Trastorno de pánico y fibrilación auricular / Panic disorder and atrial fibrillation

Este trabajo analiza la relación bidireccional entre la fibrilación auricular y el trastorno de pánico. El diagnóstico diferencial se plantea frecuentemente en los servicios de urgencias y en la consulta del médico de atención primaria. Diferentes estudios nos hablan de una alta tasa de prevalencia de trastornos de ansiedad en pacientes que han recibido el diagnóstico de fibrilación auricular. Por otra parte, se ha observado que los pacientes con trastornos de ansiedad presentan una mayor prevalencia de enfermedades cardiovascular. Los pacientes con trastorno de pánico presentarán con frecuencia quejas somáticas indicativas de enfermedad cardíaca que es obligatorio descartar mediante pruebas complementarias. El correcto diagnóstico conlleva, además, el tratamiento considerado óptimo para cada afección y, como consecuencia, la reducción del gasto sanitario (AU)

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis (AU)

[Panic disorder and atrial fibrillation]. / Trastorno de pánico y fibrilación auricular.

This paper studies the relationship between atrial fibrillation and panic disorder. There are often doubts on the differential diagnosis in emergency services and general medical settings. Panic disorder prevalence rates have been found to be high in patients suffering from atrial fibrillation. Various studies have observed that patients diagnosed with anxiety disorders frequently have higher cardiovascular disease rates compared to the general population. Usually, patients suffering from panic disorder exhibit somatic complaints suggesting coronary disease, such as chest pain or palpitations. The aim is to make the correct diagnosis and treatment for these different illnesses, and to decrease the costs due to misdiagnosis.

Estrés y factores relacionados en padres con hijos en la unidad / Stress and related factors in parents with children in neonatal intensive care unit

Objetivo: identificar el nivel de estrés y los factores relacionados, en padres con hijos en la Unidad de Cuidado Intensivo neonatal de la Clínica Universitaria Bolivariana. Metodología: estudio cuantitativo, de tipo descriptivo, transversal. Se aplicó la escala de Estrés Parental en la Unidad de Cuidado Intensivo, PSS: NICU, desarrollada y validada por Carter y Miles. En total se estudiaron a 50 padres, escogidos a conveniencia. Resultados: la edad promedio de los padres fue de 30.6 años, el 36.7 por ciento tenían escolaridad universitaria, el 42 por ciento con estrato socioeconómico nivel 3. El 62 por ciento eran empleados, el 76 por ciento de género femenino y para el 42 por ciento era su primer hijo. El principal diagnóstico del neonato fue de enfermedad respiratoria (24 por ciento). El 44 por ciento de los padres señaló que el nivel de estrés frente a lo que vio y escuchó en la unidad fue un poco estresante. El comportamiento, el aspecto y los tratamientos del bebé, fueron un poco estresantes para el 34 por ciento. El 32 por ciento de los padres señaló que era muy estresante su relación y rol de padres, valor que fue significativo estadísticamente. La comunicación con el personal de salud, para el 34 por ciento de los padres, fue poco estresante. Para el nivel de estrés general, el 28 por ciento expresó que la experiencia en general de tener a su hijo en la unidad, fue poco estresante, mientras que el 24 por ciento indicó que fue muy estresante. Conclusión: Los padres presentaron mayor estrés, cuando se desempeñan en su rol de padres, valor con significancia estadística.

Objective: To identify the level of stress and related factors in parents of children in the Neonatal Intensive Care Unit of the Clinica Universitaria Bolivariana. Methodology: study quantitative, descriptive, transversal. We applied the Parental Stress Scale in Intensive Care Unit, PSS: NICU, developed and validated by Carter and Miles. A total of 50 parents was studied, chosen for convenience. Results: The mean age of the fathers was 30.6 years; the 36.7 percent had college education, 42 percent with socioeconomic level 3. 62 percent were employed, 76 percent female and in the 42 percent was their first child. The primary diagnosis was neonatal respiratory disease (24 percent). The 44 percent of parents said that the stress level compared to what they had seen and heard in the unit was a bit stressful. The baby behavior, appearance and treatments were a bit stressful for 34 percent. The 32 percent of parents pointed that their relationship and parenting role was very stressful, value which was statistically significant. Communication with health personnel was rushed for the 34 percent of parents. For the general stress level, 28 percent expressed that the overall experience of having your child in the unit, was little stressful, while 24 percent said that it was very stressful. Conclusion: Parents showed more stress when working in their role as parents, statistically significant value.

Fear, infection and compassion: social representations of tuberculosis in Medellin, Colombia, 2007.

OBJECTIVE: To identify and analyse the social representations (SRs) of tuberculosis (TB) among three groups of people in Medellin, Colombia, with the purpose of contributing to improvements in TB treatment and control programme activities. METHODS: Cross-sectional study using free word association and evocative analysis techniques in 1049 persons within a structural SR framework. RESULTS: The terms 'cough', 'contagion', 'illness' and 'fear' were found to be components of the central core in the three groups. In the peripheral system, 'rejection' and 'treatment' were considered modifiable factors. Text analysis showed that 'fear' and 'compassion' are associated with evocations among patients and their relatives, 'contagion' among lay people and 'isolation' among health care personnel. DISCUSSION: Fear of infection may have a negative effect on relationships with patients, health care activities, treatment surveillance and family support for patients. A better understanding of patient beliefs and their family environment can improve treatment quality and adherence in the city.

Adult human spinal cord harbors neural precursor cells that generate neurons and glial cells in vitro.

Adult human and rodent brains contain neural stem and progenitor cells, and the presence of neural stem cells in the adult rodent spinal cord has also been described. Here, using electron microscopy, expression of neural precursor cell markers, and cell culture, we investigated whether neural precursor cells are also present in adult human spinal cord. In well-preserved nonpathological post-mortem human adult spinal cord, nestin, Sox2, GFAP, CD15, Nkx6.1, and PSA-NCAM were found to be expressed heterogeneously by cells located around the central canal. Ultrastructural analysis revealed the existence of immature cells close to the ependymal cells, which display characteristics of type B and C cells found in the adult rodent brain subventricular region, which are considered to be stem and progenitor cells, respectively. Completely dissociated spinal cord cells reproducibly formed Sox2(+) nestin(+) neurospheres containing proliferative precursor cells. On differentiation, these generate glial cells and gamma-aminobutyric acid (GABA)-ergic neurons. These results provide the first evidence for the existence in the adult human spinal cord of neural precursors with the potential to differentiate into neurons and glia. They represent a major interest for endogenous regeneration of spinal cord after trauma and in degenerative diseases.

Tratamiento del trastorno afectivo bipolar en el embarazo / Treatment of bipolar disorder during pregnancy

A number offactors must be evaluated in order to determine the safety ofany medication that is being considered for use during pregnancy All psychotropic medications diffuse readily across the placenta. No psychotropic medication has been approved by the Food and Drug Administration (FDA) for use during the pregnancy and pregnant women have traditionally been excluded from pharmacologic research. Numerous studies have shown a high relapse rate in psychiatrk patient during the pregnancy whose medications were discontinued. When deciding whether or not to treat a psychiatrk patient during the pregnancy the guiding principie is to weigh the risks of fetal exposure to a psychotropic medication against the risks to both the mother and fetus of not treating a psychiatrk illness. Patients with bipolar disorder are at significant risk of relapse ifuntreated, particularly following abrupt discontinuation of lithium. Untreated bipolar illness with recurrence of mania may result in progression of the disorder. Another risk is disease chronkity and treatment resistance.

Una serie de factores deben ser evaluados a fin de determinar la seguridad de la medicación que se está considerando para su uso durante el embarazo. Todos los medicamentos psicotrópicos difunden fácilmente a través de la placenta. Ninguna medicación psicotrópica ha sido aprobada por la Food and Drug Administration (FDA) para su uso durante el embarazo, y las mujeres embarazadas han sido tradicionalmente excluidas de la investigación farmacológica. Numerosos estudios han demostrado una alta tasa de recaídas en pacientes psiquiátricos cuyos medicamentos fueron descontinuados. Al decidir si se debe o no tratar a una paciente psiquiátrica durante el embarazo, el principio rector es sopesar los riesgos de la exposición del feto a una medicación psicotrópica contra los riesgos para la madre y el feto de no tratar una enfermedad psiquiátrica. Los pacientes con trastorno bipolar se encuentran en gran riesgo de recaída si no se tratan, en particular después de la interrupción abrupta de litio. Si no se trata la enfermedad bipolar, con la recurrencia de la manía puede darse lugar a la progresión del trastorno. Otro riesgo es la cronicidad de la enfermedad y la resistencia al tratamiento.

Berenjenol aislado de Oxandra cf xylopioides (Annonaceae) como insecticida / Berenjenol isolated from Oxandra cf xylopioides (Annonaceae) as insecticide

El Berenjenol (21:24-epoxi-24-metil-cicloartano), obtenido del extracto de diclorometano de las hojas de Oxandra cf. xylopioides, es evaluado como biocida sobre el gusano cogollero del maíz, Spodoptera frugiperda. El berenjenol es usado en concentraciones de 25, 50, 100, 200 y 400 ppm y aplicado en una dieta artificial sobre larvas del segundo instar. Se determina el porcentaje de mortalidad a las 24, 48 y 72 horas y se calcula la DL50 y DL90; el análisis de mortalidad demuestra que el berenjenol tiene un efecto tóxico, siendo la dosis de 400 ppm la más mortal. El efecto del berenjenol es muy rápido y efectivo encontrándose valores de DL50 de 319.6 ppm a las 24 horas y valores similares a las 48 y 72 horas.

Evaluación del programa "La aventura de la vida" desde la perspectiva de sus actores en una escuela de educación básica primaria, Medellín, 2002-2004: estudio de caso / Evaluation of the program "La Aventura de la Vida" from the perspective of its staff working in an elementary school, Medellín, 2002-2004: a case study

Esta investigación tiene como base la evaluación del programa "La aventura de la vida", trabajo conjunto entre la Universidad de Antioquia y Surgir, organización no gubernamental encargada de dicho programa en Medellín. Se escuchó a sus participantes para comprender los conocimientos, percepciones y relaciones en las comunidades educativas donde se aplicó y en esa medida se pudo establecer cómo los componentes del programa pueden dar cuenta de prácticas e interacciones de sus actores, que producen efectos e impactos. Este estudio indagó sobre dichos efectos e impactos en términos de proceso social y como vehículos transformadores de la cultura ciudadana frente al problema de la fármacodependencia. Para ello, se exploraron las concepciones y significados de la comunidad educativa sobre prevención de problemáticas socialmente relevantes asociadas a las drogas y promoción de estilos de vida saludables. La evaluación fue de tipo cualitativa (estudio de caso), lo que permitió comprender el desarrollo real del programa utilizando diferentes técnicas, tales como entrevistas en profundidad, observaciones participantes y grupos focales de niños y niñas y de sus personas significantes.

This research evaluated the program "La aventura de la vida" (Adventure of Life), a joint work between University of Antioquia and Surgir, a nongovernmental organization in charge of the program in Medellín. Participants were interviewed to understand what happens with the knowledge, perceptions and relations in the educative community where it was applied. It was possible to establish that components of the program can account for practices and interactions of their actors producing effects and impacts. The study looked for these effects and impacts in terms of social process and as transforming tool of citizen culture facing drug addition problem. Community conceptions and meanings on prevention of socially relevant problems associated to drugs and healthy life styles promotion. With a qualitative and ethnographic approach, the study allowed to understand the real development of the program, using different techniques such as comprehensive interviews, participant observations and focal groups with children and their significant people.

Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures.

An international panel reviewed the methodology for clinical trials of spinal cord injury (SCI), and provided recommendations for the valid conduct of future trials. This is the second of four papers. It examines clinical trial end points that have been used previously, reviews alternative outcome tools and identifies unmet needs for demonstrating the efficacy of an experimental intervention after SCI. The panel focused on outcome measures that are relevant to clinical trials of experimental cell-based and pharmaceutical drug treatments. Outcome measures are of three main classes: (1) those that provide an anatomical or neurological assessment for the connectivity of the spinal cord, (2) those that categorize a subject's functional ability to engage in activities of daily living, and (3) those that measure an individual's quality of life (QoL). The American Spinal Injury Association impairment scale forms the standard basis for measuring neurologic outcomes. Various electrophysiological measures and imaging tools are in development, which may provide more precise information on functional changes following treatment and/or the therapeutic action of experimental agents. When compared to appropriate controls, an improved functional outcome, in response to an experimental treatment, is the necessary goal of a clinical trial program. Several new functional outcome tools are being developed for measuring an individual's ability to engage in activities of daily living. Such clinical end points will need to be incorporated into Phase 2 and Phase 3 trials. QoL measures often do not correlate tightly with the above outcome tools, but may need to form part of Phase 3 trial measures.

Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials.

The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to provide some of this information. Almost all people living with SCI show some recovery of motor function below the initial spinal injury level. While the spontaneous recovery of motor function in patients with motor-complete SCI is fairly limited and predictable, recovery in incomplete SCI patients (American spinal injury Association impairment scale (AIS) C and AIS D) is both more substantial and highly variable. With motor complete lesions (AIS A/AIS B) the majority of functional return is within the zone of partial preservation, and may be sufficient to reclassify the injury level to a lower spinal level. The vast majority of recovery occurs in the first 3 months, but a small amount can persist for up to 18 months or longer. Some sensory recovery occurs after SCI, on roughly the same time course as motor recovery. Based on previous data of the magnitude of spontaneous recovery after SCI, as measured by changes in ASIA motor scores, power calculations suggest that the number of subjects required to achieve a significant result from a trial declines considerably as the start of the study is delayed after SCI. Trials of treatments that are most efficacious when given soon after injury will therefore, require larger patient numbers than trials of treatments that are effective at later time points. As AIS B patients show greater spontaneous recovery than AIS A patients, the number of AIS A patients requiring to be enrolled into a trial is lower. This factor will have to be balanced against the possibility that some treatments will be more effective in incomplete patients. Trials involving motor incomplete SCI patients, or trials where an accurate assessment of AIS grade cannot be made before the start of the trial, will require large subject numbers and/or better objective assessment methods.

Neurocognitive assessment before and after cranioplasty.

OBJECTIVE: This paper addresses the possible value of neurocognitive tests on the evaluation of patients before and after cranioplasty for large cranial defects. METHODS: In a single patient with a large corrected cranial defect a detailed neurocognitive analysis was performed utilizing the EXIT interview and Cognistat before and after surgery. Planning and development of the surgical prosthesis were based on the pre-operative reconstruction of the head CT and on pre-operative pictures of the patient. Xenon-CT anatomical and quantitative cerebral blood flow (CBF) analysis was performed before and periodically after cranioplasty. FINDINGS: A significant improvement in major cognitive functions was observed after surgery. INTERPRETATION: Cognistat is a detailed neuropsychological battery that permits a better assessment of patients in diverse neurological conditions. The EXIT interview gives a better rapid assessment of cognition not provided by other methods, such as the mini-mental status examination (MMSE). The utilization of these techniques permits a better understanding of long-term outcomes for patients with diverse neurological conditions, including post-cranioplasty patients.

Neurofibromatosis: presentacion de un caso / Neurofibromatoses: a case report

Se presenta un caso de neurofibromatosis en un paciente de 70 años de edad, natural de Lituania, residente en Medellín, con múltiples tumores cutáneos en la cara, de 25 años de evolución. Al examen físico, presenta manchas café con leche y efélides intertriginosas que sugieren el diagnóstico, el cual es confirmado con estudio histopatológico de la lesión.

A case of neurofibromatoses is presented in a 70 years old patient, who was borned in Lituania, resident in Medellín (Colombia), and had multiple cutaneous tumoral lesions of 25 years ofevolution in face. At physical examination we founded coffee au lait spots and intertriginous freekles that suggest the diagnosis, wich was confirmed by histopatologic studies.

Consulta de Psiquiatría de Enlace en un Servicio de Neurocirugía / Liaison Psychiatry Service work up in a Neurosurgery Department

En el presente artículo describimos el funcionamiento de un servicio de Psiquiatría de Enlace en un Departamento de Neurocirugía y el proceso de complementación entre ambos, a fin de poder compararlo con servicios similares de otros centros. Presentamos nuestras experiencias a lo largo de los últimos 7 años como parte del equipo de trabajo en el servicio de Neurocirugía de la Universidad de Illinois en Chicago, Estados Unidos. Hacemos hincapié en la importancia del trabajo multidisciplinario, describiendo las causas de consulta más frecuentes y el modelo de evaluación ilustrado con la descripción de algunos casos clínicos (AU)

Gacyclidine: a new neuroprotective agent acting at the N-methyl-D-aspartate receptor.

Gacyclidine is a new phencyclidine derivative with neuroprotective properties. Tritiated gacyclidine and its enantiomers bind to NMDA receptors with binding parameters similar to those of other non-competitive NMDA receptor antagonists. The (-)enantiomer, (-)GK11, exhibits an affinity (2.5 nM) similar to that of dizocilpine (MK-801), while the (+)enantiomer, (+)GK11, has a 10 times lower affinity. When its interaction with NMDA receptors is prevented, gacyclidine binds also to "non-NMDA" binding sites which are mainly located in the molecular layer of the cerebellum on the dendritic tree of Purkinje cells. These binding sites do not appear to be related to any known neurotransmitters. In primary cortical cultures, gacyclidine and its enantiomers, at 0.1 to 5.0 microM, prevent glutamate-induced neuronal death. In rats, in vivo neurotoxicity of gacyclidine is far low than that of MK-801. No necrotic neurons were detected in animals sacrificed at 18 or 96 h after treatment with gacyclidine (1, 5, 10 or 20 mg/kg i.v.). At the highest (20 mg/kg) but not the lower doses (1-100 mg/kg) electron microscopy revealed the presence of few cytoplasmic or intramitochondrial vacuoles. In soman-treated monkeys gacyclidine enhanced neuroprotective activity of "three drugs cocktail" (atropine + diazepam + pralidoxime). Moreover, in rats, gacyclidine exerts a dose- and time-dependent neuroprotection in three models of spinal cord lesion. Beneficial effects of gacyclidine include reduction of lesion size and improvement of functional parameters after injury. In traumatic brain injury models gacyclidine improves also behavioral parameters and neuronal survival. Optimal protection is obtained when gacyclidine is administered at 0 to 30 min after injury. It is, therefore, concluded that gacyclidine exhibits neuroprotective effects similar to those of other NMDA receptor antagonists, with the advantage of being substantially less neurotoxic maybe due to its interaction with "non-NMDA" binding sites.

Neuroprotective effects of a novel NMDA antagonist, Gacyclidine, after experimental contusive spinal cord injury in adult rats.

The aim of this study was to analyze the optimal time-window for neuroprotection by a novel NMDA antagonist, Gacyclidine, after experimental spinal cord injury, in terms of its functional, histopathological and electrophysiological effects. This molecule has already demonstrated its capacity for reducing the extent of an ischemic lesion and is currently experimented in a clinical trial of spinal cord injury. In this study, the spinal cord of rats was damaged by a contusive method and the animals were treated by saline or 1 mg/kg of Gacyclidine i.v., 10, 30, 60 and 120 min after injury. The time-course of the motor score was evaluated on days 1, 7 and 18 after injury, and somatosensory evoked potentials were determined on day 20. The animals were then killed and the cross-sectional area of the spinal cord (at the epicenter of the injury, above and below the injury), was measured. Walking recovery was better (P<0.0125) in the group treated 10 min after injury than in the untreated injured animals after 18 days of injury. Motor performances were related to the preservation of a larger undamaged area of spinal cord at the level of the injury (P<0.0125). Somatosensory evoked potential amplitudes were also higher in this group. These results confirm that Gacyclidine attenuates spinal cord damage after an experimental spinal cord lesion. Recovery was better within the group treated 10 min after injury compared with the other groups, which certainly confirms that the acute time-course of glutamate release requires rapid pharmacological intervention to achieve good results.

Neuroprotective effects of gacyclidine after experimental photochemical spinal cord lesion in adult rats: dose-window and time-window effects.

The aim of this study was to evaluate the efficacy, optimal dose, and optimal time-window of gacyclidine, a novel N-methyl-D-aspartate (NMDA) receptor antagonist, in terms of its functional, histopathological, and electrophysiological effects after experimental spinal cord injury. The spinal cord of rats was damaged by a photochemical method and the animals were treated by saline or gacyclidine at doses of 1, 2.5, or 5 mg/kg 10 min after injury or gacyclidine 1 mg/kg 10, 30, 60, and 120 min after injury. The time-course of the motor score (walking and inclined-plane stability) was evaluated until day 18, and somatosensory evoked potentials were determined on day 18. The animals were then sacrificed, and the cross-sectional area of the spinal cord (at the epicenter of the injury, above and below the injury) was measured. Walking recovery was better in most of the groups treated after injury than in the untreated injured animals. Motor performances were related to preservation of a larger undamaged area of spinal cord at the level of the injury and, interestingly, with prevention of extension of the anatomical lesion above the level of the injury. Somatosensory evoked potential amplitudes were often higher in treated groups. These results confirm that gacyclidine induces dose-dependent and time-dependent attenuation of spinal cord damage after an experimental vascular lesion. Although all three doses induced neuroprotective effects, recovery was greater and very homogeneous in the group treated with 1 mg/kg. Moreover, recovery was slightly better and more homogeneous within the groups treated 10 and 30 min after injury compared to the other groups. It appears that, according to the existing evidence, NMDA antagonists are an essential component in the elaboration of a neuroprotective strategy after spinal cord trauma.

[Fronto-temporal dementia]. / Demencia frontotemporal.

Defined barely one decade ago, Frontotemporal Dementia emerges as a new clinical entity that reestablishes the classical Pick's disease as part of a extensive syndrome with important and unsuspected prevalence. Frontotemporal Dementia includes all primary degenerative processes starting in the anterior portions of the brain. This type of dementia is clinically characterized by behavior and personality disorders, more than cognitive alterations. In the present research we performed a bibliographic review of the subject including clinical characteristics, laboratory tests, and neuropathology. Furthermore we assessed areas that require further development.

Variability of the fatigue response of paralyzed skeletal muscle in relation to the time after spinal cord injury: mechanical and electrophysiological characteristics.

The aim of this study was to determine the effect of the time after spinal cord injury (less than and greater than 10 months) on the mechanical and electrophysiological characteristics of muscle fatigue of the paralyzed electrically stimulated quadriceps muscle. Morphologically and histochemically, a relationship was observed between muscle fatigue and the delay from injury, revealing a critical period of enzymatic turning and a maximum peak of atrophy around the 10th month after the injury, followed by a long-term stabilization. Knee-torque output and M-wave variables (amplitude, latency, duration, and root mean square, RMS) of two muscular heads of the quadriceps were recorded in 19 paraplegic patients during a 120-s isometric contraction. The fatiguing muscle contraction was elicited by supramaximal continuous 20-Hz electrical stimulation. Compared to the chronic group, the acutely paralyzed group showed a greater resistance to fatigue (amount and rate of force decline, P < or = 0.01), smaller alterations of the M-wave amplitude and RMS, and a limited decrease of the muscle fiber conduction velocity (P < 0.05). Mechanical and electrophysiological changes during fatigue provided a clear functional support of the transformation of skeletal muscle under the lesion and of the existence of a critical period of muscular turn. In conclusion, when considering the artificial restoration of motor function, the evolution of the endurance and force-generating capabilities of the muscle actuator must be taken into account, particularly when tasks require important safety conditions (e.g., standing and walking).

[Frontotemporal dementia]. / Demencia frontotemporal.

Defined barely one decade ago, Frontotemporal Dementia emerges as a new clinical entity that reestablishes the classical Pick's disease as part of a extensive syndrome with important and unsuspected prevalence. Frontotemporal Dementia includes all primary degenerative processes starting in the anterior portions of the brain. This type of dementia is clinically characterized by behavior and personality disorders, more than cognitive alterations. In the present research we performed a bibliographic review of the subject including clinical characteristics, laboratory tests, and neuropathology. Furthermore we assessed areas that require further development.

Demencias Vasculares / Vascular dementia

Las demencias vasculares representam un problema médico serio. Constituyen la segunda causa de demencia en el mundo occidental y tienen un pronóstico peor que la enfermedad de Alzheimer. Su estudio ha permanecido por mucho tiempo relativamente inexplorado, quizá en parte por la diversidad de factores asociados a la génesis de la enfermedad. Este aparente olvido de una de las patologías de más prevalencia entre el grupo de personas mayores de 65 anos se ha traducido en el surgimiento de un sinnúmero de términos para una misma patología, lo cual ha dificultado en gran modo una adecuada definición del término. Las consecuencias de la falta de claridad en la fisiopatología y en el diagnóstico mismo de la enfermedad se refleja en las pocas medidas terapéuticas disponibles. En el momento, existe la feliz coincidencia de criterios diagnósticos más precisos y el desarrollo de técnicas imagenológicas que permiten una visualización más precisos de lo que sucede en el cerebro de estos pacientes. Este artículo tratara sobre el estado del arte de las demencias vasculares con un énfasis especial en los estudios que involucran las nuevas técnicas de evaluación imagenológica