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J Olazarán

Publications and source records attributed to J Olazarán.

9 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.

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PubMed2005

[Clinical validity of two scales of instrumental activities in Alzheimer's disease].

INTRODUCTION: Activities of daily living (ADL) are a major domain in the clinical assessment of Alzheimer's disease (AD) patients. However, ADL scales have not been sufficiently validated in Spain. METHODS: Patients attending a neurology outpatient clinic were classified according to the global deterioration scale (GDS). Afterwards, an independent evaluator administers two scales of instrumental activities of daily living (IADL): Lawton and Brody's scale of IADL (SIADL) and Pfeffer's functional activities questionnaire (FAQ). The SIADL was scored in the original way (dichotomic) (SIADLd) and in an alternative way (ordinal) (SIADLo). Internal consistency (Cronbach alpha coefficient), test-retest reliability (intraclass correlation coefficient), diagnostic validity (sensitivity, specificity, number of patients correctly classified) and influence of different variables (regression analysis) were analyzed for the SIADLd, the SIADLo and the FAQ. RESULTS: Ninety-eight patients were recruited. Internal consistency, reliability and diagnostic validity were good or excellent for the three scales. The SIADLo showed better diagnostic and scale features than the SIADLd, but the FAQ surpassed both in all the studied variables. No scale was able to make a proper distinction between patients with subjective complaints (GDS 2) and patients without complaints (GDS 1). Sex and age influenced the SIADL score, but not the FAQ score. The FAQ reached a sensitivity of 0.95 and a specificity of 0.88 in the screening of dementia. CONCLUSIONS: The SIADL and the FAQ are useful, valid and reliable tools for the clinical assessment of AD patients. Ordinal scoring is more advantageous than dichotomic scoring in the SIADL, but the FAQ is preferable.

Activities of Daily Living↗
PubMed2004

Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease.

OBJECTIVE: To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease (AD) who are treated with a cholinesterase inhibitor (ChEI). METHODS: Patients with mild cognitive impairment (MCI) (12), mild AD (48), and moderate AD (24) (Global Deterioration Scale stages 3, 4, and 5) were randomized to receive psychosocial support plus cognitive-motor intervention (experimental group) or psychosocial support alone (control group). Cognitive-motor intervention (CMI) consisted of a 1-year structured program of 103 sessions of cognitive exercises, plus social and psychomotor activities. The primary efficacy measure was the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary efficacy measures were the Mini-Mental State Examination, the Functional Activities Questionnaire, and the Geriatric Depression Scale. Evaluations were conducted at 1, 3, 6, and 12 months by blinded evaluators. RESULTS: Patients in the CMI group maintained cognitive status at month 6, whereas patients in the control group had significantly declined at that time. Cognitive response was higher in the patients with fewer years of formal education. In addition, more patients in the experimental group maintained or improved their affective status at month 12 (experimental group, 75%; control group, 47%; p = 0.017). CONCLUSIONS: A long-term CMI in ChEI-treated early Alzheimer disease patients produced additional mood and cognitive benefits.

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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.

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PubMed2003

Cerebral hypoperfusion detected by SPECT in patients with systemic lupus erythematosus is related to clinical activity and cumulative tissue damage.

Cerebral single-photon emission computed tomography (SPECT) is a sensitive technique for the detection of central nervous system (CNS) involvement in systemic lupus erythematosus (SLE). The objective was to determine whether a relationship exists between cerebral hypoperfusion as detected by cerebral SPECT, cumulative tissue damage and the clinical activity of SLE. Cerebral technetium-99m-L,L-ethyl cysteinate dimer (99mTc-ECD) SPECT was performed in two groups of patients: 10 women with SLE (Group A) who had no previous history of major neuropsychiatric (NPS) manifestations and no minor NPS symptoms in the last six months, and 57 unselected women with SLE (Group B). In the same week that SPECT was performed, the SLE disease activity index (SLEDAI), SLICC/ACR damage index, native anti-DNA antibodies (ELISA) and erythrocyte sedimentation rate (ESR) were determined. In Group A, cerebral SPECT showed moderate or severe hypoperfusion (abnormal SPECT) in five patients without NPS symptoms, unrelated to age (mean 24.8 versus 27.8 years) or disease duration (mean 6.8 versus 9 years). Patients with significant cerebral hypoperfusion had greater clinical disease activity (mean SLEDAI 13.6 versus 7.6) (SLEDAI > 7 in 5/5 versus 1/5; Fisher: 0.023; OR: 33; 95% CI: 2.3-469.8) and ESR (mean 43.6 versus 9.8; P < 0.05). In Group B, the mean age of the 57 unselected women with SLE was 37 years (SD 6.3) and the mean duration of the disease was 9.7 years (SD 6.3). Cerebral SPECT revealed normal perfusion or mild hypoperfusion (normal SPECT) in 30 patients (52.6%), and moderate or severe hypoperfusion in 27 (47.4%). Hypoperfusion was unrelated to age, duration of SLE or concentrations of anti-DNA antibodies and C3 and C4 fractions. Patients with significant cerebral hypoperfusion had more active clinical disease (mean SLEDAI 13.92; SD 8.44 versus 4.56; SD 4.15) (Mann-Whitney, P < 0.005), more cumulative tissue damage (mean SLICC 2.66; SD 2.84 versus 1.03; SD 1.51) (Mann-Whitney, P = 0.035), and higher ESR values (mean 28.7; SD 22.5 versus 17.7; SD 13.3) (Mann-Whitney, P = 0.023) than patients with normal SPECT studies. Significant cerebral hypoperfusion was related both to NPS manifestations present at the time of the study (17 of 27, 63% versus 3 of 30, 10%) (OR: 15.3) and cumulative manifestations (19 of 27, 70.4% versus 8 of 30, 26.7%) (OR: 6.5), whether mild (OR: 5.5) or severe (OR: 8.2). In conclusion, cerebral hypoperfusion detected by SPECT in patients with SLE is related to clinical activity (SLEDAI), cumulative tissue damage (SLICC) and concomitant or previous NPS manifestations.

Adolescent↗
PubMed2002

[Galantamine: a novel cholinergic agent for Alzheimer's disease].

Galantamine has been recently approved for the symptomatic treatment of Alzheimer's disease (AD). Apart from inhibiting acetylcholinesterase, galantamine modulates the nicotinic receptors, although the clinical significance of this action remains uncertain. Through a broad research program, it has been shown that galantamine produces a cognitive, functional and behavioral benefit in patients with either mild or moderate AD. Initially, the maintenance dose must be 16 mg a day. Later on, 24 mg dose attempts are justified on an individual patient basis. A clinical stabilization for almost one year is observed. After that time, treated patients deteriorate at a similar pace than the non-treated ones, but they remain above the non-treated during at least one more year. Additional data suggest that positive effects of galantamine spread both caregiver burden and pharmacoeconomic areas. Tolerability is good, provided that titration is made slowly. The only contraindications of this drug are atrioventricular blockade and uncontrolled bronchospasm. Galantamine has also shown efficacy in mixed dementia. New possible indications are mild cognitive impairment and vascular dementia.

Acetylcholine↗
PubMed1999

[Interobserver variation in the diagnosis of stroke].

BACKGROUND: The variability in the diagnostic observations could be a problem both in the clinical and in the epidemiological field. Scarce data exist in the literature on this phenomenon, relatives to the field of the cerebrovascular illness, in their nosologic, semiologic and etiologic aspects. We pretend to study the interobserver variability in the diagnosis of the stroke, classifying it as absentee, present or possible in front of a given case. METHODS: 1. A questionnaire of 99 clinical cases has been elaborated, in order to be subjected to the evaluation of 10 neurologists (3 "junior", residents, 3 "senior" residents, and 4 "staff"); 2. The categories are: a) not stroke either transient ischaemic attack; b) probable stroke or transient ischaemic attack; c) transient ischaemic attack and d) stroke. 3. STATISTICAL ANALYSIS: by means of the statistic kappa of Fleiss (kappa) for several observers and several categories, determination of the standard error and 95% confidence intervals. RESULTS: In the diagnosis of the cerebrovascular illness: a) among all the observers: kappa = 0.49 (0.44-0.50); b) among staff: kappa = 0.51 (0.46-0.56); c) among residents: kappa = 0.47 (0.44-0.50). Global data in transient ischaemich attack diagnosis: kappa = 0.52 (0.49-0.55); in the diagnosis of the stroke: kappa = 0.57 (0.54-0.60); in the exclusion of stroke: kappa = 0.64 (0.62-0.67). CONCLUSIONS: With Fleiss' criteria, an acceptable to good agreement exists in the diagnosis of the stroke in base to the mere description of the clinical picture. This interobserver agreement is better if it is tried to exclude the stroke, and it could increase with the training of the neurologist.

Humans↗
PubMed1997

[Reflex sympathetic dystrophy due to phenobarbital: a frequent and treatable condition].

Reflex sympathetic dystrophy (RSD) complicating barbiturates therapy is not well acknowledged in the neurologic literature in spite of the fact that barbiturates are present in 17% of the cases of RSD. Two new cases detected during one year in a general neurology clinic are described. One of them did not suffer from any previous neurologic disease. A review of the literature showed that the association of RSD and barbiturates affects predominantly upper limbs and is often accompanied by other fibrosing musculoskeletal disorders. Apart from barbiturate withdrawal, corticosteroid therapy may be necessary to prevent irreversible tissue damage.

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