Effect of probiotics on cognitive function in adults with mild cognitive impairment or Alzheimer's disease: A meta-analysis of randomized controlled trials.

BACKGROUND: Recent clinical studies have yielded controversial results regarding the effect of probiotics on cognitive function in Alzheimer's disease (AD) or mild cognitive impairment (MCI) subjects. To clarify the efficacy of probiotics on cognition, we conducted a meta-analysis of randomized controlled trials (RCTs). METHODS: Instructions of the PRISMA 2020 statement were followed. Literature from the PubMed, Embase and Cochrane databases were systematically searched and manually screened for relevant published RCTs. We performed statistical analysis using RevMan, and assessed the risk of bias using the R software. RESULTS: A total of 12 studies comprising 852 patients with MCI or AD were identified. The results of meta-analysis showed that probiotics improved global cognitive function (SMD=0.67; 95% CI, 0.32, 1.02), recall/delayed memory (SMD=0.67; 95% CI: 0.32, 1.02), attention (SMD=0.31; 95% CI: 0.04, 0.58) and visuospatial/constructional (SMD=0.24; 95% CI: 0.06, 0.42) cognitive domain. CONCLUSION: This meta-analysis found that probiotic supplementation is associated with an improvement in cognitive performance among patients with AD and MCI. However, current evidence is limited, and more reliable large-scale RCTs with higher methodological quality are needed.

Asociación entre periodontitis, enfermedad cerebrovascular y demencia. Informe científico del Grupo de Trabajo de la Sociedad Española de Periodoncia y la Sociedad Española de Neurología / The association between periodontitis, cerebrovascular disease, and dementia. Scientific report of the Working Group of the Spanish Society of Periodontology and the Spanish Society of Neurology

Objetivo: Revisar la evidencia científica disponible sobre la relación entre la periodontitis y las enfermedades neurológicas, en particular la enfermedad cerebrovascular y la demencia. Además, se facilitan una serie de recomendaciones en relación con la prevención y el manejo de la periodontitis y estas enfermedades neurológicas desde las consultas dentales y las unidades de neurología. Desarrollo: Se realizó una búsqueda bibliográfica sin restricción en cuanto al diseño del estudio para identificar aquellos artículos más relevantes sobre la asociación entre periodontitis, enfermedad cerebrovascular y demencia desde un punto de vista epidemiológico, de intervención, así como de mecanismos biológicos involucrados en estas relaciones, y así responder a diferentes preguntas planteadas por los miembros del Grupo de Trabajo SEPA-SEN. Conclusiones: La periodontitis aumenta el riesgo de ictus isquémico y demencia de tipo Alzheimer. Bacteriemias recurrentes con aumento de un estado inflamatorio sistémico de bajo grado parecen ser posibles mecanismos biológicos que explicarían esta asociación. Una evidencia limitada apunta a que diferentes intervenciones de salud oral pueden reducir el riesgo futuro de padecer enfermedad cerebrovascular y demencia.(AU)

Objective: This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. Development: In response to a series of questions proposed by the SEPA-SEN Working Group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. Conclusions: Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia.(AU)

The potential diagnostic accuracy of circulating microRNAs for Alzheimer's disease: A meta-analysis.

BACKGROUND & OBJECTIVE: Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease that seriously affects cognitive ability and has become a key public health problem. Many studies have identified the possibility of peripheral blood microRNA as effective non-invasive biomarkers for AD diagnosis, but the results are inconsistent. Therefore, we carried out this meta-analysis to evaluate the diagnostic accuracy of circulating microRNAs in the diagnosis of AD patients. METHODS: We performed a systematic literature search of the following databases: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure, updated to March 15, 2021. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity, and Deeks' funnel plot was used to assess whether there was publication bias. RESULTS: 62 studies from 18 articles were included in this meta-analysis. The pooled sensitivity was 0.82 (95% CI: 0.78-0.85), specificity was 0.80 (95% CI: 0.76-0.83), PLR was 4. 1 (95% CI: 3.4-4.9), NLR was 0.23 (95% CI: 0.19-0.28), DOR was 18 (95% CI: 13-25) and AUC was 0.88 (95% CI: 0.84-0.90). Subgroup analysis shows that the microRNA clusters of plasma type performed a better diagnostic accuracy of AD patients. In addition, publication bias was not found. CONCLUSIONS: Circulating microRNAs can be used as a promising non-invasive biomarker in AD diagnosis.

The potential diagnostic accuracy of circulating microRNAs for Alzheimer's disease: A meta-analysis / La precisión diagnóstica de los microARN circulantes para la enfermedad de Alzheimer: un metaanálisis

Background & objective Alzheimer's disease (AD) is a progressive and irreversible neurodegenerative disease that seriously affects cognitive ability and has become a key public health problem. Many studies have identified the possibility of peripheral blood microRNA as effective non-invasive biomarkers for AD diagnosis, but the results are inconsistent. Therefore, we carried out this meta-analysis to evaluate the diagnostic accuracy of circulating microRNAs in the diagnosis of AD patients. Methods We performed a systematic literature search of the following databases: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database and China National Knowledge Infrastructure, updated to March 15, 2021. A random effects model was used to pool the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the curve. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity, and Deeks’ funnel plot was used to assess whether there was publication bias. Results 62 studies from 18 articles were included in this meta-analysis. The pooled sensitivity was 0.82 (95% CI: 0.78–0.85), specificity was 0.80 (95% CI: 0.76–0.83), PLR was 4. 1 (95% CI: 3.4–4.9), NLR was 0.23 (95% CI: 0.19–0.28), DOR was 18 (95% CI: 13–25) and AUC was 0.88 (95% CI: 0.84–0.90). Subgroup analysis shows that the microRNA clusters of plasma type performed a better diagnostic accuracy of AD patients. In addition, publication bias was not found. Conclusions Circulating microRNAs can be used as a promising non-invasive biomarker in AD diagnosis. (AU)

Antecedentes y objetivo La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa progresiva e irreversible que afecta gravemente la capacidad cognitiva y se ha convertido en un problema clave de salud pública. Muchos estudios han identificado la posibilidad de que los microARN de sangre periférica sean biomarcadores no invasivos para el diagnóstico de la EA, pero los resultados son inconsistentes. Por lo tanto, llevamos a cabo este metaanálisis para evaluar la precisión diagnóstica de los microARN circulantes en el diagnóstico de pacientes con EA. Métodos Realizamos una búsqueda bibliográfica sistemática de las siguientes bases de datos: PubMed, EMBASE, Web of Science, Cochrane Library, Wanfang database y China National Knowledge Infrastructure, actualizado a 15 de marzo de 2021. Se utilizó un modelo de efectos aleatorios para agrupar la sensibilidad, especificidad, razón de probabilidad positiva, razón de probabilidad negativa, razón de probabilidades de diagnóstico y área bajo la curva. Se realizó una metarregresión y un análisis de subgrupos para explorar las fuentes de heterogeneidad, y se utilizó el gráfico en embudo de Deek's para evaluar si había sesgo de publicación. Resultados En este metaanálisis se incluyeron 62 estudios de 18 artículos. La sensibilidad combinada fue de 0,82 (IC 95%: 0,78-0,85), la especificidad fue de 0,80 (IC 95%: 0,76-0,83), la PLR fue de 4,1 (IC 95%: 3,4-4,9), la NLR fue de 0,23 (IC 95%: 0,19-0,28), la DOR fue de 18 (IC 95%: 13-25) y el AUC fue de 0,88 (IC 95%: 0,84-0,90). El análisis de subgrupos muestra que los microARN clústeres de tipo plasmático tuvieron una mejor precisión diagnóstica de pacientes con EA. Además, no se encontró sesgo de publicación. Conclusión Los microARN circulantes pueden utilizarse como un biomarcador no invasivo prometedor para el diagnóstico de la EA. (AU)

Performance on the Latin American version of the Face-Name Associative Memory Exam (LAS-FNAME) distinguishes individuals with Mild Cognitive Impairment from age-matched controls in a sample from Argentina.

INTRODUCTION: The Latin American Spanish version of the Face-Name Associative Memory Exam (LAS-FNAME) has shown promise in identifying cognitive changes in those at risk for Alzheimer's disease (AD). However, its applicability for Mild Cognitive Impairment (MCI) detection in the Latin American population remains unexplored. This study aims to analyze the psychometric properties in terms of validity and reliability and diagnostic performance of the LAS-FNAME for the detection of memory disorders in patients with amnestic MCI (aMCI). MATERIALS AND METHODS: The study included 31 participants with aMCI, diagnosed by a neurologist according to Petersen's criteria, and 19 healthy controls. Inclusion criteria for the aMCI group were to be 60 years of age or older, report cognitive complaints, have a memory test score (Craft Story 21) below a -1.5 z-score and have preserved functioning in activities of daily living. Participants completed LAS-FNAME and a comprehensive neuropsychological assessment. RESULTS: LAS-FNAME showed the ability to discriminate against healthy controls from patients with aMCI (AUC= 75) in comparison with a gold-standard memory test (AUC = 69.1). LAS-FNAME also showed evidence of concurrent and divergent validity with a standard memory test (RAVLT) (r = 0.58, p < .001) and with an attention task (Digit Span) (r = -0.37, p = .06). Finally, the reliability index was very high (α = 0.88). DISCUSSION: LAS-FNAME effectively distinguished aMCI patients from healthy controls, suggesting its potential for detecting early cognitive changes in Alzheimer's prodromal stages among Spanish speakers.

Association between psoriasis and dementia: A systematic review / Asociación entre psoriasis y el desarrollo de demencia: una revisión sistemática

Introduction Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic systemic inflammatory phenotype. Psoriasis is also considered to be a chronic systemic inflammatory disease. It has been suggested that psoriasis may also contribute to the risk of dementia. The aim of this study was to systematically review the literature on the association between psoriasis and dementia. Development Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Web of Science databases to identify articles published in peer-reviewed journals and studying the association between psoriasis and dementia. Studies meeting the inclusion criteria were reviewed. We used the Newcastle–Ottawa Scale to assess the quality of each study. After applying the inclusion and exclusion criteria, we included 8 studies for review, 3 of which were found to present a higher risk of bias. Six of the 8 studies supported the hypothesis that prior diagnosis of psoriasis increases the risk of dementia; one study including only a few cases reported that psoriasis decreased the risk of dementia, and one study including relatively young patients found no significant association between psoriasis and the risk of dementia. Conclusion Most studies included in this review supported the hypothesis that psoriasis constitutes a risk factor for dementia. However, well-designed stratified cohort studies assessing both psoriasis severity and treatment status are still required to determine the real effect of psoriasis on the risk of dementia and its subtypes. (AU)

Introducción Entre los factores de riesgo de la demencia se incluyen algunas características genéticas, el envejecimiento, factores medioambientales, determinadas enfermedades y estilos de vida poco saludables. La mayoría de los tipos de demencia comparten un fenotipo de carácter inflamatorio, sistémico y crónico. La psoriasis también se considera una enfermedad inflamatoria, sistémica y crónica. Se ha especulado que la psoriasis podría aumentar el riesgo de demencia. El objetivo de este estudio es realizar una revisión sistemática de la literatura disponible sobre la posible asociación entre la psoriasis y el desarrollo de demencia. Desarrollo Seleccionamos los artículos siguiendo las directrices de la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), utilizando las bases de datos PubMed y Web of Science para localizar artículos publicados en revistas científicas que analizaran la asociación entre psoriasis y demencia. Incluimos en nuestra revisión los artículos que cumplían los criterios de inclusión. Para valorar la calidad de los estudios, usamos la escala Newcastle-Ottawa. Tras aplicar los criterios de inclusión y exclusión, seleccionamos 8 estudios, de los cuales 3 presentaban un mayor riesgo de sesgo. Seis de los 8 estudios postulan la hipótesis de que el diagnóstico de psoriasis aumenta el riesgo de desarrollar demencia posteriormente. Por otro lado, un estudio que incluía solo algunos casos describe que la psoriasis disminuye el riesgo de demencia y un estudio con pacientes relativamente jóvenes no encontró asociación significativa entre la psoriasis y el riesgo de desarrollar demencia. Conclusiones La mayoría de los estudios incluidos en esta revisión apoyan la hipótesis de que la psoriasis representa un factor de riesgo de desarrollar demencia... (AU)

Diferencias neuropsicológicas en la enfermedad de Alzheimer en función de la edad de presentación / Neuropsychological differences in Alzheimer's disease depending on the age of onset

Introducción La enfermedad de Alzheimer (EA) es la forma más común de demencia entre las personas mayores. La enfermedad de Alzheimer de inicio precoz (EAIP) se ha definido como una demencia debido a EA que se presenta antes de la edad arbitrariamente establecida de 65 años. De los pacientes con EA precoz, 50% debutan con síntomas atípicos y muestran alteraciones neuropsicológicas diferentes de aquellos pacientes que debutan más tarde. Estas atipias conllevan un retraso en el diagnóstico y en el inicio del tratamiento. Métodos Seleccionamos retrospectivamente 359 pacientes con diagnóstico de probable demencia por EA. Subdividimos a los pacientes en tres grupos atendiendo a la edad de aparición de la enfermedad: EAIP, menores de 65 años; EA de inicio tardío (EAIT; entre 65 y 80); y EA de inicio muy tardío (EAIMT; definido como edad de inicio mayor de 80 años) y comparamos sus resultados neuropsicológicos. Resultados Los pacientes de EA con una edad de inicio más joven puntuaron peor en atención, función ejecutiva y habilidades visuoespaciales, mientras que los pacientes de mayor edad puntuaron peor en tareas de memoria y lenguaje. Los pacientes de inicio muy tardío se diferenciaron de los de inicio tardío en un mayor deterioro de la fluidez semántica y la denominación. Conclusión Aunque la edad de 65 años podría corresponder a un punto de separación arbitrario entre la forma precoz y la forma de inicio más tardío de la EA, nuestro estudio demuestra que existen diferencias significativas entre estos grupos desde un punto de vista neuropsicológico. Sin embargo, estas diferencias parecen seguir una tendencia lineal con la edad, en lugar de representar cuadros clínicos fundamentalmente distintos. (AU)

Introduction Early-onset Alzheimer's disease (EOAD) has been defined as a dementia due to AD presenting before the arbitrarily established age of 65 (as opposed to late-onset Alzheimer's disease or LOAD). There is still little research about other age sub-groups, the use of so-called senile dementia has been banished, usually including it within the late-onset Alzheimer's dementia. To the extent of our knowledge, there are no studies comparing the neuropsychological features of very-late-onset patients with early and late-onset ones. Methods We retrospectively selected 359 patients with a diagnosis of probable AD dementia. We subdivided patients into three groups attending to the age of onset of the disease: early-onset AD (EOAD; younger than 65 years old), late-onset AD (LOAD; between 65 and 80) and very-late-onset AD (VLOAD; defined here as onset age older than 80), and then we compared their neuropsychological results. Results AD patients with a younger age at onset scored worse on attention, executive function and visuospatial skills, while older-onset patients scored worse in memory tasks and language. Patients with a very-late-onset differed from the late-onset ones in a greater impairment of semantic fluency and naming. Conclusion Although the point of separation between EOAD and later-onset forms of EA at the age of 65 is an arbitrary one, our study shows that there are significant differences between these groups from a neuropsychological point of view. However, these differences do seem to follow a linear trend with age, rather than representing fundamentally distinct clinical pictures. (AU)

Association between psoriasis and dementia: A systematic review / Asociación entre psoriasis y el desarrollo de demencia: una revisión sistemática

Introduction Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic systemic inflammatory phenotype. Psoriasis is also considered to be a chronic systemic inflammatory disease. It has been suggested that psoriasis may also contribute to the risk of dementia. The aim of this study was to systematically review the literature on the association between psoriasis and dementia. Development Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Web of Science databases to identify articles published in peer-reviewed journals and studying the association between psoriasis and dementia. Studies meeting the inclusion criteria were reviewed. We used the Newcastle–Ottawa Scale to assess the quality of each study. After applying the inclusion and exclusion criteria, we included 8 studies for review, 3 of which were found to present a higher risk of bias. Six of the 8 studies supported the hypothesis that prior diagnosis of psoriasis increases the risk of dementia; one study including only a few cases reported that psoriasis decreased the risk of dementia, and one study including relatively young patients found no significant association between psoriasis and the risk of dementia. Conclusion Most studies included in this review supported the hypothesis that psoriasis constitutes a risk factor for dementia. However, well-designed stratified cohort studies assessing both psoriasis severity and treatment status are still required to determine the real effect of psoriasis on the risk of dementia and its subtypes. (AU)

Introducción Entre los factores de riesgo de la demencia se incluyen algunas características genéticas, el envejecimiento, factores medioambientales, determinadas enfermedades y estilos de vida poco saludables. La mayoría de los tipos de demencia comparten un fenotipo de carácter inflamatorio, sistémico y crónico. La psoriasis también se considera una enfermedad inflamatoria, sistémica y crónica. Se ha especulado que la psoriasis podría aumentar el riesgo de demencia. El objetivo de este estudio es realizar una revisión sistemática de la literatura disponible sobre la posible asociación entre la psoriasis y el desarrollo de demencia. Desarrollo Seleccionamos los artículos siguiendo las directrices de la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), utilizando las bases de datos PubMed y Web of Science para localizar artículos publicados en revistas científicas que analizaran la asociación entre psoriasis y demencia. Incluimos en nuestra revisión los artículos que cumplían los criterios de inclusión. Para valorar la calidad de los estudios, usamos la escala Newcastle-Ottawa. Tras aplicar los criterios de inclusión y exclusión, seleccionamos 8 estudios, de los cuales 3 presentaban un mayor riesgo de sesgo. Seis de los 8 estudios postulan la hipótesis de que el diagnóstico de psoriasis aumenta el riesgo de desarrollar demencia posteriormente. Por otro lado, un estudio que incluía solo algunos casos describe que la psoriasis disminuye el riesgo de demencia y un estudio con pacientes relativamente jóvenes no encontró asociación significativa entre la psoriasis y el riesgo de desarrollar demencia. Conclusiones La mayoría de los estudios incluidos en esta revisión apoyan la hipótesis de que la psoriasis representa un factor de riesgo de desarrollar demencia... (AU)

Diferencias neuropsicológicas en la enfermedad de Alzheimer en función de la edad de presentación / Neuropsychological differences in Alzheimer's disease depending on the age of onset

Introducción La enfermedad de Alzheimer (EA) es la forma más común de demencia entre las personas mayores. La enfermedad de Alzheimer de inicio precoz (EAIP) se ha definido como una demencia debido a EA que se presenta antes de la edad arbitrariamente establecida de 65 años. De los pacientes con EA precoz, 50% debutan con síntomas atípicos y muestran alteraciones neuropsicológicas diferentes de aquellos pacientes que debutan más tarde. Estas atipias conllevan un retraso en el diagnóstico y en el inicio del tratamiento. Métodos Seleccionamos retrospectivamente 359 pacientes con diagnóstico de probable demencia por EA. Subdividimos a los pacientes en tres grupos atendiendo a la edad de aparición de la enfermedad: EAIP, menores de 65 años; EA de inicio tardío (EAIT; entre 65 y 80); y EA de inicio muy tardío (EAIMT; definido como edad de inicio mayor de 80 años) y comparamos sus resultados neuropsicológicos. Resultados Los pacientes de EA con una edad de inicio más joven puntuaron peor en atención, función ejecutiva y habilidades visuoespaciales, mientras que los pacientes de mayor edad puntuaron peor en tareas de memoria y lenguaje. Los pacientes de inicio muy tardío se diferenciaron de los de inicio tardío en un mayor deterioro de la fluidez semántica y la denominación. Conclusión Aunque la edad de 65 años podría corresponder a un punto de separación arbitrario entre la forma precoz y la forma de inicio más tardío de la EA, nuestro estudio demuestra que existen diferencias significativas entre estos grupos desde un punto de vista neuropsicológico. Sin embargo, estas diferencias parecen seguir una tendencia lineal con la edad, en lugar de representar cuadros clínicos fundamentalmente distintos. (AU)

Introduction Early-onset Alzheimer's disease (EOAD) has been defined as a dementia due to AD presenting before the arbitrarily established age of 65 (as opposed to late-onset Alzheimer's disease or LOAD). There is still little research about other age sub-groups, the use of so-called senile dementia has been banished, usually including it within the late-onset Alzheimer's dementia. To the extent of our knowledge, there are no studies comparing the neuropsychological features of very-late-onset patients with early and late-onset ones. Methods We retrospectively selected 359 patients with a diagnosis of probable AD dementia. We subdivided patients into three groups attending to the age of onset of the disease: early-onset AD (EOAD; younger than 65 years old), late-onset AD (LOAD; between 65 and 80) and very-late-onset AD (VLOAD; defined here as onset age older than 80), and then we compared their neuropsychological results. Results AD patients with a younger age at onset scored worse on attention, executive function and visuospatial skills, while older-onset patients scored worse in memory tasks and language. Patients with a very-late-onset differed from the late-onset ones in a greater impairment of semantic fluency and naming. Conclusion Although the point of separation between EOAD and later-onset forms of EA at the age of 65 is an arbitrary one, our study shows that there are significant differences between these groups from a neuropsychological point of view. However, these differences do seem to follow a linear trend with age, rather than representing fundamentally distinct clinical pictures. (AU)

The association between periodontitis and cerebrovascular disease, and dementia. Scientific report of the working group of the Spanish Society of Periodontology and the Spanish Society of Neurology.

OBJECTIVE: This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. DEVELOPMENT: In response to a series of questions proposed by the SEPA-SEN working group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. CONCLUSIONS: Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia.

Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio / Association between myasthenia gravis and Alzheimer’s disease

Introducción La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG. (AU)

INTRODUCTION Myasthenia gravis (MG) and Alzheimer’s disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu­romuscular junction and in the second, in the central nervous system (CNS). AIM To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION. Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG. (AU)

Alteraciones genéticas asociadas a la enfermedad de Parkinson y Alzheimer: evolución y respuesta al tratamiento / Genetic Alterations Associated with Parkinson's and Alzheimer's Disease: Evolution and Response to Treatment

La enfermedad de Parkinson y Alzheimer son las enfermedades neurodegenerativas más frecuentes a nivel mundial. Tienen etiología multifactorial, entre ellas, la genética; y son motivo de interés en la investigación científica actual. Se realizó una revisión narrativa con el objetivo de determinar las alteraciones genéticas asociadas a estas patologías, además su influencia en la evolución y respuesta al tratamiento de ellas. Se consultaron artículos originales, revisiones bibliográficas, sistemáticas, metaanálisis en inglés y español, con fecha de publicación entre el 1 enero de 2018 y el 20 de mayo de 2023, en bases como PubMed y Medline. Se utilizaron los términos MeSH «Alzheimer Disease¼, «Parkinson Disease¼, «Drug Therapy¼ y «Mutations¼. El riesgo hereditario para la enfermedad de Parkinson suele ser poligenético, sin embargo, existen genes relacionados con mutaciones monogénicas. Se identifican alteraciones en genes de α-sinucleína, glucocerebrosidasa y quinasa 2 rica en leucina que se relacionan con mayor riesgo de desarrollar Parkinson, además de variaciones en el cuadro clínico y edad de inicio de síntomas. En cuanto a la enfermedad de Alzheimer, las alteraciones en los genes de la proteína precursora amiloide, presenilina 1 y 2 se relacionan con la forma familiar de la enfermedad; por otra parte, las de apolipoproteína E4 se han identificado en la forma esporádica, por lo que se consideran como el factor de riesgo genético más importante para su desarrollo

Parkinson's and Alzheimer's are the most frequent neurodegenerative diseases worldwide. They have a multifactorial etiology, including genetics, and are of interest in current scientific research. A narrative review was carried out with the aim of determining the genetic alterations associated with these pathologies, as well as their influence on their evolution and response to treatment. Original articles, literature reviews, systematic reviews, meta-analyses in English and Spanish, with publication date between January 1, 2018 and May 20, 2023, were consulted in databases such as PubMed and Medline. MeSH terms "Alzheimer Disease", "Parkinson Disease", "Drug Therapy" and "Mutation" were used. Hereditary risk for Parkinson's disease is usually polygenetic, however, there are genes related to monogenic mutations. Alterations in α-synuclein, glucocerebrosidase and leucine-rich kinase 2 genes have been identified that are related to an increased risk of developing Parkinson's disease, in addition to variations in the clinical picture and age of symptom onset. As for Alzheimer's disease, alterations in the genes of the amyloid precursor protein, presenilin 1 and 2 are related to the familial form of the disease; on the other hand, those of apolipoprotein E4 have been identified in the sporadic form, and are therefore considered to be the most important genetic risk factor for its development

Ayuno intermitente y restricción calórica como tratamiento coadyuvante en enfermedad de Alzheimer y esclerosis múltiple / Intermittent Fasting and Caloric Restriction as an Adjunctive Treatment in Alzheimer's Disease and Multiple Sclerosis

Las enfermedades de Alzheimer y esclerosis múltiple son neurodegenerativas, con tratamientos complejos y de costos elevados, orientados a disminuir la progresión de la sintomatología. Sin embargo, a causa de la falta de terapias adecuadas y de los posibles efectos adversos ocasionados por tratamientos de primera línea, es necesario implementar mejores abordajes terapéuticos complementarios que no produzcan mayores efectos secundarios y mejoren la sintomatología de dichas patologías. La restricción calórica y el ayuno intermitente han demostrado ser estrategias novedosas y beneficiosas en enfermedades neurodegenerativas, a través de mecanismos inmunitarios, metabólicos y fisiológicos. Con el objetivo de determinar el uso del ayuno intermitente y la restricción calórica como tratamiento coadyuvante en esclerosis múltiple y enfermedad de Alzheimer, se realizó una revisión narrativa de artículos originales en revistas científicas, en idiomas inglés y español, de 2018 a 2022. El uso de la restricción calórica y ayuno intermitente han generado cambios positivos produciendo disminución de estados proinflamatorios, estrés oxidativo y envejecimiento. Se consideran abordajes que modulan la progresión de la enfermedad y mejoran la función cognitiva por vías de señalización de monofosfato de adenosina cinasa, factor de crecimiento similar a la insulina y la enzima sirtuina, generando un efecto neuroprotector.

Alzheimer's disease and multiple sclerosis are neurodegenerative disorders with expensive and complex treatments aimed at reducing the progression of symptoms. However, due to the lack of adequate therapies and the possible adverse effects caused by first-line treatments, it's necessary to implement better complementary therapeutic approaches that do not produce major side effects and improve symptoms. Caloric restriction and intermittent fasting have been shown to be novel and beneficial strategies in neurodegenerative diseases, through immune, metabolic, and physiological mechanisms. To determine the use of intermittent fasting and caloric restriction as a new treatment in multiple sclerosis and Alzheimer's disease, a narrative review of original articles in both national and international scientific journals, in English and Spanish languages with no greater obsolescence than five years. The use of caloric restriction and intermittent fasting have generated positive changes, producing a decrease in pro-inflammatory states, oxidative stress, and aging. Approaches that modulate disease progression and improve cognitive function of adenosine monophosphate kinase, insulin-like growth factor, and sirtuin enzyme pathways are considered, generating a neuroprotective effect.

[Neuropsychological differences in Alzheimer's disease depending on the age of onset]. / Diferencias neuropsicológicas en la enfermedad de Alzheimer en función de la edad de presentación.

INTRODUCTION: Early-onset Alzheimer's disease (EOAD) has been defined as a dementia due to AD presenting before the arbitrarily established age of 65 (as opposed to late-onset Alzheimer's disease or LOAD). There is still little research about other age sub-groups, the use of so-called senile dementia has been banished, usually including it within the late-onset Alzheimer's dementia. To the extent of our knowledge, there are no studies comparing the neuropsychological features of very-late-onset patients with early and late-onset ones. METHODS: We retrospectively selected 359 patients with a diagnosis of probable AD dementia. We subdivided patients into three groups attending to the age of onset of the disease: early-onset AD (EOAD; younger than 65 years old), late-onset AD (LOAD; between 65 and 80) and very-late-onset AD (VLOAD; defined here as onset age older than 80), and then we compared their neuropsychological results. RESULTS: AD patients with a younger age at onset scored worse on attention, executive function and visuospatial skills, while older-onset patients scored worse in memory tasks and language. Patients with a very-late-onset differed from the late-onset ones in a greater impairment of semantic fluency and naming. CONCLUSION: Although the point of separation between EOAD and later-onset forms of EA at the age of 65 is an arbitrary one, our study shows that there are significant differences between these groups from a neuropsychological point of view. However, these differences do seem to follow a linear trend with age, rather than representing fundamentally distinct clinical pictures.

Factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer

Introducción: La principal causa de demencia degenerativa es la enfermedad de Alzhéimer. En la población cubana, una de cada cuatro personas de 65 años y más fallece por esta enfermedad u otra forma de demencia. Objetivo : Identificar los factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer en el Hospital Psiquiátrico Universitario Rene Vallejo Ortiz entre enero de 2013 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo integrado por todos los pacientes ingresados en la mencionada institución asistencial y docente. La muestra no probabilística y a criterio de los autores la integraron 77 pacientes adultos con el diagnóstico de la enfermedad en el periodo de estudio señalado. Las historias clínicas fueron la fuente secundaria de información. Se utilizó estadística descriptiva e inferencial. La información se resumió en tablas y gráficos. Resultados: El 90,6 % presentaban más de 60 años y más de la mitad eran del sexo masculino (54,5 %). La mayoría de los pacientes presentaron diversos síntomas asociados. Lo trastornos de personalidad y orientación se constataron en el 75,3 % mientras que los de memoria en el 72,7 %. Conclusiones: El agravamiento clínico luego del ingreso hospitalario se acentuó en aquellos pacientes sin escolaridad, solteros, desocupados, con enfermedades cerebro vasculares y presencia de familias disfuncionales presentaron. Los pacientes anémicos o con signos de irritación cortical focal en región frontoparietal con generalización secundaria presentaron mayoritariamente un empeoramiento clínico.

Introduction: The main cause of degenerative dementia is Alzheimer's disease. In the Cuban population, one in four people aged 65 and over dies from this disease or another form of dementia. Objective: To identify the risk factors associated with the clinical worsening of patients admitted with Alzheimer's disease at the Rene Vallejo Ortiz University Psychiatric Hospital. Methods: An observational, descriptive and cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned healthcare and teaching institution. The non-probabilistic sample and at the discretion of the authors was made up of 77 adult patients with the diagnosis of the disease in the indicated study period between January 2013 and December 2022. Medical records were the secondary source of information. Descriptive and inferential statistics were used. The information was summarized in tables and graphics. Results: 90.6% were over 60 years old and more than half were male (54.5%). Most patients presented various associated symptoms. Personality and orientation disorders were found in 75.3%, while memory disorders were found in 72.7%. Conclusions: The clinical worsening after hospital admission was accentuated in those patients without schooling, single, unemployed, with cerebrovascular diseases and presence of dysfunctional families. Anemic patients or patients with signs of focal cortical irritation in the frontoparietal region with secondary generalization mostly presented clinical worsening.

Association between psoriasis and dementia: A systematic review.

INTRODUCTION: Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic systemic inflammatory phenotype. Psoriasis is also considered to be a chronic systemic inflammatory disease. It has been suggested that psoriasis may also contribute to the risk of dementia. The aim of this study was to systematically review the literature on the association between psoriasis and dementia. DEVELOPMENT: Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Web of Science databases to identify articles published in peer-reviewed journals and studying the association between psoriasis and dementia. Studies meeting the inclusion criteria were reviewed. We used the Newcastle-Ottawa Scale to assess the quality of each study. After applying the inclusion and exclusion criteria, we included 8 studies for review, 3 of which were found to present a higher risk of bias. Six of the 8 studies supported the hypothesis that prior diagnosis of psoriasis increases the risk of dementia; one study including only a few cases reported that psoriasis decreased the risk of dementia, and one study including relatively young patients found no significant association between psoriasis and the risk of dementia. CONCLUSION: Most studies included in this review supported the hypothesis that psoriasis constitutes a risk factor for dementia. However, well-designed stratified cohort studies assessing both psoriasis severity and treatment status are still required to determine the real effect of psoriasis on the risk of dementia and its subtypes.

Condiciones de salud bucodental en personas adultas mayores con enfermedad de Alzheimer: Scoping Review

Introducción: El aumento de la longevidad de las personas ha generado en la última etapa de vida la aparición de enfermedades de tipo multifactorial y relacionadas con el estilo de vida, aumentando la prevalencia de patologías mentales y enfermedades orales. Objetivo: Identificar las condiciones de salud oral en personas adultas mayores con enfermedad de Alzheimer. Métodos: Se planteó una revisión de la literatura tipo Scoping Review, determinando una estrategia de búsqueda para tres bases de datos (Pubmed, EbscoHost y LILACS). Fueron incluidos artículos con diseño de corte transversal, cohorte y casos y controles en idioma español, inglés y portugués entre 2011 y 2021. Se realizó la extracción y evaluación del riesgo de sesgo teniendo en cuenta los criterios de elegibilidad. Resultados: Se seleccionaron 32 artículos para revisión de texto completo y síntesis cualitativa de la información. Alemania y Estados Unidos presentan mayor cantidad de publicaciones, el sexo femenino predominó como población de estudio. Se observó menor frecuencia de cepillado, mayor cantidad de ausencias dentales en pacientes con demencia por Alzheimer y consecuentemente un mayor uso de prótesis en dicha población. Conclusiones: Es importante fortalecer la relación sistémico-oral de los adultos mayores mediante un manejo interdisciplinario entre el geriatra y el odontólogo.

Introduction. The increase in the longevity of individuals has led to the emergence of multifactorial diseases related to lifestyle during the later stages of life, thereby increasing the prevalence of mental disorders and oral diseases. Objective: To identify oral health conditions in older adults with Alzheimer's disease. Methods: A Scoping Review literature review was conducted, outlining a search strategy for three databases (Pubmed, EbscoHost, and LILACS). Articles with a cross-sectional, cohort, or case-control design published in Spanish, English, or Portuguese between 2011 and 2021 were included. Extraction and bias risk assessments were performed based on eligibility criteria. Results: Thirty-two articles were selected for full-text review and qualitative synthesis of information. Germany and the United States had the highest number of publications, with females predominating as the study population. A lower frequency of brushing, a higher number of missing teeth in Alzheimer's patients, and consequently higher use of prosthetics were observed in this population. Conclusions: It is essential to strengthening the systemic-oral relationship in older adults through interdisciplinary management involving geriatricians and dentists.

Introdução: O aumento da longevidade das pessoas tem gerado na última fase da vida o aparecimento de doenças multifatoriais e relacionadas ao estilo de vida, aumentando a prevalência de patologias mentais e doenças bucais. Objetivo: identificar as condições de saúde bucal em idosos com doença de Alzheimer. Métodos: foi realizada uma revisão de escopo da literatura, determinando uma estratégia de busca em três bancos de dados (Pubmed, EbscoHost e LILACS). Foram incluídos artigos com desenho transversal, de coorte e de caso-controle em espanhol, inglês e português entre 2011 e 2021. A extração e a avaliação do risco de viés foram realizadas levando-se em conta os critérios de elegibilidade. Resultados: Trinta e dois artigos foram selecionados para revisão do texto completo e síntese qualitativa das informações. A Alemanha e os Estados Unidos tiveram o maior número de publicações, e a população do estudo era predominantemente feminina. Observou-se menor frequência de escovação, maior número de ausencias odontológicas em pacientes com demência de Alzheimer e, consequentemente, maior uso de dentaduras nessa população. Conclusões: É importante fortalecer a relação sistêmico-oral dos idosos por meio do gerenciamento interdisciplinar entre o geriatra e o dentista.

Correlación entre escalas visuales de atrofia entorrinal y temporomesial con volumetría hipocampal / Correlation between visual scales of entorhinal and temporomesial atrophy with hippocampal volumetry

Resumen Objetivo: En pacientes con enfermedad de Alzheimer (EA) se han descrito cambios neuropatológicos tempranos en la corteza entorrinal, que anteceden el compromiso temporomesial. La evaluación de la atrofia hipocampal mediante escalas visuales y volumetría son herramientas útiles en la valoración de pacientes con deterioro cognitivo. Nuestro objetivo es establecer la correlación entre la evaluación visual de la atrofia de la corteza entorrinal (ACE), la atrofia temporomesial (ATM) y el volumen hipocampal. Material y métodos: Estudio retrospectivo de corte transversal. Se incluyeron pacientes con queja cognitiva y resonancia magnética (RM) cerebral. Se utilizaron escalas visuales de ACE y ATM. Se midió el volumen hipocampal mediante el software volBrain 1.0. Resultados: Se incluyeron 48 pacientes, 31 eran mujeres (64,6%). Mediana de edad: 76,5 (RIQ: 69-83). La correlación entre las escalas visuales ACE y la ATM del lado derecho fue de 0,67 p < 0,0001) y del lado izquierdo de 0,69 (p < 0,0001). Encontramos correlación negativa moderada entre la ACE y el volumen hipocampal, del lado derecho fue de –0,59 (p < 0,0001) y del lado izquierdo de –0,42 (p = 0,003). Conclusión: La escala de ACE muestra moderada correlación con la escala de ATM y con el volumen hipocampal. Su uso podría aportar información valiosa para valoración de trastornos cognitivos.

Abstract Objective: In patients with Alzheimer’s disease (AD), early neuropathological changes in the entorhinal cortex have been described, which precede temporomesial involvement. The evaluation of hippocampal atrophy using visual scales and volumetry are useful tools in the assessment of patients with cognitive impairment. Our objective is to establish the correlation between the visual evaluations of entorhinal cortex atrophy (ECA), temporomesial atrophy (TMA), and hippocampal volume. Material and methods: Retrospective cross-sectional study. Patients with cognitive complaint and brain magnetic resonance imaging (MRI) were included. ACE and TMA visual scales were used. Hippocampal volume was measured using the volBrain 1.0 software. Results: Forty-eight patients were included, 31 were women (64.6%). Median age was 76.5 (IQR: 69-83). The correlation between ECA and TMA on the right side was 0.67 (p < 0.0001) and on the left side was 0.69 (p < 0.0001). We found a negative moderate correlation between ECA and hippocampal volume, on the right side it was –0.59 (p < 0.0001) and on the left side it was –0.42 (p = 0.003). Conclusion: The ECA scale shows high correlation with the TMA scale and moderate correlation with hippocampal volume. Its use could provide valuable information for the assessment of cognitive disorders.

Is there interest of Mexican adults in being prepared should they develop Alzheimer's or other dementia? / ¿Existe interés en adultos mexicanos de preparase en caso de llegar a padecer Alzheimer u otra demencia?

Abstract Introduction Alzheimer's disease, as well as other dementias, cause a progressive deterioration of cognitive functions, preventing patients from making decisions and having control over themselves in an advanced stage of the disease. Objective To explore some expectations, wishes and preferences in a sample of mature adults should they develop Alzheimer or other dementia. Method We surveyed 368 mature Mexican adults without dementia using a large survey created by the authors and used in a previous study; data were collected in some public places where mature people were invited to participate. The survey was completed from July 2019 to August 2020. Results Although most participants had considered they might suffer from dementia in the future, less than half had communicated their wishes to their relatives about future medical treatments in case they could no longer decide for themselves; very few had prepared a written advance directive. Most participants agreed that patients should know their initial diagnosis, mainly to be able to prepare themselves. The main reason given by those who would prefer to hide the diagnosis was to avoid suffering. Discussion and conclusion Our results highlight the need for health professionals to promote discussion with people about the possibility of suffering from dementia, as well as the importance of making decisions in advance, and letting their relatives know about them.

Resumen Introducción La enfermedad de Alzheimer, así como las otras demencias, causan un deterioro progresivo de las funciones cognitivas, evitando que en una etapa avanzada de la enfermedad los pacientes puedan tomar decisiones y tener control sobre sí mismos. Objetivo Explorar algunas expectativas, deseos y preferencias en una muestra de adultos maduros en caso de que llegaran a desarrollar Alzheimer u otra demencia. Método Encuestamos a 368 adultos mexicanos maduros sin demencia usando una encuesta creada por los autores y utilizada en un estudio anterior; los datos se recopilaron en algunos lugares públicos donde se invitó a las personas a participar. La encuesta se aplicó de julio de 2019 a agosto de 2020. Resultados Aunque la mayoría de los participantes había considerado que podría sufrir demencia en el futuro, menos de la mitad había comunicado sus deseos a sus familiares sobre futuros tratamientos médicos en caso de que ya no pudieran decidir por sí mismos; muy pocos habían preparado una voluntad anticipada por escrito. La mayoría de los participantes estuvo de acuerdo en que los pacientes deben conocer su diagnóstico inicial, principalmente para poder prepararse. La principal razón aducida por quienes preferirían ocultar el diagnóstico fue el deseo de evitar sufrimiento. Discusión y conclusión Nuestros resultados destacan la necesidad de que el personal de salud promueva la discusión con las personas sobre la posibilidad de padecer demencia, así como la importancia de tomar decisiones por anticipado e informar de ellas a sus familiares.

[Alzheimer's disease. Current evidence on the preventive role of nutrition]. / Enfermedad de Alzheimer. Evidencia actual sobre el papel preventivo de la nutrición.

Introduction: Introduction: in the last decades, a significant increase in the incidence of Alzheimer's disease (AD) has been observed. Currently, there are no effective pharmacological treatments available, which makes preventive measures particularly important. Objective: to analyze the available scientific evidence on nutritional and dietary factors and their association with AD prevention. Methods: a review of nutritional and dietary factors related to the prevention of AD was conducted. Results: several dietary components have been positively associated with AD prevention, including intake of complex carbohydrates, fiber, omega-3, plant-based proteins, vitamins (folates, choline, vitamin D, C, B6 and B9), zinc, some bioactive compounds such as flavonols and probiotics. Following the Mediterranean, Dietary Approaches to Stop Hypertension (DASH) y Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets has been associated with a lower risk of developing the disease. Conclusion: nutrition may have a protective role against AD, although further studies are needed in this regard.

Introducción: Introducción: en las últimas décadas, se ha observado un incremento significativo en la incidencia de la enfermedad de Alzheimer (EA). En la actualidad, no se dispone de tratamientos farmacológicos efectivos, lo que hace que las medidas preventivas sean particularmente importantes. Objetivo: analizar la evidencia científica disponible sobre factores nutricionales y dietéticos y su asociación con la prevención de la EA. Métodos: se llevó a cabo una revisión de la literatura científica sobre factores nutricionales y dietéticos relacionados con la prevención de la EA. Resultados: diversos componentes de la dieta se han asociado positivamente con la prevención de la EA. Estos incluyen hidratos de carbono complejos, fibra, omega-3, proteínas de origen vegetal, vitaminas (folatos, colina, vitamina D, C, B6 y B9), zinc y algunos compuestos bioactivos como los flavonoles, y los probióticos. El seguimiento de las dietas mediterránea, Dietary Approaches to Stop Hypertension (DASH) y Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) se ha asociado con un menor de riesgo de desarrollar la enfermedad. Conclusión: la nutrición podría tener un papel protector frente a la EA, aunque se requieren más estudios al respecto.