Effects of commonly prescribed drugs on cognition and mild cognitive impairment in healthy elderly people.

BACKGROUND: Chronic drug intake has been associated with negative and positive cognitive effects in elderly people, although subjacent conditions may be confounding factors. AIM: To study the effects on cognitive performance of commonly prescribed medications in a cohort of cognitively normal older adults. METHODS: Medication intake was recorded during two years in 1087 individuals 70-85 years old, without neurological or psychiatric conditions. The influence of every drug, drug family and therapeutic group on six cognitive scores and on the conversion to mild cognitive impairment over two years was ascertained by cross-sectional and longitudinal analyses controlling for demographic and clinical variables. RESULTS: Small effects of several drugs on information processing were found in cross-sectional analyses but only confirmed for a positive effect of vitamin D in case-control analyses. Longitudinal analyses showed no drug effects on the cognitive slopes. Several hypotensive drugs reduced, whereas bromazepam and glucose lowering drugs increased, the conversion rate to mild cognitive impairment with very small effects (R2=0.3-1%). CONCLUSIONS: Cognitively healthy elderly individuals show minimal negative effects on information processing associated with chronic intake of some drugs probably related to the subjacent condition. Some drugs slightly affect the rate of conversion to mild cognitive impairment. Positive effects of vitamin D, chondroitin, atorvastatin and antihypertensive drugs, and negative effects of antidepressants and benzodiazepines, should be further explored in studies with longer follow-up.

Motor effects of radio electric asymmetric conveyer in Alzheimer's disease: results from a cross-over trial.

We conducted a randomized, cross-over trial to investigate the feasibility, safety, and motor effects of brain stimulation with radio electric asymmetric conveyer (REAC) technique in patients with Alzheimer's disease (AD). Neuropostural optimization (NPO) and sham protocol were administered to 60 patients from the nursing home and day care units of the Alzheimer Center Reina Sofía Foundation. The mean age was 84.1 (SD 7.9) years and 86.7% of the subjects were female. Motor measures were collected at baseline (T1), immediately (T2), seven (T3), and 11 days (T4) after treatment and, following cross-over, immediately (T5), seven (T6), and 11 (T7) days after treatment. Close safety surveillance was conducted from seven days before T1 to the end of the study (T7), with total study duration of 35 days. Wilcoxon test was utilized in the efficacy analysis, considering T1 and T5 as independent baseline assessments and using a threshold of p < 0.05 (corrected) for statistical significance. The NPO protocol was easily administered and well accepted by the participants. Axial movements improved at T3 and T4 after NPO and at T2 after sham NPO, but no significant effects were observed in axial movements in the second phase of the trial. The effects of NPO in gait performance were not consistent. There were six falls between T2 and T7, but only two of them occurred in patients who had received NPO. In light of safety and feasibility of REAC, a trial with the more intense neuropsycho-physical optimization protocol is warranted.

Efectos locales del tratamiento transdérmico con rotigotina / Local effects of transdermal treatment with rotigotine

Introducción. La rotigotina es el primer agonista dopaminérgico transdérmico no ergótico utilizado en el tratamiento de la enfermedad de Parkinson. Presenta importantes ventajas, como una única administración diaria, ausencia de interacciones con alimentos, niveles plasmáticos estables y estimulación continua de receptores dopaminérgicos. Aunque sus efectos secundarios sistémicos son similares a los de otros agonistas dopaminérgicos, también produce diversos efectos locales derivados del sitio de aplicación, efectos que pretendemos analizar en este artículo. Pacientes y métodos. Se realizó un análisis retrospectivo de 165 pacientes tratados con rotigotina. Se descartaron aquéllos con lesiones intracraneales, patología psiquiátrica y demencia. Los pacientes fueron evaluados antes y tras dos, cuatro y seis meses de iniciar el tratamiento con rotigotina. Resultados. Se identificaron 94 varones y 71 mujeres, con una edad media de 65,2 años y una dosis media de rotigotina de 11,3 mg/día. Los efectos adversos locales afectaron a 21 pacientes y provocaron el abandono del tratamiento en dos casos por eritema y picor. Treinta pacientes se quejaron de problemas de adherencia del parche, sobre todo en los momentos de mayor calor, y 36 comunicaron la formación de arrugas. Ninguno de estos problemas se asoció a fluctuaciones motoras u otras complicaciones. Conclusiones. Las complicaciones locales de la rotigotina transdérmica son leves, pero frecuentes. Consideramos necesario tenerlas en cuenta para lograr un mejor tratamiento de los pacientes con enfermedad de Parkinson (AU)

Introduction. Rotigotine is the first transdermal non-ergolinic dopaminergic agonist used in the treatment of Parkinson’s disease. It has several important advantages such as once-daily administration, absence of interactions with food, steady levels in plasma and continuous dopaminergic stimulation. Although its systemic side effects are similar to those seen in other dopaminergic agonists, rotigotine also has local side effects derived from the site of application. The aim of this paper is to review those local problems. Patients and methods. A retrospective analysis was carried out in order to identify the first 165 patients treated with rotigotine. Patients with intracranial lesions, psychiatric pathology or dementia were excluded. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. Results. In all, 94 males and 71 females were identified, with an average age of 65.2 and an average rotigotine daily dose of 11.3 mg. Local side effects were present in 21 patients and they were usually mild. Two patients abandoned the treatment because of these local adverse events, presenting erythema and prurigo. Thirty patients complained about lack of adherence of the patch, specially when it was hot, and 36 about the formation of wrinkles in the patch. None of these problems was associated to motor fluctuations or other complications. Conclusions. Local complications of transdermal rotigotine are mild but frequent. We consider it is necessarily to take them into account to get a better treatment of patients suffering from Parkinson’s disease (AU)

[Local effects of transdermal treatment with rotigotine]. / Efectos locales del tratamiento transdérmico con rotigotina.

INTRODUCTION: Rotigotine is the first transdermal non-ergolinic dopaminergic agonist used in the treatment of Parkinson's disease. It has several important advantages such as once-daily administration, absence of interactions with food, steady levels in plasma and continuous dopaminergic stimulation. Although its systemic side effects are similar to those seen in other dopaminergic agonists, rotigotine also has local side effects derived from the site of application. The aim of this paper is to review those local problems. PATIENTS AND METHODS: A retrospective analysis was carried out in order to identify the first 165 patients treated with rotigotine. Patients with intracranial lesions, psychiatric pathology or dementia were excluded. Patients were evaluated before and at two, four and six months after beginning treatment with rotigotine. RESULTS: In all, 94 males and 71 females were identified, with an average age of 65.2 and an average rotigotine daily dose of 11.3 mg. Local side effects were present in 21 patients and they were usually mild. Two patients abandoned the treatment because of these local adverse events, presenting erythema and prurigo. Thirty patients complained about lack of adherence of the patch, specially when it was hot, and 36 about the formation of wrinkles in the patch. None of these problems was associated to motor fluctuations or other complications. CONCLUSIONS: Local complications of transdermal rotigotine are mild but frequent. We consider it is necessarily to take them into account to get a better treatment of patients suffering from Parkinson's disease.

Relación entre el sistema fibrinolítico y las enfermedades neurológicas / Relationship between fibrinolytic system and neurological diseases

Introducción. El sistema fibrinolítico, o sistema del plasminógeno, se compone de una serie de moléculas que convierten el plasminógeno en su forma activa plasmina, la cual es capaz de participar en múltiples procesos fisiopatológicos. Objetivo. Realizar una revisión de la bibliografía y analizar la relación entre el sistema fibrinolítico y las enfermedades neurológicas y sus posibles implicaciones terapéuticas al respecto. Desarrollo. El sistema fibrinolítico se ha involucrado en muy diversas patologías. Aunque tradicionalmente se pensaba que su relación con las enfermedades neurológicas era escasa, en los últimos años se han establecido importantes nexos de unión. De esta forma, el sistema fibrinolítico parece estar involucrado no solamente en enfermedades cerebrovasculares, sino también en la epilepsia, enfermedades neurodegenerativas, como la enfermedad de Alzheimer, enfermedades de perfil inflamatorio, como la esclerosis múltiple, alteraciones del sistema dopaminérgico, trastornos del aprendizaje o enfermedades del sistema nervioso periférico. Diferentes genotipos de los componentes de este sistema se han mostrado como factores protectores o de riesgo para el desarrollo de estas enfermedades, y la información acumulada a este respecto está aumentando sustancialmente. Conclusiones. Un mayor conocimiento de las relaciones entre el sistema fibrinolítico con las enfermedades neurológicas podría aclarar ciertos puntos sobre su fisiopatología y también suponer futuras líneas de prevención y tratamiento (AU)

Introduction. The fibrinolytic system, also named plasminogen system is formed by a group of molecules that transforms plasminogen in its active form plasmine, which is able to participate in a number of pathophysiological processes. Aim. To carry out a review of the literature and an analysis of the relationship between fibrinolytic system and neurological diseases and its potential therapeutic implications.Development. The fibrinolytic system has been involved in many different pathologies. Although its role in neurological diseases has always been thought to be scarce, many relations have been recently established. This way, fibrinolytic system seems to be involved not only in cerebrovascular diseases but also in epilepsy, inflammatory diseases such as multiple sclerosis, alterations of the dopaminergic system, learning disorders and several lesions of the peripheral nervous system. Different genotypes of several components of this system have been related as risk or protector factors to the development of these neurological diseases and information to this respect is rapidly increasing. Conclusions. A better knowledge about the relations between the fibrinolytic system and neurological diseases could clarify several aspects about their pathophysiology and it could suppose future prevention and treatment lines (AU)