Consumption of pharmaceuticals in primary non-Alzheimer's degenerative dementias : a cross-sectional study by the Registry of Dementias of Girona (ReDeGi).

BACKGROUND: Limited information exists regarding the consumption of psychopharmaceuticals for non-Alzheimer's degenerative dementias (n-ADDs), despite the fact that the treatment of neuropsychiatric symptoms of these diseases is an important challenge for clinicians. OBJECTIVE: The aim of this study was to describe sociodemographic and clinical data from 235 patients with various subtypes of n-ADD, together with the level of consumption of pharmaceuticals with central nervous system activity. METHODS: A descriptive, observational, cross-sectional study was conducted using the data registered by the Registry of Dementias of Girona, northeast Catalunya, Spain. All drugs were categorized according to the Anatomical Therapeutic Chemical Classification System. RESULTS: The results showed a high level of psychopharmaceutical prescription: 48.9 % of the n-ADD patients used acetylcholinesterase inhibitors and 9.8 % used memantine. Antipsychotics and benzodiazepines were prescribed to 45.5 and 46.8 % of the patients, respectively. Antidepressants were consumed by 70.2 % of the registered cases. CONCLUSIONS: High levels of psychopharmaceutical prescribing were observed in our study and many of these prescriptions lacked specific indications for n-ADDs. It is necessary to consider the risk-benefit relationship before prescribing pharmaceuticals. Specific training programmes will be necessary to improve the use of pharmaceuticals in n-ADD patients.

Profile and variables related to antipsychotic consumption according to dementia subtypes.

BACKGROUND: Antipsychotics (APs) are usually prescribed to deal with behavioral and psychological symptoms of dementia (BPSD), but poor outcomes, important side effects, and high mortality risk should be addressed. The aim of this study was to estimate the prevalence of AP consumption in patients with dementia, and to describe and compare the sociodemographic and clinical characteristics of patients consuming APs. METHODS: This was a cross-sectional study using 1,894 cases of dementia registered from 2007 to 2009 by the Registry of Dementias of Girona (ReDeGi), which is a population-based passive surveillance system of dementia diagnoses. APs were categorized according to the anatomical therapeutic chemical (ATC) classification, and grouped as typical antipsychotics (TAPs) or atypical antipsychotics (AAPs). Binary logistic regression analyses were used to detect the predictors of AP use as well as the variables associated with TAP or AAP prescription. RESULTS: APs were used in 29.6% of the cases, with Parkinsonian syndromes (PSd) being the subtype of dementia with the highest AP prescription (50.6% of the patients with PSd). AAPs were mainly prescribed in all subtypes of dementia, except in vascular dementia (VaD) and PSd, where no preference in TAP or AAP use was found. Psychotic antecedents, dementia with Lewy bodies (DLB) diagnoses, cognitive impairment, and BPSD were AP use predictors. AAP use was related to higher severity of dementia. CONCLUSIONS: Despite their disputed benefit-risk ratios, APs are extensively used, off-label, to treat BPSD, and AAPs are more commonly prescribed than TAPs. AP consumption was frequent in DLB, and was related to dementia severity indicators.

Trastorno de conducta durante el sueño REM como primera manisfestación de atrofia olivopontocerebelosa / Rem sleep behaviour disorder as an early marker of olivopontocerebellar atrophy

INTRODUCCIÓN. El Trastorno de Conducta durante el Sueño REM (TCSR) se caracteriza por pérdida de la atonía muscular propia de este estadio, acompañándose de actos motores. Se ha asociado a diversas enfermedades neurodegenerativas. Describimos un paciente con TCSR como síntoma inicial de enfermedad neurodegenerativa consistente en demencia, ataxia y parkinsonismo. CASO CLÍNICO. Varón de 55 años remitido por hipersomnia en 2002. La anamnesis constata TCSR de doce años de evolución. La exploración y Escala Epworth de Somnolencia fueron normales. La PSG mostró un patrón respiratorio normal y un incremento importante del tono muscular durante el sueño REM. Diagnosticado como parasomnia REM se inició tratamiento. Al año refiere acusada pérdida de memoria, dificultad para aparcar, sensación de "caminar sobre algodones" y su familia constata cambio conductual. La exploración evidenció marcha atáxica, dismetría, disdiadococinesia izquierdas y Romberg positivo. La TC y SPET craneales y el EEG fueron normales. En 2005 se añadió rigidez extrapiramidal izquierda, incontinencia urinaria y habla escándida con empeoramiento del deterioro cognitivo y la dificultad para la marcha. En ese momento una TC craneal muestra atrofia cerebelosa y el SPET moderada hipoperfusión cortical difusa y cerebelosa y disminución de perfusión de ganglios basales y tálamo izquierdo. CONCLUSIÓN. Este caso ilustra la necesidad de un seguimiento de los pacientes con TCSR por la posibilidad de representar el primer síntoma de una enfermedad neurodegenerativa de desarrollo posterior (AU)

INTRODUCTION. The REM Sleep Behaviour Disorder (RBD) is characterised by the intermittent loss of REM sleep atonia and the appearance of elaborate motor activity associated to dream mentation. It has been associated to some neurodegenerative diseases. We describe a patient suffering from RBD as initial symptom of neurodegenerative disease consisting of dementia, ataxia and parkinsonism. CASE REPORT. Man, 55 years old, remitted in 2002 for hypersomnia. Anamnesis showed a twelve years RBD evolution. Neurological examination and Epworth Sleepiness Scale were normal. Nocturnal PSG showed a normal respiratory pattern and important increase of muscular tone during REM sleep. Diagnosed as REM parasomnia, corresponding treatment was started. One year later, he related a noticeable memory loss, difficulty for parking, sensation of "walking on cotton" and his family mentioned a behavioural change. During exploration, ataxic gait, left dismetry, disdiadochokinesia and positive Romberg were found. Cerebral TC and SPET were normal. In 2005, extrapyramidal left rigidity, urinary incontinence and scandidum speech talk with worsening of cognitive impairment and difficulty for walking appeared. The performed cranial TC showed cerebellar atrophy and the SPET moderated cortical diffuse and cerebellar hypoperfusion and perfusion diminution in basal ganglia and left thalamus. CONCLUSION. This case report shows the necessity of controlling patients suffering from RBD, since this disorder might be the first symptom of a neurodegenerative disease (AU)

Excitability of subcortical motor circuits in Go/noGo and forced choice reaction time tasks.

The size of the response to a startling auditory stimulus (SAS) may reflect the excitability of the reticulospinal tract. In this study, we examined whether there was any excitability change in the reticulospinal tract during preparation for execution of two types of choice reaction time task: a forced choice reaction time task (fCRT) and a Go/no-Go task (GnG). In 13 healthy volunteers we used three types of trials: control trials in which subjects were requested to perform ballistic wrist movements during fCRT or GnG tasks; test trials in which a SAS was presented with the visual cue, and baseline trials in which SAS was presented alone. Latency and area of the responses to SAS were measured in the orbicularis oculi and in the sternocleidomastoid (SCM) muscles. The results obtained in baseline trials were used to calculate the mean resting baseline excitability level of the reticulospinal tract for each individual, and the values obtained in test trials were expressed as percentages of mean baseline for normalization of data from all individuals. The area of the responses to SAS in SCM was significantly larger in fCRT than in GnG (p=0.002). There was a significant shortening of reaction time in test trials that was inversely correlated with area of SCM (p<0.05). We conclude that the subcortical motor tracts activated by SAS are more excitable during fCRT tasks than GnG tasks. Changing the excitability of subcortical motor structures may be a strategy used by the central nervous system in motor control that is selected according to the motor program.