Search

Cerebrovascular disease is responsible for up to 20% of cases of dementia worldwide, but also it is a major comorbid contributor to the progression of other neurodegenerative diseases, like Alzheimer’s disease. White matter hyperintensities (WMH) are the most prevalent imaging marker in cerebrovascular disease. The presence and progression of WMH in the brain have been associated with general cognitive impairment and the risk to develop all types of dementia. The aim of this piece of work is the assessment of brain functional differences in an MCI population based on the WMH volume. One-hundred and twenty-nine individuals with mild cognitive impairment (MCI) underwent a neuropsychological evaluation, MRI assessment (T1 and Flair), and MEG recordings (5 min of eyes closed resting state). Those participants were further classified into vascular MCI (vMCI; n = 61, mean age 75 ± 4 years, 35 females) or non-vascular MCI (nvMCI; n = 56, mean age 72 ± 5 years, 36 females) according to their WMH total volume, assessed with an automatic detection toolbox, LST (SPM12). We used a completely data-driven approach to evaluate the differences in the power spectra between the groups. Interestingly, three clusters emerged: One cluster with widespread larger theta power and two clusters located in both temporal regions with smaller beta power for vMCI compared to nvMCI. Those power signatures were also associated with cognitive performance and hippocampal volume. Early identification and classification of dementia pathogenesis is a crucially important goal for the search for more effective management approaches. These findings could help to understand and try to palliate the contribution of WMH to particular symptoms in mixed dementia progress., Depto. de Radiología, Rehabilitación y Fisioterapia, Fac. de Medicina, TRUE, pub

Since 1929, when it was first introduced in infant diets, soybean has been described as a cause of a varibty of allergic reactions (i.e., urticaria, angioedema, gastrointestinal symptoms, asthma, and anaphylaxis). 1 In 1990 this antigen was listed as an agent causing occupational disease when a soybean-dependent asthma epidemic occurred in Barcelona and Cartagena, Spain, after a dust discharge into the air. 2 The partially characterized antigens were 14 and 8 kd molecular weight proteins found highly concentrated in soybean hull.3.4 We now describe other soybean hull antigens as a new cause of hypersensitivity pneumonitis (HP) in a research agronomist who was exposed to them for a long time., Depto. de Medicina, Fac. de Medicina, TRUE, pub

Recent proposals of diagnostic criteria within the healthy aging-Alzheimer’s disease (AD) continuum stressed the role of biomarker information. More importantly, such information might be critical to predict those mild cognitive impairment (MCI) patients at a higher risk of conversion to AD. Usually, follow-up studies utilize a reduced number of potential markers although the conversion phenomenon may be deemed as multifactorial in essence. In addition, not only biological but also cognitive markers may play an important role. Considering this background, we investigated the role of cognitive reserve, cognitive performance in neuropsychological testing, hippocampal volumes, APOE genotype, and magnetoencephalography power sources to predict the conversion to AD in a sample of 33 MCI patients. MCIs were followed up during a 2-year period and divided into two subgroups according to their outcome: The “stable” MCI group (sMCI, 21 subjects) and the “progressive” MCI group (pMCI, 12 subjects). Baseline multifactorial information was submitted to a hierarchical logistic regression analysis to build a predictive model of conversion to AD. Results indicated that the combination of left hippocampal volume, occipital cortex theta power, and clock drawing copy subtest scores predicted conversion to AD with a 100% of sensitivity and 94.7% of specificity. According to these results it might be suggested that anatomical, cognitive, and neurophysiological markers may be considered as “first order” predictors of progression to AD, while APOE or cognitive reserve proxies might play a more secondary role., Ministerio de Economía y Competitividad, Depto. de Psicología Experimental, Procesos Cognitivos y Logopedia, Depto. de Radiología, Rehabilitación y Fisioterapia, Fac. de Psicología, Fac. de Medicina, TRUE, pub

Cerebrovascular disease is responsible for up to 20% of cases of dementia worldwide, but also it is a major comorbid contributor to the progression of other neurodegenerative diseases, like Alzheimer’s disease. White matter hyperintensities (WMH) are the most prevalent imaging marker in cerebrovascular disease. The presence and progression of WMH in the brain have been associated with general cognitive impairment and the risk to develop all types of dementia. The aim of this piece of work is the assessment of brain functional differences in an MCI population based on the WMH volume. One-hundred and twenty-nine individuals with mild cognitive impairment (MCI) underwent a neuropsychological evaluation, MRI assessment (T1 and Flair), and MEG recordings (5 min of eyes closed resting state). Those participants were further classified into vascular MCI (vMCI; n = 61, mean age 75 ± 4 years, 35 females) or non-vascular MCI (nvMCI; n = 56, mean age 72 ± 5 years, 36 females) according to their WMH total volume, assessed with an automatic detection toolbox, LST (SPM12). We used a completely data-driven approach to evaluate the differences in the power spectra between the groups. Interestingly, three clusters emerged: One cluster with widespread larger theta power and two clusters located in both temporal regions with smaller beta power for vMCI compared to nvMCI. Those power signatures were also associated with cognitive performance and hippocampal volume. Early identification and classification of dementia pathogenesis is a crucially important goal for the search for more effective management approaches. These findings could help to understand and try to palliate the contribution of WMH to particular symptoms in mixed dementia progress., Depto. de Radiología, Rehabilitación y Fisioterapia, Fac. de Medicina, TRUE, pub

Background: Two main genetic risks for sporadic Alzheimer’s disease (AD) are a family history and ɛ4 allele of apolipoprotein E. The brain and retina are part of the central nervous system and share pathophysiological mechanisms in AD. Methods: We performed a cross-sectional study with 30 participants without a family history of sporadic AD (FH−) and noncarriers of ApoE ɛ4 (ApoE ɛ4−) as a control group and 34 participants with a family history of sporadic AD (FH+) and carriers of at least one ɛ4 allele (ApoE ɛ4+). We analyzed the correlations between macular volumes of retinal layers and thickness of the peripapillary retinal nerve fiber layer (pRNFL) measured by optical coherence tomography (OCT) with the brain area parameters measured by magnetic resonance imaging (MRI) in participants at high genetic risk of developing AD (FH+ ApoE ɛ4+). Results: We observed a significant volume reduction in the FH+ ApoE ɛ4+ group compared with the control group in some macular areas of (i) macular RNFL (mRNFL), (ii) inner plexiform layer (IPL), (iii) inner nuclear layer (INL), and (iv) outer plexiform layer (OPL). Furthermore, in the FH+ ApoE ɛ4+ group, the retinal sectors that showed statistically significant volume decrease correlated with brain areas that are affected in the early stages of AD. In the same group, the peripapillary retinal nerve fiber layer (pRNFL) did not show statistically significant changes in thickness compared with the control group. However, correlations of these sectors with the brain areas involved in this disease were also found. Conclusions: In cognitively healthy participants at high genetic risk of developing sporadic forms of AD, there are significant correlations between retinal changes and brain areas closely related to AD such as the entorhinal cortex, the lingual gyrus, and the hippocampus., Ministerio de Ciencia, Innovación y Universidades (España), Instituto de Salud Carlos III, Ministerio de Economía, Comercio y Empresa (España), Universidad Complutense de Madrid, Depto. de Medicina, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Medicina, Fac. de Óptica y Optometría, TRUE, pub

This article belongs to the Special Issue Neurodegenerative Diseases: Recent Advances and Future Perspectives. Received: 19 June 2023 ; Revised: 6 July 2023 ; Accepted: 12 July 2023 ; Published: 18 July 2023, Ministerio de Economía y Competitividad (España), Instituto de Salud Carlos III (España), Ministerio de Ciencia e Innovación (España), Ministerio de Economía (España), Universidad Complutense de Madrid, Unidad Docente de Inmunología, Oftalmología y ORL, Depto. de Inmunología, Oftalmología y ORL, Depto. de Medicina, Depto. de Psicología Experimental, Procesos Cognitivos y Logopedia, Fac. de Óptica y Optometría, Fac. de Medicina, TRUE, pub

Received: 15 December 2022 ; Accepted: 22 June 2023 ; Published: 06 July 2023. This article is part of the Research Topic: Early Indicators of Cognitive Decline, Alzheimer’s Disease, and Related Dementias Captured by Neurophysiological Tools, Introduction: Alzheimer’s disease (AD) is the most common form of dementia affecting the central nervous system, and alteration of several visual structures has been reported. Structural retinal changes are usually accompanied by changes in visual function in this disease. The aim of this study was to analyse the differences in visual function at different stages of the pathology (family history group (FH+), mild cognitive impairment (MCI), mild AD and moderate AD) in comparison with a control group of subjects with no cognitive decline and no family history of AD. Methods: We included 53 controls, 13 subjects with FH+, 23 patients with MCI, 25 patients with mild AD and, 21 patients with moderate AD. All were ophthalmologically healthy. Visual acuity (VA), contrast sensitivity (CS), colour perception, visual integration, and fundus examination were performed. Results: The analysis showed a statistically significant decrease in VA, CS and visual integration score between the MCI, mild AD and moderate AD groups compared to the control group. In the CS higher frequencies and in the colour perception test (total errors number), statistically significant differences were also observed in the MCI, mild AD and moderate AD groups with respect to the FH+ group and also between the control and AD groups. The FH+ group showed no statistically significant difference in visual functions compared to the control group. All the test correlated with the Mini Mental State Examination score and showed good predictive value when memory decline was present, with better values when AD was at a more advanced stage. Conclusion: Alterations in visual function appear in subjects with MCI and evolve when AD is established, being stable in the initial stages of the disease (mild AD and moderate AD). Therefore, visual psychophysical tests are a useful, simple and complementary tool to neuropsychological tests to facilitate diagnosis in the preclinical and early stages of AD., Ministerio de Ciencia e Innovación y Universidades (España), Ministerio de Economía y Competitividad (España), Universidad Complutense de Madrid, Unidad Docente de Inmunología, Oftalmología y ORL, Depto. de Inmunología, Oftalmología y ORL, Depto. de Psicología Experimental, Procesos Cognitivos y Logopedia, Fac. de Óptica y Optometría, Fac. de Medicina, TRUE, pub

Background: Alzheimer’s Disease (AD) can cause degeneration in the retina and optic nerve either directly, as a result of amyloid beta deposits, or secondarily, as a result of the degradation of the visual cortex. These effects raise the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. This study aimed to detect retinal changes and associated functional changes in three groups of patients consisting of AD patients with mild disease, AD patients with moderate disease and healthy controls by using non-invasive psychophysical ophthalmological tests and optical coherence tomography (OCT). Methods: We included 39 patients with mild AD, 21 patients with moderate AD and 40 age-matched healthy controls. Both patients and controls were ophthalmologically healthy. Visual acuity, contrast sensitivity, colour perception, visual integration, and choroidal thicknesses were measured. In addition, OCT and OCT angiography (OCTA) were applied. Findings: Visual acuity, contrast sensitivity, colour perception, and visual integration were significantly lower in AD patients than in healthy controls. Compared to healthy controls, macular thinning in the central region was significant in the mild AD patients, while macular thickening in the central region was found in the moderate AD group. The analysis of macular layers revealed significant thinning of the retinal nerve fibre layer, the ganglion cell layer and the outer plexiform layer in AD patients relative to controls. Conversely, significant thickening was observed in the outer nuclear layer of the patients. However, mild AD was associated with significant thinning of the subfovea and the nasal and inferior sectors of the choroid. Significant superonasal and inferotemporal peripapillary thinning was observed in patients with moderate disease. Conclusions: The first changes in the mild AD patients appear in the psychophysical tests and in the central macula with a decrease in, Ministerio de Economía, Comercio y Empresa (España), OFTARED, Instituto de Salud Carlos III, Ministerio de Educación, Formación Profesional y Deportes (España), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

The retina is an attractive source of biomarkers since it shares many features with the brain. Thickness differences in 10 retinal layers between 19 patients with mild Alzheimer’s disease (AD) and a control group of 24 volunteers were investigated. Retinal layers were automatically segmented and their thickness at each scanned point was measured, corrected for tilt and spatially normalized. When the mean thickness of entire layers was compared between patients and controls, only the outer segment layer of patients showed statistically significant thinning. However, when the layers were compared point-by point, patients showed statistically significant thinning in irregular regions of total retina and nerve fiber, ganglion cell, inner plexiform, inner nuclear and outer segment layers. Our method, based on random field theory, provides a precise delimitation of regions where total retina and each of its layers show a statistically significant thinning in AD patients. All layers, except inner nuclear and outer segments, showed thickened regions. New analytic methods have shown that thinned regions are interspersed with thickened ones in all layers, except inner nuclear and outer segments. Across different layers we found a statistically significant trend of the thinned regions to overlap and of the thickened ones to avoid overlapping., Instituto de Salud Carlos III, Ministerio de Educación, Formación Profesional y Deportes (España), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Ministerio de Economía, Comercio y Empresa (España)/Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa/Fondo Europeo de Desarrollo Regional, Ministerio de Ciencia, Innovación y Universidades (España), Universidad Complutense de Madrid (España), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Received: 08 July 2022; Accepted: 08 January 2023; Published: 24 January 2023, Background: The earliest pathological features of Alzheimer’s disease (AD) appear decades before the clinical symptoms. The pathology affects the brain and the eye, leading to retinal structural changes and functional visual alterations. Healthy individuals at high risk of developing AD present alterations in these ophthalmological measures, as well as in resting-state electrophysiological activity. However, it is unknown whether the ophthalmological alterations are related to the visual-related electrophysiological activity. Elucidating this relationship is paramount to understand the mechanisms underlying the early deterioration of the system and an important step in assessing the suitability of these measures as early biomarkers of disease. Methods: In total, 144 healthy subjects: 105 with family history of AD and 39 without, underwent ophthalmologic analysis, magnetoencephalography recording, and genotyping. A subdivision was made to compare groups with less demographic and more risk differences: 28 high-risk subjects (relatives/APOEɛ4 +) and 16 low-risk (non-relatives/APOEɛ4 −). Differences in visual acuity, contrast sensitivity, and macular thickness were evaluated. Correlations between each variable and visual-related electrophysiological measures (M100 latency and time–frequency power) were calculated for each group. Results: High-risk groups showed increased visual acuity. Visual acuity was also related to a lower M100 latency and a greater power time–frequency cluster in the high-risk group. Low-risk groups did not show this relationship. High-risk groups presented trends towards a greater contrast sensitivity that did not remain significant after correction for multiple comparisons. The highest-risk group showed trends towards the thinning of the inner plexiform and inner nuclear layers that did not remain significant after correction. The correlation between contrast sensitivity and macular thickness, and the electrophysiological measures were not signif, Ministerio de Economía, Comercio y Empresa (España), OFTARED/Instituto de Salud Carlos III de España, Ministerio de Ciencia, Innovación y Universidades (España), RETIBRAIN, Universidad Complutense de Madrid, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Copyright © 2015 Elena Salobrar-Garcia et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited., Purpose. To analyze in mild Alzheimer's disease (MAD) patients, GDS-4 (Reisberg Scale), whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) (3, 6, 12, and 18 cpds), color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis (P < 0.05 in all instances). In MAD patients, a wide a ROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT., Ministerio de Ciencia e Innovación (MICINN), Ministerio de España de Educación, Cultura y Deporte, RETICs prevención, detección precoz y tratamiento de la patología ocular prevalente degenerativa y crónica (OFTARED) (Ministerio de España de Ciencia e Innovación), Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Received: 08 July 2021; Accepted: 20 April 2022; Published: 04 June 2022, Background: Two main genetic risks for sporadic Alzheimer’s disease (AD) are a family history and ɛ4 allele of apolipoprotein E. The brain and retina are part of the central nervous system and share pathophysiological mechanisms in AD. Methods: We performed a cross-sectional study with 30 participants without a family history of sporadic AD (FH−) and noncarriers of ApoE ɛ4 (ApoE ɛ4−) as a control group and 34 participants with a family history of sporadic AD (FH+) and carriers of at least one ɛ4 allele (ApoE ɛ4+). We analyzed the correlations between macular volumes of retinal layers and thickness of the peripapillary retinal nerve fiber layer (pRNFL) measured by optical coherence tomography (OCT) with the brain area parameters measured by magnetic resonance imaging (MRI) in participants at high genetic risk of developing AD (FH+ ApoE ɛ4+). Results: We observed a significant volume reduction in the FH+ ApoE ɛ4+ group compared with the control group in some macular areas of (i) macular RNFL (mRNFL), (ii) inner plexiform layer (IPL), (iii) inner nuclear layer (INL), and (iv) outer plexiform layer (OPL). Furthermore, in the FH+ ApoE ɛ4+ group, the retinal sectors that showed statistically significant volume decrease correlated with brain areas that are affected in the early stages of AD. In the same group, the peripapillary retinal nerve fiber layer (pRNFL) did not show statistically significant changes in thickness compared with the control group. However, correlations of these sectors with the brain areas involved in this disease were also found. Conclusions: In cognitively healthy participants at high genetic risk of developing sporadic forms of AD, there are significant correlations between retinal changes and brain areas closely related to AD such as the entorhinal cortex, the lingual gyrus, and the hippocampus., Ministerio de Ciencia e Innovación (MICINN), Instituto de Salud Carlos III (ISCIII), Ministerio de Economía y Competitividad (MINECO), Universidad Complutense de Madrid, Depto. de Medicina, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Medicina, Fac. de Óptica y Optometría, TRUE, pub

En los últimos años el concepto de fragilidad como «estado de pre-discapacidad» se ha extendido de forma amplia en todos los que trabajamos en beneficio de la persona mayor. Su importancia radica no solo en su elevada prevalencia, superior al 25% en mayores de 85 años, sino a que es considerada un sindrome geriátrico capaz de identificar aquella población en riesgo de presentar sucesos adversos graves de salud que se relacionan con el envejecimiento no exitoso y con el deterioro en la calidad de vida del individuo. El estudio de la función renal es relevante en pacientes que soportan gran carga de comorbilidad, habiéndose encontrado una importante asociación entre la enfermedad renal crónica y el desarrollo de eventos clínicos adversos como la enfermedad cardiovascular, la insuficiencia cardiaca, la enfermedad renal terminal, el incremento de la susceptibilidad a infecciones y el mayor deterioro funcional y cognitivo. Entre los pacientes con enfermedad renal crónica, los adultos mayores en el estadio avanzado de la enfermedad, constituyen la población con mayor dificultad en el manejo, especialmente al plantear el inicio de la terapia renal sustitutiva (TRS), debido a su mayor comorbilidad y a la menor expectativa de vida respecto a otros grupos de pacientes. Dado que la fragilidad puede ser una condición reversible, su estudio en el paciente con enfermedad renal crónica avanzada es de especial interés. OBJETIVOS: Objetivo principal: Determinar la capacidad predictiva de la condición de fragilidad –según los criterios de Fried- en la evolución del anciano con ERCA (mortalidad, ingreso hospitalario, inicio de TRS)..., In recent years, the concept of frailty as a “state of pre-disability” has been widely accepted by those involved in elderly care. Its importance, lies not only in its high prevalence rate, more common in 25% of the population 85 years of age or older. It is considered a geriatric syndrome, capable of identifying people at risk of serious adverse health outcomes related with unsuccessful ageing and with detrimental of quality of life. The study of renal function is relevant in patients with major comorbidities. Studies have shown a significant association between chronic kidney disease and the development of adverse clinical outcomes such as heart disease, heart failure, end-stage renal disease, increased susceptibility to infections, and greater functional and cognitive impairment. When considering renal replacement therapy (RRT), compared with patients in other age groups, due to the high comorbidity rate and lower life expectancy, elderly patients among the advanced stages of chronic kidney disease make up a population with the greatest difficulty in management. However, older people can reverse frailty and improve functionality. Therefore, the study o frailty in patients with chronic kidney disease is of particular interest. OBJECTIVES: Main Objective: To determine the predictive ability of frailty condition –according to Fried's criteria- to predict risk for the onset of adverse outcomes in older patients with ACKD (mortality, hospital admission, onset of RRT)...

There is growing evidence that thinned retinal regions are interspersed with thickened regions in all retinal layers of patients with Alzheimer’s disease (AD), causing roughness to appear on layer thickness maps. The hypothesis is that roughness of retinal layers, assessed by the fractal dimension (FD) of their thickness maps, is an early biomarker of AD. Ten retinal layers have been studied in macular volumes of optical coherence tomography from 24 healthy volunteers and 19 patients with mild AD (Mini-Mental State Examination 23.42 ± 3.11). Results show that FD of retinal layers is greater in the AD group, the differences being statistically significant (p < 0.05). Correlation of layer FD with cognitive score, visual acuity and age reach statistical significance at 7 layers. Nearly all (44 out of 45) FD correlations among layers are positive and half of them reached statistical significance (p < 0.05). Factor analysis unveiled two independent factors identified as the dysregulation of the choroidal vascular network and the retinal inflammatory process. Conclusions: surface roughness is a holistic feature of retinal layers that can be assessed by the FD of their thickness maps and it is an early biomarker of AD., Ministerio de Ciencia, Innovación y Universidades (España), Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional, Depto. de Medicina, Depto. de Psicobiología y Metodología en Ciencias del Comportamiento, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Medicina, Fac. de Psicología, Fac. de Óptica y Optometría, TRUE, pub

En los últimos años el concepto de fragilidad como «estado de pre-discapacidad» se ha extendido de forma amplia en todos los que trabajamos en beneficio de la persona mayor. Su importancia radica no solo en su elevada prevalencia, superior al 25% en mayores de 85 años, sino a que es considerada un sindrome geriátrico capaz de identificar aquella población en riesgo de presentar sucesos adversos graves de salud que se relacionan con el envejecimiento no exitoso y con el deterioro en la calidad de vida del individuo. El estudio de la función renal es relevante en pacientes que soportan gran carga de comorbilidad, habiéndose encontrado una importante asociación entre la enfermedad renal crónica y el desarrollo de eventos clínicos adversos como la enfermedad cardiovascular, la insuficiencia cardiaca, la enfermedad renal terminal, el incremento de la susceptibilidad a infecciones y el mayor deterioro funcional y cognitivo. Entre los pacientes con enfermedad renal crónica, los adultos mayores en el estadio avanzado de la enfermedad, constituyen la población con mayor dificultad en el manejo, especialmente al plantear el inicio de la terapia renal sustitutiva (TRS), debido a su mayor comorbilidad y a la menor expectativa de vida respecto a otros grupos de pacientes. Dado que la fragilidad puede ser una condición reversible, su estudio en el paciente con enfermedad renal crónica avanzada es de especial interés. OBJETIVOS: Objetivo principal: Determinar la capacidad predictiva de la condición de fragilidad –según los criterios de Fried- en la evolución del anciano con ERCA (mortalidad, ingreso hospitalario, inicio de TRS)...

La Enfermedad de Alzheimer (EA) es una degeneración primaria, caracterizada por la afectación de las funciones cognitivas corticales, con un alto impacto a nivel funcional, un establecimiento lento y progresivo y por la aparición de depósitos de beta amiloide y los ovillos neurofibrilares. La retina es una proyección embrionaria del diencéfalo, y se consideran parte del sistema nervioso central. La degeneración producida en la retina y en el nervio óptico en la EA puede originarse por vía retrógrada desde la corteza visual o por vía directa desde la propia retina causada por los depósitos. Estos cambios anatómicos pueden ser detectados con técnicas de diagnóstico oftalmológicas que posibiliten el seguimiento de los cambios según progresa la neurodegeneración. Objetivos: Detectar los cambios que se producen en la retina, así como los cambios funcionales que se originan secundariamente, mediante pruebas psicofísicas oftalmológicas no invasivas y tomografía de coherencia óptica, en dos poblaciones de pacientes con EA, diferenciadas por el grado de evolución de la patología; comparando los resultados con una población control..., Alzheimer's disease (AD) is a primary degenerative disease that establishes itself slowly and progressively, involves the appearance of amyloid beta deposits and neurofibrillary tangles and affects cortical cognitive functions in ways that strongly reduce level of functioning. AD can cause degeneration in the retina and optic nerve either directly as a result of amyloid beta deposits or secondarily as a result of degradation of the visual cortex. This raises the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. Aim: To detect retinal changes and associated functional changes in two groups of AD patients with mild and moderate disease and in a group of healthy controls using non-invasive psychophysical ophthalmological tests and optical coherence tomography...

Received: March 26, 2019; Accepted: July 17, 2019; Published: August 15, 2019, Background: Alzheimer’s Disease (AD) can cause degeneration in the retina and optic nerve either directly, as a result of amyloid beta deposits, or secondarily, as a result of the degradation of the visual cortex. These effects raise the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. This study aimed to detect retinal changes and associated functional changes in three groups of patients consisting of AD patients with mild disease, AD patients with moderate disease and healthy controls by using non-invasive psychophysical ophthalmological tests and optical coherence tomography (OCT). Methods: We included 39 patients with mild AD, 21 patients with moderate AD and 40 age-matched healthy controls. Both patients and controls were ophthalmologically healthy. Visual acuity, contrast sensitivity, colour perception, visual integration, and choroidal thicknesses were measured. In addition, OCT and OCT angiography (OCTA) were applied. Findings: Visual acuity, contrast sensitivity, colour perception, and visual integration were significantly lower in AD patients than in healthy controls. Compared to healthy controls, macular thinning in the central region was significant in the mild AD patients, while macular thickening in the central region was found in the moderate AD group. The analysis of macular layers revealed significant thinning of the retinal nerve fibre layer, the ganglion cell layer and the outer plexiform layer in AD patients relative to controls. Conversely, significant thickening was observed in the outer nuclear layer of the patients. However, mild AD was associated with significant thinning of the subfovea and the nasal and inferior sectors of the choroid. Significant superonasal and inferotemporal peripapillary thinning was observed in patients with moderate disease. Conclusions: The first changes in the mild AD patients appear in the psychophysical tests and in the central macula with a decrease in, Ministerio de Economía y Competitividad (MINECO), OFTARED, Instituto de Salud Carlos III (ISCIII), Ministerio de Educación, Cultura y Deporte de España, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Received: 4 March 2019; Accepted: 24 August 2019; Published: 10 September 2019, The retina is an attractive source of biomarkers since it shares many features with the brain. Thickness differences in 10 retinal layers between 19 patients with mild Alzheimer’s disease (AD) and a control group of 24 volunteers were investigated. Retinal layers were automatically segmented and their thickness at each scanned point was measured, corrected for tilt and spatially normalized. When the mean thickness of entire layers was compared between patients and controls, only the outer segment layer of patients showed statistically significant thinning. However, when the layers were compared point-by point, patients showed statistically significant thinning in irregular regions of total retina and nerve fiber, ganglion cell, inner plexiform, inner nuclear and outer segment layers. Our method, based on random field theory, provides a precise delimitation of regions where total retina and each of its layers show a statistically significant thinning in AD patients. All layers, except inner nuclear and outer segments, showed thickened regions. New analytic methods have shown that thinned regions are interspersed with thickened ones in all layers, except inner nuclear and outer segments. Across different layers we found a statistically significant trend of the thinned regions to overlap and of the thickened ones to avoid overlapping., Instituto de Salud Carlos III, Ministerio de Educación, Cultura y Deporte, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

La Enfermedad de Alzheimer (EA) es una degeneración primaria, caracterizada por la afectación de las funciones cognitivas corticales, con un alto impacto a nivel funcional, un establecimiento lento y progresivo y por la aparición de depósitos de beta amiloide y los ovillos neurofibrilares. La retina es una proyección embrionaria del diencéfalo, y se consideran parte del sistema nervioso central. La degeneración producida en la retina y en el nervio óptico en la EA puede originarse por vía retrógrada desde la corteza visual o por vía directa desde la propia retina causada por los depósitos. Estos cambios anatómicos pueden ser detectados con técnicas de diagnóstico oftalmológicas que posibiliten el seguimiento de los cambios según progresa la neurodegeneración. Objetivos: Detectar los cambios que se producen en la retina, así como los cambios funcionales que se originan secundariamente, mediante pruebas psicofísicas oftalmológicas no invasivas y tomografía de coherencia óptica, en dos poblaciones de pacientes con EA, diferenciadas por el grado de evolución de la patología; comparando los resultados con una población control...

El envejecimiento poblacional afecta sobre todo a países desarrollados como el nuestro. Se empieza a distinguir diferentes tipos de ancianos, desde sanos o robustos a pacientes geriátricos con mayor comorbilidad, discapacidad y dependencia. No existe una definición de fragilidad que sea práctica y universal. El anciano frágil es un paciente muy vulnerable que “no está ni muy bien ni muy mal”, mayoritariamente independiente y ante la presencia de un proceso intercurrente está en riesgo de sufrir deterioro funcional y otros resultados adversos. El anciano es cada vez más frecuente (15-35%) y complejo en los SUH. Se identifica anciano frágil con anciano en riesgo de presentar eventos adversos (muerte, refrecuentación, reingreso, dependencia y mala calidad de vida). El papel actual de los Servicios de Urgencias hospitalarios (SUH) en el sistema de salud ha cambiado. Ejercen un papel central en la atención del paciente anciano y en la transición de cuidados entre la atención primaria y especializada en el hospital. En las últimas décadas han vivido situaciones de saturación y colapso asistencial. Para paliar este problema se han ido desarrollando alternativas a la hospitalización convencional vinculadas frecuentemente al SUH como las Unidades de Corta Estancia (UCE). Hasta la fecha, la Valoración convencional del paciente en los SUH y en las UCE es unidimensional, centrada en el episodio médico actual sin tener en consideración otros aspectos clínicos, funcionales, mentales y sociales asociados a malos resultados. La Valoración Geriátrica Integral (VGI) incluye los dominios anteriores pero hasta la fecha no se ha adaptado convenientemente en las UCE ni SUH..., Population aging affects all countries. It is very important to distinguish different types of elders, from healthy elderly to geriatric patient with greater comorbidity, disability and dependence. There is no practical and universal definition of frailty. The frail elderly is a very vulnerable patient ("not to bad but not very good") mostly independently and with at risk of functional decline and other adverse outcomes after a trigger process. The elderly is frequent visitor of Emergency Department (ED). Frail elderly is identified as a patient at risk for adverse events (death, revisit, readmission, dependency and poor quality of life). The current role of ED has changed in the health system. ED is a central role in the care of elderly patients and in the transition between primary care and hospital care. In recent decades, EDs have experienced situations of overcrowding. ED have developed alternatives to conventional hospitalization often linked ED as Short Stay Unit (SSU) for solving this situation. Currently, conventional management of the patient in the ED and the SSU is one-dimensional, focusing on actual medical episode without considering other clinical, functional, mental and social aspects associated with poor results. Comprehensive Geriatric Assessment (CGA) includes the above domains but to date has not been properly applied or adapted in ED and SSU...

Existe un crecimiento progresivo de la demanda de centros residenciales que no se relaciona con el envejecimiento de la población, sino con otras variables sociodemográficas. Países como Japón o Suecia tienen poblaciones muy envejecidas con bajo porcentaje de institucionalización y países jóvenes como Islandia tienen una de las mayores tasas de institucionalizados. Factores como la estructura familiar, las preferencias personales, la disponibilidad de recursos o las ayudas estatales hace que la institucionalización sea variable en cada país independientemente del envejecimiento de la población (Miel W, 1997; Onder G, 2012). Los ancianos institucionalizados son diferentes de los ancianos de la comunidad presentando mayor grado de dependencia (81,3%), mayor prevalencia de demencia (68%), mayor probabilidad de tener dolor (36%), caídas (18,6%) y úlceras por presión (10,4%) (Stephens CE, 2012). Al ser una población con tanta comorbilidad, fragilidad y vulnerabilidad precisan acudir frecuentemente a urgencias hospitalarias. Se calcula que un 62% de los residentes son derivados al menos una vez al año a urgencias y un 8% han estado los 90 días previos (Caffrey C, 2010)..., There is a striking growth in the demand for nursing home (NH) residents but this does not seem to be related with ageing. No relation appears to exist between the ageing status of a country and the number of nursing home beds. Countries like Japan or Sweden have high ageing rates but have the lowest rates of institutionalization. Interestingly young countries like Iceland has one of the highest rates of institutionalization. Age-related morbidity rates is not the only determinant of the need for nursing homes. Demographic trends like the structure of families and their preferences, the availability and type of housing are important factors that explain these differences, as well as the organization of care systems. Payment facilities show great variation in each country (Miel W, 1997; Onder G, 2012). Nursing home residents differ from community elderly. Generally NH residents are very dependant, very frail and have complex care needs. They are more likely to require assistance for activity daily living activities (41,5%) or even dependant (39,8%). High proportion of NH residents have cognitive impairment (68%) and almost a third of them (30,4%) have severe dementia. There are some diseases which are more frequent like depression (32%), behavioural symptoms (27,5%) and urinary incontinence(73,5%). This group of elderly are more likely to suffer from pain (36%), falls (18,6%) and pressure ulcers (10,4%). (Stephens CE, 2012)...

La Incontinencia Anal (IA) y el Estreñimiento (E) son problemas de salud frecuentes, con una prevalencia que llega a alcanzar el 50% en los pacientes geriátricos, dependiendo del medio donde se estudie. Constituyen importantes trastornos funcionales que provocan, no sólo una alteración en su calidad de vida, sino que pueden llegar a requerir unos cuidados sanitarios complejos e incluso tratamiento quirúrgico. Forman parte de los Grandes Síndromes Geriátricos presentándose como manifestación de muchas enfermedades, pero también son el principio de muchos otros problemas que se deben tener en cuenta desde su detección para establecer una correcta prevención de los mismos. Con una población que envejece rápidamente, el número de pacientes con incontinencia y estreñimiento se espera que crezca sustancialmente en los próximos años ya que la prevalencia de esta enfermedad aumenta progresivamente con la edad tanto en hombres como en mujeres, acarreando importantes costes económicos para la sociedad. Paradójicamente, el estreñimiento es probablemente una de las quejas mas frecuentes en la práctica diaria de un médico, mientras que el índice de consulta médica por incontinencia anal es muy bajo, ya que muchos de los pacientes o sus cuidadores consideran que ambos trastornos son consecuencia de su envejecimiento. Ya sea por esto o por la poca atención diagnóstica prestada que reciben, las actitudes terapéuticas son escasas e insuficientes, en base a las evidencias actuales..., Anal incontinence and constipation are common health disorders, with a prevalence that reaches 50% in geriatric patients depending on the environment studied. Both are important functional disruptions that cause not only an important change in quality of life, but might also require a complex health care or even surgery. They are part of the Geriatric syndromes appearing as manifestations of many diseases, but also may be the beginning of many other problems that we have to consider from their detection to establish a good prevention. With a rapidly aging population, the number of patients with incontinence and constipation is expected to grow substantially in the coming years because the prevalence of this disease increases progressively with age in both men and women, involving significant economic costs to society. Constipation is probably one of the most frequent complaints in the clinical daily practice, while the consultation rate of medical anal incontinence is very low, because most of the patients or their caregivers believe that both disorders are just a consequence of aging. Because of this and the little diagnose attention they receive, therapeutic attitudes are scarce and insufficient, based on current evidence. Several investigations show that colorectal function is not significantly affected by aging. Constipation and AI in older people are not age symptoms, but are associated with different risk factors, such as chronic diseases, immobility, neurological and psychiatric conditions, drug use or inadequate nutrition...

El síndrome metabólico (SM), también denominado síndrome X, síndrome plurimetabólico o síndrome de Reaven, es una entidad clínica que incluye una serie de anormalidades metabólicas que se asocian con una frecuencia mayor que la esperada simplemente por el azar. Este síndrome, clásicamente determina una predisposición al desarrollo de enfermedad cardiovascular arterioesclerótica, diabetes mellitus tipo 2 y muerte. Este trabajo tiene como objetivo caracterizar el síndrome metabólico en una franja concreta de la población, como es la edad más avanzada (ancianos) para analizar si el SM tiene el mismo efecto que en personas más jóvenes. Para ello se intentará definir mejor los criterios de este síndrome en la población más envejecida, describiendo cuál es su prevalencia en función de la definición que se emplee, qué definición es más relevante al respecto, determinar qué criterios son más específicos y qué medidas son más adecuadas a partir de los 65 años, así como su relación con eventos clínicos y de función, Además se propondrán variaciones en los criterios que sean más eficaz a la hora de diagnosticar este síndrome de acuerdo con las consecuencias pronosticas que implica en esta franja etaria. Este estudio bebe de las fuentes el Estudio Toledo de Envejecimiento saludable, ya que utilizando su base de datos, se obtiene una muestra sólida, donde estudiar el Síndrome metabólico. Tras revisar la literatura, se observa una gran prevalencia del SM en la población general y está en relación con el incremento progresivo de la obesidad en la población mundial. Se ha descrito que el SM aumenta con la edad, de tal manera que a partir de los 60 años es donde mayor prevalencia presenta. En contrapartida, son pocos los estudios realizados únicamente en población anciana. En edades medias de la vida el SM se comporta como un buen factor de predicción de Diabetes, enfermedades vasculares y muerte por esta y otras causas. Esta es la característica más importante de SM, que es capaz d, The metabolic syndrome (MS), also called X syndrome, Reaven’s syndrome or plurimetabolic syndrome is a clinical condition that includes a set of metabolic abnormalities that are associated with a higher rate than expected randomly. Classically, this syndrome influences the development of atherosclerotic cardiovascular disease, type 2 diabetes mellitus and death. This work aims to characterize the metabolic syndrome in a particular stratum of the population, such as the elderly to analyze whether the SM has the same consequence as in younger people. To do this, we will try to improve the criteria of this syndrome in the older population, we will describe the prevalence and relevance according to the definition used and we will determine the specificity of the criteria and the most suitable values for 65 and over, and their relationship with clinical and function events. Several variations of the criteria will be proposed in order to improve the diagnosis of this syndrome according to the prognostic implications involved in this age stratum. This study arose from the Toledo Study for Healthy Aging, using its database we obtained a solid sample, and the metabolic syndrome study was done. After reviewing the literature, the prevalence of MS in the general population was high and the SM was related to the progressive increase of obesity in the world population. It has been reported that the prevalence of MS increases with age, so that after 60 years is where most prevalent presents. On the other hand, few studies were only carried with older people. SM in middle age of life behaves as a good predictor of diabetes, vascular disease and death among others. This is the most important feature of MS, which is able to detect subjects at risk and to allow for appropriate intervention...

La concurrencia de tres condiciones en las personas mayores, el proceso de envejecimiento, el estilo de vida y las condiciones relacionadas con la salud, va a tener como principal consecuencia el desarrollo de discapacidad. Se estima que entre un 20- 30% de los mayores de 70 años residentes en la comunidad presentan discapacidad en la movilidad y en la realización de actividades básicas e instrumentales de la vida diaria. Esta discapacidad se asocia con mayor riesgo de mortalidad, hospitalización, necesidad de cuidados a largo plazo, y un mayor gasto sanitario. Pero la discapacidad, cuando se produce de manera no catastrófica, suele ir precedida de una condición que ha sido denominada como síndrome de fragilidad. La prevalencia de fragilidad en pacientes mayores de 65 años es elevada, situándose entre el 7% y el 16.9%, siendo muy variable según las distintas series y aumentando con la edad. La alta prevalencia de este síndrome en las personas mayores, así como su potencial reversibilidad hacen de la fragilidad el blanco perfecto para superar el reto de la discapacidad en los adultos mayores y de ahí la relevancia de su diagnóstico. Aunque se han descrito en la actualidad muchas herramientas para su detección, todas ellas han sido basadas y validadas a través de estudios epidemiológicos, sobre cohortes de diferentes individuos, con diferentes características y evaluando distintos dominios. Estos estudios han proporcionado una fuerte evidencia de la importancia de la fragilidad en la progresión de la discapacidad, proporcionando varios instrumentos para evaluarla. Sin embargo se ha realizado una valoración del riesgo de la población general y no una valoración del riesgo individual a través de sujetos o pacientes seleccionados. El siguiente paso debe ser ampliar la detección de la fragilidad en los ámbitos en los que el riesgo de discapacidad es más alto y donde las posibilidades de intervención son más elevadas. Se puede decir que la fragilidad ha cubierto las etapas, Disability is the main consequence of the concurrence of three conditions in the elderly: ageing process, life style and health-related conditions. It is estimated that 20-30% of the local population over 70 years of age has mobility impairments and problems with the performance of basic and instrumental activities in their daily life. This disability is associated with increased risk of death, hospitalization, need for long-term care, and increased healthcare costs. But when disability occurs in a non-catastrophic way, it is usually preceded by a condition called frailty syndrome. The prevalence of frailty in people older than 65 of age is high, ranging from 7% to 16.9%, and it increases with age and changes among several samples. The high prevalence in old people and its potential reversibility make frailty the perfect target to overcome the challenge of disability in old adults and the importance of its early diagnosis. Although there are many tools for its detection nowadays, all of them have been assessed and validated by epidemiological studies in cohorts, in different population, with different characteristics and assessing different domains. These epidemiological studies have provided strong evidence of the influence of frailty in the progression to disability, providing several tools to assess it. However, these studies have traditionally focused on the general population instead of assessing the individual risk in selected patients. Therefore, the next step should be to expand frailty detection to those settings where the risk of disability and the chance of intervention are higher. Frailty has covered the pre-clinical stages of its conceptualization, but it is time now to set the clinical basis to its practical implementation in the care settings where people at risk of developing frailty and those frail patients at risk of disability are assisted. However, at this stage we are not sure whether the instruments for frailty detection are useful from a clini