Encefalitis anti-receptor NMDA: un diagnóstico a considerar

Encephalitis are inflammatory brain disorders that are secondary to different pathological processes that include infectious and autoimmune causes. In recent years, the autoimmune processes involved have been studied with an increment in the identification of cases that present a wide variety of neurological and psychiatric symptoms, which often make their timely diagnosis difficult. This is a narrative review that describes the main aspects of encephalitis caused by antibodies against the N-methyl-D-aspartate receptor (NMDAR), its pathogenesis (mechanism shared with psychotic disorders), diagnosis, and clinical presentation; these are aspects that highlight the importance of a thorough evaluation of psychiatric manifestations in the clinical setting.Las encefalitis son trastornos inflamatorios cerebrales, secundarias a diferentes procesos patológicos que incluyen causas infecciosas y autoinmunes. En los últimos años se han estudiado los procesos autoinmunes involucrados, con una creciente identificación de casos donde presenta una amplia variedad de síntomas neurológicos y psiquiátricos que suelen dificultar el diagnóstico oportuno. Por tanto, esta es una revisión narrativa que describe los principales aspectos de la encefalitis por anticuerpos contra el receptor de N-metil-D-aspartato (NMDAR), su patogénesis (mecanismo que comparte con los trastornos psicóticos), diagnóstico y presentación clínica; aspectos que destacan la importancia de una evaluación exhaustiva de las manifestaciones psiquiátricas en el ámbito clínico

Encefalitis anti-receptor NMDA: un diagnóstico a considerar

Encephalitis are inflammatory brain disorders that are secondary to different pathological processes that include infectious and autoimmune causes. In recent years, the autoimmune processes involved have been studied with an increment in the identification of cases that present a wide variety of neurological and psychiatric symptoms, which often make their timely diagnosis difficult. This is a narrative review that describes the main aspects of encephalitis caused by antibodies against the N-methyl-D-aspartate receptor (NMDAR), its pathogenesis (mechanism shared with psychotic disorders), diagnosis, and clinical presentation; these are aspects that highlight the importance of a thorough evaluation of psychiatric manifestations in the clinical setting.Las encefalitis son trastornos inflamatorios cerebrales, secundarias a diferentes procesos patológicos que incluyen causas infecciosas y autoinmunes. En los últimos años se han estudiado los procesos autoinmunes involucrados, con una creciente identificación de casos donde presenta una amplia variedad de síntomas neurológicos y psiquiátricos que suelen dificultar el diagnóstico oportuno. Por tanto, esta es una revisión narrativa que describe los principales aspectos de la encefalitis por anticuerpos contra el receptor de N-metil-D-aspartato (NMDAR), su patogénesis (mecanismo que comparte con los trastornos psicóticos), diagnóstico y presentación clínica; aspectos que destacan la importancia de una evaluación exhaustiva de las manifestaciones psiquiátricas en el ámbito clínico

Cognitive Impairment and Depression in a Population of Patients with Chronic Kidney Disease in Colombia: A Prevalence Study

Background: Growth of the elderly population is linked to the increase of comorbid conditions such as chronic kidney disease (CKD), depression, and cognitive impairment (CI). Cognitive impairment can vary from minimal deficits in the normal aging, to mild cognitive impairment with a prevalence ranging from 1 to 29 % in people ≥ 65 years of age, up to severe impairment with a prevalence of 6 to 42 %. The CI induced by depression usually affects the functional performance of the elderly. Objective: The objective of the study is to describe the prevalence of CI and depression in patients ≥ 55 years with CKD stages 3 and 4, attending a secondary prevention program during 2012–2013. Design: The design of the study is a cross-sectional study of simple random sampling, and 308 patients were invited to participate. Setting: Patients were being treated in a CKD secondary prevention program in Bogotá, Colombia, during 2012–2013. Patients: Participants were over 54 years diagnosed with CKD in stages 3 to 4 according to the K/DOQI classification. Measurements: CI was assessed using NEUROPSI and modified Lawton Scale; depression was measured with Yesavage Geriatric Depression Scale and the MINI International Neuropsychiatric Interview. Methods: Through an interview with the subjects, information regarding age, occupation, civil status, educational level, and clinical baseline variables was collected. Clinical assessment with specific instruments was performed by a multidisciplinary team composed of nephrologists, a psychiatrist, a neurologist, and a neuropsychologist. Results: Two hundred and fifty-one patients agreed to participate. The average age was 76.3 (SD = 7.9) years, 67 % were males, and 86.5 % had CKD stage 3. Overall prevalence of CI was 51 % (95 % CI 44.7 to 57.2), and the prevalence of major depression reached 8 % (95 % CI 4.5 to 11.3); 4.8 % of the patients ( n = 12) had both CI and depression. Limitations: A limitation of the study is its design, which does not allow establishing the direction of the association between predictors and outcomes. Suggested associations must be interpreted cautiously as they are generated as hypothesis, which should be investigated in properly designed trials. Conclusions: CI and depression are prevalent conditions among patients with CKD stages 3–4, with the greatest occurrence of CI, affecting half of the investigated Colombian patients with age ≥ 55 years

Déficience cognitive et dépression dans une population de patients atteints d'insuffisance rénale chronique en Colombie: une étude de prévalence

Background: Growth of the elderly population is linked to the increase of comorbid conditions such as chronic kidney disease (CKD), depression, and cognitive impairment (CI). Cognitive impairment can vary from minimal deficits in the normal aging, to mild cognitive impairment with a prevalence ranging from 1 to 29 % in people ≥ 65 years of age, up to severe impairment with a prevalence of 6 to 42 %. The CI induced by depression usually affects the functional performance of the elderly. Objective: The objective of the study is to describe the prevalence of CI and depression in patients ≥ 55 years with CKD stages 3 and 4, attending a secondary prevention program during 2012–2013. Design: The design of the study is a cross-sectional study of simple random sampling, and 308 patients were invited to participate. Setting: Patients were being treated in a CKD secondary prevention program in Bogotá, Colombia, during 2012–2013. Patients: Participants were over 54 years diagnosed with CKD in stages 3 to 4 according to the K/DOQI classification. Measurements: CI was assessed using NEUROPSI and modified Lawton Scale; depression was measured with Yesavage Geriatric Depression Scale and the MINI International Neuropsychiatric Interview. Methods: Through an interview with the subjects, information regarding age, occupation, civil status, educational level, and clinical baseline variables was collected. Clinical assessment with specific instruments was performed by a multidisciplinary team composed of nephrologists, a psychiatrist, a neurologist, and a neuropsychologist. Results: Two hundred and fifty-one patients agreed to participate. The average age was 76.3 (SD = 7.9) years, 67 % were males, and 86.5 % had CKD stage 3. Overall prevalence of CI was 51 % (95 % CI 44.7 to 57.2), and the prevalence of major depression reached 8 % (95 % CI 4.5 to 11.3); 4.8 % of the patients (n = 12) had both CI and depression. Limitations: A limitation of the study is its design, which does not allow establishing the direction of the association between predictors and outcomes. Suggested associations must be interpreted cautiously as they are generated as hypothesis, which should be investigated in properly designed trials. Conclusions: CI and depression are prevalent conditions among patients with CKD stages 3–4, with the greatest occurrence of CI, affecting half of the investigated Colombian patients with age ≥ 55 years.Mise en contexte: On a constaté un lien entre la croissance de la population âgée et l’augmentation de pathologies comorbides telles que les maladies rénales chroniques et la dépression ou un trouble cognitif. Ce dernier peut varier de la déficience légère observée lors du vieillissement normal à un trouble cognitif léger, dont la prévalence s’étend de 1 à 29 % chez les gens âgés de plus de 65 ans, jusqu’à une déficience grave dont la prévalence se situe entre 6 et 42 %. Le trouble cognitif provoqué par la dépression a des répercussions sur les performances fonctionnelles des personnes âgées. Objectifs de l’étude: Cette étude avait pour but de qualifier la prévalence d’un trouble cognitif et de la dépression chez les patients âgés de plus de 55 ans atteints d’insuffisance rénale chronique (IRC) de stade 3 ou de stade 4, et engagés dans un programme de prévention secondaire en 2012 et 2013. Type d’étude: Il s’agit d’une étude transversale où on a utilisé un échantillonnage aléatoire simple et à laquelle 308 patients ont été invités à participer. Participants et cadre de l’étude: L’étude a porté sur des cas de patients provenant d’un programme de prévention secondaire à Bogota, en Colombie. Les participants étaient tous âgés de plus de 54 ans et avaient reçu un diagnostic d’IRC de stade 3 ou de stade 4 conformément au classement de la KDOQI (Kidney Disease Outcome Quality Initiative). Mesures: Le trouble cognitif a été mesuré à l’aide de l’évaluation neuropsychologique NEUROPSI et d’une échelle de Lawton modifiée. La dépression a été diagnostiquée en utilisant l’échelle de dépression gériatrique de Yesavage et le questionnaire MINI (Mini International Neuropsychiatric Interview). Méthodologie: Les renseignements personnels des participants tels que l’âge, la profession, l’état civil, le niveau de scolarité et les paramètres cliniques initiaux des participants ont été recueillis par le biais d’entrevues. L’évaluation clinique, effectuée à l’aide d’instruments spécifiques, est le fruit de la collaboration d’une équipe multidisciplinaire composée de néphrologues, d’un psychiatre, d’un neurologue et d’un neuropsychologue. Résultats: En tout, 251 patients ont accepté de participer à l’étude. Les hommes constituaient 67 % de la cohorte, l’âge médian se situait à 76,3 ans avec un écart-type de 7,9 ans et 85 % des participants souffraient d’IRC de stade 3. La prévalence globale d’un trouble cognitif était de 51 % (IC à 95 % entre 44,7 et 57,2) et la prévalence de dépression majeure se situait à 8 % (IC à 95 % entre 4,5 et 11,3). De plus, 4,8 % des participants (n = 12) présentaient à la fois un trouble cognitif et une forme de dépression. Limites de l’étude: La méthodologie de cette étude en limite la portée puisqu’elle ne permet pas d’établir la nature de l’association entre les indicateurs prévisionnels et les résultats. Ainsi, les liens potentiels devraient être interprétés avec prudence. Ils sont générés à titre d’hypothèses et devraient faire l’objet d’études ultérieures menées dans le cadre d’essais bien conçus. Conclusions: La dépression et les troubles cognitifs sont des affections prévalentes chez les patients souffrant d’IRC de stade 3 et de stade 4. Les troubles cognitifs se sont avérés très fréquents, affectant la moitié des patients Colombiens de plus de 55 ans ayant fait l’objet de cette étude

Principales dominios comprometidos en el deterioro cognoscitivo en pacientes con enfermedad renal crónica: un subanálisis de una población colombiana

16 p.Introducción: La enfermedad renal crónica (ERC) está asociada a la presencia de deterioro cognoscitivo. Existe la necesidad de identificar el deterioro cognoscitivo en adultos mayores con ERC, para realizar un tratamiento adecuado previo al inicio de la diálisis. En un estudio realizado en Colombia, la prevalencia global de deterioro cognoscitivo fue del 51 % (IC 95% 44,7- 57,2), con un deterioro cognoscitivo leve en el 35.9% de los pacientes. Objetivo: Realizar un subanálisis en un grupo de pacientes ≥ 55 años de edad, con Enfermedad Renal Crónica Estadio 3 y 4, en quienes se identificaron alteraciones cognoscitivas leves y establecer cuáles de los dominios evaluados en la prueba NEUROPSI se encuentran más comprometidos. Métodos: Estudio de corte transversal. Se incluyeron 85 pacientes ≥ 55 años de edad, con enfermedad renal crónica estadío 3 y 4 con deterioro cognoscitivo leve en la prueba NEUROPSI. Mediante la estadística descriptiva se resumieron las variables cualitativas con frecuencias absolutas y relativas. Resultados: El mayor número de fallas se observó en las pruebas fluidez verbal semántica (100%) y fonológica (92,68%), seguidos por secuenciación con 88,57%, mano derecha 74,12% y mano izquierda 62,35%, y aprendizaje de palabras con un 52,94%, la realización de la figura semicompleja con 51,76%, lo cual muestra un compromiso de los dominios de funciones ejecutivas y mnésicas. Conclusiones: Las funciones ejecutivas se afectan en la ERC, esto sugiere la necesidad de la realizar estudios con mayor poder que permitan determinar los factores que median su aparición temprana y contribuir a su prevención