Leonardo Bartoloni

Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina.

BACKGROUND The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs. METHODS Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008. RESULTS 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US

Familial dementia with frontotemporal features associated with M146V presenilin-1 mutation.

4625 for DAT, US

Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina

4924 for FTD, and US

Propuesta de un Registro centralizado de casos con Deterioro Cognitivo en Argentina (ReDeCAr) basado en el Sistema Nacional de Vigilancia Epidemiológica

5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76). CONCLUSIONS The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living.

A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo Study. Preliminary Results

Most of the mutations in the presenilin‐1 gene (PS‐1) are associated with familial Alzheimers disease (AD). However, certain examples can be associated with frontotemporal dementia (FTD). We performed a clinical evaluation of individuals belonging to a family with the FTD phenotype, and additional molecular studies and neuropathological assessment of the proband. The PS‐1 M146V mutation was found in the 50‐year‐old subject (the proband) with family history of early‐onset FTD. Neuropathological examination showed abundant amyloid plaques, widespread neurofibrillary pathology, Pick bodies in the hippocampus and cortex, cortical globose tangles and ubiquitin‐positive nuclear inclusions in white matter oligodendrocytes. We report a kindred with clinical features of FTD, whose proband bore the PS‐1 M146V mutation and showed diffuse Alzheimers type pathology and Pick bodies on post‐mortem neuropathological examination. As with other mutations within the same codon, this substitution may predispose to both diseases by affecting APP and/or tau processing.

MM1+2C Sporadic Creutzfeldt-Jakob Disease Presenting as Rapidly Progressive Nonfluent Aphasia

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1–96.0], Sp = 96.67 [82.8–99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8–93.0], Sp = 90.00 [73.5–97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment.

The first steps of clinical neurology in South America

Resumen Se propone el desarrollo de un Registro centralizado de casos de Deterioro Cognitivo en Argentina (ReDeCAr) basado en el modelo de vigilancia epidemiologica. Se llevara a cabo un estudio de tipo observacional prospectivo en distintos centros y hospitales del sistema de salud de todo el pais. Para la recoleccion de datos se utilizara un software de alcance nacional que incluya los sistemas de vigilancia epidemiologica en un mismo formato, estableciendo una red de vigilancia. Dicha red estara conectada a internet, sitio web del Ministerio de Salud de la Nacion ( www.msal.gov.ar ). Estos datos seran utiles para describir patrones de ocurrencia por subtipos, identificar sus principales caracteristicas clinicas y generar hipotesis para nuevos proyectos de investigacion clinica. Se establecera una unidad de referencia comun para una problematica que requiere atencion social y sanitaria multidisciplinaria. Esto permitira inferir la importancia local de esta patologia, para lo cual es necesario disponer de datos poblacionales que generen adecuadas politicas de salud.

Economic costs of dementia in Argentina: A comparison between vascular, frontotemporal and Alzheimer's dementia

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. Objective The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. Methods A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. Results and Conclusions A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population.

First report of frontotemporal dementia-like phenotype in an argentine family with presenilin-1 M146V Alzheimer's disease with Pick Bodies.

We report a 77-year-old man, presenting with progressive aphasia as an initial symptom, who developed severe dementia over the course of 20 months. Frontal cortex PrPSc western blot was type 2 and codon 129 was MM; brain neuropathology showed cortical vacuoles with perivacuolar PrP immunostaining characteristic of MM2C. Cerebellum showed focal coarse, patchy staining in different sections of the molecular layer, diffuse fine punctuate and coarse PrP immunopositive deposits in the granule cell layer, and focal synaptic immunostaining in the molecular layer, suggestive of MM1+2C by histotyping. This clinical presentation has not yet been described in an MM1+2C subtype by histotyping.

Cognitive training and long-term follow-up in patients with mild cognitive impairment

The field of neurology in South America began to emerge toward the end of the 19th century, following the origin of the specialty in Europe. There was a consistent and long-standing admiration for European training, which led to the birth of the discipline in South America. The first steps took place almost simultaneously with European countries in Argentina, Brazil, Uruguay, Chile, and Peru. In the other countries, the development of neurology took place later in the 20th century.1,2