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Article: The economic cost of Alzheimer's disease: Family or public health burden?

Castro, Diego M / Dillon, Carol / Machnicki, Gerardo / Allegri, Ricardo F

Dementia & neuropsychologia

2017 Volume 4, Issue 4, Page(s) 262–267

Abstract: Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as ... ...

Abstract	Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.
Language	English
Publishing date	2017-08-22
Publishing country	Brazil
Document type	Journal Article ; Review
ISSN	1980-5764
ISSN	1980-5764
DOI	10.1590/S1980-57642010DN40400003
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Article: Las crisis de angustia en la urgencia y su relación con los factores desencadenantes desde una perspectiva de género.

González, Marianela / Melamed, Gabriela / Dillon, Carol

Vertex (Buenos Aires, Argentina)

2014 Volume 25, Issue 115, Page(s) 172–178

Abstract: Background: Anxiety disorders and, in particular, acute stress disorder are one of the principal reasons for medical assistance, being the women the ones who frequently consult.: Aims: To describe and analyze, from a perspective of gender, the ... ...

Title translation	Acute stress disorder in the emergency, its relationship with trigger factors from a gender perspective.
Abstract	Background: Anxiety disorders and, in particular, acute stress disorder are one of the principal reasons for medical assistance, being the women the ones who frequently consult. Aims: To describe and analyze, from a perspective of gender, the factors that unleash the consultation of an episode of acute stress disorder in the emergency. Materials and method: An exploratory descriptive study was performed. A semi-directed interview and a socio-demographic questionnaire were assessed and scales to evaluate anxiety and depression were administered to females that consulted for an acute stress disorder. Results: Sixty nine percent of the patients described the physical discomfort as trigger factor, presenting in the 85% of the cases a degree of major anxiety; associating the family conflicts as the principal cause of distress, followed by violence against women. The situation of distress, in 75% of the cases, did not correspond with an isolated episode. Conclusion: The physical symptomatology was the principal cause for consultation of an episode of acute stress disorder in the emergency, being the family conflicts and the violence against women the principal reasons of distress. Therefore, interdisciplinary approach for the assistance of mental disorders in emergency should be taken in consideration.
MeSH term(s)	Adult ; Emergencies ; Female ; Humans ; Sex Factors ; Stress Disorders, Traumatic, Acute/diagnosis ; Stress Disorders, Traumatic, Acute/etiology
Language	Spanish
Publishing date	2014-05
Publishing country	Argentina
Document type	English Abstract ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	0327-6139
ISSN	0327-6139
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Article: Desinhibición en psicogeriatría: diagnóstico diferencial de la demencia fronto-temporal.

Dillon, Carol / Allegri, Ricardo F

Vertex (Buenos Aires, Argentina)

2010 Volume 21, Issue 91, Page(s) 301–313

Abstract: Disinhibition is the loss of psychological and physiological inhibition that leads to cognitive and motor impulsivity. The notion of impulsiveness is often linked to the function of the prefrontal cortex, and is usually understood as a lack of response ... ...

Title translation	Disinhibition in psychogeriatry: differential diagnosis with frontotemporal dementia.
Abstract	Disinhibition is the loss of psychological and physiological inhibition that leads to cognitive and motor impulsivity. The notion of impulsiveness is often linked to the function of the prefrontal cortex, and is usually understood as a lack of response inhibition. In other words, the subject is unable to suppress or withhold a previously rewarding response and the behavior appears impulsive. This has a social impact as disinhibition often affects the human social behavior. The "human social behavior" is how a person behaves properly with other people in a social environment. Frontotemporal Dementia produces changes in patients' behavior that frequently, manifest as disinhibition. Patients' social cognition is impaired and this is one of the key points for early diagnosis. All of these concepts will be review for a better understanding of Frontotemporal Dementia, and therefore, being able to differentiate it from other psychogeriatric disorders.
MeSH term(s)	Alzheimer Disease/diagnosis ; Animals ; Dementia ; Diagnosis, Differential ; Disease Models, Animal ; Frontotemporal Dementia/diagnosis ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Social Behavior ; Social Environment
Language	Spanish
Publishing date	2010-05
Publishing country	Argentina
Document type	Comparative Study ; English Abstract ; Journal Article ; Review
ISSN	0327-6139
ISSN	0327-6139
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Article ; Online: Insurance status and demographic and clinical factors associated with pharmacologic treatment of depression: associations in a cohort in Buenos Aires.

Machnicki, Gerardo / Dillon, Carol / Allegri, Ricardo F

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

2011 Volume 14, Issue 5 Suppl 1, Page(s) S13–5

Abstract: Objective: There is a paucity of evidence about insurance status and the likelihood of receiving medical services in Latin America. The objective of this analysis was to examine the association between insurance status and pharmacologic treatment for ... ...

Abstract	Objective: There is a paucity of evidence about insurance status and the likelihood of receiving medical services in Latin America. The objective of this analysis was to examine the association between insurance status and pharmacologic treatment for depression. Methods: Patients referred to a memory clinic of a public hospital in Buenos Aires, Argentina, and identified with any of four types of depression (subsyndromal, dysthymia, major, and due to dementia) were included. Age, years of education, insurance status, Beck Depression Inventory score, and number of comorbidities were considered. Associations between these factors and not receiving pharmacologic treatment for depression were examined with logistic regression. Use of prescription neuroleptics, hypnotics, and anticholinesterase inhibitors was also explored. Results: Out of 100 patients, 92 with insurance status data were used. Sixty-one patients (66%) had formal insurance and 31 patients (34%) lacked insurance. Twenty-seven (44%) insured patients and 23 (74%) uninsured patients did not receive antidepressants (P = 0.001). Controlling for other factors, uninsured patients had 7.12 higher odds of not receiving treatment compared to insured patients (95% confidence interval 1.88-28.86). Older patients and those with more comorbidities had higher odds of not receiving treatment. More educated patients, those with higher Beck Depression Inventory score, and those without subsyndromal depression had lower odds of not receiving treatment. None of those associations were statistically significant. Conclusions: These results suggest a potential negative effect of the lack of formal insurance regarding pharmacologic treatment for depression. These findings should be confirmed with larger samples, and for other diseases.
MeSH term(s)	Aged ; Antidepressive Agents/economics ; Antidepressive Agents/therapeutic use ; Antipsychotic Agents/economics ; Antipsychotic Agents/therapeutic use ; Argentina ; Chi-Square Distribution ; Cholinesterase Inhibitors/economics ; Cholinesterase Inhibitors/therapeutic use ; Cohort Studies ; Cross-Sectional Studies ; Depression/diagnosis ; Depression/drug therapy ; Depression/economics ; Drug Costs ; Drug Utilization ; Health Services Accessibility/economics ; Health Services Research ; Healthcare Disparities/economics ; Hospitals, Public/economics ; Humans ; Hypnotics and Sedatives/economics ; Hypnotics and Sedatives/therapeutic use ; Insurance Coverage/economics ; Insurance, Health/economics ; Logistic Models ; Medically Uninsured ; Middle Aged ; Odds Ratio ; Outcome and Process Assessment (Health Care) ; Practice Patterns, Physicians'/economics ; Risk Assessment ; Risk Factors ; Socioeconomic Factors ; Treatment Outcome
Chemical Substances	Antidepressive Agents ; Antipsychotic Agents ; Cholinesterase Inhibitors ; Hypnotics and Sedatives
Language	English
Publishing date	2011-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1471745-1
ISSN	1524-4733 ; 1098-3015
ISSN (online)	1524-4733
ISSN	1098-3015
DOI	10.1016/j.jval.2011.05.014
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Article ; Online: Geriatric depression and its relation with cognitive impairment and dementia.

Dillon, Carol / Tartaglini, María Florencia / Stefani, Dorina / Salgado, Pablo / Taragano, Fernando E / Allegri, Ricardo F

Archives of gerontology and geriatrics

2014 Volume 59, Issue 2, Page(s) 450–456

Abstract: Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with ... ...

Abstract	Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p<0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p<0.05) were found in DLA between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression.
MeSH term(s)	Aged ; Cognition Disorders/diagnosis ; Cross-Sectional Studies ; Dementia/diagnosis ; Depressive Disorder/psychology ; Female ; Geriatric Assessment ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; Psychiatric Status Rating Scales
Language	English
Publishing date	2014-09
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603162-6
ISSN	1872-6976 ; 0167-4943
ISSN (online)	1872-6976
ISSN	0167-4943
DOI	10.1016/j.archger.2014.04.006
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Article ; Online: Mild cognitive impairment: risk of dementia according to subtypes.

Serrano, Cecilia M / Dillon, Carol / Leis, Adriana / Taragano, Fernando E / Allegri, Ricardo Francisco

Actas espanolas de psiquiatria

2013 Volume 41, Issue 6, Page(s) 330–339

Abstract: Unlabelled: Mild cognitive impairment (MCI) has 3 clinical subtypes: amnestic (aMCI), multiple domains (mdMCI) and non-amnestic single domain (na-SD-MCI) whose evolutive possibility to dementia has not been profoundly studied.: Objective: This paper ... ...

Abstract	Unlabelled: Mild cognitive impairment (MCI) has 3 clinical subtypes: amnestic (aMCI), multiple domains (mdMCI) and non-amnestic single domain (na-SD-MCI) whose evolutive possibility to dementia has not been profoundly studied. Objective: This paper aims to determine the conversion to dementia of the different subtypes of MCI and determine risk factors associated to conversion to dementia. Methods: A total of 127 patients diagnosed with MCI (age=70.21; SD=13.17) were evaluated with a neuropsychological and neuropsychiatric battery. They were classified into 3 groups: amnestic MCI (n=20), multiple-domain MCI (n=98), non-amnestic MCI (n=9). Seventeen normal subjects (age=74.59; SD=10.63) were included. Results: Of those included, 27.1% developed Alzheimer's type dementia [average time for conversion to Alzheimer's dementia (AD) 11.12 months (SD=0.183)]. None of the controls developed dementia. Thirty-five percent (n=7) of amnestic MCI converted to AD: 20% (n=4) at 6 months and 15% (n=3) at 12 months); 11.1% (n=1) of the non-amnestic single domain MCI converted to AD at 6 months. It was found that 31.6% (n=31) of multiple domain MCI rotated to AD: 15.3% (n=15) at 6 months and 16.3% (n=16) at 12 months. Age (p<0.05, β=1.03) increased the likelihood of rotation to AD. Multi-domain MCI subtype was the most frequent. However, the conversion to dementia in amnestic subtype was the highest, age and retirement being the variables that increased the likelihood of conversion to Dementia.
MeSH term(s)	Aged ; Cognitive Dysfunction/complications ; Dementia/epidemiology ; Dementia/etiology ; Female ; Humans ; Male ; Prospective Studies ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2013-11
Publishing country	Spain
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1480971-0
ISSN	1578-2735 ; 1575-071X ; 1139-9287
ISSN (online)	1578-2735
ISSN	1575-071X ; 1139-9287
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Article: Behavioral symptoms related to cognitive impairment.

Dillon, Carol / Serrano, Cecilia M / Castro, Diego / Leguizamón, Patricio Perez / Heisecke, Silvina L / Taragano, Fernando E

Neuropsychiatric disease and treatment

2013 Volume 9, Page(s) 1443–1455

Abstract: Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, ...

Abstract	Neuropsychiatric symptoms (NPS) are core features of Alzheimer's disease and related dementias. On one hand, behavioral symptoms in patients with mild cognitive impairment (MCI) can indicate an increased risk of progressing to dementia. On the other hand, mild behavioral impairment (MBI) in patients who usually have normal cognition indicates an increased risk of developing dementia. Whatever the cause, all dementias carry a high rate of NPI. These symptoms can be observed at any stage of the disease, may fluctuate over its course, are a leading cause of stress and overload for caregivers, and increase rates of hospitalization and early institutionalization for patients with dementia. The clinician should be able to promptly recognize NPI through the use of instruments capable of measuring their frequency and severity to support diagnosis, and to help monitor the treatment of behavioral symptoms. The aims of this review are to describe and update the construct 'MBI' and to revise the reported NPS related to prodromal stages of dementia (MCI and MBI) and dementia stages of Alzheimer's disease and frontotemporal lobar degeneration.
Language	English
Publishing date	2013-09-19
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2186503-6
ISSN	1178-2021 ; 1176-6328
ISSN (online)	1178-2021
ISSN	1176-6328
DOI	10.2147/NDT.S47133
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Article ; Online: Risk of Conversion to Dementia in a Mild Behavioral Impairment Group Compared to a Psychiatric Group and to a Mild Cognitive Impairment Group.

Taragano, Fernando E / Allegri, Ricardo F / Heisecke, Silvina L / Martelli, María I / Feldman, Mónica L / Sánchez, Viviana / García, Virginia A / Tufro, Graciela / Castro, Diego M / Leguizamón, Patricio Perez / Guelar, Verónica / Ruotolo, Eva / Zegarra, Cecilia / Dillon, Carol

Journal of Alzheimer's disease : JAD

2018 Volume 62, Issue 1, Page(s) 227–238

Abstract: Background: There is insufficient available information on behavioral changes in the absence of cognitive impairment as factors increasing the risk of conversion to dementia.: Objective: To observe and analyze patients with mild behavioral impairment ...

Abstract	Background: There is insufficient available information on behavioral changes in the absence of cognitive impairment as factors increasing the risk of conversion to dementia. Objective: To observe and analyze patients with mild behavioral impairment (MBI), mild cognitive impairment (MCI), and a psychiatry group (PG) to compare the risk of progression to dementia. Methods: From 677 initially assessed ≥60-year-old patients, a series of 348 patients was studied for a five-year period until censoring or conversion to dementia: 96 with MBI, 87 with MCI, and 165 with general psychiatry disorders, including 4 subgroups: Anxiety, Depression, Psychosis and Others. All patients were assessed with clinical, psychiatric, neurological, neuropsychological, and neuroimaging studies. Results: From 348 patients, 126 evolved to dementia (36.2%). Conversion was significantly higher in MBI (71.5%), followed by the MCI-MBI overlap (59.6%) and MCI (37.8%) groups, compared to PG (13.9%) (Log-rank p < 0.001). MCI patients mostly converted to Alzheimer's dementia, while MBI converted to frontotemporal dementia and Lewy body dementia. Patients in PG converted to Lewy body dementia and frontotemporal dementia. Conclusion: Conversion to dementia is significantly higher in patients with neuropsychiatric symptoms. The MBI concept generates a new milestone in the refining of diagnosis of neurodegenerative diseases and the possibility of creating neuropsychiatric profiles. Its earlier identification will allow new possibilities for therapeutic intervention.
MeSH term(s)	Aged ; Cognitive Dysfunction/diagnostic imaging ; Cognitive Dysfunction/drug therapy ; Cognitive Dysfunction/epidemiology ; Dementia/diagnostic imaging ; Dementia/drug therapy ; Dementia/epidemiology ; Disease Progression ; Female ; Humans ; Kaplan-Meier Estimate ; Longitudinal Studies ; Male ; Mental Disorders/diagnostic imaging ; Mental Disorders/drug therapy ; Mental Disorders/epidemiology ; Middle Aged ; Prospective Studies ; Risk
Language	English
Publishing date	2018-02-10
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-170632
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Article: Una encuesta sobre biomarcadores y diagnóstico precoz de la enfermedad de Alzheimer.

Taragano, Fernando E / Castro, Diego M / Serrano, Cecilia M / Heisecke, Silvina L / Pérez Leguizamón, Patricio / Loñ, Leandro / Dillon, Carol

Medicina

2015 Volume 75, Issue 5, Page(s) 282–288

Abstract: Given the potential use of biomarkers in the diagnosis of Alzheimer's disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) ... ...

Title translation	A survey on biomarkers and early diagnosis in Alzheimer's disease.
Abstract	Given the potential use of biomarkers in the diagnosis of Alzheimer's disease (AD) in early stages, new ethical and communication dilemmas appear in everyday clinical practice. The aim of this study was to know the opinion of health professionals (HP) and general public (GP) on the implementation of early diagnostic techniques in AD and the use of biomarkers for this purpose. A survey with multiple choice answers was elaborated in two versions: one for HP and the other for GP. Respondents were invited to participate through a system of mass mailing e-mail; e-mail addresses were collected from CEMIC database. A total of 1503 answers were analyzed: 807 HP and 696 GP. Most respondents, 84.7%, preferred the option of early diagnosis of AD even knowing the lack of curative treatment. Forty five percent of GP and 26.8% of HP replied that there is no ethical dilemma in the use of biomarkers and that no communication or ethical dilemma is generated to physicians when informing the diagnosis of the disease. The HP group showed more divergence in the views than the GP group. These results may indicate a change in the physician-patient relationship, showing the GP group with an active and supportive position towards the use of biomarkers for early diagnosis of AD.
MeSH term(s)	Alzheimer Disease/diagnosis ; Alzheimer Disease/prevention & control ; Bioethical Issues ; Biomarkers ; Early Diagnosis ; Genetic Markers ; Health Personnel/ethics ; Humans ; Physician-Patient Relations/ethics ; Public Opinion ; Surveys and Questionnaires
Chemical Substances	Biomarkers ; Genetic Markers
Language	Spanish
Publishing date	2015
Publishing country	Argentina
Document type	English Abstract ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	411586-7
ISSN	1669-9106 ; 0025-7680 ; 0325-951X
ISSN (online)	1669-9106
ISSN	0025-7680 ; 0325-951X
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Article: Role of cognitive reserve in progression from mild cognitive impairment to dementia.

Allegri, Ricardo F / Taragano, Fernando E / Krupitzki, Hugo / Serrano, Cecilia M / Dillon, Carol / Sarasola, Diego / Feldman, Mónica / Tufró, Graciela / Martelli, María / Sanchez, Viviana

Dementia & neuropsychologia

2017 Volume 4, Issue 1, Page(s) 28–34

Abstract: Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies.: Objectives: To identify factors related to cognitive reserve associated with ... ...

Abstract	Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.
Language	English
Publishing date	2017-08-22
Publishing country	Brazil
Document type	Journal Article
ISSN	1980-5764
ISSN	1980-5764
DOI	10.1590/S1980-57642010DN40100005
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