Connectivity and Patterns of Regional Cerebral Blood Flow, Cerebral Glucose Uptake, and Aß-Amyloid Deposition in Alzheimer's Disease (Early and Late-Onset) Compared to Normal Ageing.

PURPOSE: The aim of this study was to investigate the differences in early (EOAD) and late (LOAD) onset of Alzheimer´s disease, as well as glucose uptake, regional cerebral blood flow (R1), amyloid depositions, and functional brain connectivity between normal young (YC) and Old Controls (OC). METHODOLOGY: The study included 22 YC (37 ± 5 y), 22 OC (73 ± 5.9 y), 18 patients with EOAD (63 ± 9.5 y), and 18 with LOAD (70.6 ± 7.1 y). Patients underwent FDG and PIB PET/CT. R1 images were obtained from the compartmental analysis of the dynamic PIB acquisitions. Images were analyzed by a voxel-wise and a VOI-based approach. Functional connectivity was studied from the R1 and glucose uptake images. RESULTS: OC had a significant reduction of R1 and glucose uptake compared to YC, predominantly at the dorsolateral and mesial frontal cortex. EOAD and LOAD vs. OC showed a decreased R1 and glucose uptake at the posterior parietal cortex, precuneus, and posterior cingulum. EOAD vs. LOAD showed a reduction in glucose uptake and R1 at the occipital and parietal cortex and an increased at the mesial frontal and temporal cortex. There was a mild increase in an amyloid deposition at the frontal cortex in LOAD vs. EOAD. YC presented higher connectivity than OC in R1 but lower connectivity considering glucose uptake. Moreover, EOAD and LOAD showed a decreased connectivity compared to controls that were more pronounced in glucose uptake than R1. CONCLUSION: Our results demonstrated differences in amyloid deposition and functional imaging between groups and a differential pattern of functional connectivity in R1 and glucose uptake in each clinical condition. These findings provide new insights into the pathophysiological processes of AD and may have an impact on patient diagnostic evaluation.

Concordance between 11C-PIB-PET and clinical diagnosis in a memory clinic.

INTRODUCTION: Today, ligands that bind to fibrillar ß-amyloid are detectable by Positron Emission Tomography (PET) allowing for in vivo visualization for Abeta burden. However, amyloid plaques detection per se does not establish Alzheimer's Disease diagnosis. In this sense, the utility of amyloid imaging to improve clinical diagnosis was settled only for specific clinical scenarios and few studies have assessed amyloid molecular neuroimaging in a broader clinical setting. The aim of this study is to determine the frequency of PiB amyloid findings in different diagnostic syndromes grouped into high and low probability pre- test categories, taking into account pre-test clinical assumption of the presence of AD related pathology. METHODS: 144 patients were assigned into categories of high or low pretest probability according to clinical suspicion of AD pathology. The high probability group included: amnestic Mild Cognitive Impairment (MCI), amnestic and other domains MCI, Dementia of Alzheimer's Type (DAT), Posterior Cortical Atrophy (PCA), logopenic Primary Progressive Aphasia (PPA), Cerebral Amyloid Angiopathy and mixed dementia. The low assumption group included: normal controls, non-amnestic MCI, non-logopenic PPA and Frontotemporal Dementia (FTD). RESULTS: Only normal controls and DAT patients (typical and atypical presentation) were the most consistent across clinical and molecular diagnostics. MCI, non-logopenic PPA and FTD were the syndromic diagnoses that most discrepancies were found. DISCUSSION: This study demonstrates that detecting in vivo amyloid plaques by molecular imaging is considerably frequent in most of the dementia syndromes and shows that there are frequent discordance between molecular diagnosis and clinical assumption.

Role of biological and non biological factors in congestive heart failure mortality: PREDICE-SCORE: a clinical prediction rule.

BACKGROUND: Congestive heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this project was to develop a clinical prediction model of biological and non biological factors in patients with first diagnosis of HF that facilitates the risk-stratification and decision-making process at the point of care. METHODS AND RESULTS: Historical cohort analysis of 600 patients attended at three tertiary hospitals and diagnosed of a first episode of HF according Framingham criteria. There were followed 1 year. We analyzed sociodemographic, clinical and laboratory data with potential prognostic value. The modelling process concluded into a logistic regression multivariable analysis and a predictive rule: PREDICE SCORE. Age, dependency for daily basic activities, creatinine clearance, sodium levels at admission and systolic dysfunction diagnosis (HF with left ventricular ejection fraction 〈 40%) were the selected variables. The model showed a c-statistic of 0.763. PREDICE Score, has range of 22 points to stratifications of 1-year mortality. CONCLUSIONS: The follow-up of 600 patients hospitalized by a first episode of congestive HF, allowed us to obtain a predictive 1 year mortality model from the combination of demographic data, routine biochemistry and easy handling social and functional variables at the point of care. The variables included were non-invasive, undemanding to collect, and widely available. It allows for risk stratification and therapeutical targeting and may help in the clinical decisions process in a sustainable way.

Motor complications in Parkinson's disease: ten year follow-up study.

Parkinson's disease (PD) can be symptomatically controlled with standard treatments; however, after a few years, this response typically declines and most patients develop motor complications. We carried out a prospective practice-based study to evaluate the evolution appearance and evolution of motor complications in 64 de novo PD patients over 5 years and in 38 PD patients over 10 years. We studied untreated patients from initial assessment at basal conditions and evaluated every 6 months thereafter with treatment (levodopa versus other drugs). The follow-up assessments were performed with the Unified Parkinson's Disease Rating Scale (UPDRS). At each assessment, patients were monitored regarding the development of dyskinesias, motor fluctuations, freezing, loss of postural reflexes, and cognitive impairment. We observed a significant improvement in UPDRS scores during the first year, then a progressive decline, more evident after the third year. Motor complications increased after the third year, and at the end of the survey (tenth year); drug-induced dyskinesias and motor fluctuations were experienced (71.1 and 94.7%, respectively). After the first decade, many complications arose from the non-levodopa-responsive features of the disease (cognitive impairment was present in 52.6% and gait freezing in 71.1%). Initial medication may influence medium-term complications but not long-term problems. Most long-term disabling problems of PD were related to non-levodopa-responsive features.

Influenza vaccination among the elderly Spanish population: trend from 1993 to 2003 and vaccination-related factors.

BACKGROUND: Influenza is an important public health problem that particularly affects elderly subjects and influenza vaccination is a safe, effective and efficient method for prevention of influenza-related complications in elderly individuals with or without underlying chronic conditions. This study aims to analyze adjusted time trends in the coverage of influenza vaccination among elderly Spanish subjects and to identify which variables were associated with the probability of having been vaccinated in 2003. METHODS: We undertook a cross-sectional study using data of individuals aged >/=65 years drawn from the 1993, 1995, 1997, 2001, and 2003 Spanish National Health Surveys. The answer to the question 'Did you have a 'flu shot in the latest campaign' was used as the dependent variable, and socio-demographic and health-related characteristics were analyzed as independent variables. Coverage of vaccination for each year was adjusted by the direct method for both age and gender. Multivariate logistic regression was used to estimate the independent effect of variables on the receipt of influenza vaccine. RESULTS: 15 989 records were analyzed. Adjusted influenza coverage increased from 50.1% in 1993 to 63.7% in 2003 (P < 0.001). The variables that were significantly associated with a higher likelihood of being vaccinated were older age, suffering a chronic disease, residence in towns with <10 000 inhabitants, 'worse' self-perceived health and non-smokers. CONCLUSIONS: Coverage among the Spanish elderly has increased significantly from 1993 to 2003. Still, there is room for improvement, particularly, among the subjects with 'good' self-perceived health, those with no concomitant medical conditions, and smokers.

Influenza vaccination among cardiovascular disease sufferers in Spain: related factors and trend, 1993-2003.

Based on data drawn from the 1993 and 2003 National Health Surveys (NHS), we sought to: estimate influenza vaccination coverages among Spanish cardiovascular disease (CVD) sufferers; study which variables were associated with the likelihood of being vaccinated; analyze the time-trend in coverage for the period 1993-2003. For study purposes, a CVD sufferer was defined as any adult who reported suffering from high blood pressure and/or heart disease. The proportion of vaccinated adult CVD sufferers in 1993 and 2003 totalled 39.96% and 51.73%, respectively. The following variables increased the likelihood of being vaccinated: higher age; male gender; presence of respiratory chronic diseases; non-smoker status. Coverages for CVD sufferers had improved significantly from 1993 to 2003 but still remain below desirable levels. The improvement over time is mainly due to the subgroup aged >64 years. Strategies must be implemented to improve the use of influenza vaccine among CVD sufferers in Spain in general, and among the younger age-groups in particular.