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Background: Alzheimer's disease (AD) presents a significant global health challenge. Understanding the current and upcoming treatment landscape is crucial for effectively managing patients. Objective: The aim of this study was to assess the pattern of prescription and knowledge about new therapies by physicians who treat AD patients in Argentina. Methods: A cross- sectional and analytic study was conducted. A survey was elaborated about pharmacological treatment in AD. Statistical analysis of answers of specialists in cognitive disorders (SCD), non-specialists in cognitive disorders (NSCD), recommended treatment, non-recommended treatment (NRT), and off-label treatment was performed. Results: 155 physicians answered the survey. A 19.35%prescribed at least one NRT for dementia. 78.06%prescribed at least an off-label treatment or an NRT for mild cognitive impairment (MCI). 31%would prescribe monoclonal antibodies (MABs) against cerebral amyloid-ß (Aß) to AD patients, and 42.6%responded that they were not aware of any adverse effect of these. Quetiapine was the most frequent treatment for psychotic symptoms (88.4%) and escitalopram (32.3%) for apathy. A 70%of potential prescribers of MABs (n = 100) would request biomarkers of cerebral Aß in the initial assessment. There were significant differences between the responses of SCD and NSCD regarding the prescription of MABs (52.17%versus 23.08, respectively) and knowledge about adverse events (76.09%versus 38.46%, respectively). Conclusions: A considerable percentage of physicians indicated NRT and off-label medication in MCI and dementia. In Argentina, there are many physicians who would indicate a MABs for AD, but many are not completely aware of its safety profile.

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Adverse Drug Reactions (ADRs) have a high impact on morbidity and mortality of the population, becoming a public health issue. Studying and publishing about these is referred as pharmacovigilance.The primary objective of this article is to describe and compare the adverse reactions produced by drugs of nervous system action (CNS-D) and neurological ADRs produced by drugs of systemic action (Sys-D). To further develop the need of report-ing adverse reactions.This is an observational, cross-sectional, retrospective study performed on a database of neurological consultations which took place at the Neurology department. Patients meeting the inclusion criteria were selected and divided into two groups: Sys-D and CNS-D. Demographic and neurological variables were analyzed. Parametric and non-parametric statistics were used according to distribution. The Naranjo Algorithm (NA) was used to define causality.71 ADRs were described, from which 63.38% (n = 45) were produced by CNS-D, especially antiepileptics by 47% (n = 21) and psycholeptics by 44%. Of the total, 36.62% (n = 26) were caused by Sys-D, such as antineoplastics (n = 9) and antibiotics (n = 9), being Cefepime the most frequent. The diagnosis of ADRs caused by a Sys-D was delayed prolonging hospitalization (p 0.05) due to a lower NA score (p 0.003) compared to the CNS-D group.Multiple frequently used drugs of systemic action, such as antineoplastics and antibiotics, generate neurological adverse ef-fects. From our analysis, it was presumed that the suspicion of a neurological ADR caused by these drugs was scarce, thus causing a higher morbidity for the patient.

Las Reacciones Adversas a Medicamentos (RAM) tienen un alto impacto en la morbilidad y mortalidad de la población, convirtiéndose en un problema de salud pública. El estudio y la publicación de las mismas se denomina farmacovigilancia.El objetivo principal de este artículo es describir y comparar las reacciones adversas producidas por medicamentos de ac-ción sobre el sistema nervioso (SNC-D) y las RAM neurológicas producidas por medicamentos de acción sistémica (Sys-D). Profundizar en la necesidad de notificar las reacciones adversas.Es un estudio observacional, transversal y retrospectivo realizado sobre una base de datos de consultas neurológicas que tuvieron lugar en el servicio de Neurología. Se seleccionaron los pacientes que cumplían los criterios de inclusión y se dividi-eron en dos grupos: Sys-D y CNS-D. Se analizaron variables demográficas y neurológicas. Se utilizó estadística paramétrica y no paramétrica según la distribución. Se utilizó el Algoritmo de Naranjo (NA) para definir la causalidad.Se describieron 71 RAM, de las cuales el 63,38% (n = 45) fueron producidas por SNC-D, especialmente antiepilépticos en un 47% (n = 21) y psicolépticos en un 44%. Del total, el 36,62% (n = 26) fueron causadas por Sys-D, como antineoplásicos (n = 9) y antibióticos (n = 9), siendo la Cefepime la más frecuente. El diagnóstico de las RAM causadas por un Sys-D se retrasó pro-longando la hospitalización (p 0,05) debido a una menor puntuación de NA (p 0.003) en comparación con el grupo de SNC-D.Múltiples fármacos de acción sistémica frecuentemente utilizados, como los antineoplásicos y los antibióticos, generan efectos adversos neurológicos. A partir de nuestro análisis, se presume que la sospecha de una RAM neurológica causada por estos fármacos es escasa, provocando así una mayor morbilidad para el paciente.

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Background: Immunological causes of atypical parkinsonisms linked to neuronal specific antibodies have been recently reported. As these are potentially treatable disorders, it is desirable to identify which clinical features may suggest an autoimmune etiology. Case Report: A 60-year-old-man with progressive supranuclear palsy associated with anti-LGI-1 antibodies presented with rapidly progressive dementia and moaning. Treatment with steroids and immunoglobulin resulted in temporary clinical improvement and disease stabilization. Discussion: Anti-LGI-1 antibodies interfere with normal synaptic activity and maturation in the central nervous system. We suggest that an immune-mediated mechanism might be considered in atypical parkinsonisms with unusual features such as rapidly progressive dementia. Highlights: We present a case of rapidly evolving progressive supranuclear palsy-like parkinsonism associated with anti-LGI-1 antibodies, suggesting that immune-mediated mechanisms might be involved in rapid progression of some atypical parkinsonisms. This case also contributes to the expanding spectrum of moaning-associated disorders.

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Impulse control and related disorders (ICDs-RD) encompasses a heterogeneous group of disorders that involve pleasurable behaviors performed repetitively, excessively, and compulsively. The key common symptom in all these disorders is the failure to resist an impulse or temptation to control an act or specific behavior, which is ultimately harmful to oneself or others and interferes in major areas of life. The major symptoms of ICDs include pathological gambling (PG), hypersexualtiy (HS), compulsive buying/shopping (CB) and binge eating (BE) functioning. ICDs and ICDs-RD have been included in the behavioral spectrum of non-motor symptoms in Parkinson's disease (PD) leading, in some cases, to serious financial, legal and psychosocial devastating consequences. Herein we present the prevalence of ICDs, the risk factors, its pathophysiological mechanisms, the link with agonist dopaminergic therapies and therapeutic managements.

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La evaluación de la apatía en patología neuro-psiquiátrica es muy importante en la investigación y en la práctica clínica. Muchas veces sus síntomas son sub-diagnosticados o diagnosticados como depresión y otras condiciones. La presente revisión aborda las escalas más utilizadas las últimas décadas para la valoración de apatía y ofrece recomendaciones y apreciaciones generales sobre su uso y utilidad basada en la bibliografía disponible. Al margen de las diferencias entre escalas la tarea de estandarizar el diagnóstico de apatía en la práctica clínica y la investigación nacionales una necesidad que no debe postergarse al contar con herramientas suficientes y adecuadas a la fecha que han evolucionado desde la definición de Marin hasta la escala Dimensional Apathy Scale (DAS). Se sugiere estudios que validen y adapten culturalmente estas herramientas a nuestro entorno poblacional y pongan en práctica la medición cuantitativa de la apatía en la consulta clínica

The evaluation of apathy in neuropsychiatric pathology is very important in research and in clinical practice. Many times their symptoms are underdiagnosed as part of depression and other conditions. The present review addresses the scales most used in recent decades for the assessment of apathy and offers recommendations and general assessments of their use and utility based on the available literature. Apart from the differences between scales, the task of standardizing the diagnosis of apathy in clinical practice and national research is a need that should not be postponed by having sufficient and appropriate tools to date that have evolved from the definition of Marin to the Dimensional Apathy Scale (DAS). It is suggested that studies validate and culturally adapt these tools to our population environment and put into practice the quantitative measurement of apathy in the clinical environment.

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Background: Hemichorea-hemiballism is a syndrome secondary to different etiologies. Drug-induced hemichorea is a rare syndrome related to selective serotonin reuptake inhibitors. To the best of our knowledge, no previous cases of hemichorea associated with sertraline have been reported. Case Report: A 65-year-old female noticed hemichorea 1 week after initiation of sertraline. After extensive investigations, other causes of hemichorea were excluded. Hemichorea remitted after sertraline withdrawal. Discussion: In our patient, temporal association and the negative clinical assessment supported a diagnosis of likely drug-induced involuntary movement. We hypothesized that enhanced serotonergic transmission in the ventral tegmental area or nigrostriatum may be involved in sertraline-induced hemichorea.

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OBJECTIVES: Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson disease who receive dopamine agonists; however, other factors are involved in its manifestations. To study the frequency and factors involved in the development of this adverse effect in a Latin American population, we conducted a cross-sectional multicenter study. METHODS: Two hundred fifty-five patients in 3 Latin American centers were evaluated by examination and application of scales (Unified Parkinson's Disease Rating Scale, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale, Hoehn and Yahr, Clinical Impression of Severity Index for Parkinson's Disease). RESULTS: Of the patients, 27.4% had ICD, most of whom were on dopamine agonists. Other associated risk factors included a younger age at onset of Parkinson disease, moderate symptoms, a shorter evolution of the clinical manifestations, rapid eye movement (REM) sleep disorder behavior, and the consumption of tea, mate, and alcohol. CONCLUSIONS: The frequency of ICD is higher in Latin America than in Anglo-Saxon populations. Consuming tea and mate, in addition to the use of dopamine agonists, is a factor that may demonstrate a genetic link that predisposes patients to the establishment of an ICD.

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