[Functional neuroimaging in the diagnosis of patients with Parkinsonism: Update and recommendations for clinical use]

Functional Neuroimaging has been traditionally used in research for patients with different Parkinsonian syndromes. However, the emergence of commercial radiotracers together with the availability of single photon emission computed tomography (SPECT) and, more recently, positron emission tomography (PET) have made them available for clinical practice. Particularly, the development of clinical evidence achieved by functional neuroimaging techniques over the past two decades have motivated a progressive inclusion of several biomarkers in the clinical diagnostic criteria for neurodegenerative diseases that occur with Parkinsonism. However, the wide range of radiotracers designed to assess the involvement of different pathways in the neurodegenerative process underlying Parkinsonian syndromes (dopaminergic nigrostriatal pathway integrity, basal ganglia and cortical neuronal activity, myocardial sympathetic innervation), and the different neuroimaging techniques currently available (scintigraphy, SPECT and PET), have generated some controversy concerning the best neuroimaging test that should be indicated for the differential diagnosis of Parkinsonism. In this article, a panel of nuclear medicine and neurology experts has evaluated the functional neuroimaging techniques emphazising practical considerations related to the diagnosis of patients with uncertain origin parkinsonism and the assessment Parkinson's disease progression.

[Descriptive analysis of the use of atypical antipsychotics under compassionate-use in a health area in Ferrol (La Coruña, Spain)]

BACKGROUND AND OBJECTIVE

Although atypical antipsychotics (AA) provoke fewer extra-pyramidal symptoms (ES) than classic antipsychotics, their use in patients greater than or equal to 75 years old with dementia must be under compassionate-use. This is an important limitation. We performed a descriptive analysis of the use of atypical antipsychotics under compassionate-use (AACU) in the Ferrol health area.

PATIENTS AND METHODS

We retrospectively assessed all the patients who were receiving an AACU from March, 2004 (that is the date when prescription under compassionate-use of AA came into force in Spain) to November 30, 2008.

RESULTS

One hundred and thirty-three of 164 patients (63.6% women; median ages, 81.9 ± 4.95 years) were included. Diagnostic aetiologies were: 42.9% Alzheimer's disease, 30.8% Parkinson-dementia/Lewy body disease, and 15.8% vascular/mixed dementia. A total of 68.4% of patients had received other anti-psychotic drugs previously and 32.3% had ES due to antipsychotics. The AACU received were: quetiapine (76.7%), ziprasidone (18.8%), and olanzapine (4.5%). Median follow-up time was 20.25 ± 20.38 months. Side effects were observed in 19.7% of patients. Improvement of NPI (Neuropsychiatric Inventory) was 33.3 ± 24.75 points. Agitation/aggressiveness (5.6 ± 4.55), delirious ideas (4.94 ± 5.07), irritability (4.38 ± 4.94), and anxiety (4.32 ± 4.83) were the symptoms that most improved. Although there were no differences between AACU, quetiapine was associated with significant maintenance in monotherapy (94.1% vs 72% for ziprasidone and 83.3% for olanzapine; p < 0.0001).

CONCLUSIONS

AACU are effective and well tolerated drugs. Quetiapine was the most frequently used AACU. An excessive percentage of patients previously received other antipsychotics and present with ES.

Homocysteine and hypertension in persons with spinal cord injury

STUDY DESIGN

Cross-sectional analysis of a convenience sample of locally recruited participants, including both patients and volunteers.

OBJECTIVES

To determine whether there is an association between plasma homocysteine and hypertension in persons with spinal cord injury (SCI).

SETTING

Spinal Cord Injury Service of the Veterans Affairs Palo Alto Medical Center (California, United States of America).

METHODS

The incidence of hypertension, dyslipidemia, insulin resistance, and the presence of metabolic syndrome were determined in 168 individuals with SCI (mean age 50.2 +/- 12.8 years). Fasting lipids, insulin, glucose, plasma homocysteine, and anthropometric data was gathered for each subject.

RESULTS

Blood pressure values (P < 0.001) and mean arterial pressure (P < 0.05) increased with higher plasma homocysteine levels. Homocysteine values were also significantly greater among individuals with hypertension compared with those who were normotensive or prehypertensive (P < 0.0001). There was an inverse relationship between plasma homocysteine levels and glomerular filtration rate and effective renal plasma flow (P < 0.05).

CONCLUSIONS

Plasma homocysteine levels are elevated in persons with SCI who have hypertension and inversely related to renal function, which suggests that renal dysfunction may be a link between homocysteine and hypertension in persons with SCI.

SPONSORSHIP

Funded by the VA Rehabilitation Research and Development Service, Merit Review Grant #B2549R.