[Review of recommendations and new diagnosis criteria for mild cognitive impairment due to Alzheimer's disease]. / Revisión de los nuevos criterios y recomendaciones para el diagnóstico de Deterioro Cognitivo Leve debido a Enfermedad de Alzheimer.

The symptomatic predementia phase of Alzheimer's disease (AD), known as mild cognitive impairment (MCI) is a clinical and neuropsychological condition which defines the transitional state between normal aging and dementia, and is used as a clinical description of people at risk of developing AD. A review of the diagnostic criteria of MCI due to Alzheimer's disease was recently published by the Alzheimer's Association and the National Institute on Aging of the U.S. in order to ensure early diagnosis of the disease, useful for both clinical practice and clinical trials. The objectives of this paper are to review and analyze the revised diagnostic criteria for MCI due to Alzheimer's disease recently proposed, to compare with criteria for MCI available and to establish current strengths and limitations of the new proposal in clinical practice. The new diagnostic criteria for MCI due to AD have a radical importance since they are potentially applicable in the clinical or research protocols and in all clinical settings where such markers are available. They provide a useful, consistent and valuable tool to homogenize the subgroup of patients with MCI who already has AD in a predementia phase with inexorable progression to dementia by AD over the years.

[Cholinesterase inhibitors for treating dementia. Review]. / Inhibidores de la Acetilcolinesterasa. Su utilización en la enfermedad de Alzheimer.

Alzheimer's disease is the most common form of dementia seen in the clinical practice. The principal risk factor is aging. There is not currently any available curative medication. However, there a family of drugs call the cholinesterase inhibitors (donepezile, galantamine and rivastigmine) the enhances cholinergic activity in the CNS. Also, memantine is available is a NMDA receptor modulator. A new transdermal way of administration is available now for rivastigmine. The rivastigmines patches are now a rational alternative focusing in getting more tolerance, better blood levels of the drug and compliance to treatment in Alzheimer's disease patients.

[Behavioural and psychological signs in dementia. Clinical features. Pharmacological and non-pharmacological treatment strategies]. / Trastornos psicóticos y de conducta en las demencias: clínica y estrategias terapéuticas farmacológicas y no farmacológicas.

In first term, we define the current concepts in regard to psychosis (delirium and hallucinations) and abnormal behaviours (aggression, depression and mood changes such as mania, apathy, anxiety, agitation and desinhibition) in dementia. We also review the most used drugs in order to control these symptoms (typical and atypical antipsychotics, anti-epileptic drugs, benzodiazepines, SSRI, memantine and AcheI). As well, we take in consideration pharmacokinetic and pharmacodynamic characteristics, relationship to aging and interactions of these medications. Finally, we briefly describe the management of non-pharmacological of the most common behavioural symptoms: disruptive conducts such as exaggerated responses to minimal stimuli, catastrophic reaction, violence, anger and hostility, wandering and sundowning. As well, we discuss how to manage sleep disturbances, sexual aggression, incontinence and dressing apraxia. Management of these conditions involves, in first term, a comprehensive understanding of the whole situation and identification of underlying possible causes will make possible to evaluate results. This approach will lead to a more rationale proposal of psychotherapeutic and behavioural techniques, and milieu modifications. Finaly, we consider safety patient's in the community as well as the risk of abuse originated in a non-healthy patient-caregiver relationship.

Demencias frototemporales / Dementia of frontal lobe

En 1892 Arnold Pick describió un paciente con afasia progresiva y cambios d conductas. El cerebro de ese paciente evidenció atrofia focal particularmente en los lóbulos frontales y temporales. Las demencias frontotemporales (DFT) son un grupo heterogéneo de demencias que se caracterizan por una degeneración selectiva de los lóbulos frontales y temporales. La manifestación clínica mßs común de la DFT es una profunda alteración en la personalidad, caracterizado por la inercia y perdida de la volición así como desinhibición social y francas fallas en función ejecutiva, con relativa preservación de la memoria. Asimismo, la afasia progresiva no fluente de la demencia semßntica, anteriormente englobadas bajo el epónimo de afasias primarias progresivas, actualmente se las relaciona como parte del complejo asociado a los síndromes corticales focales progresivos o degeneración fronto.temporal. La DFT es la cuarta causa de demencia, siguiendo a la enfermedad de Alzheimer y la enfermedad a cuerpos de Lewy y la demencia vascular. La prevalencia de la DFT no esta clara. Algunos estudios sugieren que representa entre 10 al 20 por ciento de todos los pacientes con demencia. A pesar que no hay acuerdo a cerca de su prevalencia, si hay acuerdo que a menudo es familiar. Algunos estudios han reportado de un 40 a 50 por ciento de pacientes con historia familiar positiva.- Actualmente los criterios de Lund Y Manchester son una guía clínica prßctica para diagnóstico de las demencias del lóbulo frontal. La RNM de cerebro así como el SPECT cerebral son los métodos complementarios de evaluación mßs útiles en la prßctica clínica. El tratamiento para las demencias del lóbulo frontal no existe. No hay estudios sistemßticos sobre el uso de los inhibidores de la acetyl colino esteraza usada en la enfermedad de Alzheimer sean útiles en la DFT. Los síntomas psiquißtricos o conductuales de la DFT deben ser manejados con antipsicoticos, prefiriéndose los antipsicotico atípicos como la olanzapina o la risperidona. ABSTRACT: In 1892, Arnold Pick described a patient suffering progressive aphasia and behavioral changes. The autopsy revealed a brain con focal atrophy involving mainly the frontal and the temporal lobes