2. Universidad Cardenal Herrera-CEU

Mild cognitive impairment (MCI) is the first sign of dementia among elderly populations and its early detection is crucial in our aging societies. Common MCI tests are time-consuming such that indiscriminate massive screening would not be cost-effective. Here, we describe a protocol that uses machine learning techniques to rapidly select candidates for further screening via a question-based MCI test. This minimizes the number of resources required for screening because only patients who are potentially MCI positive are tested further. This methodology was applied in an initial MCI research study that formed the starting point for the design of a selective screening decision tree. The initial study collected many demographic and lifestyle variables as well as details about patient medications. The Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE) were used to detect possible cases of MCI. Finally, we used this method to design an efficient process for classifying individuals at risk of MCI. This work also provides insights into lifestyle-related factors associated with MCI that could be leveraged in the prevention and early detection of MCI among elderly populations.

Introducción: la vacuna antigripal está indicada entre el personal sanitario, aunque la cobertura antigripal en farmacéuticos comunitarios españoles actualmente se desconoce. Este trabajo pretende averiguar esta cobertura, las causas de los farmacéuticos para vacunarse o no de la gripe, el absentismo laboral que les ocasiona, si recomiendan la vacunación antigripal entre los grupos de riesgo y su disposición a administrarla en la farmacia. Métodos: estudio descriptivo transversal mediante un cuestionario online destinado a farmacéuticos comunitarios de toda España. Se realizó un análisis descriptivo de las variables estudiadas y de la asociación entre la vacunación y las variables cualitativas (test Chi-cuadrado y Fisher) y cuantitativas (ANOVA). Resultados: se obtuvo una tasa de respuesta del 9,4 % (n=1.436). Los farmacéuticos refirieron vacunarse en torno al 30 % en las tres temporadas estudiadas (2016- 2019), siendo del 31-35,8 % (IC95 %) en la temporada 2018-2019. Ser titular/cotitular de la farmacia, la experiencia profesional, la edad, vacunarse para evitar la gripe y/o por responsabilidad, y vacunarse en temporadas anteriores son factores asociados a vacunarse (p<0,05). Ser socio de SEFAC también lo es. El absentismo por gripe en la temporada 2018-2019 fue del 9,5 %. Los farmacéuticos que más dijeron vacunarse recomiendan más la vacuna que los que no, y tendrían mayor predisposición a administrarla (p<0,05). Conclusiones: la cobertura vacunal antigripal entre los farmacéuticos comunitarios es baja a pesar del absentismo que les causa. Facilitar la vacunación a los farmacéuticos podría incrementar su cobertura. Los farmacéuticos recomiendan la vacunación contra la gripe a los pacientes de riesgo y estarían dispuestos a vacunar en farmacias autorizadas. / Introduction: while the influenza vaccine is indicated for healthcare personnel, its coverage among Spanish community pharmacists is currently unknown. This study aims to quantify this coverage as well as evaluate the causes leading pharmacists to be inoculated or not, their flu-related absenteeism, whether they recommend the vaccine to risk groups, and their willingness to administer it in the pharmacy. Methods: descriptive cross-sectional study using an online questionnaire aimed at community pharmacists throughout Spain. A descriptive analysis of the variables studied and of the association between vaccination and qualitative (Chi-square and Fisher test) and quantitative (ANOVA) variables was performed. Results: a response rate of 9.4% (n=1,436). Pharmacists reported vaccinating around 30 % in the three seasons under study (2016-2019), being 31-35.8% (IC95%) in the 2018-2019 season. Being a pharmacy owner/co-owner, professional experience, age, being vaccinated to avoid influenza and/or for responsibility, and being vaccinated in previous seasons are factors associated with being vaccinated (p<0.05). Being a member of SEFAC is also a factor. Flu-related absenteeism in the 2018-2019 season was 9.5%. Pharmacists who reported being vaccinated themselves were more likely to recommended the vaccine and more likely to administer it (p<0.05). Conclusions: flu vaccination coverage among community pharmacists is low despite the absenteeism this causes. Making vaccination easier for pharmacists could increase coverage. Pharmacists recommend flu vaccination for at-risk patients and would be willing to vaccinate in licensed pharmacies.

Background and Objective: Arterial Stiffness (AS) measured as pulse wave velocity has emerged in recent years as a hypertension mediated organ damage with independent prognostic value for Cardiovascular (CV) diseases that has also been discussed as a potential cause of Hypertension (HTN). The aim of this study is to (1) evaluate how measurement of AS modifies CV risk calculation by SCORE, (2) to measure the predictive value of AS for incident hypertension in normotensive patients, and (3) to analyze the association between control of HTN and presence of AS in sustained HTN. Patients and Methods: A longitudinal, prospective, observational trial under conditions of daily pharmaceutical and clinical practice will be conducted in approximately 60 community pharmacies of the Iberian Peninsula in normotensive and/or hypertensive patients entering a pharmacy spontaneously. In the first cross-sectional step, AS will be estimated with a semiautomatic, validated device (Mobil-O-Graph®, IEM), followed by a 10-item questionnaire. The patients will be referred to Primary Care for stratifying risk by SCORE tables and standard evaluation. In the second longitudinal step, patients will be asked to repeat the visit after 12 months. Discussion: This study aims to improve CV risk stratification and to investigate the potential of AS in predicting incident HTN in normotensive subjects. Besides, it will analyze the role of arterial stiffness as an associated factor to prevent control in sustained HTN in a setting of cooperation between community pharmacies and physicians in daily clinical practice.

Community pharmacists and general practitioners have daily contact with patients with Alzheimer’s disease (AD) but the number of positive cases constantly increases every day. Thus, the aim of this research is to describe the level of AD knowledge among community pharmacists and general practitioners in Spain, in order to see where the biggest gaps in the knowledge are. Therefore, a cross-sectional study has been carried out, using the Alzheimer’s disease knowledge survey (ADKS), among members of the Spanish Society of Primary Care Physicians and the Spanish Society of Family and Community Pharmacy to report the differences in AD knowledge in both professional collectives. The ADKS has been responded by 578 community pharmacists and 104 general practitioners and consists of a battery of 30 questions, whose possible answers are true or false. It assesses the AD knowledge in seven areas (impact on the disease, risk factors, course of the disease, diagnosis, care, treatment and symptoms). Results indicate that Spanish pharmacists and general practitioners have a high personal knowledge of AD, nevertheless, it is not associated with greater awareness. Both scored above 80% at the categories: diagnostic, treatment and symptoms. However, lower knowledge level (60% of correct answers) was found in those related to risk factors, such as the ignorance about hypercholesterolemia or hypertension as risk factors for the disease. Community pharmacists are already acting to control cardiovascular risk factors, but a wider knowledge of the relationship of these factors to AD is needed to act against these silent risk factors. Thus, pharmacists may also be involved in the management of AD that includes recognizing early symptoms for early detection of cognitive impairment. Hence, knowledge about risk factors is very important in developing this expanding role.

Introducción: El deterioro cognitivo (DC) es una enfermedad que aumenta con la edad. Es importante conocer los factores protectores y de riesgo de esta enfermedad. Metodología: Estudio observacional realizado a 729 personas mayores de 65 años en 13 farmacias comunitarias durante dos años. Se recogieron datos demográficos (sexo, edad, nivel de estudios) y de estilos de vida (afición a la lectura, realización de pasatiempos, horas de televisión) y para el cribaje de los pacientes se realizaron los test SPMSQ (Short-Portable Mental State Questionaire) de Pfeiffer y Mini-Mental State Examination (MMSE) versión NORMADERM. También se realizó una revisión bibliográfica del tema. Resultados: Se detectó un 17,6% de DC. Se encontró una asociación estadísticamente significativa como protección frente al DC con la afición a la lectura y el nivel de estudios. No se encontró asociación con las horas de televisión (TV) ni con la realización de pasatiempos. La revisión bibliográfica aportó más factores protectores y de riesgo. Discusión: Con nuestros datos podemos afirmar que tanto la reserva cognitiva (años de estudio) como la estimulación cognitiva (horas de lectura) protegen del DC. Sobre los demás datos obtenidos no se han encontrado coincidencias, por lo que sería necesario aumentar el tamaño muestral para poder realizar una comparación más eficaz. Conclusiones: El nivel educativo bajo es un factor de riesgo de DC, mientras que estudios superiores serían un factor preventivo. La lectura es un factor protector de DC. / Introduction: Cognitive Dysfunction (CD) is a disease that increases with age. It is important to know the protective and risk factors for this disease. Methodology: Observational study carried out on 729 people over 65 years of age in community 13 pharmacies for two years. Demographic data were collected (sex, age, level of studies) and lifestyles (love of reading, hobbies such as crossword puzzles or sudokus etc, TV hours), and the SPMSQ (Short-Portable Mental State Questionaire) test of Pfeiffer and Mini- Mental State Examination (MMSE) were carried out to check the patient’s CD. A bibliographic review of the subject was also conducted. Results: 17.6% of CD was detected. A statistically significant association was found as a protection against CD with a love of reading and the level of studies. No association was found with TV hours or hobbies. The literature review provided more protective and risk factors. Discussion: With our data we can affirm that both cognitive reserve (years of study) and cognitive stimulation (hours of reading) protect from CD. No coincidences were found on the other data obtained, so it would be necessary to increase the sample size in order to make a more effective comparison. Conclusions: Low educational level is a risk factor for CD while higher education would be a preventive factor. Reading is a protective factor of CD.

Purpose: The early detection of Mild Cognitive Impairment (MCI) is essential in aging societies where dementia is becoming a common manifestation among the elderly. Thus our aim is to develop a decision tree to discriminate individuals at risk of MCI among non-institutionalized elderly users of community pharmacy. A more clinically and patient-oriented role of the community pharmacist in primary care makes the dispensation of medication an adequate situation for an effective, rapid, easy, and reproducible screening of MCI. Methods: A cross-sectional study was conducted with 728 non-institutionalized participants older than 65. A total of 167 variables were collected such as age, gender, educational attainment, daily sleep duration, reading frequency, subjective memory complaint, and medication. Two screening tests were used to detect possible MCI: Short Portable Mental State Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). Participants classified as positive were referred to clinical diagnosis. A decision tree and predictive models are presented as a result of applying techniques of machine learning for a more efficient enrollment. Results: One hundred and twenty-eight participants (17.4%) scored positive on MCI tests. A recursive partitioning algorithmwith themost significant variables determined that the most relevant for the decision tree are: female sex, sleeping more than 9 h daily, age higher than 79 years as risk factors, and reading frequency. Moreover, psychoanaleptics, nootropics, and antidepressants, and anti-inflammatory drugs achieve a high score of importance according to the predictive algorithms. Furthermore, results obtained from these algorithms agree with the current research on MCI. Conclusion: Lifestyle-related factors such as sleep duration and the lack of reading habits are associated with the presence of positive in MCI test. Moreover, we have depicted how machine learning provides a sound methodology to produce tools for early detection of MCI in community pharmacy. Impact of findings on practice: The community of pharmacists provided with adequate tools could develop a crucial task in the early detection of MCI to redirect them immediately to the specialists in neurology or psychiatry. Pharmacists are one of the most accessible and regularly visited health care professionals and they can play a vital role in early detection of MCI.

Objetivo: desarrollar un programa de cribado de deterioro cognitivo (DC) en mayores de 50 años. Con la finalidad de que el servicio profesional farmacéutico sea más costo-efectivo utilizaremos un árbol de decisión para la selección del paciente. Además, se pretende valorar la importancia de la dieta mediterránea y el consumo de antioxidantes en la prevención del deterioro cognitivo y estudiar marcadores genéticos de riesgo de enfermedad de Alzheimer. Método: para ello se diseña un estudio observacional transversal mediante entrevista personal estructurada en pacientes que muestren indicios de pérdida de memoria. El estudio de captación se realizará en farmacias desde septiembre 2018 hasta septiembre de 2019. Los pacientes con puntuación en los test con posible DC se remitirán a atención primaria, previa presentación del proyecto a coordinación médica. Se perseguirá el resultado del diagnóstico obtenido en atención primaria y/o especializada. Se utilizarán como test de cribado el Memory Impairment Screening (MIS), Short Portable Mental State Questionnaire (SPMSQ) de Pfeiffer, el Fluidez Verbal Semántica (FVS) y siempre que sea posible el Test del Informador (TIN). Se define deterioro cognitivo por MIS ≤4; SPMSQ ≥ 3 (para analfabetos ≥ 4); FVS ≤10 palabras y el valor del TIN >57. A su vez se recogen una muestra de saliva del paciente, para estudio genético, y datos de nutrición para valorar la importancia de la dieta mediterránea y de los alimentos antioxidantes en la prevención del DC. / The aim of this study is to develop a screening program for cognitive impairment (CI) in people older than 50 year old. In order to make the pharmaceutical professional service more cost-effective, we will use a decision tree for patient’s selection. In addition, to assess the importance of the Mediterranean diet and the consumption of antioxidants in the prevention of cognitive deterioration and study genetic markers of risk of Alzheimer’s disease. A cross-sectional observational study is designed by a structured personal interview in patients showing signs of cognitive impairment. The recruitment study will be conducted in pharmacies from September 2018 to September 2019. Patients with a score on the tests with possible CI will be referred to primary care previous presentation of the project to the medical coordination. The result of the diagnosis obtained in primary and / or specialized care will be pursued. The Memory Impairment Test (MIS), the Short Portable Mental State Questionnaire (SPMSQ) of Pfeiffer, the Semantic Verbal Fluency (FVS) and, whenever possible, the Informer Test (TIN) will be used as screening tests. Cognitive impairment is defined by MIS ≤4; SPMSQ ≥ 3 (for illiterates ≥ 4); FVS ≤10 words. The value of TIN> 57. In turn, a sample of the patient’s saliva, for genetic study, and nutrition data are collected through a survey to assess the importance of the Mediterranean diet and antioxidant foods in CI prevention.