La historia olvidada del alzhéimer: recordando a Oskar Fischer

Introducción: La Enfermedad de Alzheimer (EA), es una patología neurodegenerativa progresiva que afecta la memoria y otras funciones cognitivas. Hasta ahora no existen tratamientos curativos ni modificadores de la enfermedad, por lo que el manejo está centrado en la prevención y en el tratamiento de factores que puedan contribuir a su evolución; las herramientas farmacológicas son escasas y tienen efectos modestos en la ralentización de la enfermedad. Se propone realizar una breve biografía de Oskar Fischer, describir el conflicto con Alois Alzheimer que se identifica en documentos científicos y mencionar los principales elementos de la teoría de Oskar Fischer. Método: Se realizó una revisión narrativa en las bases de datos Scielo, PubMed y Lilacs, con los términos "Oskar Fischer" y se encontró quince artículos publicados entre 1906 a 2023, los cuales fueron resumidos por los autores GS y NR. El artículo fue posteriormente revisado por los demás autores. Resultados: Se organizaron en secciones, partiendo con una breve biografía del autor, su interacción con Alois Alzheimer y un resumen de su teoría; lo descrito por Oskar Fischer en términos de las estructuras de placas y ovillos se considera como una de las principales teorías fisiopatológicas de la EA. Conclusiones: Oskar Fisher hizo un aporte invaluable y planteó conceptos clásicos con respecto a la EA, que, si bien no le valieron para ser reconocido en la posteridad, han permitido que en las investigaciones posteriores sea de gran importancia repensar estos conceptos e incluir otras posibilidades e hipótesis, para continuar en la profundización del conocimiento de la enfermedad.

Introduction: Alzheimer's disease (AD) is a progressive neurodegenerative pathology that affects memory and other cognitive functions. Until now, there are no curative or disease-modifying treatments, so management is focused on prevention and treatment of factors that may contribute to its evolution; pharmacological tools are scarce and have modest effects in slowing the disease. It is proposed to make a brief biography of Oskar Fischer, describe the conflict with Alois Alzheimer that is identified in scientific documents and mention the main elements of Oskar Fischer's theory. Method: A narrative review was carried out in the Scielo, PubMed and Lilacs databases, with the terms "Oskar Fischer" and fifteen articles published between 1906 and 2023 were found, which were summarized by the authors GS and NR. The article was subsequently reviewed by the other authors. Results: They were organized in sections, starting with a brief biography of the author, his interaction with Alois Alzheimer and a summary of his theory; what was described by Oskar Fischer in terms of the structures of plaques and tangles is considered one of the main pathophysiological theories of AD. Conclusions: Oskar Fisher made an invaluable contribution and raised classic concepts regarding AD, which, although they did not earn him recognition in posterity, have allowed subsequent research to be of great importance to rethink these concepts and include other possibilities and hypotheses, to continue deepening the knowledge of the disease.

Perfiles diagnósticos y epidemiológicos en una Unidad de Memoria / Diagnostic profiles at a Center for Memory Disturbances

Background: The Memory Disturbances Center is a multidisciplinary team devoted to the study and treatment of patients with memory problems. Aim: To report the clinical features of patients consulting to this center. Material and methods: Retrospective review of the clinical records of the first 100 patients consulting in the center. Results: The age of consulting patients ranged from 17 to 93 years and 57 were female. The most common diagnoses were Alzheimer disease, depressive pseudo dementia, mild cognitive impairment, vascular dementia and adult attention deficit disorder. A formal neuropsychological assessment was performed in 60% and 20% entered a cognitive stimulation program. Conclusions: Although Alzheimer disease is the most common cause of memory disorders in the adult, concealed depression and attention deficit disorders are also common. A multidisciplinary approach allows a better diagnosis and treatment.

Delirium en pacientes de una unidad de cuidados intermedios: estudio prospectivo / Prevalence of delirium in an intermediate care unit

Background: Delirium or acute confusional state is defined as an acute disturbance of consciousness and attention. Its prevalence among hospitalized patients fluctuates between 25 and 60 percent. Aim: To assess the prevalence and features of delirium in an intermediate care unit. Patients and methods: All patients admitted to intermediate care unit during a period of two months were assessed and followed. Delirium was assessed daily during the stay in the unit, using the Inouye Confusion Assessment Method. Delirium was classified as hyperactive if the patient required pharmacological or physical restraining methods. Results: Sixty four patients, 32 female, aged 19 to 90 years old were assessed. Forty one percent had delirium. Of these, delirium started after admission in 46 percent and was hyperactive in 35 percent. Cognitive disturbances were ascertained by the health care team in 69 percent of patients with delirium. Age over 70 years old and a history of dementia were defined as predisposing factors for delirium. Serum albumin was > 3.5 g/dl in 14 of 18 patients with and in 11 of 27 patients without delirium (p=0.04). The most frequent risk factors were systemic infections, metabolic disturbances and intracranial lesions. Physical restraining and neuroleptics were the most commonly used measures to deal with hyperactive patients. Conclusions: The prevalence of delirium found in this study is similar to that reported elsewhere, except for the high proportion of patients whose delirium started after admission