Pilar Otermín

Semantic Knowledge of Famous People in Mild Cognitive Impairment and Progression to Alzheimer’s Disease

Patients with dementia of Alzheimer’s type (DAT) show severe impairment in recognizing famous people. The aim of the current study was to investigate if this well-known memory impairment of famous faces is already present in the preclinical phase of DAT and if the famous faces test can help to differentiate patients with mild cognitive impairment (MCI) who progress to dementia and those who do not. We compared baseline performance in a task of famous face identification in a sample of 116 patients with subjective memory complaints classified in three groups: 17 participants with no evidence of cognitive impairment; 26 patients with MCI who had not developed dementia, and 27 patients with MCI who had developed probable DAT 2 years later. The remaining patients were excluded because they abandoned or did not meet the applied restrictive criteria for DAT, MCI or control. MCI patients who were diagnosed 2 years later with DAT performed significantly worse in the preclinical phase than MCI and control participants (p < 0.004). Patients with MCI but not DAT obtained intermediate results between control subjects and MCI patients who develop Alzheimer’s disease. A neuropsychological task of semantic knowledge of famous people may be useful in the early diagnosis of Alzheimer’s disease.

Diagnostic potential of acoustic startle reflex, acoustic blink reflex, and electro-oculography in progressive supranuclear palsy: A prospective study

We carried out a prospective study to analyze the diagnostic potential of acoustic startle reflex (ASR), acoustic blink reflex (ABR) and electro‐oculography (EOG) in early stages of atypical parkinsonian syndrome. The study was carried out in a consecutive series of 41 patients clinically diagnosed as atypical parkinsonism (mean time from first symptoms of 38 months and follow‐up of 26 months). The three procedures were carried out immediately after the first clinical evaluation. ASR and ABR were elicited by auditory stimuli while the patient was attending to a simple reaction time task. Outcome measures were: ASR (absence/presence, latency), ABR (absence/presence, latency) and EOG (suggestive/not suggestive of progressive supranuclear palsy [PSP]). Final clinical diagnosis was carried out by two neurologists blind to the neurophysiological results. A study of diagnostic sensitivity and odds ratio (OR) calculation for the PSP diagnosis was carried out. Neurophysiological examination showed the following sensitivity/specificity (%) for the diagnosis of PSP: ASR: 100/89; ABR 85/89; EOG 100/72. OR values were: ASR: 0.011; ABR: 0.037; EOG: 0.038. The three tests taken simultaneously showed a sensitivity of 100% and a specificity of 95%. The three neurophysiological tests investigated provided sensitive and specific measures with predictor value in early stages of atypical parkinsonian syndrome.

Transdermal Rotigotine Improves Sleep Fragmentation in Parkinson’s Disease: Results of the Multicenter, Prospective SLEEP-FRAM Study

Sleep disturbances occur frequently in patients with Parkinsons disease (PD). The aim of this study was to investigate the effects of rotigotine on sleep fluctuations in a sample of PD patients with self-reported complaints of nocturnal awakenings. This prospective, open-label, observational, and multicenter study enrolled consecutive outpatients with PD and administered rotigotine (mean dose 8.9 mg/day) for 3 months. The primary endpoint was the change from baseline in sleep fragmentation, assessed using the sleep maintenance subscale score of the Parkinsons Disease Sleep Scale (PDSS). The newly designed Parkinsons Disease Sleep Fragmentation Questionnaire (PD-SFQ) was used to measure other sleep parameters. A total of 62 patients were enrolled (mean age 70.2 years; 66% male). At 3 months, rotigotine significantly improved sleep fragmentation from baseline on the PDSS-2 sleep maintenance subscale (from 3.4 ± 0.9 to 1.9 ± 1.4; P < 0.0001). Rotigotine also significantly improved nocturnal motor symptoms (P < 0.0001), restless legs-like symptoms (P < 0.005), and nocturia (P = 0.004). Rotigotine significantly improved self-reported complaints of sleep fragmentation in PD patients and could be a useful treatment to improve this specific sleep problem in PD. However, these results are based on a small and clinically heterogeneous sample so they must be taken cautiously.

Motor circuitry re-organization after pallidotomy in Parkinson disease: a neurophysiological study of the bereitschaftspotential, contingent negative variation, and N30.

The aim of the study was to evaluate the reorganization changes in the motor circuitry of the basal ganglia following unilateral posteroventral pallidotomy in Parkinson disease (PD) patients using neurophysiological paradigms. Eight advanced PD patients received a neurophysiological battery 2 months prior and 6 months after unilateral pallidotomy. Examinations were all performed in the practically defined “off” situation. Bereitschaftspotential (BP) and N30 were recorded for each hand alternately. Contingent negative variation (CNV) was obtained using a visual Go/no-Go paradigm. ANOVAs (electrode position; surgery) were applied for BP and CNV results. N30 data were analyzed using Wilcoxon matched-pair tests. A significant increase in amplitude of the late component (NS’) of the BP was evidenced with patient performing with the hand contralateral to pallidotomy. No significant amplitude differences were found in CNV after surgery in any lead, or in any of the time windows tested. A trend toward significance was observed corresponding to a postsurgical numerical increase in amplitude of the N30 peak in the hand contralateral to pallidotomy. These results suggest that neurophysiological changes after pallidotomy are mainly in the last stages of movement preparation and execution.

Temblor postural: estudio clínico y neurofisiológico en una serie consecutiva de 300 pacientes

X0XFundamento Existen pocos estudios que analicen las caracteristicas clinicas y neurofisiologicas del temblor postural en Epana. Pacientes y metodo Se realiza un estudio clinico y neurofisiologico (acelerometria y electromiografia (EMG) de musculos antagonistas) prospectivo de 300 pacientes consecutivos que consultaron por primera vez en una seccion de trastornos del movimiento por temblor postural de las extremidades superiores. El diagnostico sindromico se establecio mediante una valoracion clinica y unos criterios de apoyo neurofisiologicos. En el grupo de pacientes diagnosticados de temblor esencial (TE) se efectuaron estudios de sensibilidad diagnostica, estudios de correlacion con las variables clinicas y neurofisiologicas, asi como un analisis multivariante. Resultados Los diagnosticos sindromicos mas frecuentes fueron TE (77%), temblor postural parkinsoniano (10%) y temblor fisiologico exagerado (6%). En los pacientes con TE, un 50% referian antecedentes familiares y un 7% una mejoria con el alcohol. Las variables mas especificas para el diagnostico de TE fueron: antecedentes familiares (77%), temblor cefalico (80%), mejora con alcohol (100%), patron EMG sincrono (79%). La presencia de antecedentes familiares y el patron EMG sincrono resultaron las unicas variables significativas predictoras de TE. Se encontro una correlacion significativa entre la edad de consulta y la frecuencia (r s = –0,561; p s = 0,470; p Conclusiones En este estudio, el TE fue la causa mas frecuente de referencia de temblor postural. Una valoracion clinica dirigida junto con un estudio neurofisiologico son de gran ayuda para el diagnostico de un paciente con temblor postural.

Preclinical memory profile in Alzheimer patients with and without allele APOE-epsilon4.

To investigate the association between APOE-Ε4 allele and memory phenotype in the preclinical stage of Alzheimer’s disease (AD). We compared an extensive preclinical memory profile at the baseline evaluation of 2 AD genotype groups: APOE-Ε4 allele carriers and patients with APOE-Ε3 homozygosity. Baseline memory performance was carried out at least 2 years (interval of 27.7 ± 4 months) before AD diagnosis was established, and analysis included different modalities of working memory (visuoperceptive, visuospatial, digit span and processing speed), of declarative memory (recent, verbal learning, prospective and semantic) and of nondeclarative memory (procedural, incidental and priming). We found no significant differences: memory performance was similar in both genotype groups. The presence of the APOE-Ε4 allele does not seem to be sufficient to cause a distinctive preclinical memory phenotype in AD patients.