Search

Background: Cross-Cultural Dementia Screening (CCD), Rowland Universal Dementia Assessment Scale (RUDAS), and European Cross-cultural Neuropsychological Test Battery (CNTB) are three novel neuropsychological instruments developed from a cross-cultural perspective to reduce the impact of culture in cognitive assessment and improve the assessment in diverse populations. Objective: We aimed to collect and present normative data on these tests in a majority population sample (Spaniards living in Spain) and in a minority population sample (Colombians living in Spain). Methods: CCD, RUDAS, and CNTB were administered to a group of 300 cognitively healthy participants (150 Spaniards and 150 Colombians). Linear regression modeling strategy was used to provide adjusted norms for demographic factors and to explore the influence of these factors on test performance. Results: Most of the CCD and CNTB scores were predicted by age and years of education, with some tests only predicted by age or showing a ceiling effect. The comparison of normative data between the two samples confirmed the favorable cross-cultural properties of these instruments, with only some differences in processing speed and executive functioning scores. Conclusions: Our study finds a comparable influence of demographic factors in both populations on the performance of CCD, RUDAS, and CNTB, confirming their adequate cross-cultural properties. We provide normative data for these tests in Spaniards and Colombians living in Spain., Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

The Five-Point Test (5PT) is a neuropsychological tool for examining design or figural fluency. In this study, we aimed to provide normative data for the 5PT in Spain. Also, we aimed to compare the norms collected in our research with other normative studies from other populations to evaluate a potential cross-cultural application of 5PT. One hundred and ninety-two healthy subjects aged were enrolled. The mean age was 68.48±9.68years old (range 50–89), and mean years of education were 10.65±5.22. There were 117 (60.9%) women. The overlapping interval strategy was used to maximize the sample size. Age- and education-adjusted scores were estimated using linear regression analysis. Intraclass correlation coefficient was used to calculate agreement with norms from other countries. Age and years of formal education showed moderate correlations with the scores, while the influence of sex was non-significant. Intraclass correlation coefficient (absolute agreement) between Spanish and German norms was 0.956 (95% confidence interval 0.906–0.978). Norms for unique designs at 1, 2, and 3minutes are provided. Our study confirms the influence of age and education on design fluency and provides normative data for people older than 50years old. We hypothesize that 5PT might be a useful test in cross-cultural settings., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Cognitive processes underlying verbal and design fluency, and their neural correlates in patients with Alzheimer’s disease (AD) and behavioural variant Frontotemporal Dementia (bvFTD) remain unclear. We hypothesised that verbal and design fluency may be associated with distinct neuropsychological processes in AD and FTD, showing different patterns of impairment and neural basis. Methods: We enrolled 142 participants including patients with AD (n = 80, mean age = 74.71), bvFTD (n = 34, mean age = 68.18), and healthy controls (HCs) (n = 28, mean age = 71.14), that underwent cognitive assessment and F-fluorodeoxyglucose positron emission tomography imaging. Results: Semantic and phonemic fluency showed the largest effect sizes between groups, showing lower scores in bvFTD than AD and HCs, and lower scores in AD than HC. Both AD and bvFTD showed a lower number of unique designs in design fluency in comparison to HC. Semantic fluency was correlated with left frontotemporal lobe in AD, and with left frontal, caudate, and thalamus in bvFTD. Percentage of unique designs in design fluency was associated with the metabolism of the bilateral fronto-temporo-parietal cortex in AD, and the bilateral frontal cortex with right predominance in bvFTD. Repetitions in AD were correlated with bilateral frontal, temporal, and parietal lobes, and with left prefrontal cortex in bvFTD. Conclusions: Our findings demonstrate differential underlying cognitive processes in verbal and design fluency in AD and bvFTD. While memory and executive functioning associated with fronto-temporo-parietal regions were key in AD, attention and executive functions correlated with the frontal cortex and played a more significant role in bvFTD during fluency tasks., Instituto de Salud Carlos III, European Commision, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Radiología, Rehabilitación y Fisioterapia, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Background: The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive test with favorable diagnostic properties for detecting dementia and a low influence of education and cultural biases. Objective: We aimed to validate the RUDAS in people with Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS). Methods: We enrolled one hundred and fifty participants (60 with AD, 30 with PD, 60 with MS, and 120 healthy controls (HC)). All clinical groups completed a comprehensive neuropsychological battery, RUDAS, and standard cognitive tests of each disorder: MMSE, SCOPA-COG, and Symbol Digit Modalities Test. Intergroup comparisons between clinical groups and HC and ROC curves were estimated. Random Forest algorithms were trained and validated to detect cognitive impairment using RUDAS and rank the most relevant scores. Results: The RUDAS scores were lower in patients with AD, and patients with PD and MS showed cognitive impairment compared to healthy controls. Effect sizes were generally large. The total score was the most discriminative, followed by the memory score. Correlations with standardized neuropsychological tests were moderate to high. Random Forest algorithms obtained accuracies over 80–90% using the RUDAS for diagnosing AD and cognitive impairment associated with PD and MS. Conclusion: Our results suggest the RUDAS is a valid test candidate for multi-disease cognitive screening tool in AD, PD, and MS., Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Depto. de Arquitectura de Computadores y Automática, Fac. de Psicología, Fac. de Medicina, Fac. de Informática, TRUE, pub

Background: LASSI-L is a novel neuropsychological test specifically designed for the early diagnosis of Alzheimer’s disease (AD) based on semantic interference. Objective: To examine the cognitive and neural underpinnings of the failure to recover from proactive semantic and retroactive semantic interference. Methods: One hundred and fifty-five patients consulting for memory loss were included. Patients underwent neuropsychological assessment, including the LASSI-L, and FDG-PET imaging. They were categorized as subjective memory complaints (SMC) (n=32), pre-mild cognitive impairment (MCI) due to AD (Pre-MCI) (n=39), MCI due to AD (MCI-AD) (n=71), and MCI without evidence of neurodegeneration (MCI-NN) (n=13). Voxel-based brain mapping and metabolic network connectivity analyses were conducted. Results: A significant group effect was found for all the LASSI-L scores. LASSI-L scores measuring failure to recover from proactive semantic interference and retroactive semantic interference were predicted by other neuropsychological tests with a precision of 64.1 and 44.8%. The LASSI-L scores were associated with brain metabolism in the bilateral precuneus, superior, middle and inferior temporal gyri, fusiform, angular, superior and inferior parietal lobule, superior, middle and inferior occipital gyri, lingual gyrus, and posterior cingulate. Connectivity analysis revealed a decrease of node degree and centrality in posterior cingulate in patients showing frPSI. Conclusion: Episodic memory dysfunction and the involvement of the medial temporal lobe, precuneus and posterior cingulate constitute the basis of the failure to recover from proactive semantic interference and retroactive semantic interference. These findings support the role of the LASSI-L in the detection, monitoring and outcome prediction during the early stages of AD., Instituto de Salud Carlos III, European Commission, National Institute of Aging, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Radiología, Rehabilitación y Fisioterapia, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Background: Radiologically isolated syndrome (RIS) patients might have psychiatric and cognitive deficits, which suggests an involvement of major resting-state functional networks. Notwithstanding, very little is known about the neural networks involved in RIS. Objective: To examine functional connectivity differences between RIS and healthy controls using resting-state functional magnetic resonance imaging (fMRI). Methods: Resting-state fMRI data in 25 RIS patients and 28 healthy controls were analyzed using an independent component analysis; in addition, seed-based correlation analysis was used to obtain more information about specific differences in the functional connectivity of resting-state networks. Participants also underwent neuropsychological testing. Results: RIS patients did not differ from the healthy controls regarding age, sex, and years of education. However, in memory (verbal and visuospatial) and executive functions, RIS patients’ cognitive performance was significantly worse than the healthy controls. In addition, fluid intelligence was also affected. Twelve out of 25 (48%) RIS patients failed at least one cognitive test, and six (24.0%) had cognitive impairment. Compared to healthy controls, RIS patients showed higher functional connectivity between the default mode network and the right middle and superior frontal gyri and between the central executive network and the right thalamus ( pFDR < 0.05; corrected). In addition, the seed-based correlation analysis revealed that RIS patients presented higher functional connectivity between the posterior cingulate cortex, an important hub in neural networks, and the right precuneus. Conclusion: RIS patients had abnormal brain connectivity in major resting-state neural networks and worse performance in neurocognitive tests. This entity should be considered not an “incidental finding” but an exclusively non-motor (neurocognitive) variant of multiple sclerosis., National Institutes of Health (EEUU), European Commission, Ministerio de Economía y Competitividad (España), Ministerio de Ciencia e Innovación (España), Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Psicología Experimental, Procesos Cognitivos y Logopedia, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Post-COVID condition (PCC) and multiple sclerosis (MS) share some clinical and demographic features, including cognitive symptoms and fatigue. Some pathophysiological mechanisms well-known in MS, such as autoimmunity, neuroinflammation and myelin damage, have also been implicated in PCC. In this study, we aimed to compare the cognitive phenotypes of two large cohorts of patients with PCC and MS, and to evaluate the relationship between fatigue and cognitive performance. Cross-sectional study including 218 patients with PCC and 218 with MS matched by age, sex, and years of education. Patients were evaluated with a comprehensive neuropsychological protocol and were categorized according to the International Classification of Cognitive Disorders system. Fatigue and depression were also assessed. Cognitive profiles of PCC and MS largely overlapped, with a greater impairment in episodic memory in MS, but with small effect sizes. The most salient deficits in both disorders were in attention and processing speed. The severity of fatigue was greater in patients with PCC. Still, the correlations between fatigue severity and neuropsychological tests were more prominent in the case of MS. There were no differences in the severity of depression among groups. Our study found similar cognitive profiles in PCC and MS. Fatigue was more severe in PCC, but was more associated with cognitive performance in MS. Further comparative studies addressing the mechanisms related to cognitive dysfunction and fatigue may be of interest to advance the knowledge of these disorders and develop new therapies., Comunidad de Madrid, Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background:Neuropsychologicalassessmentis considereda valid tool in the diag-nosisof neurodegenerativedisorders.However,thereis an importantoverlapincognitiveprofilesbetweenAlzheimer'sdisease(AD) and behaviouralvariantfronto-temporaldementia(bvFTD),andthe usefulnessin diagnosisis uncertain.Weaimedtodevelopmachinelearning‐basedmodelsfor the diagnosisusingcognitivetests. Methods:Threehundredand twenty‐nineparticipants(170AD, 72 bvFTD,87healthycontrol[HC])wereenrolled.Evolutionaryalgorithms,inspiredby the pro-cess of naturalselection,wereappliedfor both mono‐objectiveand multi‐objectiveclassificationand featureselection.Classicalalgorithms(NativeBayes,SupportVectorMachines,amongothers)werealso used,and a meta‐modelstrategy. Results:Accuraciesfor the diagnosisof AD, bvFTDand the differentialdiagnosisbetweenthemwerehigherthan 84%.Algorithmswereable to significantlyreducethe numberof testsand scoresneeded.Free and CuedSelectiveRemindingTest,verbalfluencyand Addenbrooke'sCognitiveExaminationwereamongstthe mostmeaningfultests. Conclusions:Our studyfoundhigh levelsof accuracyfor diagnosisusingexclusivelyneuropsychologicaltests,whichsupportsthe usefulnessof cognitiveassessmentindiagnosis.Machinelearningmay have a role in improvingthe interpretationand testselection., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background Primary progressive aphasia (PPA) is a clinical syndrome including a group of neurodegenerative disorders that present with language impairment. We hypothesised that impairment in reading prosody may be present in a subgroup of patients with PPA, and particularly non-fluent PPA (nfvPPA), because of the impairment of key brain regions involved in the pathophysiology of speech dysprosody and reading observed in these patients. Methods Ninety-five participants were evaluated using a narrative text comprising several declarative, exclamatory, and interrogative sentences, as well as a comprehensive language protocol. Patients were also examined with 18F-fluorodeoxyglucose positron emission tomography imaging. Results Impairment was more frequent and more severe in patients with nfvPPA, especially in the subgroup of patients with Apraxia of Speech (AOS). Patients with nfvPPA, mainly those with AOS, showed lower values in several pitch variables. Statistically significant differences were also observed in sentence duration, reading times, and types of error. A regression model including mean length of utterances, time after full stops, number of pauses, and number of pitch variables below the mean, correctly classified 70–71.3% of patients. When combined with sentence repetition task, the percentage of patients correctly classified was 96.2% and 92.4%, respectively, for each classification. The left frontal lobe was the region most strongly correlated with reading prosody parameters. Specific tasks displayed additional correlations with the left parietal and occipital lobes; right frontal lobe, thalamus, and caudate; and right cerebellum. Conclusion Reading prosody is relevant in PPA diagnosis and classification. Because reading prosody may be quantified, it is amenable to use in diagnosis and follow-up. We found neuroimaging correlation with metabolism in the left frontal lobe, as well as in other regions including the right frontal lobe, basal ganglia, and cer, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background It remains unknown whether the presence of coronary microcirculatory dysfunction (CMD) correlates with its equivalent conditionin the brain, cerebral small vessel disease (CSVD). The cerebral-coronary connection (C3), a prospective blinded study, investigatedthe prevalence of CMD in patients with coronary artery disease (CAD) and its association with CSVD and cognitive function. Methodsand results Patients with documented CAD fulfilling inclusion criteria underwent physiological assessment of epicardial vessels and the microcirculation using intracoronary pressure and Doppler. Coronary microcirculation-related indices included coronary flow reserve (CFR) and hyperaemic microvascular resistance. Brain magnetic resonance imaging, transcranial Doppler (TCD), and neurocognitive examination were performed. Overall, 67 patients were included in the study (mean age 66 years, 73% female). Patients with abnormal CFR (<2.0) (55.2%) showed higher burden of white-matter hyperintensities: 43.2 vs. 20.0% (P=0.044). After statistical adjustment, low CFR was associated with lower grey matter volume (P=0.024) and with parameters of white-matter microstructural damage in diffusion-tensor imaging (lower fractional anisotropy and higher mean diffusivity, P=0.029 and P=0.032, respectively). Low CFR was associated with higher resistive (P=0.027) and pulsatility (P=0.043) values on TCD, and worse neurocognitive test scores (lower mini mental state examination, P=0.025, and slower Trail Making Test A, P=0.034). Conclusions Coronary microcirculatory dysfunction is frequent in patients with CAD and correlates with CSVD, abnormal cerebral flow haemodynamics, and significant cognitive impairment. These findings support the hypothesis that microvascular dysfunction in the heart and the brain are part of a single pathological process affecting microcirculation in patients with CAD., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Objective Recent evidence suggests that patients suffering post-acute COVID syndrome frequently report cognitive complaints, but their characteristics and pathophysiology are unknown. This study aims to determine the characteristics of cognitive dysfunction in patients reporting cognitive complaints after COVID-19 and to evaluate the correlation between cognitive function and anxiety, depression, sleep, and olfactory function. Methods Cross-sectional study involving 50 patients with COVID-19 reporting cognitive complaints 9.12 ± 3.46 months after the acute infection. Patients were evaluated with a comprehensive neuropsychological protocol, and scales of fatigue, depression, anxiety, sleep and an olfactory test. Normative data and an age- and education matched healthy control group were used for comparison. Results COVID-19 patients showed a diminished performance on several tests evaluating attention and executive function, with alterations in processing speed, divided attention, selective attention, visual vigilance, intrinsic alertness, working memory, and inhibition; episodic memory; and visuospatial processing. Cognitive performance was correlated with olfactory dysfunction, and sleep quality and anxiety to a lesser extent, but not depression. Conclusions Patients with COVID-19 reporting cognitive symptoms showed a reduced cognitive performance, especially in the attention-concentration and executive functioning, episodic memory, and visuospatial processing domains. Future studies are necessary to disentangle the specific mechanisms associated with COVID-19 cognitive dysfunction., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background: Verbal fluency (VF) has been associated with several cognitive functions, but the cognitive processes underlying verbal fluency deficits in Multiple Sclerosis (MS) are controversial. Further knowledge about VF could be useful in clinical practice, because these tasks are brief, applicable, and reliable in MS patients. In this study, we aimed to evaluate the cognitive processes related to VF and to develop machine-learning algorithms to predict those patients with cognitive deficits using only VF-derived scores. Methods: Two hundred participants with MS were enrolled and examined using a comprehensive neuropsychological battery, including semantic and phonemic fluencies. Automatic linear modeling was used to identify the neuropsychological test predictors of VF scores. Furthermore, machine-learning algorithms (support vector machines, random forest) were developed to predict those patients with cognitive deficits using only VF-derived scores. Results: Neuropsychological tests associated with attention-executive functioning, memory, and language were the main predictors of the different fluency scores. However, the importance of memory was greater in semantic fluency and clustering scores, and executive functioning in phonemic fluency and switching. Machine learning algorithms predicted general cognitive impairment and executive dysfunction, with F1-scores over 67–71%. Conclusions: VF was influenced by many other cognitive processes, mainly including attention-executive functioning, episodic memory, and language. Semantic fluency and clustering were more explained by memory function, while phonemic fluency and switching were more related to executive functioning. Our study supports that the multiple cognitive components underlying VF tasks in MS could serve for screening purposes and the detection of executive dysfunction., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Radiologically isolated syndrome (RIS) patients might have psychiatric and cognitive deficits, which suggests an involvement of major resting-state functional networks. Notwithstanding, very little is known about the neural networks involved in RIS. Objective: To examine functional connectivity differences between RIS and healthy controls using resting-state functional magnetic resonance imaging (fMRI). Methods: Resting-state fMRI data in 25 RIS patients and 28 healthy controls were analyzed using an independent component analysis; in addition, seed-based correlation analysis was used to obtain more information about specific differences in the functional connectivity of resting-state networks. Participants also underwent neuropsychological testing. Results: RIS patients did not differ from the healthy controls regarding age, sex, and years of education. However, in memory (verbal and visuospatial) and executive functions, RIS patients’ cognitive performance was significantly worse than the healthy controls. In addition, fluid intelligence was also affected. Twelve out of 25 (48%) RIS patients failed at least one cognitive test, and six (24.0%) had cognitive impairment. Compared to healthy controls, RIS patients showed higher functional connectivity between the default mode network and the right middle and superior frontal gyri and between the central executive network and the right thalamus (pFDR < 0.05; corrected). In addition, the seed-based correlation analysis revealed that RIS patients presented higher functional connectivity between the posterior cingulate cortex, an important hub in neural networks, and the right precuneus. Conclusion: RIS patients had abnormal brain connectivity in major resting-state neural networks and worse performance in neurocognitive tests. This entity should be considered not an “incidental finding” but an exclusively non-motor (neurocognitive) variant of multiple sclerosis., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Fatigue is one of the most frequent and disabling symptoms of the post-COVID syndrome. In this study, we aimed to assess the effects of transcranial direct current stimulation on fatigue severity in a group of patients with post-COVID syndrome and chronic fatigue. We conducted a double-blind, parallel-group, sham-controlled study to evaluate the short-term effects of anodal transcranial direct current stimulation (2 mA, 20 min/day) on the left dorsolateral prefrontal cortex. The modified fatigue impact scale score was used as the primary endpoint. Secondary endpoints included cognition (Stroop test), depressive symptoms (Beck depression inventory) and quality of life (EuroQol-5D). Patients received eight sessions of transcranial direct current stimulation and were evaluated at baseline, immediately after the last session, and one month later. Forty-seven patients were enrolled (23 in the active treatment group and 24 in the sham treatment group); the mean age was 45.66 ± 9.49 years, and 37 (78.72%) were women. The mean progression time since the acute infection was 20.68 ± 6.34 months. Active transcranial direct current stimulation was associated with a statistically significant improvement in physical fatigue at the end of treatment and 1 month as compared with sham stimulation. No significant effect was detected for cognitive fatigue. In terms of secondary outcomes, active transcranial direct current stimulation was associated with an improvement in depressive symptoms at the end of treatment. The treatment had no effects on the quality of life. All the adverse events reported were mild and transient, with no differences between the active stimulation and sham stimulation groups. In conclusion, our results suggest that transcranial direct current stimulation on the dorsolateral prefrontal cortex may improve physical fatigue. Further studies are needed to confirm these findings and optimize stimulation protocols., Comunidad de Madrid, European Commission, Instituto de Salud Carlos III, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Background: The Cross-Cultural Neuropsychological Test Battery (CNTB) is a novel test battery specifically designed to reduce the impact of multiculturality in cognitive assessment. Objective:We aimed to validate the CNTB in Spaniards in patients with Alzheimer's disease (AD), including patients at mild cognitive impairment (MCI) and mild dementia stages, and Parkinson's disease with MCI (PD-MCI).Methods: Thirty patients with AD-MCI, 30 with AD-dementia (AD-D), and 30 with PD-MCI were recruited. Each clinical group was compared against a healthy control group (HC) with no differences in sex, age, or years of education. Intergroup comparisons, ROC analysis, and cut-off scores were calculated. Results: AD-MCI scored lower than HC in those subtests associated with episodic memory and verbal fluency. AD-D also showed lower scores in executive functions and visuospatial tests. Effect sizes for all the subtests were large. PD-MCI showed lower performance than HC in memory and executive functions, particularly on error scores, with large effect sizes. Comparing AD-MCI and PD-MCI, AD-MCI had lower memory scores, while PD-MCI showed the worst performance in executive functions. CNTB showed appropriate convergent validity with standardized neuropsychological tests measuring the same cognitive domains. We obtained similar cut-off scores to previous studies performed in other populations. Conclusions: The CNTB showed appropriate diagnostic properties in AD and PD, including those stages with mild cognitive impairment. This supports the utility of the CNTB for the early detection of cognitive impairment in AD and PD., Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Introduction: The Addenbrooke’s Cognitive Examination III (ACE-III) is a brief test useful for neuropsychological assessment. Several studies have validated the test for the diagnosis of Alzheimer’s disease (AD) and frontotemporal dementia (FTD). In this study, we aimed to examine the metabolic correlates associated with the performance of ACE-III in AD and behavioral variant FTD. Methods: We enrolled 300 participants in a cross-sectional study, including 180 patients with AD, 60 with behavioral FTD (bvFTD), and 60 controls. An 18F-Fluorodeoxyglucose positron emission tomography study was performed in all cases. Correlation between the ACE-III and its domains (attention, memory, fluency, language, and visuospatial) with the brain metabolism was estimated. Results: The ACE-III showed distinct neural correlates in bvFTD and AD, effectively capturing the most relevant regions involved in these disorders. Neural correlates differed for each domain, especially in the case of bvFTD. Lower ACE-III scores were associated with more advanced stages in both disorders. The ACE-III exhibited high discrimination between bvFTD vs. HC, and between AD vs. HC. Additionally, it was sensitive to detect hypometabolism in brain regions associated with bvFTD and AD. Conclusion: Our study contributes to the knowledge of the brain regions associated with ACE-III, thereby facilitating its interpretation, and highlighting its suitability for screening and monitoring. This study provides further validation of ACE-III in the context of AD and FTD., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Objective: The Cross-Cultural Dementia (CCD) is a new screening tool to evaluate cognitive impairment based on a cross-cultural perspective to reduce the bias of education, and language and cultural differences. We aimed to evaluate the diagnostic properties of the CCD in Spaniards for the assessment of patients with Alzheimer’s disease in mild cognitive impairment (AD-MCI) and mild dementia stages (AD-D) and patients with mild cognitive impairment associated with Parkinson’s disease (PD-MCI). Methods: Sixty participants with AD (50% MCI) and thirty with PD-MCI were enrolled. Each clinical group was compared against a healthy control group (HC) with the same number of participants and no significant differences in age, education, and sex. A comprehensive neuropsychological test battery and CCD were completed. Intergroup comparisons, ROC curves, and cut-off scores were calculated for the study of diagnostic properties. Results: Intergroup differences were found in accordance with the cognitive profile of each clinical condition. Memory measures (Objects test) were especially relevant for the classification between AD and HC. Memory and executive function scores (Sun-Moon and Dots tests) were useful in the case of PD-MCI and HC. Furthermore, CCD described differences in executive functions and speed scores comparing AD-MCI and PD-MCI. Correlations between standardized neuropsychological tests and CCD measures supported the convergent validity of the test. Conclusion: CCD showed good discrimination properties and cut-off scores for dementia and extended its application to a sample of prodromal stages of AD and PD with mild cognitive impairment., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Background Several batteries have been developed for the cognitive assessment of people with multiple sclerosis (MS). However, all these tests have some limitations in general clinical practice and from a cross-cultural perspective. In this study, we aimed to validate a novel cognitive screening test, the Cross-Cultural Dementia screening test (CCD), in pwMS. Methods Seventy-five participants with relapsing-remitting MS and 75 healthy controls were enrolled and completed a comprehensive neuropsychological battery and the CCD. Intergroup comparisons, effect sizes, and correlations with previously validated tests were calculated for a majority and a pilot study of a minority sample. ROC curves were estimated, and random forest classification models were developed. Results There were statistically significant differences between cognitively impaired MS (MS-CI) group and healthy controls, and between MS-CI and non-cognitively impaired MS group in all subtests of CCD with medium to large effect sizes. Correlations with standardized neuropsychological tests were moderate to high, supporting concurrent validity. These results were replicated in the minority sample. The random forest models showed a very accurate classification using the CCD. This test showed good psychometric properties compared with SDMT. Conclusions Our study validates the CCD for cognitive impairment screening in MS, showing advantages over other routinely used cognitive tests., Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Arquitectura de Computadores y Automática, Depto. de Medicina, Fac. de Psicología, Fac. de Informática, Fac. de Medicina, TRUE, pub

Genomic studies have identified numerous genetic variants associated with sus-ceptibility to multiple sclerosis (MS); however, each one explains only a small percentage of therisk of developing the disease. These variants are located in genes involved in specific path-ways, which supports the hypothesis that the risk of developing MS may be linked to alterationsin these pathways, rather than in specific genes. We analyzed the role of the TNFRSF1A gene,which encodes one of the TNF- receptors involved in a signaling pathway previously linked toautoimmune disease.Methods: We included 138 individuals from 23 families including at least 2 members with MS,and analyzed the presence of exonic variants of TNFRSF1A through whole-exome sequencing.We also conducted a functional study to analyze the pathogenic mechanism of variant rs4149584(-g.6442643C > G, NM 001065.4:c.362 G > A, R92Q) by plasmid transfection into human oligo-dendroglioma (HOG) cells, which behave like oligodendrocyte lineage cells; protein labelingwas used to locate the protein within cells. We also analyzed the ability of transfected HOGcells to proliferate and differentiate into oligodendrocytes., Depto. de Genética, Fisiología y Microbiología, Fac. de Ciencias Biológicas, TRUE, pub

Background: Recent models of visuospatial functioning suggest the existence of three main circuits emerging from the dorsal (“where”) route: parietoprefrontal pathway, parieto-premotor, and parieto-medial temporal. Neural underpinnings of visuospatial task performance and the sparing of visuospatial functioning in bvFTD are unclear. We hypothesized different neural and cognitive mechanisms in visuospatial tasks performance in bvFTD and AD. Methods: Two hundred and sixteen participants were enrolled for this study: 72 patients with bvFTD dementia and 144 patients with AD. Visual Object and Space Perception Battery Position Discrimination and Number Location (VOSP-PD and VOSP-NL) and Rey-Osterrieth Complex Figure (ROCF) were administered to examine visuospatial functioning, together with a comprehensive neuropsychological battery. FDG-PET was acquired to evaluate brain metabolism. Voxel-based brain mapping analyses were conducted to evaluate the brain regions associated with visuospatial function in bvFTD and AD. Results: Patients with AD performed worst in visuospatial tasks in mild dementia, but not at prodromal stage. Attention and executive functioning tests showed higher correlations in bvFTD than AD with ROCF, but not VOSP subtests. Visuospatial performance in patients with bvFTD was associated with bilateral frontal regions, including the superior and medial frontal gyri, supplementary motor area, insula and middle cingulate gyrus. Conclusion: These findings support the role of prefrontal and premotor regions in visuospatial processing through the connection with the posterior parietal cortex and other posterior cortical regions. Visuospatial deficits should be interpreted with caution in patients with bvFTD, and should not be regarded as hallmarks of posterior cortical dysfunction., Instituto de Salud Carlos III, Comisión Europea, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background: Fatigue is one of the most common symptoms in neurology, especially in MS patients with a prevalence of 65%. It is described as the most disabling symptom by 40% of MS patients. This study aimed to validate the Functional Assessment of Chronic Illness Therapy fatigue version (FACIT-F) and the F-2-MS scale, a new tool to distinguish between fatigue and fatigability. Methods: One hundred and fifteen patients with relapsing-remitting MS were enrolled. All patients completed a comprehensive neuropsychological battery, previously validated in MS. Fatigue was evaluated using the Fatigue Severity Scale (FSS), the Modified version of the Fatigue Impact Scale (MFIS), the Functional Assessment of Chronic Illness Therapy measure system (fatigue version) (FCIT-F), and a new tool for the assessment of fatigue and fatigability: the F-2-MS scale. Internal consistency was estimated with Cronbach’s Alpha. For intergroup comparisons, Student’s t-test and Pearson’s chi-squared test were used. Pearson’s correlation test was calculated for quantitative variables. Cohen’s d was calculated to evaluate the effect size. Binary logistic regression was performed, considering the presence of fatigue as a criterion variable, and the FACIT-F and F-2-MS scores were added as predictor variables. ROC curves were also estimated. We conducted a confirmatory factor analysis for the F-2-MS scale, considering two latent factors. Results: FACIT-F and F-2-MS showed high internal consistency. Both scales were highly correlated with MFIS and FSS, and showed a low correlation with Symbol Digit Modalities Test. There were significant differences between fatigued and non-fatigued patients on FACIT-F and F-2-MS scores with large effect sizes. Both scales showed AUC > 0.90 and achieved a correct classification >87%. Confirmatory factor analysis showed moderate evidence of two dimensions on the F-2-MS scale. Conclusions: The FACIT-F and F-2-MS scales showed appropriated psychometric properties to be u, Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Background: Primary progressive aphasia (PPA) is a clinical syndrome characterized by gradual loss of language skills. This study aimed to evaluate the diagnostic capacity of a connected speech task for the diagnosis of PPA and its variants, to determine the main components of spontaneous speech, and to examine their neural correlates. Methods: A total of 118 participants (31 patients with nfvPPA, 11 with svPPA, 45 with lvPPA, and 31 healthy controls) were evaluated with the Cookie Theft picture description task and a comprehensive language assessment protocol. Patients also underwent 18F-fluorodeoxyglucose positron emission tomography and magnetic resonance imaging studies. Principal component analysis and machine learning were used to evaluate the main components of connected speech and the accuracy of connected speech parameters for diagnosing PPA. Voxel-based analyses were conducted to evaluate the correlation between spontaneous speech components and brain metabolism, brain volumes, and white matter microstructure. Results: Discrimination between patients with PPA and controls was 91.67%, with 77.78% discrimination between PPA variants. Parameters related to speech rate and lexical variables were the most discriminative for classification. Three main components were identified: lexical features, fluency, and syntax. The lexical component was associated with ventrolateral frontal regions, while the fluency component was associated with the medial superior prefrontal cortex. Number of pauses was more related with the left parietotemporal region, while pauses duration with the bilateral frontal lobe. The lexical component was correlated with several tracts in the language network (left frontal aslant tract, left superior longitudinal fasciculus I, II, and III, left arcuate fasciculus, and left uncinate fasciculus), and fluency was linked to the frontal aslant tract. Conclusion: Spontaneous speech assessment is a useful, brief approach for the diagnosis of PPA andi, Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Arquitectura de Computadores y Automática, Depto. de Radiología, Rehabilitación y Fisioterapia, Depto. de Medicina, Fac. de Psicología, Fac. de Informática, Fac. de Medicina, TRUE, pub

La Esclerosis Lateral Amiotrófica es un desorden neurodegenerativo, progresivo e incapacitante, caracterizada por la degeneración de las motoneuronas superiores de la corteza cerebral, las motoneuronas inferiores del tronco cerebral y motoneuronas de la médula espinal. La edad de inicio de esta enfermedad es variable, generalmente, suele originarse en la edad adulta, en torno a los 40-60 años. La neuropatología asociada a esta enfermedad presenta diferentes aspectos, como pueden ser la degeneración de las motoneuronas, las inclusiones intracitoplasmáticas y la neuroinflamación, caracterizada por aumento de la microgliosis y astrogliosis, tanto de la corteza motora como de la médula espinal. En la actualidad se desconocen los mecanismos que subyacen el inicio de esta enfermedad, sin embargo, las investigaciones realizadas durante los últimos años han permitido determinar ciertos mecanismos que están involucrados en la ELA, entre ellos se encuentran el estrés oxidativo, la desregulación del tráfico axonal, la excitotoxicidad mediada por glutamato, alteraciones en el metabolismo del ARN y alteraciones en la homeostasis proteica...

La esclerosis múltiple (EM) es una enfermedad compleja y heterogénea que se caracteriza por la influencia de diferentes factores, como son genéticos, ambientales y epigenéticos. Gracias a los estudios realizados hasta la fecha se han identificado variantes genéticas y genes que están involucrados con el riesgo de desarrollar EM. Los estudios que han permitido conocer gran parte de la información genética conocida son los estudios de asociación del genoma completo (GWAS). La gran parte de las variantes de riesgo identificadas se encuentran en genes que pertenecen a vías de señalización relacionadas con la inmunidad. En concreto, muchos de las variantes y genes de interés pertenecen a vías de señalización relacionadas con la inmunidad innata. A pesar del éxito de los GWAS, estos estudios presentan diferentes sesgos que solo han permitido conocer una parte del componente genético de la enfermedad. La secuenciación completa de exoma (WES) es una técnica que permite profundizar en el conocimiento del componente genético de la EM mediante la secuenciación de la región codificante de todo el genoma..., Multiple sclerosis (MS) is a complex and heterogeneous disease, characterized by genetics, environmental and epigenetics factors. Several genes and genetic variants involved with the risk of developing MS have been identified. The majority of this known information has been detected by genome-wide association studies (GWAS). Many of the identified variants are located in genes implicated in pathways related to innate immunity. Despite the success of GWAS, these studies have only revealed part of the genetic component of MS due to different biases involved in these studies. Whole-exome sequencing (WES) is a technique which sequences the coding region of the entire genome allowing us to improve our knowledge of genetic basis of MS...

La Esclerosis Lateral Amiotrófica es un desorden neurodegenerativo, progresivo e incapacitante, caracterizada por la degeneración de las motoneuronas superiores de la corteza cerebral, las motoneuronas inferiores del tronco cerebral y motoneuronas de la médula espinal. La edad de inicio de esta enfermedad es variable, generalmente, suele originarse en la edad adulta, en torno a los 40-60 años. La neuropatología asociada a esta enfermedad presenta diferentes aspectos, como pueden ser la degeneración de las motoneuronas, las inclusiones intracitoplasmáticas y la neuroinflamación, caracterizada por aumento de la microgliosis y astrogliosis, tanto de la corteza motora como de la médula espinal. En la actualidad se desconocen los mecanismos que subyacen el inicio de esta enfermedad, sin embargo, las investigaciones realizadas durante los últimos años han permitido determinar ciertos mecanismos que están involucrados en la ELA, entre ellos se encuentran el estrés oxidativo, la desregulación del tráfico axonal, la excitotoxicidad mediada por glutamato, alteraciones en el metabolismo del ARN y alteraciones en la homeostasis proteica..., Amyotrophic lateral sclerosis is a progressive and disabling neurodegenerative disorder characterized by degeneration of the upper motor neurons of the cerebral cortex, the lower motor neurons of the brain stem and motor neurons of the spinal cord. The age of onset of this disease is variable; generally, it usually originates in adulthood, around 40-60 years of age.The neuropathology associated with this disease presents different aspects such as motor neuron degeneration, intracytoplasmic inclusions and neuroinflammation characterized by increased microgliosis and astrogliosis in both motor cortex and spinal cord. The mechanisms underlying the onset of this disease are currently unknown; however, research carried out in recent years has made it possible to determine certain mechanisms involved in ALS, including oxidative stress, deregulation of axonal trafficking, glutamate-mediated excitotoxicity, alterations in ARN metabolism and alterations in protein homeostasis...

Publicado en la sección Correspondence, The cognitive and language processes underlying verbal fluency remain unclear. While some cognitive processes related to memory and executive functioning have been more associated with category and letter verbal fluency, other less studied aspects of language ability could be also related. We discuss the contribution of the recent study by Lebkuecher and colleagues (2021) about the role of language in verbal fluency, and the data from other studies evaluating the cognitive and neuroimaging correlates of verbal fluency in MS, Instituto de Salud Carlos III, European Commission, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

La esclerosis múltiple (EM) es una enfermedad compleja y heterogénea que se caracteriza por la influencia de diferentes factores, como son genéticos, ambientales y epigenéticos. Gracias a los estudios realizados hasta la fecha se han identificado variantes genéticas y genes que están involucrados con el riesgo de desarrollar EM. Los estudios que han permitido conocer gran parte de la información genética conocida son los estudios de asociación del genoma completo (GWAS). La gran parte de las variantes de riesgo identificadas se encuentran en genes que pertenecen a vías de señalización relacionadas con la inmunidad. En concreto, muchos de las variantes y genes de interés pertenecen a vías de señalización relacionadas con la inmunidad innata. A pesar del éxito de los GWAS, estos estudios presentan diferentes sesgos que solo han permitido conocer una parte del componente genético de la enfermedad. La secuenciación completa de exoma (WES) es una técnica que permite profundizar en el conocimiento del componente genético de la EM mediante la secuenciación de la región codificante de todo el genoma...

Objective: Episodic memory is frequently impaired in Multiple Sclerosis (MS), but the cognitive characteristics and neuropsychological processes involved remain controversial. Our aim was to study episodic memory dysfunction in MS, using the LASSI-L, a novel memory-based cognitive stress test that uses a new paradigm that capitalizes on semantic interference. Methods: Cross-sectional study in which 93 patients with MS (relapsing-remitting) and 124 healthy controls were included. The LASSI-L test was administered to all participants, as well as a comprehensive neuropsychological battery including a selective reminding test. MS patients were divided into two groups, with cognitive impairment (CI-MS) and cognitively preserved (CP-MS). Results: Reliability of the LASSI-L test was high (Cronbach's alpha 0.892) and there were less ceiling effects. MS patients scored lower than controls on all LASSI-L subtests, except for maximum storage of the initial target items (CRA2). Effect sizes were moderate-large. A delay in learning, difficulties in retroactive semantic interference, failure to recover from proactive semantic interference, and delayed recall were the most frequent findings in MS patients. Scores associated with maximum storage capacity, and retroactive semantic interference were the most strongly associated with cognitive impairment and employment status. Conclusion: We found that deficits in maximum learning, difficulties in recovery from the effects of proactive semantic interference and retroactive semantic interference are three important breakdowns in episodic memory deficits among patients with MS. The LASSI-L showed good psychometric and diagnostic properties. Overall, our study supports the utility of the LASSI-L, as a new cognitive test, useful for neuropsychological assessment in MS in clinical and research settings., Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Background: Cognitive dysfunction is prevalent among patients with multiple sclerosis (MS). In recent years, several (generally brief) neuropsychological batteries have been proposed for cognitive assessment. There is a need for comprehensive batteries providing complete cognitive assessment of patients with MS. The Neuronorma battery includes several standardised neuropsychological tests examining the main cognitive domains, and is available in several countries. The aim of this study was to validate the battery for cognitive assessment in a sample of patients with MS and healthy controls, and to find the most appropriate criteria for defining cognitive impairment using this battery. Methods: Five hundred and sixty participants (280 with MS and 280 controls matched for age, sex, and years of education) were included. Inter-group differences were calculated using the Mann-Whitney U test and effect sizes with Cohen's d. Several criteria for definition of cognitive impairment were evaluated, according to different cut-off points, and the number of tests and cognitive domains impaired. Receiver operating characteristic curves with 95% confidence intervals were estimated and they were compared using the DeLong method. Results: Patients with MS showed poorer performance in almost all cognitive tests, with large effect sizes for the Symbol Digit Modalities Test and Judgement of Line Orientation, and moderate effects for Digit Span Backward, the Corsi test, Trail Making Test, Free and Cued Selective Reminding Test, Rey-Osterrieth Complex Figure (recall), verbal fluency (P words), and the Stroop Color-Word Interference Test. The area under the curve was superior for classification by cognitive domain than for the mean scaled score of the tests or the number of tests showing impairment according to different cut-off points for the adjusted scaled scores. Conclusions: Our study validates the Neuronorma battery for cognitive assessment of patients with MS. The battery is curre, Pfizer Foundation, Medical Department of Pfizer, SA, Spain, Instituto de Salud Carlos III, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

The assessment of social cognition changes may be challenging, especially in the earliest stages of some neurodegenerative diseases. Our objective was to validate a social cognition battery from a multidomain perspective. In this regard, we aimed to adapt several tests, collect normative data, and validate them in prodromal Alzheimer’s disease (AD) and multiple sclerosis (MS). Methdos: A total of 92 healthy controls, 25 prodromal AD, and 39 MS patients were enrolled. Age-, gender-, and education-matched control groups were created for comparisons. Social cognition battery was composed of an emotion-labeling task developed from FACES database, the Story-based Empathy test (SET), the Faux Pas test, and the Interpersonal Reactivity Index. Patients were also evaluated with a comprehensive cognitive battery to evaluate the other cognitive domains. Automatic linear modeling was used to predict each social cognition test’s performance using the neuropsychological tests examining other cognitive domains. Results: The reliability of the battery was moderate-high. Significant intergroup differences were found with medium-large effect sizes. Moderate correlations were found between social cognition battery and neuropsychological tests. The emotion labeling task and SET showed moderate correlations with age and education, and age, respectively. Regression-based norms were created considering the relevant demographic variables. Linear regression models including other neuropsychological tests explained between 7.7% and 68.8% of the variance of the social cognition tests performance. Conclusions: Our study provides a battery for the assessment of social cognition in prodromal AD and MS with Spanish normative data to improve the evaluation in clinical and research settings, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Fac. de Psicología, TRUE, pub

Publicado en la sección Letters to the Editor - Correspondence, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Depto. de Medicina, Fac. de Psicología, Fac. de Medicina, TRUE, pub

La esclerosis múltiple (EM) es la enfermedad desmielinizante más frecuente y la primera causa de discapacidad neurológica no traumática en adultos jóvenes. Es clínicamente heterogénea, incluye síntomas motores, cognitivos y fatiga. Esto es el resultado de una combinación de los principales procesos fisiopatológicos involucrados: inflamación, desmielinización, daño axonal y neurodegeneración. En los últimos años, se han desarrollado distintas terapias modificadoras de la enfermedad, dirigidas a actuar sobre el sistema inmunitario, con un efecto antiinflamatorio, que tienen por objetivo de intentar prevenir las recaídas y ralentizar la progresión de la discapacidad...

El envejecimiento poblacional ha generado grandes cambios en los sistemas sanitarios. La sanidad actual presenta un incremento de la demanda y un aumento del coste de los servicios médicos. La atención neurológica de nuestro país ha presentado un cambio relevante en las últimas dos décadas. El perfil del paciente tiene una edad media más alta y ha crecido espectacularmente el motivo de consulta por patología cognitiva. La telemedicina y las consultas no presenciales se plantean como soluciones para mejorar la eficiencia de los sistemas de salud. Estas innovaciones mejorarían la accesibilidad y abaratarían los costes sanitarios. Esta tesis plantea la hipótesis de que una consulta virtual de resultados (en las consultas externas de neurología) mejorará la productividad laboral y la eficacia de los procesos asistenciales. Este modelo de consulta deberá mantener la satisfacción del paciente y del profesional. Además,generará un impacto favorable medioambiental al evitar emisiones de gases contaminantes evitando los traslados de pacientes y acompañantes...

El envejecimiento poblacional ha generado grandes cambios en los sistemas sanitarios. La sanidad actual presenta un incremento de la demanda y un aumento del coste de los servicios médicos. La atención neurológica de nuestro país ha presentado un cambio relevante en las últimas dos décadas. El perfil del paciente tiene una edad media más alta y ha crecido espectacularmente el motivo de consulta por patología cognitiva. La telemedicina y las consultas no presenciales se plantean como soluciones para mejorar la eficiencia de los sistemas de salud. Estas innovaciones mejorarían la accesibilidad y abaratarían los costes sanitarios. Esta tesis plantea la hipótesis de que una consulta virtual de resultados (en las consultas externas de neurología) mejorará la productividad laboral y la eficacia de los procesos asistenciales. Este modelo de consulta deberá mantener la satisfacción del paciente y del profesional. Además,generará un impacto favorable medioambiental al evitar emisiones de gases contaminantes evitando los traslados de pacientes y acompañantes..., The aging of population has generated great changes in health systems. Current healthcare presents an increase in demand and an increase in the cost of healthcare. The neurological attention of our country has presented a relevant change in the last two decades. The profile of the patient has a higher average age and the reason for consultation due to cognitive symptoms has grown dramatically. Telemedicine and telehealth could be a solution to improve the efficiency of health services. These innovations would improve accessibility and lower healthcare costs. This thesis raises the hypothesis that a virtual consultation of results (in a neurology outpatient clinic) will improve productivityand effectiveness of care processes. This consultation model should maintain patient and professional satisfaction. In addition, it will generate a favorable environmental impact by avoiding emissions of polluting gases, avoiding transfers of patients and companions...

La esclerosis múltiple (EM) es la enfermedad desmielinizante más frecuente y la primera causa de discapacidad neurológica no traumática en adultos jóvenes. Es clínicamente heterogénea, incluye síntomas motores, cognitivos y fatiga. Esto es el resultado de una combinación de los principales procesos fisiopatológicos involucrados: inflamación, desmielinización, daño axonal y neurodegeneración. En los últimos años, se han desarrollado distintas terapias modificadoras de la enfermedad, dirigidas a actuar sobre el sistema inmunitario, con un efecto antiinflamatorio, que tienen por objetivo de intentar prevenir las recaídas y ralentizar la progresión de la discapacidad..., Multiple sclerosis (MS) is the most common demyelinating disease and the main cause of non-traumatic neurological disability in young adults. It is a clinically heterogeneous disease, including motor, cognitive and fatigue symptoms. This is the result of a combination of the main pathophysiological processes involved: inflammation, demyelination, axonal damage and neurodegeneration. In recent years, various disease-modifying therapies have been developed, aimed at acting on the immune system, with an anti-inflammatory effect that prevents relapses and slows the progression of disability...

Developing new distillation strategies can help the spirits industry to improve quality, safety and process efficiency. Batch stills equipped with a packed column and an internal partial condenser are an innovative experimental system, allowing a fast and flexible management of the rectification. In this study, the impact of four factors (heart-cut volume, head-cut volume, pH and cooling flow rate of the internal partial condenser during the head-cut fraction) on 18 major volatile compounds of Muscat spirits was optimized using response surface methodology and desirability function approaches. Results have shown that high rectification at the beginning of the heart-cut enhances the overall positive aroma compounds of the product, reducing off-flavor compounds. In contrast, optimum levels of heart-cut volume, head-cut volume and pH factors varied depending on the process goal. Finally, three optimal operational conditions (head off-flavors reduction, flowery terpenic enhancement and fruity ester enhancement) were evaluated by chemical and sensory analysis., Universitat Rovira i Virgili, Depto. de Química Analítica, Fac. de Ciencias Químicas, TRUE, pub

Las enfermedades desmielinizantes del sistema nervioso central SNC constituyen un amplio espectro de enfermedades inflamatorias idiopáticas en las que intervienen diferentes procesos y factores que se caracterizan por provocar un daño en la mielina del SNC. La enfermedad más representativa de este grupo es la Esclerosis múltiple (EM). Hay evidencia de que al inicio de la EM, existe una remielinización en las lesiones desmielinizadas. Se sabe poco sobre el papel de la VD durante la mielinización, pero hay varios estudios han indicado un potencial papel de la VD en la mielinización y la remielinización. Además, es considerada como un neuroesteroide. La VD tiene función directa sobre la expresión de la sintasa del ácido nítrico inducible en la microglía, esto podría influir en el equilibrio inflamatorio-antiinflamatorio que es relevante en la remielinización. La VD también aumenta la activación microglial lo que podría facilitar la eliminación de los restos de mielina y facilitar la remielinización. Asimismo, las células madre de origen neural (NSC) expresan VDR y 1,25(OH)2D. 1,25(OH)2D incrementa la proliferación de las NSC y su diferenciación a neuronas y oligodendrocitos reduciendo la artrogliosis. Por lo que la VD es considerada como un neuroesteroide y modula la inflamación y juega un papel primordial en los eventos remielinizantes y neuroprotectores en el sistema nerviosos central y puede estimular la generación de oligodendrocitos en los nichos neurogénicos clásicos..., Demyelinating diseases of the central nervous system CNS constitute a broad spectrum of idiopathic inflammatory diseases involving different processes and factors that are characterized by damage to the myelin sheaths of the CNS. The most representative of this group is the Multiple Sclerosis (MS). There is evidence that at the beginning of the EM, there is a remyelination in the unmyelinated. Little is known about the role of the VD during myelination, but there are several studies have indicated a potential role of the VD in myelination and remyelination. In addition, it is considered as a Neuroesteroide. The VD has direct role on the expression of the inducible nitric acid synthase in the microglia, this could influence the balance inflammatory-anti-inflammatory that is relevant in the remyelination. The VD also increases the microglial activation, which could facilitate the elimination of the remnants of myelin and facilitate remyelination. In addition, the neural stem cells (NSC) express VDR and 1.25(OH)2D. 1.25(OH)2D increases the proliferation of NSC and their differentiation into neurons and oligodendrocytes by reducing the artrogliosis. So the VD is considered as a neuroesteroid and modulates the inflammation and plays an important role in the neuroprotective agents in the central nervous system and can stimulate the generation of oligodendrocytes in the classic neurogenic niches...

Las Epilepsias Generalizadas Idiopáticas (EGI) constituyen una quinta parte de todos los casos de epilepsia. Se trata de un conjunto de síndromes de inicio en la infancia o adolescencia caracterizados por la combinación variable de crisis de ausencia, tónico clónicas generalizadas (TCG) y mioclónicas; por una frecuente sensibilidad a los fármacos antiepilépticos, especialmente el valproato (VPA); y por la presencia de rasgos reflejos como la fotosensibilidad. El hallazgo característico en el electroencefalograma (EEG) es la descarga de punta-onda (PO) o polipunta-onda (PPO) generalizada a 3-4 Hz, que suele mostrar activación con el sueño no REM, la hiperventilación (HV), la Estimulación Lumínica Intermitente (ELI) y/o la realización de ciertas praxias. Los cuatro síndromes principales son: Epilepsia de ausencias infantiles (EAI); Epilepsia de Ausencias Juveniles (EAJ); Epilepsia Mioclónica Juvenil (EMJ); y Epilepsia con Crisis Tónico Clónicas Sólo (EGI-Sólo TCG). Entre los rasgos reflejos característicos de la EGI, la activación o inducción con praxias (IP) se define por la inducción de actividad epileptiforme (AE) y crisis epilépticas con actividades que requieren concentración y algún movimiento dirigido de las manos (jugar al ajedrez, escribir, o hacer un puzzle). Es más frecuente y característica en EMJ (12,7-84%), si bien se ha descrito en todos los síndromes dentro de la EGI..., Idiopathic Generalized Epilepsies (IGE) account for 15-20% of cases of epilepsy. They comprise a group of different syndromes starting during childhood or adolescence and characterized by a variable combination of absences, generalized tonic-clonic (GTC) and myoclonic seizures. They have a good response to antiepileptic drugs, particularly to valproic acid (VPA), and present typical reflexes such as photosensitivity. Hallmark on EEG are generalized epileptiform discharges (ED) of spike-and-wave (SW) or Polyspike-and-wave (PSW) that are typically induced by non-REM sleep, hyperventilation (HV), Intermittent Photic Stimulation (IPS) and certain praxis. Principal IGE Syndromes are Childhood Absences Epilepsy (CAE), Juvenile Absences Epilepsy (JAE), Juvenile Myoclonic Epilepsy (JME), and Epilepsy with Generalized Tonic –Clonic Seizures Alone (IGE-GTCS). Paxis induction (PI) in IGE is defined as the precipitation of ED and/or seizures followed by complex and cognition-guided tasks often involving visuomotor coordination with hands (playing chess, writing, etc). PI is typical and more frequent in JME (12.7-84%), although if it has been described in all IGE syndromes. IGE is also characterized by an intellectual functioning within the normal range. Nevertheless, cognition in IGE has been mainly studied in patients with JME. Several authors have found an executive dysfunction associated with a specific personality profile in this group; firstly described by Janz in a published series of cases of JME (1957) as “unsteadiness, lack of discipline and hedonism”...

Las Epilepsias Generalizadas Idiopáticas (EGI) constituyen una quinta parte de todos los casos de epilepsia. Se trata de un conjunto de síndromes de inicio en la infancia o adolescencia caracterizados por la combinación variable de crisis de ausencia, tónico clónicas generalizadas (TCG) y mioclónicas; por una frecuente sensibilidad a los fármacos antiepilépticos, especialmente el valproato (VPA); y por la presencia de rasgos reflejos como la fotosensibilidad. El hallazgo característico en el electroencefalograma (EEG) es la descarga de punta-onda (PO) o polipunta-onda (PPO) generalizada a 3-4 Hz, que suele mostrar activación con el sueño no REM, la hiperventilación (HV), la Estimulación Lumínica Intermitente (ELI) y/o la realización de ciertas praxias. Los cuatro síndromes principales son: Epilepsia de ausencias infantiles (EAI); Epilepsia de Ausencias Juveniles (EAJ); Epilepsia Mioclónica Juvenil (EMJ); y Epilepsia con Crisis Tónico Clónicas Sólo (EGI-Sólo TCG). Entre los rasgos reflejos característicos de la EGI, la activación o inducción con praxias (IP) se define por la inducción de actividad epileptiforme (AE) y crisis epilépticas con actividades que requieren concentración y algún movimiento dirigido de las manos (jugar al ajedrez, escribir, o hacer un puzzle). Es más frecuente y característica en EMJ (12,7-84%), si bien se ha descrito en todos los síndromes dentro de la EGI...

Las enfermedades desmielinizantes del sistema nervioso central SNC constituyen un amplio espectro de enfermedades inflamatorias idiopáticas en las que intervienen diferentes procesos y factores que se caracterizan por provocar un daño en la mielina del SNC. La enfermedad más representativa de este grupo es la Esclerosis múltiple (EM). Hay evidencia de que al inicio de la EM, existe una remielinización en las lesiones desmielinizadas. Se sabe poco sobre el papel de la VD durante la mielinización, pero hay varios estudios han indicado un potencial papel de la VD en la mielinización y la remielinización. Además, es considerada como un neuroesteroide. La VD tiene función directa sobre la expresión de la sintasa del ácido nítrico inducible en la microglía, esto podría influir en el equilibrio inflamatorio-antiinflamatorio que es relevante en la remielinización. La VD también aumenta la activación microglial lo que podría facilitar la eliminación de los restos de mielina y facilitar la remielinización. Asimismo, las células madre de origen neural (NSC) expresan VDR y 1,25(OH)2D. 1,25(OH)2D incrementa la proliferación de las NSC y su diferenciación a neuronas y oligodendrocitos reduciendo la artrogliosis. Por lo que la VD es considerada como un neuroesteroide y modula la inflamación y juega un papel primordial en los eventos remielinizantes y neuroprotectores en el sistema nerviosos central y puede estimular la generación de oligodendrocitos en los nichos neurogénicos clásicos...

INTRODUCCIÓN: La epilepsia es uno de los trastornos neurológicos más frecuentes, presente en todas las sociedades y grupos de edad. La Organización Mundial de la Salud estima que 50 millones de personas padecen o han padecido epilepsia en algún momento de su vida en todo el mundo (WHO, 2012). Se trata de una patología crónica con un alto impacto social y sobre la calidad de vida tanto para quien lo sufre como sus familiares, pero también para el sistema sanitario y económico. Hasta la fecha se han realizado numerosos estudios epidemiológicos, pero la realidad es que todavía existen muchas controversias acerca de la verdadera frecuencia y distribución a lo largo de la geografía mundial de la epilepsia (Bell et al., 2014; Begui y Hesdorffer, 2014). La mayor parte de los estudios ofrecen datos sobre la epilepsia activa (EA), siendo escasos los que también aportan resultados sobre la epilepsia a lo largo de la vida (ELV). En el caso de la epilepsia activa, las cifras son dispares y varían entre 2,3 por cada 1000 habitantes en un estudio realizado en Libia (Sridharan et al., 1986) hasta 57 por cada 1000 habitantes en una pequeña comunidad en Panamá (Gracia et al., 1990). Por otro lado, los resultados acerca de la prevalencia de epilepsia a lo largo de la vida fluctuan entre 2,9 por 1000 habitantes en Rochester en el año 1940 (Hauser et al., 1991) y 32,1 por 1000 habitantes en un área rural de Perú (Montano et al., 2005). A pesar de estos valores extremos, la mayoría de los autores consideran que la prevalencia de epilepsia se encuentra en cifras entre 5-10 por 1000 habitantes aplicable a la población mundial general (Sander y Shorvon, 1996). Por otra parte, la prevalencia de la epilepsia a nivel mundial y su distribución en base al nivel de desarrollo económico continúa siendo un dilema y motivo de debate actual. Según diversos autores, varía según el grado de desarrollo de un país, con tendencia a ser más baja en países desarrollados frente a los menos desarrollados y d, INTRODUCTION: Epilepsy is one of the most frequent neurologic disorders; it can be found in any society, across all age groups. The World Health Organization estimates that 50 million people suffer or have suffered epilepsy at any moment of their lives (WHO, 2012). It is a chronic pathology with a high impact both socially and in quality of life terms, but also for the healthcare and economic system. There have been a large number of epidemiologic studies up to now, but the fact is that there are still many controversies surrounding the actual frequency and distribution of epilepsy worldwide (Bell et al., 2014; Begui and Hesdorffer, 2014). Most studies offer data about active epilepsy (AE), being fewer those contributing results about lifetime epilepsy (LTE). With respect to active epilepsy, figures are disparate, ranging from 2,3 cases per 1000 inhabitants in a study conducted in Libya (Sridharan et al., 1986) to 57 per 1000 inhabitants in a small community in Panama (Gracia et al., 1990). On the other hand, results about the prevalence of lifetime epilepsy vary from 2,9 cases per 1000 inhabitants in Rochester in 1940 (Hauser et al., 1991) and 32,1 per 1000 inhabitants in a rural area in Peru (Montano et al., 2005). In spite of these extreme values, most authors consider that the prevalence of active epilepsy can be measured from 5 to 10 per 1000 inhabitants when considering the global population (Sander and Shorvon, 1996). Moreover, the prevalence of epilepsy worldwide and its distribution in relation with economic development levels is still a current issue and a matter of debate. According to several authors, it varies with the development level of a country, tending to be lower in developed countries than in developed ones, and within these underdeveloped countries, higher in rural areas than in urban ones (Banerjee et al., 2009; Jallon, 1997; Ngugi et al., 2010, Sander and Shorvon, 1996). 4-7 per 1000 inhabitants is the estimation in developed countries (Sande

La apatía es uno de los síndromes neuropsiquiátricos más frecuentes e invalidantes de las demencias, y puede presentarse en cualquier estadio de la enfermedad. La presencia de la apatía en enfermedades neurodegenerativas se ha relacionado con una mayor morbilidad y un peor pronóstico, y con una mayor carga de estrés para el cuidador. Recientemente, se han propuesto unos criterios clínicos para el diagnóstico de apatía en la enfermedad de Alzheimer (EA) y otros trastornos neuropsiquiátricos. De acuerdo con la clasificación original de Marin, estos criterios se organizan en torno a tres dominios y resaltan la necesidad de una evaluación multidimensional de la apatía. Actualmente, la literatura existente acepta que se pueden distinguir tres subtipos o dimensiones de la apatía, asociados a disfunción de diferentes circuitos neurales: apatía cognitiva, apatía emocional y apatía por disfunción en la autoactivación. En castellano, tan sólo existen dos escalas validadas en demencias que evalúen la apatía desde un punto de vista multidimensional: la Lillés Apathy Rating Scale (LARS) y la Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH). La escala APADEM-NH está diseñada para evaluar la apatía en pacientes institucionalizados con EA mediante la entrevista a un cuidador profesional, por lo que no es válida para pacientes ambulatorios. La LARS consta de nueve dominios o subescalas (“Productividad diaria”, “Aficiones”, “Tomar la iniciativa”, “Búsqueda de novedades”, “Motivación”, “Respuesta emocional”, “Preocupación”, “Vida social” y “Autoconsciencia”), que pueden combinarse para calcular cuatro dimensiones de la apatía: “Curiosidad intelectual”, “Emoción”, “Iniciativa de acción” y “Autoconsciencia”. La versión en castellano de la LARS ha sido recientemente validada por nuestro grupo en una cohorte de pacientes con demencia, mostrando excelentes propiedades psicométricas..., Apathy is one of the most common and disabling syndromes of dementia, and presents at all stages of the disease. In neurodegenerative diseases, apathy is considered as an important source of morbidity that predicts clinical worsening and bad prognosis, and is generally accompanied by greater caregiver distress. A recent international consensus has proposed a set of new diagnostic criteria for apathy in Alzheimer's disease (AD) and other neuropsychiatric disorders (2009). According with Marińs original classification, these criteria include three symptomdomains and highlight the need for multidimensional assessment. Nevertheless, there is still a lack of objective tools to evaluate the different subtypes and many methods typically assess apathy as a non-dimensional concept. In Spanish, the only established apathy measures following a multidimensional apathetic structure are the Lillés Apathy Rating Scale (LARS) and the Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH). The APADEM-NH has been specifically designed for assessing apathy in institutionalized patients with AD through an interview with a professional caregiver, so it does not apply for ambulatory patients. The LARS includes 33 items grouped in nine domains (“Reduction in everyday productivity”, “Lack of interest”, “Lack of initiative”, “Extinction of novelty seeking”, “Motivation”, “Blunting of emotional responses”, “Lack of concern”, “Poor social life”, and “Extinction of self-awareness”), that can be combined to calculate four factors or dimensions of apathy: “Intellectual curiosity” (IC), “Emotion” (E), “Action initiation” (AI) and “Self-awareness” (SA). Our group have recently published the validation of the LARS in a dementia cohort, which demonstrated excellent psychometric properties...

Introducción: El vértigo recurrente asociado a la migraña es una causa de vértigo en los pacientes con migraña. Aunque es una entidad controvertida cada vez más autores defienden esta entidad y publican sobre el tema. Con una fisiopatología posiblemente relacionada a la migraña los pacientes presentan crisis recurrentes de vértigo que pueden durar de horas a varios días, Típicamente no suelen ser posicionales y no se acompañan de otros síntomas neurootológicos. Dentro del diagnóstico diferencial se deben incluir las causas más habituales de vértigo recurrente, como la enfermedad de Ménière, la vestibulopatía autoinmune o el vértigo recurrente asociado a la migraña. Responde habitualmente a los mismos tratamientos de la migraña, de tal manera que las crisis pueden mejorar con triptanes y el vértigo con fármacos preventivos de la migraña. Objetivos: Elaborar y validar unos criterios diagnósticos para el vértigo recurrente asociado a la migraña fiables, válidos y con confiabilidad. Validar su uso en la consulta y evaluación telefónica. Determinar la frecuencia que aparecen el vértigo recurrente asociado a la migraña en los pacientes con migraña y estimar la prevalencia en la población general..., Introduction: The recurrent vertigo associated with migraine is a cause of dizziness in patients with migraine. Although it is a controversial entity increasingly authors defend this institution and published on the subject. With a possibly related to the pathophysiology of migraine patients have recurrent episodes of vertigo that can last from hours to several days, typically they are not usually positional and not accompanied by other symptoms neurootológicos. The differential diagnosis should include the more common causes of recurrent vertigo, including Meniere's disease, autoimmune vestibulopathy or recurrent migraine-associated vertigo. Usually responds to the same treatments of migraine, so that crises can be improved with triptans and vertigo with migraine preventive drugs. Hypothesis and objectives: Develop and validate diagnostic criteria for recurrent vertigo associated with reliable, valid and reliable migraine. Validate use in telephone consultation and evaluation. Determine frequency listed recurrent migraine-associated vertigo in migraine patients and estimate the prevalence in the general population...

Ramón y Cajal introdujo el concepto de que la carga de neuronas del sistema nervioso central se mantiene inmutable tras el nacimiento (Ramon y Cajal 1928) y esta idea se consideró uno de los axiomas de las neurociencias hasta nuestros días. La posibilidad de que la neurogénesis se mantuviera en la edad adulta se apuntó por primera vez en estudios realizados en la zona subgranular del giro dentado del hipocampo de pájaros (Nottebohm 1989) y precisó de tiempo y numerosos estudios hasta que se aceptó en el total de los mamíferos y en el humano (Altman 1962, Yuan et al. 2014). Existen dos nichos neurogénicos claramente establecidos y conservados a lo largo de las especies a los que se llama nichos neurogénicos clásicos: la zona subventricular y la zona subgranular del giro dentado. La zona subventricular se encuentra adyacente al ventriculo lateral y está formada por tres capas: la capa ependimaria, la capa hipocelular o GAP y la capa astrocitaria o ribbon. La neurogénesis en la SVZ pasa por una serie de fases celulares partiendo de las células neurales progenitoras proliferativas que se encuentran en una fase de división y proliferación y que tienen marcadores gliales (Kriegstein y Alvarez- Buylla 2009), células tipo B, a las células neurales progenitoras que todavía mantienen alguna carácterística glial pero ya presentan alguna diferenciación neuronal (células tipo C) a los neuroblastos (tipo A)..., The number of neurons in the central nervous system was considered immutable after Ramon y Cajal’s works (Ramon y Cajal 1928). The concept of adult neurogenesis was introduced after some studies in the brain of adult birds (Nottebohm 1989), more evidence was needed until this concept was accepted for all mammals and even in humans (Altman 1962, Yuan et al. 2014). Two neurogenic niches are widely accepted: subventricular zone and subgranular zone in girus dentatus. These niches are conserved along the evolution of species. Subventricular zone is located near the lateral ventricle. It is formed by three layers: ependymal layer, GAP layer (hypocellular) and ribbon layer (astrocytic). Three types of stem cells are described in the SVZ: neural proliferative progenitor cells (that stain for glial markers) (Kriegstein y Alvarez-Buylla 2009) -type B-, neural pluripotential cells with some glial characteristics but also some neuronal differentiation (type C cells) and neuroblasts (type A cells). Some of these cells die after their formation and this survival phase is probably the most important one in the regulation of neurogenesis (Ribeiro Xavier et al. 2015). Those cells that are able to survive migrate and, at least in mammals, take the rostral migratory stream (RMS) to olfactory bulb (Liu y Rao 2003). RMS existence in humans is not accepted for all authors (Curtis et al. 2007c). Proliferation rate in SVZ is much more bigger than in SGZ and the number of stem cells in the niche is also bigger. However this fact is discussed in the healthy human. Subgranular zone is the second classic neurogenic niche. In this niche neural there are also three types of stem cells and they also come of glial cells: neural progenitor proliferative stem cells, type 1 or type A, neural pluripotential cells, type 2 or type D1 and neurobasts, type 3 or type D3. Again these stem cells have a survival phase and then they integrate as granular neurons...

Ramón y Cajal introdujo el concepto de que la carga de neuronas del sistema nervioso central se mantiene inmutable tras el nacimiento (Ramon y Cajal 1928) y esta idea se consideró uno de los axiomas de las neurociencias hasta nuestros días. La posibilidad de que la neurogénesis se mantuviera en la edad adulta se apuntó por primera vez en estudios realizados en la zona subgranular del giro dentado del hipocampo de pájaros (Nottebohm 1989) y precisó de tiempo y numerosos estudios hasta que se aceptó en el total de los mamíferos y en el humano (Altman 1962, Yuan et al. 2014). Existen dos nichos neurogénicos claramente establecidos y conservados a lo largo de las especies a los que se llama nichos neurogénicos clásicos: la zona subventricular y la zona subgranular del giro dentado. La zona subventricular se encuentra adyacente al ventriculo lateral y está formada por tres capas: la capa ependimaria, la capa hipocelular o GAP y la capa astrocitaria o ribbon. La neurogénesis en la SVZ pasa por una serie de fases celulares partiendo de las células neurales progenitoras proliferativas que se encuentran en una fase de división y proliferación y que tienen marcadores gliales (Kriegstein y Alvarez- Buylla 2009), células tipo B, a las células neurales progenitoras que todavía mantienen alguna carácterística glial pero ya presentan alguna diferenciación neuronal (células tipo C) a los neuroblastos (tipo A)...

La apatía es uno de los síndromes neuropsiquiátricos más frecuentes e invalidantes de las demencias, y puede presentarse en cualquier estadio de la enfermedad. La presencia de la apatía en enfermedades neurodegenerativas se ha relacionado con una mayor morbilidad y un peor pronóstico, y con una mayor carga de estrés para el cuidador. Recientemente, se han propuesto unos criterios clínicos para el diagnóstico de apatía en la enfermedad de Alzheimer (EA) y otros trastornos neuropsiquiátricos. De acuerdo con la clasificación original de Marin, estos criterios se organizan en torno a tres dominios y resaltan la necesidad de una evaluación multidimensional de la apatía. Actualmente, la literatura existente acepta que se pueden distinguir tres subtipos o dimensiones de la apatía, asociados a disfunción de diferentes circuitos neurales: apatía cognitiva, apatía emocional y apatía por disfunción en la autoactivación. En castellano, tan sólo existen dos escalas validadas en demencias que evalúen la apatía desde un punto de vista multidimensional: la Lillés Apathy Rating Scale (LARS) y la Apathy Scale for Institutionalized Patients with Dementia Nursing Home version (APADEM-NH). La escala APADEM-NH está diseñada para evaluar la apatía en pacientes institucionalizados con EA mediante la entrevista a un cuidador profesional, por lo que no es válida para pacientes ambulatorios. La LARS consta de nueve dominios o subescalas (“Productividad diaria”, “Aficiones”, “Tomar la iniciativa”, “Búsqueda de novedades”, “Motivación”, “Respuesta emocional”, “Preocupación”, “Vida social” y “Autoconsciencia”), que pueden combinarse para calcular cuatro dimensiones de la apatía: “Curiosidad intelectual”, “Emoción”, “Iniciativa de acción” y “Autoconsciencia”. La versión en castellano de la LARS ha sido recientemente validada por nuestro grupo en una cohorte de pacientes con demencia, mostrando excelentes propiedades psicométricas...

INTRODUCCIÓN: La epilepsia es uno de los trastornos neurológicos más frecuentes, presente en todas las sociedades y grupos de edad. La Organización Mundial de la Salud estima que 50 millones de personas padecen o han padecido epilepsia en algún momento de su vida en todo el mundo (WHO, 2012). Se trata de una patología crónica con un alto impacto social y sobre la calidad de vida tanto para quien lo sufre como sus familiares, pero también para el sistema sanitario y económico. Hasta la fecha se han realizado numerosos estudios epidemiológicos, pero la realidad es que todavía existen muchas controversias acerca de la verdadera frecuencia y distribución a lo largo de la geografía mundial de la epilepsia (Bell et al., 2014; Begui y Hesdorffer, 2014). La mayor parte de los estudios ofrecen datos sobre la epilepsia activa (EA), siendo escasos los que también aportan resultados sobre la epilepsia a lo largo de la vida (ELV). En el caso de la epilepsia activa, las cifras son dispares y varían entre 2,3 por cada 1000 habitantes en un estudio realizado en Libia (Sridharan et al., 1986) hasta 57 por cada 1000 habitantes en una pequeña comunidad en Panamá (Gracia et al., 1990). Por otro lado, los resultados acerca de la prevalencia de epilepsia a lo largo de la vida fluctuan entre 2,9 por 1000 habitantes en Rochester en el año 1940 (Hauser et al., 1991) y 32,1 por 1000 habitantes en un área rural de Perú (Montano et al., 2005). A pesar de estos valores extremos, la mayoría de los autores consideran que la prevalencia de epilepsia se encuentra en cifras entre 5-10 por 1000 habitantes aplicable a la población mundial general (Sander y Shorvon, 1996). Por otra parte, la prevalencia de la epilepsia a nivel mundial y su distribución en base al nivel de desarrollo económico continúa siendo un dilema y motivo de debate actual. Según diversos autores, varía según el grado de desarrollo de un país, con tendencia a ser más baja en países desarrollados frente a los menos desarrollados y d

Introducción: El vértigo recurrente asociado a la migraña es una causa de vértigo en los pacientes con migraña. Aunque es una entidad controvertida cada vez más autores defienden esta entidad y publican sobre el tema. Con una fisiopatología posiblemente relacionada a la migraña los pacientes presentan crisis recurrentes de vértigo que pueden durar de horas a varios días, Típicamente no suelen ser posicionales y no se acompañan de otros síntomas neurootológicos. Dentro del diagnóstico diferencial se deben incluir las causas más habituales de vértigo recurrente, como la enfermedad de Ménière, la vestibulopatía autoinmune o el vértigo recurrente asociado a la migraña. Responde habitualmente a los mismos tratamientos de la migraña, de tal manera que las crisis pueden mejorar con triptanes y el vértigo con fármacos preventivos de la migraña. Objetivos: Elaborar y validar unos criterios diagnósticos para el vértigo recurrente asociado a la migraña fiables, válidos y con confiabilidad. Validar su uso en la consulta y evaluación telefónica. Determinar la frecuencia que aparecen el vértigo recurrente asociado a la migraña en los pacientes con migraña y estimar la prevalencia en la población general...

La infección por VIH asocia un riesgo cardiovascular elevado por elevada prevalencia de factores de riesgo cardiovascular en esta población, por la propia infección por VIH y por las alteraciones metabólicas asociadas a la propia infección por VIH y al tratamiento antirretroviral (TAR). La arteriosclerosis carotídea subclínica es un reconocido marcador de riesgo cardiovascular. Material y métodos: Se realizó un estudio transversal incluyendo varones no diabéticos con infección por VIH a partir de 18 años, clasificados de acuerdo al grupo de tratamiento: grupo Naïve y grupo en TAR. Los pacientes del grupo TAR se dividían en grupo IP, tratado con inhibidores de la proteasa (IP) y grupo NN, grupo tratado con inhibidores de la transcriptasa inversa no análogos de nucleósidos que nunca estuvo expuesto a IP. Los dos grupos en TAR estaban en tratamiento con inhibidores de la transcriptasa inversa análogos de nucleósidos. Se evaluó por ecografía la presencia de arteriosclerosis carotídea subclínica, como aumento del grosor de íntima media (GIM) y presencia de placa carotídea, y se observó la relación con los factores de riesgo cardiovascular y metabólicos y su relación con el TAR. Resultados: Se incluyeron 93 varones con edad media 42,2 ± 8,2 años, mediana de tiempo de infección por VIH 6,6[2,9-12,4] años, mediana del tiempo total de exposición a TAR 59 [33-104,5] meses. El grupo naïve lo constituían 16 pacientes y el grupo en TAR 77 pacientes: 37 en el grupo NN y 40 en el grupo IP. Las variables asociadas de forma significativa a GIM máximo y medio en ACC fueron la edad, los años/paquete, la obesidad, la hiperglucemia basal en ayunas, HbA1c, los índices de insulinresistencia, la escala de Framingham, los años de evolución de la infección por VIH. El GIM medio se asoció de forma proporcional a presencia de síndrome metabólico, niveles de proteína C reactiva ultrasensible e insuficiencia de vitamina D e inversamente proporcional a la carga viral..., HIV infection is associated with increased cardiovascular risk by high prevalence of cardiovascular risk factors in this population, HIV infection itself and metabolic alterations associated with HIV infection and antiretroviral treatment (ART). Subclinical carotid atherosclerosis is a recognized marker of cardiovascular risk. Methods: A cross-sectional study including non-diabetic HIV-male over 18 years old, classified according to treatment group: Naïve group and ART group. ART patients were divided into PI group, treated with protease inhibitors (PI) and NN group, treated with inhibitors of non-nucleoside reverse transcriptase inhibitor never exposed to PI. The two groups were treated nucleoside reverse transcriptase inhibitors. Presence of subclinical carotid atherosclerosis was assessed by ultrasound, as increased intima-media thickness (IMT) in carotid artery and presence of carotid plaque, and factors related to cardiovascular and metabolic risk and its relationship with ART was observed. Results: We included 93 men with a mean age 42.2 ± 8.2 years, median time of HIV infection 6.6 [2.9 to 12.4] years, median ART exposure time 59 [33-104.5] months. Naïve-group 16 patients, ART-group 77 patients: NN-group 37 and PI-group 40 patients. Variables significantly associated with maximum and mean IMT in common carotid artery (CCA) were age, smoking, obesity, fasting hyperglycemia, HbA1c, insulinresistance index, Framingham risk score, years of HIV infection. Mean carotid IMT was associated to metabolic syndrome, levels of highsensitive C-reactive protein and Vitamin D insufficiency and inversely proportional to the viral load. In carotid bifurcation, it was associated with age, Framingham risk score, obesity and lipodystrophy. In CCA maximum IMT in TAR- und naïve-group was respectively 0.776±0.142 mm and 0.712 ± 0.087 mm (p 0.091) and mean IMT 0.629±0.109 mm and 0.565±0.072 mm (p 0.026). Comparing naïve-, NN- and PI-group maximum IMT in ACC was respectively 0.712 ± 0

La infección por VIH asocia un riesgo cardiovascular elevado por elevada prevalencia de factores de riesgo cardiovascular en esta población, por la propia infección por VIH y por las alteraciones metabólicas asociadas a la propia infección por VIH y al tratamiento antirretroviral (TAR). La arteriosclerosis carotídea subclínica es un reconocido marcador de riesgo cardiovascular. Material y métodos: Se realizó un estudio transversal incluyendo varones no diabéticos con infección por VIH a partir de 18 años, clasificados de acuerdo al grupo de tratamiento: grupo Naïve y grupo en TAR. Los pacientes del grupo TAR se dividían en grupo IP, tratado con inhibidores de la proteasa (IP) y grupo NN, grupo tratado con inhibidores de la transcriptasa inversa no análogos de nucleósidos que nunca estuvo expuesto a IP. Los dos grupos en TAR estaban en tratamiento con inhibidores de la transcriptasa inversa análogos de nucleósidos. Se evaluó por ecografía la presencia de arteriosclerosis carotídea subclínica, como aumento del grosor de íntima media (GIM) y presencia de placa carotídea, y se observó la relación con los factores de riesgo cardiovascular y metabólicos y su relación con el TAR. Resultados: Se incluyeron 93 varones con edad media 42,2 ± 8,2 años, mediana de tiempo de infección por VIH 6,6[2,9-12,4] años, mediana del tiempo total de exposición a TAR 59 [33-104,5] meses. El grupo naïve lo constituían 16 pacientes y el grupo en TAR 77 pacientes: 37 en el grupo NN y 40 en el grupo IP. Las variables asociadas de forma significativa a GIM máximo y medio en ACC fueron la edad, los años/paquete, la obesidad, la hiperglucemia basal en ayunas, HbA1c, los índices de insulinresistencia, la escala de Framingham, los años de evolución de la infección por VIH. El GIM medio se asoció de forma proporcional a presencia de síndrome metabólico, niveles de proteína C reactiva ultrasensible e insuficiencia de vitamina D e inversamente proporcional a la carga viral...