[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.

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.

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.

[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.

[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.

Creutzfeldt-Jacob disease: a golgi study.

A cerebral biopsy of a patient with Creutzfeldt-Jacob (C-J) disease was examined with the Golgi method. Distortion of soma and neuronal processes associated with vacuolization of the neuropil was observed. The main findings were decreased numbers of basal dendrites and of branches of the apical dendrite of the pyramidal cells, marked loss of synaptic spines, and varicosities in the proximal segment of some apical and basal dendrites. These changes, though non-specific, may be interpreted as the result of deafferentation, although primary reactions related to C-J disease cannot be ruled out. These changes underline the intense disruption of intracortical connections which takes place in this condition in addition to the neuronal loss.

Growth of abnormal neurites in atypical Alzheimer's disease. A study with the Golgi method.

A cerebral biopsy was performed in a 39-year-old male patient with subacute paraparesis who later developed severe dementia and moderate cerebellar involvement. The histological examination showed a marked neuronal loss, severe neurofibrillary degeneration, and a great number of senile plaques. No PAS-positive plaques or amyloid angiopathy could be demonstrated. Golgi's sections showed (a) meshwork of fine dendrites located distally to the soma, (b) thick, coarse dendrites full of synaptic spines in neurons otherwise lacking these structures, and (c) thick dendrites with distal varicosities and filopodium-like processes resembling growth cones. These changes have been interpreted as acquired abnormal receptor sites and represent unique facts of a group of diseases not clearly defined, including atypical Alzheimer's disease and some cases of familiar Alzheimer's disease.