J. de Pedro-Cuesta

Incidence of spinal cord injury worldwide: a systematic review.

Background: Incidence studies of spinal cord injury (SCI) are important for health-care planning and epidemiological research. This review gives a quantitative update on SCI epidemiology worldwide through a statistical evaluation of incidence rates. Methods: A systematic review was conducted. For each study, the crude rate ratio was calculated and, when possible, age- and gender-adjusted incidence rate ratios with 95% CI were determined by direct adjustment or using Poisson regression. Results: Thirteen studies were included. Annual crude incidence rates in traumatic SCI varied from 12.1 per million in The Netherlands to 57.8 per million in Portugal. Compared to the Portuguese reference study, incidence rates showed a 3-fold variation, with the highest rates in Canada and Portugal. Most traumatic SCI studies showed a bimodal age distribution. The first peak was found in young adults between 15 and 29 years and a second peak in older adults (mostly ≧65 years). Motor vehicle accidents and falls were the most prevalent causes of injury accounting for nearly equal percentages. In contrast, another age pattern in non-traumatic SCI reflected steadily increasing incidence with advancing age. Conclusions: The results show significant variation in SCI incidence with changing epidemiological patterns. A trend towards increased incidence in the elderly was observed, likely due to falls and non-traumatic injury.

Prevalence of Dementia Subtypes in El Prat de Llobregat, Catalonia, Spain: The PRATICON Study

Background: Studies on dementia subtypes show a wide variation in the prevalence of Alzheimer’s disease (AD) and vascular dementia (VD) worldwide. However, studies reporting on Lewy body dementia (LBD) and frontotemporal dementia (FTD) are sparse. Aims: To describe the prevalence ofdementia and subtypes. Method: A 34% sample of 5,150 subjects aged 70 years and over in El Prat de Llobregat (Barcelona) were screened by the Mini-Mental State Examination. When scoring <24, participants were assessed to establish a diagnosis. Results: There were 165 subjects diagnosed with dementia (prevalence of 9.4%). Subtypes of dementia were: AD 69.1%, VD 12.7%, LBD 9.1%, FTD 3% and secondary dementia 1.8%. Prevalences were: AD 6.5%, VD 1.2%, LBD 0.9% and FTD 0.3%. Conclusions: AD and VD were the most common type of dementia. Prevalence of dementia, AD and FTD were similar to those reported, while prevalence of VD and LBD were lower.

Evaluation of stroke rehabilitation by randomized controlled studies: a review.

In all, 22 reports of 20 randomized, controlled rehabilitation studies were evaluated. In 18 of these, the design of the trial was parallel, with a cross‐over format being employed in the remaining 2 instances. Seven studies related to intensive rehabilitation during the early post‐acute period. In six others, specific techniques ‐ sometimes associated with traditional physiotherapy procedures ‐ were compared: biofeedback, perceptual retraining, and amphetamine treatment. Eight experiments evaluated speech therapy in aphasia. Frequently, methodological considerations limited the interpretation of the results. The review showed that: 1) as regards activities of daily life and motor function, differences as between rehabilitation in stroke units on the one hand and non‐rehabilitation or rehabilitation in medical wards on the other, were detected in relatively few quality studies and remained particularly inconclusive insofar as life in the home environment was concerned; 2) rehabilitation for aphasia and perceptual dysfunction proved effective for at least several months after acute stroke; 3) in general, examination of the reports cited revealed no differences in the effects of biofeedback and perceptual retraining vs conventional physiotherapy; 4) rehabilitation, whether administered by specialists or amateur caregivers purpose‐trained by specialists, proved equally effective for aphasia. These conclusions constitute a valuable basis for the development and evaluation of modern rehabilitation programs for stroke patients.

Parkinson's disease occurrence in Europe

ABSTRACT Parkinsons disease (PD) surveys and death‐record studies in European populations were reviewed. Particular attention was given to methodological aspects. Two sets of quality criteria were used. Four door‐to‐door surveys revealed underdiagnosis of prevalent idiopathic parkinsonism ranging from 30% to 71%. Quality surveys based on medical records were scarce. The analysis of a) the time relationships between the diagnostic process and the study period for measurements, and b) a variation observed in the shape of the curve for age‐specific prevalences, suggested that both incidence and prevalence were underestimated by these surveys, especially among the elderly. In the UK, Denmark and Sweden, mortality from parkinsonism increased over time for ages over 70 years, but decreased for the younger age groups. A two‐fold variation in mortality was found between countries. It is concluded that PD is widely distributed in Europe, and that most geographical differences in reported disease occurrence can be explained by methodological variations in measurements. The pattern of variation of age‐specific figures was similar for mortality and prevalence. This might reflect decreasing prevalences among those aged under 70 years and increasing ascertainment in the elderly. There is a need for research methods for specific purposes in this field to be developed.

An Epidemic-Like Cluster of Motor Neuron Disease in a Swedish County during the Period 1973–1984

We have tried to find all cases of motor neuron disease (MND) with onset during the study period 1961-1990 in the county of Skaraborg, Sweden, and in this retrospective study we have identified 168 cases, 107 men and 61 women. Fifty percent of them were alive 2 years after onset. The number of MND cases in consecutive 5-year intervals during the study period was shown to be statistically significantly elevated for males in the period 1981-1985 (Knox test disjoint procedure, p = 0.02). During the period 1973-1984, 70 males had onset of MND, corresponding to an average annual incidence of 4 per 100,000 person-years. This epidemic-like cluster was compared to the MND morbidity in a neighbouring county and was shown to be statistically significantly elevated even when the p value was adjusted for multiple comparisons. Agricultural work was significantly more common among the cases compared to the rest of the population.

Independent validation of the scales for outcomes in Parkinson’s disease‐autonomic (SCOPA‐AUT)

Background and purpose:  Autonomic dysfunction is common in Parkinson’s disease (PD) and causes a great impact in health‐related quality of life (HRQL) and functional status of patients. This study is the first independent validation of the Scales for Outcomes in PD‐Autonomic (SCOPA‐AUT).

Pregnancy and Guillain-Barré syndrome: a nationwide register cohort study.

In this study, we determined the relationship between Guillain-Barré syndrome (GBS) and pregnancy. By taking advantage of several nationwide registers and the availability of personal identification numbers, we calculated person-years for Swedish females aged 15-49 years in the following categories: (1) neither pregnant nor postpartum; (2) pregnant; (3) in the first month postpartum, or (4) in the first 3 months postpartum during 1973-1983. For these women, we determined the corresponding exposure status of hospital-registered GBS cases. Medical records were examined for GBS cases hospitalized during the 2-week period postpartum and 1-month period after the last menstruation. Poisson regression analysis yielded age-adjusted relative risks (RRs) of 0.86 (95% CI 0.40-1.84) for pregnant women, and 1.47 (0.54-3.99) and 2.21 (0.55-8.94) for females during the 3-month and the 30-day period after delivery. The risk for GBS seems to be lower during pregnancy and increases after delivery.

Prevalence and European comparison of dementia in a ≥75-year-old composite population in Spain.

Virués‐Ortega J, de Pedro‐Cuesta J, Vega S, Seijo‐Martínez M, Saz P, Rodríguez F, Rodríguez‐Laso Á, Reñé R, de las Heras SP, Mateos R, Martínez‐Martín P, Mahillo‐Fernández I, López‐Pousa S, Lobo A, Reglà JL, Gascón J, García FJ, Fernández‐Martínez M, Boix R, Bermejo‐Pareja F, Bergareche A, Sánchez‐Sánchez F, de Arce A, del Barrio JL; On behalf of the Spanish Epidemiological Studies on Ageing Group. Prevalence and European comparison of dementia in a ≥75‐year‐old composite population in Spain. 
Acta Neurol Scand: 2011: 123: 316–324. 
© 2010 John Wiley & Sons A/S.

Public health surveillance and incidence of adulthood Guillain-Barré syndrome in Spain, 1998–1999: the view from a sentinel network of neurologists

Abstract.Temporal variation in Guillain-Barré syndrome (GBS) warrants monitoring in certain situations. This study sought to describe a public-health-based GBS surveillance service in Spain and conduct pilot surveillance in the period 1998-1999. Neurologists from 11 hospitals countrywide, serving a population of 3.9 million, reported all patients, ages 20 years or over, admitted to hospital with suspected GBS. Cases that did not belong to the designated hospital catchment area or failed to fulfill diagnostic criteria after follow- up were excluded. Reported monthly incidence was compared against predicted incidence obtained from retrospective data (1985–1997) using a reported method based on 97.5% percentile values. Alarm thresholds for 2000 onwards were obtained by applying the same method to the updated 1985–1999 series. During the 2-year period, 98 GBS cases were reported, yielding an overall age-adjusted incidence of 1.26 per 100 000 population, with a breakdown by sex of 1.83 for males and 0.76 for females. Monthly incidence remained below or was similar to the corresponding threshold limit value. Seasonality with highest incidence in winter was more pronounced in the elderly. Preceding events, mainly respiratory infections, were identified in 71% of patients. Pilot two-year GBS surveillance in Spain resulted neither in alarm nor in preventive measures. Adult GBS incidence in Spain might be monitored by a surveillance system set up at short notice when a possible threat is perceived. A monthly incidence of over 3 per 100 000 person-years in the population aged 20 years or older would exceed threshold values.

Analysis of disability using WHODAS 2.0 among the middle-aged and elderly in Cinco Villas, Spain

BACKGROUND The prevalence of disability, as defined by the International Classification of Functioning, Disability and Health (ICF), among the middle-aged and elderly population is poorly known. OBJECTIVE To determine disability prevalence in a resident population sample aged ≥50 years, in the Cinco Villas district, Spain, from June 2008 through June 2009. METHODS We used the WHODAS 2.0 36-item questionnaire to quantify the prevalence of disability, globally and by domain, together with a 13-item combined measure of three domains, Getting around, Self-care and Life activities, claimed to reflect the need of integrated services. In addition, we performed exploratory analyses of the relationship between disability and different variables using ordinal logistic regression. RESULTS Disability was detected by global WHODAS score in 604 of a total of 1214 persons, i.e., a prevalence of 49.8% 95% CI (46.9-52.5), with the corresponding figures for mild, moderate, severe, and extreme disability being 26.8%, 16.0%, 7.6% and 0.1%, respectively. Disability increased with age, was higher among women, and for specific domains. Prevalence of severe/extreme disability among women vs. men was as follows: Getting around, 26.8% vs. 12.1%; Life activities, 25.2% vs. 6.8%; and Self-care, 9.5% vs. 6.0%. Disability was more frequent among subjects diagnosed with dementia, chronic liver disease, severe mental disease, and stroke. The abovementioned 13-item measure yielded prevalence figures for disability levels quite similar to those obtained using 36-item scores. CONCLUSIONS For the first time, this study furnishes detailed disability prevalence figures and data on associated variables in a middle-aged and elderly Western population.