Las fronteras entre el envejecimiento cognitivo normal y la enfermedad de Alzheimer
El concepto de deterioro cognitivo leve
Palabras clave:
ENFERMEDAD DE ALZHEIMER, TRASTORNOS COGNITIVOS
Resumen
Revisamos el concepto de envejecimiento cognitivo, la epidemiología de la enfermedad de Alzheimer (EA) y especialmente sus factores de riesgo y aquellos de protección que aseguran un envejecimiento exitoso. Concluimos que el anciano normal no tiene deterioro cognitivo significativo. Revisamos el concepto de deterioro cognitivo leve (DCL), sus fundamentos clínicos, la necesidad de su diagnóstico neuropsicológico, sus bases lesionales, sus marcadores imagenológicos y paraclínicos, discutiendo con mayor detalle la situación actual en lo referente a métodos imagenológicos. Insistimos en que el DCL es una entidad clínica de relevancia ya que en muchos pacientes es una etapa preclínica o precoz de EA. Sugerimos la existencia de distintos perfiles neuropsicológicos. Describimos la situación actual del tratamiento así como varias alternativas futuras. Seleccionamos algunas conclusiones generales de interés clínico.
Citas
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45) Reisberg B, Ferris S, deLeon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139(9):1136-9.
46) Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3):189-98.
47) Erzigkeit H. SKT. Ein Kurztest zur Erfassung von Gedächtnis und Aufmerksamkeitsstörungen. Manual Beltz, Test GmbH Weinheim:Auflage, 1989:1-22.
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49) Rey A. L'examne clinique en Psychologie. Paris:Presses Universitaires de France, 1964.
50) Rey A. Éprueves mnésiques et de apprentissage. Neuchatel, Switzerland:Delachaux and Niestlé, 1968.
51) Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills, 1958; 8:271-6.
52) Reitan RM, Wolfson D. The Halsted-Reitan Neuropsychological Tests Battery:theory and clinical interpretation. Tucson, Arizona:Neuropsychology Press, 1993.
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55) Moreira S. Utilidad del SKT en el Diagnóstico del Déficit Cognitivo Leve. Monografía de Graduación en Neurología. Presentado en la Escuela de Postgraduados, Facultad de Medicina, Universidad de la República, 2002.
56) Haroutunian V, Purohit DP, Perl DP, Marin D, Khan K, Lantz M, et al. Neurofibrillary Tangles in Nondemented Elderly Subjects and Mild Alzheimer Disease. Arch Neurol 1999; 56(6):713-8.
57) Schmitt FA, Davis DG, Wekstein DR, Smith CD, Ashford JW, Markesbery WR. "Preclinical" AD revisited:neuropathology of cognitively normal older adults. Neurology 2000; 55(3):370-6.
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2) Riley KP, Snowdon DA. The challenges and successes of aging:Findings from the Nun Study. Adv Med Psychother 1999-2000; 10:1-12.
3) Snowdon DA. Aging and Alzheimer's disease:lessons from the Nun Study. Gerontologist 1997; 37(2):150-6.
4) Elias MF, Beiser A, Wolf PA, Au R,White RF, D'Agostino RB. The preclinical phase of Alzheimer disease:a 22-year prospective study of the Framingham Cohort. Arch Neurol 2000; 57(6):808-13.
5) Green MS, Kaye JA, Ball MJ. The Oregon brain ageing study. Neuropathology accompanying healthy aging in the oldest old. Neurology 2000; 54(1):105-13.
6) Tang Z, Meng C, Chan P. Longitudinal observation on cognitive function in elderly:Beijing Longitudinal Study on Aging (BLSA). Program and abstracts of the 53rd Annual Meeting of the American Academy of Neurology; May 5-11, 2001; Philadelphia, Pennsylvania. Neurology 2001; 187(56)(suppl 1):S116. (Abstract P03.062).
7) Instituto Nacional de Estadística:http://www.ine.gub.uy/socio-demograficos/proyecciones.htm. 29/09/02.
8) Ketzoian C, Romero S, Dieguez E, Rega I, Caseres R, Coirolo G. Les syndromes démentiels dans une population de l'Uruguay:"Etude de la Villa del Cerro". J Neurol Sci 1997; 150(Suppl):S155.
9) Roses AD. The predictive value of ApoE genotyping in the early diagnosis of dementia of the Alzheimer type:data from three indepent series. In:Iqbal K, Winblad B, Nishimura T, Takeda M, Wisnieski HM (eds.):Alzheimer's disease:biology, diagnosis and therapeutics. New York:John Wiley, 1997:85-91.
10) Knopmann DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N, et al. Practice parameter:diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56(9):1143-53.
11) Tanzi R. Unraveling the Genetics of Alzheimer Disease. Arch Neurol 2000; 57(8):1236. (Abstracst).
12) Riley KP, Snowdon DA, Saunders AM, Roses AD, Mortimer JA, Nanayakkara N. Cognitive function and apolipoprotein E in the very old:findings from the Nun Study. J Gerontol:Soc Sci 2000; 55(2):S69-S75.
13) Lopera F, Ardilla A, Martínez A, Madrigal L, Arango-Viana JC, Lemere CA, et al. Clinical features of early-onset Alzheimer disease in a large kindred with an E280A presenilin-1 mutation. JAMA 1997; 277(10):793-9.
14) Rosselli MC, Ardila AC, Moreno SC, Standish VC, Arango-Lasprilla JC, Tirado VM, et al. Cognitive decline in patients with familial Alzheimer's disease associated with E280A presenilin-1 mutation:a longitudinal study. J Clin Exp Neuropsychol 2000; 22(4):483-95.
15) Launer LJ, Andersen K, Dewey ME, Letenneur L, Ott A, Amaducci LA, et al. Rates and risk factors for dementia and Alzheimer's disease:results from EURODEM pooled analyses. EURODEM Incidence Research Group and Work Groups. European Studies of Dementia. Neurology 1999; 52(1):78-84.
16) Ott A, van Rossum CTM, van Harskamp F, van de Mheen H, Hofman A, Breteler MMB. Education and the incidence of dementia in a large population-based study:The Rotterdam Study. Neurology 1999; 52(3):663-6.
17) Caramelli P, Poissant A, Gauthier S, Bellavance A, Gauvreau D, Lecours AR, et al. Educational level and neuropsychological heterogeneity in dementia of the Alzheimer type. Alzheimer Dis Assoc Disord 1997; 11(1):9-15.
18) Launer LF, White LR, Petrovitch H, Ross GW, Curb JD. Cholesterol and neuropathologic markers of AD: a population-based autopsy study. Neurology 2001; 57:1447-52.
19) Kivipelto M, Helkala EL, Hänninen T, Laakso MP, Hallikainen M, Alhainen K, et al. Midlife vascular risk factors and late-life mild cognitive impairment:A population-based study. Neurology 2001; 56(12):1683-9.
20) Diaz-Arrastia R. Homocysteine and Neurologic Disease. Arch Neurol 2000; 57(10):1422-7.
21) Mungas D, Reed BR, Ellis WG, Jagust WJ. The effects of age on rate of progression of Alzheimer disease and dementia with associated cerebrovascular disease. Arch Neurol 2001; 58(8):1243-7
22) Lee JH, Olichney JM, Hansen LA, Hofstetter CR, Thal LJ. Small concomitant vascular lesions do not influence rates of cognitive decline in patients with Alzheimer disease. Arch Neurol 2000; 57(10):1474-9.
23) Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease:The Nun Study. JAMA 1997; 277(10):813-7.
24) Osuntokun BO, Sahota A, Ogunniyi AO, Gureje O, Baiyewu O, Adeyinka A, et al. Lack of an association between apolipoprotein E epsilon 4 and Alzheimer's disease in elderly Nigerians. Ann Neurol 1995; 38(3):463-5.
25) Chandra V, Pandav R, Dodge HH, Johnston JM, Belle SH, DeKosky ST, et al. Incidence of Alzheimer's disease in a rural community in India The Indo-US Study. Neurology 2001; 57(6):985-9.
26) Guo Z, Cupples LA, Kurz S, Auerbach SH, Volicer L, Chui H, et al. Head injury and the risk of AD in the MIRAGE study. Neurology 2000; 54(6):1316-23.
27) Brayne C, Harrington CR, Wischik CM, Huppert FA, Chi LY, Xucreb JH, et al. Alzheimer Disease and Neuroinflammation:Pathology, Epidemiology, and Clinical Trials. In:Alzheimer Disease Emerging Trends. AGS/AFAR 1999 Annual Meeting.
28) Andersen K, Launer LJ, Ott A, Hoes AW, Breteler MM, Hofman A. Do nonsteroidal anti-inflammatory drugs decrease the risk for Alzheimer's disease? The Rotterdam Study. Neurology 1995; 45(8):1441-5.
29) Stewart WF, Kawas C, Corrada M, Metter EJ. Risk of Alzheimer's disease and duration of NSAID use. Neurology 1997; 48(3):626-32.
30) Scharf S, Mander A, Ugoni A, Vajda F, Christophidis N. A double-blind, placebo-controlled trial of diclofenac/misoprostol in Alzheimer's disease. Neurology 1999; 53(1):197-201.
31) Broe GA, Grayson DA, Creasey HM, Waite LM, Casey BJ, Bennett HP, et al. Anti-inflammatory drugs protect against Alzheimer disease at low doses. Arch Neurol 2000; 57(11):1586-91.
32) Waring SC, Rocca WA, Petersen RC, O'Brien PC, Tangalos EG, Kokmen E. Postmenopausal estrogen replacement therapy and risk of AD:a population-based study. Neurology 1999; 52(5):965-70.
33) Seshadri S, Zornberg GL, Derby LE, Myers MW, Jick H, Drachman DA. Postmenopausal estrogen replacement therapy and the risk of Alzheimer disease. Arch Neurol 2001; 58(3):435-40.
34) Chalmers J, Neal B, MacMahon S. PROGRESS (Perindopril Protection Against Recurrent Stroke Study): regional characteristics of the study population at baseline. Progress Management Committee. J Hypertens 2000; 18(Suppl 1):S13-9.
35) Danner DD, Snowdon DA, Friesen WV. Positive emotions in early life and longevity:findings from the Nun Study. J Pers Soc Psychol 2001; 80(5):804-13.
36) Snowdon DA, Greiner LH, Markesbery WR. Linguistic ability in early life and the neuropathology of Alzheimer's disease. Findings from the Nun Study. Ann N Y Acad Sci 2000; 903:34-8.
37) Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K. Physical activity and risk of cognitive impairment and dementia in elderly persons. Arch Neurol 2001; 58(3):498-504.
38) Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild Cognitive impairment clinical characterization and outcome. Arch Neurol 1999; 56(3):303-8.
39) Petersen R. Update on mild cognitive impairment (Conference at the World Congress of Neurology. London, 2001). JNS 2001; 187(Suppl 1):S117.
40) Kluger A, Ferris SH, Golomb J, Mittelman MS, Reisberg B. Neuropsychological prediction of decline to dementia in nondemented elderly. J Geriatr Psychiatry Neurol 1999; 12(4):168-79.
41) Masur DM, Sliwinski M, Lipton RB, Blau AD, Crystal HA. Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology 1994; 44(8):1427-32.
42) Ritchie K, Artero S, Touchon J. Classification criteria for mild cognitive impairment:a population-based validation study. Neurology 2001; 56(1):37-42.
43) Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993; 43(11):2412-4.
44) Petersen RC. Mild cognitive impairment or questionable dementia? Arch Neurol 2000; 57(5):643-4.
45) Reisberg B, Ferris S, deLeon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982; 139(9):1136-9.
46) Folstein MF, Folstein SE, McHugh PR. "Mini-Mental State". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3):189-98.
47) Erzigkeit H. SKT. Ein Kurztest zur Erfassung von Gedächtnis und Aufmerksamkeitsstörungen. Manual Beltz, Test GmbH Weinheim:Auflage, 1989:1-22.
48) Chen P, Ratcliff G, Belle SH, Cauley JA, DeKosky ST, Ganguli M. Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented. Neurology 2000; 55(12):1847-53.
49) Rey A. L'examne clinique en Psychologie. Paris:Presses Universitaires de France, 1964.
50) Rey A. Éprueves mnésiques et de apprentissage. Neuchatel, Switzerland:Delachaux and Niestlé, 1968.
51) Reitan R. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills, 1958; 8:271-6.
52) Reitan RM, Wolfson D. The Halsted-Reitan Neuropsychological Tests Battery:theory and clinical interpretation. Tucson, Arizona:Neuropsychology Press, 1993.
53) Lorenzo J. Perfiles neuropsicológicos en el Deterioro Cognitivo Leve. Congreso Latinoamericano de Neuropsicología. San Pablo, 7, Noviembre, 2001.
54) Fontan L, Lorenzo J, Silveira A, Premuda P. Perfil de alteración en el MiniMental State Examination en pacientes con Deterioro Cognitivo Leve. Póster presentado en el Congreso Uruguayo de Ciencias Neurológicas, 1. Punta del Este, Agosto 2000.
55) Moreira S. Utilidad del SKT en el Diagnóstico del Déficit Cognitivo Leve. Monografía de Graduación en Neurología. Presentado en la Escuela de Postgraduados, Facultad de Medicina, Universidad de la República, 2002.
56) Haroutunian V, Purohit DP, Perl DP, Marin D, Khan K, Lantz M, et al. Neurofibrillary Tangles in Nondemented Elderly Subjects and Mild Alzheimer Disease. Arch Neurol 1999; 56(6):713-8.
57) Schmitt FA, Davis DG, Wekstein DR, Smith CD, Ashford JW, Markesbery WR. "Preclinical" AD revisited:neuropathology of cognitively normal older adults. Neurology 2000; 55(3):370-6.
58) Morris JC, Storandt M, Miller JP, McKeel DW, Price JL, Rubin EH, Berg L. Mild Cognitive Impairment Represents Early-Stage Alzheimer Disease. Arch Neurol 2001; 58(3):397-405.
59) Kordower JH, Chu Y, Stebbins GT, DeKosky ST, Cochran EJ, Bennett D, et al. Loss and atrophy of layer II entorhinal cortex neurons in elderly people with mild cognitive impairment. Ann Neurol 2001; 49(2):202-13.
60) DSM-IV:Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Washignton:American Psychiatric Press, 1994.
61) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease:report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984; 34(7):939-44.
62) Jack CR Jr, Petersen RC, Xu Y, O'Brien PC, Smith GE, Ivnik RJ, et al. Rates of hippocampal atrophy correlate with change in clinical status in aging and AD. Neurology 2000; 55(4):484-9.
63) Corey-Bloom J, Sabbagh MN, Bondi MW, Hansen L, Alford MF, Masliah E, et al. Hippocampal sclerosis contributes to dementia in the elderly. Neurology 1997; 48(1):154-60.
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Publicado
2003-05-30
Cómo citar
1.
Lorenzo Otero J, Fontán Scheitler L. Las fronteras entre el envejecimiento cognitivo normal y la enfermedad de Alzheimer. Rev. Méd. Urug. [Internet]. 30 de mayo de 2003 [citado 15 de noviembre de 2024];19(1):4-13. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/951
Sección
Trabajos de Revisión o Actualización y Puestas al día
