Descripción de una muestra de pacientes con Deterioro Cognitivo Leve (DCL) y Enfermedad de Alzheimer (EA): perfil clínico y neuropsicológico.

[ES] Introducción: La Enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa cuya característica principal es el deterioro cognitivo progresivo. Muestra una fase preclínica una década antes del desarrollo de la enfermedad propiamente dicha, denominada Deterioro Cognitivo Leve (DCL), en la cual habrá cambios en pruebas de neuroimagen y en LCR, y otros cambios clínicos más sutiles. Objetivo: Comparar la edad, el sexo, los años de escolarización y el rendimiento en diferentes test cognitivos entre pacientes diagnosticados de DCL y EA. Material y Métodos: En este estudio transversal se analiza una base de datos que incluye a pacientes de la Consulta de Demencias del Servicio de Neurología del Hospital Universitario de Cruces, en un periodo de tiempo comprendido entre el 6 de Noviembre de 1995 y el 11 de Febrero de 2019, utilizando los criterios diagnósticos de NINCDS-ADRDA, con una n = 1722. Para la comparación entre el grupo de EA y de DCL se han utilizado datos como la edad, el sexo, los años de escolarización y test cognitivos como MMSE, CDT, CDR, GDS, IQCODE y RDRS2. Resultados: De los 1177 pacientes con EA un 69'3% fueron mujeres y un 30'7% hombres. De los diagnosticados de DCL el 49'2% fue del sexo femenino y el 50'8% fueron varones. La edad media de los pacientes diagnosticados de EA fue de 75 años, mientras que la de los diagnosticados de DCL fue de 70. La media de años de escolarización en pacientes con EA fue de 8'44, mientras que en los diagnosticados de DCL fue de 10'84. La media de MMSE en EA fue de 17'13, mientras que en pacientes con DCL fue 26'77. La media de CDT en EA fue 3'25 puntos, siendo de 7'66 en DCL. En IQCODE las medias fueron 70'08 para EA y 64'19 para DCL. En CDR las medias fueron de 1'28 y 0'54 para EA y DCL, respectivamente. En GDS, la mayoría de pacientes con DCL se encontraron en los rangos 2-3, y los de EA en los rangos 4-5. En RDRS2 la media en EA fue de 27'8, y en DCL de 23'7. Todos estos resultados fueron estadísticamente significativos. Conclusiones: Las pruebas cognitivas utilizadas en el estudio muestran diferencias significativas entre EA y DCL. Factores como la edad, el sexo y los años de escolarización también mostraron un papel relevante en la edad de inicio y en la gravedad del deterioro cognitivo.[EN] Introduction: Alzheimer's disease (AD) is a neurodegenerative disease which main characteristic is a progressive cognitive impairment. It shows a preclinical phase a decade before the disease itself, known as mild cognitive impairment (MCI), in which we can find changes in both neuroimaging and CSF tests, in addition to other more subtle clinical changes. Objective: To compare age, sex, years of schooling and performance in different cognitive tests in patients diagnosed with MCI and AD. Material and Methods: This cross-sectional study analyzes a database that includes patients from the Dementia Unit of the Neurology Service of the University Hospital of Cruces, in a period of time between November 6th, 1995 and February 11, 2019, using the NINCDS-ADRDA's diagnostic criteria, with n = 1722. For the comparison between the group of AD and MCI, factors such as age, sex, years of schooling and cognitive tests like MMSE, CDT, CDR, GDS, IQCODE and RDRS2 have been used. Results: Of the 1177 patients with AD, 69.3% were women, while 30.7% were men. Of those diagnosed with MCI, 49.2% were female and 50.8% were male. The average age of patients diagnosed with AD was 75 years and the average of those diagnosed with MCI was 70. The average number of years of schooling in patients with AD was 8.44, while in those diagnosed with MCI it was 10'84. The average MMSE in AD was 17'17, while in patients with MCI it was 26.77. The CDT average in EA was 3.25 points, being 7.66 in MCI. In IQCODE the averages were 70'08 for EA and 64'19 for MCI. In CDR the average were 1'28 and 0.54 for EA and MCI, respectively. In GDS, patients with MCI were mostly in ranks 2 - 3, and patients with AD were mostly in ranks 4 - 5. In RDRS2 the average in AD was 27.8, and 23.7 in MCI. All these results were statistically significant. Conclusions: The cognitive tests used in the study show significant differences between AD and MCI. Factors such as age, sex and years of schooling also show a relevant role in the age of onset and the severity of cognitive decline

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

Background Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. Methods In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. Results A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.17.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days >= 30%,>= 50%,>= 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice

Descripción de una muestra de pacientes con Deterioro Cognitivo Leve (DCL) y Enfermedad de Alzheimer (EA): perfil clínico y neuropsicológico.

[ES] Introducción: La Enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa cuya característica principal es el deterioro cognitivo progresivo. Muestra una fase preclínica una década antes del desarrollo de la enfermedad propiamente dicha, denominada Deterioro Cognitivo Leve (DCL), en la cual habrá cambios en pruebas de neuroimagen y en LCR, y otros cambios clínicos más sutiles. Objetivo: Comparar la edad, el sexo, los años de escolarización y el rendimiento en diferentes test cognitivos entre pacientes diagnosticados de DCL y EA. Material y Métodos: En este estudio transversal se analiza una base de datos que incluye a pacientes de la Consulta de Demencias del Servicio de Neurología del Hospital Universitario de Cruces, en un periodo de tiempo comprendido entre el 6 de Noviembre de 1995 y el 11 de Febrero de 2019, utilizando los criterios diagnósticos de NINCDS-ADRDA, con una n = 1722. Para la comparación entre el grupo de EA y de DCL se han utilizado datos como la edad, el sexo, los años de escolarización y test cognitivos como MMSE, CDT, CDR, GDS, IQCODE y RDRS2. Resultados: De los 1177 pacientes con EA un 69'3% fueron mujeres y un 30'7% hombres. De los diagnosticados de DCL el 49'2% fue del sexo femenino y el 50'8% fueron varones. La edad media de los pacientes diagnosticados de EA fue de 75 años, mientras que la de los diagnosticados de DCL fue de 70. La media de años de escolarización en pacientes con EA fue de 8'44, mientras que en los diagnosticados de DCL fue de 10'84. La media de MMSE en EA fue de 17'13, mientras que en pacientes con DCL fue 26'77. La media de CDT en EA fue 3'25 puntos, siendo de 7'66 en DCL. En IQCODE las medias fueron 70'08 para EA y 64'19 para DCL. En CDR las medias fueron de 1'28 y 0'54 para EA y DCL, respectivamente. En GDS, la mayoría de pacientes con DCL se encontraron en los rangos 2-3, y los de EA en los rangos 4-5. En RDRS2 la media en EA fue de 27'8, y en DCL de 23'7. Todos estos resultados fueron estadísticamente significativos. Conclusiones: Las pruebas cognitivas utilizadas en el estudio muestran diferencias significativas entre EA y DCL. Factores como la edad, el sexo y los años de escolarización también mostraron un papel relevante en la edad de inicio y en la gravedad del deterioro cognitivo.[EN] Introduction: Alzheimer's disease (AD) is a neurodegenerative disease which main characteristic is a progressive cognitive impairment. It shows a preclinical phase a decade before the disease itself, known as mild cognitive impairment (MCI), in which we can find changes in both neuroimaging and CSF tests, in addition to other more subtle clinical changes. Objective: To compare age, sex, years of schooling and performance in different cognitive tests in patients diagnosed with MCI and AD. Material and Methods: This cross-sectional study analyzes a database that includes patients from the Dementia Unit of the Neurology Service of the University Hospital of Cruces, in a period of time between November 6th, 1995 and February 11, 2019, using the NINCDS-ADRDA's diagnostic criteria, with n = 1722. For the comparison between the group of AD and MCI, factors such as age, sex, years of schooling and cognitive tests like MMSE, CDT, CDR, GDS, IQCODE and RDRS2 have been used. Results: Of the 1177 patients with AD, 69.3% were women, while 30.7% were men. Of those diagnosed with MCI, 49.2% were female and 50.8% were male. The average age of patients diagnosed with AD was 75 years and the average of those diagnosed with MCI was 70. The average number of years of schooling in patients with AD was 8.44, while in those diagnosed with MCI it was 10'84. The average MMSE in AD was 17'17, while in patients with MCI it was 26.77. The CDT average in EA was 3.25 points, being 7.66 in MCI. In IQCODE the averages were 70'08 for EA and 64'19 for MCI. In CDR the average were 1'28 and 0.54 for EA and MCI, respectively. In GDS, patients with MCI were mostly in ranks 2 - 3, and patients with AD were mostly in ranks 4 - 5. In RDRS2 the average in AD was 27.8, and 23.7 in MCI. All these results were statistically significant. Conclusions: The cognitive tests used in the study show significant differences between AD and MCI. Factors such as age, sex and years of schooling also show a relevant role in the age of onset and the severity of cognitive decline

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years : a real-life multicentre analysis of 162 patients

Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. A total of 162 patients were included, median age 68 years (range 65-87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice. The online version contains supplementary material available at 10.1186/s10194-023-01585-2

Effectiveness and safety of anti-CGRP monoclonal antibodies in patients over 65 years: a real-life multicentre analysis of 162 patients

Abstract Background Anti-CGRP monoclonal antibodies have shown notable effectiveness and tolerability in migraine patients; however, data on their use in elderly patients is still lacking, as clinical trials have implicit age restrictions and real-world evidence is scarce. In this study, we aimed to describe the safety and effectiveness of erenumab, galcanezumab and fremanezumab in migraine patients over 65 years old in real-life. Methods In this observational real-life study, a retrospective analysis of prospectively collected data from 18 different headache units in Spain was performed. Migraine patients who started treatment with any anti-CGRP monoclonal antibody after the age of 65 years were included. Primary endpoints were reduction in monthly migraine days after 6 months of treatment and the presence of adverse effects. Secondary endpoints were reductions in headache and medication intake frequencies by months 3 and 6, response rates, changes in patient-reported outcomes and reasons for discontinuation. As a subanalysis, reduction in monthly migraine days and proportion of adverse effects were also compared among the three monoclonal antibodies. Results A total of 162 patients were included, median age 68 years (range 65–87), 74.1% women. 42% had dyslipidaemia, 40.3% hypertension, 8% diabetes, and 6.2% previous cardiovascular ischaemic disease. The reduction in monthly migraine days at month 6 was 10.1 ± 7.3 days. A total of 25.3% of patients presented adverse effects, all of them mild, with only two cases of blood pressure increase. Headache and medication intake frequencies were significantly reduced, and patient-reported outcomes were improved. The proportions of responders were 68%, 57%, 33% and 9% for reductions in monthly migraine days ≥ 30%, ≥ 50%, ≥ 75% and 100%, respectively. A total of 72.8% of patients continued with the treatment after 6 months. The reduction in migraine days was similar for the different anti-CGRP treatments, but fewer adverse effects were detected with fremanezumab (7.7%). Conclusions Anti-CGRP mAbs are safe and effective treatments in migraine patients over 65 years old in real-life clinical practice. Graphical Abstrac