[Memory loss: a reason for consultation]. / Pérdida de memoria como motivo de consulta.

INTRODUCTION: Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. METHODS: We studied 200 patients who came to general neurology consultation due to loss of memory. RESULTS: 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. CONCLUSIONS: Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

Pérdida de memoria como motivo de consulta / Memory loss: a reason for consultation

Introducción. La pérdida de memoria es motivo de consulta de frecuencia creciente en neurologia; el objetivo de este trabajo es conocer la frecuencia actual, asi como las características y patologías de los pacientes que acuden por este motivo. Métodos. Se estudian 200 pacientes que acuden a una consulta de neurología general por pérdida de memoria. Resultados. El 18,47 % de los pacientes que acuden por primera vez a una consulta de neurología general lo hacen por pérdida de memoria, siendo pérdida subjetiva de memoria (PSM) en el 39 % de los casos y pérdida referida de memoria (PRM) en el 61 %. Los grupos diagnósticos a los que pertenecen los pacientes son por orden decreciente los siguientes: demencia degenerativa primaria tipo enfermedad de Alzheimer, deterioro cognitivo leve, demencia mixta, demencia vascular pura, seudodemencia depresiva, demencia degenerativa primaria no tipo enfermedad de Alzheimer, atribuible a fármacos y tóxicos, secundaria a enfermedad sistémica, causas estructurales, amnesia global transitoria y epilepsia. En el 13 % de ellos no se encuentra ningún tipo de patología y suelen acudir por PSM. Conclusiones. La frecuencia de la pérdida de memoria como motivo de consulta continúa creciendo. Los pacientes estudiados por pérdida de memoria en los que no se encuentra patología suelen ser aquellos que presentan PSM, a pesar de lo cual la PSM es un buen predictor de deterioro cognitivo. Es importante realizar un abordaje sistematizado de todo paciente que consulte por pérdida de memoria e investigar el posible uso de fármacos o tóxicos que puedan alterar la memoria

Introduction. Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. Methods. We studied 200 patients who carne to general neurology consultation due to loss of memory. Results. 18.47 % of the patients who carne for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39 % of the cases and referred loss of memory (RLM) in 61 % of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13 % of them, and the generally carne due to SLM. Conclusions. Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are gene rally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory

APP processing and the APP-KPI domain involvement in the amyloid cascade.

Alternative APP mRNA splicing can generate isoforms of APP containing a Kunitz protease inhibitor (KPI) domain. KPI is one of the main serine protease inhibitors. Protein and mRNA KPI(+)APP levels are elevated in Alzheimer's disease (AD) brain and are associated with increased amyloid beta deposition. In the last years increasing evidence on multiple points in the amyloid cascade where KPI(+)APP is involved has been accumulated, admitting an outstanding position in the pathogenesis of AD to the KPI domain. This review focuses on the APP processing, the molecular activity of KPI and its physiological and pathological roles and the KPI involvement in the amyloid cascade through the nerve growth factor, the lipoprotein receptor-related protein, the tumor necrosis factor-alpha converting enzyme and the Notch1 protein.

Creutzfeldt-Jakob disease and non-convulsive status epilepticus: a clinical and electroencephalographic follow-up study.

OBJECTIVE: To describe the clinical and electroencephalographic findings from a confused elderly woman with Creutzfeldt-Jakob disease (CJD) that initially were compatible with the diagnosis of non-convulsive status epilepticus (NCSE). METHODS AND RESULTS: A 75-year-old right-handed woman was admitted to our hospital because of confusion and alteration of mental status. The two first electroencephalograms (EEGs) showed continuous diffuse spikes, rhythmic sharp waves and sharp-and-slow wave complexes which were completely abolished after the administration of 10 mg of intravenous diazepam. Over the following days, the clinical state of the patient was unmodified despite aggressive antiepileptic therapy. A third EEG revealed pseudo-periodic negative or positive-negative slow waves localised in the right frontal region. Subsequently, two consecutive EEGs showed continuous periodic generalised bi-triphasic complexes at a rate of 1 Hz, compatible with the diagnosis of CJD. Finally, the patient died, and postmortem examination was diagnostic of the sporadic form of CJD. CONCLUSIONS: Clinical and electroencephalographic features in the early stages of CJD may resemble NCSE. The administration of intravenous benzodiazepines and its clinical and electroencephalographic correlation, response to the antiepileptic therapy, and monitoring with serial EEG recordings may be helpful considerations in the differential diagnosis.

Multiple sclerosis in Gijon health district, Asturias, northern Spain.

The objective of this study was to ascertain the prevalence and incidence of Multiple Sclerosis (MS) in a population of 33,775 in two primary health care centres in the sanitary district of Gijon, Asturias, northern Spain. Many information sources were used but the unique advantage of Gijon was that the city has a centralized computerized register of all diagnoses made for all consultations in the clinics and hospitals in the area. The HLA distribution in the population was already known and the Poser classification of MS was used. The crude MS prevalence was 65/100,000, a similar prevalence to that found in southern and eastern Spain, Sicily and Greek-speaking Cyprus. The mean incidence was 3.7/100,000 per year. The study demonstrated the advantage of a centralized and computerized medical recording system and demonstrates that northern Spain is a moderately high or medium MS risk zone.

[Prognostic factors in multiple sclerosis in a population-based series in Asturias]. / Factores pronósticos de la esclerosis múltiple en una serie de base poblacional de Asturias.

We sought clinical, paraclinical and genetic (HLA) factors that might have prognostic value in predicting disability produced by multiple sclerosis. An epidemiologically based sample including 146 cases (86% remittent and 14% mainly progressive) was studied. The progression of disability was measured on an index after systematic follow-up of at least 3 years. Our results show that the prognosis is significantly worse for those with a high frequency of attacks (p < 0.001), multiple clinical signs at presentation (p < 0.05) or motor weakness. The best prognosis was associated with those whose symptoms began with sensory alterations (p < 0.05). Late onset correlated significantly with a short interval between the first and second attack (r = 0.24), and this short interval was in turn significantly correlated with higher frequency of attacks in later stages (r = 0.44). We conclude that cases with a short interval between the first two attacks and those with late onset have a poorer prognosis. The following variables also tended to be associated with a more unfavorable prognosis, although the relationship was not statistically significant: female, progressive form, an increase in gammaglobulins in spinal fluid, infratentorial lesions as evidenced by magnetic resonance, and the alleles HLA-DR4, DR7 and DQw8. The allele DQw5 tended to be associated with a better prognosis.

[Treatment with ubiquinone in Kearns-Sayre syndrome. Improvement in ocular motility and visual evoked potentials]. / Tratamiento con ubiquinona en el síndrome de Kearns-Sayre. Mejoría de la motilidad ocular y los potenciales evocados visuales.

In 1985 Ogasahara observed that treatment with ubiquinone produced improvement in the cardiac conduction and the metabolism of the lactic and pyruvic acids in the Kearns-Sayre syndrome. The results of the administration of 150 mg/day of ubiquinone for 3 years in a patient diagnosed with the Kearns-Sayre syndrome is described. The patient improved notably in strength, ocular movement, visual evoked potentials and in the metabolism of lactic and pyruvic acids. Other beneficial effects reported in the literature have been improvement of ataxia and the somato-sensitive evoked potentials. No side effects have been described.