Alzheimer's disease: Clinical practice guideline

El Grupo de Trabajo de Neurología de la Conducta y Neurociencias Cognitivas de la Sociedad Neurológica Argentina publicó en 2006 la primera Guía de práctica clínica sobre la enfermedad de Alzheimer para su aplicación en nuestro medio y, eventualmente, en el resto de los países hispanoparlantes del Cono Sur. La Guía que hoy publicamos, mediante la revisión y actualización del estado actual del conocimiento sobre la enfermedad de Alzheimer y su manejo clínico y neurológico, provee a los profesionales los estándares surgidos de la medicina basada en la evidencia para una adecuada implementación de las conductas diagnósticas y terapéuticas a su alcance en nuestro medio.In 2006, the Argentine Neurological Society Research Group on Behavioral Neurology and Cognitive Neurosciences published the first Clinical Practice Guideline on Alzheimer's Disease to be consulted in Argentina and eventually in other countries in Latin America. The present Guideline is a review of the state of the art concerning the 2010 knowledge on the management of this disease. It provides physicians with the usual standards provided by evidence based medicine in order to reach the most adequate diagnostic and therapeutic measures at hand in our countries.Fil: Allegri, Ricardo Francisco. Sociedad Neurológica Argentina; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia. Instituto de Neurociencias - Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Neurociencias; ArgentinaFil: Arizaga, Raúl Luciano. Sociedad Neurológica Argentina; ArgentinaFil: Bavec, Claudia V.. Sociedad Neurológica Argentina; ArgentinaFil: Colli, Liliana P.. Sociedad Neurológica Argentina; ArgentinaFil: Demey, Ignacio. Sociedad Neurológica Argentina; ArgentinaFil: Fernández, María C.. Sociedad Neurológica Argentina; ArgentinaFil: Frontera, Silvina A.. Sociedad Neurológica Argentina; ArgentinaFil: Garau, María L.. Sociedad Neurológica Argentina; ArgentinaFil: Jiménez, Julio J.. Sociedad Neurológica Argentina; ArgentinaFil: Golimstok, Angel. Sociedad Neurológica Argentina; ArgentinaFil: Kremer, Janus. Sociedad Neurológica Argentina; ArgentinaFil: Labos, Edith. Sociedad Neurológica Argentina; ArgentinaFil: Mangone, Carlos Antonio. Sociedad Neurológica Argentina; ArgentinaFil: Ollari, Juan A.. Sociedad Neurológica Argentina; ArgentinaFil: Rojas, Zenón Galeno. Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno"; Argentina. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salmini, Omar. Sociedad Neurológica Argentina; ArgentinaFil: Ure, Jorge A.. Sociedad Neurológica Argentina; ArgentinaFil: Zuin, Daniel R.. Sociedad Neurológica Argentina; Argentin

Thalamus volume change and cognitive impairment in early relapsing–remitting multiple sclerosis patients

Aims: The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods: A prospective study included patients with relapsing–remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results: Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment (P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume (P < 0.001) was observed compared with the group without cognitive impairment. Conclusion: We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.Fil: Rojas, Juan Ignacio. Hospital Italiano; ArgentinaFil: Murphy, Georgina. Hospital Italiano; ArgentinaFil: Sánchez, Francisco. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos. Universidad de Buenos Aires. Facultad de Medicina. Centro de Estudios Farmacológicos y Botánicos; ArgentinaFil: Patrucco, Liliana. Hospital Italiano; ArgentinaFil: Fernandez, Maria C.. Hospital Italiano; ArgentinaFil: Miguez, Jimena. Hospital Italiano; ArgentinaFil: Funes, Jorge. Hospital Italiano; ArgentinaFil: Golimstok, Angel. Hospital Italiano; ArgentinaFil: Cristiano, Edgardo. Hospital Italiano; Argentin

Validity and reliability of the Turkish version of the ALBA screening instrument for Lewy body dementia in older adults

ALBA screening instrument (ASI) has been demonstrated to be an effective, cheap, and noninvasive clinical instrument to screen for Lewy body dementia (LBD). We aimed to determine the validity and reliability of the Turkish version of ASI (ASI-T) in patients with LBD and to investigate the discriminative power of the test in patients with Alzheimer's Disease (AD), LBD, and cognitively healthy older adults (controls). 172 older adults over 60 years of age (43 with LBD, 41 AD, and 88 controls) were included. The sensitivity and specificity of the instrument were determined. A significant difference was found in ASI-T total score between people with LBD versus the controls (t=-9.259; p < 0.001), and versus patients with AD (t = 3.490; p = 0.001). Internal consistency of the ASI-T was good(Cronbach's alpha = 0.81). The cutoff score of 7 showed sensitivity (86%) and specificity (81%) (AUC= 0.888,CI0.95, p < 0.001) compared to controls. Also, compared to AD, it showed sensitivity (86%) and specificity(70%) (AUC = 0.590,CI .95, p < 0.001). Moreover, ASI-T demonstrated a significant concurrent validity with MMSE (r = -0.62; p < 0.001) and MoCA (r = -0.54; p = 0.003). In factor analysis, the five subscales accounted for 60% of the total variance. Our findings suggested that the ASI-T is a reliable, valid, and effective instrument for screening LBD. With acceptable psychometric properties, it has the power to distinguish patients with LBD from controls or those with AD

ALBA Screening Instrument (ASI): A brief screening tool for Lewy Body Dementia

Background Early detection of neurodegenerative diseases is essential for treatment and proper care of these patients. Screening tools available today are effective for several types of dementia. However, there is no one specific for Lewy Body Dementia (LBD). Objectives The aim of this paper is to present a tool for early detection of LBD, accessible even for non-medical staff. Methods We stratified subjects (MMSE > 20) into four groups: health controls (HC), Mild Cognitive Impairment (MCI), LBD and other dementias (Alzheimer and vascular). All subjects (age range 50–90) were examined with a comprehensive neuropsychological and neuropsychiatric evaluation, as well as neuroimaging to differentiate diagnosis between groups, fulfilling corresponding criteria. Both neurologists and neuropsychologists were blind to the performance on clinical evaluations and ASI, respectively. The sensitivity and specificity of the instrument were determined to differentiate LBD from other groups. Results We evaluated 427 subjects, 91 HC, 140 with MCI and 196 with dementia. In the dementia group, 75 were diagnosed with LBD and 121 with other dementias. ASI total score was 12.7 ± 0.4 for LBD, 2.9 ± 0.2 for HC, 5 ± 0.7 for MCI, and 5.4 ± 2.6 for other causes of dementia. ROC curve analysis showed a sensitivity of 90.7% and a specificity of 93.6% stands, with 9 as the cutoff with better test performance compared against other groups. Conclusion ASI is a brief screening tool for LBD with high sensitivity and specificity and useful even for non-medical staff.Fil: Garcia Basalo, M. M.. Hospital Italiano; ArgentinaFil: Fernandez, M. C.. Hospital Italiano; Argentina. Asociacion Lewy Body Argentina; ArgentinaFil: Ojea Quintana, M.. Hospital Italiano; Argentina. Asociacion Lewy Body Argentina; ArgentinaFil: Rojas, J. I.. Hospital Italiano; ArgentinaFil: Garcia Basalo, M. J.. Hospital Italiano; Argentina. Asociacion Lewy Body Argentina; ArgentinaFil: Bogliotti, E.. Hospital Italiano; ArgentinaFil: Cámpora, Nuria Elide. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; ArgentinaFil: Fernandez, M.. Hospital Italiano; ArgentinaFil: Berrios, W.. Hospital Italiano; ArgentinaFil: Cristiano, E.. Hospital Italiano; ArgentinaFil: Golimstok, Angel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Hospital Italiano; Argentina. Asociacion Lewy Body Argentina; Argentin

Clinical practice guideline. Fitness to drive in cognitive impairment and dementia

El deterioro de las funciones cognitivas puede afectar a las habilidades de conducción vehicular representando un riesgo de salud pública al incrementar los accidentes de tránsito. El deterioro cognitivo leve y las demencias se caracterizan por presentar alteraciones cognitivas que afectan, en mayor o menor grado, a las actividades instrumentales de la vida diaria e influyen en la conducción segura. El Grupo de Trabajo de Neurología de la Conducta y Neurociencias Cognitivas de la Sociedad Neurológica Argentina ha elaborado esta Guía de práctica clínica para facilitar a los profesionales médicos la evaluación de pacientes en quienes se sospecha deterioro cognitivo o demencia y para detectar y prevenir eventuales conductas de riesgo.Cognitive impairment may compromise driving skills and represent a public health risk by increasing traffic accidents. Mild Cognitive Impairment and Dementia are characterized by cognitive impairment affecting to a greater or lesser degree the instrumental activities of daily living and fitness to drive. The Argentine Neurologic Society Working Group on Behavioural Neurology and Cognitive Neurosciences has prepared this clinical practice guideline to help physicians evaluate patients suspected to present cognitive impairment or dementia and detect and prevent risky behaviors.Fil: Allegri, Ricardo Francisco. Sociedad Neurológica Argentina. Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Arizaga, Raúl Luciano. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bavec, Claudia Veronica. Sociedad Neurológica Argentina; ArgentinaFil: Barreto, María Dolores. Sociedad Neurológica Argentina; ArgentinaFil: Brusco, Luis Ignacio. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Colli, Liliana Patricia. Sociedad Neurológica Argentina; ArgentinaFil: Demey, Ignacio. Sociedad Neurológica Argentina; ArgentinaFil: Fernandez, Maria Cecilia. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Frontera, Silvana A.. Sociedad Neurológica Argentina; ArgentinaFil: Garau, Maria Laura. Sociedad Neurológica Argentina; ArgentinaFil: Gimenez, Julio Jorge. Sociedad Neurológica Argentina; ArgentinaFil: Golimstok, Angel. Sociedad Neurológica Argentina; ArgentinaFil: Kremer, Janus. Sociedad Neurológica Argentina; ArgentinaFil: Labos, Luisa Edit. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Leis, Adriana Mónica. Sociedad Neurológica Argentina; ArgentinaFil: Lopez Llano, María Luz. Sociedad Neurológica Argentina; ArgentinaFil: Mangone, Carlos Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Ollari, Juan Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Rojas, Zenón Galeno. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Russo, María Julieta. Sociedad Neurológica Argentina; ArgentinaFil: Serrano, Mariela Cecilia. Sociedad Neurológica Argentina; ArgentinaFil: Somale, Maria Veronica. Sociedad Neurológica Argentina; ArgentinaFil: D. Souza, Leandro. Sociedad Neurológica Argentina; ArgentinaFil: Ure, Jorge Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Zuin, Daniel Raul. Sociedad Neurológica Argentina; Argentin