[Pseudoneurologic conversion and factitious disorders: differential diagnosis in 2 clinical cases]. / Trastornos seudoneurológicos de conversión y facticios: diagnóstico diferencial a través de dos casos clínicos.

The recognition and differentiation of conversion and factitious disorders could be difficult when they coexist with physical problems and their psychopathology is not evident. We present two illustrative cases of patients who share the existence of neurological disorders and present a similar psychiatric semiology, which is phenomenologically different related with their physical deficits. The psychopathological assessment was made by means of a standardized instrument for diagnosis (SCAN) and suitable paraclinical techniques for each case. The test MMPI (Minnesota Multiphasic Personality Inventory) was used in both cases, and an exploration with Thiopental was carried out in one of them. The pertinent differential diagnosis, the advantages of coordinated interdisciplinary interventions in order to elucidate these mental disorders, and the convenience of using appropriated psychometric instruments and exploratory methods are expounded in the present paper.

[Dementias: current situation and future perspectives]. / Demencias: situación actual y perspectivas futuras (I). Diagnóstico diferencial, epidemiología y factores de riesgo.

In this paper, the first one in a series of three complementary papers on dementias, we introduce the concept and evaluate the methods for diagnostic and the data provided by modern epidemiology. The current clinic criteria for the diagnosis of dementias are based on international instructions such as those included in the DSM-III-R (1987), and the ICD-10 (1992), and the criteria developed by the NINCDS-ADRDA or the CERAD. Such a disparity makes even more difficult the transcultural reliability of epidemiological information. The differentiation with pseudodementias, being the depressive one the most frequent of them (75%), the inclusion of the denominated dementia-AIDS complex, or those dementias related with the alcoholic illness have special relevance. In Europe the more solid studies proceed from the EURODEM group, and their results are consistent with the North American and Asiatic ones, pointing all of them out an exponential growing of dementia with age, which is very similar in the different continents. The risk factors for the Alzheimer's disease and other dementias are discussed and contrasted with the contributions of the different reliable documental sources existing.

[Dementias: present situation and future perspectives (II). Biological markers]. / Demencias: situación actual y perspectivas futuras (II). Marcadores biológicos.

In the previous paper, the first one in our trilogy about dementias, we introduce the concept and evaluate the diagnostic methods and the data provided by epidemiological investigation. In this paper we review the different biological diagnostic markers, based, in the first place, on the studies of neuroimage (computerized axial tomography, magnetic resonance, functional neuroimage techniques) and those properly neurophysiological; in the second place, the anatomopathological and physiopathological markers are examined; and, in the third place, those based on the modern genetic investigations. In the absence of an 'univocal biological marker', the current investigation about markers is on the way to the study of abnormal proteins discovered in the brain, of the modifications detected in the cellular metabolism, of the manifestations of the immunologic mechanisms and of the involved inflammatory processes, and is on the way to the advances and proximate perspectives of molecular genetics and animal models. Meanwhile, the diagnostic for the main dementia, due to Alzheimer's disease, is basically a clinic, exclusive and residual one, mainly in its initial stadium.

[Dementias: present situation and future perspectives (III). Neurological, therapeutic, psychosocial aspects and patient care]. / Demencias: situación actual y perspectivas futuras (III). Aspectos neuropsicológicos, terapéuticos, psicosociales y asistenciales.

The lack of univocal diagnostic biological markers which are easily reproducible, highly specific and sensitive has propitiated the apparition of a conjunct of neuropsychological instruments for the detection and evaluation of dementias. The main markers are reviewed in this paper, the third of three papers dedicated to dementias by the authors. Also in the absence of a unic effective treatment for the Alzheimer's disease (AD), the potential pharmacological approaches pass through the design of methodologically correct trials which have to combine several drugs with palliative therapies in order to attempt to stop or delay the disturbance course. All that, in addition to the quick progresses obtained in genetics, in the neuronal transplants, in the administration of neurotrophical factors, in monogangliosides, in the intervention on the production of the beta-amyloid protein or in the excitatory amino acid toxicity prevention make it possible to conceive realistic hopes on the discovery of a future effective therapy for the AD. On the other hand, a helpful surrounding for the patient suffering from dementia should adequately contemplate his security, stability, stimulation, freedom of movement and, also, the necessary environmental treatment. Creating units and residences specialized in dementias, home assistance aids, day centres, self-help groups, patients' family associations, the effective presence of social services which evaluate, give advice and guide behaviorally, and the creation of group aid programs for caretakers are necessary elements to improve the life quality of dementia patients and their families.