Degenerative dementias: a question of syndrome or disease?

BACKGROUND: Neurologists refer to numerous "syndromes," consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative "diseases," on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage. DEVELOPMENT: We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic. CONCLUSIONS: Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new "diseases" should be defined and adapted to current knowledge and practice.

Demencias degenerativas: ¿un dilema de síndromes o de enfermedades? / Degenerative dementias: A question of syndrome or disease?

Introducción: En neurología cognitiva se identifican múltiples «síndromes», consistentes en combinaciones específicas de manifestaciones clínicas, con una evolución determinada y con el apoyo de un análisis de sangre (sin parámetros de genómica-proteómica) y pruebas de neuroimagen (TAC, resonancia, SPECT de perfusión, PET con 18F-fluorodesoxiglucosa). Por otra parte, las «enfermedades» neurodegenerativas demenciantes representan combinaciones clínico-histopatológicas concretas, cuya presencia debe comprobarse en la exploración del enfermo, junto con un estudio histológico o evidencia de marcadores del trastorno molecular específico. No obstante, actualmente se sabe que la manifestación sindrómica de cada alteración histopatológica o genética es variada, que el sustrato histopatológico o genético de cada síndrome también lo es y que a veces coexisten alteraciones fisiopatológicas de más de una enfermedad neurodegenerativa. Además, ocasionalmente se detectan biomarcadores específicos en la fase preclínica. Desarrollo: Tras realizar una búsqueda bibliográfica de casos con alteración histopatológica o genética discordante con la esperada para el síndrome observado, y de casos con coexistencia de enfermedades degenerativas, resulta evidente la heterogeneidad y el solapamiento entre síndromes y enfermedades neurodegenerativas. Además, en la revisión se comprueba que los tratamientos que se prescriben a pacientes con enfermedades degenerativas son sintomáticos. Conclusiones: De la revisión se desprende que mientras no existan tratamientos modificadores de la progresión o la supervivencia, la búsqueda de marcadores de enfermedad debe quedar reservada a centros investigadores. Además, deberían manejarse de modo independiente los síndromes y las alteraciones moleculares e histopatológicas específicas, con definición de nuevas «enfermedades», adaptada a los conocimientos y a la práctica actuales. (AU)

Background: Neurologists refer to numerous “syndromes,‿ consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative “diseases,‿ on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage. Development: We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic. Conclusions: Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new “diseases‿ should be defined and adapted to current knowledge and practice. (AU)

[Has sexuality changed in pregnancy? Baby boom generation versus millennial generation]. / ¿Ha variado la sexualidad en el embarazo? Generación baby boom versus generación millennial.

Sexuality is a complex and multidimensional phenomenon that constitutes a fundamental component in human relationships. Pregnancy is a crucial period in women's life and the physiological changes that happen in this period affect their sexuality. OBJECTIVE: Knowing how pregnancy impacts on sexual behaviors in millenial generation compared to baby boom generation. MATERIAL AND METHODS: Descriptive and cross-sectional study, by means of a self-completed, population-based survey, to a sample of pregnant women in the third trimester of gestation who attended Primary Care. A descriptive study of the frequency distribution of all the variables was carried out. RESULTS: In baby boom generation and millennial generation, it is observed that during pregnancy couple's attraction decreases slightly. According to variables desire and frequency of intercourse, results obtained show that as the pregnancy progresses there is a marked decrease in desire and intercourse frequency. Women state that they do not have enough information about sexuality in their current state, despite years having passed. CONCLUSIONS: During last 35 years, sexual behaviors have not changed in pregnant women. In both generations, changes in desire and intercourse domains were particularly significant, being in third trimester of pregnancy when frequency of intercourse decline. Pregnant women continue to hold erroneous beliefs about sexuality and request more sexual education.

¿Ha variado la sexualidad en el embarazo? Generación baby boom versus generación millennial / Has sexuality changed in pregnancy? Baby boom generation versus millennial generation

La sexualidad es un fenómeno complejo y multidimensional que constituye un componente fundamental en las relaciones humanas. El embarazo es un periodo crucial en la vida de las mujeres y los cambios fisiológicos que ocurren durante este periodo inciden en su sexualidad. Objetivo: Conocer qué impacto produce la gestación en las conductas sexuales en la generación millennial comparado con la generación baby boom. Material y métodos: Estudio descriptivo y transversal, mediante encuesta autocumplimentada, de base poblacional, a una muestra de mujeres embarazadas en el tercer trimestre de gestación que acudían a una consulta del equipo de atención primaria. Se realizó un estudio descriptivo de distribución de frecuencias de todas las variables. Resultados: Tanto en la generación baby boom como en la generación millennial se observa que durante el embarazo la atracción por la pareja disminuye ligeramente. En las variables deseo y frecuencia de coito los resultados obtenidos muestran que a medida que progresa el embarazo hay una disminución marcada del deseo y la frecuencia coital. Las mujeres manifiestan que no tienen suficiente información sobre la sexualidad en su estado actual, a pesar de los años transcurridos. Conclusión: Las conductas sexuales en las mujeres embarazadas no han cambiado en los últimos 35 años. Los cambios observados en ambas generaciones, en los dominios deseo y coito, fueron particularmente notables, siendo en el tercer trimestre de embarazo cuando más decae la frecuentación del coito. Las gestantes siguen manteniendo creencias erróneas acerca de la sexualidad y solicitan más educación sexual (AU)

Sexuality is a complex and multidimensional phenomenon that constitutes a fundamental component in human relationships. Pregnancy is a crucial period in women's life and the physiological changes that happen in this period affect their sexuality. Objective: Knowing how pregnancy impacts on sexual behaviors in millenial generation compared to baby boom generation. Material and methods: Descriptive and cross-sectional study, by means of a self-completed, population-based survey, to a sample of pregnant women in the third trimester of gestation who attended Primary Care. A descriptive study of the frequency distribution of all the variables was carried out. Results: In baby boom generation and millennial generation, it is observed that during pregnancy couple's attraction decreases slightly. According to variables desire and frequency of intercourse, results obtained show that as the pregnancy progresses there is a marked decrease in desire and intercourse frequency. Women state that they do not have enough information about sexuality in their current state, despite years having passed. Conclusions: During last 35 years, sexual behaviors have not changed in pregnant women. In both generations, changes in desire and intercourse domains were particularly significant, being in third trimester of pregnancy when frequency of intercourse decline. Pregnant women continue to hold erroneous beliefs about sexuality and request more sexual education (AU)

Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España / Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain

Introducción: En España, los sistemas sanitarios están transferidos a las Comunidades Autónomas (CC.AA.), constituyendo 19 sistemas sanitarios con gestión y recursos diferenciados. Durante la primera onda epidémica de la COVID-19 se objetivaron diferencias en los sistemas de declaración y en las tasas de letalidad (TL) entre las CC.AA. El objetivo de este estudio fue analizar las TL por CC.AA. durante la segunda onda epidémica (del 20 de julio al 25 de diciembre de 2020) y su relación con la prevalencia de la infección. Material y métodos: Se realizó un estudio observacional descriptivo con la información disponible sobre el número de fallecidos por COVID-19 registrados en el Ministerio de Sanidad, Consejerías de Salud y los Departamentos de Salud Pública de las CC.AA. y según el exceso de mortalidad informado por el Sistema de Monitorización de Mortalidad Diaria (MoMo). La prevalencia de la infección se estimó a partir de las diferencias entre la segunda y cuarta ronda del estudio ENE-COVID y sus intervalos de confianza del 95%. Se calcularon las TL (fallecidos por cada mil infectados) globales, por sexo, grupos de edad (< 65 y ≥ 65 años) y CC.AA. Se calculó la razón estandarizada de letalidad por edad (REL) de las CC.AA. utilizando las TL de España para cada grupo de etario. Estas estimaciones se realizaron con las defunciones declaradas oficialmente (TLo) y el exceso de defunciones estimadas por MoMo (TLMo). Se estimaron las correlaciones entre las prevalencias de infección y las TLo y TLMo, ponderando por población. Resultados: Para el conjunto de España, la TLo durante la segunda onda epidémica fue del 7,6%, oscilando entre 3,8% de Baleares y 16,4% de Asturias, y la TLMo fue de 10,1%, oscilando entre el 4,8% de Madrid y el 21,7% en Asturias. Se observaron diferencias significativas entre la TLo y la TLMo en Canarias, Castilla la Mancha, Extremadura, Comunidad Valenciana, Andalucía y las Ciudades Autónomas de Ceuta y Melilla (AU)

Introduction: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. Material and methods: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. Results: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%) (AU)

[Case-fatality rates of SARS-CoV-2 infection according to Autonomous Communities during the second epidemic wave in Spain]. / Tasas de letalidad por SARS-CoV-2 según Comunidades Autónomas durante la segunda onda epidémica en España.

INTRODUCTION: In Spain, health systems are transferred to the Autonomous Communities (AC), constituting 19 health systems with differentiated management and resources. During the first epidemic wave of COVID-19, differences were observed in reporting systems and in case-fatality rates (FR) between the AC. The objective of this study was to analyze the FR according to AC. during the 2 nd epidemic wave (from July 20 to December 25, 2020), and its relationship with the prevalence of infection. MATERIAL AND METHODS: A descriptive observational study was carried out, extracting the information available on the number of deaths from COVID-19 registered in the Ministry of Health, the Health Councils and the Public Health Departments of the AC, and according to the excess mortality reported by the System Monitoring of Daily Mortality (MoMo). The prevalence of infection was estimated from the differences between the second and fourth rounds of the ENE-COVID study and their 95% confidence intervals. The global FR (deaths per thousand infected) were calculated according to sex, age groups (< 65 and ≥ 65 years) and AC. The age-Standardized Fatality Rates (SFR) of the AC were calculated using the FR of Spain for each age group. These estimates were made with officially declared deaths (FRo) and excess deaths estimated by MoMo (FRMo). The correlations between the prevalences of infection and the FRo and FRMo were estimated, weighting by population. RESULTS: For the whole of Spain, the FRo during the second epidemic wave was 7.6%, oscillating between 3.8% in the Balearic Islands and 16.4% in Asturias, and the TLMo was 10.1%, oscillating between 4.8% from Madrid and 21.7% in Asturias. Significant differences were observed between the FRo and the FRMo in the Canary Islands, Castilla la Mancha, Extremadura, the Valencian Community, Andalusia and the Autonomous Cities of Ceuta and Melilla. The FRo was significantly higher in men (8.2%) than in women (7.1%). The FRo and FRMo were significantly higher in the age group ≥ 65 years (55.4% and 72.2% respectively) than in the group <65 years (0.5% and 1.4% respectively). The Basque Country, Aragon, Andalusia and Castilla la Mancha presented SFR significantly higher than the global FR of Spain. The correlations between the prevalence of infection and the FRo were inverse. CONCLUSIONS: The case-fatality from COVID-19 during the second epidemic wave in Spain improved compared to the first wave. The case-fatality rates were higher in men and the elderly people, and varied significantly between AC. It is necessary to delve into the analysis of the causes of these differences.

[Application of the PCR number of cycle threshold value (Ct) in COVID-19]. / Aplicación del valor umbral del número de ciclos (Ct) de PCR en la COVID-19.

The SARS-CoV-2 pandemic persists with all its virulence despite 650,382,819 doses of COVID vaccine worldwide. The reference test for infection identification is reverse transcription polymerase chain reaction (RT-qPCR). The usefulness of this test may be diminished by simplifying its result as positive or negative. Determining the number of cycles (Ct) in positive RT-qPCR tests can assist in decision-making when interpreted in the clinical context of patients.

COVID-19. La historia se repite y seguimos tropezando con la misma piedra / COVID-19. History repeats itself and we keep stumbling on the same stone

La pandemia por COVID-19 ha provocado un desajuste en todos los sistemas de salud. La mayoría de los países habían olvidado cómo comportarse ante una epidemia de estas características sin disponer de los recursos adecuados. Es preciso realizar un balance de todo lo sucedido, instruir a la población y generar un nuevo conocimiento que nos permita afrontar nuevas epidemias

The COVID-19 pandemic has caused a mismatch in all health systems. Most countries had forgotten how to behave in the face of such an epidemic without adequate resources. We need to take stock of everything that has happened, instruct the population and generate a new knowledge that allows us to face new epidemics

[COVID-19. History repeats itself and we keep stumbling on the same stone]. / COVID-19. La historia se repite y seguimos tropezando con la misma piedra.

The COVID-19 pandemic has caused a mismatch in all health systems. Most countries had forgotten how to behave in the face of such an epidemic without adequate resources. We need to take stock of everything that has happened, instruct the population and generate a new knowledge that allows us to face new epidemics.

Degenerative dementias: A question of syndrome or disease? / Demencias degenerativas: ¿un dilema de síndromes o de enfermedades?

BACKGROUND: Neurologists refer to numerous "syndromes," consisting of specific combinations of clinical manifestations, following a specific progression pattern, and with the support of blood analysis (without genomic-proteomic parameters) and neuroimaging findings (MRI, CT, perfusion SPECT, or 18F-FDG-PET scans). Neurodegenerative "diseases," on the other hand, are defined by specific combinations of clinical signs and histopathological findings; these must be confirmed by a clinical examination and a histology study or evidence of markers of a specific disorder for the diagnosis to be made. However, we currently know that most genetic and histopathological alterations can result in diverse syndromes. The genetic or histopathological aetiology of each syndrome is also heterogeneous, and we may encounter situations with pathophysiological alterations characterising more than one neurodegenerative disease. Sometimes, specific biomarkers are detected in the preclinical stage. DEVELOPMENT: We performed a literature review to identify patients whose histopathological or genetic disorder was discordant with that expected for the clinical syndrome observed, as well as patients presenting multiple neurodegenerative diseases, confirming the heterogeneity and overlap between syndromes and diseases. We also observed that the treatments currently prescribed to patients with neurodegenerative diseases are symptomatic. CONCLUSIONS: Our findings show that the search for disease biomarkers should be restricted to research centres, given the lack of disease-modifying drugs or treatments improving survival. Moreover, syndromes and specific molecular or histopathological alterations should be managed independently of one another, and new "diseases" should be defined and adapted to current knowledge and practice.

Nueva observación de la protección relativa que las enfermedades neurodegenerativas y el cáncer se confieren entre sí / New evidence of the relative protective effects of neurodegenerative diseases and cancer against each other

Introducción: El cáncer y las enfermedades degenerativas constituyen trastornos con algunos mecanismos compartidos que actúan en sentido opuesto, produciendo un fenómeno incontrolado de proliferación o pérdida de células. Observaciones diversas apuntan que los pacientes con enfermedad de Alzheimer tienen menor riesgo de desarrollar tumores y viceversa. En este artículo se expone la prevalencia de tumores (activos o superados) en pacientes de neurología cognitiva con y sin una enfermedad degenerativa demenciante. Pacientes y método: En 1.164 pacientes se analizó la frecuencia y topografía de tumores y la presencia o ausencia de enfermedad neurodegenerativa, que se clasificó en 4 grupos (enfermedad de Alzheimer, sinucleinopatía, enfermedad del complejo Pick y del complejo de poliglutamina). Se comparó la frecuencia de tumor en los subgrupos con y sin enfermedad degenerativa, y de esta en los pacientes con y sin trastorno tumoral. Resultados: Se registró proceso tumoral en el 12,1% de los pacientes con enfermedad neurodegenerativa y en el 17,3% del resto del grupo. En el grupo del estudio, un 14,8% de los que tienen antecedente tumoral fue diagnosticado de enfermedad neurodegenerativa, frente al 20,8% entre los que no tienen ese antecedente. Estas diferencias y las observadas en la comparación de subgrupos (tipo de enfermedad degenerativa y topografía del tumor) no alcanzaron significación estadística, excepto al contrastar enfermedades neurodegenerativas con tumores del sistema nervioso central y sinucleinopatías con neoplasias. Conclusiones: Las enfermedades neoplásicas y las neurodegenerativas demenciantes no son excluyentes, aunque muestran menor asociación de la esperada por su respectiva prevalencia

Background: Cancer and degenerative diseases share some pathogenic mechanisms which act in opposition to one another to produce either uncontrolled cell proliferation or cell death. According to several studies, patients with Alzheimer disease have a lower risk of neoplasia, and vice versa. This study describes the prevalence of tumours (active or successfully treated) in a series of patients with and without a dementing degenerative disease treated at a cognitive neurology unit. Patients and method: We analysed the frequency and topography of tumours and the presence or absence of a neurodegenerative disease in a group of 1,164 patients. Neurodegenerative diseases were classified in 4 groups: Alzheimer disease, synucleinopathies, Pick complex, and polyglutamine complex. We subsequently compared tumour frequency in patients with and without a degenerative disease, and prevalence of neurodegenerative diseases in patients with and without tumours. Results: Tumours were detected in 12.1% of the patients with a neurodegenerative disease and in 17.3% of the remaining patients. Around 14.8% of the patients with a history of neoplasia and 20.8% of the patients with no history of neoplasia were diagnosed with a neurodegenerative disease. Except for these differences and the differences between subgroups (type of degenerative disease and tumour location) were not statistically significant, except when comparing neurodegenerative diseases to central nervous system tumours, and synucleinopathies to neoplasms. Conclusion: Dementing degenerative diseases and neoplastic disorders are not mutually exclusive. Nevertheless, the rate of co-occurrence is lower than would be expected given the prevalence rate for each group

Optimization of the magnetic field homogeneity of circular and conical coil pairs.

The magnetic field generated by a pair of coaxial circular loops is analyzed in order to find the optimum separation between the loops for each value of a prescribed homogeneity. For the maximum heterogeneities considered here, 0.1%, 1%, and 10%, the optimum loop spacing is obtained following a graphical procedure so that the length of the homogeneous field region along the axis is the longest possible. This study is extended to regions near the axis and to the entire region surrounding the center, calculating the loop separation that produces the largest homogeneous volume. The field homogeneity of a pair of "Helmholtz" coaxial conical coils is also investigated to obtain the optimum spacing between the conical coils; the volumes calculated with the desired homogeneity are compared with those obtained with a single pair of optimum coaxial loops. A new arrangement is hereby proposed based on double conical coils with optimum separation between the coils and optimum aperture of the cones. Some of the proposed arrangements are carried out in the laboratory where the experimental results are in good agreement with the theoretical predictions.

[Stereotactic body radiation therapy for hepatocellular carcinoma: Results from a retrospective multicentre study]. / Radiothérapie en conditions stéréotaxiques du carcinome hépatocellulaire : résultats d'une étude rétrospective multicentrique.

PURPOSE: The purpose of this paper was to describe local control, overall survival, progression-free survival and toxicity of CyberKnife®-based stereotactic body radiation therapy of hepatocellular carcinoma. MATERIAL AND METHODS: Records of all the patients treated for hepatocellular carcinoma at the Eugene-Marquis cancer centre, Rennes and the Bretonneau hospital, Tours (France), between November 2010 and December 2016, were reviewed. Radiation therapy was performed as a salvage treatment, while awaiting liver transplantation or if no other treatment was possible. RESULTS: One hundred and thirty-six patients were consecutively included in the study. The median follow-up was 13months. Median total dose prescribed, fractionation and overall treatment time were respectively 45Gy, three fractions and 5 days. Overall survival, progression-free survival and local control rates at 1year and 2years were 79.8 % and 63.5 %, 61.3 % and 39.4 %; 94.5 % and 91 %. Two grade 3 acute toxicity events and two grade 4 late toxicity events corresponding to a duodenal ulcer have been reported. Seven patients underwent classic radiation-induced hepatitis and 13 patients showed non-classical radiation-induced hepatitis. Barcelona Clinic Liver Cancer stage, World Health Organisation grade and planning target volume were correlated with overall survival in univariate Cox analysis. CONCLUSION: Stereotactic body radiation therapy is effective and well-tolerated for inoperable hepatocellular carcinoma or as a bridge to liver transplantation. Toxicity is mainly related to cirrhotic background and requires a selection of patients and strict dose constraints.

New evidence of the relative protective effects of neurodegenerative diseases and cancer against each other. / Nueva observación de la protección relativa que las enfermedades neurodegenerativas y el cáncer se confieren entre sí.

BACKGROUND: Cancer and degenerative diseases share some pathogenic mechanisms which act in opposition to one another to produce either uncontrolled cell proliferation or cell death. According to several studies, patients with Alzheimer disease have a lower risk of neoplasia, and vice versa. This study describes the prevalence of tumours (active or successfully treated) in a series of patients with and without a dementing degenerative disease treated at a cognitive neurology unit. PATIENTS AND METHOD: We analysed the frequency and topography of tumours and the presence or absence of a neurodegenerative disease in a group of 1,164 patients. Neurodegenerative diseases were classified in 4 groups: Alzheimer disease, synucleinopathies, Pick complex, and polyglutamine complex. We subsequently compared tumour frequency in patients with and without a degenerative disease, and prevalence of neurodegenerative diseases in patients with and without tumours. RESULTS: Tumours were detected in 12.1% of the patients with a neurodegenerative disease and in 17.3% of the remaining patients. Around 14.8% of the patients with a history of neoplasia and 20.8% of the patients with no history of neoplasia were diagnosed with a neurodegenerative disease. Except for these differences and the differences between subgroups (type of degenerative disease and tumour location) were not statistically significant, except when comparing neurodegenerative diseases to central nervous system tumours, and synucleinopathies to neoplasms. CONCLUSION: Dementing degenerative diseases and neoplastic disorders are not mutually exclusive. Nevertheless, the rate of co-occurrence is lower than would be expected given the prevalence rate for each group.

Magnetic field homogeneity of a conical coaxial coil pair.

An analytical study of the magnetic field created by a double-conical conducting sheet is presented. The analysis is based on the expansion of the magnetic field in terms of Legendre polynomials. It is demonstrated analytically that the angle of the conical surface that produces a nearly homogeneous magnetic field coincides with that of a pair of loops that fulfills the Helmholtz condition. From the results obtained, we propose an electric circuit formed by pairs of isolated conducting loops tightly wound around a pair of conical surfaces, calculating numerically the magnetic field produced by this system and its heterogeneity. An experimental setup of the proposed circuit was constructed and its magnetic field was measured. The results were compared with those obtained by numerical calculation, finding a good agreement. The numerical results demonstrate a significant improvement in homogeneity in the field of the proposed pair of conical coils compared with that achieved with a simple pair of Helmholtz loops or with a double solenoid. Moreover, a new design of a double pair of conical coils based on Braunbek's four loops is also proposed to achieve greater homogeneity. Regarding homogeneity, the rating of the analyzed configurations from best to worst is as follows: (1) double pair of conical coils, (2) pair of conical coils, (3) Braunbek's four loops, (4) Helmholtz pair, and (5) solenoid pair.

Alucinaciones auditivas en neurología cognitiva / Auditory hallucinations in cognitive neurology

Introducción: Los tinnitus y las alucinaciones verbales o musicales (AVM) pueden deberse a lesiones neurológicas de naturaleza y topografía diversa. Método: Se han rastreado estos síntomas en 1.000 pacientes de una consulta de neurología cognitiva, anotando datos epidemiológicos y de neuroimagen. Resultados: Refirieron tinnitus el 6,9% y AVM el 0,9%. Hubo predominio femenino no significativo en el grupo con paracusias. La edad media fue menor en los pacientes con tinnitus y mayor en los que tenían AVM. La hipoacusia mostró mayor prevalencia en los enfermos con paracusias (significativo con AVM). No hubo diferencias en la prevalencia de trastorno psicótico u obsesivo-compulsivo, o de leucoaraiosis. El tratamiento con ácido acetilsalicílico mostró mayor frecuencia en el grupo con AVM, y otros analgésicos no opioides y benzodiacepinas en los pacientes con tinnitus. La presunta causa de las AVM fue demencia con cuerpos de Lewy (n = 2, uno con enfermedad vascular), enfermedad de Alzheimer (n = 2, uno con enfermedad vascular), enfermedad vascular cerebral pura (n = 3), lesión cerebral traumática (n = 1) y lesión quirúrgica en el tronco encefálico (n = 1). En los 9 casos había un elemento facilitador de la aparición de paracusias, como hipoacusia (n = 6) o medicación de riesgo (n = 9), además de polifarmacia (n = 9). Conclusiones: Los pacientes con tinnitus tomaban con frecuencia benzodiacepinas y analgésicos no opioides, y en los que tenían AVM había mayor prevalencia de hipoacusia y de tratamiento con ácido acetilsalicílico. Las causas de AVM fueron demencia con cuerpos de Lewy, enfermedad de Alzheimer y lesiones focales en mesencéfalo, protuberancia, lóbulo temporal izquierdo o claustro izquierdo (AU)

Introduction: Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH). Method: These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded. Results: Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n = 2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n = 3), traumatic brain injury (n = 1), and surgical brainstem lesion (n = 1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n = 6), a predisposing drug (n = 9), and polypharmacy (n = 9). Conclusions: Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum (AU)

Síntomas conductuales y psiquiátricos en neurología cognitiva / Behavioural and psychiatric symptoms in cognitive neurology

Los síntomas conductuales y psiquiátricos (SCP) son frecuentes en el enfermo neurológico, contribuyen a producir discapacidad y reducen la calidad de vida. Se ha observado, en pacientes de neurología cognitiva, la prevalencia y tipo de SCP y su asociación con diagnósticos, regiones cerebrales o tratamientos específicos. Método. Análisis retrospectivo de 843 pacientes consecutivos de neurología cognitiva, revisando SCP, diagnóstico, alteración sensorial, topografía lesional en neuroimagen y tratamiento. Se contempló el total y se comparó el grupo de pacientes con deterioro cognitivo objetivo (n = 607) y sin deterioro. Resultados. Hubo SCP en el 59,9% de los pacientes (61,3% en los deteriorados y 56,4% en el resto). Un 31,1% tenía un SCP, 17,4% dos y 11,4% más de dos. Los SCP son más frecuentes en mujeres, sobre todo depresión y ansiedad. En los mayores de 64 años predominan los síntomas psicóticos y conductuales, y en los menores de 65 la ansiedad. Las personas con alteración sensorial tienen más síntomas psicóticos. Se aprecian más síntomas conductuales y psicóticos en personas con demencia degenerativa, depresión y ansiedad en las que tienen enfermedad psiquiátrica o efecto nocivo de sustancias, labilidad emocional en relación con trastorno metabólico u hormonal, hipocondría en los síndromes dolorosos e irritabilidad en la hipoxia crónica. Hay más alteraciones de la conducta en pacientes con anomalía en lóbulos frontales o temporal o parietal derechos, y se tratan preferentemente con antipsicóticos. Aparte de los tratamientos estándar, se observó asociación de distimia con opioides, betahistina y estatinas, y síntomas psicóticos con levodopa, piracetam y vasodilatadores

Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. Method. A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n = 607) was compared to the non-CI group. Results. BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators

Auditory hallucinations in cognitive neurology. / Alucinaciones auditivas en neurología cognitiva.

INTRODUCTION: Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH). METHOD: These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded. RESULTS: Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n=2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n=3), traumatic brain injury (n=1), and surgical brainstem lesion (n=1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n=6), a predisposing drug (n=9), and polypharmacy (n=9). CONCLUSIONS: Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum.

Behavioural and psychiatric symptoms in cognitive neurology. / Síntomas conductuales y psiquiátricos en neurología cognitiva.

Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. METHOD: A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. RESULTS: BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators.

Prescripciones inconvenientes en el tratamiento del paciente con deterioro cognitivo / Inappropriate treatments for patients with cognitive decline

Introducción: Algunos fármacos resultan inconvenientes en pacientes con deterioro cognitivo. Se analiza su uso en 500 pacientes y se revisa la bibliografía. Desarrollo: Las benzodiacepinas producen dependencia y reducen la atención, memoria y agilidad motora. Pueden inducir desinhibición o agresividad, facilitan los episodios confusionales e incrementan los accidentes y la mortalidad en mayores de 60 años. En mayores de 65, la presión sistólica baja se asocia a deterioro cognitivo. Es recomendable mantenerla en 130-140 mmHg (145 en ≥ 80 años). La colesterolemia < 160 mg/dl se asocia a mayor morbimortalidad, agresividad y suicidio, y el colesterol unido a las lipoproteínas de alta densidad (c-HDL) < 40 mg/dl empeora la memoria y aumenta el riesgo vascular y la mortalidad. La edad avanzada predispone para que los opioides produzcan alteración cognitiva y confusión. En demencias no Alzheimer y no asociadas a Parkinson, deterioro cognitivo ligero y enfermedades psiquiátricas, los efectos adversos de anticolinesterásicos y memantina probablemente superan al beneficio. La alteración cognitiva por anticolinérgicos de acción preferentemente periférica también es posible. Hay que conocer la demencia o psicosis por corticoides, y saber que la polifarmacia facilita el síndrome confusional. El 70,4% de 500 pacientes con disfunción cognitiva analizados recibía polifarmacia y el 42%, benzodiacepinas. Los que compartían ambas situaciones representaron el 74,3% de los casos en los que se sospechó iatrogenia. Conclusiones: En personas con edad avanzada o deterioro cognitivo, es necesario evitar la polifarmacia innecesaria y tener presente que las benzodiacepinas, los opioides y los anticolinérgicos producen frecuentemente alteraciones cognitivas y conductuales. Además, deben evitarse la presión sistólica < 130 mmHg, el colesterol < 160 mg/dl y el colesterol HDL < 40 mg/dl

Introduction: Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Development: Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol < 40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Conclusions: Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population