Calidad de vida en la enfermedad de Alzheimer / Quality of life in Alzheimer´s disease

Introducción. La calidad de vida es un concepto de creciente interés cuya evaluación complementa la valoración clínica tradicional, de interés fundamentalmente en ámbitos de organización de la asistencia. Presentamos un estudio de calidad de vida en la enfermedad de Alzheimer y su relación con medidas cognitivas y funcionales. Pacientes y métodos. Se evalúa la calidad de vida mediante la escala EQ-5D en una muestra de casos de enfermedad de Alzheimer diagnosticados con criterios del National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association que han donado muestra de sangre para el Banco Nacional de ADN, en los que se ha determinado también el estadio de la escala de deterioro global, y se ha efectuado un test de fluencia verbal y el test minimental de Folstein. Se realizó un análisis clásico, contraste de variables mediante chi al cuadrado para las proporciones y t de Student para las medias,y estimación de r para los modelos de regresión en las variables cuantitativas. Se determinó la tarifa social mediante el programa SPSS v. 11. Resultados. Se analizan 141 casos, con una relación de 2 a 1 entre mujer y varón, y una edad media de 76,2 años. Los aspectos de cuidado personal, actividad y, en menor medida, motilidad se ven afectados en la enfermedad de Alzheimer, pero no parecen hacerlo los aspectos de dolor y ansiedad. Existe relación entre calidad de vida, escalas funcionales y escalas cognitivas. Los aspectos funcionales se correlacionan mejor que los cognitivos con la calidad de vida. Conclusiones. La calidad de vida se evalúa en la enfermedad de Alzheimer mediante escalas generales, como EQ-5D. Los aspectos cognitivos no parecen aportar información relevante en relación con la calidad de vida que no se aporte ya por los aspectos funcionales (AU)

Introduction. Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer’s disease and its relationship with cognitive and functional measures. Patients and methods. Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer’s disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student’s t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. Results. Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer’s disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. Conclusions. Quality of life is evaluated in Alzheimer’s disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects (AU)

[Quality of life in Alzheimer's disease]. / Calidad de vida en la enfermedad de Alzheimer.

INTRODUCTION: Quality of life is a concept that is receiving increasing amounts of attention; its assessment complements the traditional clinical evaluation, which is of special interest in areas related with healthcare organisation. Here, we present a study on quality of life in Alzheimer's disease and its relationship with cognitive and functional measures. PATIENTS AND METHODS: Quality of life was evaluated by means of the EQ-5D scale in a sample of cases of Alzheimer's disease (diagnosed according to criteria established by the National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) that donated blood samples for the National DNA Bank. The status of the global deterioration scale was determined and a verbal fluency test and the Folstein minimental test were also carried out. A classic analysis, variable contrast by means of chi-square for proportions and Student's t test for measurements were conducted, as well as estimation of r for the regression models in the quantitative variables. The social rate was determined using the software application SPSS v. 11. RESULTS: Altogether 141 cases were analysed, with a male to female ratio of 2:1, and a mean age of 76.2 years. Aspects such as personal hygiene, activity and, to a lesser extent, motility are affected in Alzheimer's disease, but pain and anxiety aspects do not seem to be affected. There is a relationship between quality of life, functional scales and cognitive scales. Functional aspects correlate with quality of life better than cognitive ones. CONCLUSIONS: Quality of life is evaluated in Alzheimer's disease using general scales, such as EQ-5D. Cognitive aspects do not appear to provide relevant information about quality of life that is not already provided by the functional aspects.

Estudio de la relación entre lesiones de sustancia blanca en la resonancia magnética y foramen oval permeable en pacientes con migraña / Study of the relationship between white matter lesions in the magnetic resonance imaging and patent foramen ovale

Introducción. Diversos estudios han demostrado unamayor prevalencia de lesiones de sustancia blanca (LSB) enresonancia magnética (RM) cerebral de pacientes con migraña.También se ha comunicado mayor frecuencia deshunt derecha-izquierda (SDI) en pacientes con migrañacon aura (MCA) que en población general. El objetivo denuestro estudio es explorar una eventual asociación entre laexistencia de LSB y la presencia o no de SDI en pacientescon migraña.Métodos. Se revisaron los pacientes con MCA o migrañasin aura (MSA) con estudio de RM, a los que se había determinadopreviamente SDI mediante doppler transcraneal(DTC). Se determinaron LSB (alteraciones de señal de sustanciablanca hiperintensas en secuencias ponderadas en T2y FLAIR sin alteración de señal en T1). Se relaciona la presenciade LSB con el tipo de migraña y presencia o no de SDImediante estadística univariante.Resultados. Cuarenta y cuatro pacientes con migraña(31 mujeres y 13 hombres); edad media: 39 años (23-66).Doce pacientes con MSA y 32 con MCA. Catorce pacientesmostraron LSB (31,8 %). Veintinueve pacientes (65,9 %) presentaronSDI. Los pacientes con LSB presentaron SDI tan sóloen un 26,7% y los pacientes con SDI presentaron LSB enun 34,5 %. No se apreciaron diferencias estadísticamentesignificativas (p=0,738).Conclusiones. No hemos podido demostrar una relaciónentre el SDI y la aparición de LSB en la RM cerebral ennuestra serie. Desconocemos la naturaleza de la asociaciónentre LSB y migraña, pero estos hallazgos sugieren que elmecanismo no sería el embolismo paradójico (AU)

Introduction. Previous studies have described a higherprevalence of white matter lesions (WML) in thebrain magnetic tesonance imaging (MRI) in patients withmigraine. A higher frequency of right-to-left shunt (RLS)in patients with migraine with aura (MA) than in generalpopulation has been reported. This study has aimed toinvestigate a possible association between the existenceof WML and the presence or non-presence of RLS in patientswith migraine.Methods. We have reviewed migraine patients sufferingMA or migraine without aura (MWA) with an MRIstudied in whom left-right shunt had been determinedpreviously by transcranial doppler (TCD). The presenceof WML was determined (white matter hyperintensitiesin T2-weighted MR images (T2WI) and FLAIR, withoutsignal alteration in T1WI). The presence of WML was relatedwith the type of migraine and presence or non-presenceof RLS by univariate statistics.Results. Forty four patients with migraine, 13 maleand 31 female, mean age 39 years (23-66) were studied.Twelve patients had MA and 32 MWA. Fourteen patientshad WML (31.8%), 29 patients (65.9%) RLS; 26.7% ofthe patients with WML also had RLS, and 34.5% of thepatients with RLS had WML. Non-statistically significantdifferences were observed (p=0.738).Conclusions. We could not demonstrate a relationshipbetween RLS and WML in the brain MRI of ourpatients. We do not know the nature of the associationbetween is the association between WML and migraine,but these findings suggest that the link would not be byparadoxical embolism (AU)

[Hemifacial spasm: over 10 years of treatment with botulinum toxin]. / Espasmo hemifacial: más de 10 años de tratamiento con toxina botulínica.

INTRODUCTION: The short-term beneficial and adverse effects of treatment with botulinum toxin (BT) in hemifacial spasm (HS) are well documented, but this is not the case with its long-term derivatives. AIMS. To describe the characteristics, the dose development, the side effects and the reason for giving up therapy in patients who have been on BT treatment for more than 10 years. We also sought to evaluate the effectiveness and safety of prolonged treatment in patients with HS. PATIENTS AND METHODS: We reviewed the demographic and clinical characteristics of patients who had had HS for more than 10 years since follow-up began. We analysed the mean dose development of BT per visit and year, the number of sessions per year, side effects and reasons for dropping out. We focused our attention on cases with more than 10 years' continuous treatment. RESULTS: The percentage of patients who had been on treatment for over ten years was 53.7%. The mean dose of BT per year rose progressively, and was significant (p < 0.05) during the first four years of treatment. There was no significant increase in the number of sessions. Altogether 46 side effects were observed, ptosis being the most frequent. These occurred during the first years of the early stages of the technique. The most common cause of dropout was loss to follow-up in 22 patients, followed by death in 11 cases. CONCLUSIONS: BT is a feasible, safe treatment option (with very few benign side effects) in the prolonged treatment of patients with HS.

[Painful tic convulsif and Botulinum toxin]. / Tic convulsivo doloroso y toxina botulínica.

INTRODUCTION: Painful tic convulsif is a rare disorder that associates trigeminal neuralgia (TN) and ipsilateral hemifacial spasm (HFS). These two disorders are the most common examples of hyperactive cranial rhizopathy and are frequently caused by vascular compression of these cranial nerves at the nerve root entry and exit zone in the brain stem, which leads to paroxysmal ephaptic transmission. CASE REPORTS: We report the cases of four patients with combined TN and HFS out of a total of 247 patients with HFS who were treated with botulinum toxin. One patient had TN that was contralateral to the HFS, while the other three were ipsilateral, and one of these had bilateral HFS. In all four cases both the HFS and the TN improved with botulinum toxin treatment. CONCLUSIONS: These four patients with TN and HFS suggest a common aetiology for the two disorders, due either to central neuronal hyperactivity or to vascular compression of several cranial nerves. The beneficial effect of botulinum toxin in both disorders supports the idea of this toxin having a central mechanism of action that acts by controlling neuronal hyperactivity in the brain stem, as well as its peripheral action.

Tic convulsivo doloroso y toxina botulínica / Painful tic convulsif and botulinum toxin

Introducción. El tic convulsivo doloroso es un trastorno poco frecuente que asocia neuralgia del trigémino (NT) y espasmo hemifacial (EHF) ipsilateral. Ambos trastornos son los dos ejemplos más usuales de rizopatía hiperactiva craneal, causados frecuentemente por la compresión vascular de estos nervios craneales en la zona de entrada y salida de las raíces en el tronco del encéfalo, la cual produce una transmisión efáptica paroxística. Casos clínicos. Cuatro pacientes con la combinación de NT y EHF de un total de 247 pacientes con EHF tratados con toxina botulínica. Un paciente padeció NT contralateral al EHF, los otros tres ipsilateral, uno de los cuales con EHF bilateral. Los cuatro presentaron una mejoría tanto del EHF como de la NT con el tratamiento con toxina botulínica. Conclusiones. Estos cuatro pacientes con NT y EHF sugieren una etiología común de ambos trastornos, por hiperactividad neuronal central o por compresión vascular de múltiples parescraneales. El efecto beneficioso de la toxina botulínica en ambos trastornos apoya un mecanismo central de acción de dicha toxina mediante el control de la hiperactividad neuronal en el tronco del encéfalo, además de su acción periférica (AU)

Introduction. Painful tic convuls if is a rare disorder that associates trigeminal neuralgia (TN) and ipsilateral hemifacial spasm (HFS). These two disorders are the most common examples of hyperactive cranial rhizopathy and are frequently caused by vascular compression of these cranial nerves at the nerve root entry and exit zone in the brain stem, which leads toparoxysmal ephaptic transmission. Case reports. We report the cases of four patients with combined TN and HFS out of a total of 247 patients with HFS who were treated with botulinum toxin. One patient had TN that was contralateral to the HFS, while the other three were ipsilateral, and one of these had bilateral HFS. In all four cases both the HFS and the TN improved with botulinum toxin treatment. Conclusions. These four patients with TN and HFS suggest a common a etiology for the two disorders, due either to central neuronal hyperactivity or to vascular compression of several cranial nerves. The beneficial effect of botulinum toxin in both disorders supports the idea of this toxin having a central mechanism of action that acts by controlling neuronal hyperactivity in the brain stem, as well as its peripheral action (AU)