Evaluation of the convenience of changing the rivastigmine administration route in patients with Alzheimer disease.

INTRODUCTION: Rivastigmine transdermal patches for the treatment of Alzheimer's disease (AD) have potential benefits compared to capsules because of their sustained absorption through the skin, good local tolerability and reduction of gastrointestinal problems. PURPOSE: To assess gastrointestinal and skin tolerability and the need for optimal dose titration of rivastigmine transdermal patches in Alzheimer's disease patients previously treated with oral rivastigmine. PATIENTS AND METHODS: A multicenter, randomized, open-label study including patients with mild to moderate AD (DSM-IV) previously treated with rivastigmine capsules (6-12 mg/day) was conducted. Patients were randomized to: continue with capsules for 3 months (n=49) or switch to rivastigmine patch without titration (9.5mg/day for 3 months; n=48), or switch to rivastigmine patch with titration (4.6 mg/day for 1 month followed by 9.5mg/day for 2 months, n=43). RESULTS: Incidence of gastrointestinal adverse events was 6.1% in the group treated orally and 4.2% in the group treated with non-titrated patches (P=.908). Skin tolerability was good (n=15, 16.7%) without any serious adverse events registered. Patch treatment was considered very easy to use by 72% of patients compared with 30% in the group with oral treatment (P=.0005). 60% of patients were satisfied with the patch, while only 14% were satisfied with capsules (P<.0001). CONCLUSIONS: Rivastigmine patches have a tolerability profile similar to that shown by capsules, but are associated with greater patient satisfaction.

[Progressive primary aphasia associated with corticobasal degeneration]. / Afasia primaria progresiva asociada a degeneración corticobasal.

INTRODUCTION: Progressive primary aphasia generally progresses to global cognitive deterioration of Alzheimer type, although occasionally it remains unchanged. The neuropathological findings are varied: Alzheimer, spongiform etc. The case we describe followed a very unusual course. Initially there was a clinical picture of progressive primary aphasia with which that of corticobasal degeneration was later associated. CASE REPORT: The patient, who had no relevant previous clinical history apart from chronic obstructive pulmonary disease presented with gradually deteriorating oral expression, with no loss of memory and maintenance of autonomy in everyday activities. This condition was later associated with slowing of voluntary movements, hypertonia of the right limbs, difficulty in manipulation with the right hand and myoclonic jerks. Neuro imaging on cranial CT showed global cerebral atrophy, most marked on the right and cerebral SPECT showed reduced fronto temporal uptake. No other significant alterations were found in the investigations done. On neuropsychological examination there was alteration of language in the form of mutism and reduction in denomination, repetition, fluency and comprehension (except for simple orders). However, copies of drawings were done correctly with absence of apraxia of ideas or ideomotor initiation. Handwriting was also normal. CONCLUSION: . The unusual aspect of our case was the simultaneous presentation of an aphasic disorder and corticobasal degeneration.

Afasia primaria progresiva asociada a degeneración corticobasal / Progressive primary aphasia associated with corticobasal degeneration

Introducción. La afasia primaria progresiva generalmente evoluciona hacia un deterioro cognitivo global tipo Alzheimer, aunque en ocasiones se ha mantenido como tal en el transcurso de su evolución. Los hallazgos neuropatológicos han sido de tipo diverso: Alzheimer, espongiforme, etc. El caso que describimos ha seguido un curso muy poco frecuente. En su inicio presenta un cuadro clínico de afasia primaria progresiva y posteriormente se asocia con un cuadro de degeneración corticobasal. Caso clínico. El paciente, sin antecedentes patológicos de interés, excepto una enfermedad pulmonar obstructiva crónica, inicia de forma progresiva deterioro de la expresión oral, sin alteración de la memoria y conservando su autonomía para las actividades de la vida diaria. Este cuadro se asocia posteriormente con un enlentecimiento de los movimientos voluntarios, hipertonía en las extremidades derechas, dificultades de manipulación con la mano derecha y sacudidas mioclónicas. La neuroimagen mediante TC craneal mostró atrofia cerebral global de predominio derecho y la SPECT cerebral presentaba una hipocaptación frontotemporal. Otras exploraciones como la analítica no mostraron alteraciones significativas. En la exploración neuropsicológica se objetiva alteración del lenguaje en forma de mutismo y reducción de la denominación, repetición, fluencia y comprensión (excepto órdenes simples). En cambio, la reproducción del dibujo es correcta, con ausencia de apraxia ideatoria e ideomotora por imitación, siendo la escritura igualmente normal. Conclusión. La peculiaridad de nuestro caso es la presentación clínica simultánea del trastorno afásico y de la degeneración corticobasal (AU)

[Pure alexia: presentation of three cases and review of the literature]. / Alexia pura: presentación de tres casos y revisión de la literatura.

INTRODUCTION: Pure alexia is a syndrome characterized by the inability to read aloud in the absence of agraphia or apnasia. CLINICAL CASES: Three clinical cases showing this syndrome are presented. Case I had a left occipital lesion compatible with a subacute haematoma. He had problems with reading, visuo-spatial recognition, digital gnosia and memorizing texts. One year later there was considerable improvement in most of the sub-tests evaluated. There was still deficient colour naming right/left orientation and understanding of letters and words. Case 2 presented with a right homonymous hemianopia and slight left paresis. He had a small left occipital ischaemic infarct. One year later there was improvement on testing, with some deficit still in visual recognition, naming colours and memory. Case 3 presented with right homonymous hemianopia, slight right paresis and a left occipito-parietal expansive lesion. He had defective reading, choosing and naming of colours, right/left orientation and memory. On later evaluation, considerable improvement was seen. There was still colour agnosia, although less severe and mild 'laziness' of the right side. CONCLUSIONS: In the review of the literature, the disorder and the contributions of various authors, from Déperine in 1892 to the present day, are considered in detail.

[Aphasia in a polyglot: description and neuropsychological course]. / Afasia en un políglota: descripción y evolución neuropsicológica.

We present a case of aphasia due to an ischaemic lesion in the left temporo-occipital region of the brain of a 60 year old right-handed polyglot. Mother tongues: French, Italian, Arabic. Educated at school in English. Languages learnt as an adult: German, Portuguese, Spanish. Language habitually spoken prior to illness: Spanish. His language disorder was of non-fluent type and progressed to an anomic disorder. The non-parallel recovery of languages led to an initial and predominant recovery of English (language at school) followed by French (his first language). This type of non-parallel recovery may be compatible with the inhibition-disinhibition mechanism hypothesis. This would mean that the languages of least recovery are inhibited by raising the threshold of some circuits while still permitting comprehension.

[Time in neuropsychological examination of dementias: Alzheimer's disease versus Parkinson disease]. / El tiempo en la exploración neuropsicológica de las demencias: enfermedad de Alzheimer versus enfermedad de Parkinson.

The importance of time factor studying specificity and sensitivity of neuropsychological tests was studied in two groups of patients with Parkinson's disease and Alzheimer's disease with their respective control groups, through a discriminant analysis. The results indicate that patients with Parkinson's disease are detected with mor sensitivity and specificity applying tests that control time. These findings suggest to develop bradyphrenia and frontal syndrome terms in Parkinson's disease.

[Focal neuropsychological deterioration by posterior lobar atrophy (posterior cortical dementia)]. / Deterioro neuropsicológico focal por atrofia lobar posterior (demencia cortical posterior). Correlación clinicorradiológica.

A right-handed 59 year old man who presented difficulties in the performance of complex acts (praxic) and spatial disorientation is described. Neurophysical exploration showed deterioration of the capacities linked to perceptive and spatial organization preserving the verbal capacities including the memory. After two years and a half of follow up practically no variation has been observed in his clinical manifestations with no implication of other superior mental function. CAT and MR findings revealed important posterior atrophy with an increase in the occipital loops. SPECT demonstrated cold images due to a bilateral parietal-temporal perfusion deficit. Discussion of the case leads to the needs of unifying the criteria and terminology for these focal degenerative processes.

[Permanent hemispheric pain syndrome due to traumatic cortico-subcortical lesions in the left hemisphere]. / Síndrome álgico hemilateral permanente por lesión corticosubcortical traumática del hemisferio izquierdo.

Pain due to cortical-subcortical lesions may be paroxystic or permanent. The latter may be strictly similar to that derived from the selective involvement of the thalamic ventroposterior nucleus. We report a 21 year-old right handed patient who in a cranial-encephalic injury had a counter-stroke lesion of the left parietal-temporal-frontal region, demonstrated by magnetic resonance imaging (MRI), and who remained in coma for 2 weeks. At 6 weeks the patients began to have continuous burning algias in the right hemisome with hyperpathy, allodynia, etc., with exacerbations. Treatment attempted to elevate the levels of brain serotonin was followed by partial improvement. Likewise, the patient presented certain aphasic disturbances and showed different coordination synkinesis, etc., of the right side. The somato-sensitive evoked potentials (PE) were normal. A review of the literature is undertaken emphasizing the rarity with which algic pictures by cortical-subcortical lesions appear in lesions of the dominant hemisphere. Special emphasis is made in the concept of "deafferentation", particularly developed during the last decade (Albe-Fessard, Tasker, Leijon, Boivie). Following the suggestions of Albe-Fessard, the possibility of a central algogenic mechanism by "retrograde" deafferentation (interference in the thalamic-cortical loops) of the median thalamus (unspecific nuclei or of diffuse projection) as a consequence of the cortical-subcortical lesion (of an outstanding form, probably of the parietal operculum) is suggested.

[Depression in Parkinson's disease and its relation to the cognitive and motor manifestations]. / La depresión de la enfermedad de Parkinson y su relación con las manifestaciones cognitivas y motoras.

Evaluation with the geriatric depression scale carried out in 30 patients with Parkinson's disease who did not present subjective complaint of loss of memory or impairment in superior mental function capable of interfering in daily routine showed a high frequency of depression of 50-70% depending on where the cut-off in the geriatric depression scale was located. Depression in these patients does not significantly relate with either cognitive impairment or the degree of motor incapacity. Neither were depression or anxiety in these patients related with demographic data such as the age of the patient, age at onset of the disease, sex, months of evolution, or education. In contrast, a positive correlation was found between depression and anxiety.