Microvascularización de los tumores cerebrales y factor angiogénico en el líquido cefalorraquídeo tumoral

Utilizando el método de tinción de la bencidina se realizó un estudio sobre las características morfológicas de la microvascularización de los tumores cerebrales; paralelamente, en la membrana corioalantoidea de embriones de pollo, se estudió la capacidad angiogénica del LCR de pacientes con tumores. La densidad vascular se observó reducida en astrocitomas benignos, oligodendrogliomas y craneo-faringiomas, ligeramente aumentada en astrocitomas de grado I I y meduloblastomas. Los astrocitomas malignos, glioblastomas y metástasis mostraron patrones vasculares muy aumentados. Los meningiomas están intensamente vascularizados y menos los neurinomas. Los LCR de pacientes con tumores primitivos del SNC o a distancia mostraron actividad angiogénica en el 93% de los casos. El 27% de los LCR controles fueron positivos observándose correlación con la edad

Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON collaborative study

Malaltia de Parkinson; Prevalència; Distribució per edatsEnfermedad de Parkinson; Prevalencia; Distribución de edadParkinson Disease; Prevalence; Age DistributionObjectives: To assess and compare the prevalence of parkinsonism and Parkinson's disease in five European populations that were surveyed with similar methodology and diagnostic criteria.Methods: Joint analysis of five community surveys--Gironde (France), eight centres in Italy, Rotterdam (The Netherlands), Girona (Spain), and Pamplona (Spain)--in which subjects were screened in person for parkinsonism. Overall, these surveys comprised 14,636 participants aged 65 years or older.Results: The overall prevalence (per 100 population), age adjusted to the 1991 European standard population, was 2.3 for parkinsonism and 1.6 for Parkinson's disease. The overall prevalence of parkinsonism for the age groups 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 to 89 years was respectively, 0.9, 1.5, 3.7, 5.0, and 5.1. The corresponding age specific figures for Parkinson's disease were 0.6, 1.0, 2.7, 3.6, and 3.5. After adjusting for age and sex, the prevalence figures did not differ significantly across studies, except for the French study in which prevalence was lower. Prevalence was similar in men and women. Overall, 24% of the subjects with Parkinson's disease were newly detected through the surveys.Conclusions: Prevalence of both parkinsonism and Parkinson's disease increased with age, without significant differences between men and women. There was no convincing evidence for differences in prevalence across European countries. A substantial proportion of patients with Parkinson's disease went undetected in the general population

Hacia una evaluación de las capacidades instrumentales de los ancianos validada en nuestro entorno

Activitats de la vida diària; Majors de 80 anys; Enquestes i qüestionarisActividades de la vida diaria; Mayores de 80 años; Encuestas y cuestionariosActivities of Daily Living; Aged, 80 and over; Surveys and QuestionnairesEl envejecimiento progresivo de la población mundial es incuestionable, el número de personas mayores de 60 años se ha triplicado en los últimos 50 años y está previsto que se multiplique por 5 durante los próximos 50 años. A pesar de la importancia que tiene el concepto de fragilidad, no existe un claro consenso sobre la definición operativa de dicho constructo. Mientras que algunos autores consideran que la presencia de discapacidad funcional forma parte de la definición de fragilidad, otros abogan por eliminar la discapacidad funcional de dicha definición argumentando que la presencia de discapacidad o dependencia funcional es una consecuencia de la fragilidad del individuo.Cada vez existe mayor evidencia de que la atención primaria a través de una valoración geriátrica integral consigue aumentar la supervivencia de estos pacientes en sus propios domicilios con una reducción de costes en comparación con la atención médica habitual

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: an exploratory comparative design

BACKGROUND: Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences. OBJECTIVES: The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers. DESIGN: Cross-sectional analytic study. SETTINGS: All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain). PARTICIPANTS: Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers. METHODS: The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers. RESULTS: The results show greater burden among adult-child caregivers (p<.05), who experience more feelings of guilt (p<.001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p<.001). Living with the patient has a notable influence on burden among adult children (p<.001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p<.05) and progressively worse mental health (p<.01). However, the correlations between burden and mental health were strongest in daughters (p<.001). CONCLUSION: The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle

Discrepancies Regarding the Quality of Life of Patients with Alzheimer¿s Disease: A Three-Year Longitudinal Study

Cross-sectional studies report notable discrepancies between patient and caregiver ratings of the quality of life of patients (QoL-p) with Alzheimer¿s disease (AD). This study aimed to identify the factors associated with any changes in QoL-p ratings and any discrepancies between patient and caregiver ratings of QoL-p. Three-year follow-up of a cohort of non-institutionalized patients (n = 119). QoL-p was assessed by the Quality of Life in AD (QoL-AD) scale. We analyzed the influence of functional and cognitive status and behavioral problems in patients, and burden and mental health in caregivers. Repeated measures analysis was applied to the scores of patients and caregivers on the QoL-AD, and to the discrepancies between them. Generally, patients¿ own ratings remained stable over time (F 3,116 = 0.9, p = 0.439), whereas caregiver ratings showed a decline (F 3,116 = 9.4, p < 0.001). In the analysis of discrepancies, patients with anosognosia gave higher ratings (F 1,117 = 11.9, p = 0.001), whereas caregiver ratings were lower when the patient showed greater agitation (F 1,117 = 13.0, p < 0.001), apathy (F 1,117 = 15.4, p < 0.001), and disabilities (F 1,117 = 17.1, p < 0.001), and when the caregiver experienced greater burden (F 1,117 = 9.0, p = 0.003) and worse mental health (F 1,117 = 10.1, p = 0.003). Patient ratings of QoL-p remain generally stable over time, whereas those of caregivers show a decline, there being significant discrepancies in relation to specific patient and caregiver factors

Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers

Aims To compare care recipient and caregiver perceptions of quality of life in patients (QoL-p) with Alzheimer"s disease (AD). To identify associated factors, and the concordances-discrepancies. Method Cross-sectional analytic study of 236 patients and their carers using the Quality of Life in Alzheimer"s Disease(QoL-AD) scale, socio-demographic data and clinical examination. Results Patients scored the QoL-AD more favourably than did caregivers (34.4 vs 31.3, p<0.001). Cognitive deterioration did not affect the perception of QoL-AD (rho¼ 0.05, p¼0.394). The neuropsychiatric symptoms was associated with a negative perception of the QOL-AD in both patients (rho¼ 0.22, p<0.01) and caregivers (rho¼ 0.47, p<0.001). Greater functional autonomy was associated with a better perception of the QOL-AD in patients (rho¼0.17, p<0.01) and even more so in caregivers (rho¼0.56, p<0.001). In carers, burden (rho¼ 0.56, p<0.001) and mental health (rho¼0.31, p<0.001) were inversely associated with the QoL-AD. QoL-AD scores of both patients and caregivers were higher for men, married subjects, those who lived with their spouse and those living in their own home. When the carer was a spouse both patients and caregivers scored the QoL-AD higher than when the carer was a son or daughter (35.5 vs 33.4 and 33.7; 32.9 vs 30.5 and 27.7, p<0.001). Conclusions Patients have a better perception of QoL-p. Caregivers give a more negative evaluation of neuropsychiatric symptoms, but have a more positive view of functional autonomy. Carers who are spouses have a better perception of QoL-p than do carers who are sons or daughters

Three-year Trajectories of Caregiver Burden in Alzheimer's Disease.

Although numerous studies have examined caregiver burden in the context of Alzheimer's disease, discrepancies remain regarding the influence of certain factors. This study aimed to identify trajectories of caregiver burden in the context of Alzheimer's disease, as well as the factors associated with them. A cohort of patients and caregivers (n = 330) was followed up over three years. Growth mixture models were fitted to identify trajectories of caregiver burden according to scores on the Zarit Burden Interview (ZBI). A multilevel multinomial regression analysis was then conducted with the resulting groups and the patient and caregiver factors. In the sample as a whole, burden increased during follow-up (F = 4.4, p = 0.004). Three groups were identified: G1 (initially high but decreasing burden), G2 (moderate but increasing burden), and G3 (low burden that increased slightly). Patients in G1 and G2 presented more neuropsychiatric symptoms and poorer functional status than did those in G3. Caregivers in G1 and G2 had poorer mental health. Spouses and, especially, adult children who lived with their parent (the patient) were more likely to belong to G2 (odds ratio [OR] 6.24; 95% CI 2.89-13.47), as were sole caregivers (OR 3.51; 95% CI 1.98-6.21). The patient factors associated with increased burden are neuropsychiatric symptoms and functional status, while among caregivers, being the sole carer, poor mental health, and living with the patient are of relevance

Causes, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015

Objective: To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. Materials and Methods: It is a prospective population-based cohort study of adults living in the community, 2013-15 (N = 48,691, age ≥50; deceased = 1,944). Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE): Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living (ADL), Frailty and Mobility. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios with confidence intervals (99% CI). Results: The crude mortality rate was 18.39 (1000 person-years at risk), (99% CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). Conclusions: The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed

Burden associated with the presence of anosognosia in Alzheimer's disease

Objectives: Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimer¿s disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden. Methods: This was a cross-sectional, analytical study of patients who were diagnosed with AD and their caregivers. Anosognosia was evaluated using the Experimenter Rating Scale, and caregiver burden was evaluated using the Burden Interview (BI). Using the BI¿s comprehensive scoring and each of its five factors as dependent variables, we adjusted six linear regression models to determine the effect of anosognosia on caregiver burden. Results: The sample consisted of 124 patients and 124 caregivers. The mean patient age was 78.9 years (SD = 6.9); the mean caregiver age was 59.7 years (SD = 13.6), and 66.6% of the caregivers were women. The prevalence of anosognosia was 24.2% (95% confidence interval = 16.7¿33.3). The degree of caregiver burden was associated with the degree of anosognosia (r2 = 0.426; standardised beta [bs] =0.346; p<0.001), which explained 14.7% of the variance. For the BI factors, the Experimenter Rating Scale was associated with physical and social burden (r2=0.452; bs=0.378; p<0.001), relationship of dependence (r2=0.301; bs= 0.203; p = 0.010) and emotional stress (r2=0.212; bs = 0.227; p=0.014). Conclusions: The presence of anosognosia in patients with AD is an independent factor that increases caregiver burden by increasing physical wear, social isolation, dependence and tension related to patient care

Fiabilidad interexaminador de un sistema de segmentación semiautomàtica para el cálculo del volumen del bulbo y tracto olfatorio mediante resonancia magnética

El transtorn de l'olfacte a la malaltia d'Alzheimer (MA) és freqüent i precoç. Per determinar la relació entre la MA i el volum del bulb i tracte olfactori, és necessari un instrument que ens permeti realitzar el càlcul d'aquest volum a partir d'imatges obtingudes per ressonància magnètica. S'ha desenvolupat un software específic i s'ha realitzat un estudi observacional i transversal de fiabilitat en una mostra de pacients. S'ha calculat el volum de forma semiautomàtica per dos observadors independents. El coeficient de correlació intraclasse obtingut ens permet concloure que la fiabilitat interexaminador és apropiada.El trastorno del olfato en la enfermedad de Alzheimer (EA) es frecuente y precoz. Para determinar la relación entre la EA y el volumen del bulbo y tracto olfatorio, es necesario un instrumento que nos permita realizar el cálculo de dicho volumen a partir de imágenes obtenidas por resonancia magnética. Se ha desarrollado un software específico y se ha realizado un estudio observacional y transversal de fiabilidad en una muestra de pacientes. Se ha calculado el volumen de forma semiautomática por dos observadores independientes. El coeficiente de correlación intraclase obtenido nos permite concluir que la fiabilidad interexaminador es apropiada