An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease. / Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. PATIENTS AND METHODS: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. RESULTS: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. CONCLUSIONS: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services.

Health-related quality of life in caregivers of patients with Alzheimer's disease. / Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer.

INTRODUCTION: Informal caregivers of patients with Alzheimer's disease (AD) have a poor health-related quality of life (HRQOL). HRQOL is an increasingly common user-focused outcome measure. We have evaluated HRQOL longitudinally in caregivers of AD patients at baseline and at 12 months. METHODS: Ninety-seven patients diagnosed with AD according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke, and Alzheimer's Disease and Related Disorders Association) and their 97 respective primary caregivers were included in the study. We analysed the following data at the baseline visit: sociodemographic data of both patients and carers, patients' clinical variables, and data related to the healthcare provided to patients by carers. HRQOL of caregivers was measured with the SF-36 questionnaire at baseline and 12 months later. RESULTS: At 12 months, primary caregivers scored lower in the 8 subscales of the SF-36 questionnaire; differences were statistically significant in all dimensions except for 'physical function' and 'social function'. Baseline scores in our sample were lower than those of the general population. 'Vitality' is the dimension that presented the lowest scores. CONCLUSION: HRQOL in caregivers of patients with Alzheimer's disease deteriorates over time and is poorer than that of the age- and sex-matched general population.

[Thalamic dementia secondary to acute bilateral paramedian thalamic infarcts after occlusion of the artery of Percheron]. / Demencia talámica secundaria a infarto agudo paramediano talámico bilateral por oclusión de la arteria de Percheron.

INTRODUCTION: The anterior and medial part of the thalamus is the responsible of multiples cognitive functions through the thalamus-cortical connections. A bilateral thalamic infarction can cause a secondary dementia and these are related to a thalamocortical deafferentation with a partial recovery. We report a case of sudden onset dementia caused by bilateral thalamus lesions. CASE REPORT: A 42 smoker male, that suddenly had an acute confusional syndrome with altered language, bradypsychia, right hemiparesis and right hemisensory loss. Cranial magnetic resonance imaging showed a bilateral thalamic stroke probably due to a variant talamus irrigation (artery of Percheron type 2). From this date, in three months, the patient had attention deficit, impairment of memory retention, apathy, initiative deficit, depressive syndrome and mood changes. All these symptoms improving partially in the following six months. CONCLUSIONS: The thalamic stroke can cause a thalamic dementia, commonly bilateral and preferable located in the anterior and medial nuclei. In our case, cranial SPECT showed frontal hypocaptation for diaschisis phenomenon.

Demencia talámica secundaria a infarto agudo paramediano talámico bilateral por oclusión de la arteria de Percheron / Thalamic dementia secondary to acute bilateral paramedian thalamic infarcts after occlusion of the artery of percheron

La parte anterior y medial del tálamo se encarga de múltiples funciones cognitivas por las conexionestalamocorticales. Un infarto talámico bilateral puede provocar una demencia secundaria por desaferentación talamocortical con cierto grado de reversibilidad. Presentamos el caso de una demencia de inicio aguda por lesiones talámicas bilaterales. Caso clínico. Varón de 42 años, fumador y con estrés laboral, que de forma brusca presentó un síndrome confusionalagudo con alteración del lenguaje, bradipsiquia y hemiparesia e hemihipoestesia derecha. En la resonancia magnética craneal se apreció una afectación bilateral de ambos tálamos compatibles con un infarto agudo a estos niveles por probable irrigación del tálamo a través de la variante de Percheron tipo 2. A partir de esta fecha, a los tres meses el paciente presentó faltade atención, alteraciones en la memoria de retención, apatía, falta de iniciativa, síndrome depresivo y cambios de humor, y mejoró parcialmente en los siguientes seis meses. Conclusiones. La demencia talámica se suele producir por afectación bilateralde ambos tálamos y, preferentemente, en la zona anterior y medial. En nuestro caso, mediante SPECT cerebral se pone de manifiesto la hipocaptación frontal por un fenómeno de diasquisis

The anterior and medial part of the thalamus is the responsible of multiples cognitive functions throughthe thalamus-cortical connections. A bilateral thalamic infarction can cause a secondary dementia and these are related to a thalamocortical deafferentation with a partial recovery. We report a case of sudden onset dementia caused by bilateral thalamus lesions. Case report. A 42 smoker male, that suddenly had an acute confusional syndrome with altered language,bradypsychia, right hemiparesis and right hemisensory loss. Cranial magnetic resonance imaging showed a bilateral thalamic stroke probably due to a variant talamus irrigation (artery of Percheron type 2). From this date, in three months, the patienthad attention deficit, impairment of memory retention, apathy, initiative deficit, depressive syndrome and mood changes. All these symptoms improving partially in the following six months. Conclusions. The thalamic stroke can cause a thalamic dementia, commonly bilateral and preferable located in the anterior and medial nuclei. In our case, cranial SPECT showed frontal hypocaptation for diaschisis phenomenon