Tabla. Características demográficas y clínicas de los dos grupos de estudio. |
||||
< 85 años |
≥ 85 años |
p |
||
Edad media (años) |
75,9 ± 5,8 |
87,7 ± 2,4 |
0,000 |
|
Sexo (femenino) |
67,3% |
67,5% |
0,973 |
|
Estudios |
Analfabeto |
10,9% |
15,4% |
0,869 |
Primarios, incompletos |
46,3% |
43,6% |
||
Primarios, completos |
38,1% |
35,9% |
||
Superiores |
4,8% |
5,1% |
||
Cuidador (relación) |
Cónyuge |
35,2% |
10,0% |
0,002 |
Hijo a |
56,0% |
70,0% |
||
Otra |
8,7% |
20,0% |
||
Cuidador (mujer) |
66,4% |
90,0% |
0,002 |
|
Institucionalización |
1,3% |
8,6% |
0,030 |
|
Enfermedades crónicas b |
2,7 ± 1,8 |
2,9 ± 1,5 |
0,643 |
|
Hipertensión arterial |
53,7% |
67,5% |
0,100 |
|
Diabetes |
20,1% |
25,0% |
0,476 |
|
Dislipidemia |
40,2% |
27,5% |
0,122 |
|
Cardiopatía isquémica |
10,8% |
17,5% |
0,198 |
|
Ictus isquémico |
10,8% |
12,5% |
0,787 |
|
Tabaquismo |
9,4% |
10,0% |
0,780 |
|
Enolismo |
2,7% |
0% |
0,603 |
|
Traumatismo craneal |
6,4% |
7,5% |
0,735 |
|
Fármacos |
4,2 ± 2,7 |
4,5 ± 3,0 |
0,549 |
|
Déficit auditivo |
3,1% |
2,6% |
1,000 |
|
Déficit visual |
1,0% |
5,1% |
0,106 |
|
Dependencia funcional c |
13,0% |
33,3% |
0,001 |
|
Historia familiar de demencia |
39,9% |
27,5% |
0,129 |
|
Tiempo de evolución (años) |
2,0 ± 2,1 |
1,5 ± 1,4 |
0,203 |
|
Síntomas cognitivos |
96,9% |
100% |
0,606 |
|
Síntomas afectivos |
17,4% |
17,9% |
0,933 |
|
Síntomas conductuales |
21,0% |
25,6% |
0,509 |
|
Test minimental de Folstein (MMSE) |
18,4 ± 5,5 |
15,3 ± 5,0 |
0,001 |
|
Cuestionario de actividades funcionales (FAQ) |
9,2 ± 7,8 |
16,4 ± 7,5 |
0,000 |
|
Suma de áreas de la CDR |
2,5 ± 1,8 |
4,0 ± 2,3 |
0,000 |
|
Diagnóstico cognitivo inicial |
Normalidad cognitiva |
3,0% |
0% |
0,000 |
Alteración cognitiva leve |
81,8% |
52,5% |
||
Demencia |
15,2% |
47,5% |
||
Diagnóstico cognitivo tras un año |
Normalidad cognitiva |
11,2% |
2,4% |
0,000 |
Alteración cognitiva leve |
54,6% |
26,2% |
||
Demencia |
34,2% |
71,4% |
||
Evolución cognitiva (MMSE) |
–0,7 ± 3,0 |
–0,9 ± 3,0 |
0,723 |
|
Evolución global (suma de áreas de la CDR) |
0,9 ± 2,1 |
1,5 ± 2,5 |
0,141 |
|
Diagnóstico etiológico d |
Alzheimer probable |
64,7% |
46,4% |
0,386 |
Alzheimer posible |
5,9% |
14,3% |
||
Alzheimer más vascular |
11,8% |
14,3% |
||
Cuerpos de Lewy/Parkinson |
10,8% |
17,9% |
||
Demencia vascular |
2,9% |
7,1% |
||
Otra etiología |
2,0% |
0% |
||
CDR: escala de estadificación clínica de la demencia. a Incluye yerno y nuera; b No se incluyen las enfermedades neurológicas o psiquiátricas; c Para alguna actividad básica, no debida al deterioro cognitivo; d Tras un año de seguimiento, sólo en los pacientes con demencia (n = 130). |
Cognitive impairment in very elderly patients: a retrospective study in a neurology service Introduction. A considerable proportion of very elderly patients with cognitive impairment are attended in the general neurology offices. There are few studies about the clinical characteristics of these patients. Aim. To describe the background and clinical features of very elderly patients who come to the general neurology clinic due to cognitive complaints or suspected cognitive impairment. Patients and methods. We retrospectively studied 336 patients (296 patients < 85 years vs. 40 patients ≥ 85 years of age) who had been mostly referred by primary care physicians. Cognitive performance was measured by the Mini-Mental State Examination and the overall (i.e., cognitive and functional) clinical situation was measured by the Clinical Dementia Rating scale. Results. Older patients had more frequently cognitive impairment (mild cognitive impairment or dementia), both at the first visit and at the one-year follow-up visit (p < 0.0005). No differences were found in symptom duration (2.0 ± 2.1 vs. 1.5 ± 1.4 years), type of symptoms, or comorbidity. Alzheimer’s disease was the most frequent etiological diagnosis in both age groups (82.4% vs. 75.0%; p > 0.05). Conclusions. Very elderly patients studied in the neurology office have a higher risk of presenting cognitive impairment, despite being comparable in terms of symptoms and time of evolution. These results could be explained from the hypotheses of brain reserve and combined brain pathology. Key words. Alzheimer’s disease. Clinical features. Cognitive impairment. Dementia. Neurology clinic. Very elderly population. |