No abstract

Background: Dementia has become a healthcare priority. As no disease-modifying treatment is available, treatment is aimed to act through prevention. Frailty have been defined as a geriatric multidimensional syndrome. Being a treatable condition, interest has raised to describe the relationship between Dementia and Frailty. This study describes frailty in the Autosomal Dominant Alzheimer Disease, through the largest ADAD known group.Method: A total of 75 participants (14 with MCI and 61 with Dementia) were included in this cross sectional study. They underwent a complete assessment that included a standardized clinical examination, neuropsychological evaluation and functional scales. Frailty was assessed through the Short Physical Performance Battery (SPPB) and the Time up and Go Test (TUG) . Multivariate analyses was conducted to evaluate which variables were associated with being frail in presenile onset of ADAD.Result: In the 75 patients who underwent the study, median age was of 49 years old with a cognitive profile of 18.67 % individuals with MCI, 21 % with Mild, 28 % with Moderate and 25 % Severe Dementia. According to the frailty phenotype: 60 % were non-frail and 40 % frail. When analyzing, SPPB and TUG components: Median Gait Speed in MCI and mild dementia groups were statistically significantly lower than moderate and severe dementia (p< 0.005) and significantly greater TUG was found in moderate and severe dementia groups when compared with MCI and mild dementia(p<0.005) Both, clinical severity grouped in moderate -severe dementia (OR 6.85; CI 2.07-22.65 p< 0.000) and hypertension (OR 5.80;) are significantly associated with being frail. Conclusion:This study is the first description of frailty syndrome in ADAD with a presenile onset. The prevalence found in this population is similar than in previous reports in older adults and thus reasserts the adaptability of frailty evaluation in young patients

El objetivo de esta nota es presentar la contribución de Paul Krugman a la teoría económica. Se muestra el aporte y la influencia que tienen sus artículos de 1979 y 1991 en la renovación de la teoría del comercio y la aparición de la nueva geografía económica. En especial, se muestra que Krugman crea un marco teórico que permite explicar fenómenos como el comercio intraindustrial, el comercio entre los países desarrollados y los procesos de aglomeración, bajo escenarios de competencia monopolística y de rendimientos crecientes a escala. El interés de la contribución de Krugman estriba en que estos fenómenos no habían podido ser explicados satisfactoriamente por el modelo neoclásico estándar. Palabras clave: Rendimientos crecientes, competencia monopolística, Paul Krugman, nueva teoría del comercio, nueva geografía económica. Clasificación JEL: B30, F10, F12, R10 Abstract:  The purpose of this paper is to present the major contributions of Paul Krugman to economic theory. It shows the contribution and influence that articles of 1979 and 1991 have exerted on the renewal of trade theory and the emergence of new economic geography. In these articles, Krugman successfully explains intraindustry trade, trade among developed countries and agglomeration processes, all these phenomena of great importance that had not been satisfactorily explained from the point of view of standard neoclassical models. To do so, he uses a theoretical framework that incorporates monopolistic competition and increasing returns to scale. Keywords: Increasing returns, monopolistic competition, Paul Krugman, new trade theory, new economic geography. JEL Classification: B30, F10, F12, R10 Résumé:  Cet article présente la contribution de Paul Krugman à la théorie économique. Nous montrons l.influence et la portée des articles parus 1979 et 1991 dans le renouvellement de la théorie du commerce et l'apparition de la nouvelle géographie économique. Plus précisément, on montre que Krugman établi un cadre théorique qui permet d'expliquer les phénomènes du commerce intra-industriel, du commerce entre les pays développés et les processus d'agglomération, en adoptant l.hypothèse de concurrence monopolistique et de rendements d'échelle croissants. C.est ainsi que les modèles de Krugman expliquent certains phénomènes qui n'avaient pas pu être expliqués de manière satisfaisante par la théorie néoclassique traditionnelle. Mots Clef: Rendements croissants, concurrence monopolistique, Paul Krugman, nouvelle théorie du commerce, nouvelle géographie économique. Classification JEL: B30, F10, F12, R10.

Background: Weight loss and malnutrition are frequent findings in late-onset and sporadic presentations of Alzheimer’s Disease (AD). However, less is known about nutritional status in Early-Onset Autosomal Dominant AD (EO-ADAD). Objective: To analyze the association between nutritional status and other clinical and sociodemographic characteristics in individuals with a genetic form of EO-ADAD. Design, settings, and participants: Cross-sectional study with 75 non-institutionalized participants from a cohort of Autosomal Dominant AD (13 with mild cognitive impairment and 61 with dementia, ages from 38 to 67 years) underwent a structured clinical assessment with emphasis on nutritional status. Measurements: Primary outcome was nutritional status and it was measured using the Mini Nutritional Assessment (MNA). Patients were categorized according to MNA total score, as undernourished (MNA ≤23.5) and well-nourished (MNA ≥ 24). Sociodemographic and clinical variables identified as potential predictors or confounders of nutritional status were also collected. Results: Undernourishment by MNA was present in 57.3% of the sample. Forty-two percent of participants had abnormal BMI values considered lower than 18.5 or higher than 24.9 kg/m2. Total BMI values were similar in well and undernourished patients (median 24.2 IQR 3.59 and median 23.9 IQR 4.42, respectively, p=0.476). When comparing well and undernourished groups, we found statistically significant differences for variables: severity of dementia (p=0.034), frailty (p=0.001), multimorbidity (p=0.035) and, polymedication (p=0.045). Neither adjusted logistic regression nor the Poisson regression showed that any clinical or sociodemographic variables explained undernourishment. Conclusions: Undernourishment was a frequent finding in our sample of EO-ADAD, especially in later stages of the disease. Patients with polymedication, multimorbidity, frailty and severe dementia show differences in their nutritional status with a tendency to be more frequently undernourished. Further studies with larger sample sizes are needed to establish this association.