Características neuropsicológicas de pacientes con deterioro cognitivo leve y demencia asociada a la enfermedad de Parkinson / Cognitive performance of Parkinson’s disease patients in different cognitive stages

En la enfermedad de Parkinson (EP), las áreas cognitivas pueden estar íntegras (EP cognitivamente normales,EP-CN), o afectarse desde compromisos ligeros sin compromiso de la funcionalidad (deterioro cognitivo leve asociado a EP, DCL-EP), hasta franca alteración de ella (demencia asociada a la EP, DEP). Objetivos:Evaluar el rendimiento cognitivo de pacientes con EP en diversos estadios cognitivos y compararlos con un grupo control. Pacientes y métodos:Prospectivamente se formaron cuatro grupos: 20 controles, 22 con diagnóstico de EP-CN, 18 con DCL-EP, y 23 con DEP. Siguiendo un ordenado protocolo, los individuos fueron sometidos a evaluaciones sucesivas de cribado, diagnóstico y tipo de deterioro cognitivo, luego de los cuales, fueron evaluados mediante una batería neuropsicológica para evaluación de atención, memoria, lenguaje, habilidades viso-constructivas y funciones ejecutivas. Resultados:Los pacientes con DCL-EP presentan alteraciones en la memoria viso-espacial (p˂0.01 vs EP-CN), habilidades viso-constructivas (p˂0.01 vs EP-CN) y funciones ejecutivas (p˂0.01 vs EP-CN) (con excepción de la capacidad de inhibición); mientras que en estadios más avanzados (DEP), se afecta además la atención (p˂0.01 vs EP-CN), memoria verbal (p˂0.01 vs DCL-EP) y el lenguaje (p˂0.01 vs DCL-EP). Conclusiones : Los pacientes con EP presentan según la evolución de la enfermedad, un progresivo compromiso de las áreas cognitivas.

In Parkinson’s disease (PD), cognitive areas may be intact (cognitively normal PD, PD-CN), or present light commitments without compromising on functionality (mild cognitive impairment associated with PD, MCI-PD), to frank alteration of cognition (dementia associated with PD, DPD). Objectives: To assess the cognitive performance of PD patients in different cognitive stagesand compared with control group. Patients and Methods: Prospectively, was evaluated four groups: 20 controls, 22 with a diagnosis of PD-CN, 18 MCI-PD and 23 with DPD. Individuals underwent screening tests, diagnosis and type of cognitive impairment, after which, were assessed using a neuropsychological battery: attention, verbal memory and visuospatial, language, visual-constructive skills and executive functions. Results: Patients with MCI-PD presented alterations in visuospatial memory (p ˂ 0.01 vs PD-CN), visuo-constructive skills (p ˂ 0.01 vs PD-CN) and executive functions (p ˂ 0.01 vs PD-CN ) (except for the ability of inhibition), while in more advanced stages (DPD), will also affect attention (p ˂ 0.01 vs PD-CN), verbal memory (p ˂ 0.01 vs DCL-PD) and language (p 0.01 vs ˂ DCL-PD). Conclusions: Patients with PD presented according to the evolution of the disease, a progressive commitment of the cognitive areas.

Validity of Addenbrooke's Cognitive Examination to Discriminate between Incipient Dementia and Depression in Elderly Patients of a Private Clinic in Lima, Peru.

BACKGROUND/AIMS: Dementia and depression are different clinical conditions, but share common features, and can be indistinguishable in the initial disease stages. We aimed to establish whether the Peruvian version of the Addenbrooke's Cognitive Examination (ACE-Peru) can distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression. METHODS: This was a cross-sectional study to assess the performance on the ACE-Peru of 193 elderly subjects (102 with dementia, 21 with depression, and 70 healthy controls). Depending on the diagnosis, there were two groups of cognitive impairment (CI) - the primary neurodegenerative (PN-CI) subtype and the secondary to depression (SD-CI) subtype - as well as a non-CI group. The area under the curve (AUC) of the receiver-operating characteristic curve was determined to compare the diagnostic performance, using the diagnosis of CI as the gold standard. RESULTS: In our sample of elderly subjects aged 59-82 years with at least 7 years of education, the ACE-Peru showed a significantly better performance than the MMSE (AUC = 0.997 vs. AUC = 0.887; p < 0.05) for the discrimination between PN-CI and SD-CI. CONCLUSIONS: The ACE-Peru is able to distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression.

Prevalence of frontotemporal dementia in community-based studies in Latin America: a systematic review / Prevalência de demência frontotemporal em estudos de base comunitária na America Latina: uma revisão sistemática

Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in geriatric problemssuch as dementia. There are few epidemiological studies assessing the magnitude of dementia and dementia subtypesin LA. Objective: To identify published community-based studies on the prevalence of FTD in LA countries. Methods: Adatabase search for door-to-door studies on FTD prevalence in LA was performed. The search was carried out on Medline,Embase, and LILACS databases for research conducted between 1994 and 2012. The main inclusion criteria were: use ofany internationally accepted diagnostic criteria and investigation of community samples. Results: Four hundred and ninetytwo articles were found, of which 26 were initially pre-selected by title or abstract review. Five studies from 3 differentcountries were included. The FTD prevalence rates in community-dwelling elderly were 1.2 (Venezuela), 1.3 (Peru) and1.7-1.8 (Brazil) per thousand persons, depending on age group. Conclusion: The FTD prevalence in LA studies showedvalues mid-way between those observed in western and in oriental populations. Despite the magnitude of this problem,epidemiological information on FTD remains scarce in LA.

A América Latina (AL) está experimentando um aumento na população de idosos e um consequente aumento nosproblemas geriátricos, como demência. Existem poucos estudos epidemiológicos avaliando a magnitude de demência edemência subtipos na AL Objetivo: Identificar publicações baseadas em estudos sobre a prevalência da FTD em países daAL. Métodos: A pesquisa realizada foi por estudos de prevalência de FTD em comunidade na AL. A pesquisa foi realizada emMed-line, Embase, e LILACS no período entre 1994 e 2012. Os principais critérios de inclusão foram: utilização de quaisquercritérios internacionalmente aceitos de diagnóstico e investigação de amostras em comunidade. Resultados: Quatrocentose noventa e dois artigos foram encontrados, dos quais 26 foram inicialmente pré-selecionados pelo título ou fiscalização doabstract. Cinco estudos de 3 países diferentes foram incluídos. As taxas de prevalência na comunidade em idosos com FTDeram 1,2 (Venezuela), 1,3 (Peru) e 1,7-1,8 (Brasil) por mil pessoas, dependendo da faixa etária. Conclusão: A prevalênciaFTD em estudos da AL, apresentaram valores intermediários entre os observados em populações ocidentais e orientais. Apesarda magnitude do problema, informações epidemiológicas sobre FTD permanecem escassas em AL.

Prevalence of frontotemporal dementia in community-based studies in Latin America: a systematic review.

Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in geriatric problems such as dementia. There are few epidemiological studies assessing the magnitude of dementia and dementia subtypes in LA. OBJECTIVE: To identify published community-based studies on the prevalence of FTD in LA countries. METHODS: A database search for door-to-door studies on FTD prevalence in LA was performed. The search was carried out on Medline, Embase, and LILACS databases for research conducted between 1994 and 2012. The main inclusion criteria were: use of any internationally accepted diagnostic criteria and investigation of community samples. RESULTS: Four hundred and ninety two articles were found, of which 26 were initially pre-selected by title or abstract review. Five studies from 3 different countries were included. The FTD prevalence rates in community-dwelling elderly were 1.2 (Venezuela), 1.3 (Peru) and 1.7-1.8 (Brazil) per thousand persons, depending on age group. CONCLUSION: The FTD prevalence in LA studies showed values mid-way between those observed in western and in oriental populations. Despite the magnitude of this problem, epidemiological information on FTD remains scarce in LA.

A América Latina (AL) está experimentando um aumento na população de idosos e um consequente aumento nos problemas geriátricos, como demência. Existem poucos estudos epidemiológicos avaliando a magnitude de demência e demência subtipos na AL. OBJETIVO: Identificar publicações baseadas em estudos sobre a prevalência da FTD em países da AL. MÉTODOS: A pesquisa realizada foi por estudos de prevalência de FTD em comunidade na AL. A pesquisa foi realizada em Med-line, Embase, e LILACS no período entre 1994 e 2012. Os principais critérios de inclusão foram: utilização de quaisquer critérios internacionalmente aceitos de diagnóstico e investigação de amostras em comunidade. RESULTADOS: Quatrocentos e noventa e dois artigos foram encontrados, dos quais 26 foram inicialmente pré-selecionados pelo título ou fiscalização do abstract. Cinco estudos de 3 países diferentes foram incluídos. As taxas de prevalência na comunidade em idosos com FTD eram 1,2 (Venezuela), 1,3 (Peru) e 1,7-1,8 (Brasil) por mil pessoas, dependendo da faixa etária. CONCLUSÃO: A prevalência FTD em estudos da AL, apresentaram valores intermediários entre os observados em populações ocidentais e orientais. Apesar da magnitude do problema, informações epidemiológicas sobre FTD permanecem escassas em AL.

Deterioro cognitivo leve: ¿dónde termina el envejecimiento normal y empieza la demencia? / Mild cognitive impairment: where does normal ageing end and where dementia begins?

Con el aumento de la prevalencia de demencia en el mundo, debemos poner especial atención a la evaluación diagnóstica de estadios previos a la demencia. El deterioro cognitivo leve (DCL) podría ser considerado un estadio precoz de demencia, en especial de la enfermedad de Alzheimer (AD); por lo que consideramos importante un diagnóstico adecuado, mediante la utilización de instrumentos y técnicas fiables y sensibles, que permitan discriminar entre sujetos con envejecimiento normal y patológico. Los estudios epidemiológicos muestran una elevada prevalencia de DCL en la población general. Asimismo, se ha documentado la progresión de DCL a demencia y EA, sobre todo en sujetos con DCL del tipo amnésico. La edad, el estado de portador del APOE-ε4, la atrofia del hipocampo en resonancia magnética y la presencia de algunos biomarcadores en líquido cefalorraquídeo parecen influir en la conversión. Se sugiere que el estudio de pacientes con sospecha de DCL sea el mismo que se emplea en la sospecha de demencia y EA. La evaluación neuropsicológica es la única prueba que permite confirmar el diagnóstico y nos ayuda a realizar una adecuada clasificación de los subtipos de DCL: amnésico, multidominio y monodominio no amnésico.

Due to the increasing prevalence of dementia in the world we must put special attention to diagnostic evaluation of pre-dementia stages. Mild cognitive impairment (MCI) could be considered an early stage of dementia, particularly of Alzheimer's disease (AD), so we consider important proper diagnosis using reliable and sensitive tools and techniques in order to discriminate subjects with normal and pathological aging. Epidemiological studies show high prevalence of MCI in the general population as well as progression of MCI to dementia and AD, especially in subjects with amnesia type MCI. Age, APOE-ε4 carrier status, hippocampus atrophy by MRI, and presence of certain biomarkers in cerebrospinal fluid can influence conversion. Evaluation of patients with MCI suspicion should be the same used in suspicion of dementia and AD. Neuropsychological assessment is the only test confirming diagnosis and helps making a proper classification of MCI subtypes: amnesic, multidomain and non-amnesic single domain.

[Validation of the clock drawing test - Manos´ version - as a screening test for detection of dementia in older persons of Lima, Peru]. / Validación de la prueba de dibujo del reloj - versión de Manos - como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú

INTRODUCTION: The clock drawing test (PDR-M) - Manos´ version - is a brief cognitive assessment tool for dementia detection. Objectives. To assess the validity and reliability of the PDR-M to discriminate between patients with dementia and healthy control subjects. MATERIALS AND METHODS: We evaluated subjects over 65 years of age, excluding those with severe concomitant diseases and those with hearing or visual impairment. We obtained demographic data and performed the PDR-M and Mini Mental State Examination (MMSE). Subjects of the dementia group were also submitted to clinical, laboratory and neuropsychological evaluations as well as computed tomography scanning. Sensitivity and specificity of the PDR-M were calculated as well as the area under the ROC curve. RESULTS: We evaluated 210 individuals, 103 with confirmed diagnosis of dementia and 107 healthy controls with similar age and sex in both groups, but a higher educational level in the control group. Setting a cutoff point of 7, a sensitivity of 99.0% and a specificity of 83.5% were found. When comparing the areas under the ROC curves of the PDR-M and MMSE we found no statistically significant difference. CONCLUSIONS: The PDR-M is a brief and reliable instrument for the detection of dementia in the urban population of Lima, Peru.

Validación de la prueba de dibujo del reloj - versión de Manos - como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú / Validation of the clock drawing test - Manos´ version - as a screening test for detection of dementia in older persons of Lima, Peru

Introducción. La prueba de dibujo del reloj versión de Manos (PDR-M) es un instrumento de evaluación cognitiva breve para la detección de demencia. Objetivos. Evaluar la validez y confiabilidad de la PDR-M para discriminar entre pacientes con demencia y sujetos controles sanos. Materiales y métodos. Se evaluaron sujetos mayores de 65 años de edad, excluyendo los que presentaban enfermedades concomitantes graves y con dificultades auditivas o visuales. Se recogieron datos demográficos y se les realizó PDR-M y Mini Mental State Examination (MMSE). A los individuos del grupo de demencia se les realizó además evaluaciones clínicas, de laboratorio, neuropsicológicas y tomografía cerebral. Se calculó la sensibilidad y especificidad de la PDR-M así como el área bajo la curva ROC. Resultados. Se evaluó 210 individuos, 103 con diagnóstico confirmado de demencia y 107 controles sanos, con edad y sexo similares en ambos grupos; y mayor nivel educativo en el grupo control. Estableciendo un punto de corte de 7 se obtuvo una sensibilidad de 99,0 por ciento y una especificidad de 83,5 por ciento. Cuando se compararon las áreas bajo la curva ROC de la PDR-M y del MMSE no se encontraron diferencias significativas. Conclusiones. La PDR-M es un instrumento breve y confiable para la detección de demencia en la población urbana de Lima en el Perú.

Introduction. The clock drawing test (PDR-M) - Manos´ version - is a brief cognitive assessment tool for dementia detection. Objectives. To assess the validity and reliability of the PDR-M to discriminate between patients with dementia and healthy control subjects. Materials and methods. We evaluated subjects over 65 years of age, excluding those with severe concomitant diseases and those with hearing or visual impairment. We obtained demographic data and performed the PDR-M and Mini Mental State Examination (MMSE). Subjects of the dementia group were also submitted to clinical, laboratory and neuropsychological evaluations as well as computed tomography scanning. Sensitivity and specificity of the PDR-M were calculated as well as the area under the ROC curve. Results. We evaluated 210 individuals, 103 with confirmed diagnosis of dementia and 107 healthy controls with similar age and sex in both groups, but a higher educational level in the control group. Setting a cutoff point of 7, a sensitivity of 99.0 percent and a specificity of 83.5 percent were found. When comparing the areas under the ROC curves of the PDR-M and MMSE we found no statistically significant difference. Conclusions. The PDR-M is a brief and reliable instrument for the detection of dementia in the urban population of Lima, Peru.

Prevalencia de demencia en una población urbana de Lima-Perú: estudio puerta a puerta / Dementia prevalence in a Lima, Peru urban community: door-to-door study

Objetivos: Calcular la prevalencia y tipos de demencia en una población de una comunidad urbana de Lima. Diseño: Muestreo por conglomerados bietápico. Instituciones: Instituciones de salud privadas. Pacientes: Individuos mayores de 65 años. Intervenciones: En el distrito de Cercado del Lima, 1.532 individuos mayores de 65 años, seleccionados aleatoriamente, fueron sometidos a evaluaciones neuropsicológicas breves, que incluyeron el Mini Mental State Examination (MMSE), la prueba del dibujo del reloj (PDR) y el cuestionario de actividades funcionales de Pfeffer (PFAQ). Según los resultados obtenidos luego de la aplicación del MMSE, PDR y PFAQ, los individuos fueron clasificados como seleccionados y no seleccionados, siendo el grupo de seleccionados aquellos que presentaban deterioro cognitivo luego de la aplicación de dichas pruebas. El grupo de personas seleccionadas fueron sometidas a evaluaciones neurológicas, neuropsicológicas, exámenes de laboratorio y tomografía computada (TC) cerebral. Principales medidas de resultados: Prevalencia de demencia. Resultados: Encontramos 105 casos de demencia, lo que corresponde a una prevalencia de 6,85%, siendo la enfermedad de Alzheimer el diagnóstico más frecuente (56,2%); dicha prevalencia se incrementó con la edad y tuvo predominio en el sexo femenino. El análisis de regresión logística mostró que la edad, género femenino y nivel educativo bajo se encontraban correlacionados con la prevalencia alta de demencia. Conclusiones: La prevalencia de demencia en esta población peruana fue 6,85% y la enfermedad de Alzheimer, el diagnóstico más frecuente; la edad, el género femenino y el nivel educativo bajo fueron los factores correlacionados con esta prevalencia alta.

Objective: To determine the prevalence and types of dementia in a Lima's urban community. Design: Bietapic conglomerate sampling. Setting: Private health institutions. Patients: Older than 65 years subjects. Interventions: In the Cercado de Lima district, 1.532 older than 65 years subjects randomly selected had brief neuropsychological evaluations including the Mini Mental State Examination (MMSE), drawing the Clock Test (PDR), and Pfeffer's functional activities questionnaire (PFAQ). According to the results obtained, individuals were classified as selected or not selected. The group selected included those subjects presenting/displaying cognitive deterioration, who further had neurological and neuropsychological evaluations, laboratory tests and brain computed tomography (TC). Main outcome measures: Dementia prevalence. Results: We found 105 cases of dementia corresponding to 6,95% prevalence; Alzheimer's disease was the most frequent diagnosis (56,2%). Dementia prevalence increased with age mainly in females. Logistic regression analysis showed that age, female sex and low education correlated with dementia prevalence. Conclusions: Dementia prevalence in this Peruvian population was 6,85%, and Alzheimer's disease the most frequent diagnosis; age, female gender and low educative level factors correlated with this high prevalence.

Efectos de inhibidores de colinesterasa en pacientes con enfermedad asociada a cuerpos de Lewy / Cholinesterase inhibitors effects in patients with Leweys bodies associated disease

Objetivos: Analizar los efectos de los inhibidores de colinesterasas (ICE) donepezilo, rivastigmina y galantamina en el tratamiento de demencia con cuerpos de Lewy (DCL) y demencia de la enfermedad de Parkinson (DEP). Diseño: Estudio tipo ensayo abierto. Lugar: Servicio de Neurología, Hospital Militar Central (HMC), y Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional. Participantes: Pacientes con demencia asociada a cuerpos de Lewy y demencia de la enfermedad de Parkinson. Intervenciones: Las mediciones de eficacia en 33 pacientes con diagnóstico de DCL y DEP se realizó con el Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale cognitive subscale (ADAS-cog), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change(ADCS-CGIC), Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL), Neuro-Psychiatry Inventory (NPI), Prueba de dibujo de Reloj de Manos (PDR-M) y la Unified Parkinson's Disease Rating Scalemotor subscale (UPDRS-part III). Principales medidas de resultados: Síntomas cognitivos, funcionamiento global y actividades de vida diaria de los pacientes. Resultados: Diecisiete pacientes fueron tratados con rivastigmina, 9 con galantamina y 7 con donepezilo. Luego de 6 meses de tratamiento, los pacientes en tratamiento con rivastigmina mejoraron en 1,39 puntos en ADAS-cog respecto de su medición basal, mientras que los pacientes tratados con donepezilo y galantamina no mostraron cambios (cambios < 0,2 puntos). Respecto al ADCS-ADL, los pacientes tratados con rivastigmina, donepezilo y galantamina demostraron disminución de 0,42, 0,58 y 0,75 puntos, respectivamente. En el MMSE, los pacientes tratados con rivastigmina y donepezilo no mostraron cambios y los pacientes tratados con galantamina tuvieron una disminución promedio de 1,19 puntos. No hubo diferencias significativas en la incidencia de síntomas parkinsonianos en los tres grupos ...

Objectives: To analyze the effects of cholinesterase inhibitors (CHEIs) prescribed for treatment of dementia with Lewy bodies (DLB) and dementia associated with Parkinson's disease (PDD). Design: Open essay study. Setting: Neurology Service, Hospital Militar Central, and Cognitive Deterioration Diagnosis Unit and Dementia Prevention, Clinica Internacional. Participants: Patients with dementia associated to Lewy bodies and dementia associated with Parkinson's disease. Interventions: Outcome measures included the Mini-Mental State Examination (MMSE), the Alzheimer Disease Assessment Scale cognitive subscale (ADAS-cog), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory (ADCS-ADL), Neuro-Psychiatry Inventory (NPI), Ten Point Clock-Drawing Test (CDT) andUnified Parkinson's Disease Rating Scale-motor subscale (UPDRS-part III). Main outcome measures: Patients' cognitive symptoms, global functionand daily life activities. Results: Seventeen patients were treated with rivastigmine, nine with galantamine and seven with donepezil. At six months, rivastigmine-treated patients improved by 1,39 points from baseline on the ADAS-cog, while donepezil and galantamine treated patients showed 'no change" (changes of < 0,2 points). On the ADCS-ADL, patients treated with rivastigmine, donepezil and galantamine showed decreases of 0,41, 0,68 and 0,86 points, respectively. On the MMSE, donepezil and rivastigmine-treated patients showed 'no change' and galantamine-treated patients showed a mean decrease of 1,19 points. The difference with regard to the incidence of parkinsonian symptoms as adverse events was not reflected in significant differences in UPDRS motor scores between the three groups. Side effects were similar in the three treatment groups. Conclusions: Cholinesterase inhibitors may be of benefit for cognitive impairments with impact on global function ...