Llinàs-Reglà J

Incidence of dementia in a rural community in Spain: The Girona cohort study

Background: Information on dementia incidence in Spanish populations is still scarce, and there is a dearth of prospective studies. Objective: To estimate the incidence rates of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD) in a population cohort aged 75 and over in a rural area in Spain. Methods: A prospective population cohort study over a 5-year period in 8 rural villages in the province of Girona. The baseline study in 1990 identified 200 prevalent cases of dementia. The dementia-free cohort included 1,260 persons aged 75 and over. This was the sample used for the incidence study. We rescreened and selectively reexamined this group in 1995 using a two-phase procedure consisting of a screening interview at home using the MMSE. Diagnoses of dementia, AD and VaD were established using the Cambridge Examination for Mental Disorders of the Elderly for surviving participants. For deceased participants, we used the Retrospective Collateral Dementia Interview to establish a diagnosis of dementia and AD according to DSM-III-R diagnostic criteria. Results: Information was obtained for 91% of the subjects at risk; 122 incident cases of dementia were identified. Incidence rates per 1,000 person-years at risk were 23.2 (95% CI = 19.1–27.3) for dementia, 10.8 (95% CI = 7.8–13.7) for AD and 9.5 (95% CI = 6.7–12.1) for VaD. All dementia subtypes showed an age-dependent pattern. Females had a relative risk of 1.8 (95% CI = 1.0–3.4) to develop AD. The inclusion of deceased cases with manifestations of dementia increased the rate of dementia incidence in 7.1 cases/1,000 person-years at risk. Conclusion: Incidence rates were similar to those reported by other cohort studies. All dementia subtypes increased with age, but incidence rates did not increase exponentially in the oldest old. Females were at increased risk for AD. The inclusion of information about dementia symptoms from relatives of deceased participants was useful in order to avoid underestimation of the dementia incidence rates. Underestimation of the incidence rates was more important in those aged 75–84 years.

Depression subtypes and 5‐year risk of dementia and Alzheimer disease in patients aged 70 years

The objective of this study was to estimate several subtypes of depressive disorders as risk factors for dementia and Alzheimer disease (AD) specifically.

Mortality after a Diagnosis of Dementia in a Population Aged 75 and Over in Spain

Objectives: To examine the impact of incident dementia on the risk of death, taking into account other chronic illnesses potentially related to death. Design: Six-year, prospective, two-phase, observational cohort study. Setting: 8 municipalities from a rural area in Girona (Spain). Participants: A representative community-based cohort of 1,153 adults aged over 70 living at home at study enrolment. Measurements: Surviving participants underwent detailed clinical evaluation and were assessed by means of the Cambridge Examination for Mental Disorders of the Elderly. Relatives of deceased participants were interviewed using the Retrospective Collateral Dementia Interview. Mortality rates and relative risk of death for subjects with a diagnosis of dementia were calculated. The Cox proportional hazards regression model was used to assess the relationship between mortality and the diagnosis of dementia. Results: In this cohort, 40.0% (n = 49) of the subjects with a diagnosis of dementia died. The mortality rate specific to dementia was 1.0 per 100 person-years. Mortality risk ratios for dementia were 1.79 in men [95% confidence interval (CI) = 1.06–3.02], and 3.14 in women (95% CI = 2.04–4.85). The population death risk attributable to the diagnosis of dementia in our cohort was 11.8%. The most important mortality risks were severe dementia (hazard ratio = 5.7, 95% CI = 3.7–8.6), cancer (hazard ratio = 3.2, 95% CI = 2.2–4.5), heart disease, and an age over 85 (hazard ratio = 1.4, 95% CI = 1.1–1.9). Conclusion: Dementia is a major risk factor for death in advanced age, with the highest mortality rates in women. Moderate and severe dementia was associated with an increased mortality risk even after appropriate control of comorbid conditions.

Predictors of cognitive decline in Alzheimer's disease and mild cognitive impairment using the CAMCOG: a five-year follow-up

BACKGROUND There are discrepant findings regarding which subscales of the Cambridge Cognitive Examination (CAMCOG) are able to predict cognitive decline. The study aimed to identify the baseline CAMCOG subscales that can discriminate between patients and predict cognitive decline in Alzheimers disease (AD) and mild cognitive impairment (MCI). METHODS This was a five-year case-control study of patients with cognitive impairment and a control group. Participants were grouped into AD (n = 121), MCI converted to dementia (MCI-Ad, n = 43), MCI-stable (MCI-St, n = 66), and controls (CTR, n = 112). Differences in the mean scores obtained by the four groups were examined. Receiver operating characteristic curves were used to compare subscale scores in the AD and MCI-Ad groups with those of controls. The influence of age, gender, schooling, and depression on baseline subscale scores was assessed. RESULTS Of the CAMCOG subscales, Orientation and Memory (learning and recent) (OR + MEM) showed the highest discriminant capacity in the baseline analysis of the four groups. This baseline analysis indicated that OR + MEM was the best predictor of conversion to AD in the MCI-Ad group (area under the curve, AUC = 0.81), whereas the predictive capacity of the global MMSE and CAMCOG scores was poor (AUC = 0.59 and 0.53, respectively). CONCLUSIONS In the baseline analysis, the Orientation and Memory (learning and recent) subscales showed the highest discriminant and predictive capacity as regards both cognitive decline in the AD group and conversion to AD among MCI-Ad patients. This was not affected by age, gender, schooling, or depression.

Depression subtypes and 5‐years risk of mortality in aged 70 years: a population‐based cohort study

To estimate the mortality risk related to different mood disorders in a geriatric sample of subjects aged 70 years and over without dementia.

The Trail Making Test: Association With Other Neuropsychological Measures and Normative Values for Adults Aged 55 Years and Older From a Spanish-Speaking Population-Based Sample.

The Trail Making Test (TMT) is used as an indicator of visual scanning, graphomotor speed, and executive function. The aim of this study was to examine the TMT relationships with several neuropsychological measures and to provide normative data in community-dwelling participants of 55 years and older. A population-based Spanish-speaking sample of 2,564 participants was used. The TMT, Symbol Digit Test, Stroop Color–Word Test, Digit Span Test, Verbal Fluency tests, and the MacQuarrie Test for Mechanical Ability tapping subtest were administered. Exploratory factor analyses and regression lineal models were used. Normative data for the TMT scores were obtained. A total of 1,923 participants (76.3%) participated, 52.4% were women, and the mean age was 66.5 years (Digit Span = 8.0). The Symbol Digit Test, MacQuarrie Test for Mechanical Ability tapping subtest, Stroop Color–Word Test, and Digit Span Test scores were associated in the performance of most TMT scores, but the contribution of each measure was different depending on the TMT score. Normative tables according to significant factors such as age, education level, and sex were created. Measures of visual scanning, graphomotor speed, and visuomotor processing speed were more related to the performance of the TMT-A score, while working memory and inhibition control were mainly associated with the TMT-B and derived TMT scores.

Demographically Adjusted Norms for Catalan Older Adults on the Stroop Color and Word Test

The Stroop Color and Word Test (SCWT) is a short test that is widely used in neuropsychological assessment to evaluate the executive aspects of attention control, information processing speed, selective attention, cognitive flexibility, and executive function in terms of the ability to inhibit a usual response in favor of an unusual response. The aim of this study was to create normative data from the SCWT adjusted for age, sex, and educational level for its clinical use in a population of 55 years of age and above. The SCWT was administered to a population-based sample of 2,151 participants aged 55 or older, and the effect of sex, age, and educational level was determined in the SCWT by means of linear regression models. Normative tables were created following the traditional method based on the stratification by relevant variables and on regression models.