Elena Lobo

Mild cognitive impairment diagnosed with the new DSM-5 criteria: prevalence and associations with non-cognitive psychopathology.

To contrast the prevalence of mild cognitive impairment (MCI) as diagnosed using DSM‐5 criteria (DSM5‐MCI) with MCI as diagnosed using Petersens criteria (P‐MCI) and to explore the association of both with non‐cognitive psychopathological symptoms (NCPS).

Is There an Association Between Low-to-Moderate Alcohol Consumption and Risk of Cognitive Decline?

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 of <12 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.

Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population

Lobo A, Lopez‐Anton R, Santabárbara J, de‐la‐Cámara 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.

Early detection of pneumology inpatients at risk of extended hospital stay and need for psychosocial treatment

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. APC = ancillary procedures count; B unstand = Beta unstandardized coefficients; CAGE = screen for alcohol abuse; CI = confidence interval; CIRS = Cumulative Illness Rating Scale; COPD = chronic obstructive pulmonary disease; DC = diagnostic count; HADS = Hospital Anxiety and Depression Scale; IM+ = INTERMED positive score; IM– = INTERMED negative score; INTERMED = Interdisciplinary Medicine; LOS = length of hospital stay; MBDS = minimum basic data set; MMSE = Mini Mental Status Examination; NCA = number of consultations during admission; NPD = number of physicians the patient is referred to at discharge; NHS = National Health System.

Conversion to dementia in mild cognitive impairment diagnosed with DSM‐5 criteria and with Petersen's criteria

In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimers disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM‐5 (DSM‐5‐MCI) and Petersens (P‐MCI) criteria.

Care complexity, mood, and quality of life in liver pre-transplant patients.

This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health‐related quality of life (HRQoL).

Gender differences in the incidence of and risk factors for hip fracture: A 16-year longitudinal study in a southern European population

OBJECTIVES To analyze independently in men and women the incidence rate of and risk factors for hip fracture in a southern European population. Illiteracy, dementia, clinically significant depression and disability were factors to receive special emphasis. STUDY DESIGN A community sample of 4803 individuals aged over 55 years was assessed in a two-phase case-finding study in Zaragoza, Spain, and was followed up for 16 years. Medical history and psychiatric history were collected with standardized instruments, including the History and Aetiology Schedule, the Geriatric Mental State (GMS) scale, and a Risk Factors Questionnaire. Operational criteria were used to define covariates, including diagnostic criteria for both dementia and depression. The statistical analysis included calculations of incidence rate, IR; women/men incidence rate ratio (IRR); and Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. MAIN OUTCOME MEASURES Cases of hip fracture (International Classification of Diseases, WHO) identified in the treating hospitals, validated by blinded researchers. RESULTS Hip fractures were more frequent among women than men (IRR=3.1). Illiteracy (HR=1.55) and depression (HR=1.44) increased the risk in women, and smoking (HR=2.13) and disability in basic activities of daily living (HR=3.14) increased the risk in men. Dementia was associated with an increased risk in an univariate analysis, but the association disappeared (power=85% in men, 95% in women) when disability was included in the multivariate models. CONCLUSIONS The IR of hip fractures was three times higher among women. Illiteracy and clinically significant depression among women and active smoking and disability (HR=3.14) among men independently increased the risk, but dementia did not.

Assessing Psychosocial Vulnerability and Care Needs of Pretransplant Patients by Means of the INTERMED

OBJECTIVE We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. METHOD One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Åsberg Depression Rating Scale (MADRS), and Hospital Anxiety & Depression Scale (HADS). RESULTS We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS,MADRS, and mental and physical health scores of the SF-36 Health Survey. CONCLUSIONS The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

Mortality in Mild Cognitive Impairment Diagnosed with DSM-5 Criteria and with Petersen's Criteria: A 17-Year Follow-Up in a Community Study

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 Petersens 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.

Identification of components of health complexity on internal medicine units by means of the INTERMED method

The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care.