18F-FDG PET/TC y RM funcional en un caso de afasia progresiva primaria logopénica cruzada / 18F-FDG PET/CT and functional MRI in a case of crossed logopenic primary progressive aphasia

La afasia progresiva primaria es un síndrome clínico secundario a la neurodegeneración de las áreas y redes neuronales involucradas en el lenguaje, habitualmente en el hemisferio izquierdo. El término «afasia cruzada» se refiere a una alteración del lenguaje como consecuencia de una lesión del hemisferio cerebral ipsilateral a la mano dominante. Presentamos el caso de una mujer diestra de 75 años con afasia progresiva primaria logopénica, con dificultad para encontrar palabras, de 2 años de evolución. La 18F-FDG PET/TC mostró un hipometabolismo temporoparietal derecho. Se realizó una RM funcional para caracterizar patrones de lateralización del lenguaje. Se observó un patrón de activación similar en ambos hemisferios y una menor activación de la esperada en el giro frontal inferior bilateral. Estos hallazgos apoyan que la afasia progresiva primaria logopénica no debería considerarse como una afectación de inicio en el hemisferio izquierdo, sino un síndrome caracterizado por una neurodegeneración asimétrica con preferencia por áreas y redes neuronales implicadas en el lenguaje (AU)

Primary progressive aphasia is a clinical syndrome caused by a neurodegeneration of areas and neural networks involved in language, usually in the left hemisphere. The term "crossed aphasia" denotes an acquired language dysfunction caused by a lesion in the hemisphere ipsilateral to the dominant hand. A case is presented on a 75-year-old right-handed woman with a logopenic variant of primary progressive aphasia with word-finding difficulties of 2 years onset. The 18F-FDG PET/CT showed right temporoparietal hypometabolism. A functional MRI scan was performed during a verb naming task in order to characterise language lateralisation patterns. A similar activation pattern was observed in both hemispheres, with less activation than expected in bilateral inferior frontal gyrus. These findings support that logopenic variant of primary progressive aphasia should not be considered as a neurodegeneration starting in the left brain hemisphere, but as a syndrome characterised by asymmetric neurodegeneration of brain regions and neural networks involved in language (AU)

18F-FDG PET/CT and functional MRI in a case of crossed logopenic primary progressive aphasia. / 18F-FDG PET/TC y RM funcional en un caso de afasia progresiva primaria logopénica cruzada.

Primary progressive aphasia is a clinical syndrome caused by a neurodegeneration of areas and neural networks involved in language, usually in the left hemisphere. The term "crossed aphasia" denotes an acquired language dysfunction caused by a lesion in the hemisphere ipsilateral to the dominant hand. A case is presented on a 75-year-old right-handed woman with a logopenic variant of primary progressive aphasia with word-finding difficulties of 2 years onset. The 18F-FDG PET/CT showed right temporoparietal hypometabolism. A functional MRI scan was performed during a verb naming task in order to characterise language lateralisation patterns. A similar activation pattern was observed in both hemispheres, with less activation than expected in bilateral inferior frontal gyrus. These findings support that logopenic variant of primary progressive aphasia should not be considered as a neurodegeneration starting in the left brain hemisphere, but as a syndrome characterised by asymmetric neurodegeneration of brain regions and neural networks involved in language.

Validación de la versión española del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia / Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia

Introducción: El Addenbrooke's Cognitive Examination (ACE) es un test de cribado para el diagnóstico de demencia. Recientemente, se ha desarrollado la tercera versión del test (ACE-III). El objetivo del estudio fue la traducción y adaptación del ACE-III al español y su validación. Material y métodos: El ACE-III fue traducido y adaptado al español. Se administró a un grupo de sujetos cognitivamente sanos y a pacientes con demencia leve de diferentes tipos en 2 centros españoles. Resultados: La consistencia interna del test (alfa de Cronbach = 0,927), la fiabilidad interevaluador (coeficiente de correlación intraclase = 0,976) y la fiabilidad test-retest (kappa = 0,995) fueron elevadas. Edad (r = –0,512) y escolaridad (r = 0,659) se correlacionaron significativamente con la puntuación total del test. La capacidad diagnóstica del ACE-III fue superior al Mini-Mental State Examination, especialmente en el grupo con mayor escolaridad. Se obtuvieron datos normativos por edad, y puntos de corte para la detección de demencia. Conclusiones: La versión española del test ACE-III es un instrumento válido para el diagnóstico de demencia, con una alta capacidad discriminatoria especialmente en pacientes con un mayor nivel educativo

Introduction: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. Methods: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. Results: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. Conclusions: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education

Topography of primitive reflexes in dementia: an F-18 fluorodeoxyglucose positron emission tomography study.

BACKGROUND AND PURPOSE: Although primitive reflexes (PRs) are inhibited during the first years of childhood, they may reappear with brain injury. PRs have been linked to frontal lobe dysfunction, but their precise topography has not yet been defined. The purpose of this study was to map which regions of the brain display a reduced glucose metabolism in patients with cognitive impairment and PRs. METHODS: A prospective study was conducted to evaluate PRs in a group of patients assessed due to suspected cognitive decline. Neurological and neuropsychological examinations and (18) F-fluorodeoxyglucose positron emission tomography fused with computerized tomography were performed. Voxel-based brain mapping analysis by means of statistical parametric mapping was used to compare patients with and without PRs. RESULTS: The study included 99 patients (33 diagnosed with Alzheimer's disease, 33 on the frontotemporal dementia spectrum and 33 with other diagnoses). Mean age was 71 ± 9.7 years; time since symptom onset was 3.6 ± 2.9 years. At least one PR was observed in 43 cases (43.4% of the whole sample; 48.5% in the Alzheimer disease group, 63.6% in frontotemporal dementia and 18.2% in the group with other diagnoses). The group of patients with PRs exhibited a decreased cerebral metabolism in the bilateral superior frontal gyri (Brodmann area 6), bilateral putamina and thalami. CONCLUSIONS: The presence of PRs was associated with hypometabolism at the superior frontal gyrus and putamen. This suggests that dysfunction in the corticostriatal motor circuit (supplementary motor area-putamen-thalamus) may constitute the anatomical basis of the recurrence of PRs.

Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia.

INTRODUCTION: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. METHODS: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. RESULTS: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. CONCLUSIONS: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education.