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AIM: To synthesise international findings on the alcohol-dementia relationship, including representation from low- and middle-income countries. METHODS: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24,478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. RESULTS: At baseline, the mean age across studies was 71.8 (standard deviation 7.5, range 60-102 years), 14,260 (58.3%) were female, and 13,269 (54.2%) were current drinkers. During 151,636 person-years of follow-up, there were 2,124 incident cases of dementia (14.0 per 1,000 person-years). When compared with abstainers, the risk for dementia was lower in occasional (hazard ratio [HR]: 0.78; 95% confidence interval [CI]: 0.68-0.89), light-moderate (HR: 0.78; 95% CI: 0.70-0.87) and moderate-heavy drinkers (HR: 0.62; 95% CI: 0.51-0.77). There was no evidence of differences between lifetime abstainers and former drinkers in terms of dementia risk (HR: 0.98; 95% CI: 0.81-1.18). In dose-response analyses, moderate drinking up to 40g/day was associated with a lower risk of dementia when compared with lifetime abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol-dementia relationship. CONCLUSIONS: Abstinence from alcohol appears to be associated with an increased risk for all-cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk.

Vascular dementia (DV) is the second cause of dementia with 15.8-20% of cases. Previous studies of the effect of occupation in DV do not show conclusive results, therefore, the objective was to analyze if the type of occupation can vary the risk of developing DV in those older than 55 years.In the ZARADEMP project, a community sample of 4,803 individuals were followed longitudinally in four waves. The occupation was classified following the National Classification of Occupations (CNO-11) and the International Standard Classification of Occupations (ISCO-08). Different standardized instruments were used: the medical and psychiatric histories (History and Aetiology Schedule) and other risk factors (Mini-Mental Status Examination, Geriatric Mental State-AGECAT). For this study, we calculated incidence rates, incidence rate ratios and hazard ratios in multivariate Cox regression models, stratified by gender. For this study, we included 3,883 participants.In women, the risk of DV was doubled in Blue-collar workers, with a moderate effect (Cohen's d=0.54) and multiplying by 2.7 in Homeworks respect to White Collar with a moderate effect (Cohen's d=0.77), although they did not reach statistical significance. We did not observe the effect of occupation on the risk of DV in men.We have found a moderate but non-significant effect between occupation and DV risk in women. We found no effect of occupation on the risk of VD in males while other clinical factors (age, diabetes or body mass index) presented a clearer effect than the occupation.

Resumen Introduccion La demencia vascular (DV) representa la segunda causa de demencia, con el 15,8-20% de los casos. Dado que los estudios previos del efecto de la ocupacion en DV no muestran resultados concluyentes, nuestro objetivo fue analizar si el tipo de ocupacion varia el riesgo de desarrollar DV en mayores de 55 anos. Material y metodos El proyecto ZARADEMP evaluo inicialmente una muestra comunitaria de 4.803 individuos seguidos durante 4 olas. La ocupacion se clasifico siguiendo la Clasificacion Nacional de Ocupaciones de 2011 y la Clasificacion Internacional Uniforme de Ocupaciones de 2008. Se utilizaron diferentes instrumentos estandarizados: las historias medicas y psiquiatricas (History and Aetiology Schedule) y otros factores de riesgo (Mini-Mental Status Examination, Geriatric Mental State-AGECAT). Para este estudio, se calcularon tasas de incidencia, razon de tasas de incidencia y hazard ratio en modelos multivariados de regresion de Cox, estratificados por sexo. Han sido incluidos 3.883 participantes Resultados En mujeres, el riesgo de DV se duplico en trabajadoras de cuello azul, con un efecto moderado (d de Cohen = 0,54), y se multiplico por 2,7 en labores del hogar respecto a cuello blanco, con un efecto moderado (d de Cohen = 0,77), aunque sin significacion estadistica. No observamos efecto de la ocupacion en el riesgo de DV en varones. Conclusiones Hemos encontrado un efecto moderado, pero no significativo, entre la ocupacion y el riesgo de DV en mujeres. No hallamos efecto de la ocupacion en el riesgo de DV en varones, donde otros factores de riesgo (la edad, tener diabetes o el indice de masa corporal) tienen un efecto mas claro que la ocupacion laboral.

En las últimas décadas, la nutrición se ha convertido en un tema de interés social, debido a la problemática en países del primer mundo, relacionada con hábitos de vida inadecuados y su consecuente sobrepeso. Es una cuestión que se extiende a niños y niñas en edades escolares, por tanto, la creación de intervenciones nutricionales que atiendan necesidades específicas para este tipo de muestra se torna imprescindible. Además, el calentamiento global lleva a la necesidad de educar a futuras generaciones sobre la importancia de nuestra forma de alimentarnos, y el impacto que tiene en el medio ambiente, con el fin de tener un sistema de consumo alimentario más sostenible. Este trabajo tiene como objetivo diseñar una intervención nutricional sistemática y que haga uso de una metodología científica, con el fin de que sea lo más efectiva posible. El contexto en el que se ha basado esta intervención es un colegio situado en una zona semi rural, y está dirigida a alumnado de edades de infantil y primaria. Para ello se ha usado el método DESIGN, el cual es sencillo y directo, permite abordar los comportamientos que queremos cambiar de manera específica. El resultado obtenido es el diseño de una intervención nutricional, en la que se imparten talleres de cocina y otras actividades. En el trabajo encontramos una guía para docentes, con talleres de cocina, varias recetas y actividades relacionadas con el producto local y de temporada.

Contains fulltext : 248846.pdf (Publisher’s version ) (Closed access) IMPORTANCE: The optimal systolic blood pressure (SBP) to minimize the risk of dementia in older age is unknown. OBJECTIVE: To investigate whether the association between SBP and dementia risk is U-shaped and whether age and comorbidity play a role in this association. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used an individual participant data approach to analyze 7 prospective, observational, population-based cohort studies that were designed to evaluate incident dementia in older adults. These studies started between 1987 and 2006 in Europe and the US. Participants had no dementia diagnosis and had SBP and/or diastolic blood pressure (BP) data at baseline and incident dementia status during follow-up. Data analysis was conducted from November 7, 2019, to October 3, 2021. EXPOSURES: Baseline systolic BP. MAIN OUTCOMES AND MEASURES: All-cause dementia (defined using Diagnostic and Statistical Manual of Mental Disorders [Third Edition Revised] or Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] and established at follow-up measurements or in clinical practice), mortality, and combined dementia and mortality were the outcomes. Covariates included baseline antihypertensive medication use, sex, educational level, body mass index, smoking status, diabetes, stroke history, myocardial infarction history, and polypharmacy. Cox proportional hazards regression models were used, and nonlinear associations were explored using natural splines. RESULTS: The study analyzed 7 cohort studies with a total of 17 286 participants, among whom 10 393 were women (60.1%) and the mean (SD) baseline age was 74.5 (7.3) years. Overall, dementia risk was lower for individuals with higher SBP, with the lowest risk associated with an SBP of approximately 185 mm Hg (95% CI, 161-230 mm Hg; P = .001). Stratified by overlapping 10-year baseline age groups, the lowest dementia risk was observed at somewhat lower systolic BP levels in those older than 75 years (158 [95% CI, 152-178] mm Hg to 170 [95% CI, 160-260] mm Hg). For mortality, there was a clear U-shaped association, with the lowest risk at 160 mm Hg (95% CI, 154-181 mm Hg; P

Great inter-individual variability has been reported in the maintenance of cognitive function in aging. We examined this heterogeneity by modeling cognitive trajectories in a population-based longitudinal study of adults aged 55+ years. We hypothesized that (1) distinct classes of cognitive trajectories would be found, and (2) between-class differences in associated factors would be observed. The sample comprised 2403 cognitively healthy individuals from the Zaragoza Dementia and Depression (ZARADEMP) project, who had at least three measurements of the Mini-Mental State Examination (MMSE) in a 12-year follow-up. Longitudinal changes in cognitive functioning were modeled using growth mixture models (GMM) in the data. The best-fitting age-adjusted model showed 3 distinct trajectories, with 1-high-to-moderate (21.2% of participants), 2-moderate-stable (67.5%) and, 3-low-and-declining (9.9%) cognitive function over time, respectively. Compared with the reference 2-trajectory, the association of education and depression was significantly different in trajectories 1 and 3. Instrumental activities of daily living (iADLs) were only associated with the declining trajectory. This suggests that intervention strategies should be tailored specifically to individuals with different trajectories of cognitive aging, and intervention strategies designed to maintain cognitive function might be different from those to prevent decline. A stable cognitive performance (‘successful cognitive aging’) rather than a mild decline, might be more ‘normal’ than generally expected.

Physical activity (PA) reduces the risk of cognitive decline (CD) in the general population. However, little is known about whether the presence of the apolipoprotein E epsilon 4 allele (APOE e4) could modify this beneficial effect. The aim of this systematic review was to analyze and synthetize the scientific evidence related to PA levels and CD risk in cognitively healthy APOE e4 carriers. Four electronic databases were analyzed. Only original articles with longitudinal study design were selected to analyze the relationship between PA and CD in APOE e4 carriers. Five studies were included in the systematic review. All studies except one stated that PA is a protective factor against CD in APOE e4 carriers. Moreover, partial support was found for the hypothesis that a greater amount and intensity of PA are more beneficial in CD prevention. The results support the idea that PA is a protective factor against CD in APOE e4 carriers. Nevertheless, it would be necessary to carry out further studies that would allow these findings to be contrasted.

Objective To gather consensus on professional competencies and basic public health content for the degree program in Human Nutrition and Dietetics (HND). Design In 2018, the Fifth Meeting of University Public Health Professors took place in Zaragoza (Spain). Fourteen lecturers in the HND degree program participated from 11 Spanish universities. They identified competencies and basic content for training for the HND degree using group dynamics and consensus strategies. Results The professors identified 51 basic competencies, distributed in the areas of “evaluation of population health needs” (n = 20), “development of health policies” (n = 23), and “guaranteeing provision of health care services” (n = 8). In order to reach these competencies, 35 topics were proposed organized into six thematic blocks: foundations of public health, nutritional epidemiology, health problems and diet and nutrition strategies, food security, health in all policies and health promotion and education. Conclusion The consensus reached serves as a reference to orient and update public health education as a part of the HND degree.

Psychosomatic and liaison psychiatry is intended to be the contribution from psychiatry to the general field of medicine. The philosophical support for the discipline comes from both the traditional humanistic, medical view and the empirical or evidence-based approach. In relation to this approach, we state that epidemiological research is crucial for the development of the discipline. In this chapter we present examples of the contribution of epidemiology to document the prevalence and incidence of psychiatric morbidity in medical settings, for the establishment of the outcome, for the actuarial assessment of morbid risk, for the efficacy of the treatment of psychiatric problems in medical patients, and even for the conceptual construction of diagnosis and classification.

Background Dementia shows sex difference in its epidemiology. Childbirth, a distinctive experience of women, is associated with the risk for various diseases. However, its association with the risk of dementia in women has rarely been studied. Methods We harmonized and pooled baseline data from 11 population-based cohorts from 11 countries over 3 continents, including 14,792 women aged 60 years or older. We investigated the association between parity and the risk of dementia using logistic regression models that adjusted for age, educational level, hypertension, diabetes mellitus, and cohort, with additional analyses by region and dementia subtype. Results Across all cohorts, grand multiparous (5 or more childbirths) women had a 47% greater risk of dementia than primiparous (1 childbirth) women (odds ratio [OR] = 1.47, 95% confidence interval [CI] = 1.10–1.94), while nulliparous (no childbirth) women and women with 2 to 4 childbirths showed a comparable dementia risk to primiparous women. However, there were differences associated with region and dementia subtype. Compared to women with 1 to 4 childbirths, grand multiparous women showed a higher risk of dementia in Europe (OR = 2.99, 95% CI = 1.38–6.47) and Latin America (OR = 1.49, 95% CI = 1.04–2.12), while nulliparous women showed a higher dementia risk in Asia (OR = 2.15, 95% CI = 1.33–3.47). Grand multiparity was associated with 6.9-fold higher risk of vascular dementia in Europe (OR = 6.86, 95% CI = 1.81–26.08), whereas nulliparity was associated with a higher risk of Alzheimer disease (OR = 1.91, 95% CI 1.07–3.39) and non-Alzheimer non-vascular dementia (OR = 3.47, 95% CI = 1.44–8.35) in Asia. Conclusion Parity is associated with women’s risk of dementia, though this is not uniform across regions and dementia subtypes.

Aims To investigate the association between parity and the risk of incident dementia in women. Methods We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)). Results Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1–4 parities (HR = 1.30, 95% CI = 1.02–1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02–1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00–2.55), but the risk of AD was not significantly associated with parity. Conclusions Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.

Background: Factors affecting a rotator cuff symptomatic retear after arthroscopic repair have yet to be clearly identified, since they usually influence the surgical decisions. Methods: Consecutive patients with full-thickness tear of the supraspinatus who underwent arthroscopic repair were retrospectively analyzed. Cases of symptomatic retear, defined as Sugaya type IV and V on magnetic resonance imaging, associated with intensive pain and/or functional impairment were identified at follow-up. The patients with no symptomatic retear were selected as the control group. Information from potential risk factors of symptomatic retear, including depression and subacromial corticosteroid injections, was extracted from the medical records. The statistical analysis included multivariant logistic regression. Results: The symptomatic retear rate was 9.5% in 158 patients. Patients in the symptomatic retear group were more likely to be smoking, to have massive tears, a short acromiohumeral distance, and moderate to severe fatty infiltration. They also had had more frequently subacromial corticosteroid injections and depression. However, following the multiple logistic regression analysis, only massive tears and moderate to severe fatty infiltration remained significantly associated. Similarly, in relation to the study hypothesis, both corticosteroid injections (odds ratio [OR] 6.66, 95% confidence interval [CI] 1.49, 29.81; P =.013) and depression (OR 8.26, IC 1.04, 65.62; P =.046) were significantly associated with symptomatic retear risk. Conclusions: This study found support for the hypothesis that both depression and corticosteroid infiltration before surgery are independent risk factors for symptomatic retear after arthroscopic repair of rotator cuff.

Introduction Depression commonly accompanies Alzheimer's disease, but the nature of this association remains uncertain. Methods Longitudinal data from the COSMIC consortium were harmonized for eight population-based cohorts from four continents. Incident dementia was diagnosed in 646 participants, with a median follow-up time of 5.6 years to diagnosis. The association between years to dementia diagnosis and successive depressive states was assessed using a mixed effect logistic regression model. A generic inverse variance method was used to group study results, construct forest plots, and generate heterogeneity statistics. Results A common trajectory was observed showing an increase in the incidence of depression as the time to dementia diagnosis decreased despite cross-national variability in depression rates. Discussion The results support the hypothesis that depression occurring in the preclinical phases of dementia is more likely to be attributable to dementia-related brain changes than environment or reverse causality.

Objectives To test the hypothesis that differences by gender will be observed in the association of hip fracture risk with stages of cognitive impairment; and to explore the association between Petersen’s “mild cognitive impairment” (MCI) and DSM-5 “mild neurocognitive disorder” (MND). Study design A community sample of 4803 individuals aged 55+ years was assessed in a two-phase case-finding enquiry in Zaragoza, Spain, and was followed up for 16 years. Medical and psychiatric history was collected with standardized instruments, including the Mini-Mental Status Examination (MMSE), Geriatric Mental State (GMS), History and Aetiology Schedule, and a Risk Factors Questionnaire. The statistical analysis included calculations of Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. Main outcome measures Identified cases of hip fracture, validated by blind researchers. Results In men, hip fracture risk was increased at the “mild” (HR = 4.99 (1.39–17.91)) and at the “severe” (HR = 9.31 (1.35–64.06)) stages of cognitive impairment, indicated by MMSE performance. In contrast, in women no association could be documented at the “mild stage” (power = 89%), and the association disappeared altogether at the “severe stage” in the final multivariate statistical model (power 100%). No association observed between hip fracture and mild cognitive impairment in both men (power = 28% for P-MCI) and women (power = 44% and 19% for Petersen’s MCI and DSM-5 MND, respectively). Conclusions Increased hip fracture risk was associated with “mild” stages of cognitive impairment in men, but not in women. To explore the potential association with the construct MCI or MND, studies with greater statistical power would be required.

La Ciudad de las Niñas y los Niños es un proyecto internacional que pretende fomentar la autonomía y la participación infantil plena en la construcción de la ciudad. Tras aprobarse en 2011 en el pleno del Ayuntamiento de Huesca, se crearon el Consejo de las Niñas y los Niños y el Laboratorio de la Ciudad, órganos en los que hay representación de todos los colegios de Huesca. Para hacer explícito el trabajo sobre la salud se han incorporado actividades como «Caminos saludables», en la que se utiliza la técnica del mapeo de activos. Además del trabajo interdisciplinario entre distintas áreas del ayuntamiento, profesionales de los sectores educativo (colegios y universidad), sanitario y social, se observan impactos en el entorno físico urbano, con la remodelación de un parque, una calle y una plaza; y en los estilos de vida de los escolares, al aumentar el número de aquellos que van andando solos al colegio. The City of Girls and Boys of Huesca (Spain) is an international project that seeks to foster children''s autonomy and full participation in the construction of the city. Following its formal approval at the City Council of Huesca, the Girls and Boys Board and the City Laboratory were created, both of which include children from all the schools of Huesca. To highlightthe work on health, activities such as “Healthy School Paths”, in which the asset mapping technique is used, were incorporated. Besides the interdisciplinary work among different areas of the city council, professionals from education (schools and university), health and social services, effects on the urban physical environment, with one street, park and square remodelled; and on the children''s lifestyles, with more children walking to school alone, have been observed.La Ciudad de las Niñas y los Niños es un proyecto internacional que pretende fomentar la autonomía y la participación infantil plena en la construcción de la ciudad. Tras aprobarse en 2011 en el pleno del Ayuntamiento de Huesca, se crearon el Consejo de las Niñas y los Niños y el Laboratorio de la Ciudad, órganos en los que hay representación de todos los colegios de Huesca. Para hacer explícito el trabajo sobre la salud se han incorporado actividades como «Caminos saludables», en la que se utiliza la técnica del mapeo de activos. Además del trabajo interdisciplinario entre distintas áreas del ayuntamiento, profesionales de los sectores educativo (colegios y universidad), sanitario y social, se observan impactos en el entorno físico urbano, con la remodelación de un parque, una calle y una plaza; y en los estilos de vida de los escolares, al aumentar el número de aquellos que van andando solos al colegio.

A good level of nutrition literacy (NL) is proposed as a determinant factor for following a healthy diet. Improving seniors’ NL might be particularly pertinent to enhance the quality of their diets. This study aimed to systematically design and validate a short seniors-oriented questionnaire as a screening tool to evaluate NL. We developed the Myths-NL questionnaire, composed of 10 widespread nutrition myths, and checked for its content and face validity. An observational cross-sectional study was conducted to explore the validity and the test–retest reliability, involving a community-dwelling group of 316 individuals aged 65 years and over. Construct validity was proved by establishing both discriminant and convergent validity. Cronbach α = 0.61 and Spearman r = 0.79 (p = 0.02) demonstrated internal consistency and test–retest reliability. Participants who had secondary/university studies scored significantly higher compared with those with primary (p &lt, 0.001), and a significant linear relationship (R2 = 0.044, p = 0.001) with a positive slope (β = 0.209) between Mediterranean Diet Adherence Screener (MEDAS) and Myths-NL scores was observed, proving construct validity. In conclusion, the Myths-NL questionnaire is a valid and reliable tool to screen NL in Spanish seniors and it might be useful as an assessment NL tool for designing and implementing lifestyle interventions to promote healthy eating.

Objectives In view of differences in the prevalence and conversion rate to dementia of Petersen's (P-MCI) and DSM-5's (DSM-5-MCI) categories of mild cognitive impairment, this paper is intended to examine the diagnostic agreement between the categories and to analyze clinical factors related to the potential discrepancies. Method A representative population cohort of 4580 dementia-free individuals 55+ years of age was examined in Zaragoza, Spain (ZARADEMP). Validated Spanish versions of instruments, including the Geriatric Mental State-AGECAT, were used for assessment. Research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. Between-category differences were analyzed, and the statistical methods included the calculation of Cohen's Kappa coefficients of agreement, and the McNemar's test to compare the performance of the intermediate cognitive definitions. Results Diagnostic concordance in the classification of MCI cases was very limited. In the total sample, 2.7% of individuals did not meet the P-MCI criteria but met the DSM-5-MCI criteria; and 6.4% met the P-MCI criteria, but not the DSM-5-MCI criteria. Overlap of both categories was observed in only 0.6%. The overall Kappa (agreement between both MCI categories) was 0.08 (95% CI: 0.04–0.12; p While no between-category significant differences was observed in cognitive scores, relevant differences in the populations identified had to do with demographic, non-cognitive psychopathological factors, activities of daily living and general health factors. Conclusions This study shows ‘poor’ diagnostic agreement between the P-MCI and the DSM-5-MCI categories. The non-cognitive factors should receive special attention when trying to improve the validity of the MCI construct.

Purpose of review To identify recent advances in the field of dementia care in high-income countries. Recent findings New national and international initiatives identified support the notion of an increased commitment to face the challenge of dementia care. Recent research has documented barriers and facilitators to provide good care, and provided data on the specific needs of caregivers; the needs for better training of general practitioners; the negative influence of behavioural and psychological symptoms of dementia (BPSD); the palliative care needs; and the increased risk of dementia associated with anxiety (the population-attributable fraction of Alzheimer's risk was 6.1%). Significant advances in new technologies applicable in the care of dementia have also been reported. Summary The increased awareness of the needs in dementia care is promising, although the Organisation for Economic Co-operation and Development has alerted about the limited implementation of the programmes. Barriers and facilitators identified have implications for both clinical practice and research. Particular implications for psychiatric action have the findings on BPSDs and on the preventive potential of the treatment of anxiety detected in the community. The data on palliative care needs and particularly on the advances of new technologies also have clinical implications.

Contains fulltext : 204838.pdf (Publisher’s version ) (Open Access) The human social brain is complex. Current knowledge fails to define the neurobiological processes underlying social behaviour involving the (patho-) physiological mechanisms that link system-level phenomena to the multiple hierarchies of brain function. Unfortunately, such a high complexity may also be associated with a high susceptibility to several pathogenic interventions. Consistently, social deficits sometimes represent the first signs of a number of neuropsychiatric disorders including schizophrenia (SCZ), Alzheimer's disease (AD) and major depressive disorder (MDD) which leads to a progressive social dysfunction. In the present review we summarize present knowledge linking neurobiological substrates sustaining social functioning, social dysfunction and social withdrawal in major psychiatric disorders. Interestingly, AD, SCZ, and MDD affect the social brain in similar ways. Thus, social dysfunction and its most evident clinical expression (i.e., social withdrawal) may represent an innovative transdiagnostic domain, with the potential of being an independent entity in terms of biological roots, with the perspective of targeted interventions.

Objectives: To investigate whether clinically relevant anxiety increased the risk for developing Alzheimer''s disease (AD) while controlling for the presence of depression and other confounders; and to report the population attributable fraction (PAF) associated with anxiety disorder. Method: We used data from the longitudinal, community-based Zaragoza Dementia and Depression (ZARADEMP) study. A random sample of 4057 dementia-free community dwellers aged =55 years were followed for 4.5 years. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy package was used for the diagnosis of clinically significant cases and subcases of anxiety; and AD was diagnosed by a panel of research psychiatrists according to DSM-IV criteria. Multivariate survival analysis with competing risk regression model was performed. Results: We observed a significant association between anxiety cases at baseline and AD risk in the univariate analysis that persisted in the fully adjusted model (SHR: 3.90; 95% CI: 1.59–9.60; p = 0.003), with a PAF for AD of 6.11% (95% CI: 1.30%–16.17%). No significant association between ‘subcases’ of anxiety at baseline and AD risk was found. Limitations: Data on apolipoprotein E were not available. The hospital-based diagnosis was not completed in all cases of dementia. Conclusion: Late-life, clinically significant anxiety (but not subclinical anxiety) seems to increase the risk of AD, independently of the effect of several confounders, including depression. Taking into account the high prevalence of anxiety among the elderly, future studies are warranted to determine potential risk reduction of AD.

The burden of cognitive impairment and dementia is rapidly expanding with the aging of the population worldwide. Globally, the number of people living with dementia all over the world in 2015 was 46.8 million and is predicted to triple by 2050. In this chapter, we first describe the cognitive aging profile in women: they perform better than men in tasks related to memory. We then summarize epidemiological cognitive impairment and dementia data, specifically in women: despite controversial data for mild cognitive impairment (MCI), several data in literature support that the prevalence of dementia is higher among women, specifically Alzheimer’s disease (AD). We finally discuss the potential risk and protective factors for cognitive impairment and dementia, specifically in women when there is evidence in the available literature. Women have a higher life expectancy than men, and men who survive to older ages might be healthier and have fewer risk factors for dementia than women. Aside from this survival bias, other biological, societal, and cultural factors may affect women and men differently: estrogen depletion in menopause, depression, obesity, diabetes, hypertension, smoking, alcohol, educational and occupational attainment, and physical exercise. In conclusion, there is a need to prioritize dementia as a global women’s health issue, and future studies on cognitive impairment and dementia should stratify their analysis by sex: understanding factors related to cognitive impairment and dementia specifically in women is crucial for developing interventions for their prevention which target specifically to these factors.

Objective To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5–MCI) will be higher than using Petersen's criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI. Methods A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5–MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups. Results Compared with noncases, the mortality rate ratio was approximately double in DSM-5–MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5–MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories. Conclusion The mortality risk in comparison with noncases was higher in DSM-5–MCI than in P-MCI. The PAF of mortality in DSM-5–MCI individuals was ~ 1% over a 17-year period.

Objectives To examine the association between the principal lifetime occupation and the incidence of Alzheimer’s disease (AD) in men and women in a southern European population aged 55 years or more. Study design A community-dwelling sample of 3883 dementia-free individuals aged 55 years or over was classified according the Spanish National Classification of Occupations (CNO-11) and the International Standard Classification of Occupations (ISCO-08) in a four-wave epidemiological study. Medical and psychiatric histories were collected using standardized instruments, including the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS), the Geriatric Mental State-AGECAT, and a risk factor Questionnaire. Cases of AD were diagnosed according to DSM-IV criteria. Cox regression models were performed, stratified by sex. Main outcome measures Cases of AD according to the main occupation and sex. Results In men, compared with the “white collar” category, the risk of AD in “farmers” was 66% times lower, after controlling for potential confounding factors (HR: 0.34; 95% CI: 0.08–1.33). It did not reach statistical significance but the magnitude was large (Cohen’s d = 0.84). In women, “farmers” had almost 50% less risk of AD after controlling for all potential confounding factors (HR: 0.55; 95% CI: 0.17–1.78), compared with homemakers, but with a medium effect size (Cohen’s d = 0.46). Conclusions Men and women farmers had a lower risk of AD, reinforcing the importance of lifetime occupation in the risk of AD at older ages. These results could suggest some environmental hypotheses.

Objective: To evaluate whether clinically significant anxiety is an independent risk factor for dementia, taking into account both depression among potentially confounding factors and the competing risk of death. Method: During the Zaragoza Dementia and Depression (ZARADEMP) study, a random sample of community dwellers aged 55 years or older was assessed (n = 4803), and a two-wave, 4.5-year follow-up was completed. Geriatric Mental State (GMS)-AGECAT criteria were used to diagnose anxiety and DSM-IV criteria were applied to diagnose incident dementia. The multivariate Fine and Gray regression model was implemented to calculate dementia risk. Results: Compared with non-cases (GMS-AGECAT criteria), the incidence rate of dementia was significantly higher in subcases of anxiety, and particularly significant in the cases of anxiety (incidence rate ratio (IRR): 2.77; P = 0.010). Cases of anxiety, but not subcases, at baseline were significantly associated with dementia risk (adjusted subdistribution hazard ratio (SHR): 2.7; P = 0.019). Conclusion: Clinically significant anxiety is associated with an almost threefold increase in the risk of dementia in the population, even when controlling for depression and considering mortality in the competing risks model.

Objectives Anxiety is postulated to be modifiable risk factor for dementia. Our primary aim was to conduct a meta-analysis of community-based cohort studies that investigated the association between anxiety and dementia. Design We identified relevant, high-quality papers published up to January 2018 by searching PubMed and Web of Science. Prospective cohort studies reporting relative risks (RRs) for the association between anxiety and dementia, adjusted at least for age, were considered eligible. Study-specific RRs were combined using a random-effects model. Results Six prospective cohorts (reported in 5 studies), with a total of 10,394 participants, were included in the meta-analysis. The pooled RR of 1.29 (95% CI: 1.01–1.66) indicated a significant association between anxiety and dementia. Conclusion Anxiety significantly increases the risk of dementia. However, further research is needed to determine the extent to which anxiety is a cause of dementia rather than a prodrome or marker.

The City of Girls and Boys of Huesca (Spain) is an international project that seeks to foster children's autonomy and full participation in the construction of the city. Following its formal approval at the City Council of Huesca, the Girls and Boys Board and the City Laboratory were created, both of which include children from all the schools of Huesca. To highlightthe work on health, activities such as "Healthy School Paths", in which the asset mapping technique is used, were incorporated. Besides the interdisciplinary work among different areas of the city council, professionals from education (schools and university), health and social services, effects on the urban physical environment, with one street, park and square remodelled; and on the children's lifestyles, with more children walking to school alone, have been observed.

Resumen Introduccion La prevalencia de deterioro cognitivo libre de demencia (DCLD) varia entre el 5,1 y el 35,9%, con un aumento entre los 65 y los 85 anos. El DCLD incrementa el riesgo de demencia. Factores como nivel educativo, ocupacion y actividades sociales se asocian con el riesgo de deterioro cognitivo. El objetivo principal de este estudio fue analizar la asociacion entre la principal ocupacion a lo largo de la vida y el DCLD en una muestra de poblacion general de mayores de 55 anos. Material y metodos En la fase I del proyecto ZARADEMP se entrevisto a una muestra (n = 4.803) de personas mayores de 55 anos. La medida del DCLD se obtuvo a traves del Examen Cognoscitivo Mini Mental. La actividad laboral se recodifico en cuello blanco, cuello azul, labores del hogar y agricultores. Se estimo la asociacion entre las variables ocupacion y DCLD a traves de odds ratio e intervalos de confianza del 95% mediante ecuaciones de regresion logistica. Resultados La prevalencia de DCLD en la muestra fue del 28,2%. Con respecto a los trabajadores de cuello blanco, la odds ratio de diagnostico de DCLD fue un 53% mayor para aquellos trabajadores de cuello azul, un 77% mayor para mujeres que desempenaron labores del hogar y casi el doble para los agricultores, tras controlar por variables sociodemograficas, conductuales y clinicas. Todos los resultados fueron estadisticamente significativos. Conclusiones La frecuencia de DCLD esta influida por la ocupacion laboral previa de los sujetos. Una ocupacion con mayores requerimientos intelectuales puede ayudar a mantener las funciones cognitivas intactas durante mas tiempo.

Background.To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.Method.A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.Results.Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the ‘mild’ degree of impairment; HR: 1.29 in the ‘moderate’ degree; and HR: 2.08 in the ‘severe’ degree). The PAF of mortality due to severe cognitive impairment was 3.49%.Conclusions.A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

The prevalence of cognitive impairment with no dementia (CIND) varies between 5.1% and 35.9%, increasing between 65 and 85 years. The CIND increases the risk of dementia. Factors such as education, occupation, and social activities are associated with the risk of cognitive impairment. The main objective of this study was to analyse the association between the main occupation developed throughout life and CIND in a general population sample of over 55 years.In wave I of the ZARADEMP Project, a sample (n=4803) of people over 55 years was interviewed. CIND measurement was obtained through the Mini Mental State Examination. Occupational activity data were recoded into white collar, blue collar, homemakers, and farmers. The association between the occupation variables and CIND was estimated using the odds ratio, and 95% confidence intervals using logistic regression equations.The prevalence of CIND in the sample was 28.2%. As regards white collar workers, the CIND diagnosis odds was 53% higher for blue collar workers, 77% higher for women who were homemakers and almost twice for farmers, after controlling for socio-demographic, behavioural and clinical variables. All results were statistically significant.CIND frequency is influenced by the previous occupation of the subjects. An occupation with higher intellectual requirements can help keep cognitive functions intact for longer.

La obesidad y el sobrepeso se definen como una acumulación anormal o excesiva de grasa. La obesidad infantil es uno de los problemas más graves del siglo XXI, y que conlleva diferentes repercusiones. Su etiología es compleja pero, el tipo más frecuente en nuestra sociedad es debida a un desequilibrio energético entre calorías consumidas y gastadas. El entorno de desarrollo de un niño puede ser crucial en la aparición de la obesidad. Para intentar resolver este problema se han realizado actuaciones individualizadas, y actualmente se ha optado por estrategias poblacionales. Desde el Centro de Salud Perpetuo Socorro de Huesca, se ha detectado que en determinados colectivos, incluida la población gitana, las intervenciones nutricionales individuales parecen no ser efectivas. Por ello, se ha creado una estrategia denominada “Pío se mueve”. Esta estrategia intervenir en familias gitanas, a través de la metodología investigación-acción-participación (IAP). El proyecto cuenta con un equipo multidisciplinar, incluyéndose un dietista-nutricionista. El objetivo principal del estudio fue fomentar unos correctos hábitos alimentarios en las familias de niños obesos de cultura gitana en el marco del proyecto “Pio se mueve”. Se realizó una etapa inicial de pre-investigación y diagnóstico, para obtener información del grupo de trabajo. Una segunda etapa de trabajo de campo, con cinco sesiones, y una etapa final de conclusiones y propuestas. Se han podido identificar posibles hábitos relacionados con la obesidad, pudiendo incidir en ellos y poder así lograr pequeñas modificaciones de sus hábitos alimentarios. La promoción de unos correctos hábitos alimentarios a través de la metodología IAP y sostenida en el tiempo puede lograr la modificación del estilo de vida de estas mujeres, en concreto sus hábitos alimentarios y, en consecuencia, la de sus hijos.

Resumen Fundamento y objetivo Validar al espanol la entrevista MacArthur Competence Assessment Tool for Treatment (MacCAT-T), que valora la capacidad de los pacientes para consentir tratamiento examinando 4 areas (comprension, apreciacion, razonamiento y expresion de una eleccion). Pacientes y metodo La muestra se componia de 160 sujetos (80 ingresados en Medicina Interna, 40 ingresados en Psiquiatria y 40 controles sanos). Se utilizaron los instrumentos MacCAT-T y Mini-Mental State Examination (MMSE). Se llevo a cabo un estudio de factibilidad, calculo de fiabilidad y validez (contra gold standard del experto clinico). Resultados La duracion media de la entrevista MacCAT-T fue de 18 min. Respecto a la fiabilidad interobservador, el coeficiente de correlacion intraclase fue para Comprension = 0,98, Apreciacion = 0,97, Razonamiento = 0,98 y Expresion de una eleccion = 0,91. La consistencia interna (alfa de Cronbach) fue: Comprension = 0,87, Apreciacion = 0,76 y Razonamiento = 0,86. Los pacientes considerados incapaces (gold standard) obtienen puntuaciones menores en todas las areas de la MacCAT-T. Un rendimiento bajo en la MacCAT-T se relaciona con el deterioro cognitivo evaluado por MMSE. Conclusiones La version espanola de la MacCAT-T es fiable, factible y valida para la evaluacion de la capacidad de los pacientes para consentir tratamiento.

Objective To contrast the prevalence of mild cognitive impairment (MCI) as diagnosed using DSM-5 criteria (DSM5-MCI) with MCI as diagnosed using Petersen's criteria (P-MCI) and to explore the association of both with non-cognitive psychopathological symptoms (NCPS). Method A two-phase epidemiological screening was implemented in a population-based sample of individuals aged 55+ (n = 4803). The Geriatric Mental State (GMS) was the main psychopathological instrument used, and AGECAT was used to make psychiatric diagnoses. Research psychiatrists diagnosed DSM5-MCI and P-MCI using operational criteria. Logistic regression models were then used to investigate the association of MCI with anxiety and depression and with NCPS. Results Weighted prevalence of DSM5-MCI and P-MCI was, respectively, 3.72% and 7.93% for the aged 65+. NCPS were common in both MCI categories, but negative-type symptoms such as ‘anergia’ and ‘observed slowness’ were considerably more frequent among persons with DSM5-MCI. Anxiety and depression diagnostic categories were associated with both P-MCI and DSM5-MCI, but affective-type symptoms were mainly associated with P-MCI. Some negative-type symptoms were inversely associated with P-MCI, and no association was observed with DSM5-MCI. Conclusion The prevalence of DSM5-MCI was half that of P-MCI. Negative-type NCPS were more frequently and typically associated with DSM5-MCI.

Aims.In a background of interest in staging models in psychiatry, we tested the validity of a simple staging model of cognitive impairment to predict incident dementia.Method.A large community sample of adults aged ≥55 years (N = 4803) was assessed in the baseline of a longitudinal, four-wave epidemiological enquiry. A two-phase assessment was implemented in each wave, and the instruments used included the Mini-Mental Status Examination (MMSE); the History and Aetiology Schedule and the Geriatric Mental State-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. A panel of psychiatrists diagnosed cases of dementia according to DSM-IV criteria, and cases and sub-cases of dementia were excluded for the follow-up waves. Competing risk regression models, adjusted by potential confounders, were used to test the hypothesised association between MMSE levels and dementia risk.Results.Out of the 4057 participants followed up, 607 (14.9%) were classified as ‘normal’ (no cognitive impairment), 2672 (65.8%) as ‘questionable’ cognitive impairment, 732 (18.0%) had ‘mild’ cognitive impairment, 38 (0.9%) had ‘moderate’ cognitive impairment and eight (0.2%) had ‘severe’ impairment.Cognitive impairment was associated with risk of dementia, the risk increasing in parallel with the level of impairment (hazard ratio: 2.72, 4.78 and 8.38 in the ‘questionable’, ‘mild’ and ‘moderate’ level of cognitive impairment, respectively).Conclusions.The documented gradient of increased risk of dementia associated with the severity level of cognitive impairment supports the validity of the simple staging model based on the MMSE assessment.

Lobo A, Lopez-Anton R, Santabarbara J, de-la-Camara C, Ventura T, Quintanilla MA, Roy JF, Campayo AJ, Lobo E, Palomo T, Rodriguez-Jimenez R, Saz P, Marcos G. Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population. Objective: To calculate both the incidence rates and the lifetime risk (LTR) of dementia and Alzheimer’s disease (AD). Methods: A two-phase case-finding procedure was implemented in a cohort of 4057 cognitively intact individuals 55+ years of age living in Zaragoza, Spain, and followed-up at 2.5 and 4.5 years. Age- and sex-specific incidence rates were calculated. A mortality-adjusted, multivariate model was used to document LTRs. Results: The incidence rate of dementia continued to rise after the age of 90 years, but was slightly lower than in North and West European studies. Only a tendency for an increased LTR with age was observed. Thus, LTR was 19.7% for a 65-year-old woman and 20.4% at the age of 85 years, the corresponding figures for AD being 16.7% and 17.6%. The LTR of AD was higher in women and was about twice as high among illiterate individuals when compared with individuals with higher educational levels. Conclusions: The incidence rate of dementia in this Southern European city was slightly lower than in previous studies in North-West Europe. LTR of dementia and AD seems to be slightly increased with age. The association of illiteracy with higher LTR of AD is intriguing.

Nurses are confronted with an increasing number of patients with complex health care needs. INTERMED (INTERdisciplinary MEDicine) is described here as an action oriented method to document the potential «complexity» of patients, summarising information on biological, psychological, social and health care domains, plotted on a time-axis (history, current state and prognoses). A 73 year old patient assessed with this tool on admission to an internal medicine ward is described. INTERMED identified that besides age, mental health problems were interfering with somatic state and identified the patient as a complex case. From an integral health care perspective, coordinated care was needed to focus on the psychological vulnerability of the patient that made the somatic state more complex, including all the health care providers involved. Complex patients are an important and interesting issue for today's nurses, challenging their ability for management, organisation and coordination of care beyond standard care and the INTERMED tool can be crucial in this development.

The authors evaluated the association of low-to-moderate alcohol consumption with risk of cognitive decline in a census-based cohort study of men and women aged ≥55 years conducted in Zaragoza, Spain (1994-1999). Participants free of dementia at baseline (N = 3,888) were examined after 2.5 and 4.5 years of follow-up. Information on alcohol intake was collected with the EURODEM Risk Factors Questionnaire and the History and Aetiology Schedule. The study endpoint was severe cognitive decline, defined as loss of ≥1 point/year on the Mini-Mental State Examination or a diagnosis of incident dementia (Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, Text Revision criteria). Compared with those for abstainers, the multivariate-adjusted odds ratios for severe cognitive decline for male drinkers of12 g alcohol/day, drinkers of 12-24 g alcohol/day, and former drinkers were 0.61 (95% confidence interval (CI): 0.31, 1.20), 1.19 (95% CI: 0.61, 2.32), and 1.03 (95% CI: 0.59, 1.82), respectively. The corresponding odds ratios for women were 0.88 (95% CI: 0.45, 1.72), 2.38 (95% CI: 0.98, 5.77), and 1.03 (95% CI: 0.48, 2.23). This study did not support the hypothesis that low-to-moderate alcohol consumption prevents cognitive decline. The inverse association between low-to-moderate alcohol intake and cognitive decline observed in other studies may have been due to inclusion of former drinkers in the abstainers reference category.

Background: In a context of increasing concern for complex care needs in medical patients, this study is intended to document the utility in pneumology patients of INTERMED, a reliable and valid instrument to assess case complexity at the time of hospital admission. Methods: Three hundred and fifteen consecutive patients were assessed at hospital admission with INTERMED by a trained nurse. At discharge, independent research workers, blind to the previous results, reviewed the medical database and a subsample (n = 144) was assessed for psychopathological outcome. Severity of the pulmonary disease was assessed with the Cumulative Illness Rating Scale (CIRS), and psychopathology with the Hospital Anxiety and Depression Scale, Mini-Mental Status Examination (MMSE) (cognitive disturbances), and CAGE Scale (alcohol abuse). Operational definitions were used for measures of care complexity. Results: Most patients were in geriatric age, and 78 patients (24.7%) were classified as "complex" by means of INTERMED (IM+). In support of the working hypotheses, IM+ patients scored significantly higher in measures of care complexity (Cumulative Illness Rating Scale, "number of consultations during admission" and "diagnostic count") and on both anxiety and depression. INTERMED was also associated with length of hospital stay (LOS) and with both anxiety and depression after controlling for significant predictors and socio-demographic data. Conclusions: This is the first report about the ability of INTERMED to predict complexity of care in pneumology patients, and the first to predict a negative psychopathological outcome in any type of medical patients.

Objective In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimer's disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM-5 (DSM-5-MCI) and Petersen's (P-MCI) criteria. Method A population representative cohort of 4057 dementia-free individuals 55+ years of age was followed up at 2.5 and 4.5 years in Zaragoza, Spain (ZARADEMP). Using the Geriatric Mental State- AGECAT for assessment, research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. ‘Conversion rate’ (CR), ‘annual conversion rate’ (ACR), and incidence rate (IR) were calculated along with incidence rate ratio (IRR) to compare the performance of the intermediate cognitive definitions. Results At 4.5-year follow-up, in individuals aged 65+ years, ACRs for non-cases, P-MCI, and DSM-5-MCI were 0.8, 1.9 and 3.4, respectively, for global dementia. The IRRs were 2.9 and 5.3 for P-MCI and DSM5-MCI, respectively, being the non-cases the reference category. The corresponding values were slightly lower for AD. Conclusion Conversion rate to dementia and AD was higher using DSM-5-MCI criteria than using Petersen's criteria. However, prediction of the construct still has some way to go, as most MCI individuals did not convert at 4.5-year follow-up.