Evaluating Cerebral Perfusion in Alzheimer Patients and First-Degree Relatives: Lessons from Artemisa Province, Cuba.

INTRODUCTION: Alzheimer disease is related to several risk factors including aging, family history, high blood pressure and diabetes. Studies have shown specific regional cerebral perfusion changes in patients with Alzheimer disease. Some authors state that these changes could appear years before patient memory becomes impaired, enabling early diagnosis in high-risk persons who appear to be healthy. OBJECTIVE: Determine the usefulness of cerebral perfusion studies in Alzheimer patients and first-degree relatives for obtaining additional diagnostic information and detecting functional changes that may suggest elevated disease risk. METHODS: This study involved 128 persons (87 clinically diagnosed with Alzheimer disease and 41 of their first-degree relatives with normal cognition), all from Artemisa Province, Cuba. We performed clinical, laboratory, neuropsychological and genetic (apolipoprotein E-ApoE, e4 allele) tests, as well as cerebral perfusion studies using single photon emission computed tomography after administering 740-925 MBq of 99m Tc-ECD, following internationally standardized protocols. RESULTS: In the Alzheimer disease group, the cerebral single photon emission computed tomography showed a typical Alzheimer pattern (bilateral posterior temporal-parietal hypoperfusion) in 77% (67/87) of participants; 35.9% (28/67) in stage 1; 51.3% (40/67) in stage 2; and 12.8% (10/67) in stage 3 of the disease. In this group, 12.7% (11/87) had mild or unilateral cerebral perfusion changes; 5.7% (5/87) vascular dementia; 3.4% (3/87) frontal dementia; and 1.2% (1/87) normal cerebral perfusion. Of the patients, 28.7% (25/87) received a different classification of stage and disease diagnosis after cerebral perfusion results were considered. In the relative group, 14.6% (6/41) had cerebral perfusion abnormalities. Among these, 7.1% (3/41) were mild bilateral temporal-parietal hypoperfusion; 4.8% (2/41) mild unilateral temporal-parietal hypoperfusion; and 2.4% (1/41) had perfusion defecits in their right frontal lobes. Of patients with typical Alzheimer disease patterns in the cerebral single photon emission computed tomography, 76.6% (52/67) had positive ApoE e4. All relatives with perfusion abnormalities (6/6) had positive ApoE e4. CONCLUSIONS: Cerebral perfusion studies confirmed the Alzheimer disease diagnosis, classified disease stages, and differentiated between the types of dementia. The test showed perfusion changes in several asymptomatic first-degree relatives with positive ApoE e4, which could be predictors of disease. The technique was useful for evaluating patients and their relatives.

Diagnóstico de isquemia miocárdica silente en diabéticos tipo 2 mediante electrocardiograma, ergometría y Gated-SPECT / Diagnosis of silent myocardial ischemia in type 2 diabetic patietns by electrocardiogram, ergometry and Gated-SPECT

Para determinar la relación entre los factores de riesgos ateroscleróticos y la isquémica miocárdica silente fueron estudiados 31 pacientes diabéticos tipo 2 asintomáticos con exámenes de laboratorio, electrocardiograma, ergometría, Gated-SPECT y coronariografía. Los pacientes fueron clasificados en dos grupos: SPECT positivo y SPECT negativo. Se realizaron pruebas de asociación para cada variable y se construyeron curvas ROC para identificar marcadores de riesgo. En el 35,5 por ciento de los pacientes se detectó isquemia miocárdica silente con una buena correlación angiográfica. Se evidenció asociación significativa entre SPECT positivo y los factores de riesgo ateroscleróticos: valores bajos de HDLc, antecedentes patológicos familiares de cardiopatía isquémica y enfermedad vascular periférica. Los modelos de regresión logística concluyeron que valores bajos de HDLc unidos a antecedentes patológicos familiares de cardiopatía isquémica podrían ser fuertes predictores de isquemia miocárdica silente en diabéticos tipo 2 asintomáticos(AU)

31 aymptomatic type 2 diabetic patients were studied by lab tests, electrocardiogram, ergometry, Gated-SPECT and coronariography to determine the relation between the atherosclerotic risk factors and the silent myocardial ischemia. Patients were classified into two groups: positive SPECT and negative SPECT. Association tests were made for each variable and ROC curves were constructed to identify risk markers. In 35,5 percent of the patients silent myocardial ischemia was detected with a good angiographic correlation. A siginificant association was evidenced between positive SPECT and the atherosclerotic risk factors, namely, low values of HDLc, family pathological history of ischemic heart disease and peripheral vascular disease. The logistic regression models showed that low values of HDLc together with family pathological history of ischemic heart disease may be strong predictors of silent myocardial ischemia in asymptomatic type 2 diabetic patients(AU)

Diagnóstico de isquemia miocárdica silente en diabéticos tipo 2 mediante electrocardiograma, ergometría y Gated-SPECT / Diagnosis of silent myocardial ischemia in type 2 diabetic patietns by electrocardiogram, ergometry and Gated-SPECT

Para determinar la relación entre los factores de riesgos ateroscleróticos y la isquémica miocárdica silente fueron estudiados 31 pacientes diabéticos tipo 2 asintomáticos con exámenes de laboratorio, electrocardiograma, ergometría, Gated-SPECT y coronariografía. Los pacientes fueron clasificados en dos grupos: SPECT positivo y SPECT negativo. Se realizaron pruebas de asociación para cada variable y se construyeron curvas ROC para identificar marcadores de riesgo. En el 35,5 por ciento de los pacientes se detectó isquemia miocárdica silente con una buena correlación angiográfica. Se evidenció asociación significativa entre SPECT positivo y los factores de riesgo ateroscleróticos: valores bajos de HDLc, antecedentes patológicos familiares de cardiopatía isquémica y enfermedad vascular periférica. Los modelos de regresión logística concluyeron que valores bajos de HDLc unidos a antecedentes patológicos familiares de cardiopatía isquémica podrían ser fuertes predictores de isquemia miocárdica silente en diabéticos tipo 2 asintomáticos.

31 aymptomatic type 2 diabetic patients were studied by lab tests, electrocardiogram, ergometry, Gated-SPECT and coronariography to determine the relation between the atherosclerotic risk factors and the silent myocardial ischemia. Patients were classified into two groups: positive SPECT and negative SPECT. Association tests were made for each variable and ROC curves were constructed to identify risk markers. In 35,5 percent of the patients silent myocardial ischemia was detected with a good angiographic correlation. A siginificant association was evidenced between positive SPECT and the atherosclerotic risk factors, namely, low values of HDLc, family pathological history of ischemic heart disease and peripheral vascular disease. The logistic regression models showed that low values of HDLc together with family pathological history of ischemic heart disease may be strong predictors of silent myocardial ischemia in asymptomatic type 2 diabetic patients.