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The diagnosis and evaluation of dementia and mild cognitive impairment with emphasis on SPECT perfusion neuroimaging. CNS Spectr 2012; 17:176-206. [PMID: 22929226 DOI: 10.1017/s1092852912000636] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As the world population ages, the incidence of dementing illnesses will dramatically increase. The number of people afflicted with dementia is expected to quadruple in the next 50 years. Since the neuropathology of the dementias precedes clinical symptoms often by several years, earlier detection and intervention could be key steps to mitigating the progression and burden of these diseases. This review will explore methods of evaluating, differentiating, and diagnosing the multiple forms of dementia. Particular emphasis will be placed on the diagnosis of mild cognitive impairment-the precursor to dementia. Anatomical imaging; cerebrospinal fluid markers; functional neuroimaging, such as positron emission tomography and single photon emission tomography; and molecular imaging, such as amyloid marker imaging, will be assessed in terms of sensitivity and specificity. Cost will also be a consideration, as the growing population afflicted with dementia represents an increasingly large financial encumbrance to the healthcare systems of every nation. In the face of expensive new markers and limited availability of cyclotrons, single photon emission computer tomography (SPECT) provides relatively high sensitivity and specificity at a comparatively low overall cost.
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Rojo L, Sjöberg MK, Hernández P, Zambrano C, Maccioni RB. Roles of cholesterol and lipids in the etiopathogenesis of Alzheimer's disease. J Biomed Biotechnol 2010; 2006:73976. [PMID: 17047312 PMCID: PMC1559932 DOI: 10.1155/jbb/2006/73976] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Alzheimer's disease is the principal cause of dementia throughout the world and the fourth cause of death in developed economies.This brain disorder is characterized by the formation of brain protein aggregates, namely, the paired helical filaments and senile plaques. Oxidative stress during life, neuroinflamamtion, and alterations in neuron-glia interaction patterns have been also involved in the etiopathogenesis of this disease. In recent years, cumulative evidence has been gained on the involvement of alteration in neuronal lipoproteins activity, as well as on the role of cholesterol and other lipids in the pathogenesis of this neurodegenerative disorder. In this review, we analyze the links between changes in cholesterol homeostasis, and the changes of lipids of major importance for neuronal activity and Alheimer's disease. The investigation on the fine molecular mechanisms underlying the lipids influence in the etiopathogenesis of Alzheimer's disease may shed light into its treatment and medical management.
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Affiliation(s)
- Leonel Rojo
- Laboratory of Cellular and Molecular Biology and Neurosciences, Millennium Institute for Advanced Studies in
Cell Biology and Biotechnology (CBB), Millennium Building, Las Encinas 3370, Ñuñoa, Santiago, Chile
- Department of Chemistry, Arturo Prat University, avenue Arturo Prat 2120, Iquique, Chile
| | - Marcela K. Sjöberg
- Laboratory of Cellular and Molecular Biology and Neurosciences, Millennium Institute for Advanced Studies in
Cell Biology and Biotechnology (CBB), Millennium Building, Las Encinas 3370, Ñuñoa, Santiago, Chile
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Salvador 486, 750-0922 Providencia,
Santiago, Chile
| | - Paula Hernández
- Laboratory of Cellular and Molecular Biology and Neurosciences, Millennium Institute for Advanced Studies in
Cell Biology and Biotechnology (CBB), Millennium Building, Las Encinas 3370, Ñuñoa, Santiago, Chile
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Salvador 486, 750-0922 Providencia,
Santiago, Chile
| | - Cristian Zambrano
- Laboratory of Cellular and Molecular Biology and Neurosciences, Millennium Institute for Advanced Studies in
Cell Biology and Biotechnology (CBB), Millennium Building, Las Encinas 3370, Ñuñoa, Santiago, Chile
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Salvador 486, 750-0922 Providencia,
Santiago, Chile
| | - Ricardo B. Maccioni
- Laboratory of Cellular and Molecular Biology and Neurosciences, Millennium Institute for Advanced Studies in
Cell Biology and Biotechnology (CBB), Millennium Building, Las Encinas 3370, Ñuñoa, Santiago, Chile
- Department of Neurological Sciences, Faculty of Medicine, University of Chile, Salvador 486, 750-0922 Providencia,
Santiago, Chile
- *Ricardo B. Maccioni:
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Abstract
Alzheimer disease (AD) is a chronic neurodegenerative disorder that is manifested by cognitive decline, neuropsychiatric symptoms, and diffuse structural abnormalities in the brain. Its prevalence is predicted to rise 4-fold in the next 50 years. AD is characterized pathologically by deposition of extracellular beta-amyloid and accumulation of neurofibrillary tangles. Neuronal death and specific neurotransmitter deficits also are part of the pathologic picture. Strategies to delay symptom progression have focused on addressing the neurotransmitter deficits. Strategies to delay the onset or biologic progression of AD largely have targeted the plaques formed by the deposition of beta-amyloid. AD and cardiovascular disease share common risk factors, notably hypercholesterolemia, and occur together more often than expected by chance. Therapy with the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) is the first-line treatment option for hypercholesterolemia, and observational studies have suggested that the risk of AD is reduced in patients who receive statin therapy in midlife. This reduction in risk of AD observed with statin therapy may be due to statins reducing beta-amyloid formation and deposition or to their known anti-inflammatory effects. Two randomized double-blind statin trials in patients with AD to assess the potential for statins to slow disease progression are currently under way. If successful, statin AD primary prevention trials may be developed.
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Affiliation(s)
- Steven T DeKosky
- Department of Neurology and Alzheimer Disease Research Center, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania 15213-2582, USA.
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Chiaretti A, Genovese O, Riccardi R, Di Rocco C, Di Giuda D, Mariotti P, Pulitanò S, Piastra M, Polidori G, Colafati GS, Aloe L. Intraventricular nerve growth factor infusion: a possible treatment for neurological deficits following hypoxic-ischemic brain injury in infants. Neurol Res 2005; 27:741-6. [PMID: 16197811 DOI: 10.1179/016164105x35611] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE AND IMPORTANCE Hypoxic-ischemic brain injuries in childhood are associated with poor neurological outcome. Unfortunately, no new therapeutic approaches have been proposed. Recently, animal studies show that nerve growth factor (NGF) can reduce neurological deficits following hypoxic-ischemic brain injuries. The objective of this study is to demonstrate the therapeutic effects of intraventricular NGF infusion in severe post-ischemic damage. CLINICAL PRESENTATION Two infants, aged 9 and 8 months, with hypoxic-ischemic brain damage, secondary to prolonged cardiorespiratory arrest and stabilized after the conventional treatment, were treated with intraventricular NGF infusion. Before the therapy both infants were comatose with asymmetrical tetraparesis; their Glasgow Coma Scale (GCS) was 4 and 5, respectively. One month after the treatment, their GCS was 8 and 9, respectively. EEG examinations performed after the NGF infusion showed an increased alpha/theta ratio. MRI showed a reduction of malacic areas in the brain. A SPECT study, performed only in one infant, demonstrated that the NGF treatment resulted in an improvement of regional cerebral perfusion in right temporal and occipital cortices. INTERVENTION The drug utilized was 2.5S NGF purified and lyophilized from male mouse submaxillary glands. NGF infusion was started about 30 days after the hypoxic-ischemic brain injury. 0.1 mg NGF was administered via the external drainage catheter into the right cerebral ventricle once a day for 10 days consecutively. CONCLUSION Our observations are interesting, but further studies are necessary to confirm the effects of NGF in hypoxic-ischemic brain injuries in infants.
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Affiliation(s)
- Antonio Chiaretti
- Pediatric Intensive Care Unit, Catholic University Medical School, Rome, Italy.
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Bragin V, Chemodanova M, Dzhafarova N, Bragin I, Czerniawski JL, Aliev G. Integrated treatment approach improves cognitive function in demented and clinically depressed patients. Am J Alzheimers Dis Other Demen 2005; 20:21-6. [PMID: 15751450 PMCID: PMC10833298 DOI: 10.1177/153331750502000103] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the efficacy of an integrative treatment approach on cognitive performance. The study sample comprised 35 medically ill patients (20 male, 15 female) with an average age of 71.05, who were diagnosed with mild dementia and depression. These patients were evaluated at baseline and at six, 12, and 24 months of treatment, which included antidepressants (sertraline, citalopram, or venlafaxine XR, alone or in combination with bupropion XR), cholinesterase inhibitors (donepezil, rivastigmine or galantamine), as well as vitamins and supplements (multivitamins, vitamin E, alpha-lipoic acid, omega-3 and coenzyme Q-10). Patients were encouraged to modify their diet and lifestyle and perform mild physical exercises. Results show that the integrative treatment not only protracted cognitive decline for 24 months but even improved cognition, especially memory and frontal lobe functions.
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Affiliation(s)
- Valentin Bragin
- Stress Relief and Memory Training Center, Brooklyn, New York, USA
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