ABSTRACT
In vivo Alzheimer's disease diagnosis and staging is traditionally based on clinical features. However, the agreement between clinical and pathological Alzheimer's disease diagnosis, whose diagnosis assessment includes amyloid and Braak histopathological tau staging, is not completely convergent. The development of positron emission tomography (PET) tracers targeting neurofibrillary tangles offers prospects for advancing the staging of Alzheimer's disease from both biological and clinical perspectives. Recent advances in radiochemistry made it possible to apply the postmortem Braak staging framework to tau-PET images obtained in vivo. Here, our aim is to provide a narrative review of the current literature on the relationship between Alzheimer's disease clinical features and the PET-based Braak staging framework. Overall, the available studies support the stepwise increase in disease severity following the advance of PET-based Braak stages, with later stages being associated with worse cognitive and clinical symptoms. In line with this, there is a trend for unimpaired cognition, mild cognitive impairment, and Alzheimer's disease dementia to be compatible with early, intermediate, and late patterns of tau deposition based on PET-based Braak stages. Moreover, neuropsychiatric symptom severity seems to be linked to the extent of tau-PET signal across Braak areas. In sum, this framework seems to correspond well with the clinical progression of Alzheimer's disease, which is an indication of its potential utility in research and clinical practice, especially for detecting preclinical tau levels in individuals without symptoms. However, further research is needed to improve the generalizability of these findings and to better understand the applications of this staging framework.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Humans , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/pathology , tau Proteins , Neurofibrillary Tangles/pathology , Positron-Emission Tomography/methods , Cognitive Dysfunction/diagnostic imaging , Cognitive Dysfunction/pathologyABSTRACT
El objetivo del presente análisis es comparar retrospectivamente el número de pacientes y sus características ingresados en una unidad de cuidados intermedios respiratorios (UCIR) en un hospital terciario antes y después de su dotación en equipos de elevadas prestaciones y personal. Para ello se comparó el número de ingresos, exitus e intubaciones así como la gravedad de los sujetos al ingreso, su estancia media, los parámetros ventilatorios utilizados y su origen entre los meses de enero y diciembre de 2007 con respecto a años previos. Se detectó que el número de ingresos dobló al de años anteriores. La gravedad de los pacientes ingresados era mayor y sin embargo se redujo notablemente la mortalidad y la estancia media. Globalmente aumentó la demanda entre los diferentes servicios del hospital. Los parámetros ventilatorios fueron sensiblemente menos agresivos. En conclusión, la dotación de equipos de altas prestaciones y un personal dedicado y especializado en ventilación mecánica no invasiva son vitales para implementar la eficacia de la unidad (AU)
The main objective of the present paper is to analyze in a retrospecive manner the number and characteristics of patients admitted to our Intermediate Respiratory Unit before and after the installation of new equipment and staff specially dedicated to non invasive ventilation treatment. We performed a comparison of the number of admittance, mortality and intubation rates, source of patients, ventilatory settings, severity scores, mean stay between January to 1st September 2007 compared to same period of previous years. We observed that in 2007 we received the double of admittances, patients were more severe but mortality rates, mean stay were lower. The ventilatory settings were in this 2007 period less aggressive than previously. As a conclusion, to improve our respiratory intermediate units specialized equipment and staff are critical (AU)
