2. Universidad Cardenal Herrera-CEU

Subjective memory complaints (SMCs) may be important markers in the prediction of cognitive deterioration. The aim of this study was to find associations between individual lifestyle factors, which may contribute to cognitive impairment (CI) in people with SMCs and to conduct a literature review on the relationship between internet use and CI in subjects over 50 years old, as a related factor. This was a case-controlled study that included 497 subjects aged over 50 years with SMCs who were recruited from 19 community pharmacies. Three screening tests were used to detect possible CIs, and individuals with at least one test result compatible with a CI were referred to primary care for evaluation. Having self-referred SMC increased the odds of obtaining scores compatible with CI and this factor was significantly related to having feelings of depression (OR = 2.24, 95% CI [1.34, 3.90]), taking anxiolytics or antidepressants (OR = 1.93, 95% CI [1.23, 3.05]), and being female (OR = 1.83, 95% CI [1.15, 2.88]). Thirty percent of our sample obtained scores compatible with CI. Age over 70 years increased the odds of obtaining scores compatible with CI. A high-level education, reading, and daily internet use were factors associated with a reduced risk of positive scores compatible with CI (37–91%, 7–18%, and 67–86%, respectively), while one extra hour television per day increased the risk by 8–30%. Among others, modifiable lifestyle factors such as reading, and daily internet usage may slow down cognitive decline in patients over 50 with SMCs. Four longitudinal studies and one quasi-experimental study found internet use to be beneficial against CI in patients over 50 years of age.

The increased pressure on primary care makes it important for other health care providers, such as community pharmacists, to collaborate with general practitioners in activities related to chronic disease care. Therefore, the objective of the present project was to develop a protocol of action that allows close pharmacist-physician collaboration to carry out a coordinated action for very early detection of cognitive impairment (CI). Methods: A comparative study to promote early detection of CI was conducted in 19 community pharmacies divided into two groups: one group with interprofessional collaboration (IPC) and one group without interprofessional collaboration (NonIPC). IPC was defined as an interactive procedure involving all pharmacists, general practitioners and neurologists. A total of 281 subjects with subjective memory complaints were recruited. Three tests were used in the community pharmacies to detect possible CI: Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Individuals with at least one positive cognitive test compatible with CI, were referred to primary care, and when appropriate, to the neurology service. Finally, we evaluated the differences in clinical and diagnostic follow-up in both groups after six months. Results: The NonIPC study group included 38 subjects compatible with CI referred to primary care (27.54%). Ten were further referred to a neurology department (7.25%) and four of them (2.90%) obtained a confirmed clinical diagnosis of CI. In contrast, in the IPC group, 46 subjects (32.17%) showed results compatible with CI and were referred to primary care. Of these, 21 (14.68%) were subsequently referred to a neurology service, while the remaining 25 were followed up by primary care. Nineteen individuals out of those referred to a neurology service obtained a confirmed clinical diagnosis of CI (13.29%). The percentage of subjects in the NonIPC group referred to neurology and the percentage of subjects diagnosed with CI, was significantly lower in comparison to the IPC group (p-value 0.0233; p-value 0.0007, respectively). Conclusions: The creation of IPC teams involving community pharmacists, general practitioners, and neurologists allow for increased detection of patients with CI or undiagnosed dementia and facilitates their clinical follow-up. This opens the possibility of diagnosis in patients in the very early stages of dementia, which can have positive implications to improve the prognosis and delay the evolution of the disease.

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.