Depression in Alzheimer's Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management.

Background: Alzheimer's disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice. Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician). Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients. Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.

Focus on Depression in Parkinson's Disease: A Delphi Consensus of Experts in Psychiatry, Neurology, and Geriatrics.

Major and minor forms of depression are significant contributors to Parkinson's disease morbidity and caregiver burden, affecting up to 50% of these patients. Nonetheless, symptoms of depression are still underrecognized and undertreated in this context due to scarcity of evidence and, consequently, consistent clinical guideline recommendations. Here, we carried out a prospective, multicentre, 2-round modified Delphi survey with 49 questions about the aetiopathological mechanisms of depression in Parkinson's disease (10), clinical features and connections with motor and nonmotor symptoms (10), diagnostic criteria (5), and therapeutic options (24). Items were assessed by a panel of 37 experts (neurologists, psychiatrists, and a geriatrist), and consensus was achieved in 81.6% of them. Depressive symptoms, enhanced by multiple patient circumstances, were considered Parkinson's disease risk factors but not clinical indicators of motor symptom and disease progression. These patients should be systematically screened for depression while ruling out both anhedonia and apathy symptoms as they are not necessarily linked to it. Clinical scales (mainly the Geriatric Depression Scale GDS-15) can help establishing the diagnosis of depression, the symptoms of which will require treatment regardless of severity. Efficacious and well-tolerated pharmacological options for Parkinson's comorbid depression were selective serotonin reuptake inhibitors (especially sertraline), dual-action serotonin and norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine, and duloxetine), multimodal (vortioxetine, bupropion, mirtazapine, and tianeptine), and anti-Parkinsonian dopamine agonists (pramipexole, ropinirole, and rotigotine). Tricyclic antidepressants and combining type B monoamine oxidase inhibitors with serotonergic drugs have serious side effects in these patients and therefore should not be prescribed. Electroconvulsive therapy was indicated for severe and drug-refractory cases. Cognitive behavioural therapy was recommended in cases of mild depression. Results presented here are useful diagnostic and patient management guidance for other physicians and important considerations to improve future drug trial design.

Dietary supplements for cognitive impairment.

Alzheimer disease and the other neurodegenerative dementias as yet have no curative treatment. For this reason, the prevention of these conditions and non-pharmacological treatments are important fields of research at present. The Mediterranean diet (rich in fruits, vegetables, legumes, and olive oil, with regular fish consumption and low consumption of dairy products and meats) has been shown to reduce the incidence of mild cognitive impairment (MCI) and, probably, the conversion of MCI to dementia. Vitamins, especially vitamin E and the vitamins of the B group, have also been associated with the prevention of cognitive impairment due to their antioxidant effects. Ginkgo biloba is one of the most widely used supplements in the world for cognitive improvement because of its possible effects as a vasodilator and facilitator of cerebral vascularization. Green tea polyphenols have shown beneficial effects in different diseases, including cognitive impairment. Cerebral aging is associated with changes in the lipid composition of neuronal membranes, so it has been suggested that treatment with phospholipids like phosphatidylcholine and phosphatidylserine could favor cognitive improvement. Similarly, polyunsaturated and omega-3 fatty acids, and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) supplements are associated with a beneficial effect on cognitive function due to the cumulative summation of factors that ultimately favor membrane permeability and neuronal functioning.

Suplementos nutricionales para el deterioro cognitivo / Dietary supplements for cognitive impairment

Tanto la enfermedad de Alzheimer como el resto de demencias neurodegenerativas carecen, a día de hoy, de un tratamiento curativo. Por ello la prevención y los tratamientos no farmacológicos representan, en este momento, importantes focos de investigación. La adherencia a la dieta mediterránea (rica en frutas, verduras y legumbres, así como en aceite de oliva, con un consumo regular de pescado, con bajo consumo de lácteos y carnes) se ha demostrado que reduce la incidencia de deterioro cognitivo leve (DCL) y probablemente la conversión del DCL a demencia. Las vitaminas, especialmente la vitamina E y las del grupo B, también se han asociado con la prevención del deterioro cognitivo gracias a sus efectos antioxidantes. El Ginkgo biloba es uno de los suplementos más utilizados en el mundo para la mejoría cognitiva debido a sus posibles efectos vasodilatadores y facilitadores de la vascularización cerebral. Los polifenoles del té verde han demostrado efectos beneficiosos en diferentes enfermedades incluido el deterioro cognitivo. El envejecimiento cerebral se asocia con cambios en la composición de los lípidos en las membranas neuronales, por ello se ha sugerido que el tratamiento con fosfolípidos como la fosfatidilcolina y la fosfatidilserina podrían favorecer la mejoría cognitiva. Del mismo modo los ácidos grasos poliinsaturados, omega-3, y los suplementos de ácido docosahexanoico (DHA) y ácido eicosapentanoico (EPA) se asocian con un efecto beneficioso para las funciones cognitivas debido a una suma acumulativa de factores que finalmente favorecen la permeablidad de las membranas y el funcionamiento neuronal (AU)

Alzheimer disease and the other neurodegenerative dementias as yet have no curative treatment. For this reason, the prevention of these conditions and non-pharmacological treatments are important fields of research at present. The Mediterranean diet (rich in fruits, vegetables, legumes, and olive oil, with regular fish consumption and low consumption of dairy products and meats) has been shown to reduce the incidence of mild cognitive impairment (MCI) and, probably, the conversion of MCI to dementia. Vitamins, especially vitamin E and the vitamins of the B group, have also been associated with the prevention of cognitive impairment due to their antioxidant effects. Gingko biloba is one of the most widely used supplements in the world for cognitive improvement because of its possible effects as a vasodilator and facilitator of cerebral vascularization. Green tea polyphenols have shown beneficial effects in different diseases, including cognitive impairment. Cerebral aging is associated with changes in the lipid composition of neuronal membranes, so it has been suggested that treatment with phospholipids like phosphatidylcholine and phosphatidylserine could favor cognitive improvement. Similarly, polyunsaturated and omega-3 fatty acids, and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) supplements are associated with a beneficial effect on cognitive function due to the cumulative summation of factors that ultimately favor membrane permeability and neuronal functioning (AU)

Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores / Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly

Objetivo: El principal objetivo del estudio es determinar los factores relacionados con la fragilidad y el desequilibrio de la estabilidad psicosocial en los mayores que residen en la comunidad. Métodos: Estudio prospectivo multicéntrico sobre una muestra representativa de las personas mayores de 75 años que residen en la comunidad en la provincia de Huesca. Seguimiento a 5 años con evaluaciones periódicas semestrales. Entrevista individual estandarizada realizada por médicos de atención primaria entrenados para evaluar depresión, ansiedad, deterioro cognoscitivo, síntomas psicóticos, sarcopenia, red de apoyo social, dependencia para las actividades básicas e instrumentales de la vida diaria, gravedad física, riesgo de dependencia y calidad de vida. Evaluación a los 2 y 5 años después para cuantificar acontecimientos adversos: institucionalización, dependencia funcional o mortalidad. Se valorarán posibles factores de riesgo: sexo, edad, situación social, situación funcional, situación psíquica y gravedad física. Se diseñarán modelos predictivos y de cuantificación del riesgo individual para definir finalmente las personas mayores con alta fragilidad psicosocial y riesgo de desestabilización. Conclusiones: Conociendo los posibles factores de riesgo, sería posible definir al anciano con gran riesgo o mayor fragilidad psicosocial, y aplicarlo a actividades preventivas dirigidas a reducir la fragilidad y los acontecimientos adversos asociados (institucionalización, mortalidad, etc.) (AU)

Objective: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. Methods: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. Conclusions: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.) (AU)

[Study protocol concerning the determining factors of physical and psychosocial destabilisation in the elderly]. / Protocolo de estudio sobre condicionantes de desestabilización física y psicosocial en los mayores.

OBJECTIVE: The main objective of this study is to define the factors associated with frailty and psychosocial imbalance in elderly people who live in the community. METHODS: Multicentre prospective study with a representative sample of subjects older than 75 years who live in the community in the province of Huesca (Spain). 5-year follow-up with biannual assessment. Standardised individual assessment carried out by GPs trained to assess depression, anxiety, cognitive impairment, psychotic symptoms, sarcopenia, social network, dependence for basic and instrumental activities of daily living, physical severity, risk of dependence and quality of life. Further assessment two and five years later to quantify adverse events: institutionalisation, functional impairment or mortality. Possible risk factors will be assessed: gender, age, social status, functional status, mental status and physical severity. Predictive and individual risk models will be designed in order to identify elderly people with high psychosocial frailty and destabilisation risk. CONCLUSIONS: An understanding of the possible risk factors would facilitate the identification of elderly subjects at greater risk of psychosocial frailty, thereby enabling preventive activities to be implemented aimed at reducing frailty and associated adverse events (institutionalisation, mortality, etc.).

Uso de antipsicóticos fuera de indicación en los mayores / No disponible

El uso de fármacos antipsicóticos es frecuente en los trastornos psicogeriátricos. Los antipsicóticos son los fármacos que han demostrado mayor eficacia en el tratamiento de la esquizofrenia y otros trastornos psicóticos del anciano. Sin embargo en otras indicaciones como los síntomas neuropsiquiátricos de la demencia su eficacia es más modesta y los efectos adversos pueden ser graves, incluyendo un aumento de accidentes cerebrovasculares, efectos metabólicos, síntomas extrapiramidales, caídas, empeoramiento cognitivo, arritmias, neumonías y aumento de la mortalidad. En 2004 la FDA (Food and Drugs Administration) advirtió la posible asociación del tratamiento con risperidona y olanzapina y el aumento de accidentes cerebrovasculares. Otras revisiones posteriores demostraron que el riesgo era similar para los antipsicóticos convencionales o clásicos, surgiendo una alerta similar para éstos en 2008. En España la prescripción de antipsicóticos atípicos en personas mayores de 75 años requiere un documento específico o "visado" y muchos de estos antipsicóticos se utilizan fuera de indicación, por ejemplo en los pacientes con demencia. Solamente la risperidona está indicada por la FDA y por la Agencia Española para el uso de Medicamentos y Productos Sanitarios (AEMPS) para el tratamiento de los trastorno de conducta en los pacientes con demencia. Sin embargo otros antipsicóticos atípicos han demostrado eficacia, aunque moderada, para el tratamiento de la agitación o la psicosis en los pacientes con demencia. Estos usos se enmarcan "fuera de indicación", requieren un protocolo específico y puede ser causa de preocupación para los prescriptores, pacientes, cuidadores y autoridades sanitarias

Use of antipsychotics drugs in the elderly is frequent in psychogeriatric disorders. For exemple antipsychotics are the most effective drugs used in therapy of schizophrenia and other psychotics disorders in elderly. However in other indications such as neuropsychiatric symptoms in dementia efficacy are less strong and adverse effects can include an increase of mortality risk, cerebrovascular events, metabolic effects, extrapiramidal symptoms, falls, as well as cognitive worsening, cardiac arrhythmia an pneumonia. In 2004 FDA warned of an association between risperidone and olanzapine with cerebrovascular events. Additional clinical trials of others atypical and conventional antipsychotics show similar risk with mortality and FDA warning now applies to all antipsychotics in 2008. In Spain prescription of atypical antipsychotics in older of 75 years old requires a specifically document and most antipsychotics are employed in off-label prescription as in dementia patients. Only risperidone is approved by FDA and Spanish Drugs Agency to use in dementia suffers. However others atypical antipsychotics as olanzapine, quetiapine and aripiprazol can be effective on agitation or psychosis in dementia. So these uses are off-label and can be cause for concern

Validación española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoración de los cambios de personalidad en pacientes con daño cerebral adquirido / Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury

Introducción. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de características (énfasis en las funciones motivacionales y emocionales, evaluación de las funciones ejecutivas ‘cognitivas’ en la vida cotidiana, estimación de la personalidad premórbida, valoración de la fiabilidad del informador) que hacen muy interesante su utilización tanto en la clínica como en la investigación. Objetivo. Validar en castellano la IRSPC para la evaluación de los ‘cambios de personalidad’ secundarios a las lesiones cerebrales de la corteza prefrontal en general y del área ventromedial en particular. Pacientes y métodos. Tras el proceso de traducción y adaptación de la guía de la escala al castellano, se realizó un estudio de validación con 31 pacientes con daño cerebral traumático y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmación. La validez del instrumento es confirmada por la validez concurrente (comparándolo con el inventario neuropsiquiátrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y después del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y válido para la exploración clínica, en el contexto de una evaluación integral de los síntomas derivados de las enfermedades neurológicas en general, y en particular de aquéllas en las que se encuentra involucrada la corteza prefrontal ventromedial (AU)

Introduction. The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the ‘cognitive’ executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. Aim. The aim of this study was the Spanish validation of the IRSPC, which evaluates the ‘personality changes’ secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. Patients and methods. After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. Results. The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). Conclusions. The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury (AU)

[Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury]. / Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.

INTRODUCTION: The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the 'cognitive' executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. AIM: The aim of this study was the Spanish validation of the IRSPC, which evaluates the 'personality changes' secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. PATIENTS AND METHODS: After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. RESULTS: The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). CONCLUSIONS: The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury.

TITLE: Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.Introduccion. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de caracteristicas (enfasis en las funciones motivacionales y emocionales, evaluacion de las funciones ejecutivas 'cognitivas' en la vida cotidiana, estimacion de la personalidad premorbida, valoracion de la fiabilidad del informador) que hacen muy interesante su utilizacion tanto en la clinica como en la investigacion. Objetivo. Validar en castellano la IRSPC para la evaluacion de los 'cambios de personalidad' secundarios a las lesiones cerebrales de la corteza prefrontal en general y del area ventromedial en particular. Pacientes y metodos. Tras el proceso de traduccion y adaptacion de la guia de la escala al castellano, se realizo un estudio de validacion con 31 pacientes con daño cerebral traumatico y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmacion. La validez del instrumento es confirmada por la validez concurrente (comparandolo con el inventario neuropsiquiatrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y despues del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y valido para la exploracion clinica, en el contexto de una evaluacion integral de los sintomas derivados de las enfermedades neurologicas en general, y en particular de aquellas en las que se encuentra involucrada la corteza prefrontal ventromedial.

Trastornos de la empatía en el daño cerebral traumático / Empathy disorders in traumatic brain damage

Introducción. La cognición social es un concepto teórico complejo que engloba muchas funciones mentales superiores de elevado nivel. Dentro de ella se incluye la empatía, que es un aspecto fundamental y suficientemente relevante para ser evaluado de forma independiente; sin embargo, ha sido una de las áreas menos estudiadas en el campo del daño cerebral traumático. Pacientes y métodos. Se estudia una muestra amplía de afectados de daño cerebral traumático, evaluando en ellos la disminución de la capacidad empática. Para ello, hemos utilizado uno de los instrumentos validados en nuestro medio: el Interpersonal Reactivity Index. El estudio se ha completado utilizando parcialmente el modelo de ejecutores sociales de Eslinger, por considerar que la personalidad premórbida y otros factores influyen en la expresión clínica de los cambios en la respuesta empática observados en los afectados de un daño cerebral traumático. Resultados y conclusiones. Respecto al porcentaje de afectados con disminución de la capacidad de empatía, nuestro resultado es similar a los documentados en los escasos estudios existentes sobre el tema. De acuerdo con los resultados obtenidos, el modelo de ejecutores sociales se ha constatado como un modelo válido para realizar un estudio longitudinal y analítico de los trastornos neuropsiquiátricos, en este caso de la empatía; objetivando cómo la personalidad y la inteligencia premórbida modulan la capacidad de empatizar en los afectados de una lesión traumática. Por último, las lesiones traumáticas derechas pueden ser un signo de alarma de los trastornos de la cognición social postraumáticos (AU)

Introduction. Social cognition is a complex theoretical concept that includes many great high level mental functions. Within this concept is included the empathy, which is so significant and relevant to be evaluated separately but it has been one of the least studied areas in traumatic brain injury. Patients and methods. A large sample of patients with a traumatic brain injury has been studied. The aim was to evaluate the decrease of the empathic ability. One of the validated instruments in our area has been used: the Interpersonal Reactivity Index. The study has been completed by using partially the Eslinger’s social executors model as we consider that clinic display of the empathic response changes observed in those with a traumatic brain injury are influenced by previous personality and other different factors. Results and conclusions. With regard to the percentage of empathic ability decrease our results are similar to those documented in the few existing studies on this subject. According to the results the Eslinger’s social executors model has been confirmed as a suitable model to carry out a longitudinal and analytical study of neuropsychiatric disorders like the empathy. We have realized that the empathic ability in traumatic brain injury is modulated by previous personality and intelligence. Finally, right hemisphere traumatic damage could be a warning signal in posttraumatic social cognition hanges (AU)

[Empathy disorders in traumatic brain damage]. / Trastornos de la empatia en el dano cerebral traumatico.

INTRODUCTION: Social cognition is a complex theoretical concept that includes many great high level mental functions. Within this concept is included the empathy, which is so significant and relevant to be evaluated separately but it has been one of the least studied areas in traumatic brain injury. PATIENTS AND METHODS: A large sample of patients with a traumatic brain injury has been studied. The aim was to evaluate the decrease of the empathic ability. One of the validated instruments in our area has been used: the Interpersonal Reactivity Index. The study has been completed by using partially the Eslinger's social executors model as we consider that clinic display of the empathic response changes observed in those with a traumatic brain injury are influenced by previous personality and other different factors. RESULTS AND CONCLUSIONS: With regard to the percentage of empathic ability decrease our results are similar to those documented in the few existing studies on this subject. According to the results the Eslinger's social executors model has been confirmed as a suitable model to carry out a longitudinal and analytical study of neuropsychiatric disorders like the empathy. We have realized that the empathic ability in traumatic brain injury is modulated by previous personality and intelligence. Finally, right hemisphere traumatic damage could be a warning signal in posttraumatic social cognition changes.

Demencia y personalidad: un camino de ida y vuelta / No disponible

No disponible

Los dilemas morales en el daño cerebral / No disponible

No disponible

Disminución de la capacidad empática tras un traumatismo craneoencefálico grave / No disponible

No disponible

Asistencia psicogeriátrica de aragón / Psychogeriatric care in Aragon

No disponible

Functional brain study of chronic traumatic head injury

Explosive aggressive behaviour is a significant clinical and medico-legal problem in patients suffering from head injury. However, experts in neuropsychiatry have proposed a specific category for this disorder: the "organic aggressive syndrome:". The basic reason for proposing this diagnosis is that it describes the specificity of the violent conduct secondary to "brain damage" with greater precision. Early diagnosis and treatment of the injury is critical. The impact of hnetium-99m-hexamethylpropuleneamine oxime (HMPAO) was examined for measuring brain damage in correlation to neuropsychological performance in patients with traumatic brain injury (TBI). We thus report the case of a twelve-year-old child with a history of CET, who presents with serious episodes of heteroaggressiveness and suggest the usefulness of single photon emission computerized tomography (SPECT) to establish the validity of this psychiatric diagnosis. The appearance of modern functional neuro-image techniques (SPECT) may help to increase the validity of clinical diagnoses in the field of psychiatry in general and of forensic psychiatry in particularly, as the related findings may be used as demarcation criteria to establish syndromic diagnoses

Asociación de atrofia medial del lóbulo temporal en TC e hipocaptación temporoparietal mediante SPECT / Association between medial temporal lobe atrophy on ct and parietotemporal uptake decrease on SPECT to the study of cognitive impairment and depressive symptoms

La tomografía computarizada (TC) y la resonancia magnética (RM) cerebrales aportan a la evaluación diagnóstica del paciente con depresión y deterioro cognoscitiva significativo una excelente información anatómica, mientras la tomografía computarizada de emisión de fotón único (SPECT cerebral), permite obtener una información funcional a través de la medición del flujo sanguíneo cerebral regional (FSCr). Objetivo: Evaluar la validez de la combinación de atrofia del lóbulo medial temporal e hipocaptación temporoparietal al diagnóstico de demencia degenerativa primaria, así como su capacidad para discriminar entre demencia degenerativa primaria y depresión. Material: 23 pacientes, 9 hombres (39,1 por ciento) y 14 mujeres (60,9 por ciento), edad media de 61 años, con el diagnóstico de depresión y deterioro cognoscitivo significativo sin cumplir criterios de demencia, según códigos diagnósticos GMS-HAS y DSM-IV. 10 individuos sanos, de similares características sociodemograficas y sin historia anterior de trastorno psiquiátrico, neurológico ni abuso de drogas. Métodos: se ha realizado sistemáticamente tomografía axial computarizada (TC) y por emisión de fotón único (SPECT) cerebrales en sujetos mayores de 65 años con un MEC <24 y menores de 65 años con un MEC > 27. Resultados: se han establecido 6 patrones de perfusión cerebral para el grupo de pacientes El más frecuentemente observado fue el patrón C (39,13 por ciento), hipoperfusión temporal y/o parietal bilateral. Conclusiones: