Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse

Chronic migraine patients are at risk of developing a medication overuse. Brain functional studies in these patients have demonstrated an orbitofrontal hypometabolism, persistent after overuse cessation. Orbitofrontal dysfunction is also present in addiction and thus could predispose migraineurs to medication overuse. The aim of this study was to investigate if orbitofrontal dysfunction can be demonstrated in patients with chronic migraine and medication overuse by performing a systematic neuropsychological evaluation focused on tests that assess frontal lobe function. Second, to establish whether it is related to the outcome of these patients. We prospectively studied 42 chronic migraine patients with medication overuse, 42 episodic migraineurs and 41 controls on a battery of neuropsychological tasks evaluating the orbitofrontal and dorsolateral functioning. Depression, anxiety, and personality traits were also assessed. Chronic migraineurs with medication overuse showed a significant impairment in orbitofrontal task performance and higher depression scores as compared to episodic migraineurs and controls. Dorsolateral dysfunction was present in both groups of migraneurs, who also had higher rates of anxiety as compared to controls. After 1 year of follow-up, migraine patient’s outcome was classified according to their medication overuse status. A negative outcome that included persistent or new-onset medication overuse was present in 34% of migraineurs and was associated with baseline poor orbitofrontal task performance, and with mild dorsolateral dysfunction, higher rates of depression, anxiety and neuroticism-anxiety traits. Formal education and years with migraine did not influence outcome. Orbitofrontal dysfunction is present in patients with chronic migraine and medication overuse, and associates with a poor outcome at 1 year of follow-up. Neuropsychological evaluation in migraine may help to detect patients prone to overuse so that appropriate therapeutic attitudes can be taken

Enfermedades degenerativas y demencia

Demencia es la pérdida de capacidades intelectuales en la edad adulta que conlleva una pérdida de autonomía por parte del individuo. La causa más frecuente es la Enfermedad de Alzheimer, seguida de la demencia vascular y de otras enfermedades degenerativas. La edad es un factor de riesgo para padecer demencia, pero envejecer no significa enfermar. El envejecimiento cerebral puede ser modificado con diferentes estilos de vida.Helduaroan gaitasun intelektuak galtzeari dementzia deritza eta gizabanakoaren autonomiaren galera dakar. Kausarik ohikoena Alzheimer gaixotasuna da, gero dementzia baskularra eta besteen dekapenezko gaixotasunak datoz. Adina arrisku faktore bat da dementzia jasateko, baina zahartzeak ez du gaixotzea esan nahi. Garun zahartzea aldaturik gerta daiteke bizimolde desberdinen bidez.La démence est la perte de capacités intellectuelles à l'âge adulte qui entraîne une perte d'autonomie de la part de l'individu. La cause la plus fréquente est la Maladie d'Alzheimer, suivie de la démence vasculaire et d'autres maladies dégénératives. L'âge est un facteur de risque pour souffrir de démence, mais vieillir ne signifie pas être malade. Le vieillissement cérébral peut être modifié par des styles de vie différents.Dementia is the loss of intellectual capacity in adult age that brings about a loss in autonomy in the individual. The most frequent cause it is Alzheimer's disease, followed by vascular dementia and other degenerative diseases. Age is a hazard factor in terms of suffering from dementia, although ageing does not imply having the disease. Brain ageing can be modified by different styles of life