ABSTRACT
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.
Subject(s)
Alzheimer Disease/psychology , Amnesia/psychology , Cognitive Dysfunction/psychology , Executive Function , Aged , Apathy , Case-Control Studies , Cross-Sectional Studies , Dementia/physiopathology , Disease Progression , Female , Genotype , Humans , Male , Memory Disorders/physiopathology , Middle Aged , Neuroimaging , Neuropsychological Tests , Prognosis , Prospective StudiesABSTRACT
BACKGROUND: Many genes have been studied to determine how they might be involved in Alzheimer's disease (AD). Estrogens have a protective effect in the central nervous system. The mechanisms of action of estrogens are mediated by two estrogen receptors (ERs), ERα and ERß. Thus, these genes could also play a role in the progression of amnesic mild cognitive impairment (MCIa) to AD. The aim of this study was to examine the role of ER single nucleotide polymorphisms (SNPs) as a risk factor for MCIa, as well as the interaction with apolipoprotein E (APOE) ε4 in the progression to AD. METHODS: 79 MCIa patients and 138 healthy controls were analyzed. SNPs were genotyped via restriction fragment length polymorphisms and real-time PCR, RT-PCR or RT-PCR (TaqMan) assays. RESULTS: There is a lack of association between MCIa patients who converted to AD and ER SNPs. APOE ε4 allele is an independent risk factor of MCIa (OR=1.86; 95% CI=1.02-3.38, p=0.042) with a high prevalence in converted subjects. APOE ε4 is able to predict the progression from MCIa patients to AD (OR=2.55; 95% CI=1.20-5.42, p=0.015). CONCLUSIONS: The presence of the APOE ε4 allele, and not the alleles of ER SNPs, is a risk factor for MCIa. Furthermore, APOE genotype seems to predict the conversion from MCIa to AD.
Subject(s)
Alzheimer Disease/genetics , Apolipoproteins E/genetics , Cognitive Dysfunction/genetics , Estrogen Receptor beta/genetics , Polymorphism, Genetic/genetics , Aged , Aged, 80 and over , Alleles , Alzheimer Disease/diagnosis , Apolipoprotein E4/genetics , Cognitive Dysfunction/diagnosis , Disease Progression , Estrogen Receptor alpha , Female , Gene Frequency/genetics , Genetic Predisposition to Disease/genetics , Genotype , Humans , Longitudinal Studies , Male , Middle Aged , Neuropsychological Tests , Polymorphism, Single Nucleotide/genetics , Proportional Hazards Models , Risk FactorsABSTRACT
Spontaneous cerebellar hemorrhage is a significant clinical entity because of its important incidence (more than 10 percent of intracranial hemorrhages) and its therapeutic possibilities. The diagnosis of this condition is difficult, but at the presnet time the Emi-scanner easily confirms the diagnosis. The surgical treatment was up until recently the only possible therapeutic approach, and it has been indiscriminately applied to all patients because of the high mortiality rate of this condition (80 percent). Two hypertensive patients who presented spontaneous cerebellar hematomas, verified by the scanner, were not submitted to surgery and both recovered spontaneously without sequelae. The existence of non-surgical forms of spontaneous cerebellar hemorrhage is discussed. Special attention is placed upon the variations in the level of consciousness and the presence or absence of acute hydrocephalus in the scanner in order to indicate the convenience of a surgical procedure.
