Fibrilación auricular y su asociación con la declinación cognitiva, deterioro cognitivo y demencia en ausencia de accidente cerebrovascular clínico: revisión de la evidencia y posibles mecanismos / Atrial fibrillation and its association with cognitive decline, cognitive impairment, and dementia in the absence of clinical stroke: a review of the evidence and possible mechanisms

La fibrilación auricular (FA) es la arritmia más frecuente en la población adulta. Es sabido que la FA se asocia con un aumento del riesgo de presentar muchos eventos adversos, entre los que se incluyen accidente cerebrovascular, insuficiencia cardíaca, muerte por todas las causas, así como muerte súbita cardíaca. Más recientemente también ha habido un creciente interés en la asociación de FA con deterioro cognitivo y demencia. En esta revisión narrativa describimos la actual evidencia a favor de la relación entre la FA y la declinación cognitiva, el deterioro cognitivo o la demencia en pacientes sin antecedentes de accidente cerebrovascular. Aun cuando no queda muy claro cuáles son los mecanismos exactos que explican la asociación entre la FA y la declinación cognitiva, los mecanismos propuestos incluyen isquemia silente, estado pro inflamatorio, microsangrados cerebrales e hipoperfusión cerebral. Se necesitan más estudios para dilucidar los mecanismos de base que faciliten el descubrimiento de alguna estrategia de prevención.

Atrial fibrillation (AF) is the most common arrhythmia in the adult population. AF is widely known to be associated with an increased risk of many adverse outcomes including stroke, heart failure, all-cause death, as well as sudden cardiac death. More recently, there has also been growing interest in the association of AF with cognitive impairment and dementia. In this narrative review, we describe the current evidence that supports the relationship of AF to cognitive decline, cognitive impairment, or dementia in patients without a history of stroke. The exact mechanisms underlying the association of AF with cognitive decline are unclear; however, proposed mechanisms include silent ischemia, pro-inflammatory state, cerebral microbleeds, and cerebral hypoperfusion. Further research is needed to elucidate the underlying mechanisms to facilitate discovery of prevention strategies.

Cerebral autosomal recessive arteriopathy with subcortical infarets and leukoencephalopathy / 国际脑血管病杂志

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is an autosomal recessive hereditary cerebral artery disease in the adolescence,and its main clinical manifestations are dementia,stroke,low back pain and alopecia.At present,most cases are from Japan.3-6 exon point mutations in the HTRA1 gene are associated with the onset of CARASIL.Brain histopathological examination showed a small arterial intimal thickening medial smooth muscle cell loss and hyalinization.Brain MRI showed a diffuse white matter abnormal signal and multiple subcortical infarcts.The diagnosis mainly depends on the characteristic clinical symptoms,imaging characteristics and genetic testing.It should be differentiated from cerebral autosomal dominant arteriopathy with sulcortical infarcts and leucoencephalopathy.

Serum resistin and neuron-specific enolase in patients with cerbral infarction or multi-infarct dementia / 中华全科医师杂志

Serum concentrations of resistin and neuron-specific enolage(NSE)were determined in 72 patients with cerebral infarction(CI),60 patients with multi-infarct dementia(MID),and 60 healthy controls by means of ELISA.Our data showed that serum resistin and NSE in the CI acute phase group were significantly higher than those in the normal control group(P＜0.01).No significant difference was found in serum resistin and NSE between the CI recovery phase group and normal controls group.Moreover,no significant difference was found in serum resistin between the MID group and CI recovery phase and normal control groups(P＞0.05);but NSE Was relatively lower(P＜0.05).This study suggest that serum resistin and NSE might be of great significance to patient's condition and prognosis.

A family of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy / 中华神经科杂志

Objective To report the first family of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy(CARASIL)in China,and to explore its clinicopathological characteristics.Methods The clinical,imaging and pathological findings of the two patients were studied, and the sequence of the exons from 2 to 6 on Notch 3 in the chromosome 19 was detected.Results Two siblings were born from consanguineous parents.The ages at onset were 25 and 20 years old,respectively. Clinically,both of the patients were characterized by alopecia,acute lumbago,progressive intellectual deterioration,ataxia,pseudobulbar palsy and pyramidal tract signs.MRI demonstrated diffuse leucoencephalopathy and multiple subcortical infarcts on both hemisphere.The sural nerve biopsy on the elder sister demonstrated concentric thickening of vascular wall,narrowing of the lumen and mild fibrous proliferation of the intima.There were no amyloid,PAS granular deposition and uhrastructural granular osmiophilic material on the vascular wall.No mutation of exons from 2 to 6 on Notch 3 in the chromosome 19 was found by direct sequence.Conclusion The clinicopathological findings of the two patients fulfill the diagnostic criteria based on Fukutake.

A Novel Mutation (C67Y) in the NOTCH3 Gene in a Korean CADASIL Patient

We report a 52-yr-old Korean woman with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) whose diagnosis was confirmed by skin biopsy and the presence of a novel mutation in the NOTCH3 gene. The patient's clinical features were rather unusual in that 1) clinical presentations were only two episodes of stroke and mild dementia unaccompanied by mood disturbances or migraine, and 2) there was no family history. Brain MRI showed T2 hyperintensities in both temporal pole areas in line with the recent suggestion by O'Sullivan et al. that the abnormality could be a radiologic marker of CADASIL. FDG-PET also showed a hypometabolism in the temporal pole areas with an abnormal finding on MRI in addition to the hypometabolism in cortical and subcortical regions. We could learn from this case that CADASIL may be included in the differential diagnoses in patients with vascular dementia associated with a small vessel disease, even in the absence of a family history, especially when there are no known stroke risk factors and when the MRI shows T2 hyperintensity in the temporal pole regions.

Acupuncture and Medicated Oxygen Therapy for Multiple Infarctional Dementia / 针灸推拿医学（英文版）

Purpose To observe the clinical efficacy of acupuncture and medicated oxygen therapy in the treatment of multiple infarctional dementia(MID). Methods 150 cases of MID were randomized into three groups: group A in which 50 cases were treated by acupuncture and medicated oxygen, group B in which 50 cases were treated by acupuncture and inhaled oxygen and group C in which 50 cases were simply treated by acupuncture. Results The clinical effects were obviously better in group A than those in group B and group C ( P ＜ 0.05, P ＜ 0.01 ). Conclusion Chinese medicine together with oxygen and acupuncture can improve brain blood circulation, activate brain cells, increase the volume of brain blood flow and its blood supply, and enhance the clinical effects.

Acupuncture Therapy for Multiple Infarctional Dementia / 针灸推拿医学（英文版）

Purpose To observe the clinical efficacy of combined electro-acupuncture and moxibustion in the treatment of multiple infarctional dementia. Methods Eighty-eight patients were randomized into two groups:treatment group in which 48 cases were treated by combined electro-acupuncture and moxibustion and control group in which 40 cases were treated by oral administration of Huperzine A. Results The total effective rate was 90% in treatment group and 71% in control group,with a significant difference ( P ＜ 0.05 ); the score of Mini-mental State Examination (MMSE) increased more obviously in treatment group than in control group (P＜0.05). Conclusion Combined electro-acupuncture and moxibustion is effective in improving the clinical symptoms of multiple infarctional dementia.

Demencias vasculares / Vascular dementia

Las demencias vasculares representan un problema médico serio. Constituyen la segunda causa de demencia en el mundo occidental y tienen un pronóstico peor que la enfermedad de Alzheimer. Su estudio ha permanecido relativamente inexplorado por mucho tiempo, en parte por diversos de factores asociados a la génesis de la enfermedad. Este aparente olvido de una de las patologías de más prevalencia entre los mayores de 65 años se ha traducido en el surgimiento de varias denominaciones para una misma entidad, lo cual ha dificultado la adecuada definición del término. La falta de claridad en la fisiopatología y en el diagnóstico de la enfermedad se refleja en las pocas medidas terapéuticas disponibles. Este artículo trata sobre el estado del arte en las demencias vasculares con énfasis especial en los estudios que involucran las nuevas técnicas de evaluación imagenológica...

The Vascular Dementias are one of the most serious problems in the medical studies. They are considered as the second cause of dementia in the occidental word and they seem to be worst than the Alzaheimer's disease. It has not really explored because of the origin of the disease. This pathology is commonly founded in people over 65 years. It is noum under many names and it has been difficult to define the concept properly. There are very few therapeutics measures because the reduced knowlwdge about this disease. This article is about the vascular dementias specially in it neuroimage...