Motoric Cognitive Risk Syndrome: Prevalence and Risk of Cognitive Impairment in a Population Studied in the Mexican Health and Aging Study 2012-2015.

OBJECTIVES: The aim of this study was to determine the prevalence of Motoric Cognitive Risk (MCR) syndrome, describe associated risk factors and to determine the risk of progression to cognitive impairment after three years of follow-up, in a sample of Mexican older adults. DESIGN: A prospective panel study of health and aging in Mexico. SETTING AND PARTICIPANTS: Baseline and follow-up information was obtained from the Mexican Health and Aging Study's 2012 and 2015 waves. A total of 726 subjects aged 60 years or older with normal cognition at baseline were classified into 4 groups: 1) with MCR, 2) with memory complaint only, 3) with slow gait speed only and, 4) without MCR. Cox regression analysis controlling for confounder factors was performed to determine the risk of progression to cognitive impairment in the MCR group. MEASURES: Data such as gait speed, functional status and cognitive performance (standardized by age and sex in Mexican population) was collected. RESULTS: MCR prevalence was 14.3%. When compared with non-MCR subjects, the presence of MCR was associated with older age (p<0.01), lower educational status (p=0.05), having two or more comorbidities (p<0.05) and diabetes mellitus diagnosis (p<0.05). At follow-up and after adjusting for confounders, MCR was associated with a 2.4-fold increased risk (95% CI: 1.28-4.26, p=.000) of cognitive impairment. CONCLUSIONS: MCR syndrome increases the risk of cognitive impairment in Mexican older adults. Simple measurements such as gait evaluation in subjects with memory complaints could allow early identification of those at risk of developing cognitive impairment.

Factores asociados a la demencia mixta en comparación con demencia tipo Alzheimer en adultos mayores mexicanos / Factors associated with mixed dementia vs Alzheimer disease in elderly Mexican adults

Introducción: El concepto de demencia mixta (DMix) se refiere a la demencia por enfermedad de Alzheimer (EA) y la presencia de enfermedad vascular cerebral (EVC). El objetivo del estudio fue identificar los factores clínicos e imagenológicos asociados a la DMix en comparación con la enfermedad de Alzheimer. Material y métodos: Estudio transversal que incluyó a 225 sujetos de 65 años y más, en la clínica de memoria de un hospital de tercer nivel de la Ciudad de México. A todos los pacientes se les realizó una evaluación clínica, neuropsicológica y una imagen cerebral. Se incluyó a pacientes con diagnóstico de DMix y EA. Se realizó un análisis multivariado para determinar factores de asociación a la DMix. Resultados: Se estudió a 137 sujetos con DMix. En comparación con los pacientes con EA, en los pacientes con DMix los factores asociados fueron mayor edad, diabetes, hipertensión y dislipidemia, así como antecedente de EVC, p < 0,05. El análisis multivariado mostró que la hipertensión (OR 1,92, IC: 1,.62-28.82, p < 0,05), la enfermedad de sustancia blanca (OR 3,61, IC: 8,55-159,80, p < 0,05) e infartos lacunares (OR 3,35, IC: 1,97-412,34, p < 0,05) estuvieron asociados a la DMix, mientras que la historia de depresión resuelta tuvo una asociación inversa (OR 0,11, IC: 0,02-0,47, p < 0,05). Conclusiones: La DMix podría ser más frecuente que la EA. Factores de riesgo como la edad avanzada y otros potencialmente modificables se relacionaron con esta forma de demencia. Es necesario conocer y definir a la DMix (AU)

Introduction: Mixed dementia (DMix) refers to dementia resulting from Alzheimer disease in addition to cerebrovascular disease. The study objectives were to determine the clinical and imaging factors associated with Dmix and compare them to those associated with Alzheimer disease. Material and methods: Cross-sectional study including 225 subjects aged 65 years and over from a memory clinic in a tertiary hospital in Mexico City. All patients underwent clinical, neuropsychological, and brain imaging studies. We included patients diagnosed with DMix or Alzheimer disease (AD). A multivariate analysis was used to determine factors associated with DMix. Results: We studied 137 subjects diagnosed with Dmix. Compared to patients with AD, Dmix patients were older and more likely to present diabetes, hypertension, dyslipidaemia, and history of cerebrovascular disease (P < .05). The multivariate analysis showed that hypertension (OR 1.92, CI 1.62-28.82; P = .009), white matter disease (OR 3.61, CI 8.55-159.80; P<.001), and lacunar infarcts (OR 3.35, CI 1.97-412.34; P = .014) were associated with Dmix, whereas a history of successfully treated depression showed an inverse association (OR 0.11, CI 0.02-0-47; P = .004) Conclusions: DMix may be more frequent than AD. Risk factors such as advanced age and other potentially modifiable factors were associated with this type of dementia. Clinicians should understand and be able to define Dmix (AU)

Factors associated with mixed dementia vs Alzheimer disease in elderly Mexican adults. / Factores asociados a la demencia mixta en comparación con demencia tipo Alzheimer en adultos mayores mexicanos.

INTRODUCTION: Mixed dementia (DMix) refers to dementia resulting from Alzheimer disease in addition to cerebrovascular disease. The study objectives were to determine the clinical and imaging factors associated with Dmix and compare them to those associated with Alzheimer disease. MATERIAL AND METHODS: Cross-sectional study including 225 subjects aged 65 years and over from a memory clinic in a tertiary hospital in Mexico City. All patients underwent clinical, neuropsychological, and brain imaging studies. We included patients diagnosed with DMix or Alzheimer disease (AD). A multivariate analysis was used to determine factors associated with DMix. RESULTS: We studied 137 subjects diagnosed with Dmix. Compared to patients with AD, Dmix patients were older and more likely to present diabetes, hypertension, dyslipidaemia, and history of cerebrovascular disease (P<.05). The multivariate analysis showed that hypertension (OR 1.92, CI 1.62-28.82; P=.009), white matter disease (OR 3.61, CI 8.55-159.80; P<.001), and lacunar infarcts (OR 3.35, CI 1.97-412.34; P=.014) were associated with Dmix, whereas a history of successfully treated depression showed an inverse association (OR 0.11, CI 0.02-0-47; P=.004) CONCLUSIONS: DMix may be more frequent than AD. Risk factors such as advanced age and other potentially modifiable factors were associated with this type of dementia. Clinicians should understand and be able to define Dmix.

[The history of myasthenia gravis. Men and ideas.] / La historia de la miastenia gravis. Los hombres y las ideas.

The first description of a patient with myasthenia gravis was done by Thomas Willis (1621-1675). He was an eminent professor of natural history at Oxford University who also described the arteries of the brain and made the first precise drawings of it. At the present time myasthenia gravis is considered one of the most well described autoimmune diseases with great advances in its diagnosis, pathophysiology and treatment. In this review we summarize the most important events and ideas in the history of this disease since the original description by Willis; mention the most important clinicians, anatomists and physiologists that were concerned with its understanding and make reference of some the most recent advances in its diagnosis and treatment and finally discuss some present controversies. Neurología 2007;22(0):0-0.

[Neurological manifestations in critically ill patients]. / Manifestaciones neurologicas del paciente en estado critico.

AIMS: To describe the pathophysiology, diagnosis and clinical manifestations of the neurological complications that critically ill patients often develop in intensive care units, and to discuss their treatment and prognosis, in the light of the most significant contemporary literature. DEVELOPMENT: The most frequent complication suffered by critically ill patients is sepsis, with encephalopathy as the main manifestation, and this has a direct effect on their prognosis. Polyneuropathy of the critically ill patient is linked to sepsis, as the main precipitating factor, as well as to the presence of high levels of glucose, which plays an important role in deciding whether mechanical ventilation can be withdrawn or not. Myopathy of the critically ill patient is related to the use of fluorinated steroids and neuromuscular blockers, which are frequently administered to these patients. All these entities represent a significant diagnostic challenge for the physician and are accompanied by important sequelae that continue after the patient's discharge from hospital, as well as myopathies and neuropathies associated to the use of drugs that are commonly administered to critically ill patients. It is therefore necessary to be familiar with the pathophysiology of the damage and with the associated factors, if a suitable diagnostic approach is to be employed. CONCLUSIONS: The incidence of these pathologies and their complications makes them important conditions that require a swift, accurate diagnosis so that treatment can be established early on and a prognosis can also be determined.

[Painful neuropathies: their pathophysiology and treatment]. / Neuropatías dolorosas: fisiopatología y tratamiento.

OBJECTIVES: The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the different pharmacological treatments currently available. DEVELOPMENT: Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. CONCLUSIONS: Diagnosis of thin fibre neuropathy is usually performed by carrying out a Quantitative Sudomotor Axon Reflex Test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost.

The association of myasthenia gravis and connective tissue diseases. Effects of thymectomy in six cases with rheumatoid arthritis and one case with systemic lupus erythematosus.

OBJECTIVES: To describe the effects of thymectomy in a group of patients with myasthenia gravis (MG) with associated connective tissue diseases (CTD). PATIENTS AND METHODS: We analyzed six patients with CTD and myasthenia. They were followed-up for at least 3 years. RESULTS: Records of a cohort of 132 patients with established diagnosis of MG undergoing thymectomy in our institution between 1987-1999 were reviewed. The percentage of patients with CTD was 5 % (6/132). Five patients had rheumatoid arthritis (RA) and one patient systemic lupus erythematosus (SLE). All patients were women, and the mean age was 38.5 years old (SD 13.7). Mean time of MG diagnosis to operation was 16 months (range from 1 to 144 months). Preoperative Osserman classification was the following: stage IIb, four patients; stage III, one patient; and stage IV, one patient. Before surgery all patients were on anticholinesterase agent (pyridostigmine), and four patients were on corticosteroids. An extended transsternal thymectomy was practiced on five patients and a transcervical thymectomy was performed in the remaining patient. Pathologic findings were as follows: thymic hyperplasia in four patients and thymic atrophy in the other two. Good response (remission or improvement) was present in three patients (50 %) and poor response (no change or worse) in the other three (50 %). CONCLUSIONS: A low response to the thymectomy is observed in patients with MG and associated CTD (RA and an SLE).

La asociación de miastenia gravis y enfermedades del tejido conjuntivo. Efectos de timectomía en seis casos con artritisreumatoidea y un caso con lupuseritematoso sistémico / The association of myasthenia gravis and connective tissue diseases. Effects of thymectomy in six cases

Objetivos: Describir los efectos de la timectomía en un grupo de pacientes con miastenia gravis (MG) con enfermedades del tejido conectivo asociado (ETC). Pacientes y métodos: Analizamos seis pacientes con ETC y miastenia. Se les hizo un seguimiento de al menos 3 años. Resultados: Se realizó una revisión entre los años 1987-1999 en nuestra institución de los ficheros de una cohorte de 132 pacientes con diagnosis de MG establecida que sufren de timectomía. El porcentaje de pacientes con ETC fue del 5 por ciento (6/132). Cinco pacientes tuvieron artritis reumatoidea (AR) y uno lupus eritematoso sistémico (LES). Todos los pacientes eran mujeres y la media de edad fue de 38,5 años (DE 13,7). El tiempo medio desde el diagnóstico de MG hasta la intervención fue de 16 meses (límites 1 a 144 meses). La clasificación preoperatoria de Osserman fue la siguiente: estadío IIb, cuatro pacientes; estadío III, un paciente, y estadío IV, un paciente. Antes de la intervención todos los pacientes estaban tomando anticolinesterásicos (piridostigmina) y cuatro pacientes tomaban corticoides. A cinco pacientes se les practicó una timectomía transesternal extendida y al paciente restante se le efectuó una timectomía transcervical. Los hallazgos patológicos fueron los siguientes: hiperplasia tímica n cuatro pacientes y atrofia tímica en los otros dos. Tres pacientes (50 por ciento) presentaron buena respuesta (remisión o mejora), y los otros tres pacientes (50 por ciento) pobre respuesta (ningún cambio o empeoramiento).Conclusiones: Se observó una baja respuesta a la timectomía en pacientes con MG en asociación con ETC (AR y un LES) (AU)

[Systemic lupus erythematosus with affection to brainstem: report of three cases]. / Lupus erimatoso sistémico con afectación del tronco encefálico: presentación de tres casos.

INTRODUCTION: The frequency with which the central nervous system (CNS) is affected by systemic lupus erythematosus (SLE) varies, according to different series, between 13 and 59%, whereas the brain stem is affected in 5%. CASE REPORTS: Case 1: a 33 year old male who was submitted to a Nissen funduplicature as a treatment of (hypo)incoercible hiccups. The singultus persisted and some time after a paraplegia appeared. Magnetic resonance (MRI) showed images in the medulla oblongata, and in the cervical and thoracic spine. A biopsy was also performed to examine the cervical lesions and vasculitis was diagnosed. The patient began treatment with prednisone (1 mg/kg) and two months after symptoms had begun to improve he presented an episode of bilateral optic neuritis. Until this last event, the immunological studies had been positive. Case 2: female aged 19 who had had SLE for eight months. The illness began suddenly with bilateral paralysis of the sixth cranial nerve, vertical and horizontal nystagmus, dysdiadochokinesia, truncal ataxia, 4/5 muscular strength in the upper limbs and 3/5 in the lower limbs, and left flexor plantar response, but indifferent on the right hand side. MR showed T2 hyperintensities in the pons, medulla oblongata and the junction of medulla and upper spinal cord. Case 3: female aged 31 with sudden onset of the illness, characterised by diplopy and presence of internuclear ophthalmoplegia. Brain MR showed images of T1 hypointense and T2 hyperintense in the pontobulbar region. CONCLUSION: A brain stem disorder in patients suffering from SLE is one of the rarest manifestations of this pathological condition of the CNS and is probably caused by vasculitis

Lupus erimatoso sistémico con afectación del tronco encefálico:presentación de tres casos / Systemic lupus erythematosus with affection to brainstem: report of three cases

Introducción. La frecuencia de la afectación del sistema nervioso central (SNC) por lupus eritematoso sistémico (LES) varía, de acuerdo con distintas series, entre un 13 y un 59 por ciento, mientras que el tronco encefálico se ve afectado en un 5 por ciento. Casos clínicos. Caso 1: hombre de 33 años de edad, al que se le practica una funduplicatura tipo Nissen por presentar un cuadro de singultus (hipo)incoercible. Se constató la persistencia de singultus y apareció con posterioridad una paraplejía. La resonancia magnética (RM) mostró imágenes en el bulbo y en la columna cervical y torácica. Se realizó también una biopsia de las lesiones cervicales y se diagnosticó vasculitis. El paciente inició un tratamiento con prednisona (1 mg/kg) y dos meses después de la mejoría de los síntomas presentó un episodio de neuritis óptica bilateral. Hasta este último evento hubo positividad a todos los estudios inmunológicos. Caso 2: mujer de 19 años de edad con LES de ocho meses de evolución. La enfermedad se inició de manera súbita con parálisis del sexto nervio craneal bilateral, nistagmo vertical y horizontal, disdiacocinesia, ataxia troncal, fuerza muscular 4/5 para los miembros superiores y 3/5 para los inferiores, y respuesta plantar flexora izquierda, pero indiferente en el lado derecho. La RM mostró hiperintensidades en T2, localizadas en puente, bulbo y unión bulbomedular. Caso 3: mujer de 31 años de edad con un inicio súbito de la enfermadad, caracterizada por diplopía y presencia de oftalmoplejía internuclear. La RM cerebral mostró imágenes en región pontobulbar hipointensas en T1 e hiperintensas en T2. Conclusión. La afección del tronco cerebral en pacientes con LES es una de las manifestaciones más raras de esta patología en el SNC y probablemente esté causada por vasculitis (AU)