Cognitive tests aid in clinical differentiation of Alzheimer's disease versus Alzheimer's disease with Lewy body disease: Evidence from a pathological study

Introduction: Clinical differentiation between Alzheimer's disease (AD) and AD with Lewy body disease (LBD) is relatively imprecise. The current study examined pathologically confirmed group differences in neuropsychological functioning, and the classification ability of specific tests. Methods: Fifty‐one participants with postmortem diagnoses of AD (n = 34) and AD plus LBD (n = 17) were drawn from the Predictors Study. One‐way analyses of variance (ANOVAs) and χ2 analyses examined group differences in neuropsychological performance. Binary logistic regressions examined predictive utility of specific tests for pathological diagnosis. Results: Individuals with AD had better visuoconstruction (P = .006), phonemic fluency (P = .08), and processing speed than AD plus LBD (P = .013). No differences were found in memory, naming, semantic fluency, or set‐switching. Processing speed and visuoconstruction predicted pathologic group (P = .03). Discussion: Processing speed and visuoconstruction predicted postmortem diagnosis of AD versus AD plus LBD. Current results offer guidance in the selection and interpretation of neuropsychological tests to be used in the differential diagnosis of early dementia

Bloqueos de la marcha sin respuesta al estímulo dopaminérgico con apomorfina en pacientes parkinsonianos graves

Resumen: Introducción: Los episodios de congelación de la marcha (CDM) normalmente aparecen durante el “off” y en general mejoran con tratamiento dopaminérgico a la par que mejoran otros síntomas parkinsonianos. Pacientes y métodos: Presentamos un grupo de 10 pacientes con enfermedad de Parkinson de larga evolución con episodios de CDM. Todos los pacientes presentaban las complicaciones motrices habituales tras años de enfermedad y tratamiento. En todos los pacientes, el síntoma más incapacitante era la aparición de episodios de CDM (freezing) durante el “on”. Los pacientes fueron sometidos a un test agudo de apomorfina por vía subcutánea; se consideró dosis eficaz la que inducía la reducción de al menos un 60% en la escala de motricidad de la UPDRS. Resultados: La UPDRS-III basal fue de 61,3 ± 4,7, que se reducía a 21 ± 4,3 tras la inyección de apomorfina s.c. a una dosis media de 5,5 mg (intervalo, 3-7 mg). Durante el “on” inducido por la inyección s.c. de apomorfina mejoraron los parámetros de la marcha relacionados con la bradicinesia, así como el tapping, también en extremidades inferiores, pero los episodios de CDM no variaron de forma significativa. Conclusiones: Presentamos un grupo de 10 pacientes con enfermedad de Parkinson de larga evolución con episodios de CDM que persistían durante el “on”, sin respuesta al estímulo dopaminérgico. Abstract: Introduction: Freezing of gait unresponsive to dopaminergic stimulation in patients with severe Parkinsonism. The freezing of gait episodes (FOG) normally appear during the “off” period and generally improve with dopaminergic stimulus, at the same time as improving other Parkinsonian symptoms. Patients and methods: We report a group of 10 patients with severe Parkinson’s disease. All patients suffered motor fluctuations, dyskinesias and episodes of FOG during the “on” and “off” state. The patients received a subcutaneous apomorphine bolus, without other dopaminergic medication; an effective dose of apomorphine was considered as one that induced a reduction of at least a 60% in the UPDRS motor scale. Results: The baseline motor UPDRS was 61.3 ± 4.7, which dropped to 21 ± 4.3 after the apomorphine injection. The mean dose of apomorphine was 5.5 mg (3-7 mg). The bolus of apomorphine improved the parameters of the gait related to bradykinesia and the tapping tests of the limbs, but the episodes of FOG did not vary significantly between the “off” and “on” state. Conclusions: We present a group of 10 patients with freezing of gait episodes that did not improve with treatment and persisted during the “on” period induced by dopaminergic stimulus with apomorphine. Palabras clave: Enfermedad de Parkinson, Bloqueos de la marcha, Apomorfina, Keywords: Parkinson’s disease, Freezing, Apomorphin

Síndromes neurológicos asociados al uso de medicamentos. Frecuencia y caracterización

Resumen: Introducción: La necesidad de una asistencia sanitaria segura en la que los cuidados y tratamientos no supongan daños diferentes a los derivados de la enfermedad de base, ha motivado este estudio. Nuestro objetivo ha sido determinar la frecuencia y describir los síndromes neurológicos atribuibles a fármacos, su evitabilidad y los niveles asistenciales implicados. Métodos: Estudio observacional. Cohorte prospectiva de todos los sujetos derivados desde atención primaria y especializada, en el período de diciembre de 2008 a enero de 2010, por síntomas neurológicos atribuibles a fármacos y enfermos neurológicos conocidos con clínica distinta o agravada de la enfermedad de base causada por fármacos. Las notificaciones quedaron reflejadas en un cuestionario. Se realizaron distribuciones de frecuencias, medidas de tendencia central, pruebas de la χ2 o Fisher y pruebas no paramétricas correspondientes. Resultados: La prevalencia de efectos adversos neurológicos respecto a la muestra total fue 0,586%. De los 105 pacientes seleccionados, los principales efectos adversos fueron: 25,7% síndrome rígido-acinético; 18,1% discinético; 11,4% síntomas neuropsiquiátricos, y 10,5% síndrome confusional. Los grupos farmacológicos más registrados fueron, en orden decreciente: antiepilépticos, dopaminérgicos, antidepresivos, neurolépticos, antivertiginosos y procinéticos. Describimos la población más susceptible y las asociaciones estadísticamente significativas entre la presencia de determinados grupos farmacológicos y síndromes neurológicos concretos. Conclusiones: La baja prevalencia detectada puede deberse al diseño del estudio, aunque los efectos adversos neurológicos suponen el 2,84% de los ingresos en una unidad de neurología. Conocer la epidemiología permitirá identificar los abordajes más seguros, aplicarlos correctamente a la población de mayor riesgo y reducir necesidades asistenciales y recursos médicos. Abstract: Introduction: The need for safe health care, in which the care and treatment of the patient does not cause any injuries in addition to those already arising from their baseline disease, has led to the present study. Our objective has been to determine the frequency and describe the neurological syndromes attributable to drugs, their preventability and the levels of medical care involved. Methods: Observational study. Cohort of subjects referred from Primary and Specialized Care between December 2008 and January 2010 due to neurological symptoms attributable to drugs, and previously known neurology patients who began to have symptoms other than those of the baseline disease, also caused by drugs. The notifications were recorded in a questionnaire. Frequency distributions, central tendency measurements, X2 or Fisher tests and non-parametric tests were performed. Results: The prevalence of adverse neurological events was 0.586% of the total sample. Of the 105 patients selected, the most frequent adverse events were: 25.7%, akinetic-rigid syndrome, 18.1%, dyskinetic syndrome, 11.4% neuro-psychiatric symptoms, and 10.5% confusional syndrome. The most commonly recorded pharmacological groups were, in decreasing order: anti-epileptic, dopaminergic, antidepressant, neuroleptic, antivertiginous and prokinetic drugs. We describe the most susceptible population and the statistically significant relationships between the presence of certain pharmacological groups and neurological syndromes. Conclusions: The low prevalence detected may be due to the study design, although adverse neurological events accounted for 2.84% of the admissions to a Neurology Unit. Understanding the epidemiology should help to identify the safest approaches, apply them correctly to the population at a higher risk, and reduce healthcare needs and consumption of medical resources. Palabras clave: Efecto adverso, Efecto adverso evitable, Efecto adverso inevitable, Fármaco, Reacción adversa medicamentosa, Síndrome neurológico, Keywords: Avoidable adverse event, Adverse drug reaction, Adverse event, Drug, Neurological syndromes, Unavoidable adverse even

A European observational study to evaluate the safety and the effectiveness of safinamide in routine clinical practice: The SynapSES trial

Background: Safinamide modulates both dopaminergic and glutamatergic systems with positive effects on motor and non-motor symptoms of Parkinson's disease (PD). The drug utilization study SYNAPSES was designed to investigate the use of safinamide in routine clinical practice, as recommended by the European Medicines Agency. Objective: To describe the occurrence of adverse events in PD patients treated with safinamide in real-life conditions. Methods: The SYNAPSES trial is an observational, European, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months with analyses performed in the overall population and in patients aged >75 years, with relevant comorbidities and with psychiatric conditions. Results: Of the 1610 patients included, 82.4% were evaluable after 12 months with 25.1% of patients >75 years, 70.8% with relevant comorbidities and 42.4% with psychiatric conditions. During observation 45.8% patients experienced adverse events, 27.7% patients had adverse drug reactions and 9.2% patients had serious adverse events. The adverse events were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroup of patients. Clinically significant improvements were seen in the UPDRS motor score and in the UPDRS total score in 6540% of patients, according to the criteria developed by Shulman et al. Conclusion: The SYNAPSES study confirms the good safety profile of safinamide even in special groups of patients. Motor complications and motor scores improved with clinically significant results in the UPDRS scale maintained in the long-term