Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010. / Tendencia de las tasas de hospitalización y de letalidad hospitalaria de la enfermedad cerebrovascular aguda en Aragón en el periodo 1998-2010.

INTRODUCTION: Despite the impact of cerebrovascular disease (CVD) on global health, its morbidity and time trends in Spain are not precisely known. OBJECTIVE: The purpose of our study was to characterise the epidemiology and trends pertaining to stroke in Aragon over the period 1998-2010. METHODS: We conducted a retrospective, descriptive study using the data of the Spanish health system's Minimum Data Set and included all stroke patients admitted to acute care hospitals in Aragon between 1 January 1998 and 31 December 2010. We present data globally and broken down by stroke subtype, sex, and age group. RESULTS: The number of cases increased by 13% whereas age- and sex-adjusted hospitalisation rates showed a significant decrease for all types of stroke (mean annual decrease of 1.6%). Men and women in younger age groups showed opposite trends in hospitalisation rates for ischaemic stroke. Case fatality rate at 28 days (17.9%) was higher in patients with intracerebral haemorrhage (35.8%) than in those with subarachnoid haemorrhage (26.2%) or ischaemic stroke (13%). CVD case fatality showed a mean annual decline of 2.8%, at the expense of the fatality rate of ischaemic stroke, and it was more pronounced in men than in women. DISCUSSION: Understanding stroke epidemiology and trends at the regional level will help establish an efficient monitoring system and design appropriate strategies for health planning.

The Spanish school of neurology and the first American cases of Alzheimer's disease.

The object of this review is to recapitulate historical events tied to the discovery of Alzheimer's disease and to narrate the contribution by two graduates of the Spanish School of Neurology, N. Achúcarro and G. Lafora, who went on to describe the first cases in North America. Both Achúcarro and Lafora had studied with Alois Alzheimer at his Nervenklinik in Munich, Germany. Subsequently, their scientific skills were put to work at the neuropathology laboratory at the Government Hospital for the Insane in Washington, D.C. Achúcarro described the first American case of this disease in a 77-year-old patients in 1910. All the descriptions were accompanied by new findings, such as granular degeneration. This was the sixth case recorded in the literature worldwide. One year later, in 1911, Lafora presented a third case, a 62-year-old Civil War veteran, and subsequently a fifth case, a 50-year-old woman, in 1914. In this case Lafora observed histological structures similar to Lewy bodies. These original contributions have not been sufficiently mentioned in writings dealing with the history of Alzheimer's disease.

[Not Available]. / La controversia de las placas seniles en la enfermedad de Alzheimer.

Since ancient times, the study of cognitive deterioration has been a medical and philosophical constant. Unitl the 18th century, this study took place alongside that of other mental illnesses, for which reason it could not be separated, except in certain special cases, from other processes that were genuinely psychiatric. This century has witnessed a Mental Revolution as a consequence of the divorce between neuropsychiatry on the one hand, and philosophy and religious ideas on the other, of the spread of the ideas of Cullen, Chiarugi and Pinel, the emergence of the Enlightenment and Vitalism. At the end of the 19th century there were three anatomoclinical and etiopathogenic schools of thought regarding dementia in the senile period (presbyophrenic vascular and senile dementia). Alzheimer's description of the illness which now bears his name marked a break with the earlier schools of thought and began a controversy in the different neurological schools which lasted until the second half of the twentieth century, with the publication of cases similar to that of Alzheimer (Bonfiglio, 1908; Sarteschi, 1909; Perusini, 1910) and, in particular, the dissemination of the case that came about when Kraepelin named the phenomenon Alzheimer's disease in 1910. This term was not readily accepted, and the illness was categorised in several other ways: atypical senile dementia, presenile dementia, atypical presbyophrenic dementia and so on. Given that the problem of the use of term Alzheimer's disease lay not only in the unspecific nature of clinical data, but also in the fact that it affected the most important anatomopathological discoveries, the decision to use the term was left to the discretion of the different neurological schools of thought. Kraepelin's personal opinion played a very relevant role from the first; his scientific prestige and authority decisively contributed to its denomination as Alzheimer's disease.

Comparative study of aprosody in Alzheimer's disease and in multi-infarct dementia.

Prosody is defined as the melodic line of language. In this study we included 25 patients with probable Alzheimer's disease and 14 with multi-infarct dementia for a comparative cross-sectional study of prosody. Neuropsychological analysis was based on Mini-Mental test, Blessed Scale and Clinical Dementia Rating. We used the criteria of Monrad-Krohn to evaluate prosodic categories. We found intrinsic aprosody in 8 patients with Alzheimer's disease and in none of the patients with multi-infarct dementia (prevalence ratio: 1.82, 95% CI: 1.32-2.51), and emotional aprosody in 17 patients with Alzheimer's disease in comparison to 4 with multi-infarct dementia (prevalence ratio: 1.8, 95% CI: 1.04-3.18). The differences in intellectual and inarticulate aprosody were not significant. We conclude that aprosody is more frequent and severe in Alzheimer's disease than in multi-infarct dementia.