[Main components of Neuropsychiatric Inventory in Alzheimer's disease. Definition of behavioral syndromes]. / Componentes principales del Inventario Neuropsiquiátrico en la enfermedad de Alzheimer. Definición de síndromes de conducta.

INTRODUCTION: Behavioral disturbances are an important part of the clinical picture of Alzheimer's disease (AD). Behavior is usually assessed considering each symptom one by one. Few studies have tried a more comprehensive approach. We assessed behavior in AD patients in order to define patterns of behavioral disturbances, thereby improving its classification. PATIENTS AND METHODS: Ninety consecutive AD patients were evaluated from November 1997 to November 2000. All patients meet the NINCDS-ADRDA criteria for probable or possible AD. Patients with atypical clinical features were not included. Clinical evaluation included of the Neuropsychiatric Inventory ("chronic" scores), Mini-Mental State Examination, RDRS-2 and CDR. Statistical analysis was performed with factor analysis (SPSS). RESULTS: Factor analysis rendered a three-factor solution. Each factor can be considered a behavioral syndrome: the psychotic syndrome (hallucinations and delusions), the affective syndrome (depression, euphoria and anxiety) and the discontrol syndrome (agitation, irritability and disinhibition). A relevant number of patients had mild behavioral disturbances, not meeting statistical criteria for the syndromes defined above. CONCLUSIONS: Behavioral disturbances in AD can be classified into four groups or syndromes. Our results are in accordance with and expand the results of previous reports, using different behavior scales and statistical analysis. Future studies must be aimed at better characterizing the extensive group with mild behavioral disturbances, not sufficiently defined by the methods applied in the present and previous studies.

Componentes principales del inventario neuropsiquiátrico en la enfermedad de Alzheimer: definición de síndromes de conducta / Main components in neuropsychiatric inventory in Alzheimer's disease: definition of behavioral syndromes

Introducción. Los trastornos de conducta constituyen una manifestación clínica relevante en la enfermedad de Alzheimer (EA). Habitualmente se evalúan considerando los síntomas uno a uno. Pocos estudios van más allá del síntoma aislado e intentan un análisis de los trastornos de conducta en su conjunto. Nos proponemos evaluar los trastornos de conducta en la EA para identificar patrones que permitan su sistematización y clasificación. Pacientes y métodos. Evaluamos 90 pacientes consecutivos desde noviembre de 1997 a noviembre de 2000 con criterios NINCDS-ADRDA para demencia tipo Alzheimer probable o posible. Se han excluido los pacientes con clínica atípica. La evaluación clínica incluye el Inventario Neuropsiquiátrico (puntuaciones "crónicas"), Mini-Mental, RDRS-2 y CDR. Se ha efectuado análisis estadístico de agrupación de variables (análisis factorial, SPSS-Copyright). Resultados. Se obtiene una solución de tres factores, que pueden considerarse como síndromes de conducta: síndrome psicótico (alucinaciones, delirios), afectivo (depresión, euforia, ansiedad) y discontrol (agitación, irritabilidad, desinhibición). Una proporción importante de pacientes tiene trastornos de conducta escasos, sin alcanzar las características de los síndromes mencionados. Conclusión. Los trastornos de conducta en la EA pueden sistematizarse en cuatro grupos o síndromes. Nuestros resultados son congruentes y amplían los obtenidos en estudios previos efectuados con instrumentos y análisis estadístico distintos. Los estudios futuros deben dirigirse a definir mejor el amplio grupo de pacientes con trastornos de conducta escasos

Introduction. Behavioral disturbances are an important part of the clinical picture of Alzheimer’s disease (AD). Behavior is usually assessed considering each symptom one by one. Few studies have tried a more comprehensive approach. We assessed behavior in AD patients in order to define patterns of behavioral disturbances, thereby improving its classification. Patients and methods. Ninety consecutive AD patients were evaluated from November 1997 to November 2000. All patients meet the NINCDS-ADRDA criteria for probable or possible AD. Patients with atypical clinical features were not included. Clinical evaluation included of the Neuropsychytric Inventory ("chronic" scores), Mini-Mental State Examination, RDRS-2 and CDR. Statistical analysis was performed with factor analysis (SPSS-Copyright). Results. Factor analysis rendered a three-factor solution. Each factor can be considered a behavioral syndrome: the psychotic syndrome (hallucinations and delusions), the affective syndrome (depression, euphoria and anxiety) and the dyscontrol syndrome (agitation, irritability and disinhibition). A relevant number of patients had mild behavioral disturbances, not meeting statistical criteria for the syndromes defined above. Conclusions. Behavioral disturbances in AD can be classified into four groups or syndromes. Our results are in accordance with and expand the results of previous reports, using different behavior scales and statistical analysis. Future studies must be aimed at better characterizing the extensive group with mild behavioral disturbances, not sufficiently defined by the methods applied in the present and previous studies

Projections from the 17/18 visual area transition zone to the ipsilateral visual field representation in the cat superior colliculus.

We demonstrate by retrograde tracing methods that the transition zone between visual cortical areas 17 and 18--where a representation of the ipsilateral visual field (IVF) has been described--projects to the IVF representation in the ipsilateral superior colliculus. The stratum griseum superficiale is the target of this retinotopically organized cortical projection to the rostral part of the superior colliculus.

[Multiple sclerosis lesions simulating an expansive process on CT]. / Lesiones de esclerosis múltiple que simulan un proceso expansivo en la TC.

Patients with multiple sclerosis may present clinical data suggestive of cerebral tumor. It has been accepted that multiple sclerosis failed to show expansive signs in the computerized tomography (CT). However, since 1979 a total number of 13 patients have been reported to have expansive images at the CT. We report 3 cases with clinical symptoms suggesting a cerebral tumor associated with expansive signs at the CT. The subsequent follow-up of these patients confirmed the diagnosis of clinically defined multiple sclerosis. The management of these patients is difficult. Those patients with previous history suggestive of multiple sclerosis should be probably treated with steroids and followed with serial CT. If a clear recovery was not achieved in a relatively short term, a cerebral biopsy is recommended to rule out a neoplasm. When the clinical presentation begins with signs suggestive of a neoplasm, the cerebral biopsy is recommended.

[Multifocal polyneuropathy with persistent conduction blockage. A new subset of chronic inflammatory polyneuropathies]. / Polineuropatía multifocal con bloqueos de conducción persistentes. Un nuevo subgrupo dentro de las polineuropatías inflamatorias crónicas.

Recently a subset of chronic demyelinating inflammatory polyneuropathies with asymmetrical involvement limited to upper limbs, at least at the onset, resembling a multifocal mononeuropathy has been described. Electrodiagnostic testing disclosed multifocal CB outside the common entrapment sites has been described. We report a 55 years old man with a 4 years history of paresis, numbness, fasciculations, myokymia, cramps and mild amyotrophy. Electrophysiological evaluation showed proximal multifocal conduction block and abundant spontaneous activity as fasciculations, myokymia and scarce denervation activity. The importance of taking into account this entity in the differential diagnosis of patients with suspected mononeuritis multiplex or motoneuron disease is emphasized. The nosologic place of this entity is also discussed.

Absence status following metrizamide myelography: management of nonresponders.

Acute confusional state following metrizamide myelography has been reported to occur in up to 2% of patients. These patients have been diagnosed as having toxic encephalopathy. Recently, various cases have been reported to have a nonconvulsive status (absence status or complex partial status) who responded well to diazepam or clonazepam therapy. However, some authors have described cases of nonresponders to anticonvulsive therapy. Failure of therapy can be dose-related. For this reason, our patient was closely monitored by EEG to determine if dose adjustment was warranted, thereby achieving good results.