Predictive model for falling in Parkinson disease patients.

BACKGROUND/AIMS: Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The aim of this study was to develop a multivariate model to predict falling in PD patients. METHODS: Prospective cohort with forty-nine PD patients. The area under the receiver-operating characteristic curve (AUC) was calculated to evaluate predictive performance of the purposed multivariate model. RESULTS: The median of PD duration and UPDRS-III score in the cohort was 6 years and 24 points, respectively. Falls occurred in 18 PD patients (30%). Predictive factors for falling identified by univariate analysis were age, PD duration, physical activity, and scores of UPDRS motor, FOG, ACE, IFS, PFAQ and GDS (p-value < 0.001), as well as fear of falling score (p-value = 0.04). The final multivariate model (PD duration, FOG, ACE, and physical activity) showed an AUC = 0.9282 (correctly classified = 89.83%; sensitivity = 92.68%; specificity = 83.33%). CONCLUSIONS: This study showed that our multivariate model have a high performance to predict falling in a sample of PD patients.

Utilidad de la batería ejecutiva y cognición social de INECO en la evaluación de funciones ejecutivas de una serie de pacientes peruanos con demencia fronto-temporal, variante conductual / Utility of the INECO's executive and social cognition battery in the evaluation of executive functions in Peruvians patients with behavioral variant fronto-temporal dementia

Los síntomas característicos de la demencia fronto-temporal, variante conductual reflejan disfunción del cortex prefrontal ventromedial, y no existe consenso respecto a las pruebas neuropsicológicas más sensibles y específicos para evaluarlos. Objetivos: El objetivo de este estudio fue detectar alteraciones específicas de funciones ejecutivas y de cognición social en pacientes con demencia fronto-temporal variante conductual. Material y Métodos: Evaluamos la batería ejecutiva y cognición social del Instituto de Neurología Cognitiva (INECO), la cual incluye pruebas de teoría de la mente (test de la mirada y test de metida de pata), tareas del hotel, tests de diligencias multiples-versión del hospital y el Iowa Gambling Test para toma de decisiones. Los pacientes fueron divididos en dos grupos según su desempeño en el Addenbrooke´s Cognitive Examination. Resultados: Pacientes del grupo de Addenbrooke´s Cognitive Examination Bajo mostró resultados significativamente menores, respecto a los controles en muchas de las tareas de la batería ejecutiva estándar y en la batería ejecutiva y cognición social de INECO. Pero, el grupo de Addenbrooke´s Cognitive Examination Alto no difirió de los controles en muchas de las tareas de la batería ejecutiva estándar, mientras que encontramos diferencias significativas en los pacientes con demencia fronto-temporal con Addenbrooke´s Cognitive Examination Alto y los controles en la mayoría de las tareas de la batería ejecutiva y cognición social. Conclusiones: La batería ejecutiva y cognición social de INECO es más sensible para detectar alteraciones ejecutivas y de cognición social en estadios precoces de demencia fronto-temporal, variante conductual que las tareas empleadas en la batería ejecutiva estándar...

Behavioral variant frontotemporal dementia (bvFTD) is characterized by early and substantial ventromedial prefrontal cortex (VMPFC) dysfunction and there is no consensus regarding which tests are most sensitive and specific to assess it. Objectives: To detect specific executive and social cognitive deficits in patients with early behavioural variant frontotemporal dementia. Material and Methods: In this study we assessed with theINECO´s Executive and Social Cognition Battery, which included Theory of Mind tests (Mind in the Eyes, Faux Pas), the Hotel Task, Multiple Errands Task-hospital version and the Iowa Gambling Task for complex decision-making. Patients were divided into two groups according to their AddenbrookeÆs Cognitive Examination scores. Results: We found that low AddenbrookeÆs Cognitive Examination patients differed from controls onmost tasks of the standard battery and the Executive and Social Cognition Battery. But high AddenbrookeÆs Cognitive Examination patients did not differ from controls on most traditional neuropsychological tests, while significant differences were found between this high-functioning behavioural variant of frontotemporal dementia group and controls on most measures of Executive and Social Cognition Battery. Conclusions: The INECO´s Executive and Social Cognition Battery used are more sensitive in detecting executive and social cognitive impairment deficits in early behavioural variant of frontotemporal dementia than the classical cognitive measures...

The Memory Alteration Test Discriminates between Cognitively Healthy Status, Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND/AIMS: Dementia is a worldwide public health problem and there are several diagnostic tools for its assessment. The aim of this study was to evaluate the performance of the Memory Alteration Test (M@T) to discriminate between patients with early Alzheimer's disease (AD), patients with amnestic mild cognitive impairment (a-MCI), and subjects with a cognitively healthy status (CHS). METHODS: The discriminative validity was assessed in a sample of 90 patients with AD, 45 patients with a-MCI, and 180 subjects with CHS. Clinical, functional, and cognitive studies were independently performed in a blinded fashion and the gold standard diagnosis was established by consensus on the basis of these results. The test performance was assessed by means of a receiver operating characteristic curve analysis as area under the curve (AUC). RESULTS: M@T mean scores were 17.7 (SD = 5.7) in AD, 30.8 (SD = 2.3) in a-MCI, and 44.5 (SD = 3.1) in CHS. A cutoff score of 37 points had a sensitivity of 98.3% and a specificity of 97.8% to differentiate a-MCI from CHS (AUC = 0.999). A cutoff score of 27 points had a sensitivity of 100% and a specificity of 98.9% to differentiate mild AD from a-MCI and from CHS (AUC = 1.000). CONCLUSIONS: The M@T had a high performance in the discrimination between early AD, a-MCI and CHS.

Depresión en la tercera edad como factor de riesgo y su posible rol como pródromo de demencia / Depression and dementia in the mental health of old age

Depresión y demencia, sobre todo enfermedad de Alzheimer (EA) son entidades críticas en la salud mental de la tercera edad. Ambas condiciones disminuyen la calidad de vida e incrementan el deterioro de actividades de vida diaria de individuos de la tercera edad. EA tiene pobre pronóstico al ser una enfermedad neurodegenerativa; mientras que la depresión es básicamente reversible. Los estudios de seguimiento longitudinal y de caso-control reportan una estrecha asociación entre depresión de inicio tardío y deterioro cognitivo progresivo, pues se ha demostrado riesgo de incremento en 2 a 5 veces para desarrollar demencia en pacientes con depresión de inicio tardío. Por otro lado, la depresión de inicio precoz ha demostrado en forma consistente ser también un factor de riesgo para demencia, y escasas probabilidades de ser pródromo de demencia.La naturaleza de la asociación (si depresión es un pródromo o consecuencia de demencia, o un factor de riesgo para desarrollar demencia) permanece aún sin ser esclarecida. Independiente de ello, las estrategias para tratar depresión podrían alterar el riesgo de desarrollar demencia.

Depression and dementia, in particular Alzheimer´s disease (AD) are critically important issues in the mental health of old age. Both conditions apparently reduce quality of life and increase the impairment of activities of daily living for elderly persons. AD usually shows poor prognosis owing to progressive neuronal degeneration, while depression is basically reversible. Longitudinal follow-up and case-control studies reported a strong association between late-onset depression and dementia, and therefore increased risk was observed in 2-5 times to develop dementia in patients with late-onset depression. Furthermore, early-onset depression have also consistenly demonstrated to be a risk factor for dementia and unlikely to be prodromal to dementia. The nature of this association (if depression is a prodrome or consequence of, or risk factor for dementia) remains unclear. Regardless of this, treatment strategies for depression could alter the risk of dementia.

Informal caregiver burden in middle-income countries: Results from Memory Centers in Lima - Peru.

OBJECTIVE: The aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and depression in caregivers on the Beck Depression Inventory-II (BDI-II). METHODS: Literate individuals, 18 years or older, who spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis, treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed to assess caregiver burden and predictors of higher burden in caregivers. RESULTS: A total of 92 informal caregivers were evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9% had Alzheimer's disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5 years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10 years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient of BDI was 1.38 (p-value <0.001). CONCLUSION: This sample of Peruvian informal caregivers showed elevated ZBI values. Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants of ZBI, although only BDI was a consistent predictor of ZBI.

OBJETIVO: Avaliar a sobrecarga do cuidador baseada na entrevista de Zarit (ZBI). MÉTODOS: Nós incluímos cuidadores com 18 anos ou mais de idade, língua espanhola como nativa, alfabetizados. Foram avaliadas características demográficas: idade, gênero, educação, relação com o paciente com demência, extensão do cuidado, outras fontes de ajuda para os cuidados, impacto na economia doméstica, suporte familiar e percepção do comprometimento de saúde; e dados clínicos de saúde dos pacientes: tipo de demência, tempo desde o diagnóstico, tratamento e escala de deterioração global (GDS); ZBI e BDI-II. RESULTADOS: Avaliamos 92 cuidadores informais. Os pacientes tinham 69 anos ou mais, 75% tinha pelo menos um ano do diagnóstico, 73,9% com doença de Alzheimer, 84,8% recebia algum tratamento, 75% tiveram GDS de 5 ou mais. Quanto aos cuidadores: 75% tinham 55 anos ou mais, mulheres (81,5%), casados (83,7%), cônjuge (60,9%), com pelo menos 10 anos de educação (75%) e um ano de cuidado (75%), tempo reduzido de entretenimento (90,2%) e autopercepção de comprometimento da saúde (83,7%). A mediana da ZBI foi 38 (mínimo: 3 e máximo: 74). O coeficiente de BDI foi 1,38 (p<0,001). CONCLUSÃO: Nossa amostra de cuidadores informais peruanos mostram valores consideráveis na ZBI. A autopercepção de piora de saúde, repercussão na economia familiar e tempo de cuidado foram os principais determinantes da ZBI, embora somente a BDI foi um preditor consistente de ZBI.

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.

Dos casos de atrofia cortical posterior, la demencia que inicia con síntomas visuales / Two cases of posterior cortical atrophy a dementia that begins with visual symptoms

Presentamos dos casos de demencia de inicio antes de los 65 años de edad con apraxia y manifestaciones visuo-espaciales, en los cuales no hay trastornos de memoria y de la conducta, y con diferentes grados de evolución ademencia. Las imágenes estructurales del cerebro demuestran atrofia parieto-occipital. Ambos casos reúnen los criterios de atrofia cortical posterior (ACP).

We present two cases of progressive early, onset dementia with apraxia and visuospatial disability as initial manifestations, in which there is no memory and behavior disorders, and with different degrees of progression to dementia. Structural neuroimaging demonstrated parieto-occipital atrophy. These cases fulfil the diagnostic criteria of posterior cortical atrophy (PCA).

Análisis comparativo de las características neuropsicológicas de pacientes con demencia fronto-temporal, variante conductual y enfermedad de Alzheimer / Comparative analysis of the neuropsychological features of patients with fronto-temporal dementia, behavioral variant and Alzheimer’s disease

Objetivo: Describir las características neuropsicológicas de pacientes con demencia frontotemporal variante conductual (DFTvc) y compararlas con las de pacientes con enfermedad de Alzheimer (EA). Pacientes y métodos: Se evaluó una muestra de 60 controles sanos, 60 pacientes con EA y 32 pacientes con DFTvc, empleando una batería neuropsicológica clásica. Resultados: Los pacientes con DFTvc tienen peor rendimiento que pacientes con EA en algunos parámetros de atención y funciones ejecutivas (FE) y menor compromiso de la memoria. La evaluación de atención muestra diferencia altamente significativa en el rendimiento del Trail Making Test (TMT)-A entre EA y DFTvc (t28=-2,18, p<0,001). De la misma manera, en la evaluación de FE, sólo el TMT-B (t31= -6,8, p<0,001) y las respuestas perseverativas en el Wisconsin Card Sorting Test (WCST) (U = 30,5, p<0,001) alcanzaron diferencia estadísticamente significativa entre los grupos EA y DFTvc. Conclusiones: Los pacientes con DFTvc en estadios leve a moderado presentan una relativa menor afectación de memoria, lenguaje y habilidades viso-constructivas/viso-espaciales, pero con un marcado deterioro de atención y FE.

Objectives: To describe the neuropsychological features of patients with behavioral variant of frontotemporal dementia (bvFTD) and compared them with those of patients with Alzheimer´s disease (AD). Patients and methods: 60 healthy controls, 60 patients with AD and 32 patients with bvFTD were assessed with a complete neuropsychological battery. Results: bvFTD patients were relatively more impaired on attention and executive functions (EF) and relatively less impaired in memory than AD patients. Attention tasks show significant differenceson Trail Making Test (TMT)-A performance in patients with AD vs. bvFTD (t28=-2.18, p< 0.001). Similarly in EF evaluation, only TMT-B (t31=-6.8, p<0.001) and perseverative response on Wisconsin Card Sorting Test (WCST) (U=30.5, p<0.001) achieved statistically significant difference between groups. Conclusions: bvFTD patients with mild to moderate stages have a relatively minor impairment of memory, language, and visuospatial / visuoconstructive functions, but with a marked deterioration in attention and EF.

Afasias progresivas primarias: las afasias de lenta evolución a demencia / Primary progressive aphasias: the slowly evolving aphasias to dementia

La afasia progresiva primaria (APP) es un síndrome clínico neurodegenerativo caracterizado por compromiso progresivo del lenguaje, diagnosticado cuando completa tres criterios nucleares. Primero, debe existir compromiso del lenguaje, que interfiera con el uso o comprensión de las palabras. Segundo, el plan de trabajo diagnóstico debe demostrar que la enfermedad es neurodegenerativa, y además progresiva. Tercero, la afasia debe progresar relativamente aislada, sin afectación del comportamiento o de memoria episódica. El compromiso del lenguaje puede ser fluente o no fluente y puede o no interferir con la comprensión de las palabras. La memoria para hechos recientes está preservada, sin embargo los puntajes de memoria obtenidos en las pruebas mediadas verbalmente pueden ser anormales. Pueden presentarse cambios menores en personalidad o en la conducta, pero no llevan al paciente a la consulta médica y no limitan las actividades de vida diaria. Este patrón clínico es más conspicuo en los estadios iniciales de la enfermedad, y es consecuencia de la atrofia relativamente selectiva de los circuitos del lenguaje, usualmente localizado en el hemisferio izquierdo. Existen diferentes variantes clínicas de APP, cada una con un patrón característico de atrofia. Las enfermedades neuropatológicas subyacentes son heterogéneas y pueden incluir enfermedad de Alzheimer así como degeneración lobar fronto-temporal.

Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterized by progressive language impairment diagnosed when three core criteria are met. First, there should be a language impairment (i.e., aphasia) that interferes with the usage or comprehension of words. Second, the neurological work-up should determine that the disease is neurodegenerative, and therefore progressive. Third, the aphasia should arise in relative isolation, without equivalent deficits of comportment or episodic memory. The language impairment can be fluent or non fluent and may or may not interfere with word comprehension. Memory for recent events is preserved although memory scores obtained in verbally mediated tests may be abnormal. Minor changes in personality and behavior may be present but are not the leading factors that bring the patient to medical attention or that limit daily living activities. This distinctive clinical pattern is most conspicuous in the initial stages of the disease, and reflects a relatively selective atrophy of the language network, usually located in the left hemisphere. There are different clinical variants of PPA, each with a characteristic pattern of atrophy. The underlying neuropathological diseases are heterogeneous and can include AlzheimerÆs disease as well as frontotemporal lobar degeneration.

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 ...