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Resumen: Introducción. La enfermedad pulmonar obstructiva crónica es una enfermedad común, prevenible y tratable. Constitu- ye en la actualidad la 4a causa de mortalidad a nivel mundial con tendencia ascendente. Es una entidad muy infradiag- nosticada, que supone un elevado gasto a la Sanidad Pública y una importante pérdida de calidad de vida de las perso- nas que la padecen. En la actualidad no existe un programa de cribado eficaz y el seguimiento de los pacientes es una tarea difícil. Material y métodos. Se ha realizado una búsqueda sistemática de artículos relacionados con el manejo de la EPOC basado en el uso de las tecnologías. Las bases de datos utilizadas han sido: MEDLINE, Web of Science y Cochrane Library, además de las páginas web de organismos como WHO, SEPAR y GOLD. Se han incluido un total de 12 ar- tículos. Resultados. Del total de 12 artículos, 7 encontraron beneficios estadísticamente significativos de la aplicación de estas intervenciones en comparación con la asistencia sanitaria habitual. Entre los beneficios observados se encuentran un aumento de la adherencia a los tratamientos, un aumento de la calidad de vida, un mejor control sintomático y una re- ducción del número de exacerbaciones agudas. Conclusiones. La telemedicina es una herramienta potente que ofrece un amplio abanico de posibilidades para el mane- jo de la EPOC: telemonitorización, coaching electrónico, prevención temprana de las exacerbaciones, screening, tele- rehabilitación... Sin embargo, las evidencias existentes son insuficientes por lo que se requieren estudios potentes para poder extraer conclusiones firmes. Palabras clave: telemedicina; EPOC; telemonitorización; telerehabilitación. Abstract: Introduction. Chronic Obstructive Pulmonary Disease is a common, preventable and treatable disease. It is currently the 4th cause of mortality worldwide with an upward trend. It is a underdiagnosed entity, which implies a high cost to Public Health, and a huge loss of quality of life for the people who suffer it. Currently, there is no effective screening program, and follow-up is a difficult task. Material and methods. A systematic review was made of articles related to the management of COPD based on the use of the technologies. The databases used were: MEDLINE, Web of Science and Cochrane Library in addition to the websites of organizations such as WHO, SEPAR and GOLD. A total of 12 articles have been included. Results. Of the total of 12 articles, 7 found statistically significant benefits of the application of these interventions in comparison with the usual healthcare. Among the benefits there is an increase in treatment adherence, an increase in quality of life, better control of their symptoms and a reduction in the number of accute exacerbations. Conclusions. Telemedicine is a powerful tool that offers a wide range of possibilities for the management of COPD: telemonitoring, electronic coaching, early prevention of exacerbations, screening, telerehabilitation... However, the existing evidence is weak so it is required the development of powerful studies in order to establish firm conclusions. Keywords: telemedicine; COPD; telemonitoring; telerehabilitation.

Introducción. El coste del tabaquismo en vidas, sufrimiento y dinero es muy importante. El objetivo de nuestro estudio es realizar una evaluación fármaco-económica de los tratamientos utilizados en un entorno clínico en Albacete. Material y métodos. 1484 pacientes que acudieron a la Unidad de Tratamiento Especializado en Tabaquismo del Complejo Hospitalario Universitario de Albacete desde el 1 de Enero de 2008 hasta el 31 de Diciembre de 2012, reali- zándose estudio retrospectivo donde se recogieron variables relacionadas con el éxito y fracaso, además de con el uso de los diferentes tratamientos. Se utilizaron la Chi-cuadrado y la prueba exacta de Fisher. Para variables cuantitativas se utilizó el ANOVA y la V de Cramer para la correlación. Resultados. Los costes por éxito: el psicológico, 583 euros (€); la vareniclina, 1828 €; el bupropion, 1230 € y la TSN, 2038 €. El coste por el paciente que no había fracasado fue de 806 € para la vareniclina, 495 € para el bupropion, 585 € para la TSN y 307 € para la psicológica. Conclusión. Los tratamientos antitabáquicos son medidas eficientes para el sistema sanitario.

Rocío Fernández-Ballesteros1, Juan Botella1, María Dolores Zamarrón1, María Ángeles Molina1, Emilia Cabras1, Rocío Schettini1, Lluis Tárraga21Autonomous University of Madrid, Madrid, Spain; 2ACE Foundation, Catalonian Institute of Applied Neurosciences, Barcelona, SpainAbstract: The main goal of the present study is to examine to what extent age and cognitive impairment contribute to learning performance (cognitive plasticity, cognitive modifiability, or learning potential). To address this question, participants coming from four studies (Longitudinal Study of Active Aging, age range, 55–75 years, N = 458; Longitudinal Study in the very old [90+], age range, 90–102, N = 188, and Cognitive Plasticity within the Course of Cognitive Impairment, 97 “Normal”, 57 mild cognitive impairment [MCI], and 98 Alzheimer's disease [AD] patients) were examined through a measure of verbal learning (developed from Rey). The results show that all age, MCI, and AD groups learned across the five learning trials of that test, but significant differences were found due to age, pathology, and education. The effects of pathology (MCI and AD) can be expressed in a metric of “years of normal decline by age”; specifically, being MCI means suffering an impairment in performance that is equivalent to the decline of a normal individual during 15 years, whereas the impact of AD is equivalent to 22.7 years. Likewise, the improvement associated with about 5 years of education is equivalent to about 1 year less of normal aging. Also, the two pathological groups significantly differed from “normal” groups in the delayed trial of the test. The most dramatic difference is that between the “normal” group and the AD patients, which shows relatively poorer performance for the AD group in the delayed trial than in the first learning trial. The potential role of this unique effect for quick detection purposes of AD is assessed (in the 75–89 years age range, sensitivity and specificity equal 0.813 and 0.917, respectively).Keywords: cognitive plasticity, cognitive modifiability, learning age, aging, Alzheimer's disease, mild cognitive impairment

Introduction: Genome-wide association studies (GWAS) are fundamental for identifying loci associated with diseases. However, they require replication in other ethnicities., Methods: We performed GWAS on sporadic Alzheimer's disease (AD) including 539 patients and 854 controls from Argentina and Chile. We combined our results with those from the European Alzheimer and Dementia Biobank (EADB) in a meta-analysis and tested their genetic risk score (GRS) performance in this admixed population., Results: We detected apolipoprotein E ε4 as the single genome-wide significant signal (odds ratio  = 2.93 [2.37-3.63], P = 2.6 × 10 -23 ). The meta-analysis with EADB summary statistics revealed four new loci reaching GWAS significance. Functional annotations of these loci implicated endosome/lysosomal function. Finally, the AD-GRS presented a similar performance in these populations, despite the score diminished when the Native American ancestry rose., Discussion: We report the first GWAS on AD in a population from South America. It shows shared genetics modulating AD risk between the European and these admixed populations., Highlights: This is the first genome-wide association study on Alzheimer's disease (AD) in a population sample from Argentina and Chile. Trans-ethnic meta-analysis reveals four new loci involving lysosomal function in AD. This is the first independent replication for TREM2L, IGH-gene-cluster, and ADAM17 loci. A genetic risk score (GRS) developed in Europeans performed well in this population. The higher the Native American ancestry the lower the GRS values., (© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Mosaic loss of chromosome Y (mLOY) is a common ageing-related somatic event and has been previously associated with Alzheimer's disease (AD). However, mLOY estimation from genotype microarray data only reflects the mLOY degree of subjects at the moment of DNA sampling. Therefore, mLOY phenotype associations with AD can be severely age-confounded in the context of genome-wide association studies. Here, we applied Mendelian randomisation to construct an age-independent mLOY polygenic risk score (mloy-PRS) using 114 autosomal variants. The mloy-PRS instrument was associated with an 80% increase in mLOY risk per standard deviation unit ( p = 4.22 × 10 -20 ) and was orthogonal with age. We found that a higher genetic risk for mLOY was associated with faster progression to AD in men with mild cognitive impairment (hazard ratio (HR) = 1.23, p = 0.01). Importantly, mloy-PRS had no effect on AD conversion or risk in the female group, suggesting that these associations are caused by the inherent loss of the Y chromosome. Additionally, the blood mLOY phenotype in men was associated with increased cerebrospinal fluid levels of total tau and phosphorylated tau181 in subjects with mild cognitive impairment and dementia. Our results strongly suggest that mLOY is involved in AD pathogenesis.

The use of optical coherence tomography (OCT) has been suggested as a potential biomarker for Alzheimer's Disease based on previously reported thinning of the retinal nerve fiber layer (RNFL) in Alzheimer's disease's (AD) and Mild Cognitive Impairment (MCI). However, other studies have not shown such results. 930 individuals (414 cognitively healthy individuals, 192 probable amnestic MCI and 324 probable AD) attending a memory clinic were consecutively included and underwent spectral domain OCT (Maestro, Topcon) examinations to assess differences in peripapillary RNFL thickness, using a design of high ecological validity. Adjustment by age, education, sex and OCT image quality was performed. We found a non-significant decrease in mean RNFL thickness as follows: control group: 100,20 ± 14,60 µm, MCI group: 98,54 ± 14,43 µm and AD group: 96,61 ± 15,27 µm. The multivariate adjusted analysis revealed no significant differences in mean overall (p = 0.352), temporal (p = 0,119), nasal (p = 0,151), superior (p = 0,435) or inferior (p = 0,825) quadrants between AD, MCI and control groups. These results do not support the usefulness of peripapillary RNFL analysis as a marker of cognitive impairment or in discriminating between cognitive groups. The analysis of other OCT measurements in other retinal areas and layers as biomarkers for AD should be tested further.

Mutations in three genes (PSEN1, PSEN2, and APP) have been identified in patients with early-onset (<65 years) Alzheimer's disease (AD). We performed a screening for mutations in the coding regions of presenilins, as well as exons 16 and 17 of the APP gene in a total of 231 patients from the Iberian peninsular with a clinical diagnosis of early-onset AD (mean age at onset of 52.9 years; range 31-64). We found three novel mutations in PSEN1, one novel mutation in PSEN2, and a novel mutation in the APP gene. Four previously described mutations in PSEN1 were also found. The same analysis was carried in 121 elderly healthy controls from the Iberian peninsular, and a set of 130 individuals from seven African populations belonging to the Centre d'Etude du Polymorphisme Humain-Human Genome Diversity Panel (CEPH-HGDP), in order to determine the extent of normal variability in these genes. Interestingly, in the latter series, we found five new non-synonymous changes in all three genes and a presenilin 2 variant (R62H) that has been previously related to AD. In some of these mutations, the pathologic consequence is uncertain and needs further investigation. To address this question we propose and use a systematic algorithm to classify the putative pathology of AD mutations., ((c) 2008 Elsevier Inc. All rights reserved.)

Background: In recent years, it has been claimed that learning potential (also called cognitive plasticity or rehabilitation potential) may be a good predictor of the course of cognitive impairment and the process of dementia. The basic objective of this research program is to test the extent to which the "Battery of Learning Potential for Assessing Dementia" (BEPAD) discriminates healthy people from those diagnosed with Mild Cognitive Impairment (MCI) and with Alzheimer's Disease (AD)., Methods: Two hundred people: 100 healthy elders (51 women, 49 men, mean age: 73.13), 50 diagnosed with MCI (30 women, 20 men, mean age: 74.89), and 50 diagnosed with mild AD (36 women, 14 men, mean age: 75.07). Learning potential was assessed through dynamic assessment (or testing-the-limits), using experimental test-training-post-test, a form of evaluation closely related to functional or stress testing in medicine. In several previous studies the BEPAD was developed, with four tasks: visuo-spatial, verbal recall (including delayed verbal recall), executive control and verbal fluency. For all of these tasks, training procedures were developed, converting them into learning potential tests., Results and Conclusions: All "dynamic" or learning scores (post-test) discriminate better healthy, MCI and AD subjects than all static or pre-test scores. A total of 89% of cases are correctly classified by the BEPAD: 95.7% of the healthy subjects, 90.6% of AD patients, and 71.1% of the MCI individuals were correctly classified.

Objective: To evaluate if nutritional supplementation with or without micronutrient enhancement prevent weight loss and the progression of the disease in mild Alzheimer's Disease (AD) patients., Design: Mild AD patients were recruited from an Alzheimer Day Centre. Subjects received oral liquid supplements with (Study-group: S) or without (Control-group: C) micronutrient enhancement. Intake assessment, nutritional status, biochemical parameters, cognitive function, and eating behaviour disorders were determined at baseline and at 6 months of treatment., Results: At baseline both groups were not different in any variable measured. They were norm nourished, with normal biochemical parameters. Blandford scale demonstrated a mild alteration of feeding behaviour, the cognitive scale classified the patients as impaired and there was presence of memory complaints. After 6 months of nutritional supplements, a similar increase in energy consumption was observed in both groups of patients (P<0.05). In the within-group analysis, we found a trend (P=0.05) to increase body mass index; a significant increase in triceps skin fold thickness, mid-upper-arm circumference and serum magnesium, zinc and selenium, and a significant reduction in serum vitamin E (P<0.001, each). Serum cholesterol decreased substantially only in the S-group (P=0.025). No significant differences at baseline, within-group, neither between-group analysis in feeding behaviour nor in cognitive function were observed., Conclusions: According to our results no benefits in the progression of the disease was observed with micronutrient enhancement supplements. Effectiveness of nutritional supplements in preventing weight loss in mild AD patients showed a similar behaviour as observed in other populations. Due to the beneficial evolution of serum cholesterol in the S-group, this intervention deserves further investigation.

Neuropsychiatric manifestations are common in Alzheimer's disease (AD) and their phenotypic expression might be related to physiopathological and genetic causes. Multiple studies have implicated oxidative stress to the pathogenesis and possible etiology of AD. One of the mechanisms to protect cells from oxidative stress is the expression of heat-shock proteins (HSP). HSPA1B (alternatively known as HSP70-2) has been related to AD pathophysiology. In the present analysis, 77 AD patients were classified according to their cognitive status with the Neuropsychiatric Inventory and were genotyped for an insertion/deletion (A1/A2) polymorphism. The A2 allele conferred a significant increase of psychiatric morbidity in an allele-dose manner (P < .05). This pattern can be attributed to all AD stages and the severity of the behavioral disturbances was higher for those patients carrying one or two A2 alleles. These results indicate a possible association between the A2 allele and an overexpression of noncognitive symptoms in AD.

Background: Besides the repeated association between the epsilon 4 allele of the apolipoprotein E and Alzheimer's disease, several candidate genes have been analysed with inconsistent results. Most of these studies have examined only one or two polymorphisms in a defined population, which provides a lack of a general view of the Alzheimer's disease genetic component., Objective: To overcome this limitation, nine polymorphisms in seven different candidate genes (A2M, ACT, APOE, APP, BH, HSP70-2, and IL1-A) were genotyped., Methods: The sample comprised 112 Alzheimer's disease patients and 89 controls from Spain. Since haplotype reconstruction may add power to association studies, we also tested for linkage disequilibrium within the A2M and APOE genes., Results: Except for the APOE gene, allele and genotype frequencies were not different between cases and controls, even when stratifying for the APOE genotype., Conclusion: The present results suggest that future association studies should be performed using a battery of polymorphisms in different and new candidate genes, taking into account the linkage disequilibrium in the region.

Background: The Neuropsychiatric Inventory (NPI) is a validated clinical instrument for the evaluation of psychopathology in dementia., Objective: To validate a brief questionnaire form of the NPI (NPI-Q) in Spanish from NPI-Q original version, intended for use in routine clinical practice., Patients and Method: We have developed a crossed validated form between NPI and NPI-Q in 120 Alzheimer's disease patients., Results: Test-retest reliability of the NPI-Q, using Pearson correlation index was r = 0.89 for total symptom scale and r = 0.90 for distress scale. The prevalence of analogous symptom ratings differed by less than 6.7%. Convergent validity between NPI-Q and NPI, using Pearson correlation index was r = 0.879 for total symptom and r = 0.92 for distress scale., Conclusions: The NPI-Q Spanish version offers the possibility to use a reliable and brief instrument that can be used as a screening in the evaluation of neuropsychiatric symptoms in dementia and associated caregiver distress. It may be suitable for use in general clinical practice and it could be used as a brief neuropsychiatric interview.

The aim of the study is to carry out a clinico-epidemiological study of the part of Barcelona's population over the age of 65 that suffers from cognitive deterioration, users of 'Casal d'Avis' (Old-folks centres). 369 users of 'Casals d'Avis' were studied. A specific questionnaire was used to collect the following data: personal details, social and family situation, health profile and a quantification of their degree of cognitive degeneration using Lobo's cognitive test. The quantitative and qualitative variables were studied statistically, and the arithmetical average and standard deviation were found, as well as which bivariant hypothesis tests and multivariant analyses, using the logistic regression method, were carried out. The degree of cognitive deterioration is 8.67%. Age, female sex, being widowed or single, and illiteracy are associated with low scoring in the MEC. It is also associated with subjective loss of memory and hearing difficulties. The multivariant analyses are influenced by length of schooling, age and sex. Early detection of cognitive deterioration and the supply of resources and services oriented towards cognitive stimulation and social integration would, if well-planned, do away with the need for their confinement.

The aim of the study is to carry out a clinico-epidemiological study of the part of Barcelona's in-patients of 'Health-centers/Nursing-homes' elderly people that suffers from cognitive deterioration. 363 in-patients of 'Health-centers/Nursing homes' were studied. A specific questionnaire was used to collect the following data: Personal details, social and family situation, health profile and quantification of their degree of cognitive deterioration using Lobo's cognitive test. The quantitative and qualitative variables were studied statistically, and the arithmetical average and standard deviation were found, as well as which bivariant hypothesis tests and multivariant analyses, using the logistic regression method, were carried out. Adjusted degree of cognitive deterioration was 56%. The age, the fact that the patients were female, illiteracy and working as house-wives all made for low MEC ratings. Variables such as health, subjective memory loss, the presence of cerebral vascular pathology an hypercholesterolemia behaved in a similar fashion. Age, female sex, illiteracy and being a house-wife are associated with low scoring in the cognitive test, as well as subjective loss of memory, cerebral vascular pathology and hypercholesterolemia. The multivariant analyses are affected by: age and length of schooling. Were the in-patient group is concerned, functional remodelling of specific areas is indicated, and who have to be taken into care as a result of the seriousness of deterioration their dependence and their need for assistance.