ABSTRACT
Realizamos un análisis retrospectivo de los pacientes evaluados en nuestra unidad de memoria en los que se realizó determinación de biomarcadores licuorales de enfermedad de Alzheimer (EA). Se seleccionaron aquellos casos con diagnóstico de deterioro cognitivo leve debido a EA según criterios clínicos (criterios NIA-AA), déficit neuropsicológico comprobado, una puntuación igual a 3 en la escala GDS y un perfil alterado de biomarcadores en líquido cefalorraquídeo. De los 588 casos revisados, 110 cumplieron los criterios de inclusión. Durante el seguimiento, 50 de estos 110 casos (45,45%) progresaron a demencia por EA. Se observaron diferencias significativas en los niveles basales de tau total y tau fosforilada entre los casos que evolucionaron a demencia y los que permanecieron estables como deterioro cognitivo leve, siendo los niveles más altos en el grupo que progresó a demencia. Después del ajuste por edad, sexo, antecedentes de hipertensión, diabetes y nivel educativo, un aumento del 10% en los valores de proteína tau total se asoció con un aumento del 7,60% en el riesgo de progresión a demencia (HR = 2,22, IC 95% [1,28, 3,84], p = 0,004). En pacientes con deterioro cognitivo leve debido a EA un perfil alterado de biomarcadores licuorales, concentraciones progresivamente mayores de tau-t y tau-p se asocian a un mayor riesgo de conversión a demencia.(AU)
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cognitive Dysfunction , Prognosis , Biomarkers , Alzheimer Disease , Dementia , Retrospective Studies , NeurologyABSTRACT
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; Pâ¯=â¯.004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Humans , Alzheimer Disease/diagnosis , Prognosis , Retrospective Studies , Amyloid beta-Peptides , Disease Progression , Cognitive Dysfunction/etiology , Cognitive Dysfunction/diagnosis , Biomarkers/cerebrospinal fluidABSTRACT
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.
ABSTRACT
No disponbile
Subject(s)
Humans , Male , Aged, 80 and over , Cerebral Amyloid Angiopathy/complications , Alzheimer Disease/complications , Craniocerebral Trauma/complicationsABSTRACT
The usual clinical profile of Creutzfeldt-Jakob disease (CJD) is that of subacute dementia and intractable myoclonus. Occasionally, some cases present peculiar clinical features. We report on a case of CJD with an unilateral onset showing remarkable neuroimaging features. The patient, aged 72 years, began to suffer from sudden anomia, initially restricted to persons; but in a few weeks it evolved into a global aphasia, right hemiparesis, severe gait disorder, and finally akinetic mutism and intractable myoclonus. He died 11 weeks after onset. Early in the course, an analysis of 14-3-3 protein in CSF was positive. In advanced disease, the EEG showed the typical periodic activity of CJD. FLAIR MRI study showed a mesencephalic and focal cortical hyperintensity. Autopsy was performed and confirmed the diagnosis of CJD with an extensive presence of generalised spongiosis in cerebral grey matter. This case illustrates the usefulness of the life recent paraclinical methods to diagnose CJD in life. New MRI techniques seems to be particularly relevant, as they are not limited to exclude other conditions but can also offer data with validity to a positive diagnosis, like grey matter hyperintensity, that in this case was present also in the midbrain.
Subject(s)
Cerebral Cortex/pathology , Creutzfeldt-Jakob Syndrome/diagnosis , Creutzfeldt-Jakob Syndrome/physiopathology , 14-3-3 Proteins , Aged , Creutzfeldt-Jakob Syndrome/cerebrospinal fluid , Disease Progression , Electroencephalography , Enzyme Inhibitors/cerebrospinal fluid , Humans , Magnetic Resonance Imaging , Male , Paresis/etiology , Tyrosine 3-Monooxygenase/cerebrospinal fluidABSTRACT
La presentación clínica típica de la enfermedad de Creutzfeldt-Jakob (ECJ) es la de una demencia subaguda con mioclonías intratables. Ocasionalmente, algunos casos muestran rasgos clínicos peculiares. Presentamos un caso de ECJ de inicio unilateral que presentó también rasgos destacables en la neuroimagen. El paciente, de 72 años de edad, comenzó con una anomia súbita, inicialmente restringida a personas, que evolucionó en pocas semanas a afasia, hemiparesia derecha, incapacidad para caminar y, finalmente, mutismo acinético y mioclonías intratables. Falleció tras 11 semanas de enfermedad. La determinación de la proteína 14-3-3 en una muestra de LCR tomada precozmente fue positiva. En fases avanzadas, el EEG puso de manifiesto la típica actividad periódica. Las secuencias FLAIR de RM revelaron hiperintensidad cortical focal y mesencefálica. La necropsia confirmó el diagnóstico de ECJ por presencia de espongiosis generalizada en la sustancia gris cerebral. Este caso ilustra la utilidad de los recientes métodos de laboratorio para el diagnóstico en vida de la ECJ. En particular la RM presenta datos no ya de exclusión sino de diagnóstico positivo, como la hiperintensidad de la sustancia gris, que en este caso llegó a verse en el mesencéfalo. (AU)
Subject(s)
Aged , Male , Humans , Tyrosine 3-Monooxygenase , Disease Progression , Paresis , Cerebral Cortex , Creutzfeldt-Jakob Syndrome , Magnetic Resonance Imaging , Electroencephalography , Enzyme Inhibitors , Tyrosine 3-MonooxygenaseABSTRACT
INTRODUCTION: In this paper we present epidemiological data from a register of cases of epilepsy attended in the Centro de Especialidades of the Alboraya street in Valencia. The sample corresponds to a particular type of healthcare setting, halfway between the family doctor and the specialist hospital department, which has recently begun to be developed in Spain in the field of neurology. PATIENTS AND METHODS: The sample consisted of 150 patients who completed a questionnaire-type protocol. RESULTS: The average age of the patients was 39.66 +/- 19.60 years, slightly more in the men than in the women. There were slightly more women than men included in the study. The epilepsy was either long-term or of recent onset. The average age of onset was 25.42 +/- 21.35 years. More than two thirds of the sample, that is 108 patients (72%) had partly controlled disease. However, a considerable number of them were irregularly controlled and another group of 23 (15.3%) were on polytherapy with three or more antiepileptic drugs. CONCLUSIONS: The data from this series of 150 cases is, in general, similar to that of other epidemiological studies done in Spain. However, it is noticeable that there is a high proportion of patients with problems of control, although this may be due simply to a bias in the selection. We hope that the publication of this new data will stimulate new studies to analyse the attention give to patients with epilepsy in this healthcare setting.
Subject(s)
Ambulatory Care , Antidepressive Agents/therapeutic use , Epilepsy/drug therapy , Registries , Adult , Aged , Aged, 80 and over , Catchment Area, Health , Electroencephalography , Epilepsy/diagnosis , Epilepsy/epidemiology , Female , Humans , Incidence , Magnetic Resonance Imaging , Male , Middle Aged , Spain/epidemiology , Surveys and Questionnaires , Tomography, X-Ray ComputedABSTRACT
Introducción. Presentamos en este trabajo datos de tipo epidemiológico procedentes de un registro de casos de epilepsia atendidos en el Centro de Especialidades de la calle Alboraya de Valencia. La muestra corresponde a un ámbito asistencial peculiar, a medio camino entre el médico de familia y los servicios especializados hospitalarios, en el que la neurología española tiene un reciente y creciente desarrollo. Pacientes y métodos. La muestra la componen 150 pacientes a quienes se les aplicó un protocolo tipo encuesta. Resultados. La edad media de los casos fue de 39,66 ñ 19,60 años, algo mayor en varones que en mujeres. Hubo un discreto predominio femenino en la muestra. La epilepsia podía ser tanto de larga evolución como de reciente diagnóstico; la edad media de inicio fue de 25,42 ñ 21,35 años. Más de dos terceras partes de la muestra, esto es, 108 pacientes (72 por ciento) tenían medianamente controlada su enfermedad; no obstante, todavía un buen grupo de ellos presentaban un control irregular y otro grupo de 23 (15,3 por ciento) estaba sometido a politerapia con tres o más fármacos antiepilépticos. Conclusiones. Los datos de esta serie de 150 casos son, en general, similares a los de otros estudios epidemiológicos de nuestro país, si bien llama la atención precisamente este alto porcentaje de pacientes cuya enfermedad presenta problemas de control, lo cual podría deberse simplemente a un sesgo de selección. Esperamos que la presentación de estos datos estimule nuevos estudios que analicen la atención prestada a los pacientes con epilepsia en este ámbito asistencial (AU)
Subject(s)
Middle Aged , Adult , Aged , Aged, 80 and over , Male , Female , Humans , Registries , Ambulatory Care , Spain , Tomography, X-Ray Computed , Incidence , Surveys and Questionnaires , Antidepressive Agents , Magnetic Resonance Imaging , Electroencephalography , Epilepsy , Catchment Area, HealthABSTRACT
INTRODUCTION: Some neurology clinics have been set up in specialist centres during the last ten years and their activities described. The group of patients with Parkinson's disease attended in the clinics of specialist centres have the distinguishing feature of where they are treated, which makes them different to other groups with the same disorder. OBJECTIVE: In this article we describe the general data of neurological attention for patients with Parkinson's disease, seen in two clinics belonging to specialist centres. PATIENTS AND METHODS: This article is based on records of patients made by neurologists of two structured centres in Hospital La Fe. RESULTS: In a period of 18 months 228 patients with Parkinson's disease were recorded out of a total case register of 5,101. Patients with Parkinson's disease made up between 4% and 5% of the patients attending the clinic. Between 30% and 50% of the patients seen in these clinics were evaluated only once during the period recorded. CONCLUSIONS: There seems to be a large number of cases recorded and these represent 70% of the estimated number of cases in the area. It seems that some patients do not keep in contact with the neurologist. Differences in function noted in clinics of specialist centres, between each other and compared with hospitals, are due to specific organizations and structures.
