Ramiro Ruiz-Garcia

Mild behavioral impairment (MBI) constitutes a late-life transition state that is associated with an increased risk of cognitive impairment and dementia. Herein, we cross-sectionally describe the MBI construct and its relationship with cognitive status in Mexican-Mestizos (MM) older adults. Participants were classified according to their cognitive and behavioral statuses using tests administered to older adults and their informants. APOE_rs429358/rs7412 variants were genotyped by real-time PCR. Multivariate correlation and Principal Components Analysis (PCA) were used in statistical analysis. A total of 246 participants were included, 56.1% were classified as individuals with NC, 13.0% had subjective cognitive decline, and 30.9% had mild cognitive impairment. A total of 37% (91/246) of participants from all over the cognitive spectrum met the MBI criteria; among this group, APOEε4 homozygosity was associated with two subdomains of the MBI. Subjective cognitive complaint, symptoms of depression, and cognitive decline reported by the informant were associated with an increased risk for MBI (ORs in the range of 4.7–15.89). The first three components of PCA explained 68.0% of the variance of the dataset, including the MBI-checklist total score as a main contributor. Well-known risk factors for dementia also correlated with this PCA. MBI could be a potential marker for cognitive decline in non-demented MM elderly people; however, observed associations should be confirmed in future longitudinal studies.

Mild Behavioral Impairment (MBI) constitutes a late-life transition state that is associated with an increased risk of cognitive impairment and dementia. Herein, we described the MBI construct and its relationship with cognitive status in Mexican-Mestizos (MM) older adults. Participants were classified according to their cognitive and behavioral statuses using tests administered to older adults and their informants. APOE_rs429358/rs7412 variants were genotyped by real-time PCR. Multivariate correlation and Principal Components Analysis (PCA) were used in statistical analysis. 246 participants were included, 13.0% had subjective cognitive decline and 30.9% mild cognitive impairment. 37% (91/246) of participants from all the cognitive spectrum met the MBI criteria; among this group, being carrier of APOEε4 was associated with two subdomains of the MBI. Subjective cognitive complaint, symptoms of depression and cognitive decline reported by the informant were associated with an increased risk for MBI (ORs in the range of 4.7-15.89). The first three components of PCA explained 68.0% of the variance of the data set, including MBI-checklist total score as a main contributor. Well-known risk factors for dementia also correlated with this PCA. MBI could be a relevant marker for cognitive decline in non-demented MM elderly people.

Objective: Neuropsychiatric interictal comorbidities (NPC) may increase the risk of epilepsy. Peri‐Ictal Neuropsychiatric manifestations (PI‐NPM) occur in 20–40% of people with epilepsy (PWE). Clinical phenomena and outcomes are poorly understood in PWE with NPC and/or PI‐NPM. Our study sought to describe NPC and PI‐NPM clinical features and identify their association to breakthrough seizures (BSz) in a Third‐Level Specialized Neurological Center Emergency Department (ED). Methods: A retrospective cohort including adult patients with diagnosis of epilepsy seen in the ED was analyzed. Demographic characteristics were performed using chi‐square and t ‐tests. PWE were divided into those with only one admission with BSz, and those that were readmitted to ED with BSz (2BSz) during a 1‐year period. A logistic regression analysis was designed including significant variables of the association analysis and age and time of diagnosis as covariates to look for neuropsychiatric predictors of readmission due seizure relapse. Results: Two hundred‐sixty‐four participants were included. 133 patients (50%) were male, and 111 cases (42%) of PWE with readmission (2BSz). The presence of NPC was associated with re‐admission (2BSZ) ( X ² 6.730, p = 0.009). No significant associations were found considering the PI‐NPM. Anxiety was the most prevalent pre‐ictal neuropsychiatric symptom (14.4%) and post‐ictal symptom (33.7%). No significant differences were observed in logistic regression considering PI‐NPM compared to those without PI‐NPM manifestations for readmission. The presence of NPC demonstrated a 1.88 OR for readmission in one year‐period compared to those PWE without NPC Significance: PWE with NPC have an increased risk of readmission to ED due seizure relapse. Anxiety is the most frequent pre‐ictal and post‐ictal manifestation. However, the presence of PI‐NPM did not exhibit any association for readmission due seizure relapse.

Antecedentes: La afasia progresiva primaria (APP) es un síndrome caracterizado por el declive progresivo en la función del lenguaje. Hay tres síndromes principales de APP, cada uno con perfiles linguÌ?ísticos y sustratos neuropatológicos diferentes. Aunque existen criterios diagnósticos clínicos actuales para la categorización de la APP, su utilidad requiere evaluaciones por personal especializado y la administración de extensas baterías cognitivas. En la actualidad no existe una herramienta diagnóstica estandarizada para la APP, aunque se han desarrollado y validado algunas baterías exclusivamente para su categorización. Objetivo: Averiguar qué herramienta diagnóstica cognitiva/afásica tiene la mejor precisión para el diagnóstico y la categorización de la APP. Método: Se realizará una búsqueda en las bases de datos MEDLINE (PubMed), EMBASE y Web of Science utilizando estrategias de búsqueda adecuadas. Se incluirán estudios que contengan datos originales de casos de APP posibles, probables y definitivos según los criterios diagnósticos clínicos actuales para la APP. La evaluación de la calidad se realizará de acuerdo con las directrices de Estudios de Precisión Diagnóstica-2 (QUADAS-2). Este protocolo de revisión sistemática se reporta según lo establecido en la declaración Protocolo de los Artículos de Informes Preferidos para Revisiones Sistemáticas y Meta-Análisis (PRISMA-P) de 2015. Resultados: Los hallazgos de este protocolo serán publicados en una revista de revisión por pares. Conclusiones: Las baterías clínicas pueden ayudar a facilitar el diagnóstico de APP.

Background: Primary progressive aphasia (PPA) is a syndrome characterized by progressive decline in language function. There are three main PPA syndromes, ea...

The emergence of new-onset neuropsychiatric symptoms in middle age presents a diagnostic challenge, particularly when differentiating between a primary psychiatric disorder and an early neurodegenerative disease. The discrepancy between bedside clinical diagnosis and subsequent neuropathological findings in such cases further highlights the difficulty of accurately predicting pathology, especially when there are no evident focal lesions or changes in brain volume. Here we present the case of a 59-year-old woman with inconclusive neuroimaging who exhibited pronounced neuropsychiatric and behavioral symptoms initially suggestive of a mood disorder, then of behavioral variant frontotemporal dementia. However, upon autopsy, we identified coexisting Lewy body disease pathology and tau-related changes, including argyrophilic grain disease and primary age–related tauopathy. This case illustrates the challenges encountered when diagnosing late-onset neuropsychiatric symptoms, emphasizes the link between such symptoms and early-onset dementia and argyrophilic grain disease, and contributes to our understanding of the impact of mixed neuropathology in this population. Accurate diagnosis is essential for the development of molecular-specific therapies and, as well as for accurate prognosis and enrollment in clinical trials.

Objetivo: Describir, de acuerdo con la literatura actual, las características clínico-demográficas y los tratamientos farmacológicos y no farmacológicos en los cambios cognitivos desarrollados después de la infección por el SARS-CoV-2. Material y métodos: Realizamos una búsqueda no sistemática en Medline (PubMed), con el objetivo de encontrar información sobre conceptos actualizados en definiciones clínicas, fisiopatología, características clínicas y estrategias terapéuticas, para lo cual se utilizó términos MeSH y se consideró artículos publicados desde el año 2020 sobre el deterioro cognitivo post-COVID-19. Resultados: Los factores de riesgo asociados incluyen sexo femenino, enfermedades crónicas, tabaquismo y antecedentes de hospitalización. Dentro de los dominios cognitivos más afectados se encuentran la memoria, la atención y las funciones ejecutivas. Los dominios cognitivos menos afectados son el lenguaje y las habilidades visoespaciales. Los estudios de neuroimagen han demostrado ser de utilidad para determinar correlaciones anatómicas con el deterioro cognitivo. Las terapias farmacológicas y otras estrategias no farmacológicas no cuentan con suficiente nivel de evidencia para demostrar su efectividad contra el deterioro cognitivo. La rehabilitación cognitiva y la psicoterapia pueden ayudar a mejorar el deterioro cognitivo y también algunos síntomas neuropsiquiátricos. Conclusiones: La caracterización de las definiciones y el espectro clínico-cognitivo como complicación post-COVID-19 están más estructurados en la actualidad; sin embargo, aún no se cuenta con suficiente nivel de evidencia para poder desarrollar guías de tratamiento estandarizadas para el deterioro cognitivo. El manejo interdisciplinario con rehabilitación neurocognitiva, fármacos, neuromodulación y otras terapias

Introduction. Primary Progressive Aphasia (PPA) is a syndrome characterized by progressive decline in language function. There are three main PPA syndromes, each one features different language profiles and neuropathologic substrates. Although there are current clinical diagnostic criteria for PPA categorization, the utility of these requires evaluation(s) by specialized staff and the administration of extensive cognitive batteries. A diagnostic tool for PPA is not currently standardized, though some batteries have been developed and/or validated exclusively for PPA categorization. We aim to describe which cognitive/aphasia diagnostic tool has the best accuracy for PPA diagnosis and categorization. Methods and Analysis. MEDLINE (PubMed), EMBASE and Web of Science databases will be searched using adequate search strategies. Studies including original data of possible, probable, and definite PPA cases according to current clinical diagnostic criteria for PPA will be included. Inclusion criteria will be 1) Studies describing data of a cognitive/aphasia clinical battery including at least one test measure (e.g., specificity, positive predictive values, etc.) and 2) PPA diagnosis according to current clinical criteria as the reference standard. Two reviewers will perform the screening and data extraction. Quality assessment will be performed according to the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) guidelines. This systematic review protocol is reported as stated by with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. Dissemination. Findings of this systematic review protocol will be disseminated through a publication in a peer-reviewed journal. Results will be helpful to improve the diagnosis and classification of PPA syndromes.