists, and was classified as having ET only when all 3 neurologists agreed (183 of 472). The present study was part of a large-scale epidemiological survey of neurological diseases, and served as a baseline investigation in a 3-year incidence study. Accordingly, 41 ET patients were identified when evaluating subjects who had screened positively for dementia, stroke, or parkinsonism, despite the fact that they had screened negatively for tremor; furthermore, 32 additional ET prevalent cases were detected when evaluating subjects who had screened positively for tremor in the second cross-sectional study (May 1, 1997), although they had screened negatively for tremor in the first cross-sectional study. We identified 256 persons (152 women, 104 men) with ET; of these, 87 patients (34.0%) reported having an affected relative. Two hundred and four (79.7%) of the subjects with ET were detected through this screening and had not been diagnosed previously. The prevalence of ET was 4.8% (95% CI = 4.2–5.4) for the total population; 4.6% (95% CI = 3.7–5.4) in men and 5.0% (95% CI = 4.2–5.8) in women. Age-specific prevalence increased with advancing age for both men and women. Despite the variability in worldwide data, ET is a frequently encountered disorder in elderly people. Furthermore, as ET may be seen as a relatively benign condition, a large proportion of patients may never seek neurological attention. © 2002 Movement Disorder Society

Fundamento Estimar la prevalencia de hipotension ortostatica (HO) en una poblacion anciana,determinar su relacion con el tratamiento antihipertensivo y con el control de la presion arterial(PA). Metodos Se estudiaron 2.700 ancianos (> 65 anos) pertenecientes al estudio EPICARDIAN.Se realizaron dos tomas de PA en sedestacion y otra tras 1 a 3 min en bipedestacion. Se considerohipertension arterial (HTA) una media en sedestacion ≥ 140/90 mmHg. o tratamiento antihipertensivo.,e HO como un descenso de PAS ≥ 20 mmHg y/o PAD ≥ 10 mmHg con la bipedestacion. Resultados El 71,6% de los ancianos eran hipertensos, el 57,1% tomaban farmacos antihipertensivos.La prevalencia global de HO fue del 6,8%, siendo del 8,1% en hipertensos y el 3,4%en normotensos (p Conclusiones La prevalencia de HO en la muestra de ancianos estudiada no es muy elevada,siendo significativamente mayor en hipertensos que en normotensos. No se encontro asociacionentre HO y el numero de farmacos antihipertensivos consumidos. El control de la HTA se asociaa una menor prevalencia de HO.

Producción Científica, España es uno de los países de la Unión Europea que presenta tasas de consumo de antibióticos más elevadas 1,2 , siendo prescritos en atención primaria aproximadamente el 85% de los mismos. Existen numerosos estudios que muestran un uso desmedido de este grupo de fármacos en nuestro país 3 --- 5 , sin que parezca existir una justificación desde el punto de vista epidemiológico, dado que la incidencia de enfermeda- des infecciosas en nuestro país no tiene una magnitud tal que lo haga comprensible. Con la finalidad de contribuir al conocimiento sobre la utilización de los antibióticos en atención primaria, reali- zamos un estudio descriptivo y transversal de los datos del período entre el 1 de enero de 1999 y el 31 de diciembre de 2007 en el Área de Salud de Segovia. La fuente fue el sis- tema de información de farmacia denominado « Concylia » . Los datos fueron suministrados en forma de DDD (dosis diaria definida) y el indicador utilizado es DHD (dosis por mil habitantes y día).

The antibiotics are the medicaments most used after the analgesics, being prescribed more than 85 % in Primary Care. The aim of the study is to analyze the evolution of the prescription of antibiotics of systemic use in the general population of the Area of Segovia, during the years 1999-2007 and to know his trends evolution.Antibiotics prescribed to the general population on the part of the Family physicians were processed using the information system of drugstore "CONCYLIA" that supplies the information in the shape of defined daily dose (DDD), transformed later into the indicator DHD (DDD for 1.000 inhabitants per day) taking as a base the population information of sanitary card.The global prescription of antibiotics of systemic use was high, 18,06 DHD (IC:17,22-18,90), with a variable evolution along the study in the shape of basin of low concavity. The percentage of prescription of penicillins was 64.42 % of the total of prescriptions corresponding to the group J01.The prescription in the Area of Segovia has presented a contained consumption in relation to other studies, showing differences in the volume of prescription from each the subgroups. The centralization of the consumption emphasizes in the subgroup of penicillins that supposed almost two third parts of the prescribed DDD. A change in the habits of prescription is observed detailing a decrease of the amoxicillin use and an increase of amoxicillin-clavulanic acid.

Given the uncertain relationship between objective and subjective memory complaints (SMC), we conducted a study of cognitive function in older people with memory complaints in a large population-based elderly Spanish cohort (NEDICES). A total of 1,073 subjects with SMC and 1,073 matched controls free from dementia underwent a neuropsychological assessment, including tests of global cognitive performance, frontal executive function, verbal fluency, and memory. SMC were associated with a number of specific objective cognitive deficits including poor verbal fluency, and poor immediate and delayed recall. However, there was a limited association with global cognitive impairment despite a strong influence upon Pfeffer Functional Activities Questionnaire based daily function. In the full sample the strongest predictors of SMC were poor psychological well-being, depressive symptoms (including those taking antidepressants) and hearing impairment. Moderate predictors were age and gender. If individuals with mild cognitive impairment (MCI) were removed, then the strongest predictors were poor psychological well-being, depressive symptoms, hearing impairment, illiteracy, age, and gender. For those with MCI alone, the only significant predictor of memory complaints was poor psychological well-being. Predictors of SMC in those with depressive symptoms included poor psychological well-being and hearing impairment. With depressive symptoms excluded the strongest predictors were poor psychological well-being, hearing impairment, illiteracy, and gender. In this population-based sample, individuals with SMC had evidence of impairments on specific neuropsychological testing which might not be apparent on global measures. Predictors of SMC may differ in those with versus without MCI and those with versus without depressive symptoms.

Many investigators have observed mild cognitive deficits in essential tremor (ET), yet the functional significance of these deficits is unclear. Also, there are very few data in which functional activity in ET has been divided into cognitively based activities (remembering appointments) versus motor-based activities (writing cheques).The authors (1) compared functional level in ET cases versus controls, assessing functional activities that are cognitively based and those that are dependent upon both motor and cognitive factors, and (2) determined whether lower mini mental status test scores in ET cases have a functional correlate.In a population-based study of peopleor = 65 years in central Spain (NEDICES), a 37-item version of the Mini-Mental State Examination (37-MMSE) and an 11-item version of the Pfeffer Functional Activities Questionnaire (FAQ) were administered to non-demented ET cases and controls.The FAQ was 55.5% higher (ie, lower function) in 208 cases than 3616 controls (2.8+/-4.8 vs 1.8+/-4.2, p0.001). Cases reported more difficulty (ie, higher FAQ scores) with FAQ items that were cognitive measures as well as FAQ items that were cognitive-motor in nature. In cases, a lower 37-MMSE was associated with more difficulty on both cognitively based and cognitive-motor-based FAQ items (p0.001).In this large, population-based study, ET cases reported more functional difficulty than controls, and this functional difficulty was present in both cognitive and cognitive-motor domains. Lower cognitive test scores were associated with more reported functional difficulty, indicating that lower cognitive test scores in ET, rather than being inconsequential, have a clear clinical-functional correlate.

Background In Spain, more than 85% of coronary heart disease deaths occur in adults older than 65 years. However, coronary heart disease incidence and mortality in the Spanish elderly have been poorly described. The aim of this study is to estimate the ten-year incidence and mortality rates of myocardial infarction in a population-based large cohort of Spanish elders. Methods A population-based cohort of 3729 people older than 64 years old, free of previous myocardial infarction, was established in 1995 in three geographical areas of Spain. Any case of fatal and non-fatal myocardial infarction was investigated until December 2004 using the "cold pursuit method", previously used and validated by the the WHO-MONICA project. Results Men showed a significantly (p < 0.001) higher cumulative incidence of myocardial infarction (7.2%; 95%CI: 5.94-8.54) than women (3.8%; 95%CI: 3.06-4.74). Although cumulative incidence increased with age (p < 0.05), gender-differences tended to narrow. Adjusted incidence rates were higher in men (957 per 100 000 person-years) than in women (546 per 100 000 person-years) (p < 0.001) and increased with age (p < 0.001). The increase was progressive in women but not in men. Adjusted mortality rates were also higher in men than in women (p < 0.001), being three times higher in the age group of ≥ 85 years old than in the age group of 65-74 years old (p < 0.001). Conclusion Incidence of fatal and non-fatal myocardial infarction is high in the Spanish elderly population. Men show higher rates than women, but gender differences diminish with age.

Background and purpose: We determined in a population-based study whether sleep duration was associated with an increased risk of incident dementia. Methods: In a population-based study in central Spain, participants were evaluated at baseline and 3 years later. Baseline demographic variables were recorded and participants indicated their daily sleep duration as the sum of night-time sleep and daytime napping. The average daily total sleep duration was grouped into five categories: ≤5 (short sleepers), 6, 7 (reference), 8, and ≥9 h (long sleepers). We identified all cases with incident dementia, diagnosed using DSM-IV criteria. Results: Three thousand two hundred eighty six participants with baseline information about sleep duration had a median duration of follow-up of 3.2 years. There were 140 incident cases of dementia. The relative risks (RR) for short sleepers and for long sleepers were 2.36 (95% CI = 1.07–5.21, P = 0.03) and 2.40 (95% CI = 1.20–4.81, P = 0.01), respectively. After adjustment for potential confounders, the RR was only marginally increased for short sleepers (1.87, 95% CI = 0.85–4.15, P = 0.12) but remained increased for long sleepers (2.18; 95% CI = 1.09–4.37, P = 0.03). Conclusions: Prolonged sleep duration (night-time sleep and daytime napping) may be associated with an increased risk of dementia.

Background This study describes the prevalence of dementia and major dementia subtypes in Spanish elderly. Methods We identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008). Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression. Results The reanalyzed study population (aged 70 year and above) was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimer's disease, 238 of vascular dementia). Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimer's disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists. Conclusion Prevalence of dementia and Alzheimer's disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimer's disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted Financial aid was obtained from the Spanish RECSP C03-09, CIEN C03-06 and CIBERNED networks, and from the Pfizer Foundation in particular SI

Objective We studied attrition (i.e., participant dropout) 3 years after the baseline interview in a population-based Spanish cohort. Study Design and Setting The Neurological Disorders in Central Spain study is a longitudinal, population-based survey of chronic neurologic conditions in persons aged ≥65 years. Multivariate logistic regression analysis was used to examine baseline differences between participants who took part in the 3-year follow-up evaluation vs. those who did not. Results Of the 5,278 participants evaluated at baseline (1994–1995), 1,482 (28.1%) were lost to the follow-up (1997–1998). Factors that were associated with dropout due to refusal were as follows: living in a rural area and being single. Contact failure was associated with older age and being unmarried and widowed. Unreachable participants were less likely to take three or more medications or live in a professional neighborhood. Predictors of dropout due to death were male gender, older age, having impaired activities of daily living, taking more medications, poor self-perceived health, dementia, and smoking. Conclusions These findings on participants who are at high risk of dropout may be useful in the planning phase of future prospective studies. Of the possible reasons for attrition, refusal is the most important because it is amenable to change.

Objective To assess age-, gender, and subtype-specific incidence rates of dementia in three populations in central Spain using data from the Neurological Disorders in Central Spain (NEDICES), a population-based survey of elderly participants. Methods Individuals were evaluated at baseline (1994–1995) and at follow-up (a median of 3.2 years later in 1997–1998). The evaluation included a screening questionnaire for dementia and a neurological assessment, when possible. Results Of 5278 participants evaluated at baseline, there were 306 prevalent dementia cases. One hundred and sixty-one incident dementia cases were identified among 3,891 individuals assessed at follow-up. The large majority had Alzheimer's disease (AD): 115 (71.4%) AD, 18 (11.2%) vascular dementia (VaD), 11 (6.8%) dementia associated with parkinsonism, 11 (6.8%) undetermined etiology, and 6 (3.7%) secondary dementia. Average annual incidence rates (per 1,000 person-years) in the population aged 65 to 90 and over years, adjusted to the standard European population, were 10.6 (95% CI, 8.9 to 12.3) for dementia, 7.4 (95% CI = 6.0 to 8.8) for AD, and 1.4 (95% CI = 0.6 to 2.3) for VaD. Age-specific incidence rates of dementia and AD increased exponentially with advancing age. Age, stroke and illiteracy were independent risk factors for dementia and AD. Aggregation of vascular risk factors was related to a higher risk of both VaD and AD. Conclusions In the NEDICES study, incidence of dementia increased with age beyond age 85 and AD was the most frequent type of dementia. The risk of AD and VaD increased with the number of vascular risk factors.

Despite a greater incidence of ischemic heart disease among individuals over age 65, most cardiovascular research has been focused on the middle-aged adult population. To date no cohort study on this population have been made in Spain. This study is aimed as reviewing the role and methodology of cohort studies as an epidemiological tool absolutely essential for researching the prevalence and incidence of angina, AMI, stroke and the major cardiovascular risk factors.Cohort study in three areas of Spain (Lista district in Madrid), Arevalo (Avila) and Begonte (Lugo). Age and sex stratified random sample by based on the municipal censuses of each area and municipality (n = 5.079). Two-stage initial cohort assessment: home survey structured for the screening ischemic heart disease and classic risk factors (hypertension, dyslipemia, diabetes and smoking habit) and clinical assessment for case confirmation. In the follow-up phase the MONICA project "cold pursuit" method modified for pinpointing and investigating indicent cases was used, employing all of the hospital and primary care clinical records for confirming the cardiovascular event. Data was also requested from the Spanish National Institute of Statistics as to the cause and date of death of the deceased individuals in the cohort.The overall AMI prevalence was 4% (95% CI: 3.4%, 4.5%); definite plus probable AMI being 6.2% (95% CI: 5.5-6.9). The definite AMI prevalence was higher among the mean 6.7% (95% CI: 5.63-7.79) than among the women, 2% (95% CI: 1.51-2.55) (p0.001). Hypertension prevalence according to JNCV1 criteria was 68%, hypercholesterolemia 26.4% according to NCEP criteria, diabetes prevalence 13.4% according to WHO criteria, and 11.3% were smokers. The cumulative incidence for a 3.2-year period for nonfatal definite AMI was 1.4% (95% CI: 1.1-1.8); 1.1% (95% CI: 0.74-1.37) probable AMI: 1.17 (IC95%: 0.824-1.48) for fatal definite AMI or death due to AMI and 1.13% (IC 95%: 0.824-1.48) for sudden death.The elderly population included in this study shows a high prevalence of cardiovascular risk factors, as well as ischemic heart disease incidence rates three times higher than those of the middle-aged adult population in Spain. The risk profile for women is significantly worse than for men, which may be due to the higher death rate at earlier ages among men.

The aim of this study was to describe the lipid profile, the levels of serum total cholesterol (TC), LDL cholesterol (C-LDL), HDL cholesterol (C-HDL) and triglyceride (TG), to compare these levels between geographical areas and to estimate the prevalence of dyslipidemia in elderly residents (65 years and older) from urban and rural areas of Spain.Epidemiological, observational, multicentre study of Spanish elderly people residents (or= 65 years old) of 3 communities in 3 Spanish regions: Arévalo (Avila) and Begonte (Lugo) as rural areas and Lista (Central Madrid) as urban area. Stratified randomized sample by age and sex from population census of each area. The participation rate was: 84.6%. At-home interviews (phase 1) (n = 4522): with determination of capillary blood cholesterol levels (Reflotron) and clinical visit (phase 2) (1/3 selected randomly, n = 1907): determination of serum TC levels (enzymatic colorimetric method CHOP-PAD), C-HDL, C-LDL (Friedewald equation) and TG (Trinder Method).Mean concentrations of TC was 230.3 (46.8) mg/dl. These levels decreased significantly with increasing age (p0.001), higher in women (p = 0.001); lower in Lugo (226.4 [49.7] mg/dl) than in Madrid (233.2 [42.3] mg/dl) and Arévalo (236.5 [43] mg/dl) (p = 0.002). Global prevalence of hypercholesterolemia by SEA simplified criteria was: 68.9% (95% confidence interval, 66.8-71). Mean concentrations of C-LDL was: 159.4 (37.9) mg/dl; C-HDL: 48.2 (15) mg/dl, and TG: 119.7 (63.85) mg/dl. 31% of cases were awarded about the hypercholesterolemia. Only 30% of them were under treatment with lipid lowering drugs; and 30% of the subjects showed CT concentrations200 mg/dl, with no differences by sex, age, study area or education level. Female sex, urban habitat and hypertension were the only variables independently associated to hypercholesterolemia in the logistic model.The prevalence of dyslipidemia is slightly higher to SEA estimation for the European elderly population (50%), greater in women and in younger groups. The awareness, treatment and control of hypercholesterolemia are low among the Spanish elderly population.

Fundamentos: A pesar de que la incidencia de cardiopatia isquemica es mas alta en sujetos mayores de 65 anos, la mayor parte de la investigacion cardiovascular se ha centrado en la poblacion adulta de mediana edad, careciendo en Espana hasta la fecha de un estudio de cohortes en este grupo de poblacion. El objetivo de este trabajo es revisar el papel y la metodologia de los estudios de cohortes como herramienta epidemiologica imprescindible para la investigacion de la prevalencia e incidencia de angina, IAM, ictus, y sus principales factores de riesgo cardiovascular. Metodos: Estudio de cohortes en tres zonas de Espana: Madrid (barrio de Lista), Arevalo (Avila) y Begonte (Lugo). Muestra aleatoria estratificada por edad y sexo a partir de los padrones municipales de cada zona y municipio (n=5,079). Evaluacion basal de la cohorte en dos fases: domiciliaria mediante encuesta estructurada para cribado de enfermedad isquemica cardiaca y factores de riesgo clasicos (hipertension, dislipemia, diabetes y tabaquismo) y clinica para confirmacion de casos. En la fase de seguimiento se utilizo el «metodo de busqueda en frio» del proyecto MONICA modificado para la busqueda e indagacion de casos incidentes usando todos los informes clinicos hospitalarios y de atencion primaria para la confirmacion del evento cardiovascular. Adicionalmente se solicito al INE informacion sobre causa y fecha de la muerte de los individuos de la cohorte fallecidos. Resultados: La prevalencia global de IAM seguro fue del 4% (IC 95%: 3,4% y 4,5%), y de IAM seguro mas probables del 6,2% (IC 95%: 5,5-6,9). La prevalencia de IAM seguro fue mas elevada en los varones 6,7 % (IC 95%:5,63-7,79) que en las mujeres, 2% (IC 95%:1,51-2,55) (p< 0,001). La prevalencia de hipertension segun criterios JNCVI fue 68%, de hipercolesterolemia 26,4% segun criterios del NCEP, de diabetes 13,4% segun criterios de la OMS y el 11,3% eran fumadores. La incidencia acumulada en 3,2 anos de IAM seguro no fatal fue del 1,4% (IC 95%: 1,1-1,8); 1,1% (IC95%:0,74-1,37) de IAM posible; 1,17 (IC95%: 0,824-1,48) de IAM seguro fatal o muerte por IAM y 1,13% (IC 95%: 0,824-1,48) de muerte subita. Conclusiones: La poblacion de ancianos incluida en este estudio presenta una elevada prevalencia de factores de riego cardiovascular, asi como tasas de incidencia de cardiopatia isquemica tres veces superiores a las de la poblacion adulta espanola de mediana edad. En las mujeres, el perfil de riesgo es significativamente peor que en los hombres, lo que puede ser debido a la mayor mortalidad en edades mas precoces en el sexo masculino.

Objective: To analyze the causes of death in two neurodegenerative disorders: AD, PD, and in vascular dementia (VaD) from the Neurologic Disorders in Central Spain (NEDICES). Background Several mortality studies have demonstrated a negative association among some complex diseases (Alzheimer disease –AD-, Parkinson disease –PD-, Down syndrome and others), and cancer as cause of death. Design/Methods: NEDICES is an elderly population-based cohort that investigated neurological disorders and general health in three areas of Central Spain. The mortality status has been evaluated linking the participants with the National Death Registry (NDR) of Spain from the cohort baseline from 1994 until 31-12-2007. The cause of death analyzed was the official cause of death in the NDR. In several logistic regression analyses the Risk Ratio (RR) of the main causes of death were evaluated in AD, PD and VaD cases, adjusted by age, sex and cultural level. Results: The NEDICES cohort was integrated by 5,278 participants. 2,810 were death during the follow up (range: 0-14.7 years). 306 dementia (207 AD and 44 VaD; 54 other and unknown etiology) and 81 PD cases were detected in the baseline study. The cancer diagnosis as cause of death in the NDR were 10 in AD cases; 10 in PD; 2 in VaD cases, and 674 in the rest of death participants.In the logistic regression analysis the adjusted RR for cancer in AD was 0.3 (CI95% =0.2-0.9); p Conclusions: The NEDICES cohort confirmed previous reports of an inverse relationship among AD and PD and cancer as cause of death. This association was not present in VaD. These findings suggest that this association is biologically motivated for an unknown mechanism. Supported by: Fundacion Mutua Madrilena, FIS 93/0773, and Network Center for Neurodegenerative Diseases Research (CIBERNED). Carlos III Institute, Madrid. Spain. Disclosure: Dr. Bermejo-Pareja has nothing to disclose. Dr. Benito-Leon has nothing to disclose. Dr. Trincado has nothing to disclose. Dr. Vega has nothing to disclose. Dr. Villarejo Galende has nothing to disclose. Dr. Posada Rodriguez has nothing to disclose. Dr. Medrano has nothing to disclose. Dr. Louis has nothing to disclose.

Background:Self-perceived health is a well-recognised predictor of later health outcomes and mortality, but its relationship to incident dementia has been scarcely explored.Objective:To analyze self- perceived health as a risk factor for dementia and Alzheimer disease (AD) in a population- based survey of the elderly (NEDICES) Study.Methods:Participants were evaluated at baseline (1994-1995) with a standardized questionnaire that included subjective and objective (chronic disorders) health status and screening questions for depression and neurologic disorders. At follow-up (a median of 3.2 years later in 1997-1998) an analogous protocol and neurological assessment were performed.Results:Of 5,278 participants evaluated at baseline there were 306 prevalent dementia cases, and 161 incident dementia cases were identified among 3,891 individuals assessed at follow-up (D: 115).Cox hazard ratio analyses showed that age, stroke and illiteracy were independent risk factors for dementia and AD. Aggregation of vascular risk factors was related to a higher risk of both dementia and AD. Good (and very good) versus less than good (fair, bad and very bad) self-perceived health was an independent risk factor for dementia (CI 95% 1.13- 2.16; p= .006) and AD (CI 95% 1.02- 2.18; p= .038) after adjusting by age, sex education and vascular risk factors.Discussion:Self-perceived health increased the risk for incident dementia and AD in the NEDICES cohort as it was previously described in the United Kindom MRC- CFA Study of dementia incidence. Global health measurements (self-perceived health, quality of life) needs farther studies as risk for dementia and AD.

Introduction Several studies suggested a role of 'oxidative stress' (increased production of prooxidants, antioxidants deficiencies or both) in the pathogenesis of Parkinson's disease. In this study we have measured the serum levels of a number of prooxidant and antioxidant substances to evaluate their possible relation with the risk for Parkinson's disease. Patients and methods We assessed the serum levels of iron, ferritin, ansferrin, ceruloplasmine, vitamin A, alpha-carotene, beta-carotene, and alpha-tocopherol, in 28 patients with Parkinson's disease and 85 matched controls. All of them were recruited from a population study. Results None of the values studied differed significantly between the two study groups, and none of them were correlated with age at onset, duration of the disease, scores of the Unified Parkinson Disease Rating Scale or the Hoehn and Yahr staging in the Parkinson's disease group. Conclusions These results confirm the previous findings of classic case-control studies, suggesting the absence of relationship of the studied values with the risk for Parkinson's disease.