SpRMBPC is a validated tool for assessing the dementia stage and the psychiatric morbidity of patients and caregivers. The Frequency Disruption and Memory subscales assess specifically patient's disruptive symptoms and dementia stages. These tools can be applied to analyze the burden of the patient's disease and the caregiver's distress in Spanish-speaking populations.
Introduction
Antipsychotic medications are widely prescribed to manage neuropsychiatric symptoms (NPS) of dementia. NPS produce a negative impact on the caregiver and represent a cause of institutionalization. The benefit of antipsychotics is controversial and should be the last treatment option.
Objective
To detect potential predictors of antipsychotic drug (risperidone, quetiapine, olanzapine, clozapine, haloperidol) use in patients with mild cognitive impairment and mild dementia.
Methods
Data was collected as part of the prospective study of home‐dwelling people with cognitive impairment and their caregivers. The associations between antipsychotic medication use and cognitive‐clinical measures were analyzed using a multivariate binomial generalized linear model.
Results
228 patients were evaluated at baseline. MCI and dementia were diagnosed in 125 and 30 subjects respectively. After a median (25th to 75th percentile range) of 4.5 (4.1‐4.9) years 21 patients died. Antipsychotics were prescribed in 46 cases (16 with dementia and 30 with MCI). In the multivariate model, baseline Boston naming test (OR: 0.93, 95% confidence interval: 0.89‐0.98, p=0.004) and instrumental activities of the daily living score (OR: 0.65, 95% confidence interval: 0.47‐0.90, p=0.009) were independently related to antipsychotic use (table).
Conclusion
Within 4 years of follow‐up, thirty percent of the patients with cognitive impairment received antipsychotic drugs. Baseline instrumental activity of the daily living and Boston naming test were identified as independent predictors.
Background
Small vessel disease is a frequent cause of vascular damage, observed on magnetic resonance imaging and increased with age.(Pantoni, Poggesi & Inzitari,2007) One scale to assess vascular damage that correlates with cognitive measures is Fazekas scale.(Fazekas, Chawluk, et.al. 1987). Vascular damage can have an impact on cognitive and functional performance.
Method
Cross‐sectional study with prospective recruitment of patients 65 years or more, evaluated in the Geriatric Section, Italian Buenos Aires Hospital. Patients with MCI and brain MRI were included. All subjects were evaluated with a complete neurocognitive battery, and functional scales (complex activities of daily living: EFE). Patients were divided in 3 categories of vascular brain damage according to the MRI in Fazekas (F) group: 0‐1, 2 and 3. Bivariate analysis and multivariable analysis was performed. Odds ratio (OR) and confidence intervals 95% (CI) were informed.
Result
346 patients were included, women 71.7%, mean age: 77.9 (ds 6.1). Fazekas (F) categories: F0‐1: 229 (66.2%), F 2: 79 (22.8 %) y F 3: 38 (11.0 %). Patients with hippocampus atrophy (HA)119 (46.1%).There were no differences in the presence of comorbidities between the 3 categories of Fazekas. Patients with F3 were older (table1). In cognitive profile, patients with F3 showed greater impairment in executive functions and episodic memory than patients with F2 and F0‐1 (table2); in functional profile, patients with F3 showed greater impairment in complex functionality than patients with F2 and F 0‐1 (table 2). Fazekas categories were an independent factor associated with the impairment of the EFE (F3 OR 2.53 CI1.05‐6.11 p= 0.039 ) (Figure 1) and with the free memory delayed recall impairment (F3 OR: 2.84 CI 1.09‐7.43 p= 0.033) (Figure 2)
Conclusion
The results obtained show a functional cognitive profile in patients with MCI and its associations with vascular damage. Severe vascular damage was independently associated with: 1) the deterioration of complex activities of daily living as a manifestation of executive impairment and 2) the deterioration of free memory delayed recall by compromise executive control processes that is critical for to maintain, code and retrieve long time memories.
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