Cholesterol dysregulation in peripheral blood mononuclear cells of Alzheimer's disease.

Cholesterol and the immune system are involved in Alzheimer's Disease (AD). To investigate the relations among them, we compared the cholesterol content in peripheral blood mononuclear cells (PBMC) of cognitively healthy controls and patients with mild cognitive impairment (MCI) and AD in two independent samples. Free cholesterol content of PBMC was lower in MCI and AD patients, and was modulated by APOE genotype. A decrease of CD8+ and an increase of CD16+ was also found in AD patients. These results suggest that cholesterol levels in PBMCs may represent an early signature of the disease and support the involvement of immune system in AD.

Diagnostic validity of the Alzheimer's disease functional assessment and change scale in mild cognitive impairment and mild to moderate Alzheimer's disease.

BACKGROUND: The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS) is a functional assessment instrument widely used in clinical research. AIMS: To test the diagnostic and concurrent validity of the Spanish version of this scale and to describe the functional deficit pattern for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. METHODS: The ADFACS, the Interview for Deterioration in Daily Living Activities in Dementia (IDDD), and the Mini Mental State Examination (MMSE) were administered to 146 control subjects (CS) and 165 patients (67 MCI and 98 AD). Nonparametric tests were used to compare the diagnostic groups. Cronbach's α and correlations with the MMSE and the IDDD were calculated. Sensitivity, specificity and predictive values were studied. RESULTS: The ADFACS had a high internal consistency (α = 0.95). Three cutoff points of 1, 4, and 17 were provided to separate CS and MCI patients, MCI and mild AD patients, and mild AD and moderate AD patients, respectively. The ADFACS strongly correlated with functional (IDDD, 0.927) and cognitive (MMSE, 0.747) measures. A similar pattern of dysfunction, but in different grades, was found for the MCI and AD groups. CONCLUSION: The ADFACS is a reliable, valid, and sensitive instrument to assess functional abilities; it is useful in dementia assessment for elderly populations.

APOE and Alzheimer disease: a major gene with semi-dominant inheritance.

Apolipoprotein E (APOE) dependent lifetime risks (LTRs) for Alzheimer Disease (AD) are currently not accurately known and odds ratios alone are insufficient to assess these risks. We calculated AD LTR in 7351 cases and 10 132 controls from Caucasian ancestry using Rochester (USA) incidence data. At the age of 85 the LTR of AD without reference to APOE genotype was 11% in males and 14% in females. At the same age, this risk ranged from 51% for APOE44 male carriers to 60% for APOE44 female carriers, and from 23% for APOE34 male carriers to 30% for APOE34 female carriers, consistent with semi-dominant inheritance of a moderately penetrant gene. Using PAQUID (France) incidence data, estimates were globally similar except that at age 85 the LTRs reached 68 and 35% for APOE 44 and APOE 34 female carriers, respectively. These risks are more similar to those of major genes in Mendelian diseases, such as BRCA1 in breast cancer, than those of low-risk common alleles identified by recent GWAS in complex diseases. In addition, stratification of our data by age groups clearly demonstrates that APOE4 is a risk factor not only for late-onset but for early-onset AD as well. Together, these results urge a reappraisal of the impact of APOE in Alzheimer disease.

Fe de errores de «La guardia específica de neurología en la formación del médico residente en España» / Erratum. Specific neurology emergency training of medical residents in Spain

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[Specific neurology emergency training of medical residents in Spain]. / La guardia específica de Neurología en la formación del médico residente en España.

INTRODUCTION: Training in emergency neurological illness is very important for the neurologist today. The Neurology National Commission has decided to obtain information on the work duties of neurologist residents in the different neurology units of the hospitals of our country and the supervision of the training in urgent pathology. METHOD: A survey of adult neurology program directors to find out if their hospital fulfils the program criteria for the residents duty work. RESULTS: A response rate of 98.5% was obtained. In 47% of the neurology training units a neurologist supervised resident duty work 24 hours a day. In the rest of the neurology training units they did not fulfil all the training program criteria. We analysed the differences between the neurologist training units, and there are great differences between the hospitals and all regions and communities in our country. Only 65% of neurology residents do their education in neurology units who fulfill the national program criteria on training on urgent neurology pathology CONCLUSIONS: There is too much diversity in resident duty work in neurologist training units and not all the units meet the national training program requirements.

Análisis de las unidades docentes de neurología en España y cumplimientode los criterios de acreditación / Analysis of the neurology teaching unit in Spain and compliance of accreditation criteria

Introducción. Ante la promulgación de la Ley de Ordenación dela Profesiones Sanitarias y la publicación del nuevo programa de laespecialidad de neurología, la Comisión Nacional de Neurología considerónecesario conocer la situación actual de las unidades docentes(UD) acreditadas para la especialidad en lo referente a los criterios deacreditación vigentes. El objetivo de este trabajo es conocer dichasituación.Métodos. Estudio transversal mediante una encuesta de cumplimentaciónvoluntaria (cuestionario ad hoc) remitida por correoen el año 2005 a todas UD acreditadas en ese momento. Incluyópreguntas específicas respecto a los requerimientos estructurales,humanos y de organización contemplados en dichos criterios deacreditación.Resultados. Se remitieron 64 cuestionarios (porcentaje de respuesta:76,6%). El 87 % de las UD cumplían los requisitos estructuralespara la asistencia neurológica, aunque el 21 % tenían menos de4 despachos para consulta y menos de 15 camas neurológicas. El 25%de las UD no cumplían los requisitos en lo referente a los facultativos deplantilla con dedicación a tiempo completo. Aunque prácticamente el100% cumplían los requisitos organizativos cuantitativos asistenciales,sólo el 69 % refirieron tener guardias de neurología, aunque porel diseño del cuestionario no es posible conocer su grado de tutorización.Prácticamente el 100% cumplen los requisitos de docencia einvestigación.Conclusiones. Aunque el grado de cumplimiento de los actualesCA es alto, existen deficiencias preocupantes, fundamentalmente enrelación al número de facultativos de plantilla contratados a tiempocompleto y a la disponibilidad de guardias de neurología debidamentetutorizadas (AU)

Introduction. Faced with the promulgation of the HealthCare Professionals Ordinance Law and the publication of the newprogram of the Neurology training, the National Committee ofneurology has considered it necessary to know the current situationof the Teaching Units (TU) accredited for the neurology trainingin regards to the existing accreditation criteria (AC). Thepurpose of this study is to know said situation.Methods. A cross-sectional study performed by a voluntarilyfilled-out survey (ad hoc questionnaire) sent by regular mailin the year 2005 to all the TU accredited at that time. It includedspecific questions regarding the structural, human andorganizational requirements contemplated in those accreditationcriteria.Results. A total of 64 questionnaires were sent (response percentage:76.6%). Eighty seven percent of the TU met the structuralrequirements for neurological care, although 21 % had fewerthan 4 offices for visits and fewer than 15 neurology beds. A totalof 25 % of the TU did not met the requirements in regards to fulltimestaff members. Although almost 100% met the quantitativecare organizational requirements, only 69 % reported that therewere neurology duties. However, the grade of the tutorial systemcould not be known due to the survey design. Almost 100% metthe teaching and research requirements.Conclusions. Although the compliance grade of the currentAC is high, there are important deficiencies, basically related tothe number of full-time staff professionals and the availability ofduly tutorized neurology duties (AU)

[Analysis of the neurology teaching unit in Spain and compliance of accreditation criteria]. / Análisis de las unidades docentes de neurología en España y cumplimiento de los criterios de acreditación.

INTRODUCTION: Faced with the promulgation of the Health Care Professionals Ordinance Law and the publication of the new program of the Neurology training, the National Committee of neurology has considered it necessary to know the current situation of the Teaching Units (TU) accredited for the neurology training in regards to the existing accreditation criteria (AC). The purpose of this study is to know said situation. METHODS: A cross-sectional study performed by a voluntarily filled-out survey (ad hoc questionnaire) sent by regular mail in the year 2005 to all the TU accredited at that time. It included specific questions regarding the structural, human and organizational requirements contemplated in those accreditation criteria. RESULTS: A total of 64 questionnaires were sent (response percentage: 76.6%). Eighty seven percent of the TU met the structural requirements for neurological care, although 21 % had fewer than 4 offices for visits and fewer than 15 neurology beds. A total of 25 % of the TU did not met the requirements in regards to full-time staff members. Although almost 100% met the quantitative care organizational requirements, only 69 % reported that there were neurology duties. However, the grade of the tutorial system could not be known due to the survey design. Almost 100% met the teaching and research requirements. CONCLUSIONS: Although the compliance grade of the current AC is high, there are important deficiencies, basically related to the number of full-time staff professionals and the availability of duly tutorized neurology duties.

[Unilateral papillitis as the presenting symptom of neurosarcoidosis]. / Papilitis unilateral como presentación de neurosarcoidosis.

INTRODUCTION: Sarcoidosis is a granulomatous, multisystemic disease, of unknown etiology. Its prevalence is low, 40 cases by 100,000 inhabitants in Northern European countries. Respiratory symptoms are the most common, however this disease can affect other vital systems. Neurooftalmological manifestations have been reported one out of five cases, such as uveitis, cranial nerves palsy, and choroiditis; papillitis is seldom described. When initial symptoms of sarcoidosis are neurological features (less than 5%), diagnosis is challenging. CASE REPORTS: We present two cases of neurosarcoidosis in our hospital, during the last two years, in patients without previous diagnosis, which came for loss of visual acuity. The diagnostic was achieved by magnetic resonanace white matter lesions hyperintenses in T2, computed tomography thoracic mediastinic adenopathy and elevated determinations of angiotensin-converting enzyme, according to diagnostic criteria of neurosarcoidosis published in 2004. CONCLUSIONS: We propose to include neurosarcoidosis among known etiologies of unilateral papilitis. Since that, determination of angiotensin-converting enzyme should be performed in those cases.

Papilitis unilateral como presentación de neurosarcoidosis / Unilateral papillitis as the presenting symptom of neurosarcoidosis

La sarcoidosis es una enfermedad multisistémica granulomatosa, más frecuente en mujeres, con unaprevalencia de 40 casos por 100.000 habitantes y una clínica preferentemente pulmonar. La afectación neurooftalmológica se da en el 15-25% de los pacientes y la clínica habitual es la parálisis de los pares craneales, la uveítis y la coroiditis. El iniciode esta enfermedad con clínica neurológica apenas se da en el 5% de los pacientes con sarcoidosis. Casos clínicos. Presentamos dos casos de neurosarcoidosis en nuestro centro en los últimos dos años, en pacientes sin diagnóstico sistémico previo, que consultaron por una disminución de la agudeza visual. En la resonancia magnética craneal se encontraron lesiones en lasustancia blanca, hiperintensas en la secuencia T2; la tomografía computarizada de tórax mostró adenopatías mediastínicas y las determinaciones de la enzima convertidora de angiotensina estuvieron por encima de la normalidad. Se diagnosticó a los pacientes mediante criterios clínicos publicados en 2004. Conclusiones. Destacamos la importancia de incluir la neurosarcoidosisen el diagnóstico diferencial de la papilitis unilateral, así como la determinación de la enzima convertidora de angiotensina como parte de su estudio

Sarcoidosis is a granulomatous, multisystemic disease, of unknown etiology. Its prevalence is low, 40cases by 100.000 inhabitants in Northern European countries. Respiratory symptoms are the most common, however this disease can affect other vital systems. Neurooftalmological manifestations have been reported one out of five cases, such as uveitis, cranial nerves palsy, and choroiditis; papillitis is seldom described. When initial symptoms of sarcoidosis areneurological features (less than 5%), diagnosis is challenging. Case reports. We present two cases of neurosarcoidosis in our hospital, during the last two years, in patients without previous diagnosis, which came for loss of visual acuity. The diagnosticwas achieved by magnetic resonanace white matter lesions hyperintenses in T2, computed tomography thoracic mediastinic adenopathy and elevated determinations of angiotensin-converting enzyme, according to diagnostic criteria of neurosarcoidosis published in 2004. Conclusions. We propose to include neurosarcoidosis among known etiologies of unilateral papilitis. Sincethat, determination of angiotensin-converting enzyme should be performed in those cases

[Alzheimer's disease, category-specific impairment and relevant variables in object naming]. / Enfermedad de Alzheimer, deterioro categorial y variables relevantes en la denominación de objetos.

INTRODUCTION: The study of the dissociations or category-specific effects between the domains of living beings and non-living beings in Alzheimer's disease (AD) is a controversial issue in the cognitive neurosciences. The lack of agreement among the different studies may be due to deficient control of certain cognitive and psycholinguistic variables that affect processing of the items. AIM: To determine whether the presence of category-specific effects in AD can be caused by inadequate control of variables, such as the typicality or familiarity of the items. Furthermore, since the groups may contain different types of patients with opposing impairments (which would mask this kind of effect in the group analysis), both group and individual analyses were conducted. SUBJECTS AND METHODS: A retrospective study was carried out to evaluate 66 participants (32 patients with AD) using a colour photo naming task with items controlled for seven disruptive variables. RESULTS: No evidence of living/non-living dissociation was found in the analyses by groups, although the individual-based analysis did show some cases of category-specific effects. CONCLUSIONS: Our data show that category-specific effects are not as widespread as they were believed to be and that the lack of control over the so-called disturbing variables may play an important role in studies on category-specific impairment. Our study also highlights the importance of conducting individual analyses in order to avoid overlooking certain effects that are masked in the group studies.

Enfermedad de Alzheimer, deterioro categorial y variables relevantes en la denominación de objetos / Alzheiher´s disease, category-specific impairment and relevant variables in object naming

Introducción. El estudio de las disociaciones o efectos categoriales entre los dominios de seres vivos y seres novivos en la enfermedad de Alzheimer (EA) es un tema polémico para las neurociencias cognitivas. La falta de acuerdo entrelos estudios puede deberse a un deficiente control sobre determinadas variables cognitivas y psicolingüísticas que influyen enel procesamiento de los ítems. Objetivo. Verificar si en la EA la presencia de efectos categoriales puede deberse a un controlinadecuado de variables como la tipicidad o la familiaridad de los ítems. Además, dado que en los grupos puede haber tiposde pacientes con deterioros opuestos –que enmascararían esta clase de efectos en los análisis de grupo– se realizaron análisisde grupo e individuales. Sujetos y métodos. Se evaluó a 66 participantes (32 pacientes con EA) de forma retrospectiva conuna tarea de denominación de fotografías en color con ítems controlados en siete variables perturbadoras. Resultados. No sehalló evidencia de disociación vivo/no vivo al realizar análisis de grupo, aunque el análisis individualizado mostró algunoscasos de efectos categoriales. Conclusiones. Nuestros datos muestran que los efectos categoriales no son tan generales comose pensaba y que la falta de control de las llamadas variables perturbadoras puede desempeñar una función importante en losestudios sobre deterioro categorial. Además, se verifica la importancia de realizar análisis individuales que impidan pasarpor alto algunos efectos enmascarados por los estudios de grupo

Introduction. The study of the dissociations or category-specific effects between the domains of living beings andnon-living beings in Alzheimer’s disease (AD) is a controversial issue in the cognitive neurosciences. The lack of agreementamong the different studies may be due to deficient control of certain cognitive and psycholinguistic variables that affectprocessing of the items. Aim. To determine whether the presence of category-specific effects in AD can be caused by inadequatecontrol of variables, such as the typicality or familiarity of the items. Furthermore, since the groups may containdifferent types of patients with opposing impairments (which would mask this kind of effect in the group analysis), both groupand individual analyses were conducted. Subjects and methods. A retrospective study was carried out to evaluate 66 participants(32 patients with AD) using a colour photo naming task with items controlled for seven disruptive variables. Results. Noevidence of living/non-living dissociation was found in the analyses by groups, although the individual-based analysis didshow some cases of category-specific effects. Conclusions. Our data show that category-specific effects are not as widespreadas they were believed to be and that the lack of control over the so-called disturbing variables may play an important role instudies on category-specific impairment. Our study also highlights the importance of conducting individual analyses in orderto avoid overlooking certain effects that are masked in the group studies

Terapia hormonal sustitutiva y enfermedad de Alzheimer / Hormonal substitute therapy and Alzheimer´s disease

El objetivo del presente artículo es el de establecer la relación del tratamiento hormonal sustitutivo y la enfermedad de Alzheimer. Estudios previos avalaron que el uso de la terapia hormonal sustitutiva podría prevenir o disminuir la aparición de síntomas de Alzehimer, al combatir la deprivación estrogénica que se insinuó como un factor de riesgo. En el presente trabajo se revisa la bibliografía y se definen las nuevas consideraciones existentes en la actualidad sobre el tema

The aim of the present article is, of establishing the relation of the hormonal substitute treatment and Alzheimer’s disease. Previous studies supported, that the use of the hormonal substitute therapy might anticipate or diminish the appearance of Alzehimer’s symptoms, when the deprivation attacks estrogénica that was insinuated as a factor of risk. In the present work the bibliography is checked and the new existing considerations are defined at present on the topic

[The organization of health care for stroke. The stroke units make the difference]. / Organización asistencial en el cuidado agudo de ictus. Las unidades de ictus marcan la diferencia.

INTRODUCTION: The advantages of care in stroke units (UI) are known, as are those of being in neurology wards as compared with the general medical wards, although to date there are no studies which make a comparative evaluation of the stroke team (EI) as compared with the UI with regard to benefits in care obtained by the patients. PATIENTS AND METHODS: We made a sequential analysis from the stroke register comparing three groups of patients attended during the years 1994-1996. During 1994 the patients were attended in the neurology ward by the EI. In 1995 an acute UI was set up. The criteria for inclusion or exclusion, health staff and technical resources were similar. We analysed the average stay, complications, mortality, hospital costs, functional state and destination on discharge. RESULTS: We included 1,491 patients: 435 (1994), 529 (1995) and 527 (1996). Comparing UI with EI we observed a reduced average stay (29.5%; p<0.001), fewer complications (47.8%; p<0.001), better functional state on discharge (Rankin 1 +/- 2 against 2 +/- 2; p<0.0001), increased transference to rehabilitation units (78%; p<0.001) with less long-term hospitalisation (22%; VS) and a reduction in costs ( up to 14.2%). There was no difference in mortality. CONCLUSIONS: The UI is a better system of attendance than EI for the management of strokes, since it reduces the average stay, hospital complications and health costs, as well as permitting a better functional state on discharge. Therefore treatment in the UI makes the difference in prognosis for these patients and the institutional expenses.

Un paciente con pérdida de memoria

La pérdida de memoria constituye el rasgo común y fundamental de prácticamente todas las demencias, por ello su identificación correcta y precoz es fundamental para llegar a un diagnóstico en etapas tempranas de una demencia e incluso en sus estadios previos o preliminares.El reconocimiento de las funciones cognitivas y su caracterización en las distintas entidades nosológicas que constituyen este síndrome, junto a un adecuado proceder diagnóstico, son fundamentales a la hora de enfrentarnos a un paciente en el que se sospeche una demencia.Las actitudes nihilistas en el tratamiento de la demencia no están justificadas y no sólo porque existan causas secundarias de demencia potencialmente tratables, sino porque actualmente existen tratamientos farmacológicos, como los inhibidores de la acetilcolinesterasa, capaces de modificar el curso natural de demencias degenerativas primarias como la enfermedad de Alzheimer (causa más frecuente de demencia) (AU)