Fernando E. Taragano

A Double-Blind, Randomized, Fixed-Dose Trial of Fluoxetine vs. Amitriptyline in the Treatment of Major Depression Complicating Alzheimer's Disease

The objective of this study was to determine the relative efficacy and safety of fluoxetine and amitriptyline in the treatment of major depression complicating Alzheimers disease (AD). The sample included 37 patients with AD and major depression. The study design was a double-blind, fixed-dose, randomized clinical trial with 45 days of follow-up. The outcome measures were the Hamilton Depression Rating Scale (Ham-D), the Mini-Mental State Exam (MMSE), and the number of dropouts from each arm of the study. Efficacy was similar for fluoxetine and amitriptyline. At Day 45, there was a mean 9.4-point reduction in Ham-D scores (t[df,62] = 9.68, P < 0.0001) and a 2.4-point mean increase in MMSE scores as compared to baseline (t[df,2] = 2.69, P = 0.009). Eleven (58%) of the amitriptyline-treated patients dropped out, compared with 4 (22%) of the fluoxetine-treated patients (chi 2[df,2] = 8.9, P = 0.017). The authors conclude that antidepressant treatment for major depression complicating AD is effective. While fluoxetine and amitriptyline are equally effective, fluoxetine is better tolerated.

Spanish boston naming test norms

Abstract The Spanish version of the Boston Naming Test (BNT) has enjoyed widespread use in many clinical and research studies since its introduction. However, there are no normative data available for this test, and the original English language order of presentation is maintained. The purpose of this study was to collect normative information in Buenos Aires and to evaluate age and education effects for the BNT. We studied 200 independent healthy controls between 30 and 82 years of age. No subjects had any history of neurological or psychiatric disorders or alcohol abuse. Neuropsychological evaluation included the Mini-Mental State Examination, Signoret Memory Battery, Serial Frontal Test, Phonologic and Semantic Fluency Test, and Hamilton Depression Scale. The Spanish version of the Boston Naming Test was administered according to the standard protocol. We observed that naming abilities remain generally intact throughout advancing age. Results on the BNT were significantly correlated with education (p<....

Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-type dementia in Argentina

BACKGROUND There is no previous information about economic costs of Alzheimers disease (AD) in South America. The objective of this study was to evaluate the costs of AD in Argentina. METHODS Eighty community-dwelling patients, 20 institutionalized AD patients and their respective primary caregivers, and 25 healthy elderly subjects participated in this study. The cognitive and neuropsychiatric impairments and severity of dementia were assessed with the Mini-mental State Examination, Neuropsychiatric Inventory and Clinical Dementia Rating, respectively. A structured interview about health and health-care resources used during the past 3 months was administered to family caregivers. The time devoted by carers to looking after the patients and the caregiver burden (Zarits Burden Interview) were recorded. RESULTS The annual direct costs of the disease increased with cognitive deterioration from US

Cognitive, functional and behavioral factors associated with the burden of caring for geriatric patients with cognitive impairment or depression: evidence from a South American sample

3420.40 in mild to US

Behavioral symptoms related to cognitive impairment.

9657.60 in severe AD, and with institutionalization (US

Mild cognitive impairment: Believe it or not?

3189.20 outpatient vs. US

Late- versus early-onset geriatric depression in a memory research center.

14,447.68 institutionalized). Most direct costs were paid for by the family. CONCLUSIONS With the projected increase in the number of persons at risk for developing AD in emerging countries, the family cost of the disease will be significant. Dementia costs should be a matter of analysis when health policies are being designed in developing countries.

Validity and Reliability of the SF-36 Administered to Caregivers of Patients with Alzheimer’s Disease: Evidence from a South American Sample

To examine behavioral, cognitive and functional factors associated with psychosocial burden in caregivers of geriatric patients.

Role of cognitive reserve in progression from mild cognitive impairment to dementia

Neuropsychiatric symptoms (NPS) are core features of Alzheimer’s disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct ‘MBI’ and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer’s disease and frontotemporal lobar degeneration.

Mild behavioral impairment: A prodromal stage of dementia

Mild cognitive impairment (MCI) was previously defined as a transitional state that can precede dementia, but the condition and the rates of conversion remain controversial. MCI is now the focus of natural history studies, along with Alzheimers disease (AD) prevention. The objective of our review will be to consider the question of whether MCI is a well enough established entity that it can be a diagnosis in medical practice and a valid target of Alzheimers prevention therapy. MCI was originally defined by Petersen et al. (31) as progressive memory loss, prodrome of Alzheimers disease. More recently MCI has been expanded to other cognitive domains with other potential causes like normal aging, fronto-temporal dementia, and vascular dementia. Despite many consensus conferences, experts cannot agree on critical aspects of the MCI, particularly with respect to its clinical utility. Based on neuropsychological studies, a hippocampal memory profile has been proposed for MCI as prodromal AD. Further research is needed to advance these criteria. We have no doubt, however, that in the future, the diagnosis of AD as disease (not only a dementia syndrome) will be made in the early pre-dementia stage and will be drawn from a combination of neuropsychological, neuro-imaging and CSF biomarkers.