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S López-Pousa

Publications and source records attributed to S López-Pousa.

At least 19 recordsLinked to original sources
PubMed2005

Differential efficacy of treatment with acetylcholinesterase inhibitors in patients with mild and moderate Alzheimer's disease over a 6-month period.

There are various anticholinesterase inhibitors (AChEIs) for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). All AChEIs have shown greater efficacy than placebo in randomized, double-blind, parallel-group clinical trials. No differential studies have yet been made of the efficacy between all AChEIs. The study aims to determine the differential efficacy of the AChEIs with respect to a historical sample of patients with AD that were not treated with AChEIs. An open-label, prospective, observational study with a retrospective control group was undertaken to examine the evolution of the cognitive function over a 6-month period. The patients were assessed with the Mini-Mental State Examination (MMSE) at study entry and at 6 months. A general linear model was applied for repeated measurements with the MMSE score as the dependent variable, treatment type as an independent variable and the severity of the deterioration, age and the MMSE baseline score as covariables. Of the sample of 147 patients, 40 initiated treatment with donepezil, 32 with galantamine, 30 with rivastigmine and 45 were part of a historical sample of the memory clinic patients between 1991 and 1996 that had not been treated with AChEIs. The average age was 73.7 years (SD = 6.9; range = 52-86), 67.3% were women, 78.2% of the cases were mild and the MMSE baseline score was 18.1 points (range = 11-27). No significant intergroup differences were observed in these variables. The average doses of donepezil, galantamine and rivastigmine were 5.87 mg/day (SD = 1.92), 14.81 mg/day (SD = 6.25) and 6.41 mg/day (SD = 1.82), respectively. At 6 months, the difference in the MMSE score with respect to the untreated group was 1.6 points for donepezil (95% CI 0.79-2.37; p < 0.001), 0.99 points for galantamine (95% CI 0.14-1.85; p = 0.01) and 0.90 points for rivastigmine (95% CI 0.05-1.74; p = 0.03). No significant differences were observed in the efficacy among the groups treated with AChEIs (p > 0.05). Treatment with AChEIs significantly delays the global cognitive impairment associated with AD for at least 6 months. Our study found no significant differences in efficacy between donepezil, galantamine and rivastigmine. Further studies in the context of daily clinical practice will determine the clinical significance of the changes observed. An important variability of the response to the treatment was observed in treated patients.

Aged↗
PubMed2004

Teaching of neuroepidemiology in Europe: time for action.

Many epidemiological and clinical studies in Europe, especially in Eastern Europe and countries in transition, are of poor methodological quality because of lack of background knowledge in clinical epidemiology methods and study designs. The only way to improve the quality of epidemiological studies is to provide adequate undergraduate and/or postgraduate education for the health professionals and allied health professions. To facilitate this process, the European Federation of Neurological Societies (EFNS) Task Force on teaching of clinical epidemiology in Europe was set up in October 2000. Based on analyses of the current teaching and research activities in neuroepidemiology in Europe, this paper describes the Task Force recommendations aimed to improve these activities.

Education, Medical↗
PubMed2003

Neuropsychological profile of Alzheimer's disease in women: moderate and moderately severe cognitive decline.

INTRODUCTION: Alzheimer's disease (AD) is characterised by progressive cognitive and functional decline. There is evidence that AD is more prevalent in women. This study aims at identifying the clinical and sociodemographic variables associated with the cognitive functions and the pattern of decline in women with moderate to moderately severe AD. METHODS: Cross-sectional observational study of 165 women with dementia of the AD type according to NINCDS-ADRDA criteria. The cognitive functions were assessed using the Cambridge Cognitive Examination (CAMCOG). The sociodemographic and clinical data were collected from the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) interview, and the Neuropsychiatric Inventory (NPI) was administrated to the caregiver. RESULTS: The number of years of schooling and the score on the CAMDEX depression scale were the variables associated with the CAMCOG score. The effect of these variables was not homogenous for all the CAMCOG subtests. CONCLUSIONS: The number of years of schooling and the presence of depressive symptomatology influence the results of the neuropsychological exploration, but the effect is moderate and not homogenous for all the CAMCOG subtests. The differences in cognitive profile between moderate and moderately severe are characterised by a greater effect on temporal orientation, calculation and perception.

Aged↗
PubMed2001

[Effectiveness of donepezil on several cognitive functions in patients with Alzheimer's disease over 12 months].

OBJECTIVES: The efficacy of donepezil for the treatment of cognitive dysfuntion in Alzheimer's disease has been demonstrated. The objective [corrected] of this study was to evaluate the effectiveness of donepezil in different neuropsychological areas of mild or moderate AD patients over a period of twelve months compared with data from untreated patients (historical control). METHODS: This was an open-label study where 100 patients received donepezil 5mg or 10 mg/day for twelve months. Because the study was uncontrolled, data were compared with historical data from 81 patients who had not received anticholinesterase inhibitors. The CAMCOG neuropsychological battery was used in both groups at baseline and at month 12. RESULTS: A hundred patients (30% male and 70% female) were enrolled in the study receiving donepezil 5 or 10 mg/day (average age: 74.3 6.1 years). The historical control group consisted of 81 people (average age 72.9 6.5 years), 29.6% of whom were men. There were no significant differences with respect to age, sex and CAMCOG score at baseline. The differences within the groups were significant in the following neuropsychological areas: recent, remote and learning memory, attention, calculation and abstract verbal thinking. Differences in expressive language and learning memory between both groups were confirmed by the multivariative analysis of baseline. CONCLUSION: The rate of cognitive deterioration observed in mild to moderate AD patients receiving open-label donepezil treatment was less than expected if this cohort had not been treated. The cognitive beneficial effects observed during one year treatment with donepezil were mainly focused on memory and verbal expression.

Acetylcholine↗
PubMed1999

[Treatment of Alzheimer's disease: acetylcholinesterase inhibitors].

AIM: The cognitive deficiency of Alzheimer's disease is attributed to a dysfunction in the cerebral cholinergic systems. Current drug treatments are directed at stimulating cholinergic transmission. The aim of this study was to evaluate the latest cholinergic drugs available an those about to appear in the market. METHODS: A review of the most recent studies published regarding the physiopathology of Alzheimer disease and the results following treatment with donepezil, rivastigmine and metriphonate was carried out. RESULTS: Donepezil is a specific, reversible acetylcholinesterase inhibitor of close to 100% absorption and a half-life of 70 h, achieving stable concentrations at approximately 3 weeks. Patients treated with a single daily dosis of 5 or 10 mg improve in the ADAS-Cog scale. The medication is initiated with a dosis of 5 mg/day. Rivastigmine is a competitive, pseudoirreversible inhibitor with a half-life of 2 h, although it acts for approximately 10 h. The Adas-Cog scale and the CIBIC-Plus improve in patients treated with a daily dosis of 6 or 12 mg taken in two doses. Administration should be initiated at low doses (3 mg/day) which are progressively increased. Metriphonate is a prodrug of short life which inhibits acetylcholinesterase through a metabolite (DDVP) with a half-life in the circulation of 2 h. Improvement is observed in the ADAS-Cog scale and the CIBIC-Plus and in behavior disorders at doses of 0.3 and 0.65 mg/kg/day. Doses between 30 and 60 mg/day are effective. CONCLUSIONS: Different studies carried out with the acetylcholinesterase inhibitors donepezil, rivastigmine and metriphonate have been effective in the control of the cognitive symptoms of Alzheimer disease in the initial or moderate phases of the disease.

Alzheimer Disease↗
PubMed1998

[Prevalence of depressive disorders in dementia].

OBJECTIVE: To find the prevalence of depressive illness associated with dementia in our geriatric population. MATERIAL AND METHODS: A study was made of the entire population aged over 69 years in eight rural districts of the province of Girona (Spain). Diagnosis was made using CAMDEX criteria. RESULTS: The prevalence of depression (depressive disorders plus pseudo dementia) was 9.1% (IC = 7.6-10.5%). In the group of patients with dementia, the frequency of depression was 28.15% whilst in the group with no dementia it was 5.4% (p = 0.0000). No differences were seen in the prevalence of depression between patients with Alzheimer type dementia (ATD) and those with vascular dementia (VD). The gravity of dementia, sex and age did not influence the frequency of depression. CONCLUSIONS: Depression in patients with dementia was very frequent in our geriatric population. Dementia was seen to be a risk factor with regard to depression.

Age Distribution↗
PubMed1998

[Medical treatment of Alzheimer's disease].

OBJECTIVE: To review the drugs commercially available at present and in the near future in relation to the evolution of Alzheimer disease, bearing in mind the possible psychiatric disorders which may be associated with the disease. DEVELOPMENT: The therapeutic approach is planned according to the different phases of the disease. In the preclinical phase, anti-inflammatory drugs and estrogens in post-menopausal women have been effective. In the initial phase current recognition therapy is directed basically towards correcting the break-down of acetylcholine (tacrine, donepezil, SB202026, SDZ ENA 713). For depressive symptoms serotonin levels are corrected using selective inhibitors of serotonin uptake. CONCLUSIONS: Drug treatment should be considered with the association of drugs which activate the malfunctioning circuits and/or pathways. It would also be useful to design clinical studies using pharmacological combinations of cholinergic agonists, estrogens, anti-inflammatory drugs, seligiline and/or new anti-cholinesterase drugs amongst others.

Acetylcholine↗
PubMed1998

[Dementia registry: current status in Catalonia].

OBJECTIVE: This article describes the theoretical basis on which to begin and develop a record of dementias, emphasizing particularly the records of dementias of the programme Vida als Anys in Cataluña. Records of dementias give information regarding the number of cases of dementia and also for planning use of resources as required by the population. DEVELOPMENT: A record of dementias obtains, stores, keeps up to date and re-uses information about cases of dementia in a consistent manner. There are two types of records, that dealing with the population and that of the hospital. Records of the population include information from epidemiological studies, both descriptive and analytical, and also data on public health. The hospital records follow and study the natural history of dementias from an aetiological point of view but do not use a population for reference. In Cataluña records of dementias have been done for the populations of Girona, Tarragona and Barcelona and the hospitals of Barcelona, Girona, Lleida, Martorell, Reus, Santa Coloma de Gramanet and Terrassa, as part of the programme Vida al Anys. CONCLUSIONS: In order to make satisfactory plans for care in dementia, it is necessary to create databases which are as unified and as exhaustive as possible. Unified records of dementia help understanding of the course and risk factors of the condition.

Aged↗
PubMed1998

[Non-cognitive aspects of dementia].

OBJECTIVE: To observe the frequency of various psychiatric disorders (depressive disorders, anxiety state and paraphrenic-paranoid disorders). PATIENTS AND METHODS: This study includes the 'cases' of dementia detected in an epidemiological field study done door-to-door, double phased and including non-institutionalized persons aged over 69 years in a rural area. All diagnoses were done by CAMDEX and on these criteria. RESULTS: Depressive disorder was diagnosed in 26.5% studied, paraphrenic or paranoid disorder in 14% and anxiety state in 6.5%. Depression and paraphrenic-paranoid disorder were not associated with the severity of the dementia, whilst anxiety state was more commonly seen in mild dementia. Paraphrenic-paranoid disorders were commoner in women than in men. CONCLUSION: The considerable prevalence of other psychiatric diagnoses in persons with dementia shows that non-cognitive symptoms are common in these patients.

Aged↗
PubMed1998

[Cognition and depression].

OBJECTIVES: To find the relationship between cognitive deterioration and the symptoms of depression. PATIENTS AND METHODS: A sample from the community of 602 persons, 200 of whom had been diagnosed as having dementia and 81 depression. Cognitive deterioration was evaluated using the CAMLOG and the depressive symptoms by means of the CAMDEX depression scale. RESULTS: On multiple regression analysis it was observed that the CAMLOG did not influence the results on the depression scale. Similarly, on ANOVA it was seen that the diagnosis of depression did not influence the results of CAMLOG either. CONCLUSIONS: Cognitive deterioration does not affect depressive symptoms, nor does depression affect cognitive function.

Aged↗
PubMed1997

A new method for quantifying the cognitive impairment. Its application in patients with vascular dementia.

Seven-three patients diagnosed with vascular dementia (VD) left to their natural evolution have been observed during a period of time of one year. The objective of this study is to find an index to quantify the degree of loss of cognitive capabilities in patients affected by VD, as well as to define the minimum loss of punctuation in this index, that can only be caused by an unfavourable evolution of the disease. This index, which we call Percentual Variation Index (PVI), is based on the evolution of the punctuations of the Cognoscitive Mini-Exam (CME) after a follow-up of one year. Our definition states that in order to consider patients as having cognitive impairment of vascular origin, they must lose more than 10% of their basal CME score in one year. This method could be useful in assessing the therapeutic efficacy of drugs used in treating such illnesses.

Aged↗
PubMed1997

[Triflusal in the prevention of vascular dementia].

INTRODUCTION: Vascular dementia is the second commonest cause of dementia after Alzheimer's disease. The most important risk factor for this is previous cerebral vascular accident. OBJECTIVE: To eliminate the risk factors and/or progression of this illness would be of considerable benefit to these patients. Triflusal, a platelet anti-aggregant chemically related to the salicylates, whose clinical efficacy has been shown in cardiac and cerebrovascular pathology, has been used in the treatment of patients with vascular dementia. MATERIAL AND METHODS: An open study was done a sample of 73 patients with vascular dementia randomly distributed into two groups (control and undergoing treatment with triflusal). RESULTS: To check the efficacy of treatment with triflusal, the percentage of variation in the scoring of the Cognitive Mini Examination was used after a clinical course of 12 months (IVP 12), considering the critical point of no efficacy to be a loss equal or greater than 10%. In the control group, 33% (8/24) and in the group treated with triflusal 8% (3/35) had a negative course which was greater than this critical point. CONCLUSIONS: The difference in the IVP 12 between the two groups was statistically significant (p = 0.0375), with a statistical power of 87% (beta = 0.13). This gives triflusal a therapeutic activity which is sufficient to limit cognitive deterioration of patient with vascular dementia.

Aged↗
PubMed1996

The Mini Cognitive Examination for screening in epidemiologic studies of dementia.

We assessed the efficiency of the Mini Cognitive Examination (MCE) for detecting dementia and studied the influence of certain variables (age, sex, education) on its global rating. The study was carried out on a rural population in two stages: the MCE was administered in the first stage, whilst the Cambridge Mental Disorders of the Elderly (CAMDEX) was given in the second. The sensitivity of the MCE was 93.5% and specificity was 82%. Multivariate statistical analysis showed that the age, sex and education all had significant impacts on the MCE global rating. Out of 13 MCE items, only nine (temporal orientation, spatial orientation, calculation, repetition of a sentence, inverting the order of 3 numbers, sequence of praxic orders, abstraction and naming of objects) discriminated between subjects with dementia and controls. The MCE proved to be a highly efficient screening instrument for dementia.

Aged↗
PubMed1995

Apolipoprotein E4 allele frequency in Spanish Alzheimer and control cases.

We have found an APOE epsilon 4 allelic frequency of 0.289 (95% CI 0.195-0.383) in Spanish AD patients (n = 88; average age = 71.2 +/- 9.37) and of 0.061 (95% CI 0.023-0.099) in age-matched controls (n = 147; average age = 71.5 +/- 10.29). Remarkably no ApoE 4/4 subjects were observed in any of the age-matched control groups compared to a total of 22 AD patients with the ApoE 4/4 phenotype. The combined odds ratio for subjects with one or two epsilon 4 alleles in the present study is 6.25 (95% CI 3.13-12.60), which is one of the highest so far reported. Altogether our results suggest a trans-European difference in the ApoE epsilon 4 frequency but no differences in the strength of the association between APOE4 and AD.

Adult↗
PubMed1995

[Validation of the Spanish version of the Severe Impairment Battery].

We examine the cognitive ability of 58 demented patients who were evaluated with the Spanish version of the Severe Impairment Battery (SIB). The SIB is composed of multiple simple subtests for memory, language, orientation, attention, visual perception and ability to construct. The battery also assesses social skills, praxis and the ability to respond appropriately to name. The mean SIB scores (72.55 +/- 17.99; range 8-99) correlated with mean scores (10.76 +/- 6.41; range 0-31) on the Spanish version of Folstein's Mini-Mental State Examination (MMSE). The SIB detected deterioration in the nine cognitive areas examined, even in the most severely impaired patients (MMSE = 0-6). These results indicate that the Spanish version of the SIB is a useful instrument for examining severely demented patients.

Aged↗