[Treatment of non cognitive symptoms of Alzheimer's disease]. / Tratamiento de los síntomas no cognitivos de la enfermedad de Alzheimer.

INTRODUCTION AND DEVELOPMENT: Owing to their functional repercussions, the secondary or non-cognitive symptoms displayed by patients with Alzheimer's disease (AD) are very important both for the patients themselves and for the work of the caregiver. In this article we review the treatment of some of them, such as psychotic disorders and depressive symptoms. Atypical neuroleptic drugs are the preferred treatment for symptoms such as delusions, hallucinations, agitation and aggressive behaviour. The most widely used are olanzapine and risperidone. Their pharmacological characteristics, therapeutic effectiveness and side effects are reviewed. CONCLUSIONS: Broader and better designed clinical studies are required to evaluate their usefulness. Recent reports, from 2004, have described a significant increase in the mortality rate (3.5 vs. 1.5%) and in the risk of suffering a stroke (1.3 vs. 0.4%) in elderly demented patients associated to the use of olanzapine and risperidone. The good tolerance and absence of anticholinergic effects of the serotonin reuptake inhibitors, fluoxetin and paroxetine, make them the first-choice medication for the treatment of the depressive symptoms in AD. Despite their widespread use, the evidence currently available with respect to their therapeutic effectiveness is not very convincing and clinical trials with a wider scope and a better design need to be carried out.

Tratamiento de los síntomas no cognitivos de la enfermedad de Alzheimer / Treatment of non cognitive symptoms of Alzheimer’s disease

Introducción y desarrollo. Los síntomas secundarios o no cognitivos son muy importantes, por su repercusión funcional para el paciente y para el trabajo del cuidador, en los enfermos afectos de enfermedad de Alzheimer (EA). Se revisa el tratamiento de algunos de ellos, como los trastornos psicóticos y los síntomas depresivos. Los neurolépticos atípicos son los fármacos de primera elección para el tratamiento de síntomas como delirios, alucinaciones, agitación y conducta agresiva. Los más utilizados son la olanzapina y la risperidona. Se revisan sus características farmacológicas, eficacia terapéutica y efectos adversos. Conclusiones. Se precisan estudios clínicos más amplios y mejor diseñados para valorar su utilidad. Recientemente, en 2004, se ha descrito en pacientes dementes de edad avanzada un significativo aumento de la mortalidad (3,5 frente a 1,5%) y del riesgo de padecer accidentes vasculares cerebrales (1,3 frente a 0,4%), con el empleo de olanzapina y risperidona. Los inhibidores de la recaptación de serotonina,fluoxetina y paroxetina, son los fármacos de elección para el tratamiento de los síntomas depresivos de la EA, por su buena tolerancia y ausencia de efectos anticolinérgicos. A pesar de su amplia utilización, las evidencias disponibles de su eficacia terapéutica son poco convincentes y se requieren ensayos clínicos más amplios y mejor diseñados (AU)

Introduction and development. Owing to their functional repercussions, the secondary or non-cognitive symptomsd is played by patients with Alzheimer’s disease (AD) are very important both for the patients themselves and for the work of the caregiver. In this article we review the treatment of some of them, such as psychotic disorders and depressive symptoms. Atypical neuroleptic drugs are the preferred treatment for symptoms such as delusions, hallucinations, agitation and aggressive behaviour. The most widely used are olanzapine and risperidone. Their pharmacological characteristics, therapeutic effectiveness and side effects are reviewed. Conclusions. Broader and better designed clinical studies are required to evaluate their usefulness. Recent reports, from 2004, have described a significant increase in the mortality rate (3.5 vs. 1.5%) and in the risk of suffering a stroke (1.3 vs. 0.4%) in elderly demented patients associated to the use of olanzapine and risperidone. The good tolerance and absence of anticholinergic effects of the serotonin reuptake inhibitors, fluoxetin and paroxetine, make them the first-choice medication for the treatment of the depressive symptoms in AD. Despite their widespread use, the evidence currently available with respect to their therapeutic effectiveness is not very convincing and clinical trials with a wider scope and a better design need to be carried out (AU)

Estado vegetativo persistente. Aspectos clínicos / The persistent vegetative state. Clinical features

El estado vegetativo persistente es un diagnóstico clínico que se debe diferenciar de otras alteraciones del nivel de conciencia (coma, muerte encefálica, enclaustramiento, mutismo acinético, fases terminales de demencia). Estos pacientes mantienen espontáneamente las constantes y funciones vitales, el ritmo sueño-vigilia y carecen de actividad voluntaria. El estado vegetativo se define como persistente cuando se mantiene durante un período superior a 1 mes. Se califica como estado vegetativo permanente cuando se establece un criterio pronóstico de irreversibilidad en dicho estado (AU)

[Anti-GQ1b antibodies: usefulness of its detection for the diagnosis of Miller-Fisher syndrome]. / Anticuerpos anti-GQ1b: utilidad de su determinación en el diagnóstico del síndrome de Miller-Fisher.

BACKGROUND: To study the presence of anti-GQ1b antibodies as a tool for the diagnosis of Miller-Fisher syndrome (MFS). PATIENTS AND METHOD: We studied 54 patients with probable diagnosis of MFS and 10 patients diagnosed as Guillain-Barré syndrome plus ophthalmoplegia (1 case), Bickerstaff's encephalitis (1 case), relapsing ophthalmoplegia (7 cases) and relapsing diplopia (1 case). Results were compared with 130 patients with other disimmune neuropathies. Antibodies were detected by ELISA and checked by thin layer chromatography. Campylobacter jejuni serology was studied using a complement fixation test. RESULTS: Diagnosis of MFS was confirmed in 38 patients. A 97.3% were positive for GQ1b, being all negative for Campylobacter jejuni serology. A second test after 4-5 weeks of nadir was negative in 84.2% (16/19), concomitant with clinical recovery. CONCLUSIONS: Anti-GQ1b antibodies are useful markers for the differential diagnosis of MFS, specially with some acute brainstem disorders. Testing must be performed during the first four weeks of clinical course. This correlation between the triad ataxia, arreflexia and ophthalmoplegia and anti-GQ1b antibodies confirms that they are highly specific of MFS.

Intermediate scale for assessment of Parkinson's disease. Characteristics and structure.

The present study is devoted to the verification of the basic metrical characteristics of the ISAPD. One hundred and sixty-seven Parkinson's disease (PD) patients were included. Group A (n = 40) was simultaneously assessed by five raters who applied the ISAPD and other PD rating scales (PDRS). A set of timed tests, the MiniMental State Examination (MMSE) and the Hamilton Scale for Depression (HSD) were administered by an independent examiner. Group B (n = 127) was individually assessed through the UPDRS and the other PDRSs by separate neurologists in four different hospitals. The ISAPD was administered in 7.0 +/- 3.7 min. The internal consistency of this scale was high (Cronbach's alpha = 0.97). The inter-rater reliability of their items was very satisfactory (for all items, kappa > 0.70). There was a high correlation with the Hoehn and Yahr classification (r(s) = 0.71; p < 0.001) and some timed tests. The convergent validity with the other PDRS (UPDRS and Schwab and England Scale) was also very high (r(s) = 0.83-0.92; p < 0.001). The ISAPD also correlated with the MMSE and the HSD. Factor analysis identified three factors (activities of daily living; gait and mobility; speech and eating) that explained 76% of the variance. The ISAPD is an easy to apply, reliable, and valid scale that fulfills the aim for which it was designed.

[Memory changes in Parkinson's disease. Relation with clinical variables]. / Alteraciones de la memoria en la enfermedad de Parkinson. Relación con las variables clínicas.

We studied verbal and visual short term memory, learning capabilities and long term retention in a sample of 96 patients with Parkinson's Disease (PD) and 42 controls matched by sex, age, years of education and verbal intelligence. We found significant differences between groups in visual short term memory and verbal learning, but not in verbal short term memory and long term retention. Performance in visual short term memory and learning correlated with the severity of disease and motor performance. Forty-one per cent of patients had impairment in visual short term memory, and this impairment is related with bradykinesia and correlated with age of onset. These results suggest that two forms of memory failure are closely related to motor symptoms and other clinical variables probably reflecting the same neuropathological substrate.

Evaluation of disability in Parkinson's disease. Clinical evaluation and instrumental tests.

To investigate the relationship between instrumental and clinical tests and their validity for the evaluation of disability in Parkinson's disease, we studied 33 patients using three neuropsychological tests for speed and motor evaluation, as well as Yahr's Clinical and the Northwestern University Disability Scales for clinical purposes. Multiple regression analysis revealed that clinical measures explain 30% of disability variance and instrumental tests 34%, although without statistical significance. However, used simultaneously they may account for 98% (p less than 0.02). These results suggest that clinical and instrumental measures are complementary and should be used together in the evaluation of Parkinson's disease.