Neuropsychiatric symptoms and associated caregiver stress in geriatric patients with Parkinson’s disease

Objectives: In Parkinson´s disease, researchers are becoming increasingly aware of the need to include the assessment of behavioural and psychological symptoms as important outcome measures in clinical trials. Besides, clinicians are starting to recognise the need to identify and manage these symptoms in addition to the motor ones. Our objective is to explore the presence of neuropsychiatric symptoms in geriatric patients with Parkinson and the associated distress in their caregivers. Methods: 100 patients with PD ageing 75 years old or more (50 PD without dementia and 50 PD Dementia (PDD) were assessed using the 10-item Neuropsychiatric Inventory-questionnaire (NPI-Q), and the NPI Caregiver Distress Scale (NPI-D). Results: The mean total NPI score was 12.9. At least one neuropsychiatric symptom was present in more than 80% of participants. Within PDD patients about 89% suffered at least one NPI symptom, 70% suffered at least 2 symptoms and one of those symptoms had an intensity scoring 4 of higher in more than 50%. Numbers in PD patients without dementia were significantly lower, though more than 50% of patients had at least 2 symptoms. The most frequent symptom was depression, followed by apathy, anxiety, depression and hallucinations. Antiparkinsonian agents can exacerbate psychotic symptoms. Nearly 60% of caregivers reported suffering a moderate to severe level of stress due to these symptoms. Symptoms causing more stress were agitation/aggression followed by hallucinations and irritability/lability. Conclusions: Neuropsychiatric symptoms are frequent in geriatric patients with PD –specially in patients with PDD– and lead to moderate to severe caregiver distress

Biomarcadores para el diagnóstico de la Enfermedad de Alzheimer

La Enfermedad de Alzheimer se diagnostica en base a criterios clínicos y su diagnóstico precoz, en fases prodrómicas continúa siendo un reto. Las pruebas complementarias que se realizan rutinariamente ante un caso de sospecha no van dirigidas a evidenciar la presencia de la enfermedad, sino a descartar otros procesos que pueden producir un cuadro clínico similar. Estudios prospectivos han demostrado que los diagnósticos de Enfermedad de Alzheimer eran erróneos en aproximadamente la cuarta parte de los casos, aún en centros especializados. La solución a este reto son los biomarcadores; pruebas que permitan confirmar o excluir la presencia de la enfermedad. En este artículo se describen sucintamente los cuatro tipos de biomarcadores aceptados para apoyar el diagnóstico de Enfermedad de Alzheimer: las pruebas de laboratorio, la neuroimagen estructural, la neuroimagen funcional y la neuroimagen molecular. También se discuten someramente los aspectos más relevantes de su utilización en la práctica clínica diaria. Palabras clave: Alzheimer, deterioro cognitivo leve, biomarcadores, PET, RM, tau, amiloid

Planimetry of the medial temporal lobe: a feasible method for supporting the diagnosis of Alzheimer’s disease in clinical practice

Albeit a disproportionate rate of atrophy in the medial temporal lobe (MTA) represents a reliable marker of Alzheimer’s disease (AD) pathology, the measurement of MTA is not being widely used in daily clinical practice. This is mainly because the methods available to date are sophisticated and diffiult to implement (volumetric methods) or lack objectivity (visual rating scales). Here, we aimed to assess the reproducibility of computing the 2D-yrA-MTL and the efforts needed to start the usage of 2D-yrA-MTL. A series of 290 1.5T-MRI studies on 230 subjects in the age range of 65–85 years, including patients with AD (n = 100), MCI (n = 100) and matched controls (n = 90) were examined by experienced tracers (ET) and inexperienced tracers (IT). The IT got suffiiently trained by attending to a minimum of 3 cases before being able to perform the 2D-yrA-MTL on their own and without mistakes according to the corrections made by the ET. After training, the IT needed 5 minutes to perform the 2D-yrA-MTL on a new case. The intrarater and interrater reproducibility of 2D-yrAMTL was good. In conclusion, the 2D-yrA-MTL is a simple, objective and reproducible method that could be easily implemented in clinical practice