Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

Alzheimer’s Disease

 

Restaurando la Homeostasis Metálica en Alzheimer: Avances y Desafíos en la Terapia de Quelación

To the Editor:

Alzheimer’s disease (AD) continues to challenge conventional therapeutic approaches, necessitating alternative strategies based on its pathophysiology. Among these, metal chelation therapy emerges as a promising option that directly addresses the metal dyshomeostasis implicated in AD, offering disease-modifying effects beyond symptomatic relief. Copper, iron, and zinc actively participate in the progression of AD, promoting amyloid-β oligomerization, oxidative stress, and tau hyperphosphorylation. Post-mortem studies have identified elevated concentrations of these metals in the brains of AD patients, particularly copper in amyloid plaques, which reaches levels three times higher than normal.

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Palabras clave: Enfermedad de Alzheimer, Homeostasis Metálica, Terapia de Quelación,

Keywords: Alzheimer’s Disease, chelation therapy, Metal homeostasis,

Diagnóstico de la Enfermedad de Alzheimer de Inicio Temprano Mediante el Uso de Biomarcadores en Líquido Cefalorraquídeo: Reporte de Caso. Diagnosis Of Early-Onset Alzheimer’s Disease Using Cerebrospinal Fluid Biomarkers: A Case Report

Alzheimer’s disease (AD) represents between 50% and 75% of dementia cases worldwide. It is classified into two types: Late-onset (LOAD), which is common in individuals over 65 years old, and Early-onset (EOAD), which affects 5-10% of individuals before the age of 65. Its manifestations vary considerably, ranging from typical amnestic presentation in LOAD to atypical forms such as non-fluent aphasia, executive, and visuoperceptive alterations in EOAD, which makes timely diagnosis difficult.

Currently, the diagnostic model goes beyond conventional, proposing the use of biomarkers in cerebrospinal fluid for early detection and management.

In the case presented, we describe a 57-year-old woman with EOAD, characterized by a two-year history of progressive and insidious memory loss accompanied by logopenic aphasia and behavioral changes. In her family history, the patient had a history of dementia in three generations on the maternal side. To confirm the diagnosis, complementary studies were performed such as conventional brain magnetic resonance imaging with perfusion sequences and the measurement of Tau protein and Beta-amyloid peptide biomarkers in cerebrospinal fluid. These analyses confirmed the presence of early-onset Alzheimer’s disease.

In this study, we discuss the diagnostic process of Alzheimer’s disease, emphasizing in the use of biomarkers in cerebrospinal fluid.

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Palabras clave: biomarcadores en líquido cefalorraquídeo, Demencia por Alzheimer, diagnóstico de la Enfermedad de Alzheimer, Enfermedad de Alzheimer de inicio temprano, péptidos beta-amiloide, proteínas de líquido cefalorraquídeo,

Keywords: Alzheimer's Dementia, Alzheimer's disease diagnosis, Alzheimer’s Disease, Amyloid beta-peptides, Biomarkers, cerebrospinal fluid, Cerebrospinal fluid proteins, Early-onset,

Columbo y la enfermedad de Alzheimer. Columbo and Alzheimer’s disease.

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Palabras clave: demencia, Enfermedad de Alzheimer, series de televisión, trastornos cerebrales,

Keywords: Alzheimer’s Disease, brain disorders, dementia, television drama,

Boro y la ruta hacia el diagnóstico temprano de enfermedades neurodegenerativas. Boron towards early diagnosis of neurodegenerative diseases.

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Palabras clave: boro, Enfermedad de Alzheimer, enfermedad de Parkinson, Neurodegeneración,

Keywords: Alzheimer’s Disease, boron, Neurodegeneration, Parkinson’s disease,

Escala de Conocimiento de la Enfermedad de Alzheimer: Adaptación y Análisis de las Propiedades Psicométricas en Estudiantes Universitarios Ecuatorianos. Alzheimer’s Disease Knowledge Scale: Adaptation and Analysis of Psychometric Properties in Ecuadorian University Students

The aim of this study was to develop a linguistic adaptation of the Alzheimer’s Disease Knowledge Scale (ADKS), and to provide evidence on the reliability and validity of the adapted test. The ADKS is a self-administered instrument that examines knowledge about risk factors, assessment and diagnosis, symptoms, course, impact on life, care and treatment and management of Alzheimer’s disease (AD).

Methods: An instrumental study was implemented. The ADKS items were adapted to the Ecuadorian use of the Spanish language through an iterative process of translation by experts. Next, a sample of 523 university students completed the adapted scale together with a set of other instruments to analyze the fiability and criterion validity of the scale.

Results: ADKS Ecuador showed good internal consistency (Cronbach’s α=.78), adequate test-retest reliability, p > .05, and convergent and discriminatory evidence of validity when related to other variables.

Conclusion: ADKS Ecuador is an adequate instrument to assess general knowledge about AD in young highlgy educated Ecuadorian population with low dom ain knowledge.

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Palabras clave: Conocimiento, Educación para la salud, Enfermedad de Alzheimer, evaluación., psicometría,

Keywords: Alzheimer’s Disease, assessment, Health educations, Knowledge, psychometrics,

Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática. Cognitive, biological, anatomical and behavioral markers of mild cognitive impairment and Alzheimer’s disease. A systematic review

Alzheimer’s disease (AD) is a progressive neurodegenerative disease that affects 50% of people over 85 years of age and is one of the most common in adulthood and the most common cause of dementia in developed countries. The objective was to determine which have been the most studied cognitive, biological, anatomical and behavioral markers of mild cognitive impairment (MCI) and AD in the last 10 years. Observational studies were searched in the Scopus, Pubmed and Sciencedirect databases. 187 articles were identified, of which 23 with full text were finally selected. The studies corresponded to cognitive (15 studies), biological (8 studies), anatomical (3 studies) and behavioral (2 studies) markers. The identified markers will help guide the design of early detection programs and future interventions that reduce neuropathological effects and significant alterations in quality of life.

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Palabras clave: biomarcador, Deterioro Cognitivo Leve, Enfermedad de Alzheimer, marcador, Revisión Sistemática,

Keywords: Alzheimer’s Disease, biomarker, marker, Mild Cognitive Impairment, Systematic Review,

Calambres musculares relacionados con uso de donepezilo. Donepezil-related muscular cramps

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Palabras clave: calambres musculares, donepezilo, Enfermedad de Alzheimer, inhibidores de acetil-colinesterasa,

Keywords: acetyl-cholinesterase inhibitors, Alzheimer’s Disease, donepezil, muscular cramps,

Memoria Episódica en las Etapas Preclínicas de la Enfermedad de Alzheimer Genética. Episodic Memory In The Preclinical Stages Of Genetic Alzheimer’s Disease

Introduction: Episodic memory (EM) allows us to recall events or lived experiences. EM is associated to the medial temporal lobe (MTL) activity, which has circuits integrated by different cortical association areas. EM impairment is the first symptom of Alzheimer’s disease (AD), which is explained by the abnormal beta amyloid (βA) and phosphorylated tau protein (PTF) deposition in the MTL.

Development: A review about EM components and its assessment is done, especially related to preclinical stages of genetic AD. The relationship of EM components to βA and TFP deposition and the activity of MTL networks, using positron emission tomography (PET) of the brain, particularly in asymptomatic members of families at genetic risk for early AD, caused by the E280A mutation in preseniline 1 (PSN1), is revised.

Conclusions: The reviewed studies trend to validate the hypothesis, which would suggest that EM allows us to consolidate and recalling lived subjective experiences, which also allows us learning from the past. EM has been assessed with verbal declarative memory tasks. The asymptomatic members, carrying the E280A PSN1 mutation for genetic AD, have showed lower scores than asymptomatic non carriers on these memory tasks, which significantly correlates to PET-amyloid and PET-tau of MTL signals, up to 20 years before dementia onset.

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Palabras clave: Alzheimer, hipocampo, Lóbulo temporal medial, memoria episódica, preclínico,

Keywords: Alzheimer’s Disease, Episodic Memory, hippocampus, Medial Temporal Lobe,

Bacterias, Endotoxinas y Neuroinflamación Crónica: ¿Una Etiopatogenia Para las Enfermedad de Alzheimer? Bacteria, Endotoxins And Chronic Neuroinflammation: An Etiopathogenesis For Alzheimer’s Disease?

Alzheimer’s disease represents one of the main health problems in advanced countries. Actually, we do not have an effective therapy for disease and its cause remains unknown. For several decades, research has focused on amyloidogenesis as the primary cause of disease. However, clearly satisfactory results have not been obtained in this line of research. In recent years there has been growing evidence about the role of neuroinflammation in AD and other neurodegenerative diseases. The role of ß-Amyloid as an element of the innate immune response places it in a new position in the pathophysiology of the disease. Alterations of intestinal and oral microbiota could have a role in the generation of neuroinflammatory changes, either directly by pathogens or by bacterial endotoxins. Endotoxins are polysaccharides of gram-negative bacteria that produce a potent immune reaction. Recently, there is evidence that gingipains have a role in production of neurotoxicity and amyloidogenesis. Gingipains are endotoxins produced by a pathogen associated with chronic periodontitis, Porphyromonas gingivalis. Gingipains generate direct neurotoxicity and its effect could be reversed with various molecules that are currently under development.

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Palabras clave: Endotoxinas, Enfermedad de Alzheimer, Gingipaína, Liposacáridos, Microbiota, Neuroinflamación, Patogenia, Periodontitis, Porphyromonas gingivalis,

Keywords: Alzheimer’s Disease, Endotoxins, Gingipain, Liposaccharides, Microbiota, neuroinflammation, pathogenesis, Periodontitis, Porphyromonas gingivalis,

Batería Neuropsicológica Set de Datos Uniformes (UDS) Para la Evaluación de Enfermedad de Alzheimer y Deterioro Cognitivo Leve: Una Revisión Sistemática. Neuropsychological Battery Uniform Data Set (Uds) For The Evaluation Of Alzheimer’s Disease And Mild Cognitive Impairment: A Systematic Review.

The neuropsychological battery UDS (of the English Uniform Data Set), is used worldwide to homogenize the investigations of Alzheimer’s disease. Objective: Quantitatively synthesize the results of the subtests of the UDS for the cognitive profile of controls, patients with mild cognitive impairment and dementia of the Alzheimer type. Method: An advanced and manual systematic search was performed in databases (PubMed / MedLine, Web of Science, Scopus, Lilacs, Science Direct, Cochrane Library, PsycINFO) evaluating the diagnostic performance of the UDS. Results: The systematic review showed a narrative synthesis where 8 articles were included that included 9260 subjects, with an age range between 60 and 90 years. The quantitative synthesis used 13 articles with a total sample of 2,884 participants, with an average age of 74 years and an average of 15 years of education. Conclusion: We described a synthesis of the medial scores, which generate cut-off points for Alzheimer’s type dementia (DTA), mild cognitive impairment (MCI) and cognitively normal controls, evidencing an adequate diagnostic precession.

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Palabras clave: Alzheimer, demencia, Detección, Deterioro Cognitivo Leve, evaluación neuropsicológica, Revisión Sistemática, Uniform Data Set,

Keywords: Alzheimer’s Disease, assessment, Detection, Mild Cognitive Impairment, Neuropsychological Battery, Systematic Review, Uniform Data Set,

Adaptación del Test de Colores y Palabras de Stroop: Su Importancia en la Detección Precoz de los Déficits en las Funciones Ejecutivas.

Neuropsychological assessment is increasingly used as complementary diagnostic test for different brain pathologies, and Portugal is not an exception. Therefore urges that the instruments used for the evaluation present adequate psychometric criteria and normative data adjusted to the same population. Aging is a dynamic and progressive process, leading to greater vulnerability and incidence of pathological processes. Within these processes included neurodegenerative diseases, the most common, Alzheimer’s Disease.1 Executive functions seem to be the most involved in the overall functioning of the individual and the Stroop Test, is frequently used to evaluate these functions. We present a study of adaptation of this instrument in a Portuguese sample, trying to verify the importance of sociodemographic variables on test performance and whether there were significant differences between healthy subjects and with neuropathology. The results have allowed verifying the importance of adaptation of populations where tests are used. Thus, the Stroop Test seems a test to take into account when establishing a neuropsychological evaluation protocol, as well unlike the patterns of performance between normative and pathological aging.

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Palabras clave: Enfermedad de Alzheimer, Envejecimiento normal, Funciones Ejecutivas, Test de Colores y Palabras de Stroop,

Keywords: Alzheimer’s Disease, Executive functions, Normal aging, Stroop Color and Word Test,

El Estrés Crónico, ¿Factor de Riesgo para la Enfermedad de Alzheimer?

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder, with epidemiological importance due to the high prevalence of people affected worldwide. Over time, various hypotheses have been raised in the pathophysiology and etiology of the disease and now the study of this disorder, is tackled from a multi-causal perspective, taking into account different etiological factors, among which are: genetics, oxidative stress, intracellular calcium dynamics, vascular effects, inflammation and stress, among others. The following literature review, aims to show studies that correlate stress as a risk factor in AD, recognizing the pathophysiological findings of AD, due to augmentation on glucocorticoids by chronic stress and the subsequent alteration of the hypothalamic-pituitary-adrenal axis. Critical view of these findings according to the literature.

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Palabras clave: depresión, Eje hipotálamo-hipófisis-adrenal, Enfermedad de Alzheimer, estrés, Glucocorticoides, ovillos neurofibrilares, proteína tau,

Keywords: Alzheimer’s Disease, depression, Glucocorticoids, hypothalamic-pituitary-adrenal axis, neurofibrillary tangles, stress, tau protein,
 
 
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