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S Giménez-Roldán

Publications and source records attributed to S Giménez-Roldán.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Mini-mental state examination: proposal of protocol to be used].

The Mini-Mental State Examination (MMSE) is currently one of the most widely used tools for the assessment and screening of cognitive impairment despite a number of issues raised regarding the sensitivity of some subtests and the negative impact of advanced age and poor education. The informal use of invalidated and poor quality translations of the MMSE into Spanish language is widespread, and presumably this further increases some of the uncertainties linked to this test. The result may be misleading, not only as it may overestimate the prevalence of dementia but because it decreases interrater consistency with a view to epidemiological projects. A validated translation of the MMSE into Spanish is therefore much needed. Such a version would not only pay attention to educational and age issues but it would also take into account potential cultural and linguistics inter-community difference of some subtests when specifically applied in Spain which may represent another potential source of inconsistency throughout the country. Furthermore, subtle inhomogeneities in the way the test is administered may result in gross intra-rater and inter-rater variability, hence further decreasing reliability. On the basis of experience gained from a large hospital-based experience in administering the traditional MMSE to neurological patients we propose a standardized version to apply MMSE in Spanish with the alm to improve reliability. This is a preliminary step toward developing a reliable and sensitive Spanish version of the MMSE.

Aged↗
PubMed1997

[Depressive pseudodementia in early Parkinson's disease: lessons from a case with long-term follow-up].

A common observation in neurological practice is parkinsonism with concomitant cognitive decline, an association that usually arises from various underlying degenerative or vascular conditions, most of which are untreatable. An elderly woman with no history of psychiatric disease presented complaining of memory and cognitive impairment serious enough to interfere with daily life activities over the preceding year. She soon developed a predominantly left-sided tremor, rigidity and bradykinesia. She had had only 2 years of formal education. Neuropsychological assessment showed poor performance on Wechsler memory scale sub-items, as well as constructional apraxia, dyscalculia, reasoning difficulties and gross information deficits. A 3-month trial course of levodopa was followed by dramatic improvement in both parkinsonian symptoms and cognitive performance, including a 7-point gain in the Mini-Mental Status Examination score. At the same time, the Beck Depression Inventory score fell from 27 (baseline) to 18. Over the 10-year follow-up period the patient developed late levodopa syndrome and a persistent but mild dysthymic disorder, but never manifested dementia as defined by DSM-III-R criteria. This patient's case illustrates three important principles. First, although parkinsonism is known to be preceded by depressive episodes, particularly in a subgroup of younger patients, the symptoms of the elderly patient whose Parkinson's disease is foreshadowed by depression can mimic depressive pseudodementia, potentially leading to diagnostic confusion. Second, impaired motivation and disturbances in cognitive function are different from mood disorders, as the former involve the mesolimbic/mesocortical dopamine system, explaining the beneficial effect of levodopa on motivation and cognition in this patient even as mood was unaffected. Finally, depressive pseudodementia in Parkinson's disease does not necessarily herald the development of organic dementia in the long term.

Aged↗
PubMed1997

[Driving licence renewal in persons with Parkinson disease].

INTRODUCTION: The legal requirement to renew a driving licence is feared by most symptomatic or already formally diagnosed individuals with Parkinson's disease (PD) as the medical assessment they are required to submit may eventually conclude in withdrawal of their driving licence. OBJECTIVE AND METHODS: The purpose of our study was to gain information about PD patients applying for a driving licence renovation and their willingness to uncover his or her illness to medical personnel in charge, and how often current medical assessment procedures proved unable to detect abnormalities among parkinsonian applicants who retain data on their health status. Using a confidential, 'face-to-face' questionnaire, we obtained information from 62 licensed parkinsonian drivers (32 current drivers) and 120 age and sex matched drivers controls gathered from an identical socioeconomic background. RESULTS: Thirty eight individuals with symptomatic PD (in 30 of who the disorder has been already diagnosed) applied with a view to licence renovation. Drivers with PD did not retain information regarding their health status more often than sex- and age-matched control drivers with various other chronic ailments as 63.1% and 77% respectively, abstained from declaring (z = 0.945; p = 0.344). A parkinsonian subject illegally managed to renew his driving licence without submission to any medical assessment. The attending physicians perceived abnormalities related to motor difficulties in 30.4% of those parkinsonian who withdrew information. A similar proportion of controls (29.1%) were also informed about health problems during their medical assessment, in the vast majority related to sight problems. CONCLUSIONS: Overall, the exam concluded in cancellation of the driving licence in 10.8% of the parkinsonian and 1.6% of the controls, a significant difference (z = 2.075; p = 0.03). We conclude that at the time of renewal of a driving licence parkinsonian patients do not retain problems related to fitness to drive more often than the general population afflicted by other medical conditions do. However, current tests for driving performance appears to be not sensitive enough to detect selective difficulties in motor execution tasks that may impair driving ability in persons with PD.

Aged↗
PubMed1997

[Ropinirol: a new dopamine agonist in the treatment of Parkinson's disease].

Ropinirol is a novel dopamine agonist recently marketed for treatment of Parkinson's disease. Compared with available dopamine agonists, ropinirole possesses 3 novel structural properties which may be relevant in terms of clinical benefit: a) it is the first dopamine agonist with a non-ergolic structure, therefore it may be devoid of some infrequent side-effects of ergolic agonists, such as retroperitoneal fibrosis; b) ropinirole is unique compared to other agonists due to stric selectivity for D2 receptors, a property that may decrease levodopa-induced dyskinesias, and c) as ropinirole does not activate serotonin receptors, it may theoretically cause less neuropsychiatric side-effects in late stages of the disease. Available clinical trials indicate that ropinirole may be effective as monotherapy during early stages in patients not severely disabled, and may also decrease the extent and severity of akinetic periods in fluctuating patients. More information is needed, however, on patients prolongedly exposed to ropinirol as well as about its antiparkinsonian potency compared with those agonists already available.

Dopamine Agonists↗
PubMed1996

[The effect of piracetam on involuntary movements in Huntington's disease. A double-blind, placebo-controlled study].

Piracetam and its derivatives, a group of "nootropic" drugs thought to act as metabolic enhancers in the brain, have been widely used to treat a variety of cognitive disorders. Two studies have reported that this compound reduces the severity of involuntary movements in acute onset hemichorea. We therefore randomly assigned 11 patients with Huntington's disease to receive high doses of intravenous piracetam (12 g in 250 ml of saline) or placebo on different days. A blinded observer then rated the severity of involuntary movements over a period of 4 hours. Significant aggravation (p < 0.05) of chorea was seen in patients taking piracetam, in comparison with ratings for both baseline and placebo, 4 hours after administration but not during earlier assessments. Although the mechanism causing this effect is unidentified, we believe that our findings indicate that piracetam should not be used to treat the cognitive disorders accompanying Huntington's disease.

Adult↗
PubMed1996

[Depression and Parkinson's disease: neurobiologic foundations and therapeutic management].

The prevalence of depression in Parkinson's disease (PD) is estimated to be around 40% and generally takes the form of dysthymia. Although psychological factors probably contribute to depression, data point to a relation to structural and biochemical changes linked to PD. Thus, the onset of motor impairment is often preceded by a depressive episode, although there is no consistency between the seriousness of motor disability and depression. Furthermore, depression aggravates the memory and language impairments of PD and is thought to be a risk factor for developing dementia. Regional cerebral blood flow abnormalities in the medial frontal and cingulate cortices and low 5-HIIA concentrations in cerebro-spinal fluid suggest that degeneration of the mesocorticolimbic dopaminergic system as well as dorsal raphe changes may be implicated. Assessment of depression in PD is difficult, as none of the currently available scales were specifically designed for patients with this disease Furthermore, there is a lack of well-controlled studies showing that current antidepressants are effective in PD patients or are safe for use when the motor, cognitive and autonomic impairments of PD are present.

Brain↗
PubMed1995

[Aggravation of Parkinson's disease after inadequate use of levodopa in controlled-release preparations].

We describe 16 patients with Parkinson's disease seen during a 6-month period because of aggravation related to the recent introduction of a levodopa/carbidopa controlled-release (CR) preparation, either in combination with or substituting for the standard levodopa preparations. Disease duration was longer than 5 years (mean 8.4 +/- 5.9 years) in most cases at the time the CR preparation was introduced, and the patients were suffering from either severe late levodopa syndrome or progression in disability. For 9 out of 14 patients the CR formula had replaced the older preparation overnight. Though patients often accumulated multiple side-effects, we were able to identify 3 subgroups based on the main problem developing after the CR preparation had been introduced: a) apparent acceleration of the course of disease in patients in advanced stages, even if their response to treatment was otherwise stable (n = 4); b) subacute onset or aggravation of dyskinesias or painful "off"-period dystonia that often prompted reevaluation of the patient (n = 4); c) deterioration of akinetic "off" periods in patients already experiencing response fluctuations (n = 5) or appearance of dose failures in patients who had so far been enjoying stable responses (n = 3). These problems appeared in spite of a significant increase (p = 0.046) in total levodopa daily dose even though there were no differences (p = 0.685) in dose frequency between the CR preparation and standard levodopa.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Progressive supranuclear palsy and corticobasal ganglionic degeneration: differentiation by clinical features and neuroimaging techniques.

To assess the extent of overlap between clinically diagnosed patients with progressive supranuclear palsy (PSP) and corticobasal ganglionic degeneration (CBGD) we compared clinical scores for rigidity, bradykinesia, supranuclear gaze abnormalities, hemineglect and limb apraxia, postural instability, neck rigidity, and limb dystonia in 15 patients with a degenerative rigid-akinetic syndrome at presentation and at follow-up 3 to 120 months later. Only the presence of hemineglect, usually in combination with limb apraxia, was a reliable and early clinical factor for discriminating between these two conditions. These symptoms were present at admission in all 4 CBGD patients but not in any of the 11 PSP patients either at presentation or later during serial examinations. Though supranuclear ophthalmoplegia, neck rigidity, and postural instability were already observed in most CBGD patients at presentation, their scores remained low compared to those for PSP patients over the longterm. CT-scans and MRI were helpful in supporting clinically-based diagnoses made at presentation in that the vast majority of the PSP patients exhibited various degrees of midbrain atrophy and 50 percent of the CBGD patients exhibited asymmetric pericentral cortical atrophy.

Aged↗
PubMed1994

Discontinuation of prolonged bromocriptine therapy in Parkinson's disease patients with uncontrolled motor oscillations.

The beneficial effect of bromocriptine in fluctuating Parkinson's disease (PD) under chronic levodopa therapy has been reported to be lost in the long term in most patients. We attempted slow bromocriptine discontinuation in nine PD patients to whom this drug have been added to levodopa because of fluctuating motor responses but who appeared to cease benefitting from this association after an average of 4.6 years (range, 1.3-8 years) of sustained bromocriptine therapy. Bromocriptine was discontinued by gradually tapering off the dosage (mean, 8.5 mg/week) while leaving levodopa medication unchanged. The percentage time spent "off" during waking hours increased in all patients (average, 30.2 +/- 18.5% versus 65.6 +/- 82.6%, p < 0.001) and in three patients the "on-off" pattern shifted from random fluctuations to disabling "off" periods 23-26 times longer than before discontinuation. Sustained bromocriptine therapy does not prevent the continuous deterioration of motor fluctuations. However, we believe that this drug remains partially effective over the long term and should not be discontinued in PD patients with uncontrolled fluctuations, even though their condition may actually appear to worsen as compared to when bromocriptine therapy was first started.

Aged↗
PubMed1994

Acetylator polymorphism in multiple sclerosis.

To elucidate whether any relationship exists between genetic polymorphic acetylation and the risk for multiple sclerosis (MS), we determined this polymorphism, using sulphamethazine, in 71 patients with definite MS and in 268 age-matched controls. Thirty-seven patients (52.1%) and 151 controls (56.3%) were classified as slow acetylators (not significant difference). No relation was found between acetylator polymorphism and age at onset of disease in MS patient's group. Our results do not support the existence of any relationship between acetylator polymorphism and the risk for MS.

Acetylation↗
PubMed1994

[Patient care in a hospital based unit for treating Parkinson's disease and movement disorders: a 3-year prospective study].

A register covering a 3-year period (1991-1993) was opened for all patients attending a Parkinson's disease and movement disorder clinic which has been running for 15 years in a reference hospital covering a population of 629,555 in Madrid. During the last 2 years, all 5 neurologists serving the reference health area joined to the hospital on a part-time basis. A total of 764 patients were seen during the study period, 56.2% of whom were follow-up patients. About half of the later (49%) were suffering from Parkinson's disease (PD), follow-up duration averaging 4.7 +/- 4.4 years. Follow-up in dystonias (11.8%) and choreas (8.1%) cases was similar and averaged 5.0 +/- 4.2 and 4.5 +/- 4.2 years, respectively. Out of 334 new referrals 192 were new parkinsonism patients, half of them (48.4%) with secondary parkinsonism, particularly drug-induced parkinsonism (32.2%). Incorporation of neurologists serving the reference health area to hospital activities correlated to a decrease in secondary parkinsonism referrals, a slight drop in de novo PD patients, but not in an earlier detection of new PD cases. We conclude that a monographic out-patient clinic may benefit from sharing activities with neurologists serving the referral health area, and from improving the neurological education of general practitioners.

Antipsychotic Agents↗
PubMed1992

Exposure to well water and pesticides in Parkinson's disease: a case-control study in the Madrid area.

Past exposure to well water and pesticides was assessed in 128 unselected Parkinson's disease (PD) patients and 256 age and sex-matched controls. All were residents in a defined urban area of Madrid, Spain. In keeping with other reports, we found that exposure to well water might be a factor associated with the likelihood of developing PD, though only prolonged exposures of 30 years or longer were significantly different between PD and controls (p less than 0.02). In contrast, past exposure to pesticides did not appear to be associated with an increased risk of developing PD. Prolonged well water drinking antedating the development of PD was not associated with early onset of the disease, nor did such cases progress to greater disability. Future case-control studies addressing prolonged well water consumption as a risk factor in PD should look for differences in the content of substances other than pesticides in the water as determined by the source of water to which patients may have been specifically exposed.

Aged↗
PubMed1992

Neuroleptic malignant syndrome related to tetrabenazine introduction and haloperidol discontinuation in Huntington's disease.

We describe the second reported case of neuroleptic malignant syndrome (NMS) related to tetrabenazine therapy in Huntington's disease. In the previously reported case, factors capable of potentiating NMS included a high dosage of tetrabenazine exceeding the accepted therapeutic range, and co-medication with the dopamine-synthesis inhibitor alpha-methylparatyrosine, while in the present case abrupt introduction of the drug and discontinuation of concomitant neuroleptics may have contributed to this important adverse reaction. Uneventful recovery occurred in both cases without the need for drugs specifically enhancing dopaminergic transmission, while rechallenge by tetrabenazine with conventional doses and slow upward titration was not followed by recurrence of the NMS. Tetrabenazine has proved to be a safe and frequently useful drug in the long-term treatment of approximately 400 dyskinetic patients. We believe that NMS related to this drug is rare, provided that it is properly administered.

Female↗