Introduction Antipsychotic medications are widely prescribed to manage neuropsychiatric symptoms (NPS) of dementia. NPS produce a negative impact on the caregiver and represent a cause of institutionalization. The benefit of antipsychotics is controversial and should be the last treatment option. Objective To detect potential predictors of antipsychotic drug (risperidone, quetiapine, olanzapine, clozapine, haloperidol) use in patients with mild cognitive impairment and mild dementia. Methods Data was collected as part of the prospective study of home‐dwelling people with cognitive impairment and their caregivers. The associations between antipsychotic medication use and cognitive‐clinical measures were analyzed using a multivariate binomial generalized linear model. Results 228 patients were evaluated at baseline. MCI and dementia were diagnosed in 125 and 30 subjects respectively. After a median (25th to 75th percentile range) of 4.5 (4.1‐4.9) years 21 patients died. Antipsychotics were prescribed in 46 cases (16 with dementia and 30 with MCI). In the multivariate model, baseline Boston naming test (OR: 0.93, 95% confidence interval: 0.89‐0.98, p=0.004) and instrumental activities of the daily living score (OR: 0.65, 95% confidence interval: 0.47‐0.90, p=0.009) were independently related to antipsychotic use (table). Conclusion Within 4 years of follow‐up, thirty percent of the patients with cognitive impairment received antipsychotic drugs. Baseline instrumental activity of the daily living and Boston naming test were identified as independent predictors.

Background: Early detection of dementia is currently of great interest and of crucial importance for the implementation of preventive measures and treatment of the disease. Impairment in verbal episodic memory, and in particular in a delayed recall phase, is considered one of the early markers of progression from mild cognitive impairment (MCI) to dementia. Therefore, having cognitive screening instruments with predictive value for progression is of utmost importance. Objective: The purpose of this work is to show the predictive value, sensitivity and specificity of the Memory Impairment Screen with delayed recall (MIS-DR) to predict conversion to dementia in patients with MCI. Methods: In retrospective study 502 patients over 60 years old, evaluated in the Older Adult Functional Evaluation Unit of our hospital for cognitive complaint, were diagnosed with MCI. They were followed up to assess conversion to dementia. Results: During follow up, 144 participants developed dementia (28.6%, 95% CI 24.76-32.85) and the average time of progression to dementia were 23 months (SD 13.2). The cutoff point was established below 6 for MIS-DR and it showed a sensitivity of 76% (95% CI 68.77-77.84) and a specificity of 56% (95% CI 50.44-61.58), with a positive predictive value of 41% (95% CI 34.78-47.6) and a negative predictive value of 85% (95% CI 80.53-91.11) for predicting progression to dementia. Of those patients who obtained a MIS-DR score below 6, 41% developed dementia, in contrast to 14.53% of those with a score above or equal to 6, OR 4.09 (95% CI 2.64-6.34), p < 0.00001. There were no significant differences in terms of gender, education level or vascular risk factors among patients who converted and those who did not convert to dementia. Conclusion: We believe that MIS-DR is a useful and valid test to detect episodic memory impairment and to identify patients at risk of progression to dementia.

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La queja cognitiva es un motivo de consulta frecuente en la atención primaria de los adultos mayores y puede ser la primera manifestación de deterioro cognitivo por lo que su evaluación y seguimiento son fundamentales para un diagnóstico temprano. Objetivo: describir el perfil neurocognitivo basal y la evolución de pacientes con queja cognitiva evaluados en la unidad de evaluación funcional del adulto mayor del Hospital Italiano de Buenos Aires. Método: estudio observacional de cohorte retrospectiva de 518 pacientes con queja cognitiva a quienes se les administró una evaluación geriátrica integral y escalas de rastreo de deterioro cognitivo en la primera consulta y en consultas de seguimiento. Se excluyeron los participantes con diagnóstico de demencia en la evaluación inicial. Resultados: en la evaluación inicial 323 (62,36%) sujetos tuvieron diagnóstico de deterioro cognitivo leve y 195 (37,64%) no presentaron deterioro cognitivo. Del total de los pacientes, 216 (41,7%) empeoraron su estatus cognitivo inicial. Presentaron mayor edad en la evaluación basal, menor nivel de educación y peor rendimiento en Mini Mental State Examination, escalas de memoria, funciones ejecutivas y lenguaje que aquellos que se mantuvieron estables. Conclusión: En el estudio de seguimiento de esta cohorte con queja cognitiva, se verifica el impacto de la edad, el nivel de instrucción y un bajo rendimiento en los dominios de memoria, función ejecutiva y lenguaje como variables asociadas a la progresión del deterioro cognitivo.

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