ABSTRACT
BACKGROUND: Studies conducted in animal models and humans suggest the presence of a dynamic equilibrium of amyloid-ß (Aß) peptide between cerebrospinal fluid (CSF) and plasma compartments. OBJECTIVE: To determine whether plasma exchange (PE) with albumin replacement was able to modify Aß concentrations in CSF and plasma as well as to improve cognition in patients with mild-moderate Alzheimer's disease (AD). METHODS: In a multicenter, randomized, patient- and rater-blind, controlled, parallel-group, phase II study, 42 AD patients were assigned (1â:â1) to PE treatment or control (sham) groups. Treated patients received a maximum of 18 PE with 5% albumin (Albutein®, Grifols) with three different schedules: two PE/weekly (three weeks), one PE/weekly (six weeks), and one PE/bi- weekly (12 weeks), plus a six-month follow-up period. Plasma and CSF Aß1-40 and Aß1-42 levels, as well as cognitive, functional, and behavioral measures were determined. RESULTS: CSF Aß1-42 levels after the last PE compared to baseline were marginally higher in PE-treated group versus controls (adjusted means of variation: 75.3 versus -45.5âpg/mL; 95% CI: -19.8, 170.5 versus 135.1, 44.2; pâ=â0.072). Plasma Aß1-42 levels were lower in the PE-treated group after each treatment period (pâ<â0.05). Plasma Aß1-40 levels showed a saw-tooth pattern variation associated with PE. PE-treated patients scored better in the Boston Naming Test and Semantic Verbal Fluency (pâ<â0.05) throughout the study. Neuropsychiatric Inventory scores were higher in controls during the PE phase (pâ<â0.05). CONCLUSION: PE with human albumin modified CSF and plasma Aß1-42 levels. Patients treated with PE showed improvement in memory and language functions, which persisted after PE was discontinued.
Subject(s)
Albumins/therapeutic use , Amyloid beta-Peptides/blood , Amyloid beta-Peptides/cerebrospinal fluid , Cognition Disorders/therapy , Plasma Exchange/methods , Aged , Aged, 80 and over , Alzheimer Disease/complications , Alzheimer Disease/diagnostic imaging , Cognition Disorders/diagnostic imaging , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Tomography Scanners, X-Ray ComputedABSTRACT
Una persona de edad avanzada suele tener múltiples factores de riesgo para depresión, entre ellos enfeermedad sintomática, dolor crónico, el uso de numerosos medicamentos, transtornos del sueño y situaciones productoras de estrés adicional, como la pérdida del cónyuge o dificultades económicas. Reconocer oportunamente este cuadro es algo tan fundamental como en ocaciones difícil
