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J Benito-León

Publications and source records attributed to J Benito-León.

At least 19 recordsLinked to original sources
PubMed2005

[Regional correlations between MR imaging perfusion and SPECT in Alzheimer's disease].

INTRODUCTION: Dynamic susceptibility contrast (DSC) is a magnetic resonance (MR) technique that provides an estimation of cerebral blood flow (CBF) through the obtention of a cerebral blood volume map. As observed with nuclear medicine methods, DSC MR studies have demonstrated a temporoparietal hypoperfusion in Alzheimer's disease (AD). However, the concurrent validity of DSC and nuclear medicine techniques has not been sufficiently investigated. PATIENTS AND METHODS: A single-photon emission computed tomography (SPECT) and a DSC MR perfusion study were performed consecutively in 14 AD patients. Expert based qualitative assessments of CBF were carried out in eight regions of interest (ROI). RESULTS: Level of agreement in the studied ROI was highly variable. Presence of large blood vessels and patient head movement were possibly the main causes of this variability. Nevertheless, when interrater variability was eliminated, intraclass correlation coefficients became more uniform, ranging from 0.32 to 0.71. CONCLUSIONS: DSC MR imaging was concordant with SPECT at the different cerebral lobes of AD patients. The positive findings should be confirmed under better technical and methodological conditions.

Aged↗
PubMed2004

Incidence of Parkinson disease and parkinsonism in three elderly populations of central Spain.

BACKGROUND: A two-phase investigation method (screening followed by detailed examination) is the most accurate epidemiologic approach to estimate the epidemiology of Parkinson disease (PD) and secondary parkinsonism. The scarcity of statistics on the incidence of PD and other types of parkinsonism using this methodology led the authors to estimate them in three elderly populations. METHODS: A Spanish elderly parkinsonism-free cohort was followed for an average of 3 years. At the end of the follow-up, the cohort survivors were contacted by way of screening and clinical examination. RESULTS: The cohort consisted of 5,160 subjects (ages 65 to 85 and over): Eight hundred twenty-eight died before the examination, 3,685 completed the screening procedure, and 647 could not be screened because they refused (108) or were unreachable (539). Sixty-eight incident cases of parkinsonism were found: 30 PD (44.1%), 22 drug-induced parkinsonism (32.3%), 8 parkinsonism with associated features (11.7%), and 3 vascular parkinsonism (4.4%). The remaining five cases (7.3%) were classified as unspecified parkinsonism. Average annual incidence rate (per 100,000 person-years) in the population aged 65 to 85 and over years, adjusted to the standard European population, was 409.9 (95% CI 299.0 to 520.8) for parkinsonism and 186.8 (95% CI 110.4 to 263.2) for PD. Incidence rates of parkinsonism increased with advancing age. For PD, incidence rates increased with age in men but decreased beyond the age of 79 in women. Age-adjusted relative risk in men compared with women was 1.56 (95% CI 0.97 to 2.51) for parkinsonism and 2.55 (95% CI 1.21 to 5.37) for PD. Sixteen (53.3%) patients with PD were detected through the screening and had not been diagnosed previously. CONCLUSIONS: Incidence estimates of PD based on two-phase investigation methodology are higher than those based on other approaches. Men had a risk of developing PD that was twice that of women. A large proportion of PD patients may never seek neurologic attention.

Aged↗
PubMed2004

Selective memory impairment on an adapted Mini-Mental State Examination increases risk of future dementia.

OBJECTIVE: To determine whether selective memory impairment (SMI) on an adapted Mini-Mental State Examination (aMMSE) test increases risk of future dementia in a population-based survey of central Spain. BACKGROUND: SMI is a strong predictor of dementia in the elderly. However, most approaches have used extensive memory batteries, which are not always suitable for screening purposes. METHODS: The basal cohort consisted of 2982 poorly educated individuals aged 65 or over. Dementia, stroke and parkinsonism cases were previously excluded. At entry, participants received a structured interview including an aMMSE. Two groups were created according to basal cognitive performance, namely: (1) aMMSE > 23 and no word remembered on the aMMSE delayed-recall task (SMI group); and (2) aMMSE > 23 and at least one word remembered on the delayed-recall task (control group). In a three-year follow-up wave, conversion rate to dementia was calculated and logistic regression was performed. RESULTS: Of a total of 2507 subjects who completed the two evaluations, 280 qualified for SMI at entry. In the SMI group, 25 subjects (8.9%) developed dementia vs 26 subjects (1.2%) in the control group. Taking the two groups together, and once demographic and medical variables had been controlled, a low delayed-recall score increased dementia conversion rate (OR 0.47, 95% CI 0.34-0.64). Alzheimer's disease was the main cause of dementia (79.8%). CONCLUSIONS: Memory impairment is a risk factor for future dementia in the neurologically-healthy elderly. This can be observed in a subgroup of subjects with SMI defined on the aMMSE delayed-recall subscore. Some other measurements should be added to the SMI construct to improve its predictive validity.

Aged↗
PubMed2004

Neurosyphilis masquerading as corticobasal degeneration.

We report on a patient with a syndrome resembling corticobasal ganglionic degeneration (CBD), including slight cognitive impairment, asymmetric akinesia, rigidity with myoclonus, and arm levitation, which can be one of the features of alien limb phenomenon; however, further diagnostic testing was consistent with neurosyphilis. Syphilis, "the great imitator," may also masquerade as CBD. Because neurosyphilis is treatable, it should be considered in the workup of patients with cognitive impairment and motor signs of CBD.

Atrophy↗
PubMed2004

Methods and demographic findings of the baseline survey of the NEDICES cohort: a door-to-door survey of neurological disorders in three communities from Central Spain.

OBJECTIVE: To describe the methods and general results of the baseline longitudinal survey in a defined cohort of elderly people from three areas of Central Spain (urban and rural). The survey was designed to study dementia, essential tremor, Parkinson's disease and stroke. STUDY DESIGN: A population-based longitudinal study with door-to-door interviews. METHODS: This study was carried out in two phases: Phase 1 (health status questionnaire and screening performed by lay interviewers) and Phase 2 (diagnosis of neurological illnesses by neurologists). RESULTS: The study flow chart, screening instruments for neurological disorders, main demographic data (age, sex, educational attainment, occupation) and general health status of the 5,278 screened participants (2,238 men and 3,040 women) are given for the two phases. The response rate was 85.3%, and participation was higher in men and in the urban area. CONCLUSIONS: Participation rates were good in both phases of the NEDICES baseline study, and this was influenced by age, sex and setting of the participants. Educational attainment, occupation and health status data are analogous to other Spanish studies performed in the elderly. As the study population was large and good participation rates were achieved, precise analysis of morbidity of the neurological disorders investigated will be possible.

Age Factors↗
PubMed2004

A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study.

OBJECTIVE: To describe a holistic and comprehensive approach to the assessment of sufferer's perceptions of health-related quality of life (HRQoL) in a cohort of multiple sclerosis (MS) patients. METHODS: The GEDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functional Assessment of Multiple Sclerosis quality of life instrument Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. RESULTS: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9+/-0.9 years. Age, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Qualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. On the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients' physical disability. Furthermore, primary caregivers described the influence of MS on their own occupational status, their nonacceptance of the disease, a perception of a lack of support by other members of the family as well as a 'selfish and intransigent' attitude of the patients themselves. CONCLUSIONS: The analysis of the GEDMA cohort provides valuable information that helps clarify the impact of MS on patients' HRQoL.

Adult↗
PubMed2004

[Intracranial and spinal subdural hematoma: a rare complication of epidural and subarachnoid anesthesia].

Subdural and epidural hematomas complicating central blocks are rare but serious complications that can lead to permanent neurological deficits. This review discusses cranial and spinal subdural hematomas, including the history of this complication in the literature. Theories to explain the mechanisms by which hematomas are formed are presented and risk factors are analyzed. The associations between such hematomas and the design of the various needles used for lumbar puncture are evaluated and the most common cranial and spinal locations are discussed. The anatomy of tissues that envelop and contain chronic subdural hematomas are described and the various neurological alterations that can develop are mentioned. Finally, diagnostic imaging options and corrective surgical techniques are reviewed.

Anesthesia, Epidural↗
PubMed2003

[Health-related quality of life in multiple sclerosis].

The clinical scales used to assess disease severity in multiple sclerosis (MS) patients share a common feature: assessment is made and interpreted by neurologists, and, therefore, someone other than the patient. Furthermore, these scales do not assess the health factors that are important components of patient's experienced quality of life. Health-related quality of life (HRQoL) instruments include several domains, which are regarded by patients as being more important determinants of their overall health states. In fact, HRQoL measurements in MS are becoming important in assessing the effect of treatment and progression of the disease. This article will provide a review of the most significant studies on HRQoL in MS.

Health Status↗
PubMed2002

Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients.

The existing knowledge about the health-related quality of life (HRQoL) and its relationship to cognitive and/or emotional functioning in multiple sclerosis (MS) is scarce. We assessed differences between subgroups of MS outpatients (n = 209) on one HRQoL instrument: a version of the Functional Assessment of Multiple Sclerosis quality of life instrument; on two cognitive functioning tests: the Mini-Mental State Examination and the clock drawing test; and on two emotional functioning tests: the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Three disease-related characteristics were assessed: physical disability, duration of the illness, and clinical course. The results showed that each of these has an effect on at least one dimension of HRQoL and on one mental functioning test. Thus, the more severe, the more progressive, and the longer the illness duration, the lower the HRQoL. Likewise, cognitive mean scores decreased and emotional mean scores increased with greater illness severity and progressive the MS. Furthermore, we also found significant correlations between cognitive and emotional functioning tests and HRQoL dimensions. Thus, the worse cognitive functioning and the higher depressive and anxiety symptoms score the lower the HRQoL.

Adult↗
PubMed2002

Proton magnetic resonance spectroscopy in dementia with Lewy bodies.

Proton magnetic resonance spectroscopy ((1)H-MRS) provides a non-invasive, in vivo insight into the brain metabolism, and has been successfully used in several neurological conditions. Our objective was to characterise the cerebral metabolic changes in dementia with Lewy bodies (DLB) patients using (1)H-MRS. Single Voxel (1)H-MRS was performed in 12 DLB patients with mild to moderate symptoms and 11 age-matched healthy controls. Volumes of interest (VOI) were selected, including white matter (WM) in the centrum semiovale and grey matter (GM) in the parasagittal parietal cortex. Main metabolic peaks corresponding to N-acetylaspartate (NAA), glutamate/glutamine (Glx), choline-containing compounds (Cho), myo-inositol (Ins), and creatine plus phosphocreatine (Cr) were identified. These areas were measured and referred to that of the water. Metabolic ratios among the different peak areas were also calculated. In comparison with the control group, DLB patients showed significantly lower mean NAA/Cr, Glx1/Cr and Cho/Cr ratios in the WM, while their Ins/Cr and Ins/NAA ratios did not differ from those of the control group. In the GM, no significant differences were found between both groups. Correlations between age at onset, disease duration, Mini-Mental State Examination, the motor section of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging and metabolic ratios, both for WM and GM, were not significant in DLB patients. Our spectroscopy data show WM involvement, along with GM preservation, in DLB patients with early or intermediate stages. Hence, (1)H-MRS may provide adjunctive information in the ante-mortem diagnosis of DLB.

Aged↗
PubMed2002

[Usefulness of functional magnetic resonance imaging and spectroscopy in the diagnosis of frontotemporal dementia].

Early diagnosis of frontotemporal dementia is difficult, especially at its early stages, being mainly misdiagnosed as a psychiatric condition. The main source of uncertainty comes from the primacy of behavioral disturbances, for which sufficiently validated detection tools are not available. The increasing development of magnetic resonance (MR) techniques permits a triple approach that combines morphology, biochemistry and perfusion in the study of dementing neurodegenerative conditions. A 64-year-old male patient is described with prominent behavioral disturbances and a frontotemporal pattern of cognitive impairment. He met criteria for frontotemporal dementia. Conventional MR imaging showed minimal frontotemporal atrophy. A moderate hypoperfusion of the frontal lobes was observed in the MR perfusion study. The spectroscopy showed a decrease of the n-acetyl-aspartate peak in the medial frontal region with normal values in the medial parietal region. The whole MR imaging study aided to distinguish frontotemporal dementia from other conditions, such as brain structural processes and depression, offering relevant information for prognostic and therapeutic purposes. The usefulness of the new MR imaging techniques in the early diagnosis of dementing neurodegenerative conditions must be confirmed by larger studies accompanied by pathological material.

Dementia↗
PubMed2002

[Magnetic resonance in dural post-puncture headache in patient with cerebrospinal fluid hypotension].

Magnetic resonance imaging (MRI) has allowed us to establish a set of radiologic signs associated with intracranial hypotension syndrome. Findings are partly influenced by cerebral displacement. Intracranial hypotension syndrome is characterized by a decrease in cerebrospinal fluid (CSF) pressure to less than 60 mm H2O associated with occipital headache radiating to the frontal and temporal zones. For diagnostic purposes, the most common cause is anesthetic or therapeutic dural puncture, although spontaneous CSF leakage can occur. CSF protein and lymphocyte counts may be high, while the cranial meninges biopsy is normal. MRI images may show a descended brain, taking the start of the sylvian aqueduct and the location of the cerebellar amygdalae as points of reference; diminished size of the subarachnoidal cisterns and occasionally of the cerebral ventricles; meningeal enhancement from increased uptake of the contrast solution; subdural hygromas and hematomas; and pituitary enlargement. Paraspinal fluid and dilated epidural veins may be observed. Radiologic images and clinical signs are related. When CSF pressure is very low, there is greater meningeal enhancement, subdural collection and cerebral displacement. Findings gradually disappear as symptoms diminish. The signs and symptoms that might develop during intracranial hypotension syndrome vary according to the brain structure that might be affected during descent, repositioning and the traction of anchoring structures. MRI allows the degree of cerebral and spinal involvement to be ascertained, to predict whether resolution of the clinical picture will be early or late and to visualize the effect of approaches to reducing CSF leakage.

Anesthesia, Spinal↗
PubMed2001

[Intracranial hypotension syndrome].

Intracranial hypotension syndrome is an essential or, more frequently, secondary entity. This is characterized by orthostatic headaches and diffuse dural gadolinium enhancement on magnetic resonance imaging with or without subdural fluid collections or evidence of descent of the brain. What determines the various clinical and imaging features of intracranial hypotension syndrome is the cerebrospinal fluid volume depletion. In this article, we review the clinical and neuroimaging findings, pathophysiology, and treatment of this syndrome.

Adult↗