Eyelid myokymia in patients with migraine taking topiramate.

OBJECTIVE: Although ocular side effects of topiramate are common, neuroophthalmologic manifestations such as blepharospasm, myokymia and oculogyric crisis are scarcely reported. METHODS: We present a serie of 8 patients with migraine who developed eyelid myokymia after treatment with topiramate. We reviewed all patients with migraine treated with topiramate attending the headache outpatient clinic of our hospital from January 2008 to December 2012. RESULTS: During the study period, a total of 140 patients with migraine were treated with topiramate in our headache clinic. Eight presented eyelid myokymia after beginning treatment with topiramate (5,7%). Topiramate was stopped and myokymia disappeared in all patients, it was prescribed again and eyelid myokymia reappeared with their previous characteristics in all patients. CONCLUSIONS: Eyelid myokymia is an underreported side-effect of topiramate in patients with migraine, of unknown cause, so that in future, further studies are need to examine whether patients with migraine are predisposed or not to this adverse effect.

Migraine education brochures and patient-perceived satisfaction.

INTRODUCTION: Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. OBJECTIVES: This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. MATERIAL AND METHODS: Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. RESULTS: We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. CONCLUSIONS: Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement.

Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características / Characteristics of informal caregivers of patients with dementia in Alicante province

Introducción: Los cuidadores informales garantizan el cuidado de los pacientes con demencia, prolongando la estancia en su domicilio. Objetivos: Describir las características de los pacientes con demencia de la provincia de Alicante, así como los perfiles y roles de los cuidadores implicados en su manejo. Pacientes y métodos: Estudio prospectivo multicéntrico realizado en 4 consultas de neurología de la provincia de Alicante (junio del 2009-enero del 2010). Inclusión consecutiva de familiares/cuidadores de pacientes con demencia. Analizamos: a) datos demográficos del paciente y cuidadores (edad/sexo, estado civil/laboral, estudios, parentesco); b) unidad de convivencia del paciente; c) motivación para el cuidado del cuidador principal (CP); d) roles del cuidador secundario (CS); e) nacionalidad del cuidador formal (CF) y origen remuneración (privada/institucional), y f) formación en demencias de los cuidadores. Resultados: Nuestros pacientes residen en su domicilio (74,8%). Principalmente, son mujeres (69%) con enfermedad de Alzheimer (78,4%) moderadamente grave (GDS 4-5, 71,6%). CP y CS son mujeres (72,1% vs 60,5%), de edad media, parentesco directo (hijo/a 64,3% vs 54,4%), nivel cultural bajo y amas de casa. Las primeras garantizan el cuidado por obligación moral (75%), las segundas se ocupan del ocio/estimulación del paciente (82,3%). Los grandes ausentes son los varones (73,3%), quienes residen lejos del familiar (52,4%). El CF es una mujer (91,7%), espa˜nola (81,8%) con remuneración privada. Conclusiones: La mujer es el elemento principal en la red de cuidadores de pacientes con demencia: como CP, de apoyo o CF (todos con escasa formación en demencias), siendo el varón el gran ausente. Conocer la estructura de cuidados de estos pacientes facilitará su manejo (AU)

Introduction: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. Objectives: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. Patients and methods: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients’ relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient’s family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers’ knowledge of dementia. Results: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer’s disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. Conclusions: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients (AU)

Characteristics of informal caregivers of patients with dementia in Alicante province.

INTRODUCTION: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. OBJECTIVES: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. PATIENTS AND METHODS: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. RESULTS: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. CONCLUSIONS: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients.

Cefalea menstrual: subtipos, fenotipos clínicos y tratamiento / Menstrual headache: subtypes, clinical phenotypes and treatment

Introducción. Más del 60% de las mujeres refieren presentar cefalea relacionada con el ciclo menstrual. Se ha incluido la ‘migraña menstrual’ en la segunda edición de la Clasificación Internacional de las Cefaleas; sin embargo, la ‘cefaleatensional durante la menstruación’ es una entidad no reconocida por la Sociedad Internacional de Cefaleas.Objetivos. Evaluar la prevalencia de los diferentes subtipos de cefalea menstrual y analizar sus características clínicas y eltratamiento prescrito.Pacientes y métodos. Evaluamos de forma prospectiva a todas las mujeres atendidas en varias consultas de neurología,desde enero a noviembre de 2008, cuya cefalea aparecía durante el período menstrual. Resultados. Se incluyeron un total de 108 pacientes durante el período del estudio, con una edad media de 34,8 ± 8,9 años. El 29,3% presentaba migraña menstrual pura, el 58,7% migraña menstrual relacionada con la menstruación, el 4,5% cefalea tensional pura durante la menstruación y el 7,5% cefalea tensional relacionada con la menstruación. Conclusiones. Nuestros resultados sugieren que la cefalea tensional en el contexto de la menstruación existe, con unaprevalencia en torno al 12% en las pacientes valoradas en nuestras consultas (AU)

Introduction. Up to 60% of women relate their episodes of headache to menstrual cycle. Menstrual migraine has been included in the second edition of the International Classification of Headache disorders. Menstrual tension-type headache has not yet been recognised by the International Headache Society. Aims. To evaluate the prevalence of different subtypes of menstrual headache and to analyze their clinical features and the treatment prescribed. Patients and methods. We prospectively included women attending several neurology outpatient clinics, from January toNovember 2008 whose headache appeared during the menstrual period. Results. A total of 108 patients were included during the study period. Mean age was 34.8 ± 8.9 years-old. 29.3% sufferedfrom pure menstrual migraine, 58.7% from menstrual related migraine, 4.5% from pure menstrual tension-type headacheand 7.5% from menstrual related tension type headache.Conclusions. Our data suggest that menstrual related tension-type headaches exist with a prevalence found about 12%, inour neurology outpatient clinics

[Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome: a well-defined clinical condition with a heterogeneous immunological profile]. / Variante faringocervicobraquial del síndrome de Guillain-Barré: una entidad clínica bien definida con un perfil inmunológico heterogéneo.

INTRODUCTION: The pharyngeal-cervical-brachial variant of Guillain-Barre syndrome (GBS) is rare. This variant has its own specific clinical aspects but a heterogeneous immunological profile. CASE REPORT: A 38-year-old male who presented progressive symptoms of dysphagia, dysphonia and weakness hindering movement of the upper limbs. Two weeks earlier, the patient had presented acute self-limiting diarrhoea. He displayed predominantly right-side bilateral peripheral facial paresis, and paresis of the 9th and 12th cranial nerves and upper limbs (proximal 0/5, distal 1/5), although strength in the lower limbs was not compromised; sensitivity was preserved and deep tendon reflexes were diminished (0 in the upper limbs and + in the lower extremities). At 24 hours after admission, he suffered severe respiratory distress and had to be moved to the Intensive Care Unit with invasive mechanical ventilation. An electronystagmography/electromyogram study revealed severe demyelinating damage that predominantly involved the brain, but also included a small axonal component. The most striking immunological finding was the presence of positive IgG anti-GQ1b, IgM anti-GMI and IgM anti-asialo GM1 titres. CONCLUSIONS: The pharyngeal-cervical-brachial variant is a clinical condition with its own clinical characteristics and well-established diagnostic criteria that allow it to be distinguished from the other variants of GBS. Our case highlights the wide clinical spectrum of acute inflammatory demyelinating polyradiculoneuropathies and the important degree of heterogeneity that exists as regards the immunological parameters.

Variante faringocervicobraquial del síndrome de Guillain-Barré: una entidad clínica bien definida con un perfil inmunológico heterogéneo / Pharyngel-cervical-brachial variant of guillain-barre syndrome: A well-defined clinical condition with a heterogeneous immunological profile

Introducción. Una variante poco frecuente del síndrome de Guillain-Barré (SGB) es la faringocervicobraquial. Dicha variante posee aspectos clínicos específicos, pero un perfil inmunológico heterogéneo. Caso clínico. Varón de 38 años de edad que presentó cuadro progresivo de disfagia, disfonía y debilidad para movilizar las extremidades superiores. Dos semanas antes, presentó un cuadro diarreico autolimitado. Mostraba paresia facial periférica bilateral de predominio derecho, y paresia de los IX y XII pares craneales y de miembros superiores (proximal 0/5, distal 1/5), sin afectación de la fuerza en miembros inferiores, sensibilidad conservada y reflejos osteotendinosos disminuidos (0 en miembros superiores y + en inferiores). A las 24 horas de ingreso sufrió deterioro respiratorio grave, que requirió traslado a la Unidad de Cuidados Intensivoscon ventilación mecánica invasiva. La electronis-tagmografía/electromiograma mostró un grave daño desmielinizante de predominio cefálico y cierto componente axonal. Inmunológicamente destacó la presencia de títulos positivos de IgG anti-GQ1b, IgM anti-GM1 e IgM anti-asialo GM1. Conclusiones. La variante faringocervicobraquial es una entidad clínica con características clínicas propias y criterios diagnósticos establecidos que permiten distinguirla de las otras variantes del SGB. Nuestro caso pone de relieve el amplio espectro clínico de las polirradiculoneuropatías desmielinizantes inflamatorias agudas y la gran heterogeneidad existente respecto a parámetros inmunológicos

Introduction. The pharyngeal-cervical-brachial variant of Guillain-Barré syndrome (GBS) is rare. This variant has its own specific clinical aspects but a heterogeneous immunological profile. Case report. A 38-year-old male who presented progressive symptoms of dysphagia, dysphonia and weakness hindering movement of the upper limbs. Two weeks earlier, the patient had presented acute self-limiting diarrhoea. He displayed predominantly right-side bilateral peripheral facial paresis, and paresis of the 9th and 12th cranial nerves and upper limbs (proximal 0/5, distal 1/5), although strength in the lower limbs was not compromised; sensitivity was preserved and deep tendon reflexes were diminished (0 in the upper limbs and + in thelower extremities). At 24 hours after admission, he suffered severe respiratory distress and had to be moved to the Intensive Care Unit with invasive mechanical ventilation. An electronystagmography/electromyogram study revealed severe demyelinating damage that predominantly involved the brain, but also included a small axonal component. The most striking immunologicalfinding was the presence of positive IgG anti-GQ1b, IgM anti-GMI and IgM anti-asialo GM1 titres. Conclusions. Thepharyngeal-cervical-brachial variant is a clinical condition with its own clinical characteristics and well-established diagnostic criteria that allow it to be distinguished from the other variants of GBS. Our case highlights the wide clinical spectrum of acute inflammatory demyelinating polyradiculoneuropathies and the important degree of heterogeneity that existsas regards the immunological parameters

[Massive cerebral infarction secondary to apoplexy due to pituitary adenoma]. / Infarto cerebral masivo secundario a apoplejía de un adenoma hipofisario.

INTRODUCTION: Pituitary apoplexy is a rare clinical entity. It is a rare cause of stroke, whose pathogenic mechanism has not been fully understood. Compression in intracavernous carotid artery and vasospastic mechanism have been described. It may initially begin as a meningeal syndrome, in which neuroimaging techniques may be fundamental, above all resonance magnetic imaging for a correct diagnosis of the disease and its complications. CASE REPORT: We report the case of a 23 year-old male who suffered a massive stroke due to bilateral carotid compression in its intracavernous portion due to apoplexy of a previously unknown pituitary tumor. The diffusion sequences and acute angioresonance of the circle of Willis are presented. CONCLUSIONS: This is a rare entity with controversial management. An exhaustive review of cases and series of patients with pituitary apoplexy related stroke is also presented.

[Passive smoking as a cerebrovascular risk factor]. / El fumador pasivo como factor de riesgo cerebrovascular.

INTRODUCTION: Stroke is one of the main causes of morbidity and mortality in developed countries today. Smoking is a risk factor that is associated with arteriosclerotic disease. AIM: To evaluate the risk of having a stroke associated to both active and passive smoking in a case-control study. PATIENTS AND METHODS: A case-control study was conducted which included 151 stroke patients who were admitted to hospital in the Neurology Service at the Hospital General Universitario in Alicante over a 12-month period. The control group (302) was obtained from patients who visited the emergency department at the hospital with no history of strokes and who reported clinical signs and symptoms that were not compatible with a stroke. The cases and controls were paired according to age and sex, including two controls of the same sex and whose ages were within a year of that of each case which was obtained. RESULTS: The mean age of the patients was 70.6 years (range: 59-81 years). Males predominated in the sample (57.6%). Stroke patients had a significantly higher percentage of hypertension, peripheral arterial disease, heart disease and dyslipidemia than the control group. The most frequently affected vascular territory was the carotid (33.8%). The most frequent presenting symptom of the stroke was motor syndrome together with language disorders (39.4%). The risk of suffering a stroke associated to active smoking was 1.40 (CI 95% = 0.91-2.15) and in the case of passive smoking it was 1.45 (CI 95% = 0.82-2.58). CONCLUSIONS: The findings from this study suggest there is a relevant association between environmental exposure to tobacco smoke and increased vascular risk (which confirms other results that have been published in the literature) and stress how important it is for non-smokers to find smoke-free zones.

El fumador pasivo como factor de riesgo cerebrovascular / Passive smoking as a cerebrovascular risk factor

El ictus es actualmente una de las principales causas de morbimortalidad en los países desarrollados.El tabaco es un factor de riesgo que está relacionado con la enfermedad arterioesclerótica. Objetivo. Valorar el riesgo de presentación de ictus asociado al tabaquismo tanto activo como pasivo en un estudio de casos y controles. Pacientes y métodos.Se realizó un estudio de casos y controles en el que se incluyó a 151 pacientes con ictus que fueron ingresados en el Servicio de Neurología del Hospital General Universitario de Alicante durante un período de 12 meses. El grupo control (302 sujetos) se obtuvo de pacientes que acudieron a urgencias del hospital sin antecedentes de ictus y que referían una clínica no compatible con un ictus. Los casos y controles se aparearon por edad y sexo, incluyendo dos controles del mismo sexo y ± un año que cada caso obtenido. Resultados. La edad media de los pacientes fue de 70,6 años (rango: 59-81 años). El 57,6% correspondíaa varones. Los pacientes con ictus tenían de forma significativa un porcentaje mayor de hipertensión, arteriopatía periférica, cardiopatía y dislipemia que el grupo control. El territorio vascular más afectado fue el carotídeo (33,8%). La clínica de presentación más frecuente del ictus fue el síndrome motor junto con alteración del lenguaje, con un 39,4%. El riesgode ictus asociado al tabaquismo activo fue de 1,40 (IC 95% = 0,91-2,15) y al tabaquismo pasivo fue de 1,45 (IC 95% = 0,82-2,58). Conclusión. Los datos obtenidos en este estudio sugieren una asociación relevante entre la exposición ambiental al tabaco y un aumento del riesgo vascular, confirmando otros trabajos publicados, y recalcan la importancia de que los no fumadoresencuentren espacios libres de humo

Introduction. Stroke is one of the main causes of morbidity and mortality in developed countries today. Smoking is a risk factor that is associated with arteriosclerotic disease. Aim. To evaluate the risk of having a stroke associated to both active and passive smoking in a case-control study. Patients and methods. A case-control study was conducted which included151 stroke patients who were admitted to hospital in the Neurology Service at the Hospital General Universitario in Alicante over a 12-month period. The control group (302) was obtained from patients who visited the emergency department at the hospital with no history of strokes and who reported clinical signs and symptoms that were not compatible with a stroke. Thecases and controls were paired according to age and sex, including two controls of the same sex and whose ages were within a year of that of each case which was obtained. Results. The mean age of the patients was 70.6 years (range: 59-81 years).Males predominated in the sample (57.6%). Stroke patients had a significantly higher percentage of hypertension, peripheral arterial disease, heart disease and dyslipidemia than the control group. The most frequently affected vascular territory wasthe carotid (33.8%). The most frequent presenting symptom of the stroke was motor syndrome together with language disorders (39.4%). The risk of suffering a stroke associated to active smoking was 1.40 (CI 95% = 0.91-2.15) and in the case of passive smoking it was 1.45 (CI 95% = 0.82-2.58). Conclusions. The findings from this study suggest there is a relevantassociation between environmental exposure to tobacco smoke and increased vascular risk (which confirms other results that have been published in the literature) and stress how important it is for non-smokers to find smoke-free zones

Accidente Cerebrovascular

[Preadmission statins treatment in stroke patients: opportunity to treat high vascular risk patients]. / Antecedente del uso de estatinas en el ictus: oportunidad de mejora en el paciente con alto riesgo vascular por aterotrombosis.

AIM: To describe the use of preadmission statins in patients with cerebrovascular accident and the possible predictive factors. PATIENTS AND METHODS: Cross-sectional observational study of 795 consecutive patients with acute cerebrovascular accident. We assessed the differences among patients who were on preadmission statins (161) and those who were not (634), regarding vascular risk factors and clinical and neurosonological atherothrombotic disease markers. For univariate analysis, we used squared chi test, and for multivariate analysis, logistic regression analysis. RESULTS: Preadmission statins were 20.3%. In high vascular risk patients defined based on National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), this reached 28% and it might be 72%. Predictive factors for preadmission statins use were, in a positive sense, the antecedent of hypercholesterolemia diagnosis (OR = 189; 95% CI = 58-615; p < or = 0.001) and stroke (OR = 2.1; 95% CI = 1.2-3.6; p < or = 0.01), and in a negative sense, smoking (OR = 0.38; 95% CI = 0.18-0.81; p = 0.012). CONCLUSIONS: In our population of patients with stroke, the predictive factors of preadmission statins did not adjust to the current therapeutic NCEP-ATP III recommendations; treatment with statins in high vascular risk population was way below the indications, it was 28% and it might be 72%.

Estudio del diámetro del ventrículo III mediante dúplex transcraneal / Study of the diameter of the third ventricle with transcranial sonography

Introducción. La insonación transtemporal mediante sistemas de ultrasonidos dúplex transcraneal codificado en color (DTCC) con sondas de baja frecuencia (2-2,5 MHz) permite la evaluación no sólo de los vasos del polígono de Willis, sino también de estructuras parenquimatosas cerebrales. Un número reducido de estudios, ninguno en nuestro medio, ha evidenciando su utilidad para la evaluación del sistema ventricular en adultos. Objetivo. Evaluar la utilidad del dúplex transcraneal como técnica de medición del diámetro del ventrículo III en una muestra de pacientes con enfermedades neurológicas. Pacientes y métodos. Se seleccionaron pacientes de cualquier edad ingresados en nuestro servicio de neurología y a los que dentro del protocolo de estudio se solicitaba una resonancia magnética (RM) encefálica. El máximo diámetro del ventrículo III se medía mediante DTCC y RM en planos axiales. Se presentan los resultados obtenidos mediante cada técnica y la correlación lineal entre ambas mediciones. Resultados. Se han estudiado 30 pacientes con una edad media de 48,5 años y 66,6% de mujeres. El diámetro del ventrículo III (media±desviación estándar) fue de 3,97± 2,58 mm medido con el DTCC y de 3,70±2,27 mm con la RM. La correlación lineal entre los valores obtenidos por ambas técnicas fue elevada (r=0,85). Conclusiones. Con el dúplex transcraneal disponemos de una técnica económica, inocua y de fácil aplicación que obtiene resultados equiparables a la RM en la determinación del tamaño del ventrículo III

Introduction. Transtemporal insonation by means of transcranial color-coded duplex sonography (TCDS) with low frequency probes (2-2.5 MHz) makes it possible to not only evaluate the blood vessels of the circle of Willis but also of brain parenchymal structures. A reduced number of studies, none of them in our area, have reported its usefulness for the evaluation of the ventricular system in adults. Aim. To evaluate ability of the transcranial duplex to measure the third ventricle diameter in a sample of patients with different neurological illnesses. Patients and methods. Patients of all ages admitted to our neurology ward and whose diagnostic procedure included a brain magnetic resonance (MRI) were recruited. The largest third ventricle diameter was measured with both the TCDS and MRI in axial planes. We report the results observed with both techniques and the lineal correlation between both of them. Results. We included 30 patients with mean age 48.5 years and 66.6% females. The third ventricle diameter (average ± standard deviation) was 3.97 ± 2.58 mm as measured with TCDS and 3.70±2.27 mm on MRI. Linear correlation between the values observed was high (r=0.85). Conclusions. Transcranial duplex is a cheap, safe and easy to perform technique. It has similar results in comparison with those obtained with the MRI when the third ventricle size is measured

[The neuropsychological profile of mild cognitive impairment with involvement of multiple cognitive areas. The importance of amnesia in distinguishing two subtypes of patients]. / Perfil neuropsicológico del deterioro cognitivo leve con afectación de múltiples áreas cognitivas. Importancia de la amnesia en la distinción de dos subtipos de pacientes.

INTRODUCTION: The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). AIM: To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. PATIENTS AND METHODS: Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. RESULTS: Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. CONCLUSIONS: The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise.

Perfil neuropsicológico del deterioro cognitivo leve con afectación de múltiples áreas cognitivas. Importancia de la amnesia en la distinción de dos subtipos de pacientes / The neuropsychological profile of mild cognitive impairment with involvement of multiple cognitive areas. The importance of amnesia in distinguishing two subtypes of patients

Introducción. El uso de criterios diagnósticos de deterioro cognitivo leve (DCL) que no exigen la presencia de amnesia, permite clasificar a los pacientes en tres tipos de DCL: DCL amnésico puro (DCLa), DCL con afectación de múltiples funciones cognitivas y amnesia (DCLmf-A) y DCL con afectación de múltiples funciones cognitivas sin amnesia o DCL no amnésico (DCLmf-noA). Objetivo. Determinar si los pacientes con DCL con afectación de múltiples funciones (DCLmf) tienen un perfil de afectación cognitiva distinto en función de la presencia o no de amnesia. Pacientes y métodos. De un total de 175 pacientes con DCL, estudiamos a 138 con DCLmf. De ellos, 109 (79%) tenían afectación de la memoria (DCLmf-A) y 29 (21%) no la presentaban (DCLmf-noA). Para cada grupo determinamos el porcentaje de pacientes que tenían una puntuación inferior a la normal en cada uno de los elementos del test Barcelona abreviado. Resultados. Los pacientes con DCLmf-A fallaban con más frecuencia en los tests de orientación temporal, denominación y evocación categorial semántica. Los pacientes con DCLmf-noA fallaban más en las pruebas de praxis motora y abstracción. Las diferencias eran estadísticamente significativas. Además, se apreciaba una tendencia mayor a cometer errores en las pruebas de atención por parte de los pacientes con DCLmf-noA. Conclusiones. La presencia de amnesia permite identificar a un grupo de DCLmf-A con un perfil cognitivo sugestivo de afectación temporal, diferente del grupo de DCLmf-noA con perfil cognitivo, que sugiere afectación subcortical

Introduction. The use of diagnostic criteria for mild cognitive impairment (MCI) that do not require the presence of amnesia enables patients to be classified into three types of MCI: pure amnestic MCI (aMCI), MCI with involvement of multiple cognitive functions and amnesia (mf-aMCI) and MCI with involvement of multiple cognitive functions without amnesia, or non-amnestic MCI (mf-nonaMCI). Aim. To determine whether patients with MCI with involvement of multiple functions (mfMCI) have a different profile of cognitive involvement depending on whether amnesia is present or not. Patients and methods. Out of a total sample of 175 patients with MCI, we studied 138 with mfMCI. Of these, 109 (79%) had memory disorders (mf-aMCI) and 29 (21%) did not (mf-nonaMCI). For each group of patients, we determined the percentage who scored below normal in each of the items on the abbreviated Barcelona test. Results. Patients with mf-aMCI failed more frequently in temporal orientation, naming and semantic category evocation tests. Patients with mf-nonaMCI failed more often in motor praxis and abstraction tests. Differences were statistically significant. Additionally, it was noted that patients with mf-nonaMCI tended to make more mistakes in attention tests. Conclusions. The presence of amnesia allows us to identify an mf-aMCI group with a cognitive profile suggesting temporal involvement, unlike the mf-nonaMCI group, whose members have a cognitive profile that suggests subcortical compromise

Sistema nervioso autónomo, ¿el gran olvidado? / Autonomic nervous system: has it been greatly ignored?

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[An update on the diagnosis of vascular dementia]. / Actualización en el diagnóstico de la demencia vascular.

INTRODUCTION: Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer's disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. CONCLUSIONS: Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies.

Actualización en el diagnóstico de la demencia vascular / An update on the diagnosis of vascular dementia

Introduction. Vascular dementia (VD) is the second most frequent cause of dementia after Alzheimer’s disease in western societies. It includes a heterogeneous group of disorders in which vascular factors are believed to play a vital role in the development of cognitive impairment. Aims and development. Our aim was to determine what instruments can be used to diagnose VD and to what extent such a diagnosis is reliable. To this end, we review the diagnostic criteria that have been used up to now, the role played by neuropsychology, the value of neurosonology studies, and the growing development of neuroimaging techniques, especially magnetic resonance. Conclusions. Current diagnostic criteria for VD select a group that is clinically and aetiologically very heterogeneous. Such criteria need shifting towards new evidence-based criteria derived from analyses of population studies that focus on the early stages of the disease and that make a proper distinction between patients with mixed dementia. The subcortical subtype of vascular cognitive impairment (SVCI) is a form of vascular impairment that is more homogeneous and which selects more representative patients with a more predictable clinical pattern, natural history, response to treatment and prognosis. These characteristics make SVCI cases an ideal group for comparisons between clinical trials and studies (AU)

Introducción. La demencia vascular (DV) es la segunda causa de demencia tras la enfermedad de Alzheimer en la sociedad occidental. Incluye un grupo heterogéneo de trastornos en los que se piensa que los factores vasculares desempeñan un papel esencial en el desarrollo del deterioro cognitivo. Objetivo y desarrollo. Nuestro objetivo es analizar con qué instrumentos y con qué fiabilidad somos capaces de diagnosticar la DV. Para ello, revisamos los criterios diagnósticos existentes hasta la actualidad, el papel de la neuropsicología, del estudio neuroecográfico y el creciente desarrollo de las técnicas de neuroimagen, en especial la resonancia magnética. Conclusión. Los criterios diagnósticos actuales para la DV seleccionan a un grupo clínica y etiológicamente muy heterogéneo, y es necesario modificarlos hacia unos nuevos criterios basados en evidencias, derivados del análisis de estudios poblacionales que se centren en la enfermedad en sus estadios iniciales, y que diferencien adecuadamente a los pacientes con demencia mixta. El subtipo de deterioro cognitivo vascular subcortical (DCVS) representa una forma de deterioro vascular más homogéneo y que selecciona a pacientes más representativos, con un cuadro clínico, evolución, respuesta al tratamiento y pronóstico más predecibles. Estas características hacen del DCVS un grupo ideal para la comparabilidad de estudios y ensayos clínicos (AU)