Publication: Microhemorragias cerebrales en ancianos con demencia: prevalencia, factores de riesgo e implicaciones clínicas
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2016-08-25
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Universidad Complutense de Madrid
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Abstract
Las microhemorragias cerebrales (MHC) se observan con frecuencia en la resonancia magnética (RM) asociadas al envejecimiento, la enfermedad de Alzheimer (EA) y, en particular, a la enfermedad cerebrovascular (ECV). Si bien el sustrato patológico de MHC ha sido suficientemente aclarado, sigue existiendo una considerable controversia acerca de su posible papel fisiopatológico tanto en ECV, como en la EA, así como sobre sus implicaciones clínicas. Se ha propuesto recientemente que las MHC podrían desempeñar un papel fisiopatológico clave para explicar la asociación entre EA y ECV. En consecuencia, las MHC deberían transmitir peor pronóstico clínico en personas mayores con demencia. Distintos estudios realizados en las últimas dos décadas muestran resultados que asocian las MHC con el deterioro cognitivo, especialmente en relación con las funciones ejecutivas, incluso después de que se controlaron las variables fuertemente asociadas, tales como las lesiones isquémicas. Sin embargo, hay muy pocos estudios longitudinales y las áreas clínicas más allá de la cognición (por ejemplo, las capacidades funcionales, problemas de comportamiento o la mortalidad) apenas han sido investigados. Entre estas áreas ignoradas, el estudio del estado de ánimo, el comportamiento y las capacidades funcionales son de particular relevancia en pacientes ancianos con demencia avanzada...
Brain microbleeds (BMB) are frequently observed by magnetic resonance imaging (MRI) in aging, Alzheimer’s disease (AD) and, particularly, cerebrovascular disease (CVD). While the pathological substrate of BMB has been sufficiently elucidated, there remains considerable controversy about their possible physiopatological role in both CVD and AD, as well as about their clinical implications. A key physipathological role of BMB was recently proposed to explain the association between AD and CVD. Accordingly, BMB should convey poorer clinical prognosis in old people with dementia. Several studies conducted in the last two decades displayed consistent association of BMB and cognitive impairment, particularly concerning executive functions, even after tightly associated variables such as ischemic lesions were controlled. However, there are very few longitudinal studies and the clinical areas beyond cognition (e.g., functional capacities, behavioral problems, mortality) were barely investigated. Among those ignored areas, the study of a potential repercussion of BMB in mood, behavior, and functional capacities is of particular relevance in old patients with advanced dementia...
Brain microbleeds (BMB) are frequently observed by magnetic resonance imaging (MRI) in aging, Alzheimer’s disease (AD) and, particularly, cerebrovascular disease (CVD). While the pathological substrate of BMB has been sufficiently elucidated, there remains considerable controversy about their possible physiopatological role in both CVD and AD, as well as about their clinical implications. A key physipathological role of BMB was recently proposed to explain the association between AD and CVD. Accordingly, BMB should convey poorer clinical prognosis in old people with dementia. Several studies conducted in the last two decades displayed consistent association of BMB and cognitive impairment, particularly concerning executive functions, even after tightly associated variables such as ischemic lesions were controlled. However, there are very few longitudinal studies and the clinical areas beyond cognition (e.g., functional capacities, behavioral problems, mortality) were barely investigated. Among those ignored areas, the study of a potential repercussion of BMB in mood, behavior, and functional capacities is of particular relevance in old patients with advanced dementia...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 12-01-2016