Eder Herrera-Pérez

Association between Allergic Rhinitis and Asthma Control in Peruvian School Children: A Cross-Sectional Study

Background. Asthma and allergic rhinitis are highly prevalent conditions that cause major illness worldwide. This study aimed to assess the association between allergic rhinitis and asthma control in Peruvian school children. Methods. A cross-sectional study was conducted among 256 children with asthma recruited in 5 schools from Lima and Callao cities. The outcome was asthma control assessed by the asthma control test. A score test for trend of odds was used to evaluate the association between allergic rhinitis severity and the prevalence of inadequate asthma control. A generalized linear regression model was used to estimate the adjusted prevalence ratios of inadequate asthma control. Results. Allergic rhinitis was present in 66.4% of the population with asthma. The trend analysis showed a positive association between allergic rhinitis and the probability of inadequate asthma control (P < 0.001). It was associated with an increased prevalence of inadequate asthma control, with adjusted prevalence ratios of 1.53 (95% confidence interval: 1.19−1.98). Conclusion. This study indicates that allergic rhinitis is associated with an inadequate level of asthma control, giving support to the recommendation of evaluating rhinitis to improve asthma control in children.

Mixed dementia: A review of the evidence

ABSTRACT. Mixed dementia is the coexistence of Alzheimers disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimers dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimers dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.

Prevalence of frontotemporal dementia in community-based studies in Latin America: A systematic review

Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in geriatric problems such as dementia. There are few epidemiological studies assessing the magnitude of dementia and dementia subtypes in LA. OBJECTIVE To identify published community-based studies on the prevalence of FTD in LA countries. METHODS A database search for door-to-door studies on FTD prevalence in LA was performed. The search was carried out on Medline, Embase, and LILACS databases for research conducted between 1994 and 2012. The main inclusion criteria were: use of any internationally accepted diagnostic criteria and investigation of community samples. RESULTS Four hundred and ninety two articles were found, of which 26 were initially pre-selected by title or abstract review. Five studies from 3 different countries were included. The FTD prevalence rates in community-dwelling elderly were 1.2 (Venezuela), 1.3 (Peru) and 1.7-1.8 (Brazil) per thousand persons, depending on age group. CONCLUSION The FTD prevalence in LA studies showed values mid-way between those observed in western and in oriental populations. Despite the magnitude of this problem, epidemiological information on FTD remains scarce in LA.

Evaluation of the INECO Frontal Screening and the Frontal Assessment Battery in Peruvian patients with Alzheimer's disease and behavioral variant Frontotemporal dementia

Background The physicians often confuse the early symptoms of Frontotemporal dementia (FTD) with Alzheimer dementia (AD), leading to misdiagnosis. There are some cognitive tests to discriminate between AD and behavioral variant FTD (bvFTD), and the INECO Frontal Screening (IFS) is a promising test for this purpose. Objective To assess the performance of the IFS to differentiate patients with AD from patients with bvFTD, compared with the Frontal Assessment Battery (FAB). Methods A prospective study with 117 patients of our cognitive unit (35 case-patients with AD, 34 case-patients with bvFTD, and 48 control subjects). They were submitted to the following successive phases of evaluation: 1) screening; 2) dementia diagnosis; and 3) dementia sub-type diagnosis. The IFS and FAB were blind and independently applied by one neurologist to all the participants to end of phase 1 (screening), before to the definitive diagnosis establishment. Results bvFTD showed a lower performance than AD patients on the IFS total score (F(1, 66) = 70.10, p < 0.01) and FAB total score (F(1, 66) = 17.91, p < 0.01). The IFS and FAB showed a sensitivity of 94.12% (95%CI = 80.3–99.2) and 82.3% (95%CI = 65.4–93.2), and a specificity of 94.2% (95%CI = 80.8–99.3) and 48.5% (95%CI = 31.3, 66.1), respectively. The IFS showed significantly superior discriminatory accuracy than the FAB (AuCIFS = 0.98; AuCFAB = 0.73, p < 0.00001). Conclusion The IFS is useful for discriminating between AD and bvFTD patients. The performance of the IFS to differentiate patients with AD from patients with bvFTD is greater than FAB.

Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru

Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries. Objective The aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru. Methods. We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs). Results. In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US

Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer’s Dementia in Population with Low Educational Level

23 over three months, demented patients had costs of US

Rendimiento en pruebas cognitivas breves, de adultos mayores con demencia en estadios avanzados, residentes de una comunidad urbana de Lima, Perú

1500 or over (and more than US

Crisis epilépticas en la demencia de la enfermedad de Alzheimer

1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US

Informal caregiver burden in middle-income countries: results from Memory Centers in Lima - Peru

570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US

Validity of Addenbrooke's Cognitive Examination to Discriminate between Incipient Dementia and Depression in Elderly Patients of a Private Clinic in Lima, Peru

222.22). Conclusion. Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patients family.