Dysexecutive syndrome in amnesic mild cognitive impairment: a multicenter study.

BACKGROUND: Executive functions (EF) in Alzheimer's disease (AD), classically related to the prefrontal cortex, have been forgotten in mild stages, given more importance to temporal lobe associated disorders, such as memory. The study of disexecutive syndrome (DS) has been relegated to advanced stages of the disease. Our goal is to demonstrate that EF are already present in amnesic mild cognitive impairment (aMCI). Furthermore, we are interested in knowing whether poor scores in EF tests are related to the progression to AD or another kind of dementia. METHODS: We studied patients with aMCI (n = 81) and healthy controls (n = 142) from neurological departments of several centers of Basque Country with a cross-sectional design. Patients underwent a complete neuropsychological evaluation, neuroimaging testing APOE genotype and 3 year of prospective follow-up. RESULTS: In the first visit, patients with aMCI showed more alterations in tests that evaluate EF such as Stroop, trail-making and categorical verbal fluency. More alterations were also found in NPI scale (P <0.05). Stroop and Trail-Making test were not associated with the future development of AD, but fluency (p = 0.01) and apathy (p = 0.031) did. No patient developed a different kind of dementia different from AD. CONCLUSIONS: DS is a broad concept not confined to frontal lobes, and can be found in early stages of aMCI. DS impacts negatively on patient autonomy and may have prognostic value.

[A study using positron emission tomography of a case of vascular dementia due to left thalamic haematoma, an example of the diaschisis phenomenon]. / Estudio con tomografia por emision de positrones de un caso de demencia vascular por hematoma talamico izquierdo, ejemplo del fenomeno de diasquisis.

INTRODUCTION: Thalamic vascular lesions as strategic strokes can cause amnesia, executive dysfunctions or dysphasia and behavioral or psychological symptoms causing vascular dementia. CASE REPORT: A 58 years-old woman with hypertension and dyslipemia, who after a left thalamic hemorrhage with good radiological evolution, presents a severe amnesic syndrome as well as other subtle changes in orientation and in language, difficulties in managing money and depressive symptoms requiring anxiolytic and antidepressive treatment. All this joined to limitations in the normal course of her work. Followed by neurology service, a positron emission tomography with 18F-2-fluoro-2-deoxy-D-glucose integrated with computed tomography was performed, which showed a hypometabolism in left thalamic area and also in ipsilateral inferior frontal region, explained by the diaschisis phenomenon. CONCLUSIONS: Diaschisis phenomenon is a neuroimaging and pathophysiological finding whereby thalamic or basal ganglia strokes cause hypoperfusion/hypometabolism in the ipsilateral or contralateral cortex and could explain cortical distal symptoms. This case report demonstrates the presence of thalamocortical connections, which helps to understand the circuitry of memory and help to explain the association of other cortical symptoms as dysphasia or executive dysfunction.

TITLE: Estudio con tomografia por emision de positrones de un caso de demencia vascular por hematoma talamico izquierdo, ejemplo del fenomeno de diasquisis.Introduccion. Las lesiones vasculares talamicas que se comportan como ictus estrategicos pueden causar amnesia, disfunciones ejecutivas o disfasia, asi como sintomas comportamentales o psicologicos, y causar una demencia vascular. Caso clinico. Mujer de 58 años, hipertensa y dislipidemica, que, tras una hemorragia talamica izquierda que evoluciono radiologicamente de manera favorable, presento un sindrome amnesico grave y otras alteraciones sutiles en la orientacion y el lenguaje, dificultades en el manejo del dinero y sintomas depresivos que precisaron tratamiento ansiolitico y antidepresivo, todo lo cual fue causa de limitaciones para el normal desempeño de su trabajo. Seguida en la consulta de neurologia, se le practico una tomografia por emision de positrones/tomografia axial computarizada con 18F-2-fluoro-2-desoxi-D-glucosa, donde se aprecio un hipometabolismo en el talamo izquierdo y, ademas, en la region frontal inferior ipsilateral, que se explicaria mediante el fenomeno de diasquisis. Conclusiones. El fenomeno de diasquisis es un hallazgo de neuroimagen y fisiopatologico por el cual los ictus talamicos o de los ganglios basales causan hipoperfusion/hipometabolismo en la corteza ipsilateral o contralateral, y que puede explicar sintomas a distancia corticales. El presente caso evidencia la presencia de conexiones talamocorticales, lo cual ayuda a comprender los circuitos de la memoria y a explicar la asociacion en el de otros sintomas corticales, como la disfasia o las alteraciones ejecutivas.

[Bladder tumor lethality. Results in the autonomous community of Rioja between 1975-1991]. / Letalidad por tumor vesical. Resultados en la comunidad autónoma de la Rioja entre los años 1975-1991.

Between 1975-1991, a total of 557 cases of bladder carcinoma were identified in the Autonomous Community of La Rioja (CAR) which were followed up to December 1994. The overall lethality was 21.9%. 492 cases with 22.35% lethality were identified in males. In females, however, there was 65 cases with 18.46% lethality. The comparison of males and females lethality resulted in p = 0.525. Lethality between cases diagnosed within each 5-year period analyzed is: 1975-1981: 177 cases, lethality 23.72%. 1982-1986: 168 cases, lethality 30.95%. 1987-1991: 212 cases, lethality 13.20%. Between the first and the second 5-year periods, p = 0.132; between the first and third 5-year periods p = 0.007 and between the second and third 5-year periods p < 0.000. Bladder tumours accounts in CAR for a 22.35% lethality. Lethality is higher in males that in females but the difference is not statistically significant. In the last 5-year period assessed, 1987-1991, a reduction of lethality from bladder neoplasms has been documented.

Necrosis avascular de ambas cabezas femorales en un paciente VIH+ / Avascular necrosis of the femoral heads in a HIV patient

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[Bladder cancer survival, study of 557 cases identified at the autonomous community of La Rioja from 1975 to 1991]. / Supervivencia por cáncer de vejiga, estudio de 557 casos identificados en la Communidad Autónoma de La Rioja entre 1975 y 1991.

OBJECTIVE: To analyze survival in 557 cases of bladder cancer that had been detected in La Rioja (Spain) from 1975 to 1991. METHODS/RESULTS: The Kaplan Meier and Mantel and Haenszel methods were used for the statistical analyses. The survival rate for each 5-year period analyzed was 69%, 58% and 73%, respectively. Most deaths occurred within the first 24 months. The survival rates were 25%, 21% and 0%, respectively, for infiltrating tumors and 84%, 76% and 85% for superficial tumors was of the. The survival rates for males and females were not statistically significant. CONCLUSION: The survival rate in patients with bladder cancer has increased. Patients with infiltrating bladder tumors have a worse prognosis. The survival rates for males and females are not statistically significantly different.