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Biomedical subjects

O L López

Publications and source records attributed to O L López.

15 recordsLinked to original sources
PubMed2006

A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer's disease.

OBJECTIVE: To determine the usefulness of an interactive multimedia internet-based system (IMIS) for the cognitive stimulation of Alzheimer's disease. METHODS: This is a 24-week, single-blind, randomised pilot study conducted on 46 mildly impaired patients suspected of having Alzheimer's disease receiving stable treatment with cholinesterase inhibitors (ChEIs). The patients were divided into three groups: (1) those who received 3 weekly, 20-min sessions of IMIS in addition to 8 h/day of an integrated psychostimulation program (IPP); (2) those who received only IPP sessions; and (3) those who received only ChEI treatment. The primary outcome measure was the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog). Secondary outcome measures were: Mini-Mental State Examination (MMSE), Syndrom Kurztest, Boston Naming Test, Verbal Fluency, and the Rivermead Behavioral Memory Test story recall subtest. RESULTS: After 12 weeks, the patients treated with both IMIS and IPP had improved outcome scores on the ADAS-Cog and MMSE, which was maintained through 24 weeks of follow-up. The patients treated with IPP alone had better outcome than those treated with ChEIs alone, but the effects were attenuated after 24 weeks. All patients had improved scores in all of the IMIS individual tasks, attaining higher levels of difficulty in all cases. CONCLUSION: Although both the IPP and IMIS improved cognition in patients with Alzheimer's disease, the IMIS program provided an improvement above and beyond that seen with IPP alone, which lasted for 24 weeks.

Aged↗
PubMed2005

[Neuropsychiatric Inventory-Nursing Home version (NPI-NH): Spanish validation].

INTRODUCTION: The Neuropsychiatric Inventory-Nursing Home version (NPI-NH) is a screening instrument to be used by the nursing staff to evaluate neuropsychiatric symptoms in dementia patients in the nursing home setting. The aim of the present study was to validate the NPI-NH in Spanish. METHODS: We assessed the validity of the NPI-NH in 80 patients who were also nursing home residents, comparing the responses of nursing home staff on the NPI-NH with that filled out by the external observer. We developed a crossed validated form between the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and both NPI-NH. We determined the concurrent validity of the domains "depression" and "agitation/aggression" of the NPI-NH with the Cohen-Mansfield Agitation Inventory (IAACM, Spanish version) and the Hamilton Depression Rating Scale (HDRS). RESULTS: Among the totals of the NPI-NH of the nursing staff and the NPI-Q, the convergent validity was r = 0.536 and r = 0.669 for the occupational disruptiveness scale (distress in NPI-Q). The Pearson correlation index between the NPI-Q and NPI-NH of the observations was r = 0.342. The convergent validity between the NPINH of the nursing home staff and NPI-NH of the observers with the Pearson correlation index was r = 0.274. CONCLUSIONS: The NPI-NH Spanish version offers the possibility to use a screening tool for detecting neuropsychiatric symptoms in dementia patients in the nursing home setting. It should be administered by adequately trained staff to avoid limitations in the evolutive control of behavioral changes.

Aged↗
PubMed2001

Obsessivecompulsive disorder and traumatic brain injury: behavioral, cognitive, and neuroimaging findings.

OBJECTIVE: The goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disorder (OCD) after suffering a traumatic brain injury (TBI). BACKGROUND: Because OCD is a rare sequelae of TBI, the phenomenology of obsessions and compulsions, the comorbid psychiatric disorders, the performance on cognitive tests, and the neural correlates have not been well characterized. METHODS: Ten adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were studied using structured psychiatric rating scales (i.e., Yale-Brown Obsessive Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI). RESULTS: Global severity of OCD ranged from moderate to severe, and all patients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sexual obsessions as well as cleaning/washing, checking, and repeating compulsions. Unusual features such as obsessional slowness (3 cases) and compulsive exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests of general intelligence, attention, learning, memory, word-retrieval, and executive functions; these cognitive deficits were more pervasive among patients displaying obsessional slowness. All OCD patients with mild TBI had normal MRI scans, whereas focal contusions in the frontotemporal cortices, subcortical structures (caudate nucleus), or both were found in OCD patients with moderate and severe TBI. CONCLUSIONS: Posttraumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety. The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.

Adult↗
PubMed1995

[Validation of the Spanish version of the Severe Impairment Battery].

We examine the cognitive ability of 58 demented patients who were evaluated with the Spanish version of the Severe Impairment Battery (SIB). The SIB is composed of multiple simple subtests for memory, language, orientation, attention, visual perception and ability to construct. The battery also assesses social skills, praxis and the ability to respond appropriately to name. The mean SIB scores (72.55 +/- 17.99; range 8-99) correlated with mean scores (10.76 +/- 6.41; range 0-31) on the Spanish version of Folstein's Mini-Mental State Examination (MMSE). The SIB detected deterioration in the nine cognitive areas examined, even in the most severely impaired patients (MMSE = 0-6). These results indicate that the Spanish version of the SIB is a useful instrument for examining severely demented patients.

Aged↗
PubMed1995

[Difficulties in differential diagnosis of long-term Creutzfeldt- Jakob disease].

Creutzfeldt-Jakob disease (CJD) is characterized by a rapidly progressive dementia that often leads to death within a few months of onset. However, some cases evolve over a much longer period of time and have a clinical picture that is difficult to distinguish from other progressive dementias that occur in the adult, especially Alzheimer's disease (AD). We examine the clinical features of 3 patients with pathologically confirmed CJD whose course was slow (4-5 years) and who were initially diagnosed as having AD. Only two of them had shown signs of CJD in the terminal stages. In this study we examine the clinical characteristics of these patients, and discuss of differentiating CJD from other entities, especially from AD.

Aged↗
PubMed1984

Ga-67 uptake post cesarean section.

Gallium-67 distribution in normal patients is well known; it is also known that the concentration in some tissues may vary according to an individual physiologic stimulus. In this report, the case of a young woman is presented who was studied 15 days after a cesarean section and showed physiologic and pathologic Ga-67 accumulation.

Adult↗
PubMedDate not supplied

[The Neuropsychiatric Inventory. Psychometric properties of its adaptation into Spanish].

OBJECTIVE: The purpose of this study was to examine the reliability and validity of the Spanish (Spain) version of the Neuropsychiatric Inventory. PATIENTS AND METHODS: The Neuropsychiatric Inventory was administered to the caregivers of 63 subjects from the Dementia Unit, Hospital Santa Caterina, Girona. All patients had detailed neuropsychological assessment, and their non-cognitive symptoms were also examined with the CAMDEX. RESULTS: There was a high level of internal consistency reliability. The Neuropsychiatric Inventory subscores correlated with those of the CAMDEX, indicating an acceptable level of validity. The most frequent symptom was apathy (56%), followed by irritability (38%), depression/dysphoria (35%), aberrant motor behavior (30%), agitation/aggression (29%), anxiety (27%), disinhibition (24%), delusions (19%), hallucinations (14%) and euphoria (3%). CONCLUSIONS: This study showed that the Spanish version of the Neuropsychiatric Inventory is a reliable instrument, which can briefly assess non-cognitive symptoms in demented patients. The Neuropsychiatric Inventory is a useful instrument for research and clinical practice in different culture around the world.

Adult↗
PubMedDate not supplied

[Neuropsychiatric inventory questionnaire (NPI-Q): Spanish validation of an abridged form of the Neuropsychiatric Inventory (NPI)].

BACKGROUND: The Neuropsychiatric Inventory (NPI) is a validated clinical instrument for the evaluation of psychopathology in dementia. OBJECTIVE: To validate a brief questionnaire form of the NPI (NPI-Q) in Spanish from NPI-Q original version, intended for use in routine clinical practice. PATIENTS AND METHOD: We have developed a crossed validated form between NPI and NPI-Q in 120 Alzheimer's disease patients. RESULTS: Test-retest reliability of the NPI-Q, using Pearson correlation index was r = 0.89 for total symptom scale and r = 0.90 for distress scale. The prevalence of analogous symptom ratings differed by less than 6.7%. Convergent validity between NPI-Q and NPI, using Pearson correlation index was r = 0.879 for total symptom and r = 0.92 for distress scale. CONCLUSIONS: The NPI-Q Spanish version offers the possibility to use a reliable and brief instrument that can be used as a screening in the evaluation of neuropsychiatric symptoms in dementia and associated caregiver distress. It may be suitable for use in general clinical practice and it could be used as a brief neuropsychiatric interview.

Aged↗
PubMedDate not supplied

[Treatment of Alzheimer's disease].

OBJECTIVE: To review the experience of the last twenty years in the treatment of Alzheimer s disease (AD). METHODS: Literature review. RESULTS: The neuropathological bases of AD are centered on two important pathophysiological mechanisms: 1) Structural damage (e.g., senile plaques, neurofibrillary tangles, neuronal loss, inflammatory processes), and 2) Loss of cholinergic neurons (and acetylcholine depletion) in the nucleus basalis of Meynert, which sends cholinergic projections to all areas of the neocortex, especially the temporal lobes and frontal and parietal association areas. The indemnity of this system is essential for normal cognitive functioning. At this moment, the only long term treatment available for AD are acetylcholinesterase inhibitors (CEIs) (e.g., tacrine, donepezil, rivastigmine, galanthamine). There are being investigated several treatments that may alter the development of neurofibrillary tangles and neuritic plaques (e.g., peripherally administered antibodies against beta amyloid proteins). Nerve growth factors may have the capability of improving neuronal survival, although their form of administration remains a problem. Amelioration of oxidative stress and CNS inflammatory processes may slow dawn the rate of neurodegeneration. CONCLUSION: All suspected mechanisms of the metabolic cascade of AD have been explored with specific and non specific treatments. Current treatments (e.g., CEIs) still have to prove that their effects can last for long periods of time. With the advent of further understanding of the neurodegenerative processes that cause AD, new treatments that may slow down the progression of the disease will be available.

Acetylcholine↗
PubMedDate not supplied

[Classification of mild cognitive impairment in a population study].

OBJECTIVE: The purpose of this study was to describe the methodology for the diagnosis of mild cognitive impairment (MCI) in the Cardiovascular Health Study Cognition Study (CHS CS). METHODS: The CHS CS examined the 3602 participants with detailed neurological, neuropsychological, neuroradiological, and psychiatric testing to identify dementia and MCI in four U.S. populations. The prevalence of MCI was determined for the whole cohort, and specific subtypes of MCI were examined in detail only in Pittsburgh. MCI was classified as follows: MCI Amnestic type (AT): These were patients with documented memory deficits, but otherwise normal cognitive functions. MCI Multiple cognitive deficits type (MCDT): These participants had: a) documented impairments on two tests (>1.5 SD) in a single cognitive domain other than memory, or b) one abnormal domain and one abnormal test in other domain, or c) at least one abnormal test in two different domains. MCI was considered probable when there was no other cause that may explain the cognitive deficits, and possible when there were systemic, neurological, or psychiatric disorders that might have affected cognition. CONCLUSIONS: This study showed that up to 22% of the subjects age 75 or older have MCI. MCI can present in two forms, one with a purely amnestic syndrome, and the other with broader cognitive deficits

Aged↗
PubMedDate not supplied

[Factors that modify the natural course of Alzheimer's disease].

Alzheimer s disease (AD) is an insidious, and progressive disorder of the nervous system that typically occurs after age 65, with incidence rising with chronological age. The disorder is characterized by a pronounced memory loss, due to neuropathological changes in the mesial temporal lobes; as the pathology spreads throughout the cerebral cortex. However, it is still unknown why some areas are more affected than others, with the subsequent clinical heterogeneity (or phenotypes), and variability in the clinical course. The most salient neurobehavioral syndromes that can affect the clinical course are extrapyramidal signs, as well as a wide variety of psychiatric syndromes (e.g., psychotic symptoms, depression, aggression). Similarly, medication use (e.g., antipsychotics, sedatives) have shown to have a detrimental effect in the course of the disease. Current palliative treatments for AD may alter the natural history of the disease by extending the time that affected patients may live at home.

Alcoholism↗
PubMedDate not supplied

[Neuropathology of Alzheimer's disease and mild cognitive impairment].

The neuropathological hallmarks of Alzheimer s disease (AD) are the presence of senile (neuritic) plaques (NP), neurofibrillary tangles (NFT), synapse loss, and neuronal cell loss. Large neurons are more affected than small ones. AD patients can also have other non specific lesions, such as granulovacuolar degeneration, Hirano bodies, and Lewy bodies. AD patients present a loss of many cholinergic neurons, especially those located in the nucleus basalis of Meynert, as well as a decrease of choline acetyl transferase (ChAT) activity, which suggested that the core of the cognitive deficits of AD was caused by the loss of cholinergic input. Interestingly, recent studies conducted in subjects with mild cognitive impairment (MCI) (these are patients that are at risk of developing AD) have shown that these subjects can have NP and NFT in the neocortex and allocortex, with relatively normal levels of ChAT in a variety of brain regions. This suggests the structures of the cholinergic system are preserved in early stages of the disease. Scientists have made significant advances in understanding both the clinical manifestations and pathobiological manifestations of AD. However, the mechanisms of specific vulnerability of the cholinergic system to AD, as well as the initial process that leads to the complex neuropathological lesions are unknown.

Aged↗
PubMedDate not supplied

Scintigraphic documentation of systemic-portal shunting.

Two unusual cases of iliac vein thrombosis are presented. They were studied with radionuclide venography of the left lower-extremity in which one of the collateral channels was the inferior mesenteric vein and showed the entire liver and lungs simultaneously. This vein does not appear to have been clearly identified with radioisotopic techniques previously. Using the anterior projection over the lungs and liver, ratios of liver to lungs, liver to (liver + lungs), right lung to (liver + lungs) and left lungs to (liver + lungs) were calculated. In patient 1, the shunted tracer represented 82% of the total activity and in patient 2 it was 21.5%.

Collateral Circulation↗