Test Digital de Percepción (TDP) para la valoración de trastornos perceptivos incipientes en la enfermedad de Alzheimer inicial / Perception Digital Test (PDT) for the assessment of incipient visual disorder in initial Alzheimer's disease

Introducción. Los trastornos de la percepción visual son frecuentes en las enfermedades degenerativas con afectación cerebral de localización posterior como la enfermedad de Alzheimer (EA). El objetivo principal de este estudio es la creación de un test de percepción visual basado en el tratamiento de fotografías digitales (Test Digital de Percepción, TDP), así como ofrecer sus valores normativos en la población española anciana. El segundo objetivo del estudio es validar el test en un grupo de pacientes con EA leve, en estadio 4 según la Global Deterioration Scale (GDS) (EA-4). Sujetos. Los grupos estaban formados por 86 controles sanos y 27 pacientes con EA-4.Método. A todos los sujetos se les aplicó el TDP que consta de 15 ítems con cuatro opciones de respuesta.Resultados. El tiempo medio de aplicación en controles sanos fue de 85 s (desviación estándar: 33). La diferencia en las medias obtenidas por los grupos resultó estadísticamente significativa (control: 13,5 [1,4]; EA-4: 10,6 [2,9]; p=0,05]. La edad no tuvo una influencia significativa en el rendimiento obtenido en el TDP en ninguno de los grupos; sin embargo, los años de escolaridad influyeron significativamente en la puntuación del grupo control.Conclusión. El TDP es un test rápido, fácil y sensible para evaluar los trastornos de percepción visual en la EA inicial

Introduction. Visual perception disorders are frequent in degenerative diseases with posterior cerebral lobe involvement, such as Alzheimer's disease (AD). The main aim of this study is to create a Perception Digital Test (PDT) based on the treatment of digital photographs, and to present normative values in the elderly Spanish population. The second objective is to validate the test in a group of patients with mild AD, stage 4 in the Global Deterioration Scale (GDS) (AD-4).Subjects. The group were constituted by 86 healthy controls (CTR) and 27 AD patients.Method. VPT, which was formed by 15 items with four options of answer, was administered to all subjects.Results. Mean time of administration of PDT in CTR was 85 seconds (standard desviation: 33). Mean result obtained for each groups was significantly different (CTR: 13.5 [1.4]; AD-4: 10.6 (2.9); p = 0.05). Age did not significantly influence PDT performance in any of the groups. However, years of education influenced significantly the CTR group score.Conclusion. PDT is an easy, quick and sensitive test to assess visual perception disorders in initial AD

[Efficacy of memantine in the treatment of Alzheimer's disease]. / Eficacia de la memantina en el tratamiento de la enfermedad de Alzheimer.

Alzheimer's disease (AD) is a neurodegenerative disorder clinically characterized by cognitive loss with impairment of daily living activities. The benefits presently observed with the approved treatments are mainly symptomatic without clear evidence of neuroprotection. N-methyl-D-aspartate (NMDA) glutamate receptor antagonists have very extensive therapeutic potential in several central nervous system disorders and can be used in chronic neurodegenerative diseases and in other neurological diseases such as epilepsy. Memantine, a moderate-low affinity, uncompetitive NMDA receptor antagonist, is the only antiglutamatergic drug currently approved for the treatment of moderate to severe AD. Several studies have demonstrated that treatment with memantine has cognitive and functional benefits through all disease stages, while it is safe and well tolerated. Additionally, memantine generates an indirect positive effect on the caregiver, which results in some social benefits. This fact, together with a delay on the transition towards a greater dependence stage is probably associated with a decrease in the number of patients institutionalized. From a socio-economic perspective, these effects mean lower global cost of disease, therefore being a cost-effective drug.

Eficacia de la memantina en el tratamiento de la enfermedad de Alzheimer / Efficacy of memantine in the treatment of Alzheimer's disease

La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa caracterizada clínicamente por la pérdida de funciones cognitivas con repercusión en las actividades de la vida diaria. En la actualidad los tratamientos aprobados para el manejo de la EA generan un beneficio fundamentalmente sintomático, sin que hayan demostrado capacidad neuroprotectora. Los fármacos antagonistas de los receptores del glutamato N-metil-D-aspartato (NMDA) tienen un potencial terapéutico muy extenso, pudiendo emplearse como tratamiento en procesos neurodegenerativos y en otras enfermedades neurológicas como la epilepsia. La memantina, un antagonista no competitivo de moderada-baja afinidad del receptor NMDA, representa en la actualidad el único fármaco antiglutamatérgico aprobado para el tratamiento de la EA moderada-avanzada. Diversos estudios han demostrado que el tratamiento con memantina produce beneficios cognitivos y funcionales en todos los estadios de la EA, siendo, asimismo, un fármaco seguro y bien tolerado. Por otro lado, la memantina indirectamente genera un efecto positivo sobre el cuidador, lo cual se traduce en un beneficio social. Ello, junto al retraso en la transición a un estado de mayor dependencia, se asocia probablemente a una reducción en el número de pacientes institucionalizados. Desde una perspectiva socioeconómica, estos efectos se traducen en un menor coste económico global de la enfermedad, siendo por ello un fármaco coste-efectivo

Alzheimer's disease (AD) is a neurodegenerative disorder clinically characterized by cognitive loss with impairment of daily living activities. The benefits presently observed with the approved treatments are mainly symptomatic without dear evidence of neuroprotection. N-methyl-D-aspartate (NMDA) glutamate receptor antagonists have very extensive therapeutic potential in several central nervous system disorders and can be used in chronic neurodegenerative diseases and in other neurological diseases such as epilepsy. Memantine, a moderate low affinity, uncompetitive NMDA receptor antagonist, is the only antiglutamatergic drug currently approved for the treatment of moderate to severe AD. Several studies have demonstrated that treatment with memantine has cognitive and functional benefits through all disease stages, while it is safe and well tolerated. Additionally, memantine generates an indirect positive effect on the caregiver, which results in some social benefits. This fact, together with a delay on the transition towards a greater dependence stage is probably associated with a decrease in the number of patients institutionalized. From a socio-economic perspective, these effects mean lower global cost of disease, therefore being a cost-effective drug

El anciano con demencia

La prevalencia de la demencia aumentará en las próximas décadas asociada al envejecimiento de lapoblación. El diagnóstico precoz de estos pacientes es importante para su manejo y la aplicación de estrategias terapéuticas. En el presente capítulo describiremos la patogenia, las características clínicas y los criterios diagnósticos de las demencias neurodegenerativas más frecuentes: la enfermedad de Alzheimer, la demencia con cuerpos de Levy y la demencia frontotemporal. Finalmente, abordaremos su manejo, tanto desde un punto de vista social como farmacológico (AU)

[Present and future of neurology in Spain]. / Presente y futuro de la neurología española.

This is a document prepared by the Spanish Society of Neurology (SEN), which was given to the President of Spain (Mr. José María Aznar) last September with the main aim of examining the current situation of Neurology in our country. It analyses the present and future of Neurology in clinical assistance, teaching and research. To prepare this document the criteria of patients' associations has been considered, including the Declaration of Madrid which has been subscribed by thirty of these associations. In spite of its relevant development in the previous decades, the current situation of Neurology in Spain is far from the ideal. To reach the recommendable menber of 3 or 4 neurologists per 100,000 inhabitants it is necessary to duplicate the present number of neurologists which has been estimated around 2/100,000; this situation is especially urgent in some Autonomous Communities. The most important problems in neurological assistance are: inadequate follow-up of the chronic outpatients, low numbers of neurological beds and of duties of Neurology, as well as of neurological case of patients with urgent neurological disorders. It is also necessary to increase the number of professors of Neurology to adequately cover pregraduate teaching; again there are important differences in teaching positions among Autonomous Communities. Neurology residence should be prolonged from 4 to 5 years. Finally, it is necessary to support the appearance of superespecialised units and to promote a coordinated research with other close specialities including basic neuroscience.