Manuel Salamero

Excessive Daytime Sleepiness in Multiple System Atrophy (SLEEMSA Study)

BACKGROUND Sleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known. OBJECTIVE To assess the frequency and associations of EDS in MSA. DESIGN Survey of EDS in consecutive patients with MSA and comparison with patients with Parkinson disease (PD) and individuals without known neurologic disease. SETTING Twelve tertiary referral centers. PARTICIPANTS Eighty-six consecutive patients with MSA; 86 patients with PD matched for age, sex, and Hoehn and Yahr stage; and 86 healthy subject individuals matched for age and sex. MAIN OUTCOME MEASURES Epworth Sleepiness Scale (ESS), modified ESS, Sudden Onset of Sleep Scale, Tandberg Sleepiness Scale, Pittsburgh Sleep Quality Index, disease severity, dopaminergic treatment amount, and presence of restless legs syndrome. RESULTS Mean (SD) ESS scores were comparable in MSA (7.72 [5.05]) and PD (8.23 [4.62]) but were higher than in healthy subjects (4.52 [2.98]) (P < .001). Excessive daytime sleepiness (ESS score >10) was present in 28% of patients with MSA, 29% of patients with PD, and 2% of healthy subjects (P < .001). In MSA, in contrast to PD, the amount of dopaminergic treatment was not correlated with EDS. Disease severity was weakly correlated with EDS in MSA and PD. Restless legs syndrome occurred in 28% of patients with MSA, 14% of patients with PD, and 7% of healthy subjects (P < .001). Multiple regression analysis (with 95% confidence intervals obtained using nonparametric bootstrapping) showed that sleep-disordered breathing and sleep efficiency predicted EDS in MSA and amount of dopaminergic treatment and presence of restless legs syndrome in PD. CONCLUSIONS More than one-quarter of patients with MSA experience EDS, a frequency similar to that encountered in PD. In these 2 conditions, EDS seems to be associated with different causes.

Validación del cuestionario MOS-SSS de apoyo social en pacientes con cáncer

Fundamento y objetivo Muchos estudios hacen referencia a los beneficios que sobre la salud tiene la percepcion de estar recibiendo apoyo social. En este trabajo realizamos un estudio descriptivo y transversal para validar el cuestionario MOS-SSS (Medical Outcomes Study-Social Support Survey) de apoyo social. Pacientes y metodo En una muestra de 400 pacientes ambulatorios con cancer validamos el cuestionario MOS-SSS con un analisis factorial de componentes principales con rotacion varimax. Mediante un analisis unifactorial se efectuo una comparacion de las medias de las dimensiones del cuestionario MOS-SSS con otras variables, tales como tamano de la red social, sexo y edad. Resultados En el analisis de fiabilidad del cuestionario se obtiene una alta consistencia interna de la prueba, con un coeficiente alfa de 0,94. Del analisis factorial extraemos 3 factores: apoyo emocional/informacional, apoyo afectivo y apoyo instrumental. La cuarta dimension propuesta en la version original del instrumento, interaccion social positiva, queda incluida en la dimension de apoyo emocional/informacional. En la comparacion de medias de las dimensiones de la escala con el tamano de la red social, sexo y edad, se concluye que cuanto mayor es el tamano de la red social mayor es la percepcion de apoyo social cualitativo que se recibe. Los varones tienen la percepcion de recibir mas apoyo instrumental y emocional/informacional que las mujeres. La edad no aporta diferencias respecto a la percepcion del tipo de apoyo social que se recibe. Conclusiones Consideramos que el cuestionario MOS-SSS de apoyo social es un instrumento valido para medir gran parte de la multidimensionalidad del constructo.

Basal ganglia N-acetylaspartate correlates with the performance in the procedural task ‘Tower of Hanoi’ of neuroleptic-naive schizophrenic patients

We tested the hypothesis that basal ganglia dysfunction may be related to procedural learning impairment in schizophrenia. We determined the N-acetylaspartate/choline (NAA/Cho) ratio in the left striatal area in 11 young first-episode antipsychotic-naive patients and matched controls. Procedural learning was assessed by the four-disk version of the Tower of Hanoi. Analysis of variance showed that the number of moves and the execution time had a significant group effect (P=0.02, P<0.0001, respectively). Correlation analysis between procedural learning and the NAA/Cho ratio showed a negative significant correlation only in patients, measured by both time (P=0.006) and by moves (P=0.001). In summary, we found that schizophrenic patients have impaired procedural learning, and that this impairment is related to basal ganglia metabolism.

Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy

BACKGROUND Objective data regarding adverse cognitive deficits associated with maintenance electroconvulsive therapy (M-ECT) are lacking. This study examined the cognitive state of depressive patients during M-ECT. METHOD A cross-sectional study was carried out in 11 depressive patients in remission, all with a DSM-IV diagnosis of major depressive disorder. The mean number of previous ECT sessions was 36.1, and the mean intersession interval was 52.7 days. A group of 11 patients who had not received ECT was selected for comparison and matched for diagnosis, sex, age and years of schooling. All subjects were assessed using a complete neuropsychological battery including memory, attention and frontal function tests. RESULTS Groups did not present differences in long delay verbal recall. Encoding of new information and results on the frontal function tests were significantly lower in the M-ECT patients. CONCLUSION Depressed patients preserve long-term memory, but suffer short-term memory impairment and frontal function alteration during M-ECT. Further longitudinal studies are necessary to determine the influence of M-ECT on non-memory functions and different memory subtypes.

Patrón de déficit neuropsicológico en la demencia tipo Alzheimer y en la demencia vascular

Fundamento Algunos autores han postulado una division entre un patron de alteracionpredominantemente “cortical” para la demencia tipo Alzheimer y un patron de alteracion mas“subcortical” para la demencia vascular. El principal objetivo de este trabajo fue identificar unpatron de deterioro cognitivo neuropsicologico que discriminase el tipo de demencia en fases oestadios iniciales. Metodo Se compararon dos grupos de pacientes: uno con demencia, leve, tipo Alzheimer (DTA,n = 30) y otro con demencia vascular (DV, n = 30), administrando una bateria de tests neuropsicologicos.La bateria estaba compuesta por los siguientes tests: Orientacion Temporal (Bentonet al); Vocabulario, Semejanzas, Digitos, Clave y Kohs (WAIS); el test de Forma-Color deWeigl; el test del Trazo (A y B) (HRNB); el Tapping (McQuarrie); la Memoria Logica, MemoriaVisual y Aprendizaje Asociativo (WMS), y Memoria Diferida (Russell). Los dos grupos eran similaresen edad y caracteristicas socioculturales. Se compararon a traves de la nota z y su significacionestadistica con el test de Mann-Whitney y se realizo un analisis discriminante exploratoriopara clasificar a los pacientes en los dos grupos. Resultados En general, los resultados fueron mas pobres en el grupo DTA, no detectandose diferenciassignificativas en los tests neuropsicologicos, aunque en algunos casos (Memoria VisualInmediata y Cubos de Kohs) casi se alcanzo la significacion. A traves del analisis discriminanteexploratorio, se clasificaron correctamente un 67% de sujetos del grupo DTA y un 70%del grupo DV. Conclusiones En los estadios iniciales de las demencias es dificil diferenciar entre un patronde deficit cortical en la DTA y un patron de deficit subcortical en la DV. Cuando se usan testsneuropsicologicos complejos los rendimientos dependen de la coordinacion de multiples sistemasrelacionados. Estos hallazgos estan de acuerdo con los modelos holisticos de las funcionescorticales superiores.