[Treatment of Alzheimer's Disease cognitive symptoms]. / Tratamiento de los síntomas cognitivos en la enfermedad de Alzheimer.

This chapter will focus in the currently treatments for Alzheimer Disease. The meeting points in the proposed pathogenesis of the disease are the cholinergic and the cascade amyloid hypothesis based mainly in postmortem brain changes: 1- Pathological based on greater density of neuritic plaques and the characteristic presence of neurofibrillary tangles associated with neuronal loss, synaptic alterations and evidence for chronic inflammatory reactions, 2) Biochemical based on major depletion of cortical cholinergic innervation, dramatic loss in levels of biochemically determined choline acetyltransferase, accumulation of beta-amyloid peptide, oxidation, glutamatergic excitotoxicity and activation of the apoptotic cascade. The currently available therapies based on the hypothesized pathophysiology of AD are: Acetylcholinesterase inhibitors (donepezil, rivastigmine and galantamine) and the NMDA receptor inhibitor Memantine. None of the "head to head" analyses done with cholinesterase inhibitors (CI) were able to demonstrate a between group effect for efficacy. However the treatment planning is based on their differences, their titration phase to reach the therapeutic doses, interactions and side effects. The non pharmacological treatment in the early and late stages of the disease, the different cognitive stimulation techniques and available prevention trials are also addressed and discussed.

[Development of a sensitive neuropsychological battery to foretell the performance in elder's car driving]. / Desarrollo de una batería neuropsicológica sensible para predecir el rendimiento en la conducción de vehículos en adultos mayores de 55 años.

INTRODUCTION: The increase in life expectancy move older people to continue driving. OBJECTIVE: Development of sensitive neuropsychological battery to evaluate driving routines. METHODS: 78 men were received at the Santojanni Hospital, derived by the General Direction of Road Education and licenses of Buenos Aires city (DGEVL) when people were transacting their driving license renovation. Age 64.2 (DS14,0) years and education 7.9 (DS4,5) years. They were evaluated with MMSE, Cognitive Reaction test (TRC); Procedural memory test (TMP); Continuous Performance test (TPC); Trail Making Test (TMT); Stroop (ST); WAIS III Subtests: Digit-Symbol (DS), Search of Symbols (BS); Digits and Construction with cubes (CC); Rey visual Complex Figure (FC); Benton Visual Discrimination test (TB) and Test of transit Signals (DST). Statistical package SPSS 12.0 was used to obtain, descriptive, frequencies and correlations statistics. RESULTS: The most sensitive tests were: FC; TMT; ST; TPC; DS; TRC; TMP signifying impairment in: perceptual organization; visuospatial skills; information processing speed; reaction capacity before decision making; maintained, selective and executive attention and procedural memory, all of them of critical importance in driving and its control in the transit. Alarming ignorance of transit signals was observed. CONCLUSIONS: Of 78 subjects, 23.1% renewed their registry; 33,3% renewed but with lower category and sooner next control; 38,5% were not renewed; 3,8% did not return to DGEVL; 1,3% we do not know data.

[Nosography of dementia]. / Nosografía de las demencias.

Dementia diagnostic criteria presently in use are referred. The authors underline the importance of an early diagnosis for prognosis and treatment. Diagnostic criteria from international groups and their harmonization to Argentine culture proposed by the CAED (Argentine Consortium for the Study of Dementias) are reviewed.

[Behavioral-cognitive disorders due to chronic exposure to industrial and environmental toxic substances]. / Trastornos cognitivo conductuales debidos a la intoxicación crónica con sustancias neurotóxicas laborales y ambientales.

UNLABELLED: A review of neurotoxics is made, given the low tendency to investigate for chronic exposure to environmental and industrial potential central nervous system toxic substances (heavy metals, insecticides, organic solvents and carbon monoxide) in the history of a patient consulting for behavioral - cognitive complains, and considering the potential overturn of the disease if a correct diagnosis and early treatment is made. OBJECTIVE: to determine the onset of the cognitive - behavioral features, presentation pattern, diagnosis and treatment of such neurotoxics (NT). METHODOLOGY: systematized search in Cochrane and Medline reviews, Embase and Lilacs. RESULTS: chronic exposure to neurotoxics can produce personality changes (sleeping problems, excitation, depression, delusions and hallucinations) as well as cognitive problems (memory, learning, language and cognitive reaction problems). NT may cause changes in the neuron morphology and its sub cellular structures, affecting its normal biochemistry and physiology (proteins and neurotransmitters synthesis). The clinical history, diagnosis and treatment of each neurotoxic are discussed. CONCLUSION: The NT must be taken in consideration among the possible different etiologies when a patient with a bizarre behavioral cognitive syndrome is examined.

[New assessment variables in the Clock Drawing Test (CDT) allow an early and easy diagnosis of degrees of cognitive impairment]. / Nuevas variables de evaluación del test del reloj permiten un precoz y fácil diagnóstico del grado de deterioro cognitivo.

OBJECTIVE: We developed new subroutines and scoring procedures of the CDT to detect markers of early cognitive impairment. SUBJECTS AND METHODS: We compared the performance of 41 mild Alzheimer's patients (AD) (MMSE 22.7+/-3.2); and 18 mild cognitive impairment patients (MCI) (MMSE 28.3+/-1.4), with 33 age and education matched normal controls (NC) regarding their ability in drawing a clock on command, copying a printed clock, setting hands and reading the time. We search for differences in the placement of the hands using a colloquial hour code ("a quarter to ten") and a formal numeric code ("10:45"). We focused our attention on placement and clock hands size. The drawing of hands pointing at 2:50 hs and 8:40 hs were of particular interest. RESULTS: Planning strategies, placement of clock hands using a formal numeric code, clock hands size and hands drawing pointing at 2:50 hs. and 8:40 hs. were the variables that best discriminated AD, MCI and NC ( p<0.01). A stepwise regression analysis using as dependent variables (AD - NC ) and (MCI - NC) showed in both cases that the best predictor model was that formed by: planning strategies, clock hands pointing to 8:40, clock hands size, reading hours and set up clock hands following a formal numeric code (p<.001). CONCLUSIONS: Our proposed modifications in this test convert it in an appropriate tool for cognitive impairment screening because they do not only detect visuoconstructional abilities but also frontal planning, contents and processing of the hour memory code and transcodification of semantic memory processes.

Nuevas variables de evaluación del test del reloj permiten un precoz y fácil diagnóstico del grado de deterioro cognitivo. / [New assessment variables in the Clock Drawing Test (CDT) allow an early and easy diagnosis of degrees of cognitive impairment]

OBJECTIVE: We developed new subroutines and scoring procedures of the CDT to detect markers of early cognitive impairment. SUBJECTS AND METHODS: We compared the performance of 41 mild Alzheimers patients (AD) (MMSE 22.7+/-3.2); and 18 mild cognitive impairment patients (MCI) (MMSE 28.3+/-1.4), with 33 age and education matched normal controls (NC) regarding their ability in drawing a clock on command, copying a printed clock, setting hands and reading the time. We search for differences in the placement of the hands using a colloquial hour code ([quot ]a quarter to ten[quot ]) and a formal numeric code ([quot ]10:45[quot ]). We focused our attention on placement and clock hands size. The drawing of hands pointing at 2:50 hs and 8:40 hs were of particular interest. RESULTS: Planning strategies, placement of clock hands using a formal numeric code, clock hands size and hands drawing pointing at 2:50 hs. and 8:40 hs. were the variables that best discriminated AD, MCI and NC ( p<0.01). A stepwise regression analysis using as dependent variables (AD - NC ) and (MCI - NC) showed in both cases that the best predictor model was that formed by: planning strategies, clock hands pointing to 8:40, clock hands size, reading hours and set up clock hands following a formal numeric code (p<.001). CONCLUSIONS: Our proposed modifications in this test convert it in an appropriate tool for cognitive impairment screening because they do not only detect visuoconstructional abilities but also frontal planning, contents and processing of the hour memory code and transcodification of semantic memory processes.

Nuevas variables de evaluación del test del reloj permiten un precoz y fácil diagnóstico del grado de deterioro cognitivo / [New assessment variables in the Clock Drawing Test (CDT) allow an early and easy diagnosis of degrees of cognitive impairment]

OBJECTIVE: We developed new subroutines and scoring procedures of the CDT to detect markers of early cognitive impairment. SUBJECTS AND METHODS: We compared the performance of 41 mild Alzheimer’s patients (AD) (MMSE 22.7+/-3.2); and 18 mild cognitive impairment patients (MCI) (MMSE 28.3+/-1.4), with 33 age and education matched normal controls (NC) regarding their ability in drawing a clock on command, copying a printed clock, setting hands and reading the time. We search for differences in the placement of the hands using a colloquial hour code ([quot ]a quarter to ten[quot ]) and a formal numeric code ([quot ]10:45[quot ]). We focused our attention on placement and clock hands size. The drawing of hands pointing at 2:50 hs and 8:40 hs were of particular interest. RESULTS: Planning strategies, placement of clock hands using a formal numeric code, clock hands size and hands drawing pointing at 2:50 hs. and 8:40 hs. were the variables that best discriminated AD, MCI and NC ( p<0.01). A stepwise regression analysis using as dependent variables (AD - NC ) and (MCI - NC) showed in both cases that the best predictor model was that formed by: planning strategies, clock hands pointing to 8:40, clock hands size, reading hours and set up clock hands following a formal numeric code (p<.001). CONCLUSIONS: Our proposed modifications in this test convert it in an appropriate tool for cognitive impairment screening because they do not only detect visuoconstructional abilities but also frontal planning, contents and processing of the hour memory code and transcodification of semantic memory processes.