ABSTRACT
Introducción. Dentro de los síndromes con deterioro cognitivo se hallan múltiples entidades que asocian parkinsonismo como síntoma acompañante a lo largo de su evolución. En ocasiones no se valoran los signos de patología extrapiramidal de forma adecuada, atribuyéndolos a efectos secundarios de la medicación o simplemente obviándolos si son leves y no causan incapacidad notable. Sin embargo, cuando aparecen es conveniente pensar en otras causas que los expliquen, replanteándose el diagnóstico inicial. Objetivo. Realizar un repaso breve de las entidades que presentan demencia como síntoma principal además de síndrome parkinsoniano en diferente medida. Desarrollo. Entre los síndromes con demencia y parkinsonismo asociado se encuentran numerosas patologías muy heterogéneas tanto en frecuencia como en etiología y pronóstico. Algunas son poco frecuentes, como las asociadas a mutaciones del cromosoma 17, y otras son tan comunes como la enfermedad de Alzheimer o la hidrocefalia normotensiva. También se incluyen procesos de diferente etiología: degenerativa, infecciosa, traumática, tóxica o metabólica, vascular, etc... que pueden, entre otros síntomas, presentar demencia y parkinsonismo. Conclusiones. Conocer dichas patologías nos puede ayudar a realizar un diagnóstico correcto, siempre deseable para tratar al paciente adecuadamente e informar de la forma más veraz a la familia sobre la evolución y pronóstico esperables (AU)
Introduction. Among the syndromes with cognitive impairment, there are a number of conditions that associate parkinsonism as an accompanying symptom throughout the whole of its development. On some occasions the signs of extrapyramidal pathology are not appraised properly and are attributed to secondary effects of the medication or are simply ignored if they are mild and do not cause any notable disability. When they do appear, however, it is wise to think about other causes that can explain them, reconsidering the initial diagnosis. Aims. To carry out a brief review of the conditions that present dementia as the main symptom, in addition to Parkinsonian syndrome, although to different extents. Development. Among the syndromes with dementia and parkinsonism associated to them, there are a number of pathologies that are very heterogeneous in terms of both their frequency and their causation and prognosis. Some of them are not very frequent, such as those associated to mutations of chromosome 17, and others are as common as Alzheimer's disease or normotensive hydrocephalus. They also include processes with different aetiologies (which can be degenerative, infectious, traumatic, toxic or metabolic, vascular, and so forth) that can present dementia and parkinsonism, among other symptoms. Conclusions. An understanding of such pathologies can help reach a correct diagnosis, which is fundamental to be able to treat the patient adequately and provide the family with information that is as accurate as possible about the expected development and prognosis (AU)
Subject(s)
Humans , Male , Female , Frontotemporal Dementia/genetics , Chromosomes, Human, Pair 17/genetics , Parkinson Disease/genetics , Cognition Disorders/psychology , Alzheimer Disease/genetics , Deglutition Disorders/diagnosis , Memory Disorders/psychology , Basal Ganglia/abnormalities , Frontotemporal Dementia/complications , Chromosomes, Human, Pair 17/classification , Parkinson Disease/metabolism , Cognition Disorders/complications , Alzheimer Disease/metabolism , Deglutition Disorders/complications , Memory Disorders/metabolism , Basal Ganglia/metabolismABSTRACT
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Subject(s)
Humans , Deep Brain Stimulation , Parkinson Disease/surgery , Electrodes, Implanted/adverse effects , Prosthesis FailureABSTRACT
AIM: To review the increasing number of papers that report diverse neuropsychiatric disorders that happen in patients diagnosed of Parkinson's disease submitted to brain deep stimulation of subthalamic nuclei with high frequency current. DEVELOPMENT: It is a fact the need to evaluate carefully all the patients who have to submit to this surgical procedure analyzing previous psychiatric history, and the possible appearance of psychiatric sphere symptoms after surgery. The acute depression and the euphoric moods (than can occur immediately after surgery) and major depression, obsession, widespread anxiety and substance abuse (among those of more delayed appearance) constitute examples of this pathology. The treatment of previous psychiatric disorders is forced in all cases and specially relevant in the major depression when suicide ideas coexist. CONCLUSIONS: Information that allow to predict the risk of developing depressive disorders in the postoperative period does not exist at present time, though it is more predictable that it happens in those patients with previous severe depressive history. In general, euphoric moods, apathy and depression, usually are transient and of multifactorial origin that includes the existence of endogenous predisposition, the change to an independence pattern after surgery, the psychotropic effect of levodopa, and the high frequency current stimulation effect on the non motor structures target and in the adjacent regions. It must be outlined that it is possible the appearance of psychotic symptoms after brain deep stimulation of subthalamic nuclei in patients with ideal results on motor disability.
