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Introduction Age- and sex-stratified incidence rates of uncommon dementia subtypes are imprecise and scarce. Methods We used data from 7357 newly diagnosed individuals aged between 30.6 and 101.0 years from the Registry of Dementia of Girona during 2007-2016 to determine the incidence rates of uncommon dementia subtypes stratified by sex and age groups and to describe their clinical characteristics. Results Uncommon dementia subtypes were classified according to their etiology. The incidence rate of uncommon dementia subtypes was 27.8 cases per 100,000 person-years for those aged 30 years and older, 3.7 cases per 100,000 person-years for people aged less than 65 years, and 110.9 per 100,000 person-years for those aged 65 years and older. Age, sex, dementia severity, and medical comorbidities were different depending on the dementia subtype. Discussion There are differences in the incidence rates and the demographic and clinical characteristics among uncommon dementia subtypes for age and sex groups.

Background The epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions. Method Prospective cohort design using data from waves 5 and 6 (2013–15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D. Results The prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61–6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60–6.61) countries than in the Northern and Continental (4.45–5.31) ones. Limitations The EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression. Conclusion The risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region.

Background: Dementia care is associated with physical, emotional, and monetary impact on the informal carers providing unpaid care. Differences in the personal characteristics of caregivers may help explain the variations in the costs of dementia care. Objective: The aim of this study was to analyze the effect of caregivers’ sense of coherence (SOC) on direct and indirect costs in dementia care. Methods: A cross-sectional study was conducted in community dwelling caregivers of patients with Alzheimer’s disease. Data of healthcare services were obtained from clinical registries, and information was collected from caregivers regarding their use of social care resources and time spent caregiving. The transformation of all costs into Euros was made assigning a fixed cost of 10.29 € /h and 16.24 € /h for assisting in instrumental and basic activities of daily living, respectively. Caregivers’ SOC was assessed using the Orientation to Life Questionnaire (OLQ-13). Adjusted regression models were developed, with different types of costs as dependent variables. Results: A sample of 147 caregivers was recruited. The mean OLQ-13 score was 73.3 points (SD = 11.6). The regression models showed a small association between caregivers’ SOC and direct costs, mainly linked to the use of social care resources (r2 = 0.429; β= –15.6 € /month), and a greater association between SOC and indirect costs (r2 = 0.562; β= –222.3 € /month). Conclusion: Increasing caregivers’ SOC could reduce dementia care costs by decreasing the use of social care resources and caregiving time.

The multifactorial origin of violent behaviors generates the need to use prediction tools adapted to different contexts, patient profiles and types of aggression. The main objective of this work was to design an instrument to detect the risk of violence and aggression quickly and effectively in patients with mental disorder in psychiatric intensive care units.The sample consisted of 722 admissions of 629 patients from the psychiatric intensive care units. Violent incidents were recorded using the Overt Aggression Scale (OAS). A new scale has been designed and its psychometric properties have been evaluated.The Scale for the Evaluation of Risk of Aggressiveness (ERA) includes static and dynamic risk factors, has an AUC=0.854, a sensitivity of 82%, a specificity of 73%, a positive predictive value of 62% and a negative predictive value of 88% when the cut-off point of ¾ is used to determine the risk of violent or aggressive behavior.The ERA has proven to be a valid and reliable instrument to forecast the risk of aggressiveness in patients admitted to an acute care unit of psychiatry. It also allows monitoring and updating this risk during the patient's stay in the psychiatric intensive care unit.

Objective To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. Materials and methods It is a prospective population-based cohort study of adults living in the community, 2013–15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios. Results The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37–18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). Conclusions The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.

Resumen Introduccion La depresion es un trastorno psiquiatrico incapacitante y frecuente en la edad adulta asociado a mayor mortalidad y discapacidad funcional. Objetivos Determinar la asociacion de las variables clinicas y sociodemograficas con la depresion, en una muestra de personas mayores de 50 anos residentes en Espana, y comparar la prevalencia de depresion con los demas paises del estudio Survey of Health, Ageing and Retirement in Europe (SHARE). Material y metodos Muestra de 5.830 participantes de la muestra espanola de la «Wave 5», de 2013, del estudio SHARE. Instrumentos: EURO-D (depresion) y CASP-12 (calidad de vida). Analisis estadistico: bivariante y logistico binario. Resultados En la regresion logistica binaria, las variables asociadas a la depresion (EURO-D ≥ 4) fueron, principalmente, la mala percepcion de salud fisica (OR = 13,34; IC 95%: 9,74-18,27), la presencia de mas de 2 dificultades en las actividades de la vida diaria (AVD) (OR = 4,46; IC 95%: 3,13-6,34) y el genero femenino (OR = 2,16; IC 95%: 1,83-2,56). La depresion fue mas frecuente en los participantes que padecian Alzheimer (76,4%), trastornos emocionales (73,9%), Parkinson (57,4%), fractura de cadera (55,4%) y reumatismos (50,9%). En la comparacion con paises europeos, Espana tenia un porcentaje de personas con depresion (29,3%) superior a la media europea (27,9%). Conclusiones Las variables mas relevantes asociadas a la depresion fueron la mala percepcion de salud fisica, la presencia de dificultades en las AVD y el genero femenino.

Introduction Depression is a common and disabling psychiatric disorder in adulthood and is associated with higher mortality and functional disability. Objectives To determine the association between clinical and sociodemographic variables with depression in a sample of people over 50 years old living in Spain, and compare the prevalence of depression with the other Survey of Health, Ageing and Retirement (SHARE) countries. Material and methods There were 5830 participants in the Spanish sample of the Wave 5, 2013, of SHARE. Tools used: EURO-D (Depression) and CASP-12 (Quality of Life). Statistical analysis: bivariate, and binary logistic. Results The variables associated with depression in the binary logistic regression (EURO-D ≥ 4) were poor self-perceived physical health (OR = 13.34; 95% CI: 9.74–18.27), having more than 2 difficulties in Activities of Daily Living (ADL) (OR = 4.46; 95% CI: 3.13–6.34) and female gender (OR = 2.16; 95% CI: 1.83–2.56). Depression was more common among participants with Alzheimer (76.4%), emotional disorders (73.9%), Parkinson (57.4%), hip fracture (55.4%), and rheumatism (50.9%). Compared with other European countries, Spain had a percentage of people with depression (29.3%) that was higher than the European average (27.9%). Conclusions The most important variables associated with depression were poor perceived physical health, presence of difficulties in ADL, and female gender.

Objective: To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study). Methods: Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used. Results: Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD = 11.5). The selfrated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence. Conclusions: The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence Objetivo: Describir las principales características demográficas, de salud y socioeconómicas de los participantes en el Estudio sobre la Madurez y el Envejecimiento Satisfactorio en Girona (estudio MESGI50). Métodos: Estudio epidemiológico poblacional vinculado a la Survey of Health, Ageing, and Retirement in Europe (SHARE). La población de referencia fueron los habitantes de la provincia de Girona de 50 y más anos ˜ de edad. Se utilizó un muestreo probabilístico por conglomerados bietápico estratificado según el número de habitantes y el grado de envejecimiento de la población. Resultados: Se seleccionaron aleatoriamente 28 municipios según su tipo (demográficamente envejecidos o jóvenes) y estratificados según el número de habitantes. La tasa de respuesta fue del 65%, con una media de 1,7 sujetos elegibles por hogar y una muestra final de 2065 hogares y 3331 participantes. El efecto del diseno˜ fue de 1,27. El 52,9% eran mujeres y la media de edad era de 66,9 anos ˜ (desviación estándar: 11,5). La salud autorreferida, la fuerza de agarre manual, la limitación en las actividades de la vida diaria y la sintomatología depresiva aumentaron con la edad y de forma más acusada en las mujeres. Se observaron diferencias en el consumo de alcohol y en los patrones de alimentación según el ámbito de residencia. Conclusiones: Las características demográficas, de salud y socioeconómicas durante el proceso de envejecimiento son distintas según los grupos de edad, el sexo y el ámbito de residencia

BACKGROUND There are several position statements and clinical practice guidelines (CPG) for diagnosing dementia. OBJECTIVE Our aims were to evaluate the adherence to CPG among specialists in the 7 memory clinics included in the Registry of Dementias of Girona (ReDeGi), and to compare the results between 2007-2011 and 2012-2015. We also determined the time and number of visits required to achieve a diagnosis, the supplementary tests ordered, and the drugs prescribed according to dementia subtypes. METHODS Medical charts of a stratified random sample of 475 ReDeGi cases were reviewed. Basic dementia work-up was evaluated using as a reference evidence-based CPG. An Index of Adherence (AI) was calculated using the following items in the medical chart: cognitive symptomatology; functional disability evaluation; physical examination; neurological examination; psychiatric examination; brief cognitive examination; activities of daily living performance examination; blood test; structural neuroimaging (CT-scan or MRI). RESULTS The mean AI to CPG among specialists was of 8.2 points, and it improved from 7.9 points in 2007-2011 to 8.5 points in 2012-2015 (Cohen's d = 0.46). A lower adherence was detected in the most severe cases. A dementia diagnosis required 3.5 visits, regardless of the subtype of dementia, although milder cases required more time, more visits, and more supplementary tests than severe cases. CONCLUSION The adherence to CPG in the catchment area of the ReDeGi is high, and an epidemiological surveillance system such as the ReDeGi may help in improving it. Dementia guidelines should establish procedures adapted to clinical practice, with simplified recommendations for most severe cases.

Taking care of people with dementia (PWD) has been associated with some degree of burden. The variability of the carer's burden can be partially explained by their personal characteristics. Antonovsky's model of health defined the resistance resources (RRs) as essential mechanisms to cope with stressors, and to shape the personal sense of coherence (SOC). This study identifies the RRs related with carer's SOC, and their implications in the perception of burden in family dementia carers.Methods: A sample of 308 participants from the 'SOC & DEM study' (154 carers and 154 PWD) was recruited from two memory clinics. Carer's personal characteristics of burden, SOC, self-efficacy, coping strategies, perceived social support, and depression were evaluated using standardized instruments. PWD's degree of dependence and behaviour and psychological symptoms of dementia (BPSD) were assessed too. A path analysis was used to test the relationship between caregiver burden and SOC including the personal RRs of the carers and clinical data of PWD.Results: The path model identified SOC as a major factor related to carer's burden perception (r = -.327). Self-efficacy (r = .285), two coping strategies, 'use instrumental support' (r = -.235) and 'behavioural disengagement' (r = -.219), and social support perceived (r = .304) were the main carer's personal characteristics directly related with SOC. Caring experience (r = -.281) was the main carer factor related with burden while dependence (r = .156) and BPSD (r = .157) were the dementia factors.Conclusion: The SOC has previously related with carer's burden. The results contributed to identify relevant and modifiable personal characteristics as RRs that could reduce this burden The study was conducted with the help of external funds from the Carlos III Spanish Institute of Health (PI17/000029). EM is supported by a grant from the Alzheimer’s Society (UK)

Malaltia d'Alzheimer; Demència; Epidemiologia Enfermedad de Alzheimer; Demencia; Epidemiología Alzheimer's disease; Dementia; Epidemiology The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.

Background The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries. Methods The study population was taken from waves 4–5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence. Results Prevalences of depression, pain, and depression–pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9–2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2–1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2–2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3–2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1–1.7; treated OR=2.0; 95% CI=1.5–2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1–1.7; men OR=1.8; 95% CI=1.3–2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1–1.6). Limitations We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred. Conclusions Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.

Background:The concept of dependence has been proposed as an integrative measure to assess the progression of Alzheimer's disease (AD).This study aimed to investigate the association of patient's dependence level with the caregiver burden within a general theoretical model that includes other well-established determinants.Methods:Observational and cross-sectional multicenter study. The sample consisted of patients with AD recruited in outpatient consultation offices by a convenience sampling procedure stratified by dementia severity. Cognitive and functional status, behavioral disturbances, dependence level, medical comorbidities, and caregiver burden were assessed by using standardized instruments. A path analysis was used to test the hypothesized relationships between the caregiver burden and its determinants, including the level of dependence.Results:The sample consisted of 306 patients (33.3% mild, 35.9% moderate, 30.7% severe), the mean age was 78.5 years (SD = 7.8), and 66.2% were women. The model fit was acceptable and explained 29% of the caregiver burden variance. Primary stressors were the level of dependence and the distress related to behavioral disturbances. Caregiver's age, gender, and co-residence with the patient were the contextual factors related to caregiver burden. The job status of the caregiver was a significant secondary stressor, functional disability was indirectly associated with caregiver burden via dependence, and frequency of behavioral disturbances was indirectly associated with the caregiver burden via distress.Conclusions:Dependence was, apart from behavioral disturbances, the most important primary stressor directly related to caregiver burden irrespective of the disease severity.

Cuidadores informales; Política pública europea; Vigilancia de la salud pública Cuidadors informals; Política pública europea; Vigilància de la salut pública Informal caregivers; European public policy; Public health surveillance In Europe, informal caregiving is frequent and is expected to grow. Caregiving has an impact on caregivers’ health, but its effect may vary according to the policies of support that are available to caregivers. The aim of this study was to assess the association between the policies of support to caregivers available in 12 European countries and the health of caregivers, considering separately the policies based on financial help and those based on training and other non- financial services. We used data from 13,507 caregivers from 12 European countries from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to build a path model. Poor health among caregivers was associated with living in a family-based care country (β = 0.50; 95% CI = 0.42–0.59), and with an increased extent of caregiving (β = 0.18; 95% CI = 0.15–0.22). Non-financial support measures seem to have a larger protective impact (β = –0.33; 95% CI = –0.38 - –0.28) on the health of caregivers than do financial support measures (β = 0.03; 95% CI = 0.01–0.04), regardless of the gender of the caregiver. According to our results, the currently available policies of support associated with better health among caregivers are those that: 1) provide them with some free time, 2) help them to deal emotionally with caregiving, and 3) give them skills to both improve the care situation and to deal with it better. This study has been funded by the Instituto de Salud Carlos III (http://www.isciii.es) through the project PI16/00184.

Objectives: The aims of this study are: to analyze the factor structure of the EURO-D depression scale; to explore the variables associated with depressive symptoms in the total sample and in the EURO-D factors; and to compare the presence of depressive symptoms and the factor distribution in 15 European countries. Method: 62,182 participants in Wave 5 (2013) of the Survey of Health, Aging and Retirement in Europe (SHARE) were included. Instruments: The SHARE study and the EURO-D scale. Factor, bivariate and multilevel analyses were performed. Results: Higher levels of depressive symptoms were associated with a poorer self-perception of physical health (η2 = 0.22) and economic difficulties (η2 = 0.07). Factor analysis of the EURO-D identified two factors: Suffering and Motivation. Higher levels of depressive symptoms were associated with female gender and younger age (≤ 60) in the Suffering factor, and with less activity and exercise, older age (≥ 71), widowhood and lower educational level in the Motivation factor. Poorer self-perception of physical health and economic difficulties were associated with higher depressive symptomatology in both factors. Conclusions: Poorer self-perception of physical health, female gender, economic difficulties, widowhood, lower levels of activity and exercise and lower educational level were associated with higher depressive symptomatology. In the countries of southern Europe, the Motivation factor predominated.

Deterioro cognitivo leve; Cinemática; Demencia; Pérdida de memoria Mild cognitive impairment; Kinematics; Dementia; Memory loss Deteriorament cognitiu lleu; Cinemàtica; Demència; Pèrdua de memòria Alzheimer's disease (AD) is the most common neurodegenerative dementia of old age, and the leading chronic disease contributor to disability and dependence among older people worldwide. Clinically, AD is characterized by a progressive cognitive decline that interferes with the ability to perform the activities of daily living. Handwriting and drawing are complex human activities that entail an intricate blend of cognitive, kinesthetic, and perceptual-motor features. To compare the kinematic characteristics of handwriting and drawing between patients with AD, patients with mild cognitive impairment (MCI) and healthy controls. We used a cross-sectional and observational design to assess the kinematic and pressure features of handwriting and drawing using a computerized system. Participants were asked to copy one sentence, write a dictated sentence and an own sentence, copy two and-three dimensions drawings, and to execute the clock drawing test. By means of discriminant analyses, we explored the value of several kinematic features in order to classify participants depending on their degree of cognitive functioning. The sample consisted of 52 participants (23 AD, 12 MCI, and 17 healthy controls) with a mean age of 69.7 years (SD=8.11). The degree of correct classification was largely dependent on the nature of the groups to be classified and the specific task, and ranged between 63.5% and 100%. Diagnostic accuracy based on kinematic measures showed higher specificity values for distinguishing between normal and impaired cognition (MCI and AD), and higher sensitivity was obtained when distinguishing between impaired cognition levels (MCI vs. AD). The kinematic features of writing and drawing procedures, rather than the final product, may be a useful and objective complement to the clinical assessment of patients with cognitive impairment. This work has been supported by FEDER and MICINN, TEC2016-77791-C4-2-R.

Objective To describe the prevalence and concordance of anticholinergic exposure according to 9 published scales, to quantify the relative weight of the drug subtypes included in each scale, and to identify clinical variables related to anticholinergic exposure. Methods Observational and cross-sectional study using 5323 cases of dementia diagnosed in the 7 hospitals of the public health care system of the Health Region of Girona (Spain) between 2007 and 2014 and registered by the Registry of Dementias of Girona (ReDeGi). We used the Pharmacy database that includes all the drugs prescribed by specialist and primary care physicians and dispensed in pharmacies. We calculated the anticholinergic exposure using the scoring rules of each scale. Age, gender, place of residence, dementia subtype, Clinical Dementia Rating score, Mini-Mental Status Examination score, and Blessed Dementia Rating Score at the moment of dementia diagnose were retrieved from the ReDeGi. Results Prevalence of the annual anticholinergic exposure ranged from 36.3% to 69.0% according to the different scales, the concordance among scales was poor to moderate, and the central nervous system drugs accounted the most for anticholinergic exposure. Being in a nursing home, having depressive symptoms, having a non-Alzheimer's dementia subtype, the number of drug treatments, and the severity of dementia were main determinants of anticholinergic exposure. Conclusions There is a large difference in outcomes among the 9 anticholinergic risk scales. Clinicians and researchers should be aware of these differences when using these instruments in patients with dementia.

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

Objective: To determine the direct and indirect relationships of cognitive, functional, and behavioral factors and other medical comorbidities with the quality of life (QoL) of patients with Alzheimer’s disease (AD) according to the theoretical model of dependence. Methods: Observational and cross-sectional study. Cognitive and functional status, behavior, dependence, medical comorbidities, and QoL were assessed by using standardized instruments. A path analysis was used to model the direct and indirect relationships among clinical indicators according to the theoretically based model of dependence. Results: The sample consisted of 343 patients with AD (32.1% mild, 36.7% moderate, and 31.2% severe). Medical comorbidities, disease severity, and dependence level had a direct relationship with QoL. The functional disability and the behavior disturbances were indirectly related to QoL via dependence level, and the cognitive impairment was indirectly related to QoL via severity level. Conclusion: Direct and indirect effects exist between clinical indicators, dependence, and QoL.

Background and objectives: The perception of quality of life (QoL) in people over 65 years of age can be affected by individual clinical and sociodemographic characteristics, and also by the nature of the welfare models in place in particular countries. The objective of this study was to compare the association between clinical/sociodemographic variables and QoL in people ≥65 in samples from Spain and from Central-Northern European countries, using data from the SHARE (Survey of Health, Ageing and Retirement in Europe) study. Methods: Data from 22,189 participants in Wave 5 (2013) of the SHARE study were obtained. Instruments: CASP-12 (quality of life) and EURO-D (depression). Statistical analysis: Bivariate and multiple linear regression and correlations. Results: In the regression analysis, the variables most closely associated with a lower QoL (CASP-12) in both groups (Spain, r2 = 0.586 and Central-Northern Europe, (r2 = 0.453) were high depression (β = 0.444 vs. 0.361), poor physical health, economic difficulties, and deficits in activities of daily living (ADL); low level of education was relevant only in the Spanish sample. The mean QoL score in Spain was lower than in the other countries (34.8 ± 6.8 vs. 38.5 ± 5.8, p < 0.001; d = 0.58) and depression was more frequent (34.9% vs 27.4%, p < 0.001; V = 0.06). Conclusions: In all countries, low QoL was associated with high rates of depression and poor physical health. The Spanish sample had lower QoL than their Central-Northern European counterparts. A high rate of depression was the most relevant differential variable

Objectives Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. Methods Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. Results Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). Conclusions Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.

Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia.We used a cross-sectional design using 1186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used.Analgesics were prescribed to 78.6% (95% CI, 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI, 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI, 14.4-19.3) following step 2 and 2.6% (95% CI, 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia.The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.

The Stroop Color and Word Test (SCWT) is a short test that is widely used in neuropsychological assessment to evaluate the executive aspects of attention control, information processing speed, selective attention, cognitive flexibility, and executive function in terms of the ability to inhibit a usual response in favor of an unusual response. The aim of this study was to create normative data from the SCWT adjusted for age, sex, and educational level for its clinical use in a population of 55 years of age and above. The SCWT was administered to a population-based sample of 2,151 participants aged 55 or older, and the effect of sex, age, and educational level was determined in the SCWT by means of linear regression models. Normative tables were created following the traditional method based on the stratification by relevant variables and on regression models.

Background. Anosognosia is common in patients with Alzheimer's disease (AD) and it is frequently related with an increase of time of care demand. Objective. The aim of the study was to examine the effect of anosognosia on the total costs of informal care in patients with AD. Methods. This was a prospective longitudinal study with community-dwelling AD patients. Anosognosia, the number of hours of informal care and the use of support services (p.e. home-care services, day care centers, etc.) were recorded at baseline and after 24 months. The cost of informal caregiving was calculated as 'market price'. Results. At baseline the prevalence of anosognosia was 54.3% (n=221), and 43.9% were classified as mild-AD. The average time spent on care was 5 hours/day ±2.4 (IADL: 1.3 h/d ±1.4 and BADL: 3.6 h/d ±1.5). Thirty percent of the patients used home care services, and 25.1% attended a day care center. Patients with anosognosia were more likely to use support services and received more time of care than did their asymptomatic peers. The presence of anosognosia increased the use of the support services after 24-months, including institutionalization. The mean cost of support services was 490.4 /month (SD=413.1 ; range=25-2,212.38 ), while the overall cost of care (support services plus informal care) was 1,787 /month (SD=972.4 ), ranging from 834.1 in mild-AD patients without anosognosia, to 2,424.8 in severe-AD patients with incident anosognosia. Conclusions. Anosognosia was associated with an increased number of hours of informal care, and a greater use of support services, regardless of the severity of the dementia, which lead to an increase of the total family-care costs.

To describe the demographic, health and socio-economic characteristics of the participants in the Study on Maturity and Satisfactory Ageing in Girona (MESGI50 study).Population-based Study linked to the Survey of Health, Ageing, and Retirement in Europe (SHARE). The reference population was the inhabitants of the province of Girona (Spain) aged 50 and over. A probabilistic two-stage stratified cluster sampling according to the number of inhabitants and the degree of ageing of the population was used.Twenty-eight municipalities were randomly selected according to their type (demographically aged or young), and then stratified by the population size. The response rate was 65% with a mean of 1.7 eligible individuals per household and a final sample of 2,065 households and 3,331 participants. The design effect was 1.27. 52.9% were women and the mean age was 66.9 years (SD=11.5). The self-rated health status, hand grip strength, restriction in daily life activities and depressive symptomatology increased with age and more markedly in women. There were differences in alcohol consumption and eating patterns depending on the area of residence.The demographic, health and socio-economic characteristics during the ageing process differ depending on age group, gender, and area of residence.

Limited information exists regarding the consumption of psychopharmaceuticals for non-Alzheimer’s degenerative dementias (n-ADDs), despite the fact that the treatment of neuropsychiatric symptoms of these diseases is an important challenge for clinicians. The aim of this study was to describe sociodemographic and clinical data from 235 patients with various subtypes of n-ADD, together with the level of consumption of pharmaceuticals with central nervous system activity. A descriptive, observational, cross-sectional study was conducted using the data registered by the Registry of Dementias of Girona, northeast Catalunya, Spain. All drugs were categorized according to the Anatomical Therapeutic Chemical Classification System. The results showed a high level of psychopharmaceutical prescription: 48.9 % of the n-ADD patients used acetylcholinesterase inhibitors and 9.8 % used memantine. Antipsychotics and benzodiazepines were prescribed to 45.5 and 46.8 % of the patients, respectively. Antidepressants were consumed by 70.2 % of the registered cases. High levels of psychopharmaceutical prescribing were observed in our study and many of these prescriptions lacked specific indications for n-ADDs. It is necessary to consider the risk–benefit relationship before prescribing pharmaceuticals. Specific training programmes will be necessary to improve the use of pharmaceuticals in n-ADD patients.

Malaltia d'Alzheimer; Demència frontotemporal; Donepezil Enfermedad de Alzheimer; Demencia frontotemporal; Donepezil Alzheimer's disease; Frontotemporal dementia; Donepezil Clinical evidence indicates that acetylcholinesterase inhibitors (AChEIs) are not efficacious to treat frontotemporal lobar degeneration (FTLD). The British Association for Psychopharmacology recommends avoiding the use of AChEI and memantine in patients with FTLD. Cross-sectional design using 1092 cases with Alzheimer’s disease (AD) and 64 cases with FTLD registered by the Registry of Dementias of Girona. Bivariate analyses were performed, and binary logistic regressions were used to detect variables associated with antidementia drugs consumption. Results: The AChEIs were consumed by 57.6% and 42.2% of the patients with AD and FTLD, respectively. Memantine was used by 17.2% and 10.9% of patients with AD and FTLD, respectively. Binary logistic regressions yielded no associations with antidementia drugs consumption. There is a discrepancy regarding clinical practice and the recommendations based upon clinical evidence. The increased central nervous system drug use detected in FTLD requires multicentric studies aiming at finding the best means to treat these patients.

Objective The objective of this study was to estimate several subtypes of depressive disorders as risk factors for dementia and Alzheimer disease (AD) specifically. Methods This is a population-based cohort study using a sample of 451 non-demented older people. Adjusted Cox proportional hazard models were calculated to determine the association of depression with dementia or AD development after 5 years. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination (CAMDEX). Depressive disorders (major episode [MD] and minor depressive disorders [MDDIS]) were assessed following DSM-IV criteria and further classified according to the age at onset (early versus late onset). In turn, all late-onset depressions were grouped as with or without depression-executive dysfunction syndrome (DEDS). Dementia (and dementia subtypes) diagnoses were made using the CAMDEX. When the patients were deceased, the Retrospective Collateral Dementia Interview was used. Results Late-onset depressions (both MD and MDDIS) were associated with increased dementia (hazard ratio [HR] = 2.635; 95% CI = 1.153–6.023; and HR = 2.517; 95% CI = 1.200–5.280, respectively), and AD (HR = 6.262; 95% CI = 2.017–19.446; and HR = 4.208; 95% CI = 1.828–9.685, respectively) after adjustment by age, gender, marital status, education, cognitive impairment, executive function and stroke history. A second model revealed that only late-onset depressions with DEDS increased the risk for both dementia (late-onset MD with DEDS: HR = 6.262; 95% CI = 2.017–19.446; late-onset MDDIS with DEDS: HR = 4.208; 95% CI = 1.828–9.685) and AD (late-onset MD with DEDS: HR = 7.807; 95% CI = 1.567–38.894; late-onset MDDIS with DEDS: HR = 6.099; 95% CI = 2.123–17.524). Conclusions Late-onset depressive episodes with DEDS are risk factors for dementia and AD development, regardless of the severity of the depression. Copyright © 2012 John Wiley & Sons, Ltd.

Background: Antipsychotics (APs) are usually prescribed to deal with behavioral and psychological symptoms of dementia (BPSD), but poor outcomes, important side effects, and high mortality risk should be addressed. The aim of this study was to estimate the prevalence of AP consumption in patients with dementia, and to describe and compare the sociodemographic and clinical characteristics of patients consuming APs.Methods: This was a cross-sectional study using 1,894 cases of dementia registered from 2007 to 2009 by the Registry of Dementias of Girona (ReDeGi), which is a population-based passive surveillance system of dementia diagnoses. APs were categorized according to the anatomical therapeutic chemical (ATC) classification, and grouped as typical antipsychotics (TAPs) or atypical antipsychotics (AAPs). Binary logistic regression analyses were used to detect the predictors of AP use as well as the variables associated with TAP or AAP prescription.Results: APs were used in 29.6% of the cases, with Parkinsonian syndromes (PSd) being the subtype of dementia with the highest AP prescription (50.6% of the patients with PSd). AAPs were mainly prescribed in all subtypes of dementia, except in vascular dementia (VaD) and PSd, where no preference in TAP or AAP use was found. Psychotic antecedents, dementia with Lewy bodies (DLB) diagnoses, cognitive impairment, and BPSD were AP use predictors. AAP use was related to higher severity of dementia.Conclusions: Despite their disputed benefit–risk ratios, APs are extensively used, off-label, to treat BPSD, and AAPs are more commonly prescribed than TAPs. AP consumption was frequent in DLB, and was related to dementia severity indicators.

The Trail Making Test (TMT) is used as an indicator of visual scanning, graphomotor speed, and executive function. The aim of this study was to examine the TMT relationships with several neuropsychological measures and to provide normative data in community-dwelling participants of 55 years and older. A population-based Spanish-speaking sample of 2,564 participants was used. The TMT, Symbol Digit Test, Stroop Color-Word Test, Digit Span Test, Verbal Fluency tests, and the MacQuarrie Test for Mechanical Ability tapping subtest were administered. Exploratory factor analyses and regression lineal models were used. Normative data for the TMT scores were obtained. A total of 1,923 participants (76.3%) participated, 52.4% were women, and the mean age was 66.5 years (Digit Span = 8.0). The Symbol Digit Test, MacQuarrie Test for Mechanical Ability tapping subtest, Stroop Color-Word Test, and Digit Span Test scores were associated in the performance of most TMT scores, but the contribution of each measure was different depending on the TMT score. Normative tables according to significant factors such as age, education level, and sex were created. Measures of visual scanning, graphomotor speed, and visuomotor processing speed were more related to the performance of the TMT-A score, while working memory and inhibition control were mainly associated with the TMT-B and derived TMT scores.

Background:There is a lack of information regarding geographical differences in the incidence and prevalence of dementia diagnosis according to the degree of aging of the population. The objectives of this study were to analyze the rate of dementia diagnoses, and to compare the dementia subtypes and the clinical characteristics of the patients depending on the degree of aging of their municipalities.Methods:We used data from the Registry of Dementias of Girona (ReDeGi), containing the cases of dementia diagnosed in the memory clinics of the Health Region of Girona, in Catalonia (Spain), during 2007–2012. The municipalities were classified by a cluster analysis as aged or young municipalities according to their proportion of older people using population ageing indicators. The incidence rates of dementia diagnosis in each type of municipality were compared.Results:The ReDeGi registered 4,314 cases in the municipalities under surveillance. The clinical incidence of dementia was lower in aged municipalities (4.5 vs. 6.1 cases per 1,000 person-years aged 65 and over). Patients from young municipalities had an increased frequency of behavioral and psychological symptoms of dementia.Conclusions:The environment may influence the clinical manifestations of dementia that predispose people to visit health specialists and obtain a diagnosis.

The objective of this cross-sectional and multicenter study was to evaluate the psychometric properties of the Spanish version of the Dependence Scale (DS) and to assess the relationship between dependence and clinical measures according to disease severity. Medical comorbidities, cognitive status and functional status, behavior, dependence, caregiver burden, and medical and social resources were assessed using standardized instruments. The sample consisted of 343 patients (32.1% mild, 36.7% moderate, and 31.2% severe), the mean age was 78.9 years (standard deviation = 7.4), and 67.0% were women. Criterion and construct validity index of DS were appropriate. The DS standard error of measurement was ±1.23. The explained variance in DS ranged between 0.598 and 0.731, and the relative contribution of clinical measures depended on disease severity. Current findings confirm that the Spanish version of the DS has appropriate psychometric indices and suggest that clinical indicators have different contribution to dependence according to disease severity.

Although numerous studies have examined caregiver burden in the context of Alzheimer's disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer's disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89-13.47), as were sole caregivers (OR 3.51; 95% CI 1.98-6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance.

The objective of this paper was to assess the prevalence, incidence, persistence, and risk and mortality factors for Apathy Syndrome in Alzheimer's disease (ASAD) in a clinical sample. This was a cohort study of 491 patients with probable Alzheimer's disease (AD). The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX), the Neuropsychiatric Inventory (NPI), the Rapid Disability Rating Scale (RDRS-2), and the Zarit Burden Interview (ZBI) were administered, and all patients were reevaluated after 12 months. Baseline ASAD diagnosis was made using specific diagnostic criteria. ASAD prevalence and incidence/year were 21.0% and 10.6%, respectively. After one year, ASAD persisted in 61.2% of patients. At baseline, patients with ASAD scored lower on the CAMCOG and higher on the Blessed, RDRS-2, and ZBI. Antipsychotic use was the only risk factor for ASAD (RR = 3.159; 95% CI: 1.247-8.003). ASAD was related to an increased functional disability, but no relationship with cognitive impairment or increased caregiver burden was detected. Finally, ASAD was associated with an increased risk of mortality (HR = 1.987; 95% CI: 1.145-3.450; p = 0.014). ASAD suggests a more severe AD clinical profile, with poorer functional progression and increased mortality risk. Antipsychotic use seems to be the only risk factor for ASAD.

The Computerised Support System for the Diagnosis of Dementia in Primary Care (SISDDAP, in Spanish) is an asynchronous telemedicine programme that establishes protocols for the screening and diagnosis of dementia, thereby enabling primary care (PC) and specialised care (SC) professionals to reach shared diagnoses of dementia.To determine the feasibility and degree of implementation of an asynchronous telemedicine programme and to evaluate the rate of agreement between the cognitive and functional measures taken by professionals from two different levels of healthcare.The study examines the use of the SISDDAP programme by professionals from four basic areas of healthcare (BAH) in which the programme was introduced on a voluntary basis. The absolute and relative frequency of use of the SISDDAP programme and the number of variables registered were calculated, together with the intra-class correlation coefficient among the scores obtained by PC and SC professionals on the different psychometric instruments, including the SISDDAP diagnostic module (Mini-Mental State Examination, Blessed Dementia Rating Scale and Patient Health Questionnaire 9).The four BAH that incorporated the SISDDAP referred 215 (45.3%) applications via the telemedicine programme, and 82.2% of these applications had a maximum of two data items missing. The intra-class correlation coefficient was above 0.70 among all the instruments evaluated.The SISDDAP is an asynchronous telemedicine programme that is well accepted among PC professionals. After suitable training, the level of agreement among the psychometric instruments is acceptable.

Background To determine the prognostic value of various self-blood pressure (BP) monitoring (SBPM) cutoff at the time of diagnosis.MethodsCohort of 466 newly diagnosed and never-treated hypertensive patients. At baseline and at 1 year, the patients underwent a physical examination, clinic BP (CBP), SBPM, and ambulatory BP monitoring (ABPM), fasting blood and urine analysis, electrocardiogram (ECG), and retinography. The diagnosis of hypertension was made based on CBP average of two readings, separated by 2 min, taken over three different days, with results ≥140/90 mm Hg. At 1-year follow-up, target organ damage (TOD) evolution was classified as favorable or unfavorable.ResultsMean age was 57.4 years, 56.8% were men. Adjusted multivariate analysis showed that hypertensive patients with baseline SBPM

Objectives: to determine the prevalence of three independent, disability-free and operationally defined frailty phenotypes and the associated risk of mortality in a community-dwelling older people cohort over 74 years of age. Methods: observational, prospective and population-based design. Bio-psycho-social variables were assessed using a range of standardised instruments. The physical frailty phenotype (PFP), mental frailty phenotype (MFP) and social frailty phenotype (SFP) were operationally defined using a deficit accumulation model that excluded disability. Logistic regression analyses explored associations of the frailty phenotypes with sex, age and marital status, and a Cox proportional hazard regression analysis was performed to evaluate the association between frailty phenotypes and mortality. Results: of the eligible individuals, 82% (n= 875) participated. The prevalence of any frailty phenotype in an individual was 38.8%; 17.3% exhibited the PFP, 20.2% exhibited the MFP, and 8.9% exhibited the SPF. Older and female were more likely to exhibit the PFP, and widowhood was associated with the SFP. The hazard ratios of mortality were 3.09 (95% CI = 1.54– 6.17) for the PFP and 2.69 (95% CI = 1.01–7.25) for the SFP. Conclusion: three different disability-free frailty phenotypes were differentially related to the socio-demographical characteristics of sex, age and marital status and independently predicted risk of mortality.

The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population-based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in the Girona Health District.To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia.The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010.A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases.The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources.

To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.

Aims: To describe central nervous system (CNS) drug consumption patterns depending on the time to diagnosis of Alzheimer’s disease (AD), and to check whether the cases diagnosed later are associated with greater severity and consuming more CNS drugs. Methods: Cross-sectional study using 952 cases of the Registry of Dementias of Girona. A binary logistic regression was used to detect variables associated with the use of CNS drugs depending on the time to diagnosis. Results: CNS drugs were consumed by 95.8% of the AD patients. Only antipsychotics presented a statistically significant increase in the frequency of prescription to patients with longer time elapsed from symptom onset to AD diagnosis. Conclusion: Longer time elapsed from the onset of symptoms to the diagnosis resulted in increased probability of antipsychotic consumption.

The objective of this study was to estimate several subtypes of depressive disorders as risk factors for dementia and Alzheimer disease (AD) specifically.This is a population-based cohort study using a sample of 451 non-demented older people. Adjusted Cox proportional hazard models were calculated to determine the association of depression with dementia or AD development after 5 years. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination (CAMDEX). Depressive disorders (major episode [MD] and minor depressive disorders [MDDIS]) were assessed following DSM-IV criteria and further classified according to the age at onset (early versus late onset). In turn, all late-onset depressions were grouped as with or without depression-executive dysfunction syndrome (DEDS). Dementia (and dementia subtypes) diagnoses were made using the CAMDEX. When the patients were deceased, the Retrospective Collateral Dementia Interview was used.Late-onset depressions (both MD and MDDIS) were associated with increased dementia (hazard ratio [HR] = 2.635; 95% CI = 1.153-6.023; and HR = 2.517; 95% CI = 1.200-5.280, respectively), and AD (HR = 6.262; 95% CI = 2.017-19.446; and HR = 4.208; 95% CI = 1.828-9.685, respectively) after adjustment by age, gender, marital status, education, cognitive impairment, executive function and stroke history. A second model revealed that only late-onset depressions with DEDS increased the risk for both dementia (late-onset MD with DEDS: HR = 6.262; 95% CI = 2.017-19.446; late-onset MDDIS with DEDS: HR = 4.208; 95% CI = 1.828-9.685) and AD (late-onset MD with DEDS: HR = 7.807; 95% CI = 1.567-38.894; late-onset MDDIS with DEDS: HR = 6.099; 95% CI = 2.123-17.524).Late-onset depressive episodes with DEDS are risk factors for dementia and AD development, regardless of the severity of the depression.

Objectives To establish the prevalence, incidence, persistence, risk factors, and mortality risk increase of psychosis of Alzheimer disease (PoAD) in a clinical sample. Design, participants, and measurements Cross-sectional, observational study of 491 patients with probable AD who, at baseline visit, were evaluated with the Cambridge Examination for Mental Disorders of the Elderly, the Neuropsychiatric Inventory–10, the Rapid Disability Rating Scale–2, and the Zarit Burden Interview. All participants were reevaluated at 6, 12, 18, and 24 months. PoAD diagnoses were made using specific criteria. Results PoAD prevalence was 7.3%, and the cumulative incidence at 6, 12, 18, and 24 months was 5.8%, 10.6%, 13.5%, and 15.1%, respectively. After 1 year, psychotic symptoms persisted in 68.7% of the patients with initial PoAD. At baseline, patients with PoAD scored lower in the Cambridge Cognitive Examination and Mini-Mental State Examination and higher in the Rapid Disability Rating Scale–2 and Zarit Burden Interview tests. Both low scores in the Cambridge Cognitive Examination subscale of learning memory (hazard ratio [HR] = 0.874; 95% CI: 0.788–0.969; Wald χ 2 = 6.515; df = 1) and perception (HR = 0.743; 95% CI: 0.610–0.904; Wald χ 2 = 8.778; df = 1), and high scores in expressive language (HR = 1.179; 95% CI: 1.024–1.358; Wald χ 2 = 5.261; df = 1) and calculation skills (HR = 1.763; 95% CI: 1.067–2.913; Wald χ 2 = 4.905; df = 1) were found to be associated with PoAD. PoAD leads to a faster functional impairment, and it increases mortality risk (HR = 2.191; 95% CI: 1.136–4.228; Wald χ 2 = 5.471; df = 1) after controlling for age, gender, cognitive and functional disability, general health status, and antipsychotic treatment. Conclusions PoAD seems to define a phenotype of AD of greater severity, with worsened functional progression and increased mortality risk.

Introduccion. El Sistema Informatizado de Soporte al Diagnostico de Demencia en Atencion Primaria (SISDDAP) es un programa de telemedicina asincronico que, mediante la protocolizacion del cribado y diagnostico de demencia, tiene como objetivo el diagnostico compartido de demencia entre profesionales de atencion primaria (AP) y atencion especializada (AE). Objetivos. Determinar la viabilidad y grado de implementacion de un programa de telemedicina asincronico y evaluar el grado de concordancia de las medidas cognitivas y funcionales entre los profesionales de dos niveles asistenciales distintos. Pacientes y metodos. Se analiza la utilizacion del programa SISDDAP por parte de los profesionales de cuatro areas basicas de salud (ABS) en las que se introdujo el programa voluntariamente. Se calculo la frecuencia absoluta y relativa de utilizacion del programa SISDDAP y del numero de variables registradas, y se calculo el coeficiente de correlacion intraclase entre las puntuaciones obtenidas por los profesionales de AP y AE en los diversos instrumentos psicometricos que incluye el modulo de diagnostico del SISDDAP (Mini-Mental State Examination, Blessed Dementia Rating Scale y Patient Health Questionnaire 9). Resultados. Las cuatro ABS que incorporaron el SISDDAP remitieron 215 (45,3%) solicitudes mediante el programa de telemedicina, y el 82,2% de estas solicitudes tenia dos o menos datos faltantes. El coeficiente de correlacion intraclase fue superior a 0,70 entre todos los instrumentos evaluados. Conclusiones. El SISDDAP es un programa de telemedicina asincronico que tiene una buena acogida entre los profesionales de AP. Tras una formacion adecuada, el grado de concordancia de los instrumentos psicometricos es aceptable.