Tirso Ventura

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

Objective:  To compare the prevalence of dementia in two different time periods and two different studies.

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.

Prevalence and implications of psychopathological non-cognitive symptoms in dementia

Objective:  Clinical experience and recent population studies suggest that psychopathological, non‐cognitive symptoms are both frequent and relevant in dementia.

The ZARADEMP Project on the incidence, prevalence and risk factors of dementia (and depression) in the elderly community: I. The context and the objectives

Background and Objectives: The public health dimension of the problem of dementia and depression in the elderly population is well documented, but epidemiological data are generally considered to be insufficient and, at times, contradictory. This paper identifies relevant research areas for the 7ARADEMP Project, which follows the Zaragoza Study (or ZARADEMP 0) and is part of both EURODEM and EURODEP Studies. Methods: Review of the literature. Hypotheses emerging in previous studies of this research group. Results: The following relevant objectives to study in relation to dementia (and depression) have been identified: a) potential variations over time in the prevalence rate; b) provision of reliable estimations of incidence rates, specific for age and gender; c) data about the course and natural history of so called mild cognitive deficit; d) association between hypothesized risk factors and cases of dementia (and depression) and its most frequent subtypes; and e) testing of hypotheses related to the overlap between dementia and depression and, specifically, to what extent depression has an increased risk for DAT. Other objectives of the study are also reviewed, in particular the cross-cultural comparison of findings in Zaragoza and in other European cities incorporated in both EURODEM and EURODEP Studies. The importance of maintaining good, contemporary methodological standards is emphasized. Conclusions: A number of relevant research areas in the epidemiology of both dementia and depression in the elderly have been identified. Case-control studies based on incident cases of dementia of the Alzheimers type (DAT) to adequately assess risk factors seem particularly timely.

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.

Prevalence of "organic brain syndrome" in a Southern European population in two different time periods: The ZARADEMP Project

Background: Comparative studies of dementia in different time periods are quite limited in the international literature, but might be useful to test environmental hypotheses. The aim of this study is to compare the prevalence of organic brain syndrome, as a measure of dementia, in the elderly living in the same community in two different time periods and using the same methods. Methods: Representative samples of the elderly in the Zaragoza Study or ZARADEMP 0 (n= 1,080), completed the past decade, and now in Wave I of the ZARADEMP Project or ZARADEMP I (n= 4,803) were interviewed. The Geriatric Mental State (GMS) was the main case-finding instrument and the results were analysed using the AGECAT diagnostic package to generate diagnoses. Results: Adjusted, total prevalence of organic brain syndrome in individuals aged 65 years and older has not varied from the previous decade. It was 8.4% in ZARADEMP I, and 7.4% in ZARADEMP 0 (prevalence ratio, PR = 0.83; CI 0.65-1.07). Adjusted prevalence among men was lower in ZARADEMP 1(3.6%) when compared to ZARADEMP 0 (5.5%), although the differences do not reach statistically significance (PR= 0.65; CI 0.41-1.05). However, in support of the working hypothesis, the differences were more marked, and we consider they reach statistically significant proportions in the age group 80-84 years. Conclusions: The prevalence of organic brain syndrome has not increased from the previous decade. On the contrary, the prevalence tends to be lower in men, and the differences reach stastistical significance in the age group 80-84 years. New analysis using diagnostic criteria of dementia in the same sample are required to confirm these findings.

Reliability and validity of the Spanish version of the IDEAL Schedule for assessing care needs in dementia: Cross-sectional, multicenter study

The IDEAL Schedule was developed for staging “care needs” in patients with dementia. We here aim to validate the Spanish version, further test its psychometric properties and explore a latent construct for “care needs”.

Innovative methods in teaching psychiatry to medical students

Background and Objectives: To test the conjecture that the innovative method to teach psychosomatic psychiatry previously reported will be confirmed as bene- ficial in the training of medical students in the field of general psychiatry. Methods: The emphasis in this course is placed on the discussion of clinical cases, bed- side clinical teaching, and a research-oriented part. The “Innovative Teaching Plan” (ITP) is intended to train student-leaders to guide small groups (SG) of students. The results of an intensive clerkship on bedside teaching are also studied. Trainee performance was assessed by the marks in the final examination, and a reliable and valid tool, the Medical Tea ching Quality Questionnaire (MTQQ) was used to document trainee satisfaction. The results of five academic courses are presented in this report. Results : External experts consulted assured that the content of the course was adequate. Eight hundred and thirty eight medical students have completed the learning course in the study period, and 418 (one of the two groups) completed the evaluation with the MTQQ. Most items related to the students’ satisfaction were rated “high” or “very high”, in- cluding the items asking about the usefulness of the course for physicians, the quality of the teaching methods and the bedside teaching. In relation to innovation, the discussion of clinical cases in small groups was also very satisfactory and the “enhancement of a re- searcher’s mind” was rated “high” or “very high” by 1/3rd of medical students. The utili- ty of the yearly evaluation of the quality of teaching methods was supported by results showing that items scored not favourably in the initial evaluation were considerably im- proved in the follow-up evaluations, when modifications in the method were introduced. Conclusions: Good performance and high satisfaction of medical students was docu- mented in a course on general psychiatry. Lessons may be drawn to inform about efficient and effective ways of teaching and learning this subject

A proposal of basic guidelines for training in psychosomatic and liaison psychiatry in Spanish psychiatry training programs

The Psychosomatic and Liaison Psychiatry is an emerging psychiatric subspecialty. This article is intended to summarize the philosophy supporting training programmes in Spain, and the recommended training guidelines. Methods: Review of the literature and teaching experience. Results: The increasing complexity of diagnosis and treatment, and the demand by patients and providers of resources for higher and more efficient quality of care, make skills training a key tool for achieving these goals. The human being is biology, feelings, thoughts, experiences and thus individuality when sick. Understanding all this is the core on which to base our competencies in this exciting crossroads between psychiatry and other medical specialties. We propose a set of competencies to achieve, and point learning spaces and evaluation mechanisms. Conclusions: Based on accumulated experiences in Spain, and the review of European and international literature, it is possible to summarize a realistic set of norms and directions for training in Psychosomatic and Liaison Psychiatry in residency programmes.