ABSTRACT
Introducción: Los parches transdérmicos de rivastigmina para el tratamiento de la enfermedad de Alzheimer presentan posibles beneficios respecto a las cápsulas por su absorción sostenida a través de la piel, buena tolerabilidad local y reducción de problemas gastrointestinales. Objetivo: Evaluar la tolerabilidad gastrointestinal y cutánea y la necesidad de titulación para obtener dosis óptimas de rivastigmina transdérmica en pacientes con Alzheimer previamente tratados oralmente. Pacientes y métodos: Se llevó a cabo un estudio multicéntrico, aleatorizado y abierto que incluyó a 142 pacientes con Alzheimer de leve a moderado y previamente tratados con rivastigmina oral (6-12 mg/día). La muestra fue aleatorizada a: continuar con tratamiento oral durante 3 meses (n = 49); cambio al parche sin titulación (9,5 mg/día durante 3 meses, n = 47) o cambio al parche con titulación (4,6 mg/día por 1 mes seguido de 9,5 mg/día por 2 meses, n = 43). Resultados: La incidencia de efectos adversos gastrointestinales fue del 6,1% en el grupo tratado oralmente y del 4,2% en el grupo tratado con parche sin titulación (p = 0,908). La tolerabilidad cutánea fue buena (n = 15, 16,7%), sin observarse acontecimientos adversos graves. El tratamiento con parche fue considerado muy fácil de utilizar por el 72% de pacientes en comparación con el 30% con tratamiento oral (p = 0,0005). El 60% se mostraron satisfechos con el parche, mientras que únicamente un 14% se declaró satisfecho con las cápsulas (p < 0,0001). Conclusiones: Los parches de rivastigmina presentan un perfil de tolerabilidad similar a las cápsulas y se asocian con una mayor satisfacción de los pacientes (AU)
Introduction: Rivastigmine transdermal patches for the treatment of Alzheimers disease (AD) have potential benefits compared to capsules because of their sustained absorption through the skin, good local tolerability and reduction of gastrointestinal problems. Purpose: To assess gastrointestinal and skin tolerability and the need for optimal dose titration of rivastigmine transdermal patches in Alzheimers disease patients previously treated with oral rivastigmine. Patients and methods: A multicenter, randomized, open-label study including patients with mild to moderate AD (DSM-IV) previously treated with rivastigmine capsules (6-12 mg/day) was conducted. Patients were randomized to: continue with capsules for 3 months (n = 49) or switch to rivastigmine patch without titration (9.5 mg/day for 3 months; n = 48), or switch to rivastigmine patch with titration (4.6 mg/day for 1 month followed by 9.5 mg/day for 2 months, n = 43). Results: Incidence of gastrointestinal adverse events was 6.1% in the group treated orally and 4.2% in the group treated with non-titrated patches (P = .908). Skin tolerability was good (n = 15, 16.7%) without any serious adverse events registered. Patch treatment was considered very easy to use by 72% of patients compared with 30% in the group with oral treatment (P = .0005). 60% of patients were satisfied with the patch, while only 14% were satisfied with capsules (P < .0001). Conclusions: Rivastigmine patches have a tolerability profile similar to that shown by capsules, but are associated with greater patient satisfaction (AU)
Subject(s)
Humans , Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/pharmacokinetics , Drug Tolerance , Transdermal Patch , Patient Satisfaction/statistics & numerical data , Cholinesterase Inhibitors/administration & dosageABSTRACT
INTRODUCTION: Rivastigmine transdermal patches for the treatment of Alzheimer's disease (AD) have potential benefits compared to capsules because of their sustained absorption through the skin, good local tolerability and reduction of gastrointestinal problems. PURPOSE: To assess gastrointestinal and skin tolerability and the need for optimal dose titration of rivastigmine transdermal patches in Alzheimer's disease patients previously treated with oral rivastigmine. PATIENTS AND METHODS: A multicenter, randomized, open-label study including patients with mild to moderate AD (DSM-IV) previously treated with rivastigmine capsules (6-12 mg/day) was conducted. Patients were randomized to: continue with capsules for 3 months (n=49) or switch to rivastigmine patch without titration (9.5mg/day for 3 months; n=48), or switch to rivastigmine patch with titration (4.6 mg/day for 1 month followed by 9.5mg/day for 2 months, n=43). RESULTS: Incidence of gastrointestinal adverse events was 6.1% in the group treated orally and 4.2% in the group treated with non-titrated patches (P=.908). Skin tolerability was good (n=15, 16.7%) without any serious adverse events registered. Patch treatment was considered very easy to use by 72% of patients compared with 30% in the group with oral treatment (P=.0005). 60% of patients were satisfied with the patch, while only 14% were satisfied with capsules (P<.0001). CONCLUSIONS: Rivastigmine patches have a tolerability profile similar to that shown by capsules, but are associated with greater patient satisfaction.
Subject(s)
Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/administration & dosage , Phenylcarbamates/administration & dosage , Administration, Cutaneous , Administration, Oral , Aged , Female , Humans , Male , RivastigmineABSTRACT
INTRODUCTION: Lewy body dementia (LBD) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). A cardiac post-ganglionic sympathetic denervation has been described in this condition which can be quantified by MIBG (metaiodobenzylguanidine) myocardial scintigraphy. The aim of our work was to retrospectively evaluate cardiac MIBG uptake (expressed as the heart-to-mediastinum ratio at 4h (HMR) in patients with suspected LBD, and to examine its relationship with clinical and para-clinical data. MATERIAL AND METHODS: A total of 77 patients with clinical suspicion of LBD evaluated at our centre between September 2005 and June 2008 to whom a MIBG myocardial scintigraphy has been performed were retrospectively reviewed. International Consensus Criteria of LBD were applied to divide the sample into probable LBD, possible LBD and non-LBD. HMR values and their relationships with clinical and neuropsychological data were analysed. A subgroup of patients had FP-CIT (fluoropropyl-carbomethoxy-3ß-4-iodophenyltropane) SPECT as a part of the evaluation. RESULTS: Mean HMR values were significantly lower in probable LBD group than in possible LBD and non-LBD groups. Low HMR values were associated only with reduced FP-CIT uptake in the striatum, but not with any clinical or neuropsychological item. CONCLUSIONS: Low MIBG myocardial scintigraphy uptake is a robust measure in LBD, and it is not largely affected by medical conditions, or by the stage of the disease. In LBD reduced MIBG myocardial uptake is associated with nigrostriatal degeneration.
Subject(s)
3-Iodobenzylguanidine , Iodine Radioisotopes , Lewy Body Disease , Myocardial Perfusion Imaging/methods , Radiopharmaceuticals , Aged , Aged, 80 and over , Female , Humans , Lewy Body Disease/diagnosis , Lewy Body Disease/diagnostic imaging , MaleABSTRACT
Introducción: La demencia con cuerpos de Lewy (DCLw) es la segunda causa más frecuente de demencia degenerativa tras la demencia tipo Alzheimer (DTA). En esta entidad se ha descrito una denervación simpática cardíaca posganglionar, que puede cuantificarse mediante la gammagrafía miocárdica con MIBG (metayodobencilguanidina). El objetivo de nuestro trabajo fue evaluar retrospectivamente la captación miocárdica de MIBG, expresada cuantitativamente como el índice corazón/mediastino a las 4h (ICM) en pacientes con sospecha clínica de DCLw, y examinar su relación con los datos clínicos y paraclínicos. Pacientes y métodos:Se revisaron retrospectivamente datos de 77 pacientes con sospecha clínica de DCLw evaluados entre septiembre de 2005 y junio de 2008 en nuestro hospital a los que se les había realizado una gammagrafía miocárdica con MIBG. Se aplicaron los criterios internacionales de consenso para dividir la muestra en DCLw probable, DCLw posible y sin DCLw. Se analizaron el ICM en cada grupo y su relación con variables clínicas y neuropsicológicas. A un subgrupo de pacientes se le había realizado además un SPECT con FP-CIT (fluoropropil-carbometoxi-3β-4-yodofeniltropano) como parte de la evaluación. Resultados:Los valores medios de ICM fueron significativamente menores en el grupo de DCLw probable que en los grupos de DCLw posible y sin DCLw. Valores disminuidos de ICM solamente se asociaron a una captación disminuida en el estriado en el FP-CIT SPECT, pero no a ninguna variable clínica ni neuropsicológica. Conclusiones:La captación miocárdica reducida de MIBG es una medida robusta en la DCLw, y no se ve afectada por condiciones médicas o el estadio de la enfermedad. Una disminución en la captación miocárdica de MIBG se asocia a la degeneración nigroestriada en la DCLw (AU)
Introduction: Lewy body dementia (LBD) is the second most common cause of neurodegenerative dementia after Alzheimer's disease (AD). A cardiac post-ganglionic sympathetic denervation has been described in this condition which can be quantified by MIBG (metaiodobenzylguanidine) myocardial scintigraphy. The aim of our work was to retrospectively evaluate cardiac MIBG uptake (expressed as the heart-to-mediastinum ratio at 4h (HMR) in patients with suspected LBD, and to examine its relationship with clinical and para-clinical data. Material and methods: A total of 77 patients with clinical suspicion of LBD evaluated at our centre between September 2005 and June 2008 to whom a MIBG myocardial scintigraphy has been performed were retrospectively reviewed. International Consensus Criteria of LBD were applied to divide the sample into probable LBD, possible LBD and non-LBD. HMR values and their relationships with clinical and neuropsychological data were analysed. A subgroup of patients had FP-CIT (fluoropropyl-carbomethoxy-3β-4-iodophenyltropane) SPECT as a part of the evaluation.Results: Mean HMR values were significantly lower in probable LBD group than in possible LBD and non-LBD groups. Low HMR values were associated only with reduced FP-CIT uptake in the striatum, but not with any clinical or neuropsychological item.Conclusions: Low MIBG myocardial scintigraphy uptake is a robust measure in LBD, and it is not largely affected by medical conditions, or by the stage of the disease. In LBD reduced MIBG myocardial uptake is associated with nigrostriatal degeneration (AU)
Subject(s)
Humans , Male , Female , /methods , Lewy Body Disease/diagnosis , Retrospective Studies , 3-IodobenzylguanidineABSTRACT
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Subject(s)
Humans , Memory/physiology , Alzheimer Disease/physiopathology , Dementia/physiopathology , StatisticsABSTRACT
INTRODUCTION: The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. METHODS: A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimer's disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearson's correlation coefficient. RESULTS: The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). DISCUSSION: The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimer's disease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimer's disease pathology evaluated.
Subject(s)
Activities of Daily Living , Alzheimer Disease/complications , Alzheimer Disease/physiopathology , Cognition Disorders/etiology , Neuropsychological Tests , Alzheimer Disease/psychology , Female , Humans , Male , Severity of Illness IndexABSTRACT
Introducción. El objetivo del presente trabajo es establecer el grado de las posibles correlaciones de las puntuaciones globales del Test Barcelona Abreviado (TB-A) con escalas funcionales de la vida diaria. Métodos. Se estudiaron 107 sujetos (42 controles sanos, 19 casos de trastorno cognitivo leve y 46 sujetos afectos de enfermedad de Alzheimer). Se obtuvieron las puntuaciones del Test Barcelona y de las escalas funcionales siguientes: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS) e Interview for Deterioration of Daily Living in Dementia (IDDD). En el estudio estadístico se estableció el grado de correlación mediante el coeficiente de Pearson. Resultados. Todas las correlaciones obtenidas fueron significativas (p < 0,0001) y altas, con una variación desde 0,72 a 0,80. Las puntuaciones estandarizadas del TB-A tienen un rango menor de correlación en relación con las puntuaciones brutas en el caso de la RDRS-2 y la BDRS y superior en caso de la IDDD. Discusión. Este trabajo establece la existencia de una buena correlación funcional de las puntuaciones globales del TB-A y las actividades de la vida diaria, al menos en los casos del deterioro cognitivo propio de los trastornos leves sin demencia y los grados discretos a moderados-graves de la enfermedad de Alzheimer. El TB-A permite predecir el estado funcional de los sujetos
Introduction. The objective is to establish the existence of possible correlations between cognitive measures using the a-BT, and functional measures in a population of normal to moderately severe demented subjects. Methods. A sample of 107 subjects (42 healthy controls, 19 subjects with mild cognitive impairment and 46 patients with probable Alzheimers disease) were included in the present study. The instruments of the cognitive measure used was the abbreviated Barcelona Test (a-BT), a test of general cognitive function. Apart from that, the following functional scales, evaluating activities of daily living, were used: Rapid Disability Rating Scale-2 (RDRS-2), Blessed Dementia Rating Scale (BDRS), and Interview for Deterioration in Daily living in Dementia (IDDD). The statistical procedures were the correlations between cognitive and functional measures using Pearsons correlation coefficient. Results. The correlations obtained between the cognitive and all functional measures were all highly significant (p < 0.0001) and consistently high, with correlations ranging between 0.72 and 0.80. Correlations between the a-BT and functional measures of more basic activities of daily living (RDRS-2, BDRS) were lower than those that included instrumental and some advanced activities of daily living (IDDD). Discussion. The present paper establishes the existence of satisfactory correlations between the functional measures studied and the global scores of the a-BT. These correlations are applicable for groups of subjects with cognitive impairment that does not reach the threshold of a diagnosis of dementia as well as subjects suffering from Alzheimers diasease, at least up to moderately severe cases. The global score of the a-BT allows for some degree of prediction of the functional status of a subject with suspected Alzheimers diasease pathology evaluated
Subject(s)
Male , Female , Aged , Middle Aged , Humans , Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Psychiatric Status Rating Scales/statistics & numerical data , Neuropsychological Tests/statistics & numerical data , Case-Control Studies , Motor Skills Disorders/complications , Geriatric Assessment/methodsABSTRACT
This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.
