Revista de neurologia最新文献

Introduction: Dementia is a major global health challenge, with Alzheimer's disease (AD) being the most common cause.In China, due to its large and aging population, AD poses a significant threat. Although systematic reviews on the prevalence of dementia in the Chinese population exist, relatively few have specifically targeted AD. This study aimed to analyze the prevalence of AD among the population aged 60 years and older in China from 2014 to 2024.

Methods: A literature search on the prevalence of AD in China was conducted. A meta-analysis was performed using Stata version 16.0. The I² was used to assess heterogeneity. The random-effects model was used to calculate the pooled effect size. Subgroup analyses were conducted based on different characteristics. Meta-regression was used to explore the sources of heterogeneity and identify the factors that significantly affect the effect size. Funnel plots and Egger's test were utilized to evaluate publication bias.

Results: A total of 23 studies were included, with a total sample size of 307,415, including 13,662 patients with AD. The results of the meta-analysis showed that the prevalence of AD among the elderly Chinese population was 5.4% (95% CI: 4.7%-6.2%). The results of the meta-regression indicated that factors such as female sex, advanced age, low educational level, rural residence, and geographical region are the main factors influencing the prevalence of AD.

Conclusion: In the past decade, the prevalence of AD among people over 60 years of age in China was approximately 5.4%, which is a major public health problem for China.

Background: Individuals with Autism Spectrum Disorder (ASD), may present with behavioral disturbances, difficulties dealing with change, restricted interests and/or sensory disturbances. Among their characteristic behaviors are self-injurious behaviors that tend to be compulsive, unplanned, rhythmic and repetitive. The aim of this study was to investigate the relationship between self-injurious behaviors in hospitalized adolescents with ASD, depression and anxiety.

Methods: The sample included 50 patients with ASD, aged between 14 and 27 years. These patients were assessed using the Autism Diagnostic Observation Scale (ADOS-2), the Autism Diagnostic Interview-Revised (ADI-R), the Trait-State Anxiety Questionnaire, the Beck Depression Inventory (BDI), the Adolescent/Adult Sensory Profile (AASP) and the Inventory of Statements About Self-injury (ISAS).

Results: The results revealed significant and positive correlations between the level of self-injury and its dimensions: self-regulation (ρ = 0.861), sensation seeking and strength (ρ = 0.767), suicide avoidance (ρ = 0.732), revenge (ρ = 0.643), self-control (ρ = 0.700), manifestation of distress (ρ = 0.828) and blunting (ρ = 0.702).

Conclusions: There is evidence of a positive relationship between levels of self-harm and sensory defensiveness, specifically in the emotion avoidance profile.

Introduction: As Parkinson's disease progresses, symptoms develop that make it more difficult to control, either because of the presence of fluctuations despite adequate oral treatment, or because of the adverse effects caused by the continued use of levodopa, considered the gold standard. At this point in the course of the disease, there are different therapeutic alternatives that provide more continuous dopaminergic stimulation and help to improve this symptomatology: deep brain stimulation (Medtronic®: Percept™ Primary Cell (PC), Percept™ ReChargable (RC)), intestinal gel Levodopa/Carbidopa (Duodopa®) o Levodopa/Carbidopa/Entacapona (Lecigon®), as well as subcutaneous infusion of foslevodopa/foscarbidopa (Foslevodopa®) and continuous infusion of apomorphine (Dacepton®, Apo-Go®).

Objective: Pharmacoeconomic study of the different therapies for treating advanced Parkinson's disease in Spain.

Patients and methods: Based on a Markov model, the efficacy and costs of these therapies were compared, measuring life years gained (LYG) and quality-adjusted life years (QALY).

Results: Dacepton® (apomorphine) is the most cost-effective option with a cost of 20,782€/QALY (1€ = 1.0815 USD, 2025), compared to three times or more for the other therapies with Lecigon® (levodopa/carbidopa/entacapone) being the least cost-effective with a cost of 104,000€/QALY. Deep brain stimulation (DBS) and Duodopa® also proved to be effective options, but more costly than Dacepton®.

Conclusions: These results provide additional information on the efficiency of treatments that should inform decision-making in the management of advanced Parkinson's disease, thus enabling better resource management.

Introduction: Post-traumatic stress disorder (PTSD) develops in response to a traumatic experience, whether real or threatening, which produces emotions of intense fear and memory problems, significantly damaging the quality of life of those who manifest it. In recent years, anatomical-functional changes in the amygdala-hippocampus-prefrontal cortex circuit have begun to be studied as a key factor in the prevention, vulnerability, and treatment of PTSD, with neuroplasticity being one of the factors of greatest interest. Therefore, this review will address the latest published data regarding PTSD and neuroplasticity.

Development: Data from preclinical and clinical models support that a traumatic experience modifies both synaptic plasticity through electrophysiological and chemical variables, as well as myelin plasticity which enables short and long-distance connections. This remodelling of circuitry is crucial for the development of PTSD. However, it is also closely associated with prevention and positive treatment outcomes. Variables such as social support or the use of psychotherapy following a traumatic experience are linked to a good prognosis.

Conclusions: Therefore, there is an interesting connection between neuroplasticity and PTSD, although many questions remain open today, along with promising lines of prevention and intervention, including psychedelic substances.

Introduction: Stroke is highly prevalent worldwide; however, associated symptoms and risk factors are unknown in the general population. Our aim was to describe the knowledge of early signs of stroke and its association with the risk of stroke at 5 and 10 years according to the "Stroke Riskometer™".

Subjects and methods: This was an observational, descriptive, cross-sectional study, including adults in the Neurology outpatient clinic of the University Hospital "Dr. José Eleuterio González". Vital signs were recorded, anthropometric and the "Stroke Riskometer™" measurements were collected, and the risks at 5 and 10 yearswere calculated. Patients were questioned about the early signs of stroke (with emphasis on the acronym FAST: F = Face uneven, A = Arm hanging down, S = Speech slurred, T = Time is vital [CAMALEÓN in Spanish]). Spearman's evaluation was used to measure the association between risk and knowledge of signs.

Results: A total of 300 participants were included; 208 (69.3%) were women and the mean age was 54.5 (±14.0) years. The most prevalent risk factors for stroke were sedentary lifestyle (46.3%), high blood pressure (40.0%), and diabetes (31.0%). The population median risk at 5 years was 3.6% (interquartile range (IQR) 1.9-7.0) and at 10 years 6.3% (IQR 3.1-14.0). Of all participants, 31.2% were aware of at least one early sign of stroke. No significant correlation was found between awareness of early signs and risk at 5 or 10 years (r = 0.039, p = 0.5; r = -0.05, p = 0.380, respectively).

Conclusions: Knowledge of the signs of stroke is low but remains an ongoing goal for educational campaigns in Mexico. A large-scale national and long-lasting campaign is necessary, given the high risk of stroke in the population.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects attentional and executive functions, which may interfere with facial emotion recognition. This study explored the recognition of basic and complex emotions in pediatric subjects with ADHD.

Method: This was a prospective, cross-sectional, controlled study. A total of 60 participants were included, divided into two groups: the ADHD Group (n = 30) and the Control Group (n = 30) with neurotypical development. Each participant was presented with a series of photographs and video clips of children and adults and was asked to identify the emotion expressed on the face.

Results: No significant differences were found in the recognition of basic emotions between the Control Group (M = 44.43; SD = 2.01) and the ADHD Group (M = 43.90; SD = 2.14; t(58) = -0.995; p = 0.324), nor in the recognition of complex emotions [t(58) = 0.514; p = 0.609]. No differences were found by age [Z = 463; p = 0.843] or by sex (p = 0.92). We observed significantly better performance with a large effect size when recognizing child faces (M = 29.56; 95% CI 28.98-30.14) compared with adult faces (M = 14.86; 95% CI 14.46-15.26; p < 0.001; d = 11.03), with performance on adult faces improving with age (rho = 0.39; p = 0.03).

Conclusion: The ADHD Group did not show differential performance compared with the neurotypical group in emotion recognition. Performance significantly improved for child faces, suggesting that adult faces should be avoided when assessing this population. Recognition of adult faces improved with age.

Migraine is a complex condition when considered from the perspective of its pathophysiology. Moreover, it is highly prevalent and of priority interest in public health. Gepants are a highly-effective and specific therapeutic option, although their recent arrival in Latin America raises particular questions and expectations. A narrative review of the four medications available outside Latin America at this time is provided and the main considerations that should be borne in mind before and during their adoption are presented. Appropriate patient selection and marketing cost will be key determinants for their consolidation as an alternative to traditional medications used in migraine.

Background: Stroke is a leading cause of death and disability worldwide, prompting significant interest in rehabilitation. Despite existing recommendations and clinical guidelines, the current state of stroke rehabilitation practices in Catalonia remains unclear. This study aims to identify physiotherapists' main approaches for stroke survivors in Catalonia across recovery stages.

Methods: An observational study was conducted via an anonymous survey distributed among all the registered members of the College of Physiotherapists of Catalonia (CPC). A total of 118 physiotherapists from both the public and private sector participated. The study collected data on therapists' experience, preferred therapeutic modalities, user demographics, and work settings. The data was collected from January to March, 2023.

Results: The survey on stroke rehabilitation approaches showed that 57.60% of participants use a mix of methods (Basal Stimulation, Proprioceptive Neuromuscular Facilitation (PNF), neurodevelopmental or neurocognitive therapy) tailored to individuals or stroke stages, regardless of the work setting. Regarding the techniques, the most used were passive mobilization, stretching, task-oriented approaches, motor imagery, intensive therapy, mirror therapy, and balance training. In contrast, electrotherapy, music therapy, mindfulness, and advanced technologies were the least used.

Conclusions: Physiotherapists did not rely on a single technique or approach; instead, they combined various methods. Therefore, we are unable to definitively determine what constitutes conventional physiotherapy. Considering this ambiguity, it is recommended to explicitly identify the techniques and methods used during conventional physical therapy in all scientific studies.

Clinical trial registration: No: NCT05546840. 15 September 2022, https://clinicaltrials.gov/study/NCT05546840?cond=NCT05546840&rank.