Prevalence and Correlates of Cognitive Impairment in

Original Research Article Dement Geriatr Cogn Disord 2012;33:226–232 DOI: 10.1159/000338607

Accepted: April 2, 2012 Published online: June 4, 2012

© Free Author Copy – for perPrevalence and Correlates of Cognitive sonal use only

Impairment in Adults with Subjective Memory ANY DISTRIBUTION OF THIS ARTICLE WITHOUT WRITTEN Complaints in Primary Care Centres CONSENT FROM S. KARGER AG, BASEL IS A VIOLATION OF THE COPYRIGHT. a,c

Onesimo Juncos-Rabadana Arturo X. Pereiroa David Written Facal permission to distriba a b b ute the PDFSueiro will be granted Nelly Rodriguez Cristina Lojo Jose A. Caamaño Jesus against payment of a perJulia Bovedab Peregrina Eiroab mission fee, which is based on the number of accesses Department of Developmental Psychology, University of Santiago de Compostela, and bServicio Galego de required. Please contact Saúde, Atención primaria Santiago de Compostela y Vigo, Santiago de Compostela, and cFundación Ingema [email protected] Instituto Gerontológico Matía, San Sebastián, Spain a

Key Words Aging ⴢ Cognitive reserve ⴢ Daily functioning in dementia and mild cognitive impairment ⴢ Early detection of mild cognitive impairment and dementia

Abstract Aims: To examine the prevalence and correlates of cognitive impairment (CI) in adults over 50 years old attending primary care centres with complaints of memory failure. Methods: A sample of 580 individuals aged 50+ years with no previous diagnosis of dementia was assessed by use of the Mini Mental State Examination, the Cambridge Cognitive Assessment-Revised and the California Verbal Learning Test – to evaluate CI-dependent variables – and administration of a questionnaire on memory complaints and other instruments – to measure correlates. Results: The prevalence of CI was 46.20% and positive associations were found for age, gender, level of education, subjective memory complaints, instrumental activities of daily living, reading habits and frequency of leisure activities. In the logistic regression, modelled CI was associated with older age, gender (49.12% women, 39.66% men), instrumental activities of daily living, and reading habits. Conclusion: Almost half of the adults aged 50+ years attending primary care centres with

Fax ⫹41 61 306 12 34 E-Mail [email protected] www.karger.com

© 2012 S. Karger AG, Basel 1420–8008/12/0334–0226$38.00/0 Accessible online at: www.karger.com/dem

subjective memory complaints were affected by CI. Early evaluation of cognitive is essential to establish © Free Authorfunctioning Copy – for personal use only adequate preventive and intervention strategies. ANY DISTRIBUTION OF THIS ARTICLE WITHOUT WRITTEN CONSENT FROM S. KARGER AG, BASEL IS Stroke Note 2012 S. Karger AG, Basel Written permission to distribute the PDF willCopyright be granted©against payment of a permission fee, whic Introduction

The presence of subjective memory complaints (SMC) has been regarded as one ofCED336332.indd the first symptoms of cogni3 tive impairment (CI) and as a necessary criterion for the early diagnosis of mild cognitive impairment (MCI) [1]. Some studies have found that SMC are related to objective CI and dementia [2–4]. However, other studies have found little or no correlation between such complaints and CI [5, 6], indicating that an individual’s own subjective evaluation of his/her cognitive functioning may not provide an accurate appraisal of the actual cognitive deficits [7]. SMC are common in adult patients attending primary care centres (PCC), and as CI is widely known to be underrecognized in these settings, with rates of nonrecognition estimated to be between 50 and 70% [8–10], it is important to investigate the prevalence of objective CI in this population, for early identification of probable

Onesimo Juncos-Rabadán Department of Developmental and Educational Psychology University of Santiago de Compostela Campus Sur ES–15782 Santiago de Compostela (Spain) Tel. +34 981563100, E-Mail [email protected]

dementia. Many studies have stressed the key position of general practitioners in detecting and diagnosing CI and associated factors [11–13]. Studies of the prevalence of CI including cases of MCI and dementia have increased in the last two decades. Many of these are population-based studies and the reported incidence rates (ranging from 3 to 30%) vary depending on the age of the sample, the inclusion of MCI and/or dementia and the evaluation instruments used [14–18]. Literature on the incidence of CI in primary care patients is scarce and the results vary widely, depending on the patients’ age, and on the type and degree of the impairment [19–21], although all studies promote early and timely detection of the risk of dementia. The aim of the present study was to estimate the current prevalence of CI and associated factors in adults over 50 years old attending PCC with complaints of memory failure.

Table 1. Demographic characteristics of the subjects included in the study Demographic characteristics Age groups 50–54 years 55–59 years 60–64 years 65–69 years 70–74 years 75–79 years 80–84 years 85–90 years Gender Women Men Formal education 0–4 years 5–8 years 9–12 years 13+ years

Study sample (n = 580) 050 (8.6%) 055 (9.5%) 094 (16.2%) 096 (16.6%) 108 (18.6%) 100 (17.2%) 051 (8.8%) 026 (4.5%) 401 (69.1%) 179 (30.9%) 090 (15.5%) 269 (46.4%) 114 (19.7%) 107 (18.4%)

Methodology A cross-sectional study was conducted in 8 representative PCC in Galicia, an autonomous region in northwest Spain (total surface area, 29,430 km2 and population 2,724,500). The study received approval by the Ethics in Clinical Research Committee of the Galician Government, and was conducted in accordance with the Declaration of Helsinki, the International Conference on Harmonization Tripartite Guidelines for Good Clinical Practice 1996, and the Rules Governing Medicinal Products in the European Community (Directive 91/507/ EEC). Written informed consent was obtained from all participants prior to the study.

Instruments of Assessment A questionnaire on sociodemographic and clinical data was used to obtain information from the patients and/or a family member regarding the following variables: age, years of formal education, marital status, occupation, medical history, reading habits and participation in leisure activities. Occupation was evaluated according to the general protocol of the NESTDD (Network for Efficiency and Standardization of Dementia Diagnosis) project [22], and the main occupation of participants was scored on a scale from 1 to 6, as follows: 1 = unemployed, 2 = unskilled workers, 3 = housewife, 4 = qualified workers, 5 = technical workers, teachers, liberal professions,

managers, and 6 = professors and high-level executives. For the analyses, these occupations were grouped into two main categories according to the level of qualification: low qualification (score 1–3) and high qualification (score 4–6). The Charlson Comorbidity Index [23] was obtained from the medical history. Data on peripheral arterial obstructive disease, diabetes and hypertension were analysed separately, taking into account our exclusion criteria. A short version of the Questionnaire for Subjective Memory Complaints (QSMC) [24], comprising 7 items scored on a Likert scale from 1 to 5 (maximum score 35), was administered to participants and to a family member in order to assess the severity of SMC. The general cognitive functioning of participants was evaluated by the Spanish version of the Mini Mental State Examination (MMSE), adapted and validated by Lobo et al. [25] with normal age and education groups. CIs were evaluated in several domains (orientation, language, attention, praxis, perception and executive functioning) by the Cambridge Cognitive Assessment-Revised (CAMCOG-R) [26], and memory impairments were tested by the Spanish version [27] of the California Verbal Learning Test (CVLT), which evaluates free and cued recall of words and delayed recognition. Diagnosis of CI included MCI and probable dementia. MCI was essentially diagnosed following the criteria outlined by Petersen and colleagues [28–30]. The categories of MCI included the following four types: (a) individuals with multiple-domain amnestic MCI who scored 1.5 SDs below age- and education-related norms in the MMSE and in at least two CAMCOG subscales as well as in the CVLT (short delay free recall); (b) individuals with single-domain amnestic MCI, with normal cognitive functioning in the MMSE and

Cognitive Impairment in Adults

Dement Geriatr Cogn Disord 2012;33:226–232

Sample The sample comprised 580 participants aged 50 years or more, with no prior diagnosis of dementia, psychiatric or neurological disorders and who attended PCC with complaints of memory failure. The participants spontaneously reported that their memory was not as good as before (demographic characteristics are shown in table 1).

227

CAMCOG subscales, but with memory impairment in the CVLT; (c) individuals with multiple-domain non-amnestic MCI with normal memory functioning but with CIs (as in the multiple-domain amnestic MCI type), and (d) individuals with single-domain non-amnestic MCI with normal memory and cognitive (MMSE) functioning but who scored 1.5 SDs below age- and education-related norms in one of the CAMCOG subscales. Diagnosis of probable dementia was made when the MMSE scores were below the cut-off for MCI and the participants fulfilled the corresponding DSM-IV criteria [31]. The Lawton and Brody Index [32] was used to evaluate instrumental activities of daily living (IADL). This estimates an individual’s performance in certain activities according to self-assessment of information provided by a family member. The scale indicates the level of dependence according to the amount of help needed. Individuals who did not require any help or assistance in any of the activities investigated obtained the maximum score (8 points) and were considered to be independent. The 15-item version of the Geriatric Depression Scale [33] was used with a cut-off point of 6+ as indicative of depressive symptoms. Statistical Analysis Statistical analyses were performed with SPSS for Windows, version 18.0. Sex, age, years of formal education, profession, reading habits, leisure activities, autonomy for IADL, participant memory complaints, informant memory complaints (family member), comorbidity and depression were considered independent variables. The χ2 test was used for categorical variables. Prevalence was estimated from the number and percentage of cases and odds ratios (ORs), with 95% confidence intervals. A multivariate analysis (forward stepwise logistic regression) was carried out to adjust for possible confounding variables. Multivariate logistic regression models were used to analyse the relationships between CI and explanatory variables, and only those variables that were significantly (p < 0.05) associated with CI in univariate analyses were considered.

Results

The incidence of CI was 268 cases (46.20%) from the total sample of 580 participants. Of these, 169 cases presented MCI and 99 cases presented probable dementia. The results concerning the prevalence of the independent variables for CI are shown in table 2. CI was significantly more prevalent in women than in men (OR = 1.47; 95% confidence interval = 1.02–2.10). Prevalence rates of CI increased significantly between age 55 and 59 years and between age 60 and 64 years (OR = 2.30; 95% confidence interval = 1.04–5.05). From 60 to 64 years, the prevalence increased progressively with older age and in comparison with the 50- to 54-year age group, the 85- to 90-year age group yielded an OR of 9.62. 228


Level of education was significantly and inversely associated with the prevalence of CI; the highest level of CI was observed in the group with 0–4 years of higher education, and the lowest for the group with 13+ years of higher education (OR = 3.07; 95% confidence interval = 1.71–5.51). CI was more prevalent in individuals with low-qualification occupations than in those with high-qualification occupations (OR = 2.26; 95% confidence interval = 1.61–3.16). Reading habits that involved infrequent reading activities were associated with a higher rate of prevalence than frequent reading activities (OR = 3.40; 95% confidence interval = 2.36– 4.90). Infrequent participation in leisure activities was not significantly associated with higher prevalence of CI, although the results indicated a trend towards significance (p = 0.051, OR = 1.42; 95% confidence interval = 0.99–2.02). Dependence in IADL measured as a categorical variable (scores 0–4 on the Lawton scale) compared with autonomy (5–8 on the Lawton scale) was associated with a higher prevalence of CI (OR = 3.00; 95% confidence interval = 2.00–4.49). A high level of SMC (scores 20–35 in the QSMC) was also associated with a higher prevalence of CI than low levels of SMC (scores 0–19 in the QSMC), and the OR for participants was 1.75 (95% confidence interval = 1.25–2.44) and for informants 2.32 (95% confidence interval = 1.63–3.29). No significant differences in prevalence rates for CI were found in the Charlson Comorbidity Index, in peripheral arterial obstructive disease, diabetes, hypertension or depressive symptoms (with a cut-off point of 6 on the Yesavage scale). The following variables were included in the multivariate logistic regression model: gender, age, years of education, profession, reading habits, dependence in IALD, and memory complaints (subjective and informant-reported). In the final model, only age (70 years or over), reading habits, dependence in IADL and SMC (informant-reported) remained significantly associated with CI (table 3), and the influence of profession was almost significant.

Discussion

A prevalence rate of 46.20% for CI was found in adults aged 50 years and older attending PCC with SMC. This prevalence is higher than reported in population-based studies [14–18] and the prevalence reported for random samples in PCC, e.g. by Olivera et al. [21] (16.4%). Juncos-Rabadan/Pereiro/Facal/Rodriguez/ Lojo/Caamaño/Sueiro/Boveda/Eiroa

Table 2. Prevalence of CI according to gender, age and other covariates (univariate logistic regression) Covariates

Cases

Percentage

Gender Women 197/401 49.12 071/179 39.66 Men Total 268/580 46.20 Age group 011/50 22 50–54 years 016/55 29.09 55–59 years 037/94 39.36 60–64 years 041/96 42.70 65–69 years 055/108 50.92 70–74 years 058/100 58.00 75–79 years 031/51 60.78 80–84 years 019/26 73.07 85–90 years Years of education 00–4 053/90 58.88 05–8 127/269 47.21 09–12 054/114 47.36 034/107 31.77 13+ Profession Low qualification 147/256 57.42 High qualification 121/324 37.34 Reading habits Low 124/187 66.31 High 144/393 36.64 Leisure activities Infrequent 193/394 48.98 075/186 40.32 Frequent Instrumental activities daily living (Lawton) 090/135 66.66 Dependence Autonomy 178/445 40.00 Memory complaints (participant) High 136/255 53.33 Low 129/325 39.69 Memory complaints (informant) High 118/197 59.89 Low 150/383 39.16 Comorbidity (Charlson’s Index) 071/142 50.00 2–3 points 0–1 points 197/438 44.97 Peripheral arterial obstructive disease 007/14 50.00 Yes No 261/566 46.11 Diabetes 034/68 50.00 Yes No 234/512 45.70 Hypertension Yes 101/197 51.26 No 167/383 43.60 Depression (Yesavage) 091/175 52.00 6–15 points 0–5 points 177/405 43.70


Wald’s χ2

p values

OR

95% confidence interval

04.45

0.035

1.47 1

1.02–2.10

00.68 04.31 05.93 11.04 16.01 14.60 16.42

0.408 0.038 0.015 0.001 0.0001 0.0001 0.0001

1 1.45 2.30 2.64 3.67 4.89 5.49 9.62

0.59–3.53 1.04–5.05 1.20–5.77 1.70–7.93 2.24–10.66 2.29–13.16 3.22–28.76

14.18 07.33 05.54

0.0001 0.007 0.019

3.07 1.92 1.93

1.71–5.51 1.19–3.07 1.11–3.34

22.85

0.0001

2.26 1

1.61–3.16

42.98

0.0001

3.40 1

2.36–4.90

03.80

0.051

1.42 1

0.99–2.02

28.26

0.0001

3.00 1

2.00–4.49

10.94

0.001

1.75 1

1.25–2.44

22.07

0.0001

2.32 1

1.63–3.29

00.89

0.345

1.20 1

0.82–1.75

00.30

0.582

0.73 1

0.24–2.21

00.42

0.515

0.84 1

0.51–1.40

02.97

0.085

0.74 1

0.52–1.04

03.01

0.081

1.37 1

0.86–1.97


229

Table 3. Final multivariate logistic regression model Covariates

Wald’s χ2

p values

Age group 50–54 years 00.30 0.584 55–59 years 02.50 0.113 60–64 years 03.45 0.063 65–69 years 07.08 0.008 70–74 years 07.14 0.008 75–79 years 04.57 0.032 80–84 years 04.66 0.031 85–90 years Profession 0.06 Low qualification 03.34 High qualification Reading habits Low 14.00 0.0001 High Instrumental activities daily living (Lawton) Dependence 10.52 0.001 Autonomy Memory complaints (informant) 07.62 0.006 High Low

OR

1 1.29 1.96 2.20 3.04 3.15 2.66 2.83

95% confidence interval

0.51–3.28 0.85–4.53 0.95–5.05 1.34–6.89 1.35–7.32 1.08–6.54 1.70–7.72

1.44 1

0.97–2.14

2.23 1

1.46–3.40

2.95 1

1.53–5.69

1.75 1

1.17–2.62

According to the present results, almost half of the patients attending PCC with SMC had objective CI diagnosed as MCI or probable dementia. Although the high severity of SMC reported by participants and informants (family members) was associated with a higher prevalence of CI when the multivariate model was applied, only the high severity of SMC from informants predicted an objective CI. This indicates that SMC are related to CI and that informants appeared more accurate than participants in endorsing a complaint when CI is objectively present [5]. General practitioners must be cautious with SMC and confirm CI by objective testing in order to improve the current rates of recognition [8–10]. Unlike other studies, which examined only the presence and frequency of SMC [7], the present study analysed the severity of subjective symptoms and showed that the severity of SMC is as an important correlate of CI, especially those reported by informants. We suggest that subjective complaints should be measured by general practitioners, with items scored on a Likert scale and not with common questions with yes/no answers. Primary care clinicians attending patients with subjective complaints should bear in mind that when severe complaints are made and confirmed by an informant, they 230


may be regarded as one of the first symptoms for early diagnosis of CI [1, 2–4]. The prevalence of CI increased with age, as in previous studies [14–18]. In the present study, the prevalence rates increased slightly after age 65–69 years and clearly increased after age 70–74 years. It is important to point out that the prevalence was not significant for participants aged 55–64 years, with respect to those aged 50–54 years. The positive association between CI and female sex observed in this study is consistent with previous findings [18, 21, 34–36]. No significant differences were found in either the comorbidity index, or in peripheral arterial obstructive disease, diabetes and hypertension, between participants with and without CI (table 2). Stroke, peripheral arterial obstruction and other vascular diseases have been associated with CI in some studies [18, 34] but not in others [36]. In the present study, patients with neurological diseases were excluded from the analysis, which may explain the results for comorbidity. In the present sample, depression was not significantly associated with CI, in keeping with the results of other studies in which depression was not consistently related to conversion to dementia [37]. The present results revealed a significant association between education/occupation and CI, and support the hypothesis of cognitive reserve as protection against cognitive decline and deterioration [38]. CI was more frequent among participants with a low level of education and with low-qualification jobs than among those with higher education and more highly qualified jobs. Reading habits, which are obviously closely related to the level of education, were also significantly associated with CI. These results are extremely important with respect to prevention. The prevalence of CI was higher in patients who were dependent in IADL, according to informant reports on the Lawton and Brody scale. This is consistent with previous findings, which indicate that in the early stages of Alzheimer’s disease [39] and in MCI [40], performance of daily household activities essential to maintaining independence is altered, according to functional deficits identified by informants. In conclusion, the present findings showed that almost one of every two patients who attended PCC with SMC had objective CI diagnosed as MCI or probable dementia. This high prevalence may be significantly influenced by the fact that these people have presumably sought medical advice because of their memory complaints. Prevalence rates were higher in women, parJuncos-Rabadan/Pereiro/Facal/Rodriguez/ Lojo/Caamaño/Sueiro/Boveda/Eiroa

ticipants aged over 70 years, and in participants with a low level of education and low-qualification jobs. SMC and functional deficits reported by informants should be used by general practitioners as important markers of CI.

Disclosure Statement There are no conflicts of interest in this work.

Acknowledgements This work was financially supported by the Spanish Directorate General for Science and Technology under Projects SEJ2007-67964-CO2–01 and PSI2010-22224-C03–01.

References 1 Petersen RC, Roberts RO, Knopman DS, Boeve BF, Geda YE, Ivnik RJ, et al: Mild cognitive impairment. Ten years later. Arch Neurol 2009;66:1447–1455. 2 Geerlings MI, Jonker C, Bouter LM, et al: Association between memory complaints and incident Alzheimer’s disease in elderly people with normal baseline cognition. Am J Psychiatry 1999;156:531–537. 3 Glodzik-Sobanska L, Reisberg B, De Santi S, Babb JS, Pirraglia E, Rich KE, et al: Subjective memory complaints: presence, severity and future outcome in normal older subjects. Dement Geriatr Cogn Disord 2007;24: 177–184. 4 Reisberg B, Prichep L, Mosconi L, John ER, Glodzik-Sobanska L, Boksay I, et al: The pre-mild cognitive impairment, subjective cognitive impairment stage of Alzheimer’s disease. Alzheimers Dement 2008;4(1 suppl): S98–S108. 5 Slavin ML, Brodaty H, Kochan NA, Crawford JD, Trollor JN, Draper B, Sachdev PS: Prevalence and predictors of ‘subjective cognitive complaints’ in the Sydney Memory and Ageing Study. Am J Geriatr Psychiatry 2010;18:701–710. 6 Jungwirth S, Fischer P, Weissgram S, Kirchmeyr W, Bauer P, Tragl KH: Subjective memory complaints and objective memory impairment in the Vienna-Transdanube aging community. J Am Geriatr Soc 2004;52: 263–268. 7 Roberts JL, Clare L, Woods RT: Subjective memory complaints and awareness of memory functioning in mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord 2009;28:95–109. 8 Boise L, Neal MB, Kaye J: Dementia assessment in primary care: results from a study in three managed care systems. J Gerontology 2004;59A:621–626. 9 Borson S, Scanlan JM, Watanabe J, Tu Sh, Lessig M: Improving identification of cognitive impairment in primary care. Int J Geriatr Psychiatry 2006;21:349–355.


10 Callahan CM, Hendrie HC, Tierney WM: Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med 1995;122:422–429. 11 Bamford C, Eccles M, Steen N, Robinson L: Can primary care record review facilitate earlier diagnosis of dementia? Fam Pract 2007; 24:108–116. 12 Valcour VG, Masaki KH, Curb JD, Blanchette PL: The detection of dementia in the primary care setting. Arch Intern Med 2000;160: 2964–2968. 13 Van den Kommer TN, Bontempo DE, Comijs HC, Hofer SM, Dik MC, Piccinin AM, et al: Classification models for early identification of persons at risk for dementia in primary care: an evaluation in a sample aged 80 years and older. Dement Geriatr Cogn Disord 2009;28:567–577. 14 Llibre J, Ferri CP, Acosta D, Guerra M, Huang Y, Jacob KS, et al: Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet 2008;3:464–474. 15 Copeland JRM, Dewey ME, Wood N, Searle R, Davidson IA, McWilliam C: Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatry 1987;150:815–823. 16 Lobo A, Saz P, Marcos G, Dia JL, De-la-Camara C, Ventura T, et al: Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project. Acta Psychiatr Scand 2007;116: 299–307. 17 Graciani A, Banegas JR, Guallar-Castillon P, Dominguez-Rojas V, Rodriguez-Artalejo F: Cognitive assessment of non-demented elderly community dweller in Spain. Dement Geriatr Cogn Disord 2006;21:104–112. 18 Millan-Calenti JC, Tubio J, Pita-Fernandez S, Gonzalez-Abraldes I, Lorenzo T, Maseda A: Prevalence of cognitive impairment: effects of level of education, age, sex and associated factors. Dement Geriatr Cogn Disord 2009; 28:455–460.

19 Bradford A, Kunik M, Schulz P, Williams S, Singh H: Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors. Alzheimer Dis Assoc Disord 2009;23:306–314. 20 Luck T, Luppa M, Briel S, Riedel-Heller SG: Incidence of mild cognitive impairment: a systematic review. Dement Geriatr Cogn Disord 2010;29:164–175. 21 Olivera J, Benabarre S, Lorente L, Rodríguez M, Pelegrín, C, Calvo JM, et al: Prevalence of psychiatric symptoms and mental disorders detected in primary care in an elderly Spanish population. The PSICOTARD Study: preliminary findings. Int J Geriatr Psychiatry 2008;23:915–921. 22 Garibotto V, Borroni B, Kalbe E, Herholz K, Salmon E, Holtoff V, et al: Education and occupation as proxies for reserve in aMCI converters and AD FDG-PET evidence. Neurology 2008;71:1342–1349. 23 Charlson M, Pompei P, Ales KL, McKenzie CR: A new method of classyfing prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987; 40:373–383. 24 Benedet MJ, Seisdedos N: Evaluación clínica de las quejas de la memoria en la vida cotidiana. Madrid, Editorial Médica Panamericana, 1996. 25 Lobo A, Saz P, Marcos G, Dia JL, De-laCamara C, Ventura T, et al: Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica. Med Clín 1999; 112:767–774. 26 Roth M, Huppert FA, Mountjoy CQ, Tym E: Prueba de exploración Cambridge revisada para la valoración de los trastornos mentales en la vejez. Madrid, TEA, 2003. 27 Benedet MJ, Alejandre MA: TAVEC: test de aprendizaje verbal España-Complutense. Madrid, TEA, 1998. 28 Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256: 183–194.


231

29 Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al: Mild cognitive impairment: beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256: 240–246. 30 Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, et al: Mild cognitive impairment. Lancet 2006;367:1262–1270. 31 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994. 32 Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;3: 179–186. 33 Sheikh JI, Yesavage JA: Geriatric depression scale (GDS): recent evidence and development of a shorter version; in Bring TL (ed): Clinical Gerontology: A Guide to Assessment and Intervention. New York, Haworth, 1986, pp 165–173.

der P, Bogousslavsky J, Dillon WP, Pedraza S: Perfusion-CT assessment ol 2002;113:702–712. of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke 2006;37:979–985. 2 Bivard A, McElduff P, Spratt N, Levi C, Parsons M: Defining the extent of irreversible brain ischemia using perfusion computed tomography. Cerebrovasc Dis 2010;31:238–245. Finnigan SP, RoseL,SE, Walsh Janke AL, McMahon 37 M, Rozzini L, Chilovi BV, KL, TrabucchiA/Prof. M, Pa-Thanh G. Pha 34 Rait G, 3Fletcher A, Smeeth Brayne C, M, Stir-Griffin Department of Neuro Gillies MW,ofPettigrew J, Brown P, dovani J,A:Brown Depression is unrelated to conling S, Nunes M,R, et Strudwick al: Prevalence cogni- CM, Semple Monash Chalk JB: Correlation of MRC quantitative acute ischemic stroke version to dementia inwith patients with mildUniversity, 2 tive impairment: results from the trial EEG in 30-day score: of comparison and perfusion Arch MRI. Neurol Clayton, cognitive impairment. 2005;62: VIC 3168 (A of assessment andNIHSS management older peo- with diffusion Tel. +61 3 9594 5527, E 2004; 35: 899–903. 505–506. ple in the Stroke community. Age Ageing 2005;34: 38 Fratiglioni L, Wang H: Brain reserve hypoth242–248. esis in dementia. J Alzheimers Dis 2007;12: 35 Luck T, Riedel-Heller SG, Kaduszkiewicz 11–22. H, Bickel H, Jessen F, Pentzek M, et al: Mild 39 Stern Y, Hesdorffer D, Sano M, Mayeux R: cognitive impairment in general practice: Measurement and prediction of functional age-specific prevalence and correlate results capacity in Alzheimer’s disease. Neurology from the German study on ageing, cognition 1990;40:8–14. and dementia in primary care patients (Age40 Tabert MH, Albert SM, Borukhova-Milov L, CoDe). Dement Geriatr Cogn Disord 2007; Camacho Y, Pelton G, Liu X, et al: Function24:307–316. al deficits in patients with mild cognitive im36 Zang Z: Gender differentials in cognitive pairment: prediction of AD. Neurology 2002; impairment and decline of the oldest old in 58:758–764. China. J Gerontol B Psychol Sci Soc Sci 2006; 61B:S107–S115.

© Free Author Copy – for personal use only ANY DISTRIBUTION OF THIS ARTICLE WITHOUT WRITTEN CONSENT FROM S. KARGER AG, BASEL IS A VIOLATION OF THE COPYRIGHT. Written permission to distribute the PDF will be granted against payment of a permission fee, which is based on the number of accesses required. Please contact [email protected]

© Free Author Copy – for personal use only

ANY DISTRIBUTION OF THIS ARTICLE WITHOUT WRITTEN CONSENT FROM S. KARGER AG, BASEL IS A VIOLATION OF THE COPYRIGHT. Cerebrovasc Dis Stroke Note Written permission to distribute the PDF will be granted against payment of a permission fee, which is based on the number of accesses required. Please contact permission@

CED336332.indd 3

232


Juncos-Rabadan/Pereiro/Facal/Rodriguez/ Lojo/Caamaño/Sueiro/Boveda/Eiroa