Factors associated with mixed dementia vs Alzheimer disease in elderly Mexican adults

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Moreno Cervantes, A. Mimenza Alvarado, S. Aguilar Navarro, P. Alvarado Ávila, L. Gutiérrez Gutiérrez, S. Juárez Arellano, J.A. Ávila Funes" "autores" => array:7 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Moreno Cervantes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "A." "apellidos" => "Mimenza Alvarado" "email" => array:1 [ 0 => "a.mimenza@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Aguilar Navarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Alvarado Ávila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "L." 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"apellidos" => "Ávila Funes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores asociados a la demencia mixta en comparación con demencia tipo Alzheimer en adultos mayores mexicanos" ] ] "textoCompleto" => "IntroductionAlzheimer disease (AD) is the world's leading cause of dementia, accounting for 50% to 56% of all cases. AD combined with cerebrovascular disease (CVD) has been called mixed dementia (MD) and has both cortical and subcortical components; it represents 13% to 17% of all dementia cases worldwide.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Both AD and vascular cognitive impairment are directly associated with age.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>According to a review article of epidemiological studies, the estimated prevalence of MD is between 20% and 40%.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> In a study analysing the autopsies of a series of patients with dementia, 38% of the patients with AD displayed lacunar infarcts.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Co-presence of other diseases in elderly patients plays a major role in the pathogenesis of dementia, and this implies that there will be fewer cases of ‘pure’ forms of dementia in the future. Some studies have shown that degeneration combined with cardiovascular risk factors constitutes the most frequent cause of cognitive impairment in the elderly.<a class="elsevierStyleCrossRefs" href="#bib0010">2,5</a>Other researchers have used the term MD to refer to combinations of at least 2 types of dementia (AD, vascular dementia, Lewy body dementia, frontotemporal lobar degeneration, etc.). According to the most widely accepted definition, MD combines histopathologically confirmed features of AD (senile plaques due to amyloid beta deposition) and cerebrovascular lesions of ischaemic and/or haemorrhagic origin. However, diagnosing this entity and distinguishing it from other conditions remains controversial.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>From a clinical viewpoint, loss of memory (especially episodic and semantic) is considered a typical feature of AD, whereas executive dysfunction has traditionally been associated with vascular cognitive impairment. For this reason, a joint statement by the American Heart Association and the American Stroke Association recommends performing a complete neuropsychological assessment with specific tests of different cognitive domains to determine which cognitive functions are impaired and identify the type of dementia.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> However, the cognitive profile of MD has not been precisely defined. In addition, the literature on MD remains limited; no consensus documents or diagnostic criteria have been published to date. The purpose of our study was to identify clinical and imaging factors associated with DM that may help differentiate this condition from AD.MethodsThis retrospective study was conducted between January 2010 and September 2014. We gathered data from a memory clinic in a tertiary referral hospital in Mexico City which provides care to patients referred by other specialists due to memory problems. We included all patients diagnosed with either AD or MD. Probable AD was diagnosed by a neurologist and/or a geriatrician based on the NINCDS-ADRDA criteria.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> MD was diagnosed when patients met criteria for possible AD<a class="elsevierStyleCrossRef" href="#bib0040">8</a> with imaging studies pointing to vascular disease (small or large vessel disease) and evidence of both cortical and subcortical dysfunction on neuropsychological tests. The neuropsychologist assessing patients’ cognitive profiles was an expert in diagnosing both conditions.We excluded patients with other types of dementia, those whose assessment was incomplete, patients with depression or other psychiatric disorders, and those with uncompensated metabolic disorders.Neuropsychological function was assessed on the Mini-Mental State Examination (MMSE),<a class="elsevierStyleCrossRef" href="#bib0045">9</a> the clock-drawing test,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> semantic fluency test (temporal lobe function), and phonemic fluency test (frontal lobe function). We also evaluated the number of intrusion and perseveration errors. Patients also completed the 5-word test, an evaluation of verbal episodic memory based on free and cued recall of a list of 5 words and intended to identify alterations in any of the phases of episodic memory (encoding, storage, and retrieval),<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> as well as the Frontal Assessment Battery.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Function was assessed on the Katz index of independence in activities of daily living<a class="elsevierStyleCrossRef" href="#bib0070">14</a> (feeding, dressing, continence, toileting, bathing, transferring) and the Lawton instrumental activities of daily living scale<a class="elsevierStyleCrossRef" href="#bib0075">15</a> (ability to handle finances, shopping, mode of transportation, laundry, food preparation, housekeeping, ability to use telephone, and responsibility for own medications). Inability to perform at least one basic daily living activity and/or one instrumental activity due to cognitive impairment supported the diagnosis of dementia. Sociodemographic characteristics and risk factors were obtained from medical records. We included the following data to describe our sample: sex; age; level of education and total years of schooling; presence/absence of arterial hypertension (AHT), diabetes mellitus, dyslipidaemia, CVD, and heart disease; and history of depression and alcohol or tobacco use documented and/or diagnosed by a geriatrician. We also gathered data on serum levels of vitamin B12 and folic acid, using reference values from the laboratory corresponding to the centre where analyses were conducted to establish an abnormal cut-off point.An independent neurologist viewed the patients’ brain CT and/or 1.5T MR images and used standard neuroimaging terminology for small and large vessel disease to define imaging features (atrophy, leukoencephalopathy, lacunar infarcts, CVD, etc.).<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Statistical analysisClinical and imaging differences in our sample were analysed with parametric and non-parametric descriptive statistics. We used the chi-square test for categorical variables and the t test or Mann–Whitney U test for continuous variables. Univariate and multivariate logistic regression models were subsequently applied to identify factors associated with MD; patients diagnosed with AD constituted the reference group. Significance was set at P<.05. Statistical analysis was performed with SPSS version 20.0 for Windows (SPSS Inc., Chicago, IL). Our study was approved by the ethics committee at our centre.ResultsWe included 225 patients: 88 with AD (39%) and 137 with MD (61%). The mean age of our sample was 82.9±6.83 years. Women accounted for 52% of the total. Mean years of schooling were 9.5±6.33.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> compares sociodemographic, health-related, imaging, and cognitive characteristics in our sample. Patients with MD were older than those with AD (P=.033) and showed higher frequencies of diabetes mellitus (48%; P=.017), AHT (69%; P=.022), dyslipidaemia (68%; P=.022), vitamin B12 deficiency (9%; P=.016), and history of CVD (25%; P=.015). In contrast, patients in this group were less likely to have a family history of dementia (9%; P=.017) or history of depression (11%; P=.035).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Regarding neuroimaging findings, patients with MD showed more signs of ischaemic stroke (P=.079) and of white matter disease (P<.001).According to neurocognitive test results, patients with MD tended to make more perseveration errors than those with AD (3.2 vs 1.86; P=.007).No significant intergroup differences were found regarding sociodemographic characteristics and other risk factors (sex, level of education, marital status, history of tobacco or alcohol dependency, history of cardiovascular disease).The following factors were found to be associated with MD in the univariate analysis: vitamin B12 deficiency (OR 8.7; 95% CI, 1.08-70.12; P=.016), white matter disease (OR 4.56; 95% CI, 2.38-8.74; P<.001), history of CVD (OR 2.63; 95% CI, 1.18-5.86; P=.015), diabetes mellitus (OR 2.05; 95% CI, 1.13-3.74; P=.017), AHT (OR 2.00; 95% CI, 1.10-3.65; P=.022), and dyslipidaemia (OR 2.00; 95% CI, 1.10-3.63; P=.022) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Depression was inversely correlated with MD (OR 0.37; 95% CI, 0.15-0.94; P=.035).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> displays the multivariate logistic regression analysis in which AHT (OR 1.92; 95% CI, 1.62-28.82; P=.009), white matter disease on MRI (OR 3.61; 95% CI, 8.55-159.80; P<.001), and lacunar infarction on MRI (OR 3.35; 95% CI, 1.97-412.34; P=.014) continued to be associated with MD. History of depression was inversely correlated with MD, that is, patients with a history of resolved depression were less likely to present MD (OR 0.11; 95% CI, 0.02-0.47; P=.004).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionMD was the most frequent form of dementia in our sample (60%), with patients with AD accounting for 40% of the total. Our results are in line with the literature; according to published autopsy studies, prevalence of MD ranges from 2% to 58% and is more frequent in the elderly (mainly patients over 80).<a class="elsevierStyleCrossRef" href="#bib0030">6</a> The Honolulu-Asia Ageing Study,<a class="elsevierStyleCrossRef" href="#bib0025">5</a> which included results from 363 autopsies, found a weak correlation between clinical and neuropathological diagnoses of dementia. Although 56% of the patients had been diagnosed with possible or probable AD, only 19% showed compatible autopsy findings. In contrast, the number of patients diagnosed with MD in life increased considerably after autopsies (16% vs 40%).Mean age in our study was 82.95 years; elderly patients are obviously more likely to experience multiple diseases that may promote dementia. According to our analysis, patients with MD were older, and the difference was statistically significant. In a study by James et al.,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> DM was more frequent in individuals older than 90 whereas AD was more prevalent in younger individuals. These researchers hypothesised that clinical expression of AD is attenuated in advanced age due to the presence of multiple disorders, especially cardiovascular diseases. Our study found an association between MD and vascular risk factors, which suggests that vascular factors may be involved in the pathogenesis of cognitive impairment. Diabetes mellitus, AHT, dyslipidaemia, and history of CVD were more frequent among patients with MD; out of all risk factors, AHT displayed the strongest association. Unverzagt et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> conducted a prospective study including over 23000 patients to analyse the association between cardiovascular risk factors and cognitive impairment; here, only elevated systolic blood pressure was found to be correlated with cognitive impairment. Shah et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> demonstrated the association between history of AHT in adulthood and plasma amyloid beta concentrations; in this study, high blood pressure was found to be correlated with low plasma levels of Aβ42 and findings of cerebral amyloid angiopathy in postmortem studies. Jellinger et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> performed over 1100 autopsies of patients with dementia and such chronic diseases or vascular risk factors as CVD, heart failure, arthritis, diabetes mellitus, thyroid disease, AHT, and dyslipidaemia. These researchers observed an association between vascular risk factors and amyloid-β pathology, neurofibrillary pathology, cerebral small-vessel disease, cerebral amyloid angiopathy, and even α-synuclein deposition, especially in very elderly patients.Interestingly, our study found an association between MD and history of vitamin B12 deficiency in the univariate analysis. Neurological disorders associated with vitamin B12 deficiency tend to affect patients aged 40 to 90; incidence peaks between ages 60 and 70.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Diabetes mellitus has been reported as a cause of functional B12 deficiency in elderly diabetic patients<a class="elsevierStyleCrossRef" href="#bib0110">22</a> as in treatment with metformin.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Age is another risk factor for vitamin B12 deficiency.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> Advanced age and the high incidence of diabetes mellitus in our sample of patients with MD (48%) may explain these results. Further longitudinal studies should be conducted to confirm the association between vitamin B12 deficiency, AD, and MD.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>History of late-onset or refractory depression constitutes a risk factor for dementia. Taylor et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> have described an association between depression and cognitive impairment. According to these researchers, this association is stronger in the elderly due to the presence of multiple cardiovascular risk factors, leading to what is known as vascular depression. Vascular depression is more frequent among elderly patients and more long-lasting than non-vascular depression. It is characterised by poor response to pharmacological treatment, greater risk of recurrence, and cognitive impairment, especially executive dysfunction. CVD is believed to promote or trigger symptoms of depression. Our study supports this hypothesis: according to our results, a history of resolved depression seemed to protect against MD.<a class="elsevierStyleCrossRef" href="#bib0130">26</a>Furthermore, patients with MD made a greater number of perseveration errors on neuropsychological tests. Semantic and phonemic verbal fluency primarily reflect memory and executive function. Semantic fluency, also called category fluency, evaluates temporal lobe function, whereas phonemic fluency assesses both frontal and temporal lobe function, given that patients must refrain from using certain words (proper names, numbers, etc.), a task also involving working memory. Although both semantic and phonemic fluency are impaired in AD, the latter is considerably more impaired in these patients.<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> Intrusion errors are normally associated with semantic and memory impairment and therefore help assess temporal lobe function. Perseveration errors, in contrast, are typically associated with problems with self-monitoring, working memory, and executive function (frontal and subcortical circuits).<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a> Patients in our study made both types of errors, although perseveration errors were considerably more frequent among patients with MD. This may indicate that cognitive impairment in these patients arises from multiple aetiologies.Imaging findings were clearly different between groups: patients with MD displayed small and large vessel disease (especially lacunar infarcts). Brain MRI evidence of white matter lesions was 3 times more frequent in patients with MD than in those with AD. White matter disease, appearing as hyperintensities in T2-weighted and FLAIR MRI sequences, has been linked to cognitive impairment and depression. Likewise, it is more frequent in patients with such other conditions as diabetes mellitus, AHT, atherosclerosis, and tobacco use, but it also appears in elderly individuals with no comorbidities.<a class="elsevierStyleCrossRef" href="#bib0155">31</a>Our study has several limitations. Firstly, the study population was drawn from a tertiary referral hospital and presented multiple comorbidities, which may explain the high number of cases with MD. Furthermore, the sample size was small and did not use validated Spanish-language neuropsychological tests; likewise, histology studies and biomarkers might have provided valuable additional data. Its cross-sectional design limits our ability to establish casual associations between risk factors and dementia.However, our study also has several strengths. In contrast with other types of dementia, MD has only been addressed by a few studies. To our knowledge no other studies of this entity have been conducted in the Mexican population. Anticipating more detailed future studies, our findings provide preliminary data on the characteristics of MD and the role of potentially modifiable risk factors.ConclusionsMixed dementia is a frequent cause of cognitive impairment. Increased life expectancy and presence of comorbidities in elderly individuals pose major challenges for healthcare systems worldwide. Populations with a higher degree of cardiovascular risk are more likely to include cognitive impairment profiles with a mixed aetiology. This is relevant in that correctly identifying these potentially modifiable risk factors may result in multiple approaches to treating MD. Future studies should aim to define the concept and clinical characteristics of MD and establish the most appropriate diagnostic tools and protocols.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres844905" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec839838" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres844906" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec839839" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-03" "fechaAceptado" => "2015-12-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec839838" "palabras" => array:5 [ 0 => "Mixed dementia" 1 => "Alzheimer disease" 2 => "Diabetes" 3 => "Hypertension" 4 => "Depression" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec839839" "palabras" => array:5 [ 0 => "Demencia mixta" 1 => "Enfermedad de Alzheimer" 2 => "Diabetes" 3 => "Hipertensión" 4 => "Depresión" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionMixed dementia (DMix) refers to dementia resulting from Alzheimer disease in addition to cerebrovascular disease. The study objectives were to determine the clinical and imaging factors associated with Dmix and compare them to those associated with Alzheimer disease. Material and methodsCross-sectional study including 225 subjects aged 65 years and over from a memory clinic in a tertiary hospital in Mexico City. All patients underwent clinical, neuropsychological, and brain imaging studies. We included patients diagnosed with DMix or Alzheimer disease (AD). A multivariate analysis was used to determine factors associated with DMix. ResultsWe studied 137 subjects diagnosed with Dmix. Compared to patients with AD, Dmix patients were older and more likely to present diabetes, hypertension, dyslipidaemia, and history of cerebrovascular disease (P<.05). The multivariate analysis showed that hypertension (OR 1.92, CI 1.62-28.82; P=.009), white matter disease (OR 3.61, CI 8.55-159.80; P<.001), and lacunar infarcts (OR 3.35, CI 1.97-412.34; P=.014) were associated with Dmix, whereas a history of successfully treated depression showed an inverse association (OR 0.11, CI 0.02-0.47; P=0.004) ConclusionsDMix may be more frequent than AD. Risk factors such as advanced age and other potentially modifiable factors were associated with this type of dementia. Clinicians should understand and be able to define Dmix." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl concepto de demencia mixta (DMix) se refiere a la demencia por enfermedad de Alzheimer (EA) y la presencia de enfermedad vascular cerebral (EVC). El objetivo del estudio fue identificar los factores clínicos e imagenológicos asociados a la DMix en comparación con la enfermedad de Alzheimer. Material y métodosEstudio transversal que incluyó a 225 sujetos de 65 años y más, en la clínica de memoria de un hospital de tercer nivel de la Ciudad de México. A todos los pacientes se les realizó una evaluación clínica, neuropsicológica y una imagen cerebral. Se incluyó a pacientes con diagnóstico de DMix y EA. Se realizó un análisis multivariado para determinar factores de asociación a la DMix. ResultadosSe estudió a 137 sujetos con DMix. En comparación con los pacientes con EA, en los pacientes con DMix los factores asociados fueron mayor edad, diabetes, hipertensión y dislipidemia, así como antecedente de EVC, p<0,05. El análisis multivariado mostró que la hipertensión (OR 1,92, IC: 1,.62-28.82, p<0,05), la enfermedad de sustancia blanca (OR 3,61, IC: 8,55-159,80, p<0,05) e infartos lacunares (OR 3,35, IC: 1,97-412,34, p<0,05) estuvieron asociados a la DMix, mientras que la historia de depresión resuelta tuvo una asociación inversa (OR 0,11, IC: 0,02-0,47, p<0,05). ConclusionesLa DMix podría ser más frecuente que la EA. Factores de riesgo como la edad avanzada y otros potencialmente modificables se relacionaron con esta forma de demencia. Es necesario conocer y definir a la DMix." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Moreno Cervantes C, Mimenza Alvarado A, Aguilar Navarro S, Alvarado Ávila P, Gutiérrez Gutiérrez L, Juárez Arellano S, et al. Factores asociados a la demencia mixta en comparación con demencia tipo Alzheimer en adultos mayores mexicanos. Neurología. 2017;32:309–315." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AD: Alzheimer disease; CVD: cerebrovascular disease; SD: standard deviation; MD: mixed dementia; AHT: arterial hypertension; MRI: magnetic resonance imaging; CT: computed tomography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="table-head " align="left" valign="top" scope="col">AD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">MD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=88 (39%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n=137 (61%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Sociodemographic data and medical history</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81.82±7.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.94±6.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Years of schooling, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.39±6.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.77±5.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.081 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Family history of dementia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (21.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (8.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Katz index score, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.29±1.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.32±1.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.835 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lawton IADL scale score, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.77±2.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.26±2.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.213 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GDS score, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.06±2.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.84±3.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.155 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resolved depression, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (18.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (10.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (31.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66 (48.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHT, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (53.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95 (69.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidaemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46 (52.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 (67.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (38.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 (43.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.421 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol use, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.385 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 (27.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (29.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.564 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin B12 deficiency, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (8.76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of CVD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 (24.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Perseveration errors, mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.86±1.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.20±3.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Imaging findings</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischaemia on CT, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (1.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (5.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White matter disease on MRI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 (20.45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74 (54.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lacunar infarct on MRI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (11.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.358 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute CVD on MRI, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (4.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1426948.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic, health-related, psychometric, and imaging characteristics of our sample." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AD: Alzheimer disease; CVD: cerebrovascular disease; SD: standard deviation; MD: mixed dementia; AHT: arterial hypertension; MRI: magnetic resonance imaging; CT: computed tomography." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.13-3.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10-3.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10-3.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resolved depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15-0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.035 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin B12 deficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.08-70.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of CVD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.18-5.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischaemia on CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65-47.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White matter disease on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.38-8.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lacunar infarct on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.59-4.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.358 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute CVD on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.45-0.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1426952.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Factors associated with MD. Univariate analysis." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "CVD: cerebrovascular disease; AHT: arterial hypertension; CI: confidence interval; MRI: magnetic resonance imaging; OR: odds ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.62-28.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resolved depression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02-0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White matter disease on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.55-159.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lacunar infarct on MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.97-412.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1426953.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Logistic regression analysis." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alzheimer's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.W. 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Factores asociados a la demencia mixta en comparación con demencia tipo Alzheimer en adultos mayores mexicanos

C. Moreno Cervantesa, A. Mimenza Alvaradob,

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a.mimenza@hotmail.com

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, S. Aguilar Navarroa, P. Alvarado Ávilaa, L. Gutiérrez Gutiérrezc, S. Juárez Arellanoc, J.A. Ávila Funesa

a Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico

b Servicio de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico

c Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F., Mexico

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the cognitive profile of MD has not been precisely defined&#46; In addition&#44; the literature on MD remains limited&#59; no consensus documents or diagnostic criteria have been published to date&#46; The purpose of our study was to identify clinical and imaging factors associated with DM that may help differentiate this condition from AD&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This retrospective study was conducted between January 2010 and September 2014&#46; We gathered data from a memory clinic in a tertiary referral hospital in Mexico City which provides care to patients referred by other specialists due to memory problems&#46; We included all patients diagnosed with either AD or MD&#46; Probable AD was diagnosed by a neurologist and&#47;or a geriatrician based on the NINCDS-ADRDA criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> MD was diagnosed when patients met criteria for possible AD<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with imaging studies pointing to vascular disease &#40;small or large vessel disease&#41; and evidence of both cortical and subcortical dysfunction on neuropsychological tests&#46; The neuropsychologist assessing patients&#8217; cognitive profiles was an expert in diagnosing both conditions&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We excluded patients with other types of dementia&#44; those whose assessment was incomplete&#44; patients with depression or other psychiatric disorders&#44; and those with uncompensated metabolic disorders&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Neuropsychological function was assessed on the Mini-Mental State Examination &#40;MMSE&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the clock-drawing test&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> semantic fluency test &#40;temporal lobe function&#41;&#44; and phonemic fluency test &#40;frontal lobe function&#41;&#46; We also evaluated the number of intrusion and perseveration errors&#46; Patients also completed the 5-word test&#44; an evaluation of verbal episodic memory based on free and cued recall of a list of 5 words and intended to identify alterations in any of the phases of episodic memory &#40;encoding&#44; storage&#44; and retrieval&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> as well as the Frontal Assessment Battery&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Function was assessed on the Katz index of independence in activities of daily living<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> &#40;feeding&#44; dressing&#44; continence&#44; toileting&#44; bathing&#44; transferring&#41; and the Lawton instrumental activities of daily living scale<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> &#40;ability to handle finances&#44; shopping&#44; mode of transportation&#44; laundry&#44; food preparation&#44; housekeeping&#44; ability to use telephone&#44; and responsibility for own medications&#41;&#46; Inability to perform at least one basic daily living activity and&#47;or one instrumental activity due to cognitive impairment supported the diagnosis of dementia&#46; Sociodemographic characteristics and risk factors were obtained from medical records&#46; We included the following data to describe our sample&#58; sex&#59; age&#59; level of education and total years of schooling&#59; presence&#47;absence of arterial hypertension &#40;AHT&#41;&#44; diabetes mellitus&#44; dyslipidaemia&#44; CVD&#44; and heart disease&#59; and history of depression and alcohol or tobacco use documented and&#47;or diagnosed by a geriatrician&#46; We also gathered data on serum levels of vitamin B<span class="elsevierStyleInf">12</span> and folic acid&#44; using reference values from the laboratory corresponding to the centre where analyses were conducted to establish an abnormal cut-off point&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">An independent neurologist viewed the patients&#8217; brain CT and&#47;or 1&#46;5<span class="elsevierStyleHsp" style=""></span>T MR images and used standard neuroimaging terminology for small and large vessel disease to define imaging features &#40;atrophy&#44; leukoencephalopathy&#44; lacunar infarcts&#44; CVD&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical and imaging differences in our sample were analysed with parametric and non-parametric descriptive statistics&#46; We used the chi-square test for categorical variables and the <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for continuous variables&#46; Univariate and multivariate logistic regression models were subsequently applied to identify factors associated with MD&#59; patients diagnosed with AD constituted the reference group&#46; Significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46; Statistical analysis was performed with SPSS version 20&#46;0 for Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#41;&#46; Our study was approved by the ethics committee at our centre&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We included 225 patients&#58; 88 with AD &#40;39&#37;&#41; and 137 with MD &#40;61&#37;&#41;&#46; The mean age of our sample was 82&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;83 years&#46; Women accounted for 52&#37; of the total&#46; Mean years of schooling were 9&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;33&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> compares sociodemographic&#44; health-related&#44; imaging&#44; and cognitive characteristics in our sample&#46; Patients with MD were older than those with AD &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41; and showed higher frequencies of diabetes mellitus &#40;48&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#44; AHT &#40;69&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41;&#44; dyslipidaemia &#40;68&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41;&#44; vitamin B<span class="elsevierStyleInf">12</span> deficiency &#40;9&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41;&#44; and history of CVD &#40;25&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#46; In contrast&#44; patients in this group were less likely to have a family history of dementia &#40;9&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41; or history of depression &#40;11&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Regarding neuroimaging findings&#44; patients with MD showed more signs of ischaemic stroke &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;079&#41; and of white matter disease &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">According to neurocognitive test results&#44; patients with MD tended to make more perseveration errors than those with AD &#40;3&#46;2 vs 1&#46;86&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;007&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No significant intergroup differences were found regarding sociodemographic characteristics and other risk factors &#40;sex&#44; level of education&#44; marital status&#44; history of tobacco or alcohol dependency&#44; history of cardiovascular disease&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The following factors were found to be associated with MD in the univariate analysis&#58; vitamin B<span class="elsevierStyleInf">12</span> deficiency &#40;OR 8&#46;7&#59; 95&#37; CI&#44; 1&#46;08-70&#46;12&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;016&#41;&#44; white matter disease &#40;OR 4&#46;56&#59; 95&#37; CI&#44; 2&#46;38-8&#46;74&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; history of CVD &#40;OR 2&#46;63&#59; 95&#37; CI&#44; 1&#46;18-5&#46;86&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;015&#41;&#44; diabetes mellitus &#40;OR 2&#46;05&#59; 95&#37; CI&#44; 1&#46;13-3&#46;74&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;017&#41;&#44; AHT &#40;OR 2&#46;00&#59; 95&#37; CI&#44; 1&#46;10-3&#46;65&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41;&#44; and dyslipidaemia &#40;OR 2&#46;00&#59; 95&#37; CI&#44; 1&#46;10-3&#46;63&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;022&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Depression was inversely correlated with MD &#40;OR 0&#46;37&#59; 95&#37; CI&#44; 0&#46;15-0&#46;94&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> displays the multivariate logistic regression analysis in which AHT &#40;OR 1&#46;92&#59; 95&#37; CI&#44; 1&#46;62-28&#46;82&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#44; white matter disease on MRI &#40;OR 3&#46;61&#59; 95&#37; CI&#44; 8&#46;55-159&#46;80&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and lacunar infarction on MRI &#40;OR 3&#46;35&#59; 95&#37; CI&#44; 1&#46;97-412&#46;34&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41; continued to be associated with MD&#46; History of depression was inversely correlated with MD&#44; that is&#44; patients with a history of resolved depression were less likely to present MD &#40;OR 0&#46;11&#59; 95&#37; CI&#44; 0&#46;02-0&#46;47&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">MD was the most frequent form of dementia in our sample &#40;60&#37;&#41;&#44; with patients with AD accounting for 40&#37; of the total&#46; Our results are in line with the literature&#59; according to published autopsy studies&#44; prevalence of MD ranges from 2&#37; to 58&#37; and is more frequent in the elderly &#40;mainly patients over 80&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The Honolulu-Asia Ageing Study&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which included results from 363 autopsies&#44; found a weak correlation between clinical and neuropathological diagnoses of dementia&#46; Although 56&#37; of the patients had been diagnosed with possible or probable AD&#44; only 19&#37; showed compatible autopsy findings&#46; In contrast&#44; the number of patients diagnosed with MD in life increased considerably after autopsies &#40;16&#37; vs 40&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Mean age in our study was 82&#46;95 years&#59; elderly patients are obviously more likely to experience multiple diseases that may promote dementia&#46; According to our analysis&#44; patients with MD were older&#44; and the difference was statistically significant&#46; In a study by James et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> DM was more frequent in individuals older than 90 whereas AD was more prevalent in younger individuals&#46; These researchers hypothesised that clinical expression of AD is attenuated in advanced age due to the presence of multiple disorders&#44; especially cardiovascular diseases&#46; Our study found an association between MD and vascular risk factors&#44; which suggests that vascular factors may be involved in the pathogenesis of cognitive impairment&#46; Diabetes mellitus&#44; AHT&#44; dyslipidaemia&#44; and history of CVD were more frequent among patients with MD&#59; out of all risk factors&#44; AHT displayed the strongest association&#46; Unverzagt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> conducted a prospective study including over 23<span class="elsevierStyleHsp" style=""></span>000 patients to analyse the association between cardiovascular risk factors and cognitive impairment&#59; here&#44; only elevated systolic blood pressure was found to be correlated with cognitive impairment&#46; Shah et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> demonstrated the association between history of AHT in adulthood and plasma amyloid beta concentrations&#59; in this study&#44; high blood pressure was found to be correlated with low plasma levels of A&#946;<span class="elsevierStyleInf">42</span> and findings of cerebral amyloid angiopathy in postmortem studies&#46; Jellinger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> performed over 1100 autopsies of patients with dementia and such chronic diseases or vascular risk factors as CVD&#44; heart failure&#44; arthritis&#44; diabetes mellitus&#44; thyroid disease&#44; AHT&#44; and dyslipidaemia&#46; These researchers observed an association between vascular risk factors and amyloid-&#946; pathology&#44; neurofibrillary pathology&#44; cerebral small-vessel disease&#44; cerebral amyloid angiopathy&#44; and even &#945;-synuclein deposition&#44; especially in very elderly patients&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Interestingly&#44; our study found an association between MD and history of vitamin B<span class="elsevierStyleInf">12</span> deficiency in the univariate analysis&#46; Neurological disorders associated with vitamin B<span class="elsevierStyleInf">12</span> deficiency tend to affect patients aged 40 to 90&#59; incidence peaks between ages 60 and 70&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Diabetes mellitus has been reported as a cause of functional B<span class="elsevierStyleInf">12</span> deficiency in elderly diabetic patients<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> as in treatment with metformin&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Age is another risk factor for vitamin B<span class="elsevierStyleInf">12</span> deficiency&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Advanced age and the high incidence of diabetes mellitus in our sample of patients with MD &#40;48&#37;&#41; may explain these results&#46; Further longitudinal studies should be conducted to confirm the association between vitamin B<span class="elsevierStyleInf">12</span> deficiency&#44; AD&#44; and MD&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">History of late-onset or refractory depression constitutes a risk factor for dementia&#46; Taylor et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> have described an association between depression and cognitive impairment&#46; According to these researchers&#44; this association is stronger in the elderly due to the presence of multiple cardiovascular risk factors&#44; leading to what is known as vascular depression&#46; Vascular depression is more frequent among elderly patients and more long-lasting than non-vascular depression&#46; It is characterised by poor response to pharmacological treatment&#44; greater risk of recurrence&#44; and cognitive impairment&#44; especially executive dysfunction&#46; CVD is believed to promote or trigger symptoms of depression&#46; Our study supports this hypothesis&#58; according to our results&#44; a history of resolved depression seemed to protect against MD&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Furthermore&#44; patients with MD made a greater number of perseveration errors on neuropsychological tests&#46; Semantic and phonemic verbal fluency primarily reflect memory and executive function&#46; Semantic fluency&#44; also called category fluency&#44; evaluates temporal lobe function&#44; whereas phonemic fluency assesses both frontal and temporal lobe function&#44; given that patients must refrain from using certain words &#40;proper names&#44; numbers&#44; etc&#46;&#41;&#44; a task also involving working memory&#46; Although both semantic and phonemic fluency are impaired in AD&#44; the latter is considerably more impaired in these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> Intrusion errors are normally associated with semantic and memory impairment and therefore help assess temporal lobe function&#46; Perseveration errors&#44; in contrast&#44; are typically associated with problems with self-monitoring&#44; working memory&#44; and executive function &#40;frontal and subcortical circuits&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> Patients in our study made both types of errors&#44; although perseveration errors were considerably more frequent among patients with MD&#46; This may indicate that cognitive impairment in these patients arises from multiple aetiologies&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Imaging findings were clearly different between groups&#58; patients with MD displayed small and large vessel disease &#40;especially lacunar infarcts&#41;&#46; Brain MRI evidence of white matter lesions was 3 times more frequent in patients with MD than in those with AD&#46; White matter disease&#44; appearing as hyperintensities in T2-weighted and FLAIR MRI sequences&#44; has been linked to cognitive impairment and depression&#46; Likewise&#44; it is more frequent in patients with such other conditions as diabetes mellitus&#44; AHT&#44; atherosclerosis&#44; and tobacco use&#44; but it also appears in elderly individuals with no comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46; Firstly&#44; the study population was drawn from a tertiary referral hospital and presented multiple comorbidities&#44; which may explain the high number of cases with MD&#46; Furthermore&#44; the sample size was small and did not use validated Spanish-language neuropsychological tests&#59; likewise&#44; histology studies and biomarkers might have provided valuable additional data&#46; Its cross-sectional design limits our ability to establish casual associations between risk factors and dementia&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">However&#44; our study also has several strengths&#46; In contrast with other types of dementia&#44; MD has only been addressed by a few studies&#46; To our knowledge no other studies of this entity have been conducted in the Mexican population&#46; Anticipating more detailed future studies&#44; our findings provide preliminary data on the characteristics of MD and the role of potentially modifiable risk factors&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Mixed dementia is a frequent cause of cognitive impairment&#46; Increased life expectancy and presence of comorbidities in elderly individuals pose major challenges for healthcare systems worldwide&#46; Populations with a higher degree of cardiovascular risk are more likely to include cognitive impairment profiles with a mixed aetiology&#46; This is relevant in that correctly identifying these potentially modifiable risk factors may result in multiple approaches to treating MD&#46; Future studies should aim to define the concept and clinical characteristics of MD and establish the most appropriate diagnostic tools and protocols&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mixed dementia &#40;DMix&#41; refers to dementia resulting from Alzheimer disease in addition to cerebrovascular disease&#46; The study objectives were to determine the clinical and imaging factors associated with Dmix and compare them to those associated with Alzheimer disease&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study including 225 subjects aged 65 years and over from a memory clinic in a tertiary hospital in Mexico City&#46; All patients underwent clinical&#44; neuropsychological&#44; and brain imaging studies&#46; We included patients diagnosed with DMix or Alzheimer disease &#40;AD&#41;&#46; A multivariate analysis was used to determine factors associated with DMix&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We studied 137 subjects diagnosed with Dmix&#46; Compared to patients with AD&#44; Dmix patients were older and more likely to present diabetes&#44; hypertension&#44; dyslipidaemia&#44; and history of cerebrovascular disease &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The multivariate analysis showed that hypertension &#40;OR 1&#46;92&#44; CI 1&#46;62-28&#46;82&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#44; white matter disease &#40;OR 3&#46;61&#44; CI 8&#46;55-159&#46;80&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and lacunar infarcts &#40;OR 3&#46;35&#44; CI 1&#46;97-412&#46;34&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;014&#41; were associated with Dmix&#44; whereas a history of successfully treated depression showed an inverse association &#40;OR 0&#46;11&#44; CI 0&#46;02-0&#46;47&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">DMix may be more frequent than AD&#46; Risk factors such as advanced age and other potentially modifiable factors were associated with this type of dementia&#46; Clinicians should understand and be able to define Dmix&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El concepto de demencia mixta &#40;DMix&#41; se refiere a la demencia por enfermedad de Alzheimer &#40;EA&#41; y la presencia de enfermedad vascular cerebral &#40;EVC&#41;&#46; El objetivo del estudio fue identificar los factores cl&#237;nicos e imagenol&#243;gicos asociados a la DMix en comparaci&#243;n con la enfermedad de Alzheimer&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal que incluy&#243; a 225 sujetos de 65 a&#241;os y m&#225;s&#44; en la cl&#237;nica de memoria de un hospital de tercer nivel de la Ciudad de M&#233;xico&#46; A todos los pacientes se les realiz&#243; una evaluaci&#243;n cl&#237;nica&#44; neuropsicol&#243;gica y una imagen cerebral&#46; Se incluy&#243; a pacientes con diagn&#243;stico de DMix y EA&#46; Se realiz&#243; un an&#225;lisis multivariado para determinar factores de asociaci&#243;n a la DMix&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 137 sujetos con DMix&#46; En comparaci&#243;n con los pacientes con EA&#44; en los pacientes con DMix los factores asociados fueron mayor edad&#44; diabetes&#44; hipertensi&#243;n y dislipidemia&#44; as&#237; como antecedente de EVC&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El an&#225;lisis multivariado mostr&#243; que la hipertensi&#243;n &#40;OR 1&#44;92&#44; IC&#58; 1&#44;&#46;62-28&#46;82&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; la enfermedad de sustancia blanca &#40;OR 3&#44;61&#44; IC&#58; 8&#44;55-159&#44;80&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; e infartos lacunares &#40;OR 3&#44;35&#44; IC&#58; 1&#44;97-412&#44;34&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; estuvieron asociados a la DMix&#44; mientras que la historia de depresi&#243;n resuelta tuvo una asociaci&#243;n inversa &#40;OR 0&#44;11&#44; IC&#58; 0&#44;02-0&#44;47&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La DMix podr&#237;a ser m&#225;s frecuente que la EA&#46; Factores de riesgo como la edad avanzada y otros potencialmente modificables se relacionaron con esta forma de demencia&#46; Es necesario conocer y definir a la DMix&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno Cervantes C&#44; Mimenza Alvarado A&#44; Aguilar Navarro S&#44; Alvarado &#193;vila P&#44; Guti&#233;rrez Guti&#233;rrez L&#44; Ju&#225;rez Arellano S&#44; et al&#46; Factores asociados a la demencia mixta en comparaci&#243;n con demencia tipo Alzheimer en adultos mayores mexicanos&#46; Neurolog&#237;a&#46; 2017&#59;32&#58;309&#8211;315&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">AD&#58; Alzheimer disease&#59; CVD&#58; cerebrovascular disease&#59; SD&#58; standard deviation&#59; MD&#58; mixed dementia&#59; AHT&#58; arterial hypertension&#59; MRI&#58; magnetic resonance imaging&#59; CT&#58; computed tomography&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"></th><th class="td" title="table-head  " align="left" valign="top" scope="col">AD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">MD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>88 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>137 &#40;61&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sociodemographic data and medical history</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#46;82<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;033&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Years of schooling&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;081&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Family history of dementia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;21&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;8&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Katz index score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;835&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lawton IADL scale score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;77<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>GDS score&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;84<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resolved depression&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;18&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;10&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;31&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;48&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>AHT&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;53&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95 &#40;69&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyslipidaemia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;67&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;38&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;421&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alcohol use&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;385&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;29&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;564&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vitamin B<span class="elsevierStyleInf">12</span> deficiency&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;8&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>History of CVD&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;24&#46;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perseveration errors&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Imaging findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ischaemia on CT&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;5&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>White matter disease on MRI&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;20&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;54&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lacunar infarct on MRI&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;11&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;358&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Acute CVD on MRI&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;4&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic&#44; health-related&#44; psychometric&#44; and imaging characteristics of our sample&#46;</p>"
        ]
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AD&#58; Alzheimer disease&#59; CVD&#58; cerebrovascular disease&#59; SD&#58; standard deviation&#59; MD&#58; mixed dementia&#59; AHT&#58; arterial hypertension&#59; MRI&#58; magnetic resonance imaging&#59; CT&#58; computed tomography&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AHT&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10-3&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;022&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;10-3&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resolved depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15-0&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;035&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin B<span class="elsevierStyleInf">12</span> deficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;08-70&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of CVD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;18-5&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischaemia on CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65-47&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;079&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;38-8&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;59-4&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;358&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute CVD on MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45-0&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;058&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Factors associated with MD&#46; Univariate analysis&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CVD&#58; cerebrovascular disease&#59; AHT&#58; arterial hypertension&#59; CI&#58; confidence interval&#59; MRI&#58; magnetic resonance imaging&#59; OR&#58; odds ratio&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;62-28&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resolved depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02-0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White matter disease on MRI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;97-412&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Logistic regression analysis&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alzheimer&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;W&#46; Querfurth"
                            1 => "F&#46;M&#46; LaFerla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra0909142"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "362"
                        "paginaInicial" => "329"
                        "paginaFinal" => "344"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20107219"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Morphologic diagnosis of vascular dementia&#58; a critical update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;A&#46; Jellinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jns.2008.03.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol Sci"
                        "fecha" => "2008"
                        "volumen" => "270"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18455191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mixed dementia&#58; epidemiology&#44; diagnosis&#44; and treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Zekry"
                            1 => "J&#46;J&#46; Hauw"
                            2 => "G&#46; Gold"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAGS"
                        "fecha" => "2002"
                        "volumen" => "50"
                        "paginaInicial" => "1431"
                        "paginaFinal" => "1438"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
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Article information

ISSN: 21735808
Original language: English

DOI:10.1016/j.nrleng.2015.12.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	14	2	16
2024 September	39	10	49
2024 August	40	7	47
2024 July	21	6	27
2024 June	23	35	58
2024 May	21	6	27
2024 April	17	4	21
2024 March	20	3	23
2024 February	26	7	33
2024 January	22	5	27
2023 December	15	5	20
2023 November	23	15	38
2023 October	36	11	47
2023 September	20	3	23
2023 August	21	5	26
2023 July	24	13	37
2023 June	23	3	26
2023 May	11	5	16
2023 April	9	3	12
2023 March	12	7	19
2023 February	25	10	35
2023 January	27	2	29
2022 December	11	6	17
2022 November	31	21	52
2022 October	25	15	40
2022 September	12	8	20
2022 August	25	10	35
2022 July	14	10	24
2022 June	14	10	24
2022 May	30	6	36
2022 April	28	13	41
2022 March	34	10	44
2022 February	18	6	24
2022 January	22	7	29
2021 December	15	14	29
2021 November	30	12	42
2021 October	34	15	49
2021 September	17	10	27
2021 August	15	17	32
2021 July	18	13	31
2021 June	13	8	21
2021 May	16	11	27
2021 April	21	21	42
2021 March	32	23	55
2021 February	24	9	33
2021 January	23	11	34
2020 December	13	19	32
2020 November	18	9	27
2020 October	15	6	21
2020 September	19	13	32
2020 August	20	11	31
2020 July	16	14	30
2020 June	19	8	27
2020 May	18	21	39
2020 April	20	4	24
2020 March	19	6	25
2020 February	28	10	38
2020 January	17	5	22
2019 December	17	11	28
2019 November	13	8	21
2019 October	14	2	16
2019 September	10	6	16
2019 August	15	6	21
2019 July	8	9	17
2019 June	10	19	29
2019 May	32	34	66
2019 April	34	19	53
2019 March	18	1	19
2019 February	11	10	21
2019 January	3	5	8
2018 December	4	2	6
2018 November	8	10	18
2018 October	10	10	20
2018 September	13	3	16
2018 August	5	2	7
2018 July	4	2	6
2018 June	14	8	22
2018 May	11	10	21
2018 April	5	2	7
2018 March	8	1	9
2018 February	11	7	18
2018 January	4	0	4
2017 December	17	3	20
2017 November	8	5	13
2017 October	14	3	17
2017 September	11	6	17
2017 August	20	6	26
2017 July	20	5	25
2017 June	28	8	36
2017 May	3	6	9
2017 April	0	1	1

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