Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS): Study design and harmonization.

INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.

Biomarkers for Alzheimer's disease. Where we stand and where we are headed.

Alzheimer disease (AD) is one of the major unresolved health burdens accompanying the increase in life expectancy. The great paradigm shift for this disease has resulted from finding amyloid deposition and neurobrillary degeneration 20 years and 10 years, respectively, prior to onset of the typical clinical memory loss symptoms. The advent of AD biomarkers has enabled a molecular definition of AD, making the clinical definition almost dispensable. Various types of AD biomarkers are available in our country. Each biomarker reflects a particular process and stage of the disease. Although costs restrict their use, the biomarker analysis may be justified in certain clinical scenarios, such as an early onset or an atypical presentation of the disease. Today, the usefulness of biomarkers in AD clinical research is beyond question. Furthermore, the introduction of biomarkers into medical practice has led to significant changes in therapeutic interventions, even in the absence of disease-modifying drugs.

La enfermedad de Alzheimer (EA) es uno de los mayores flagelos aún no resueltos que acompañan al aumento de la expectativa de vida. El gran cambio de paradigma en los últimos años fue consecuencia de descubrir que el depósito amiloideo se presenta hasta 20 años antes, y la degeneración neurofibrilar hasta 10 años antes, de que aparezca la sintomatología clínica típica de pérdida de memoria. La aparición de los biomarcadores permitió reestructurar el concepto de la EA, intentándose llegar a una definición molecular de la misma casi prescindiendo de la emblemática clínica. Existen distintos tipos de biomarcadores de EA disponibles en nuestro país. Cada uno nos habla de un proceso y un momento distinto de la enfermedad. Aunque su uso clínico aún se encuentra restringido por cuestiones de costos, existen escenarios particulares en donde sí se justifica, casi siempre en relación a presentaciones clínicas atípicas o de comienzo muy temprano. Sin embargo, hoy en día ya nadie discute que son imprescindibles en investigaciones clínicas sobre EA. La incorporación de biomarcadores en la práctica médica ha generado cambios significativos en la intervención terapéutica de los pacientes, incluso en un contexto en el que todavía no hay medicamentos modificadores de la enfermedad.

Sphenoid wing meningioma behavior on 11C-PiB and 18F-FDG PET.

Two patients with mild cognitive impairment underwent C-PiB and F-FDG brain PET. Both patients had previously gone through a contrast-enhanced MRI scan that revealed extra-axial tumors next to the sphenoid wing, suggestive of meningiomas. C-PiB PET images showed a highly increased uptake by the extra-axial masses. These 2 cases represent 1.2% of our C-PiB population (n = 163). No meningioma was found with negative C-PiB uptake. The F-FDG concentration was not increased within the lesions. C-PiB could be used as a meningioma marker.

Fiabilidad diagnóstica de la doble lectura en RM cráneoespinal: evaluación retrospectiva / Diagnostic reliability of the double reading in craniospinal MRI: retrospective evaluation

Objetivo: Evaluar en forma retrospectiva la fiabilidad diagnóstica del sistema de doble lectura en RM craneoespinal a fin de obtener datos que permitan valorar su impacto sobre la calidad del informe final. Material y Métodos: Sobre un total de 13.460 RM craneoespinales realizadas en 2007 se revisaron en forma retrospectiva y aleatoria 450 informes de RM de columna y 900 informes de RM de cráneo. Entre la primera y la segunda lectura se juzgaron unicamente cambios de fondo, es decir aquellos pasibles de modificar la interpretación de las imágenes y consecuentemente, el diagnóstico final. Resultados: Se realizaron modificaciones en 75 informes de columna (17%) y en 115 de cráneo (13%). Conclusión: el sistema de doble lectura modifica de manera significativa la calidad del informe final.

Purpose:The aim of this paper is to evaluate retrospectively the diagnostic reliability of the double reading system in Spinal and Brain MRI. Material and Methods: Along 2007, 13460 Spinal andBrain MRI were performed, we reviewed 450 reports of Spinal MRI and 900 Brain MRI reports.Between the firstand the second report we paid attention only at major modifications that can modify the final diagnosis. Results: We founded major modifications in 75 (17%) of Spinal MRI reports and in 115 (13%) of the MRI brain reports. Conclusion: The double reading system improve significatively the quality of the final report.