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Resumen: Introducción: El conocimiento del alcance socioeconómico de las enfermedades que cursan con demencia es esencial para la planificación de recursos y la concienciación social. Desarrollo: Se ha realizado una revisión de los datos publicados hasta el momento sobre la epidemiología, morbilidad, mortalidad, discapacidad, dependencia e impacto económico de la demencia y la enfermedad de Alzheimer en España. Conclusiones: La mayoría de estudios en población mayor de 65 años estiman una prevalencia entre el 4% y el 9%. La prevalencia es mayor en mujeres en casi todos los grupos de edad. La enfermedad de Alzheimer es la causa de demencia más frecuente (50-70% del total). La demencia provoca un aumento de la morbilidad, mortalidad, discapacidad y dependencia de los pacientes, con una importante disminución de la calidad de vida y la supervivencia. El 80% de los enfermos es cuidado por sus familias, que asumen de media el 87% del coste total, con la consiguiente sobrecarga y menoscabo de la salud y calidad de vida de los cuidadores. El impacto económico de la demencia es enorme, y de evaluación compleja, por la mezcla de costes sanitarios y no sanitarios, directos e indirectos. Es necesario desarrollar programas globales e incrementar los recursos enfocados a fomentar la investigación, prevención, diagnóstico precoz, tratamiento multidimensional y abordaje multidisciplinario, que permitan reducir la carga sanitaria, social y económica de la demencia. Abstract: Introduction: Knowledge of the socioeconomic impact of dementia-related disorders is essential for appropriate management of healthcare resources and for raising social awareness. Methods: We performed a literature review of the published evidence on the epidemiology, morbidity, mortality, associated disability and dependence, and economic impact of dementia and Alzheimer disease (AD) in Spain. Conclusions: Most population studies of patients older than 65 report prevalence rates ranging from 4% to 9%. Prevalence of dementia and AD is higher in women for nearly every age group. AD is the most common cause of dementia (50%-70% of all cases). Dementia is associated with increased morbidity, mortality, disability, and dependence, and results in a considerable decrease in quality of life and survival. Around 80% of all patients with dementia are cared for by their families, which cover a mean of 87% of the total economic cost, resulting in considerable economic and health burden on caregivers and loss of quality of life. The economic impact of dementia is huge and difficult to evaluate due to the combination of direct and indirect costs. More comprehensive programmes should be developed and resources dedicated to research, prevention, early diagnosis, multidimensional treatment, and multidisciplinary management of these patients in order to reduce the health, social, and economic burden of dementia.

Introduction: Knowledge of the socioeconomic impact of dementia-related disorders is essential for appropriate management of healthcare resources and for raising social awareness. Methods: We performed a literature review of the published evidence on the epidemiology, morbidity, mortality, associated disability and dependence, and economic impact of dementia and Alzheimer disease (AD) in Spain. Conclusions: Most population studies of patients older than 65 report prevalence rates ranging from 4% to 9%. Prevalence of dementia and AD is higher in women for nearly every age group. AD is the most common cause of dementia (50%-70% of all cases). Dementia is associated with increased morbidity, mortality, disability, and dependence, and results in a considerable decrease in quality of life and survival. Around 80% of all patients with dementia are cared for by their families, which cover a mean of 87% of the total economic cost, resulting in considerable economic and health burden on caregivers and loss of quality of life. The economic impact of dementia is huge and difficult to evaluate due to the combination of direct and indirect costs. More comprehensive programmes should be developed and resources dedicated to research, prevention, early diagnosis, multidimensional treatment, and multidisciplinary management of these patients in order to reduce the health, social, and economic burden of dementia. Resumen: Introducción: El conocimiento del alcance socioeconómico de las enfermedades que cursan con demencia es esencial para la planificación de recursos y la concienciación social. Desarrollo: Se ha realizado una revisión de los datos publicados hasta el momento sobre la epidemiología, morbilidad, mortalidad, discapacidad, dependencia e impacto económico de la demencia y la enfermedad de Alzheimer en España. Conclusiones: La mayoría de estudios en población mayor de 65 años estiman una prevalencia entre el 4% y el 9%. La prevalencia es mayor en mujeres en casi todos los grupos de edad. La enfermedad de Alzheimer es la causa de demencia más frecuente (50-70% del total). La demencia provoca un aumento de la morbilidad, mortalidad, discapacidad y dependencia de los pacientes, con una importante disminución de la calidad de vida y la supervivencia. El 80% de los enfermos es cuidado por sus familias, que asumen de media el 87% del coste total, con la consiguiente sobrecarga y menoscabo de la salud y calidad de vida de los cuidadores. El impacto económico de la demencia es enorme, y de evaluación compleja, por la mezcla de costes sanitarios y no sanitarios, directos e indirectos. Es necesario desarrollar programas globales e incrementar los recursos enfocados a fomentar la investigación, prevención, diagnóstico precoz, tratamiento multidimensional y abordaje multidisciplinario, que permitan reducir la carga sanitaria, social y económica de la demencia.

Resumen: Introducción: El uso de antidepresivos está muy extendido en la enfermedad de Parkinson (EP), aunque existen pocos estudios de calidad que aclaren su eficacia. Desarrollo: La metodología para esta guía clínica se ha basado en la revisión de la literatura y en la opinión de consenso del grupo de trastornos del movimiento de la AMN, recogida mediante una encuesta. Conclusiones: Según la evidencia científica, nortriptilina, venlafaxina, paroxetina o citalopram podrían ser utilizados en el tratamiento de la depresión en la EP, aunque paroxetina y citalopram con resultados contradictorios. Sin embargo, en la práctica clínica, los inhibidores selectivos de la recaptación de serotonina suelen ser los fármacos de primera elección. Por otro lado, aunque con menor evidencia, duloxetina podría ser una alternativa a venlafaxina y la asociación de venlafaxina con mirtazapina podría ser útil en casos refractarios. Además, podemos considerar el uso de citalopram para la ansiedad, atomoxetina para el tratamiento de la hipersomnia diurna, trazodona y mirtazapina para el tratamiento del insomnio y la psicosis, y bupropión para el tratamiento de la apatía. En general, los antidepresivos son fármacos bien tolerados en la EP. No obstante, es necesario considerar el efecto anticolinérgico de los tricíclicos, el efecto sobre la presión arterial de los inhibidores de la recaptación de serotonina y noradrenalina, la capacidad de los antidepresivos para desarrollar síntomas extrapiramidales y tener precaución con la asociación de inhibidores de la monoaminooxidasa B. Abstract: Introduction: Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted. Development: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey. Conclusions: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants. Palabras clave: Antidepresivos, Depresión, Ansiedad, Enfermedad de Parkinson, Efectos secundarios, Mecanismos de acción, Keywords: Antidepressants, Depression, Anxiety, Parkinson's disease, Side effects, Mechanisms of action

Introduction: Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted. Development: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey. Conclusions: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants. Resumen: Introducción: El uso de antidepresivos está muy extendido en la enfermedad de Parkinson (EP), aunque existen pocos estudios de calidad que aclaren su eficacia. Desarrollo: La metodología para esta guía clínica se ha basado en la revisión de la literatura y en la opinión de consenso del grupo de trastornos del movimiento de la AMN, recogida mediante una encuesta. Conclusiones: Según la evidencia científica, nortriptilina, venlafaxina, paroxetina o citalopram podrían ser utilizados en el tratamiento de la depresión en la EP, aunque paroxetina y citalopram con resultados contradictorios. Sin embargo, en la práctica clínica, los inhibidores selectivos de la recaptación de serotonina suelen ser los fármacos de primera elección. Por otro lado, aunque con menor evidencia, duloxetina podría ser una alternativa a venlafaxina y la asociación de venlafaxina con mirtazapina podría ser útil en casos refractarios. Además, podemos considerar el uso de citalopram para la ansiedad, atomoxetina para el tratamiento de la hipersomnia diurna, trazodona y mirtazapina para el tratamiento del insomnio y la psicosis, y bupropión para el tratamiento de la apatía. En general, los antidepresivos son fármacos bien tolerados en la EP. No obstante, es necesario considerar el efecto anticolinérgico de los tricíclicos, el efecto sobre la presión arterial de los inhibidores de la recaptación de serotonina y noradrenalina, la capacidad de los antidepresivos para desarrollar síntomas extrapiramidales y tener precaución con la asociación de inhibidores de la monoaminooxidasa B. Keywords: Antidepressants, Depression, Anxiety, Parkinson's disease, Side effects, Mechanisms of action, Palabras clave: Antidepresivos, Depresión, Ansiedad, Enfermedad de Parkinson, Efectos secundarios, Mecanismos de acción

Systemic inflammatory diseases could produce neurologic complications, and they are frequently incorporated in the differential diagnosis of neurological symptoms. There are wellestablished criteria to meet the diagnosis of neurologic manifestations of these systemic diseases. Methods: However, the range of clinical presentations varies in each condition, and the prevalence of these complications differs between studies. Hence, in many cases, an etiological relationship is not clearly defined. Results and Conclusion: For these reasons, it is challenging to make an accurate diagnosis. We analyzed the spectrum of neurological manifestations in a cohort of patients with systemic lupus erythematosus, rheumatoid arthritis, Behçet disease and sarcoidosis in order to improve our current knowledge of these complications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Knowledge of the socioeconomic impact of dementia-related disorders is essential for appropriate management of healthcare resources and for raising social awareness., Methods: We performed a literature review of the published evidence on the epidemiology, morbidity, mortality, associated disability and dependence, and economic impact of dementia and Alzheimer disease (AD) in Spain., Conclusions: Most population studies of patients older than 65 report prevalence rates ranging from 4% to 9%. Prevalence of dementia and AD is higher in women for nearly every age group. AD is the most common cause of dementia (50%-70% of all cases). Dementia is associated with increased morbidity, mortality, disability, and dependence, and results in a considerable decrease in quality of life and survival. Around 80% of all patients with dementia are cared for by their families, which cover a mean of 87% of the total economic cost, resulting in considerable economic and health burden on caregivers and loss of quality of life. The economic impact of dementia is huge and difficult to evaluate due to the combination of direct and indirect costs. More comprehensive programmes should be developed and resources dedicated to research, prevention, early diagnosis, multidimensional treatment, and multidisciplinary management of these patients in order to reduce the health, social, and economic burden of dementia., (Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Fabry's disease is an infrequent metabolic pathology linked to the X chromosome which causes a wide variety of signs and symptoms., Case Report: A 39-year-old male who was admitted to our stroke unit with right-side hemiparesis (1 + 0) and dysarthria (1). The score on the National Institute of Health Stroke Scale was 2. The patient presented angiokeratomas in both thighs. A computerised axial tomography scan of the head showed left thalamic acute infarction. The duplex scan of the supra-aortic trunks was normal, and the transcranial Doppler reflected a generalised increase in the pulsatility indices. Transthoracic echocardiography showed left ventricular hypertrophy and left atrial dilatation. He was discharged five days later, with antiaggregating medication but asymptomatic. The prolonged Holter-electrocardiogram recording showed paroxysmal atrial fibrillation. One notable value in the urine analysis was microalbuminuria of 281 mg/L. In view of the multi-organic involvement and the family history, a study for Fabry's disease was performed. Activity of the enzyme alpha-galactosidase A was diminished, and the presence of a mutation in the GLA gene was found. The patient's brother, who suffered from kidney failure and atrial fibrillation, was positive for this mutation. The patient is on treatment with agalsidase beta., Conclusions: Fabry's disease must be suspected in young males with heart disease, stroke or peripheral neuropathy, skin lesions, kidney failure and a history of cases in the family. Hormone replacement therapy must be established at an early stage, as it can improve the prognosis.

Introduction: In Parkinson's disease patients, impulse control disorders (ICDs) have been associated with younger age and early disease onset, yet the prevalence of ICDs in early-onset Parkinson's disease (EOPD) patients has yet to be studied. Thus, we set out to compare the prevalence of impulse control behaviors (ICBs) in a cohort of EOPD patients with that in age and gender matched healthy controls (HCs), as well as to analyze the association of these symptoms with the use of dopaminergic drugs and other clinical or demographic factors., Methods: A cross-sectional, multicenter study was carried out on patients recruited from outpatient Movement Disorder Clinics, assessing ICBs using the short form of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP). In addition, depression and quality of life (QoL) were measured, along with other demographic and clinical variables., Results: Of the 87 EOPD patients, 49 (58.3%) displayed an ICB, as did 28 of the 87 HCs (32.9%; p=0.001). Most of the EOPD patients that displayed an ICB (91.8%) were medicated with a dopamine agonist (DA) and accordingly, DA treatment was associated with a 7-fold increased risk of developing an ICB. Patients with ICBs had a higher depression score and a worse QoL., Conclusions: ICBs are much more prevalent in EOPD patients than in HCs and they are associated with DA intake, depression and a worse QoL., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Although antidepressants are widely used in Parkinson's disease (PD), few well-designed studies to support their efficacy have been conducted., Development: These clinical guidelines are based on a review of the literature and the results of an AMN movement disorder study group survey., Conclusions: Evidence suggests that nortriptyline, venlafaxine, paroxetine, and citalopram may be useful in treating depression in PD, although studies on paroxetine and citalopram yield conflicting results. In clinical practice, however, selective serotonin reuptake inhibitors are usually considered the treatment of choice. Duloxetine may be an alternative to venlafaxine, although the evidence for this is less, and venlafaxine plus mirtazapine may be useful in drug-resistant cases. Furthermore, citalopram may be indicated for the treatment of anxiety, atomoxetine for hypersomnia, trazodone and mirtazapine for insomnia and psychosis, and bupropion for apathy. In general, antidepressants are well tolerated in PD. However, clinicians should consider the anticholinergic effect of tricyclic antidepressants, the impact of serotonin-norepinephrine reuptake inhibitors on blood pressure, the extrapyramidal effects of antidepressants, and any potential interactions between monoamine oxidase B inhibitors and other antidepressants., (Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Left atrial appendage closure is a useful technique for patients at high thromboembolic risk and contraindications for oral anticoagulation therapy. However, it can be challenging when anatomical difficulties are encountered. We present a unique case of atypical appendage uptake and how we completed the procedure., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Cluster-like headaches have been described as secondary to several intracranial lesions. We report the case of a 47-year-old man who presented with a throbbing periocular pain associated with lacrimation and red eye. A contralateral epidermoid cyst was detected in the magnetic resonance imaging.