Promoting research in advanced dementia: early clinical results of the Alzheimer Center Reina Sofía Foundation.

The Alzheimer Center Reina Sofía Foundation (ACRSF) was envisaged to address the complex and multi-disciplinary research and care needs posed by Alzheimer's disease (AD) and other neurodegenerative dementias. Patients may be admitted at ACRSF either as inpatients (i.e., nursing home) or outpatients (i.e., day-care center). The research program includes clinical, social, biochemical, genetic, and magnetic resonance investigations, as well as brain donation. We present the inception of the clinical research protocol for the ACRSF, the early results, and the amendments to the protocol. Foreseen as distinct populations, inpatient and outpatient results are presented separately. Data were collected from 180 patients (153 inpatients, 27 outpatients) (86% AD), with informed consent for participation in the research program of the ACRSF. Most patients (95%) had moderate to severe dementia. Nursing home patients were older, displayed marked gait dysfunction, and were significantly more dependent in the activities of daily living (ADL), compared to the day-care patients (p < 0.05). Some cognitive, ADL, and quality of life (QoL) scales were eliminated from the protocol due to floor effect or lack of specificity of contents for advanced dementia. New measurements were added for evaluation of cognition, apathy, agitation, depression, ADL, motor function, and QoL. The final assessment is expected to be sensitive to change in all the clinical aspects of advanced degenerative dementia, to promote multidisciplinary and, desirably, inter-center collaborative research and, eventually, to contribute to the improvement of treatment and care for these patients.

Empleo de reboxetina en el trastorno por déficit de atención e hiperactividad infantil asociado a retraso mental y epilepsia. A propósito de dos casos / The use of reboxetine in attention deficit and hiperactivity disorder in children, associated to mental retardation and epilepsy. Presenting two cases

El Trastorno por déficit de atención e hiperactividad (TADH) constituye uno de los problemas clínicos y de salud mental más importantes en niños y adolescentes por la incapacidad que asocia. Su etiología es aún desconocida, y aunque tradicionalmente se han implicado sistemas dopaminérgicos, en los últimos años están apareciendo nuevos datos que sugieren un papel relevante de los sistemas noradrenérgicos. Los psicoestimulantes son actualmente el tratamiento de elección del TADH, si bien un importante porcentaje de niños y adolescentes no responden, presentan alguna contraindicación para su uso, o no pueden tolerar los efectos adversos asociados. Es por ello la necesidad de encontrar agentes terapéuticos alternativos. Algunos autores han propuesto la Reboxetina, cuyo mecanismo de acción es predominantemente noradrenérgico, como fármaco efectivo en el tratamiento del TADH. Presentamos dos casos de niñas con Trastorno por déficit de atención e hiperactividad, Retraso Mental y Epilepsia en los que se ha utilizado Reboxetina, con buena tolerancia, y una respuesta positiva tanto a nivel conductual como cognitivo. Sugerimos la utilidad de este fármaco en niños con similar perfil clínico y planteamos la necesidad de realizar futuras líneas de investigación que vayan en esta dirección

The attention deficit/hyperactivity disorder (ADHD) represents one of the most predominant clinical and mental health problems in children and adolescents due to the great incapacity it produces. The etiology is still unknown, and although traditionally it was associated to the dopaminergic system in these last years new information reveals the growing importance of the noradrenergic system. At this moment we use stimulants as the main treatment in attention deficit and hyperactivity disorder, although a big percentage of children and adolescents don't respond or have major side effects. This is why we need to find new treatments in this field .Some authors have suggested the use of Reboxetine, which mainly works trough a noradrenergic mechanism, as an effective treatment. We present the cases of two girls with attention deficit and hyperactivity disorder plus mental retardation and epilepsy in which we used Reboxetine with good tolerance and a positive response in conduct and cognitive areas. We suggest this treatment as a useful option in children with a similar clinical pattern and we express the need to create future lines of investigation in this direction