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Barcelona, Spain

Garre-Olmo J.,Institute DAssistencia Sanitaria | Garre-Olmo J.,University of Girona | Genis Batlle D.,Hospital Universitari Josep Trueta | Del Mar Fernandez M.,Hospital de Figueres | And 7 more authors.
Neurology | Year: 2010

Objective: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. Methods: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. Results: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30-64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3-15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. Conclusions: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30-49 years; in the age group 50-64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase. © 2010 by AAN Enterprises, Inc. All rights reserved. Source

Calvo-Perxas L.,Institute DAssistencia Sanitaria | De Eugenio R.M.,Dementia Unit | Marquez-Daniel F.,Hospital dOlot | Martinez R.,Neurology Unit | And 11 more authors.
International Psychogeriatrics | Year: 2012

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. © 2012 International Psychogeriatric Association. Source

Vilalta-Franch J.,Institute DAssistencia Sanitaria | Vilalta-Franch J.,Dementia Unit | Planas-Pujol X.,Institute DAssistencia Sanitaria | Lopez-Pousa S.,Institute DAssistencia Sanitaria | And 4 more authors.
International Journal of Geriatric Psychiatry | Year: 2012

Aims To estimate the mortality risk related to different mood disorders in a geriatric sample of subjects aged 70 years and over without dementia. Method All non-demented subjects at baseline who participate on a second phase of a population-based cohort study were included. Adjusted Cox proportional hazards models were used to determine the association between depression and 5-year survival of 451 elderly people without dementia originally recruited for a representative community dementia cohort study. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination Schedule. Depressive disorders (major and minor episode) were assessed according DSM-IV criteria and classified according the age of onset (late vs. early). The late-onset depression was classified according to the presence or absence of depression-executive dysfunction syndrome (DEDS). Results The initial cohort size was 451 subjects, among which 10.9% (n=49) suffered a major depressive episode and 10.4% (n=47) a minor depressive disorder. Among the total affective disorders, 77.9% (n=74) were late-onset depressions and 29.5% (n=28) had executive dysfunction. After 5 years, the vital status of 94% (n=424) of the participants was known and the mortality was 18.9% (n=80). Late-onset major depressive episode with executive dysfunction was related to mortality after adjustment by age, gender, marital status, level of education, comorbidity (or health global status) and cognitive impairment (HR=3.70; 95% CI=1.55-8.83). The executive dysfunction was found to be an independent mortality risk factor (HR=2.05; 95% CI=1.15-3.64). Conclusions There is a statistically significant association between mortality and late-onset major depression with executive dysfunction. © 2011 John Wiley & Sons, Ltd. Source

Vilalta-Franch J.,Institute DAssistencia Sanitaria | Vilalta-Franch J.,Dementia Unit | Lopez-Pousa S.,Institute DAssistencia Sanitaria | Lopez-Pousa S.,Dementia Unit | And 3 more authors.
American Journal of Geriatric Psychiatry | Year: 2013

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 Inventorye10, the Rapid Disability Rating Scalee2, 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 Scalee2 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 χ2 = 6.515; df = 1) and perception (HR = 0.743;95% CI: 0.610-0.904; Wald χ2 = 8.778; df = 1), and high scores in expressive language (HR = 1.179;95% CI: 1.024-1.358; Wald χ2 = 5.261; df = 1) and calculation skills (HR = 1.763;95% CI: 1.067-2.913; Wald χ2 = 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 χ2 = 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. © 2013 American Association for Geriatric Psychiatry. Source

Vilalta-Franch J.,Institute DAssistencia Sanitaria | Vilalta-Franch J.,Dementia Unit | Lopez-Pousa S.,Institute DAssistencia Sanitaria | Lopez-Pousa S.,Dementia Unit | And 5 more authors.
International Journal of Geriatric Psychiatry | Year: 2013

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. © 2012 John Wiley & Sons, Ltd. Source

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