Incidence and subtypes of early-onset dementia in a geographically defined general population.

OBJECTIVE: To estimate the incidence of early-onset dementia (EOD) and to compare the clinical characteristics of EOD vs late-onset dementia (LOD) in a geographically defined area. METHODS: We used data from the Registry of Dementia of Girona (ReDeGi), an epidemiologic surveillance system of dementia. The ReDeGi is a standardized clinical registry of new dementia cases diagnosed in the 7 hospitals of the Health Region of Girona (Catalonia, Spain), which encompasses an area of 5,517 km(2) and 690,207 inhabitants. EOD cases were defined as those patients residing in the target area at the time of diagnosis who were diagnosed with dementia with an age at onset of symptoms before 65 years. RESULTS: The ReDeGi registered 2,083 patients between January 1, 2007, and December 31, 2009 (6.9% EOD). The incidence rate of EOD for the age range 30-64 was 13.4 cases per 100,000 person-years (95% confidence interval 11.3-15.8). Alzheimer disease was the most frequent cause of EOD (42.4%), followed by secondary dementia (18.1%), vascular dementia (13.8%), and frontotemporal dementia (9.7%). EOD cases at the time of diagnosis were less impaired on the Mini-Mental State Examination and had a greater score on the Blessed Dementia Rating Scale behavior subscale than LOD cases. The frequency of a personal history of depression was higher in EOD cases. CONCLUSIONS: The incidence of EOD was less than 6 cases per 100,000 person-years in the age group 30-49 years; in the age group 50-64 years, the incidence rate was 3-fold higher and doubled with each 5-year increase.

[Prevalence of cognitive deterioration in people over 80-years-old: COGMANLLEU study]. / Prevalencia de deterioro cognitivo en personas mayores de 80 años: estudio COGMANLLEU.

INTRODUCTION: We want to detect the prevalence of cognitive prevalence deterioration in the elderly population of 80-years-old or older, their grade of deterioration and the causal pathogenic entity. DESIGN: a cross-sectional population study, including a first phase of screening and a second one of diagnosis confirmation. STUDY SUBJECTS: a total of 877 elderly people of 80-years-old or older belonging to the basic health care area of Manlleu (Osona, Catalonia midlands). In the first phase, relatives and/or caregivers were interviewed, and the participating subjects underwent a set of tests. Those who obtained 24 points or less on the Mini-Mental State Examination (MMSE) and/or an equal Global Deterioration Scale (GDS) or over 3 were admitted to the second phase. During the second phase, a general and a neurological examination were performed, along with blood tests, cranial computed tomography scan and a neuropsychological study. DSM-IV criteria were used for dementia diagnosis, NINCDS-ADRA criteria for Alzheimer's disease (AD) and NINCS-AIREN for vascular dementia. RESULTS: Half of the people over 80-years-old had cognitive deterioration. One-fourth had dementia. A total of 70.3% of these dementias corresponded to AD (47.2% AD without vascular lesions and 23.1% AD with vascular lesions) and 12% corresponded to vascular dementia. The percentage of other degenerative dementias was 17.6%. Age and gender were observed to be associated to dementia. CONCLUSIONS: The prevalence of dementia in the COGMANLLEU study is similar to other European studies. AE is the most frequent dementia.

[Genetic and environmental factors that may influence in the senile form of Alzheimer's disease: nested case control studies]. / Factores genéticos y ambientales que pueden influir en la forma senil de la enfermedad de Alzheimer: estudio de casos y controles anidado.

INTRODUCTION: We identify the genetic and environmental factors associated to Alzheimer's disease (AD) in a population aged 80 years or greater. POPULATION STUDIED: subjects who participated in the COGMANLLEU study on prevalence of cognitive deterioration in Manlleu (Osona, Central Catalonia). DESIGN: nested case control studies. The subjects who were diagnosed of AD (cases) in phases 2 of said study were paired 1:1 by age and gender with control subjects who were selected from among those who had no suspicion of cognitive deterioration and who had been examined in phase 1 of the study. The participating subjects (cases and controls) and their family or caregivers were interviewed. This included psychometric tests, physical examination, biological measurements, cranial computed tomography scan and determination of ApoE genotype. RESULTS: Age is the principal factor associated to AD: risk of getting the disease is six time greater among those over 85 years (odds ratio [OR]: 6.54; 95% confidence interval [CI]: 2.05-20.81; p<0.05). Other factors associated of AD were female gender (OR: 3.17; 95 % CI: 0.80-12.50) and having been exposed to general anesthesia (OR: 3.22; 95 % CI: 1.03-10.09; p < 0.05). Arterial hypertension (AHT) presented a negative association (OR: 0.37; 95% CI: 0.10-1.31; p<0.05). An association was also observed between AD and the presence of ApoE4 allele so that the likelihood of ApoE4 in subjects with AD was three times greater than in the control group (OR: 3.44; 95% CI: 0.67-17.62). CONCLUSIONS: The results agree with the hypothesis that senile AD is a complex, multifactorial disease in which different genetic and environmental factors play a part, among which having received general anesthesia has a role that can be considered in future research.

Prevalencia de deterioro cognitivo en personas mayores de 80 años: estudio COGMANLLEU / Prevalence of cognitive deterioration in people over 80 years old: COGMANLLEU study

Introducción. Se quiere detectar la prevalencia de deteriorocognitivo en la población de edad igual o superior a 80 años, asícomo el grado de deterioro y la entidad patológica causal.Método. Diseño: estudio transversal de base poblacional con unaprimera fase de cribado y una segunda fase de confirmación del diagnóstico.Sujetos de estudio: 877 personas de edad igual o mayor a 80años adscritas al área básica de salud de Manlleu (Osona, Cataluñacentral). En la primera fase se realizó una entrevista a familiares y/o acuidadores y se pasó una batería de tests a los sujetos participantes.Pasaron a la segunda fase los que obtuvieron una puntuación igual omenor a 24 en el Mini-Mental State Examination (MMSE) y/o una EscalaGlobal de Deterioro (GDS) igual o superior a 3. En la segunda fasese procedió a la exploración general y neurológica, a la realización deuna analítica, tomografía computerizada craneal y estudio neuropsicológico.Para el diagnóstico de demencia se utilizaron los criteriosdel DSM-IV, para la enfermedad de Alzheimer (EA) los del NINCDSADRDAy para la demencia vascular los del NINCS-AIREN.Resultados. La mitad de las personas mayores de 80 años presentabandeterioro cognitivo. Una cuarta parte presentaban demencia.El 70,3 % de las demencias correspondía a EA (47,2% EA sin lesionesvasculares y 23,2% EA con lesiones vasculares) y el 12% ademencia vascular. El porcentaje de otras demencias degenerativas ysecundarias fue del 17,6%. Se observó asociación de la demenciacon la edad y el género.Conclusiones. La prevalencia de demencia en el estudio COGMANLLEUes similar a la descrita en otros estudios europeos. La EAconstituye la demencia más frecuente (AU)

Introduction. We want to detect the prevalence of cognitiveprevalence deterioration in the elderly population of 80 years oldor older, their grade of deterioration and the causal pathogenicentity.Method. Design: a cross-sectional population study, includinga first phase of screening and a second one of diagnosisconfirmation. Study subjects: a total of 877 elderly people of 80years old or older belonging to the basic health care area of Manlleu(Osona, Catalonia midlands). In the first phase, relativesand/or caregivers were interviewed, and the participating subjectsunderwent a set of tests. Those who obtained 24 points orless on the Mini-Mental State Examination (MMSE) and/or anequal Global Deterioration Scale (GDS) or over 3 were admittedto the second phase. During the second phase, a general and aneurological examination were performed, along with bloodtests, cranial computed tomography scan and a neuropsychologicalstudy. DSM-IV criteria were used for dementia diagnosis,NINCDS-ADRA criteria for Alzheimer’s disease (AD) and NINCSAIRENfor vascular dementia.Results. Half of the people over 80 years old had cognitivedeterioration. One-fourth had dementia. A total of 70.3% of thesedementias corresponded to AD (47.2% AD without vascularlesions and 23.1% AD with vascular lesions) and 12 % correspondedto vascular dementia. The percentage of other degenerativedementias was 17.6%. Age and gender were observed to beassociated to dementia.Conclusions. The prevalence of dementia in the COGMANLLEUstudy is similar to other European studies. AE is the mostfrequent dementia (AU)

Factores genéticos y ambientales que pueden influir en la forma senil de laenfermedad de Alzheimer: estudiode casos y controles anidado / Genetic and environmental factors that may influence in the senile form of Alzheimer's disease: nested case control studies

Introducción. Se identifican los factores genéticos y ambientalesasociados a la enfermedad de Alzheimer (EA) en una población deedad igual o superior a 80 años.Método. Población estudiada: sujetos que participaron en el estudioCOGMANLLEU sobre prevalencia de deterioro cognitivo en Manlleu(Osona, Cataluña central). Diseño: estudio de casos y controles anidado.Los sujetos que fueron diagnosticados de EA (casos) en la fase 2 delmencionado estudio se emparejaron 1:1 por edad y sexo a sujetos controlque se seleccionaron entre los que no presentaron ninguna sospechade deterioro cognitivo y que habían sido examinados en la fase 1del estudio. Se realizó una entrevista a los sujetos participantes (casosy controles) y a sus familiares o cuidadores que incluyó pruebas psicométricas,exploración física, determinaciones biológicas, tomografíacomputarizada craneal y determinación del genotipo ApoE.Resultados. La edad es el principal factor asociado a la EA: elriesgo de contraer la enfermedad es seis veces superior entre los mayoresde 85 años (odds ratio [OR]: 6,54; intervalo de confianza [IC]95%: 2,05-20,81; p<0,05). Otros factores asociados a la EA fueron elsexo femenino (OR: 3,17; IC 95 %: 0,80-12,50) y haber estado expuestosa anestesia general (OR: 3,22; IC 95%: 1,03-10,09; p<0,05).La hipertensión arterial (HTA) presentaba una asociación negativa(OR: 0,37; IC 95 %: 0,10-1,31; p<0,05). También se observó asociaciónentre la EA y la presencia del alelo ApoE4 de manera que la probabilidadde ApoE4 en los sujetos con EA era tres veces superior a ladel grupo control (OR: 3,44; IC 95%: 0,67-17,62).Conclusiones. Los resultados concuerdan con la hipótesis deque la EA senil es una enfermedad compleja, multifactorial, en la queintervienen diversos factores genéticos y ambientales entre los queel recibir anestesia general puede desempeñar un papel a consideraren investigaciones futuras (AU)

Introduction. We identify the genetic and environmentalfactors associated to Alzheimer's disease (AD) in a populationaged 80 years or greater.Method. Population studied: subjects who participated in theCOGMANLLEU study on prevalence of cognitive deterioration inManlleu (Osona, Central Catalonia). Design: nested case controlstudies. The subjects who were diagnosed of AD (cases) in phases2 of said study were paired 1:1 by age and gender with controlsubjects who were selected from among those who had no suspicionof cognitive deterioration and who had been examined inphase 1 of the study. The participating subjects (cases and controls)and their family or caregivers were interviewed. This includedpsychometric tests, physical examination, biological measurements,cranial computed tomography scan and determinationof ApoE genotype.Results. Age is the principal factor associated to AD: risk ofgetting the disease is six time greater among those over 85 years(odds ratio [OR]: 6.54; 95% confidence in-terval [CI]: 2.05-20.81;p<0.05). Other factors associated of AD were female gender (OR:3.17; 95 % CI: 0.80-12.50) and having been exposed to generalanesthesia (OR: 3.22; 95 % CI: 1.03-10.09; p < 0.05). Arterialhypertension (AHT) presented a negative association (OR: 0.37;95% CI: 0.10-1.31; p<0.05). An association was also observedbetween AD and the presence of ApoE4 allele so that the likelihoodof ApoE4 in subjects with AD was three times greater thanin the control group (OR: 3.44; 95% CI: 0.67-17.62).Conclusions. The results agree with the hypothesis that senileAD is a complex, multifactorial disease in which different geneticand environmental factors play a part, among which havingreceived general anesthesia has a role that can beconsidered in future research (AU)

Características clínicas de una serie de 134 pacientes con infarto lacunar / Clinical characteristics of a serie of 134 patients with lacunar infarct

Objetivo: estudio comparativo del infarto lacunar IL versus infarto de otra categoría clínica INL. Pacientes/método: análisis prospectivo de 354 pacientes con ictus isquémico ingresados consecutivamente en nuestro hospital durante un año. Se consideraron dos grupos IL (37,9%9 e INL (62,1%). Se comparan edad, sexo, factores de riesgo, grado de déficit neurológico, latencia de ingreso hospitalario, estancia media, evolución, mortalidad y pronóstico a los tres meses. Resultados: los pacientes con IL son más jóvenes (70,81 vs 75,05 años; p<0,0001), la gravedad del déficit neurológico es menor (p<0,0001), el pronóstico funcional semanal es significativamente mejor (p<0,0001) y presentan una menor mortalidad hospitalaria (p<0,001). No encontramos diferencia en la latencia de ingreso, pronóstico trimestral ni tampoco en los factores de riesgo vascular exceptuando la fibralación auricular (p<0,0001). El análisis multivariante confirma como predictores IL la diabetes mellitus (OR: 2.23), el desconocimiento de la hora de inicio del ictus (OR: 2.12), el índice de Barthel semanal (OR: 2,279, la fibrilación auricular (OR: 0.095), el antecedente de ictus previo (OR: 0,43) y una Escala Canadiense ≤ 5 en el momento del ingreso (OR: 0.193). Conclusión: la categoría clínica de IL cursa con factores de riesgo independientemente asociados (diabetes mellitus) y diferencias significativas en el pronóstico a corto plazo (estancia hospitalaria, desarrollo de complicaciones, mortalidad y calidad de vida a los siete días) (AU)

Aim: a comparative study between lacuanr infarct LI and non-lacunar infarct NLI. Patients/methods: a prospective analysis of 134 patients suffering from ischemic infarct that were consecutively hospitalized during a year. Two groups were considered: LI (39,1%) and NLI (62,1%). Age sex, risk factors, degree of neurological deficit, time for being in hospital, evolution, mortality and functional outcome at three months. Results: patients with LI are younger (70,81 vs 75,05 years; p<0,0001), with a mild degree of neurological deficit (p<0,0001), funcional outcome at the seventh day is better (p<0,0001) adn had a lower in hospital mortality (p<0,0001). We do not found any difference about time to be hospitalized, three-month functional outcome and risk factors except for atrial fibrilation (p<0,0001). Multivariate analysis confirms as predictors of Li diabetes mellitus (OR: 2.23), unknown time of stroke onset (OR; 2,12), the seven-day Barthel Index (OR:2,27) atrial fibrilation (OR; 0,095) previous stroke (OR; 0,43) and acute Canadian scale ≤5 (Or: 0,193). Conclusions: LI associates independent risk factors (diabetes mellitus) and significative differences in the immediate clinical features (median time of hospital-stay, mortality, seven-day funcional outcome) (AU)

["Household items" : an alternative task to "animals" in the assessment of semantic verbal fluency: a validation study]. / "Cosas en una casa", una tarea alternativa a "animales" en la exploración de la fluidez verbal semántica: estudio de validación.

INTRODUCTION: The semantic verbal fluency (SVF) is usually evaluated with the task animals in 1 minute . This is a test widely applied in the screening of cognitive impairment. In our best knowledge there are not other alternatives categories for this task validated in our environment (Spanish as mother tongue, Spain). OBJECTIVE: To validate the category households items as an alternative parallel task to animals in the assessment of SVF. PATIENTS AND METHODS: Prospective assessment of two categories (animals and household items) in two groups: normal controls and patients with Alzheimer s disease (AD). CONTROL GROUP: n= 22 (13 M, 9 W); age: 73 5 years, education: 12 5 years; MMSE MEC 35: 30 4; Animals : 15 4. Percentile distribution 10th: 11; 50th: 15; 90th: 20; household items : 17 4. Percentile distribution: 10th: 12; 50th: 17; 90th: 22. AD group: n= 24 (9 M, 15 W); age: 74 5 years; education: 11 5 years; MMSE MEC 35: 17 8; Animals : 6 3. Percentile distribution: 10th: 2; 50th: 6; 90th: 9; household items : 6 4. Percentile distribution: 10th: 1; 50th: 6; 90th: 11. It is observed a positive correlation between the two categories (Spearman s Rho: 0.83, p< 0.0001). CONCLUSIONS: Both SVF categories had a similar distribution and a high correlation. This findings demonstrated the validity of the household items as an alternative and parallel form to animals in the assessment of SVF in patients with cognitive impairment or dementia.

'Cosas en una casa', una tarea alternativa a 'animales' en la exploración de la fluidez verbal semántica:estudio de validación / 'Household items': an alternative task to 'animals' in the assessment of semantic verbal fluency. A validation study

Introducción. La fluidez verbal semántica (FVS) se explora habitualmente con la tarea `animales en un minuto', un test que se utiliza generalmente para evaluar el deterioro cognitivo. En nuestro conocimiento no existen tareas de exploración alternativas para esta categoría validadas en nuestro medio (población española y el castellano como lengua materna). Objetivo. Validación de la categoría `cosas que hay en una casa' como forma alternativa para la categoría `animales' en la exploración de la FVS. Pacientes y métodos. Evaluación prospectiva de un grupo control y un grupo de pacientes con la enfermedad de Alzheimer (EA), de la FVS en dos categorías paralelas (animales y cosas en una casa). Resultados. Grupo control: n= 22 (13 H y 9 M); edad: 73ñ5 años; escolaridad:12ñ5 años; MEC-35: 30ñ4; `animales': 15ñ4. Dist. percentil: P-10: 11; P-50: 15; P-90: 20; `cosas en una casa': 17ñ4. Dist. percentil: P-10: 12; P-50: 17; P90: 22. Grupo Alzheimer: n= 24 (9 H y 15 M); edad: 74ñ5 años; escolaridad: 11ñ5 años; MEC-35: 17ñ8; `animales': 6ñ3. Dist. percentil: P-10: 2; P-50: 6; P-90: 9; `cosas en una casa': 6ñ4. Dist. percentil: P-10: 1; P-50: 6; P-90: 11. Se observa una correlación positiva entre ambas categorías, Rho: 0,83, p< 0,0001.Conclusiones. Ambas categorías de FVS presentan una distribución percentil similar y una alta correlación, lo que demuestra su validez y permite su utilización sin restricciones como categorías paralelas de exploración de la FVS en pacientes con deterioro cognitivo (AU)

[Opercular syndrome of vascular aetiology]. / Síndrome opercular de etiología vascular.

INTRODUCTION: Facio linguo masticatory paralysis resulting from bilateral lesion of the anterior opercular region, known today as Foix Chavany Marie syndrome, appears very frequently in adult patients as a consequence of generally ischemic vascular lesions, which directly affect the Rolandic opercula or the subcortical area surrounding them. However, forms that are secondary to infections, neoplasias and even unilateral lesions have been reported. CASE REPORT: Female patient, aged 70, with unknown auricular fibrillation, which started suddenly with right faciobrachial paresis secondary to a left striated ischemic infarction. Approximately 24 hours after beginning intravenous heparinization, the patient presents anarthria, facial hypomimia without asymmetries, dysphagia above all for liquids and bilateral lingual paresis. Extraoccular movements, blinking and corneal reflex were normal. Understanding of spoken and written language was maintained and there were no apraxias or agnosias. Neurological exploration was compatible with an opercular syndrome (OS). Urgent brain CT revealed the existence of a right cortiico subcortical temporal haemorrhage, in addition to the prior contralateral ischemia. The association of both lesions, ischemic and haemorrhagic, mirrored, justified all the symptomatology. DISCUSSION: Anterior OS is characterised by a bilateral voluntary central paresis of the muscles innervated by the 5th, 7th, 9th, 10th and 12th cranial pairs with preservation of emotional or automatic mobility. Underlying mechanisms are also discussed.

Síndrome opercular de etiología vascular / Opercular syndrome of vascular aetiology

Introducción. La parálisis faciolinguomasticatoria por lesión bilateral de la región opercular anterior, conocida hoy como síndrome de Foix-Chavany-Marie, aparece en los pacientes adultos muy frecuentemente como consecuencia de lesiones vasculares generalmente isquémicas, que afectan directamente a los opérculos rolándicos o sus inmediaciones subcorticales. Se han descrito, no obstante, formas secundarias a infecciones, neoplasias e incluso lesiones unilaterales. Caso clínico. Paciente mujer, de 70 años de edad, con fibrilación auricular no conocida, que debuta bruscamente con paresia faciobraquial derecha secundaria a infarto isquémico estriado izquierdo. Aproximadamente 24 horas tras el inicio de la heparinización intravenosa, la paciente presentó anartria, hipomimia facial sin asimetrías, disfagia predominantemente para líquidos y paresia lingual bilateral. Los movimientos extraoculares, el parpadeo y el reflejo corneal eran normales. La comprensión del lenguaje oral y escrito se conservaba. No había apraxias ni agnosias. La exploración neurológica era compatible con un síndrome opercular (SO). La TAC cerebral de urgencia reveló la existencia de una hemorragia temporal corticosubcortical derecha, añadida a la previa isquémica con tralateral. La asociación de ambas lesiones, isquémica y hemorrágica, en espejo, justificaba toda la sintomatología. Discusión. El SO anterior se caracteriza por una paresia central voluntaria bilateral de los músculos inervados por los pares craneales V, VII, IX, X y XII, con preservación de la movilidad emocional o automática. Se discuten los mecanismos subyacentes (AU)

Pseudotumor cerebral: análisis de nuestra casuística y revisión de la literatura / Pseudotumor cerebri: analysis of our cases an review of the literature

Introducción. El pseudotumor cerebral (PC) es un síndrome complejo caracterizado por un aumento de la presión intracraneal (PIC) en ausencia de proceso expansivo, en general autolimitado aunque con frecuencia recidiva. El diagnóstico se basa en el registro del aumento de la PIC que será superior al límite de 250 mmH20. Su morbilidad radica básicamente en la posible pérdida visual asociada por la atrofia del nervio óptico. Cuando la etiología es desconocida esta entidad clínica se denomina hipertensión intracraneal idiopática. Pacientes y métodos. Presentamos las principales características de una serie de pacientes ingresados en nuestro servicio con el diagnóstico de PC y revisamos la literatura al respecto. Resultados. Ingresaron con el diagnóstico de PC 14 pacientes (12 mujeres y 2 varones). Doce pacientes empezaron con cefalea asociada o no a clínica visual. Los principales síntomas visuales fueron el oscurecimiento visual transitorio, escotomas, fotopsias y disminución de la agudeza visual. La cefalea fue holocraneal, continua y bien tolerada, o por el contrario uni o bilateral, pulsátil, moderada, con o sin fotofonofobia y con o sin náuseas o vómitos. En todos los pacientes se objetivó papiledema bilateral. En un caso existía además paresia facial bilateral y rigidez cervical. La campimetría fue patológica en cuatro casos (escotoma inferonasal, reducción concéntrica bilateral). La evolución fue tórpida en tan solo un caso. Conclusión. A pesar de su teórica benignidad y de las múltiples posibilidades terapéuticas, el PC puede generar una gran morbilidad visual que obliga a un precoz diagnóstico y a un estrecho seguimiento evolutivo (AU)

Memoria de trabajo y actividades complejas de la vida diariaen el estadio inicial de la enfermedad de Alzheimer / Working memory and complex activities of everyday life in the initial stages of Alzheimer´s disease

Introducción. La evaluación de la memoria de trabajo (MDT) permite analizar el grado de amnesia anterógrada y el déficit de fijación que existe en los pacientes con enfermedad de Alzheimer (EA). Las actividades de la vida diaria (AVD) complejas también se ven afectadas precozmente. Existe una estrecha interrelación entre el grado de deterioro cognitivo y la pérdida de competencia funcional en las AVD. Objetivo.Analizar el grado de pérdida de memoria y rendimiento en las AVD complejas en pacientes con EA y trastorno cognitivo leve. Pacientes y métodos. Evaluación de la afectación funcional con el cuestionario de actividad funcional de Pfeffer (FAQ) y la evaluación cognitiva mediante el protocolo de exploración de la MT en un grupo de 36 pacientes.Resultados. En la MDT total (4,2ñ5,7) existen diferencias significativas entre pacientes con alteración de memoria asociada a la edad (AMAE) (11ñ7) y EA posible (3,2ñ4,6), y entre AMAE y EA probable (2,8ñ4,8).La evaluación funcional de las AVD (FAQ) obtiene una media de 8,5ñ7,1 y existen diferencias significativas entre EA probables (11ñ8) y EA posibles (6ñ4) con el grupo AMAE 1ñ1,8. La correlación entre el FAQ y la MDT total es significativa (-0,70, p= 0,0001) y se observa que los pacientes con FAQ elevados son los que tienen menor puntuación en la MDT total.Conclusión. El FAQ y la MDT tienen una elevada correlación y son instrumentos útiles en la evaluación de pacientes con deterioro cognitivo en estadios iniciales (AU)

[Neurological alterations related to Crohn's disease]. / Alteraciones neurológicas relacionadas con la enfermedad de Crohn.

INTRODUCTION: The incidence of alterations of the central and/or peripheral nervous system in a patient with Crohn s disease (EC) is 33.2%. Casual association may occur in 19.3% of the cases. The disorder of the nervous system may precede the diagnosis of EC. DEVELOPMENT: We review the main neurological complications of EC. The predominant cerebral vascular pathology is arterial although cases of venous thrombosis have been reported. One of the mechanisms involved is the state of hypercoagulability secondary to thrombocytosis and increase in the factors V, V111 and fibrinogen. In other cases there was confirmation of the presence of antiphospholipid antibodies and lupus anticoagulant, and therefore of an autoimmune mechanisms being involved. Other neurological features include peripheral neuropathy (axonal, demyelinating and autonomic), myopathies, pseudotumor cerebri, papilloedema, psychiatric disorders (anxiety, phobias, depression) and association with syndromes such as multiple sclerosis, Cogan s syndrome, Melkersson Rosenthal syndrome, connective tissue disorders and vasculitis. CONCLUSION: As well as hypercoagulability being one of the pathogenic mechanisms of cerebral ischaemia, there is alteration of humoral and cellular immunity in patients with EC. This justifies this and other neurological manifestations, and explains its association with other immunity disorders.

Alteraciones neurológicas relacionadas con la enfermedad de Crohn / Neurological alterations related to Croh´s disease

Introducción. La incidencia de alteraciones en el sistema nervioso central o periférico en el paciente con enfermedad de Crohn (EC) es del 33,2 por ciento. Se considera que existe una asociación casual en el 19,3 por ciento de los casos. El compromiso del sistema nervioso puede preceder al diagnóstico de la EC. Desarrollo. Se revisan las principales complicaciones neurológicas de la EC. La patología vascular predominante a nivel cerebral es la arterial aun cuando se han notificado casos de trombosis venosa. Uno de los mecanismos implicados es el estado de hipercoagulabilidad secundario a trombocitosis e incremento de los factores V, VIII y fibrinógeno. En otros casos se ha confirmado la positividad de los anticuerpos antifosfolipídicos y anticoagulante lúpico y por lo tanto de un mecanismo autoinmune implicado. Otras manifestaciones neurológicas incluyen la neuropatía periférica (axonal, desmielinizante y autonómica), miopatías, pseudotumor cerebral, edema del disco óptico, alteraciones psiquiátricas (ansiedad, fobias, depresión) así como la asociación a entidades como la esclerosis múltiple, el síndrome de Cogan, el síndrome de Melkersson-Rosenthal, conectivopatías y vasculitis. Conclusión. Además de la hipercoagulabilidad como uno de los mecanismos patogénicos de la isquemia cerebral, existe una alteración de la inmunidad humoral y celular en pacientes con EC que justifica ésta y otras manifestaciones neurológicas, y explica su asociación con otras entidades de patogenia inmune (AU)

[Working memory and complex activities of everyday life in the initial stages of Alzheimer's disease]. / Memoria de trabajo y actividades complejas de la vida diaria en el estadio inicial de la enfermedad de Alzheimer.

INTRODUCTION: Evaluation of the working memory (WM) permits analysis of the degree of anterograde amnesia and fixation deficit present in patients with Alzheimer s disease (AD). Complex activities of everyday life (AEL) are also affected early. There is a close relation between the degree of cognitive deterioration and loss of functional competence in AEL. OBJECTIVE: To analyze the degree of memory loss and performance in carrying out complex AEL in patients with AD and mild cognitive disorder. PATIENTS AND METHODS: Evaluation of functional disorder, using Pfeffer s functional activity questionnaire (FAQ), and cognitive evaluation, using the WM examination protocol in a group of 36 patients. RESULTS: In the total MT (4.2+/-5.7) there were significant differences between patients with age associated memory impairment (AAMI) (11+/-7) and possible EA (3.2+/-4.6) and between AAMI and probable AD (2.8+/-4.8). The functional evaluation of the AEL (FAQ) gave a mean of 8.5+/-7.1. There were significant differences between probable AD (11+/-8) and possible EA (6+/-4) with the group AAMI 1+/-1.8. There was significant correlation between FAQ and total WM ( 0.70, p= 0.0001). It was found that patients with high FAQ scores had lower total WM scores. CONCLUSION: FAQ and WM have high correlation and are useful instruments for the evaluation of patients with cognitive deterioration at the initial stages.

[Pseudotumor cerebri: analysis of our cases and review of the literature]. / Pseudotumor cerebral: análisis de nuestra casuística y revisión de la literatura.

INTRODUCTION: Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self limiting, but often relapsing. Diagnosis is based on a record of intracranial pressure of over a limit of 250 mmH2O. Morbidity is basically due to possible loss of vision associated with atrophy of the optic nerve. When the aetiology is unknown this clinical condition is known as idiopathic intracranial hypertension. PATIENTS AND METHODS: We describe the principal characteristics of a series of patients who were admitted to our department with the diagnosis of PC and review the relevant literature. RESULTS: Altogether 14 patients (12 women and 2 men) were admitted with the diagnosis of PC. In 12 patients the disorder presented with headache, with or without associated symptoms of disorders of vision. The main visual symptoms were transient darkening of vision, scotomas, photopsias and reduction in visual acuity. The headache was holocranial, continuous and well tolerated or alternatively uni or bilateral, pulsatile, moderate, with or without photophobia, and with or without nausea and vomiting. Bilateral papilloedema was seen in all patients. In one case there was also bilateral facial palsy and neck rigidity. In four cases visual field measurement were abnormal (inferoneasal scotoma, bilateral concentric reduction). Progress was poor in only one case. CONCLUSIONS: In spite of being theoretically benign, and there being many forms of treatment, PC may cause considerable morbidity of vision. Therefore, early diagnosis and close follow up attention is essential.

Predicting eruptions at mount st. Helens, june 1980 through december 1982.

Thirteen eruptions of Mount St. Helens between June 1980 and December 1982 were predicted tens of minutes to, more generally, a few hours in advance. The last seven of these eruptions, starting with that of mid-April 1981, were predicted between 3 days and 3 weeks in advance. Precursory seismicity, deformation of the crater floor and the lava dome, and, to a lesser extent, gas emissions provided telltale evidence of forthcoming eruptions. The newly developed capability for prediction reduced risk to life and property and influenced land-use decisions.