Universitat Internacional de Catalunya
From Cognitive Normality to Dementia: Experience in Clinical Practice, Research and Translational Medicine
Other languages of instruction: English, Spanish
Teaching staff
Students may ask lecturers questions at the end of each class. For enquiries outside of class time, students must make an appointment by email:
Titular professor: Dra. Mercè Boada Rovira, MD, PhD . Mail: mboada@fundacioace.org / mboada@uic.es
Subject's coordinator and professor: Dra Ester Esteban de Antonio, MD. Mail: eesteban@uic.es
Other professors:
Dra Marta Marquié: mmarquie@uic.es
Dra Maria Pilar Cañabate: mcanabate@uic.es
Lda. Maitee Rosende-Roca: mrosenderoca@uic.es
Dra Maria Montserrat Alegret: malegret@uic.es
Dr Sergi Valero Ventura: svalero@uic.es
MsU Pablo García
Dr Xavier Morató (PhD)
Dra Amanda Cano (PhD)
Dra. Vanesa Pytel (PhD)
Introduction
Alzheimer's disease is the fourth global health problem, considering the pandemic of the 21st century. Its health, social and economic impact is of the first magnitude. Given the high prevalence of this pathology, all medical professionals will attend people with cognitive impairment in their daily clinical practice. This fact makes it necessary for medical students to receive training in comprehensive care for dementias and to know the main current and future scientific challenges of this medical field.
ACE Alzheimer Centre is a specialized and reference monographic entity that serves not only people with cognitive disorders, Alzheimer's disease or other dementias, but also their families. We offer comprehensive and personalized high-quality care in the area of diagnosis, treatment, research, training and awareness. We address the entire cognitive spectrum, from normality, to mild cognitive impairment and dementia. In ACE Alzheimer Centre we integrate the clinical experience with the scientific rigor of basic, clinical and social research and participate in multiple national and international research projects.
The subject “From cognitive normality to dementia. Practical experience in clinical, research and translational medicine”, aims to:
- Acquire knowledge and clinical skills in the comprehensive care of cognitive pathology: its prevention, diagnosis, monitoring and treatment.
- Know the current challenges, the lines of research and the main advances implemented in a centre of world excellence.
The signature is optional, it consists of a total of 60 hours corresponding to 2 ECTS.
Pre-course requirements
The student should have knowledge about neuroanatomy, medical psychology and neurology.
Objectives
- General: Understanding and acquiring the knowledge and skills of clinical and research practice in the comprehensive care of cognitive disorders and dementias.
- Specific: Acquiring basic knowledge and skills in the following aspects:
- Knowing the most prevalent cognitive disorders of adults. Learning the correct realization of the neurological clinical history and cognitive exploration.
- Knowing the diagnostic procedures and usefulness of the neuropsychological study.
- Identify diagnostic tools for early detection.
- Knowing how to determine the evolutionary stage of cognitive pathology.
- Learning the importance of the comprehensive approach in the diagnosis and management of patients by a multidisciplinary team.
- Knowing the therapeutic options and the evolution of the disease.
- Knowing the healthcare model that integrates clinical practice and research.
- Knowing the main lines of research and acquire knowledge in basic and clinical research.
Competences/Learning outcomes of the degree programme
- 01 - Recognise the essential elements of the medical profession, including ethical principles, legal responsibilities and patient-centered professional skills.
- 04 - Develop professional practice with respect for patient autonomy, beliefs and culture.
- 06 - Develop professional practice with other health professionals, acquiring teamwork skills.
- 09 - Understand and recognize the effects, mechanisms and manifestations of disease on the structure and function of the human body.
- 12 - Understanding the foundations for action, the indications and efficacy of therapeutic interventions, based on available scientific evidence.
- 13 - Obtain and develop a clinical history that contains all relevant information.
- 14 - Perform a physical examination and a mental assessment.
- 15 - Ability to formulate an initial diagnosis and establish a rationalised diagnostic strategy.
- 17 - Establish the diagnosis, prognosis and treatment, applying principles based on the best information possible and safe clinical practice..
- 18 - To indicate the most appropriate (pharmacological, surgical, psychological, social or other) treatments that are pertinent to the most prevalent procedures, in terms of rehabilitation and also terminally ill patients, including an evaluation of their effectiveness.
- 20 - Acquire adequate clinical experience in hospitals, health centers and other health institutions under supervision, as well as basic knowledge of clinical management and patient-centered proper use of tests, drugs and other health system resources.
- 21 - Listen carefully, obtain and synthesize relevant information about the problems affecting the patient and understand the contents of this information.
- 24 - Establish good interpersonal communication skills that enables efficient and empathetic communication with patients, relatives, media and other professionals.
- 26 - Assume role in the prevention and protection from diseases, injuries or accidents and maintenance and promotion of health, both individual and at the community level.
- 33 - Maintain and use records with patient data for later analysis, preserving the confidentiality of the data.
- 34 - Ability for critical thinking, creativity and constructive skeptisim with a focus on research within professional practice.
- 37 - Acquire basic training for research.
Syllabus
The contents of the course are based on basic knowledge and clinical and research practice of attention to cognitive impairment, applied in daily practice in a specialized unit.
- To perform a complete history of cognitive pathology.
- To recognize the existence of cognitive impairment through physical examination and history.
- To know the natural history of dementias.
- To indicate and interpret the complementary tests to establish an adequate diagnosis, evolutionary stage and prognosis of the disease.
- To know the different procedures used in early detection and the criteria for referral to a specialized integral care unit.
- Pharmacological and non-pharmacological management of symptoms associated with cognitive pathology.
- To participate in the daily discussion of clinical cases of patients treated in the diagnostic unit.
- To know the operation of a clinical trial unit: selection process for candidates, information, informed consent, inclusion, follow-up and usual procedures.
- To participate in the daily work of the multidisciplinary team that integrates clinical practice and basic research: translational medicine.
- To know how a researcher designs, requests, executes and communicates the results of a research project.
- To raise awareness with the ethical problem raised by cognitive pathology at the health, family and social levels.
Teaching and learning activities
In person
The subject will be taught in the Attention Units of Ace Alzheimer Center. The mandatory attendance will be from 8 to 13 hours and students will be tutored by a neurologist.
Different teaching methodologies will be implemented:
- Attendance at clinical sessions in the Diagnostic Unit, Ace Alzheimer Centre Barcelona: 1 hour a day.
- Theoretical-practical seminars according to calendar; 11 Seminars (9 hours).
- Internships in the different units of Ace Alzheimer Center: 4 hours a day; 9 days (36 hours).
• Clinical practices:
- Diagnosis Unit: Neurology, neuropsychology and social work consultations. Open House Initiative.
- Day Care Unit: Day Care Centre, Day Hospital.
In-person internships will be prioritised, but it depends on the Covid-19 pandemia evolution, face-to-face clinical visits and number of students. Telemedicine has evolved as an added and valid option in our centre.
• Research practices:
- Applied research: Clinical trials. Students could attend Neurology and Neuropsychology consultations, and Day Hospital for clinical trials treatments.
-Basic research: Laboratory.
The program of the subject in the 11 theoretical-practical sessions is as follows:
1- Current status and main challenges in cognitive pathology. History of Alzheimer's disease. Progress and history of pharmacologic treatment in Alzheimer's Disease.
2- Cognitive disorders: Classification, etiopathogenesis and differential diagnosis. Practical cases.
3- Diagnostic process of cognitive pathology: Neurological evaluation and administration of brief cognitive tests.
4- Diagnostic process of cognitive pathology: Neuropsychological evaluation.
5- Social diagnostic process and socio-family evaluation.
6- Treatment and prognosis of cognitive pathology: Prevention, pharmacological and non-pharmacological treatment.
7- Biomarkers in Alzheimer's Disease.
8- Research projects: Design and implementation.
9- Translational research: Precision Medicine.
10- Applied research: Future treatments and clinical trials.
11- Cognitive disorders in MIR exam.
- Course evaluation
Evaluation systems and criteria
In person
- Continuous evaluation during practices (attendance, interest, knowledge, proactivity, etc.) will be assessed. Value of 40% on the final grade.
- Oral presentation of the resolution of a clinic case previously provided to the students (groups of 3-4 students): syndromic and aetiologic diagnosis, neuropsychological diagnosis and social evaluation, arriving to a consensus diagnosis in group. Oral presentation (15-20 minutes). Value of 40% on the final grade (last day of practice).
- Final test. Value of 20% on the final grade (last day of practice).
Bibliography and resources
- Guia de demencias de la Sociedad Española de Neurologia
- ¿Puede diagnosticarse la demencia en la Atención Primaria?
DOI: 10.1016/j.aprim.2010.09.004 https://www.elsevier.es/es-revista-atencion-primaria-27-articulo-puede-diagnosticarse-demencia-atencion-primaria-S0212656711000047
- Design of a comprehensive Alzheimer's disease clinic and research center in Spain to meet critical patient and family needs
Alzheimers Dement. 2014 May; I.F. 4,48 doi:10(3):409-15.
Boada M, Tárraga LL, Hernández I, Valero S, Alegret M, Ruiz A, Lopez OL, Becker JT; Fundació ACE Alzheimer Research Center and Memory Clinic.
- Beneficial Effects of an Integrated Psychostimulation Program in Patients with Alzheimer's Disease . J Alzheimers Dis. 2015; I.F. 4.15 doi:50(2):559-66.
Ibarria M, Alegret M, Valero S, Morera A, Guitart M, Cañabate P, Moreno M, Lara S, Diego S, Hernández J, Tantinyá N, Vera M, Hernández I, Becker JT, Ruíz A, Boada M, Tárraga L.
- A longitudinal follow-up of 550 Mild Cognitive Impairment patients: evidence for large conversion to dementia rates and detection of major risk factors involved. J Alzheimers Dis. 2013 Jan 1; I.F. 4.17 doi:34(3):769-80. PDF ResearchGate
Espinosa A, Alegret M, Valero S, Vinyes-Junqué G, Hernández I, Mauleón A, Rosende-Roca M, Ruiz A, López O, Tárraga L, Boada M.
- Social Representation of Dementia: An Analysis of 5,792 Consecutive Cases Evaluated in a Memory Clinic
J Alzheimers Dis. 2017;58(4):1099-1108. F.I. 3.731. doi: 10.3233/JAD-161119.
Cañabate P, Martínez G, Rosende-Roca M, Moreno M, Preckler S, Valero S, Sotolongo O, Hernández I, Alegret M, Ortega G, Espinosa A, Mauleón A, Vargas L, Rodríguez O, Abdelnour C, Sánchez D, Martín E, Ruiz A, Tárraga L, Boada M..
- FACEHBI: A Prospective Study Of Risk Factors, Biomarkers and Cognition in a Cohort of Individuals with Subjective Cognitive Decline. Study Rationale and Research Protocols. J Prev Alzheimers Dis. 2017;4(2):100-108. doi: 10.14283/jpad.2016.122.
O. Rodriguez-Gomez, A. Sanabria, A. Perez-Cordon, D. Sanchez-Ruiz, C. Abdelnour, S. Valero, I. Hernandez, M. Rosende-Roca, A. Mauleon, L. Vargas, M. Alegret, A. Espinosa, G. Ortega, M. Guitart, A. Gailhajanet, O. Sotolongo-Grau, S. Moreno-Grau, S. Ruiz, M. Tarragona, J. Serra, E. Martin, E. Peleja, F. Lomeña, F. Campos, A. Vivas, M.Gomez-Chiari, M.A. Tejero, J. Giménez, P. Pesini, M. Sarasa, G.Martinez, A. Ruiz, L. Tarraga, M.Boada.
- Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer disease and three causality networks of AD: the GR@ACE project.
Alzheimer's & Dementia. doi:10.1101/528901
Sonia Moreno-Grau, Itziar de Rojas, Isabel Hernandez, Ines Quintela, Laura Montrreal, Montserrat Alegret, Begona Olasagarre, Laura Madrid, Antonio Gonzalez, Olalla Marona, Matiee Rosende-Roca, Ana Mauleon, Liliana Vargas, Asuncion Lafuente, Carla Abdelnour, Octavio Rodriguez-Gonzalez, Silvia Gil, Miguel Angel Santos-Santos, Ana Espinosa, Gemma Ortega, Angela Sanabria, Alba Perez-Cordon, Susana Ruiz, Nuria Aguilera, Juan Antonio Pineda, Juan Macias, Emilio Alarcon-Martin, Oscar Sotolongo-Grau, GR@ACE consortium, DEGESCO consortium, Alzheimer Disease Neuroimaging Initiative, Marta Marquie, Gemma Monte-Rubio, Sergi Valero, Jordi Clarimon, Maria Jesus Bullido, Guillermo Garcia-Ribas, Pau Pastor, Pascual Sanchez-Juan, Victoria Alvarez, Gerard Pinol-Ripoll, Jose Maria Garcia-Alberca, Jose Luis Royo, Emilio Franco, Pablo Mir, Miguel Calero, Miguel Medina, Alberto Rabano, Jesus Avila, Carmen Antunez, Luis Miguel Real, Adelina Orellana, Angel Carracedo, Maria Eugenia Saez, LLuis Tarraga, Merce Boada, Agustin Ruiz.
- https://www.fundacioace.com/es/publicaciones.html
- Ace Alzheimer Center: www.fundacioace.org
- Ace Alzheimer Center Memòria d’activitat https://www.fundacioace.com/es/memorias-de-actividad.html
- Alzheimer Disease International : https://www.alz.co.uk/
- World Alzehimer Report 2019 : Attitudes to demència https://www.alz.co.uk/research/world-report-2019
- WHO: https://www.who.int/es/news-room/fact-sheets/detail/dementia