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BACKGROUND: Cardiovascular risk factors increase the risk of developing dementia, including Alzheimer's disease and vascular dementia. OBJECTIVE: Studying individuals with autosomal dominant mutations leading to the early onset of dementia, this study examines the effect of the global cardiovascular risk profile on early cognitive and neuroimaging features of Alzheimer's disease and vascular dementia. METHODS: We studied 85 non-demented and stroke-free individuals, including 20 subjects with Presenilin1 (PSEN1) E280A mutation leading to the early onset of autosomal dominant Alzheimer's disease (ADAD), 20 subjects with NOTCH3 mutations leading to cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to the early onset of vascular dementia, and 45 non-affected family members (non-carriers). All subjects underwent clinical and neuropsychological evaluations and an MRI. The global cardiovascular risk profile was estimated using the office-based Framingham Cardiovascular Risk Profile (FCRP) score. RESULTS: In individuals with CADASIL, a higher FCRP score was associated with a reduced hippocampal volume (Bâ=â-0.06, pâ<â0.05) and an increased severity of cerebral microbleeds (Bâ=â0.13, pâ<â0.001), lacunes (Bâ=â0.30, pâ<â0.001), and perivascular space enlargement in the basal ganglia (Bâ=â0.50, pâ<â0.05). There was no significant association between the FCRP score and neuroimaging measures in ADAD or non-carrier subjects. While the FCRP score was related to performance in executive function in non-carrier subjects (Bâ=â0.06, pâ<â0.05), it was not significantly associated with cognitive performance in individuals with CADASIL or ADAD. CONCLUSION: Our results suggest that individuals with CADASIL and other forms of vascular cognitive impairment might particularly benefit from early interventions aimed at controlling cardiovascular risks.
Assuntos
Doença de Alzheimer , Encéfalo , Demência Vascular , Presenilina-1/genética , Receptor Notch3/genética , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/genética , Doença de Alzheimer/prevenção & controle , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Colômbia/epidemiologia , Demência Vascular/diagnóstico , Demência Vascular/epidemiologia , Demência Vascular/genética , Demência Vascular/prevenção & controle , Diagnóstico Precoce , Família , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mutação , Testes Neuropsicológicos , Serviços Preventivos de Saúde/métodos , Fatores de Risco , Comportamento de Redução do RiscoRESUMO
RESUMEN Ante el número cada vez mayor de pacientes con covid-19 y los rápidos cambios que ha traído consigo la pandemia en los estilos de vida, se redactó el presente documento, con el objetivo de proveer una recomendación a los neurológos y médicos en general para el abordaje del paciente con cefalea. Inicialmente, se realiza el abordaje de la cefalea como uno de los síntomas del covid-19, revisando las series de casos y proponiendo posibles clasificaciones diagnósticas para explicar su presencia en estos pacientes. Posteriormente, se evaluará la cefalea secundaria a otros trastornos neurológicos también reportados en pacientes con covid-19 y los signos de alarma para realizar estudios complementarios. Por último se revisará como ha cambiado el seguimiento de los pacientes con cefalea primaria en medio de la pandemia, recomendaciones sobre ajustes que se deben hacer durante este tiempo en su manejo y formulación, y finalmente recomendaciones sobre interacciones en sus medicamentos en caso de enfermar por covid-19.
SUMMARY Given the increasing number of patients with COVID-19 and the rapid changes that the pandemic has brought about in lifestyles, this document was developed with the aim of providing a recommendation to neurologists and doctors in general for the approach of the patient with headache. Initially, the headache was treated as one of the symptoms of COVID-19, reviewing the case series and proposing possible diagnostic classifications to explain its presence in these patients. Subsequently, headache secondary to other neurological disorders also reported in patients with COVID-19 and the warning signs will be evaluated to carry out complementary studies. Finally, it will be reviewed how the follow-up of patients with primary headache in the midst of the pandemic has changed, recommendations on adjustments to be made during this time in its management and formulation, and finally recommendations on drug interactions in case of illness due to COVID-19.
Assuntos
Mobilidade UrbanaRESUMO
OBJECTIVES: Executive dysfunction is a predominant cognitive symptom in cerebral small vessel disease (SVD). The Institute of Cognitive Neurology Frontal Screening (IFS) is a well-validated screening tool allowing the rapid assessment of multiple components of executive function in Spanish-speaking individuals. In this study, we examined performance on the IFS in subjects with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), an inherited condition leading to the early onset of SVD. We further explored associations between performance on the IFS and magnetic resonance imaging (MRI) markers of SVD. METHODS: We recruited 24 asymptomatic CADASIL subjects and 23 noncarriers from Colombia. All subjects underwent a research MRI and a neuropsychological evaluation, including the IFS. Structural MRI markers of SVD were quantified in each subject, together with an SVD Sum Score representing the overall burden of cerebrovascular alterations. General linear model, correlation, and receiver operating characteristic curve analyses were used to explore group differences on the IFS and relationships with MRI markers of SVD. RESULTS: CADASIL subjects had a significantly reduced performance on the IFS Total Score. Performance on the IFS correlated with all quantified markers of SVD, except for brain atrophy and perivascular spaces enlargement. Finally, while the IFS Total Score was not able to accurately discriminate between carriers and noncarriers, it showed adequate sensitivity and specificity in detecting the presence of multiple MRI markers of SVD. CONCLUSIONS: These results suggest that the IFS may be a useful screening tool to assess executive function and disease severity in the context of SVD.
Assuntos
CADASIL/psicologia , Doenças de Pequenos Vasos Cerebrais/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Função Executiva/fisiologia , Imageamento por Ressonância Magnética , Adulto , Transtornos Cognitivos , Estudos de Coortes , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
CADASIL is the most common hereditary cause of repeated ischemic strokes, and has also been identified as a model of pure vascular dementia. The objective of this study was to establish the cognitive performance of asymptomatic carriers with the mutations R1031C and R141C. This observational crosssectional analytical study divided subjects into three groups: asymptomatic carriers of the R1031C mutation (ð = 39), asymptomatic carries of the R141C mutation (ð = 8) and noncarriers (ð = 50). Statistically significant differences were found (ð < 0.05) between the group of the R1031C mutation and the noncarriers in constructional praxis, executive function and abstract reasoning. For the R141C mutation, scores below expected values in executive function and mental calculation were observed. It is concluded that asymptomatic carriers of the two mutations showed low performance in working memory, mental abstraction and processing speed, which could be associated with preclinical cognitive biomarkers preceding the presentation of the first vascular event.
La Arteriopatía Cerebral Autosómica Dominante con Infartos Subcorticales y Leucoencefalopatía (CADASIL), es producida por mutaciones en el gen NOTCH3, es la causa hereditaria más común de accidentes cerebrovasculares isquémicos repetidos. Objetivo: establecer el desempeño cognitivo en portadores asintomáticos con las mutaciones R1031C Y R141C. Método: estudio observacional, analítico transversal. Se dividieron en tres grupos: portadores asintomáticos con mutación R1031C (ð = 39), asintomáticos con mutación R141C (ð = 8) y no portadores (ð = 50). Resultados: se encontraron diferencias estadísticamente significativas (ð < 0.05) entre el grupo de portadores asintomáticos de la mutación R1031C y los no portadores en praxias construccionales, función ejecutiva y razonamiento abstracto. En la mutación R141C, se observaron puntuaciones bajas en función ejecutiva y cálculo mental. Conclusiones: los portadores asintomáticos de las dos mutaciones evidenciaron bajo rendimiento en memoria de trabajo, abstracción mental y velocidad de procesamiento, pudiendo estar asociados como biomarcadores cognitivos preclínicos, antes del primer evento vascular o los primeros síntomas.
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Introducción. En Colombia, la esquizofrenia presenta una prevalencia similar a la de otras partes del mundo, de 1 %, lo que permite estimar una población de 471.052 colombianos con esta enfermedad. En regiones como Cali y Bogotá, alcanza el 1,5 %, por encima del promedio mundial. Objetivo. Describir el perfil sociodemográfico y clínico de un grupo de pacientes con esquizofrenia, atendidos en el Hospital Psiquiátrico Universitario del Valle, en el período de enero a diciembre de 2012. Materiales y métodos. Se trata de un estudio descriptivo y retrospectivo, en el que se revisaron 8.472 historias clínicas de la base de datos de pacientes con diagnóstico de esquizofrenia; se identificaron aquellas que cumplían con los criterios de inclusión y, finalmente, se incluyeron 1.410 historias clínicas. Resultados. El 65 % de los pacientes eran hombres y la edad osciló entre los 13 y los 89 años, con un promedio de 40 (DE=31,6). El 89 % eran solteros (IC95% 87,2-90,6 %), el 98 % provenían de la zona urbana (IC95% 97,3-99,4 %) y el 76,6 % residía en la ciudad de Cali. La esquizofrenia indiferenciada fue el diagnóstico más frecuente (81 %), seguida de la paranoide (9 %) y de la de tipo desorganizada (3 %). Los fármacos más prescritos fueron clozapina (18 %), biperideno (15 %) y levomepromazina (14 %). Conclusiones. La descripción de la esquizofrenia en el hospital muestra que la mayoría de los pacientes cumplen con el tratamiento farmacológico indicado; la principal razón para no observarlo, lo cual sucede en un bajo porcentaje de los pacientes, es la falta de conciencia de la enfermedad.
Introduction: In Colombia, schizophrenia prevalence is similar to that of other parts of the world, 1%, which allows estimating a population of 471,052 Colombians with this disease. In regions such as Cali and Bogotá, it reaches 1.5%, above the world average Objective: To describe the sociodemographic and clinical profile of a group of patients with schi-zophrenia treated at the Hospital Psiquiátrico Universitario del Valle, from January to December of 2012. Materials and methods: A retrospective descriptive study was conducted; 8,472 medical records from the database of patients diagnosed with schizophrenia were reviewed; those meeting the inclu-sion criteria were selected for a total of 1,410 medical records. Results: 65% of patients were male aged between 13 and 89 with an average of 40 years (SD=31.6). 89% were single (CI 95% 87.2%-90.6%) and 98% came from urban areas (CI 95% 97.3%- 9.4%), 76.6% lived in the city of Cali. Undifferentiated schizophrenia was the most frequent diagnosis (81%), followed by paranoid (9%), and disorganized type (3%). The most prescribed medicines were clozapine (18%), biperideno (15%) and levomepromazina (14%). Conclusions: The description of schizophrenia in the Hospital Psiquiátrico Universitario del Valle evi-dences compliance and adherence to the established pharmacological treatment. Among the low percentage of patients with no adherence, the main cause was found to be the lack of awareness of the disease
Introdução. Na Colômbia, a esquizofrenia apresenta uma prevalência semelhante à de outras partes do mundo, de 1%, o que permite estimar uma população de 471,052 colombianos com esta doença. Em regiões tais como Cali e Bogotá, atinge 1,5%, acima da média mundial. Objetivo. Descrever o perfil sociodemográfico e clínico de um grupo de pacientes com esquizofrenia atendidos no Hospital Psiquiátrico Universitário del Valle, no período de Janeiro a Dezembro de 2012. Materiais e métodos. Se realizo um estudo descritivo e retrospectivo, foram revisados 8,472 registros médicos do banco de dados dos pacientes diagnosticados com esquizofrenia; aqueles que atenderam com os critérios de inclusão foram selecionados obtendo 1,410 registros médicos Resultados. 65% dos pacientes eram do sexo masculino e a idade variou entre 13 a 89 anos, com uma média de 40 (DP = 31,6). O 89% eram solteiros (95% CI 87,2-90,6%), 98% eram procedentes de áreas urbanas (95% IC 97,3-99,4%) e 76,6% moravam na cidade de Cali. A esquizofrenia indiferenciada foi o diagnóstico mais comum (81%), seguido por paranoico (9%) e o tipo desorganizado (3%). Os medicamentos mais prescritos foram clozapina (18%), biperideno (15%) e levomepromazina (14%). Conclusões. A descrição da esquizofrenia no hospital mostra que a maioria dos pacientes cumprem com o tratamento farmacológico indicado; a principal razão para não observar o tratamento ade-quado, que ocorre em uma pequena porcentagem de pacientes, é a falta de conscientização sobre a doença.
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Humanos , Esquizofrenia , Perfil de Saúde , Saúde MentalRESUMO
Durante las últimas dos décadas se han desarrollado muchas iniciativas para el rescate y la valoración de la diversidad de plantas útiles subutilizadas en distintas regiones del mundo. En Colombia se han realizado varias investigaciones etnobotánicas, sin embargo, se requiere ampliar las investigaciones sobre el uso de plantas comestibles por comunidades afrodescendientes. El objetivo global de la investigación era contribuir a la identificación de los saberes de las comunidades afrodescendientes de la Costa Caribe colombiana con respecto a la utilización, sistemas de manejo y producción de las plantas comestibles tradicionales. Este artículo se enfoca en la pregunta de cómo se distribuyen los saberes y cambian las prácticas de uso por generación y género de las plantas en tres comunidades del departamento de Bolívar. A través de una actividad con familias sobre el reconocimiento de 91 plantas se evidenció una pérdida intergeneracional de saberes y tradiciones de uso. Los porcentajes altos de no consumo y/o de consumo no reciente en combinación con las explicaciones dadas en grupos focales sugieren un declive en el uso alimenticio de alrededor de 20 plantas, en su mayoría silvestres y semisilvestres. Las razones dadas variaban según las plantas e incluían percepciones de cambio en las costumbres de producción, preparación de alimentos y consumo, y desaparición de ciertas plantas a causa de cambios en las prácticas de gestión del territorio y de los recursos naturales. Los adultos mayores pueden reconocer más plantas de las que usan. Los hombres reportaron niveles de reconocimiento más altos en comparación a las mujeres para el caso de 28 especies, principalmente de estatus silvestre. Los resultados muestran que el diseño de estrategias exitosas de fomento de procesos de desarrollo rural sostenible que pongan en valor la gran diversidad de plantas comestibles de la región necesita un enfoque diferencial según usuarios y recursos.
In the last two decades a significant number of initiatives have been undertaken to promote and revalue the diversity of useful under-utilized plants in various regions around the world. In Colombia there have been various ethnobotanical studies, however, there is still a need for further research, particularly on the use of food plants in Afro-descendant communities. The overall objective of this research project was to contribute to the documentation of the use of traditional food plants and knowledge of the management and production systems by Afro-descendant communities in the Colombian Caribbean coastal region. This article focuses specifically on the question of how knowledge is distributed and how use practices of the plants change by generation and gender in three communities in the department of Bolívar. Through a recognition exercise, undertaken with families on 91 plants, evidence was found of intergenerational loss of knowledge and traditions of use. High percentages of reported non-consumption and/or not recent consumption combined with explanations given in focus groups, suggest a decline in the food use of about 20 species, the majority of them having wild and semi-wild status. The reasons given varied depending on the plant species and included perceptions of change in production and food preparation and consumption practices and the disappearance of certain plants because of changes in land use and natural resource management. Older respondents recognized more plants than they actually used. Recognition rates by men were higher in comparison to women in the case of 28 plants, mainly wild resources. These results highlight that the design of successful strategies to promote sustainable rural development processes which revalue the significant diversity of food plants in the region requires a differential focus depending on the user and the type of resource.