Orientación y tratamiento del anciano con demencia

La demencia es un síndrome caracterizado por un deterioro global de las funciones cognitivas, de carácter orgánico, que origina una desadaptación social del paciente, sin alteración del nivel de conciencia. Es una entidad anatomo-clínica por lo que la historia clínica y la exploración son los elementos indispensables para un correcto diagnóstico. La exploración neuropsicológica a través del uso adecuado de las escalas es uno de los actos fundamentales del proceso diagnóstico. Los trastornos del comportamiento son extraordinariamente abundantes en las formas más frecuentes de demencia, en ocasiones su presencia constituye la forma de inicio de la enfermedad, suelen desencadenar la institucionalización del paciente y son los síntomas de la demencia que mejor responden al tratamiento. En cuanto al tratamiento, hoy en día contamos únicamente con fármacos sintomáticos para tratar el deterioro cognitivo. Hoy por hoy han demostrado su eficacia y han sido aprobados por la FDA cuatro anticolinesterásicos: tacrina, donepezilo, rivastigmina y galantamina. En cuanto al tratamiento de los síntomas no cognitivos la experiencia clínica es abundante pero faltan estudios bien controlados que demuestren la eficacia de los antipsicóticos que son los fármacos de primera elección. PALABRAS CLAVE: Demencia, trastornos del comportamiento, tratamient

In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study

Summary We have characterised 997 hip fracture patients from a representative 45 Spanish hospitals, and followed them up prospectively for up to 4 months. Despite suboptimal surgical delays (average 59.1 hours), in-hospital mortality was lower than in Northern European cohorts. The secondary fracture prevention gap is unacceptably high at 85%. Purpose To characterise inpatient care, complications, and 4-month mortality following a hip or proximal femur fracture in Spain. Methods Design: prospective cohort study. Consecutive sample of patients ≥ 50 years old admitted in a representative 45 hospitals for a hip or proximal femur fragility fracture, from June 2014 to June 2016 and followed up for 4 months post-fracture. Patient characteristics, site of fracture, in-patient care (including secondary fracture prevention) and complications, and 4-month mortality are described. Results A total of 997 subjects (765 women) of mean (standard deviation) age 83.6 (8.4) years were included. Previous history of fracture/s (36.9%) and falls (43%) were common, and 10-year FRAX-estimated major and hip fracture risks were 15.2% (9.0%) and 8.5% (7.6%) respectively. Inter-trochanteric (44.6%) and displaced intra-capsular (28.0%) were the most common fracture sites, and fixation with short intramedullary nail (38.6%) with spinal anaesthesia (75.5%) the most common procedures. Surgery and rehabilitation were initiated within a mean 59.1 (56.7) and 61.9 (55.1) hours respectively, and average length of stay was 11.5 (9.3) days. Antithrombotic and antibiotic prophylaxis were given to 99.8% and 98.2% respectively, whilst only 12.4% received secondary fracture prevention at discharge. Common complications included delirium (36.1 %) and kidney failure (14.1%), with in-hospital and 4-month mortality of 2.1% and 11% respectively. Conclusions Despite suboptimal surgical delay, post-hip fracture mortality is low in Spanish hospitals. The secondary fracture prevention gap is unacceptably high at > 85%, in spite of virtually universal anti-thrombotic and antibiotic prophylaxis