Calidad de vida en la enfermedad de Alzheimer / Quality of life in Alzheimer´s disease

Introducción. La calidad de vida es un concepto de creciente interés cuya evaluación complementa la valoración clínica tradicional, de interés fundamentalmente en ámbitos de organización de la asistencia. Presentamos un estudio de calidad de vida en la enfermedad de Alzheimer y su relación con medidas cognitivas y funcionales. Pacientes y métodos. Se evalúa la calidad de vida mediante la escala EQ-5D en una muestra de casos de enfermedad de Alzheimer diagnosticados con criterios del National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association que han donado muestra de sangre para el Banco Nacional de ADN, en los que se ha determinado también el estadio de la escala de deterioro global, y se ha efectuado un test de fluencia verbal y el test minimental de Folstein. Se realizó un análisis clásico, contraste de variables mediante chi al cuadrado para las proporciones y t de Student para las medias,y estimación de r para los modelos de regresión en las variables cuantitativas. Se determinó la tarifa social mediante el programa SPSS v. 11. Resultados. Se analizan 141 casos, con una relación de 2 a 1 entre mujer y varón, y una edad media de 76,2 años. Los aspectos de cuidado personal, actividad y, en menor medida, motilidad se ven afectados en la enfermedad de Alzheimer, pero no parecen hacerlo los aspectos de dolor y ansiedad. Existe relación entre calidad de vida, escalas funcionales y escalas cognitivas. Los aspectos funcionales se correlacionan mejor que los cognitivos con la calidad de vida. Conclusiones. La calidad de vida se evalúa en la enfermedad de Alzheimer mediante escalas generales, como EQ-5D. Los aspectos cognitivos no parecen aportar información relevante en relación con la calidad de vida que no se aporte ya por los aspectos funcionales (AU)

Introduction. Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer’s disease and its relationship with cognitive and functional measures. Patients and methods. Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer’s disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student’s t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. Results. Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer’s disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. Conclusions. Quality of life is evaluated in Alzheimer’s disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects (AU)

[Quality of life in Alzheimer's disease]. / Calidad de vida en la enfermedad de Alzheimer.

INTRODUCTION: Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer's disease and its relationship with cognitive and functional measures. PATIENTS AND METHODS: Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer's disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student's t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. RESULTS: Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer's disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. CONCLUSIONS: Quality of life is evaluated in Alzheimer's disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects.

[Experiences with the Eurotest in neuropsychological examinations. A screening test]. / Experiencia con el Eurotest en la exploración neuropsicológica. Un test de cribado.

INTRODUCTION: The increasing number of foreign patients being attended in our health centres makes it necessary to have tests that are compatible among different countries, especially in Europe. The objective of this study is to compare the Eurotest with other screening tests and to determine whether there are any differences between European (other than Spanish) and Spanish patients. PATIENTS AND METHODS: We included patients who were referred because of complaints that were compatible with cognitive impairment and they were asked to carry out a protocol of tests that included the global deterioration scale (GDS), Folstein's MMSE (Mini-Mental State Examination), the Clock Test (CT) and the Eurotest. Epidemiological data were collected. The sample used in the study included 45 patients, 21 males and 24 females, with a mean age of 69.76 years; 34 were born in Spain and 11 abroad. RESULTS: Diagnoses were 17 with mild cognitive impairment, 8 with Alzheimer's disease, 6 with age-associated impairment, 5 with vascular dementia, 5 with a psychiatric disorder, 1 with mixed dementia and 1 with dementia with Lewy bodies. The distribution according to the GDS was as follows: 10 with a GDS of 2, 18 with a GDS of 3, and 17 with a GDS of 4. All the patients with a GDS 2 completed the tests correctly, those with a GDS 3 scored below the cut-off point 5 for the Eurotest, 4 for the MMSE and 3 for CT, and in the GDS 4 they were 9, 7 and 6, respectively. Results did not vary between Spaniards and foreigners, the kappa index between MMSE and the Eurotest was 0.39 and the Pearson coefficient was 0.67. CONCLUSION: The Eurotest was slightly more useful in patients with a greater degree of impairment.

Experiencia con el Eurotest en la exploración neuropsicológica. Un test de cribado / Experiences with the eurotest in neuropsychological examinations. A screening test

Introducción. El incremento de pacientes extranjeros atendidos en nuestras consultas hace necesario disponer de tests compatibles entre múltiples países, especialmente del ámbito europeo. El objetivo del estudio es comparar el Eurotest con otros tests de cribado y comprobar si existen diferencias entre pacientes europeos (no españoles) y españoles. Pacientes y métodos. Incluimos pacientes remitidos por presentar quejas compatibles con deterioro cognitivo; se les realizó un protocolo de tests para su estudio, que incluyó la escala global de deterioro (GDS), el MMSE (Mini-Mental state examination) de Folstein, el test del reloj (TR) y el Eurotest. Recogimos datos epidemiológicos. Fueron 45 pacientes, 21 hombres y 24 mujeres, con una edad media de 69,76 años, 34 nacieron en España y 11 fuera. Resultados. Los diagnósticos fueron 17 con deterioro cognitivo leve, 8 con enfermedad de Alzheimer, 6 con deterioro asociado a la edad, 5 con demencia vascular, 5 con trastorno psiquiátrico, 1 con demencia mixta y 1 con demencia por cuerpos de Lewy. La distribución según GDS fueron: 10 con GDS de 2, 18 con GDS de 3, y 17 con GDS de 4. Todos los pacientes con GDS 2 realizaron los tests correctamente, con GDS 3 dieron por debajo del punto de corte 5 para Eurotest, 4 para MMSE y 3 para TR, y en GDS 4 fueron 9, 7 y 6, respectivamente. Los resultados no variaron entre españoles y extranjeros, el índice kappa entre MMSE y Eurotest fue de 0,39, y el coeficiente de Pearson, de 0,67. Conclusión. El Eurotest fue ligeramente más útil en pacientes más deteriorados (AU)

Introduction. The increasing number of foreign patients being attended in our health centres makes it necessary to have tests that are compatible among different countries, especially in Europe. The objective of this study is to compare the Eurotest with other screening tests and to determine whether there are any differences between European (other than Spanish) and Spanish patients. Patients and methods. We included patients who were referred because of complaints that were compatible with cognitive impairment and they were asked to carry out a protocol of tests that included the global deterioration scale (GDS), Folstein’s MMSE (Mini-Mental State Examination), the Clock Test (CT) and the Eurotest. Epidemiological data were collected. The sample used in the study included 45 patients, 21 males and 24 females, with a mean age of 69.76 years; 34 were born in Spain and 11 abroad. Results. Diagnoses were 17 with mild cognitive impairment, 8 with Alzheimer's disease, 6 with age-associated impairment, 5 with vascular dementia, 5 with a psychiatric disorder, 1 with mixed dementia and 1 with dementia with Lewy bodies. The distribution according to the GDS was as follows: 10 with a GDS of 2, 18 with a GDS of 3, and 17 with a GDS of 4. All the patients with a GDS 2 completed the tests correctly, those with a GDS 3 scored below the cutoff point 5 for the Eurotest, 4 for the MMSE and 3 for CT, and in the GDS 4 they were 9, 7 and 6, respectively. Results did not vary between Spaniards and foreigners, the kappa index between MMSE and the Eurotest was 0.39 and the Pearson coefficient was 0.67. Conclusion. The Eurotest was slightly more useful in patients with a greater degree of impairmen (AU)

Trombosis venosa cerebral y enfermedad inflamatoria intestinal / Cerebral venous thrombosis and inflammatory bowel disease

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[Encephalitis caused by Rickettsia conorii without exanthema]. / Encefalitis por Rickettsia conorii sin exantema.

INTRODUCTION: Mediterranean boutonneuse fever, caused by Rickettsia conorii, is an endemic disease in the Mediterranean area. The serious forms of the disease, which include encephalitis, are infrequent but are associated with a high mortality rate. Diagnostic suspicion is backed up by the development of exanthema. We report the case of a patient who developed encephalitis caused by Rickettsia conorii without exanthema. Clinical case. A 27 year old woman who had nauseas, headache, fever, abdominal upset and generalised pain during the days before being admitted to hospital. On the day she was admitted, she noticed reduced strength in the left limbs, together with numbness and pins and needles in the left side of the body. In the casualty department she presented tonic seizures in the left extremities and later generalised tonic clonic seizures. Exploration showed facial paresis and 4/5 hemiparesis on the left side. Complementary tests carried out in casualty, including cerebrospinal fluid (CSF), did not reveal any significant findings. She was admitted after a loading dose of phenytoin. After 48 hours she presented fever and repeated complex partial seizures. A new CSF analysis was normal. She was treated with valproate, clonazepam, ceftriaxone, doxycycline and acyclovir. An electroencephalogram (EEG) showed theta activity in the left centroparietal areas and slow delta waves in the right temporal regions. Magnetic resonance imaging (MRI) of the brain showed contrast enhancement in the meninges. 24 later, due to the frequency of the seizures, phenobarbital and methylprednisolone were added, which enabled the seizures to be controlled. The posterior brain MRI revealed a right parasylvian lesion. Serological Rickettsia conorii IgM +, IgG 1/256 was administered. After eight months, she has presented no seizures or neurological deficit. CONCLUSIONS: There are cases of encephalitis from Rickettsia conorii that can present without exanthema. This means that in endemic areas early treatment with doxycycline could be advisable when faced with encephalitis of unknown aetiology, bearing in mind the high mortality rate that occurs when no early treatment is administered and the good tolerance to doxycycline.

Encefalitis por Rickettsia conorii sin exantema / Encephalitis caused by Rickettsia conorii without exanthema

Introducción. La fiebre botonosa mediterránea, causada por Rickettsia conorii, es una enfermedad endémica en el área mediterránea. Las formas graves, entre las que se encuentra la encefalitis, son infrecuentes, pero se asocian a una elevada mortalidad. La sospecha diagnóstica se apoya en el desarrollo de exantema. Presentamos un paciente que desarrolló encefalitis por R. conorii sin exantema. Caso clínico. Mujer de 27 años que días antes del ingreso había presentado náuseas, cefalea, fiebre, malestar abdominal y dolor generalizado. El día del ingreso notó una disminución de la fuerza en las extremidades izquierdas, así como adormecimiento y hormigueos en el hemicuerpo izquierdo. En urgencias presentó crisis tónica en las extremidades izquierdas y posteriormente una crisis generalizada tonicoclónica. En la exploración mostró paresia facial y hemiparesia 4/5 izquierdas. Las pruebas complementarias que se realizaron en urgencias no mostraron hallazgos significativos, incluido el líquido cefalorraquídeo (LCR).Se le ingresó tras dosis de carga de fenitoína. Después de 48 horas presentó fiebre y crisis parciales complejas repetidas. Un nuevo análisis del LCR fue normal. Se trató con valproato, clonacepam, ceftriaxona, doxiciclina y aciclovir. Se realizó un electroencefalograma (EEG) con actividad theta en las áreas centroparietales izquierdas y ondas lentas delta temporales derechas. La imagen por resonancia magnética (IRM) cerebral mostró captación de contraste en las meninges. 24 horas después, ante la frecuencia de las crisis, se añadió fenobarbital y metilprednisolona, con lo que se controlaron las crisis. En la IRM cerebral posterior se detectó una lesión parasilviana derecha. Se recibió serología R. conorii IgM +, IgG 1/256. Después de ocho meses, no ha presentado crisis ni déficit neurológico. Conclusiones. Existen casos de encefalitis por R. conorii que pueden presentarse sin exantema, por lo que en áreas endémicas podría estar indicado el tratamiento precoz con doxiciclina ante una encefalitis de etiología no filiada, dada la elevada mortalidad que representa no tratar de forma precoz y dada la buena tolerancia a la doxiciclina (AU)

Epilepsia y demencia por cuerpos de Lewy / Epilepsy and dementia due to Lewy bodies

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Epidemiological, microbiological, clinical, and prognostic factors of bacteremia caused by high-level vancomycin-resistant Enterococcus species.

A case-control study was performed between 1994 and 1996 in order to study the epidemiological, microbiological, clinical, and prognostic features of high-level vancomycin-resistant enterococcal bacteremia. Seventeen consecutive patients who had clinically significant bacteremia due to vancomycin-resistant enterococci (vanA genotype: 16 Enterococcus faecalis, 1 Enterococcus faecium) were compared with 169 who had vancomycin-susceptible enterococcal bacteremia. The following were selected by multivariate analysis as independent risk factors that influenced the development of high-level vancomycin-resistant enterococcal bacteremia: prior glycopeptide therapy (P=0.049); inclusion in a hemodialysis program (P=0.046); prior therapy with corticosteroids or antineoplastic agents (P=0.029); and prior surgical treatment (P=0.022). The following other factors were selected by univariate analysis: tracheostomy (P=0.002); prolonged hospitalization (P=0.01); and any kind of puncture (P=0.02). The crude associated-mortality rate was 13.4%. Gene amplification of vanA was positive for 17 strains of enterococci. Pulsed-field gel electrophoresis of genomic DNA after SmaI digestion of vanA isolates revealed that one strain predominated (10 isolates), though at least four similar banding patterns were identified (6 isolates). The 16 strains closely related to the outbreak were investigated further. The surgical intensive care unit was the first and most involved service. The hospital outbreak of vanA vancomycin-resistant enterococcal bacteremia occurred between 1994 and 1995 and was caused by Enterococcus faecalis. This is believed to be the first and only such outbreak described in a Spanish hospital thus far.

[Molecular typing and sensitivity of Candida albicans isolates proceeding from critically ill patients]. / Tipificación molecular y sensibilidad de aislamientos de Candida albicans procedentes de pacientes críticos.

BACKGROUND: Nosocomial infection due Candida albicans in immunocompromised patients are recognized as a significant cause of morbidity and mortality. The endogenous forms of infections may require effective strategies for prevention which are different from those for exogenous infections due to transmission of any organism from patient to patient. Typing by PCR of isolates of C. albicans maybe useful for that. METHODS: Twenty-four isolates in blood cultures of 24 critically ill patients were studied. Typing by interrepeat PCR and in vitro antifungal susceptibility tests was performed by a microdilution. RESULTS: Twenty-one different genotypes were obtained. The isolates with same genotype shown different patterns of susceptibility. With one strain a band pattern very different from that obtained with the remaining isolates. CONCLUSIONS: No were relation between strain of same unit. The isolates with same genotype was different critically unit or year of isolation.

[Evolution of resistance in the genus Enterococcus in strains isolated from blood]. / Evolución de las resistencias del género Enterococcus en cepas aisladas en sangre.

The objective of this study was to determine the evolution of the species distribution and the prevalence of resistance to the Enterococcus genus. We studied 281 strains of enterococcus isolated from blood samples: 90 throughout 1984 and 791 from the years 1994 to 1996. identification was made using PosCombo 4Y Microscan-Baxter dehydrated panels and the Rapid ID 32 Strep system (bioMerieux). The MICs were calculated using the agar dilution method according to recommendations of the NCCLS for the following antibiotics: ampicillin, vancomycin, teicoplanin, gentamicin, kanamycin and streptomycin. The production of betalactamases were evaluated using a paper disk with nitrocefin for all the strains. The genotypes with resistance to glycopeptides were determined using PCR. The percentage of E. faecalis for 1984-1986/1994-1996 was 82.2/79.4; of E. faecium 4.4/16.4; and other species 12.214.3. The resistance to ampicillin went from 1.1% to 5.8%; high level resistance to glycopeptides went from 0% to 9.9%; for low level from 7.7% to 2.6%; resistance to a high charge of gentamicin went from 27.7% to 40.8%; and that for kanamycin from 45.5% to 62.8%. Resistance to streptomycin remained constant (45.5%). No strains produced betalactamases. For the species E. faecium, a statistically significant increase was detected for global resistance to ampicillin, gentamicin and kanamycin, with resistance to streptomycin remaining at similar percentages. No high level resistance to glycopeptides was detected in the first time period, but the low level resistance was greater.