Alterations in cerebral perfusion in patients with systemic sclerosis and cognitive impairment

Main Article Content

Juan Moreno-Gutiérrez
Luis Alonso Coria-Moctezuma
María del Pilar Cruz-Domínguez
Olga Lidia Vera-Lastra

Keywords

Systemic sclerosis, Cerebral perfusion, Cognitive impairment, Gammagram cerebral

Abstract

Background: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, immunological and vascular abnormalities. Cerebral hypoperfusion can be caused by cerebral ischemia. Cognitive impairment (CI) are a major cause of morbidity in SSc The aim of this study is to estimate the frequency of alterations in cerebral perfusion (CP) in SSc patients with CI. 

Methods: We studied 88 patients with SSc. The Montreal Test (MT) was given to all patients to evaluate CI. To 15 patients with CI and without systemic hypertension, diabetes mellitus, cerebrovascular disease, vasculitis, hypothyroidism, depression, and drugs that interfere with the cognitive assessment, the PC was measured by cerebral gammagram (CG). 

Results: Of the 88 patients with ES, 58 had CI by MT. A decrease in CP was observed in following lobes: frontal in 9 of 15 patients, temporal in 7 of 15, and parietal in 3 of 15. Concordance between MT and CG was 60 % for the frontal, 46 % for the temporal and parietal 13 %. 

Conclusions: The CI is common in SSc. A decrease in CP was more frequent in the frontal lobe, predominating in older patients and with longer duration of SSc.

Abstract 731 | PDF (Spanish) Downloads 96 HTML (Spanish) Downloads 654 PubMed (Spanish) Downloads 0 HTML Downloads 255

References

Furst D, Clements P. Hypothesis for the pathogenesis of Systemic Sclerosis. J Rheumatol 1997;24; Supl.48:53-7.

 

Nitta Y, Sobue G. Progressive Systemic Sclerosis Associated with multiple Mononeuropathy. Dermatology 1996; 193: 22-26.

 

Piera-Velazquez S, Jimenez S. Esclerosis sistémica y patogenia. En Vera Lastra O, Jimenes S Editores. Esclerosis sistémica. México, Elsevier; 2009. pp. 

 

Recasens M.A., Puig C, Vera-Ortiz S., Nutrition in systemic sclerosis. Rev Reumatol Clín. 2012;8(3):135-140.

 

Albin MS, Textbook of neuroanesthesia with neurosurgical and neuroscience perspectives. New York. MacGraw-Hill Co; 1997.

 

Piecyk M, Chur P, Yilmaz P. Neuromuscular manifestations of systemic sclerosis,(scleroderma), 2011, may 31. New England Baptist Hospital.

 

Sardanelli F, Lozzelli A, Cotticelli B, Losacco C, Cutolo C, Sulli C, Nobili F, Rodriguez G. White matter hyperintensities on brain magnetic resonance in systemic sclerosis, Ann Rheum Dis 2005;64:777-779.

 

Nobili F, Cutolo M, Sulli A, Castaldi A, Sardanelli F, Accardo S, Rosadini G, Rodriguez G. Impaired quantitative cerebral blood flow in scleroderma patients. J Neurol Sci. 1997;152(1):63-71.

 

Navarro C, Afección pulmonar en la esclerosis sistémica. Alveolitis, fibrosis e hipertensión arterial pulmonar, Reumatol Clin. 2006;2:16-9. 

 

Ooi GC, Mok MY, Tsang KW, Wong Y, Khong PL, Fung PC, et al. Interstitial lung disease in systemic sclerosis. Acta Radiol. 2003;44:258-64.

 

Mitchel A.J, Shiri-Feshki M. Temporal tends in the long term risk of progression of mild cognitive impairment: a pooled analysis. J Neurology 2008,79: 1386-91.

 

Rosselli M. Deterioro Cognitivo Leve: Definición y Clasificación. Rev Neuropsicología, Neuropsiquiatría y Neurociencias, 2012;12(1):151-162.

 

León-Arcila R, Feliciano, Milián-Suazo N, Camacho-Calderón, Arévalo-Cedano R, Escartín-Chávez M, Factores de riesgo para deterioro cognitivo y funcional en el adulto mayor, Rev Med Inst Mex Seguro Soc 2009;47(3):277-84. 

 

Gallegos-Bouchan M, Flores- Fajardo Q, Castillo-Díaz de León R, Rosas- Carrasco O. Demencia en el adulto mayor. Hospital Ángeles Mocel. Departamento de Geriatria, disponible en http://es.scribd.com/doc/219196745/X-Demencia-Am o www.facmed.unam.mx/deptos/salud/censenanza/.../X_demencia_am.pdf

 

Sosa A.L, Becerra M, Orozco B, García N, Ugalde O. Trastornos cognoscitivos: las demencias. En: Manual de trastornos mentales. México: Asociación Psiquiátrica Mexicana, 2005, pp. 287-340. 

 

Fairbairn A. Dementia, A NICE–SCIE Guideline on supporting people with dementia and their carers in health and social care National Clinical Practice Guideline Number 42. NCCMH commissioned by the Social Care Institute for Excellence National Institute for Health and Clinical Excellence, The British Psychological Society and Gaskell, Great Britain, March 2011. Disponible en: www.rcpsych.ac.uk

 

Sartorius N. Organic, including symptomatic, mental disorders; The ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1993. http://www.who.int/classifications/icd/en/bluebook.pdf

 

WIttich W, Phillips N, Nasreddine Z, Chertkow H. Sensitivity and specificity of the Montreal cognitive assessment modified for individuals who are visually impaired. Journal of visual impairment & blindness. 2010;104(6): 360-368.

 

Zadikoff C, Fox SH, et al. A comparison of the Mini Mental State Exam to the Montreal Cognitive Assessment in identifying cognitive deficits in Parkinson’s disease. Mov Disord. 2008;23:297-299.

 

Nasreddine ZS, Phillips NA, et al. The Montreal cognitive assessment, MOCA: a brief screening tool for mild cognitive impairment. J AM Geriatr Soc. 2005; 53:695-699.

 

Bonte FJ, Weiner MF, Bigio EH, et a,l Brain flow in the dementias: spect with histopathologic correlation in 54 patients. Radiology. 1997; 202: 793-7.

 

Jobst KA, Barnetson LP, Shepstone BJ. Accurate prediction of histologically confirmed Alzheimer’s disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT, and Apo E4 in medial temporal lobe dementias. Oxford Project to Investigate Memory and Aging. Int Psychogeriatr. 1998;10(3):271-302.

 

Del Pilar V M, García F. Sección de Medicina Nuclear. Spect cerebral. Rev Peruana de Radiología. 1999;3:1-2.

 

Nobil F, Cutolo M, Suli A. Brain functional involvement by perfusión SPECT in systemic sclerosis and Behcet disease. Ann N Y Acad Scl. 2002 ;966:409-1. 

 

Sardanelli F, Iozzelli A, B Cotticelli, C Losacco, M Cutolo, A Sulli, F Nobili, G Rodriguez.White matter hyperintensities on brain magnetic resonance in systemic sclerosis Ann Rheum Dis 2005;64: 777-9.

 

Amaral TN, Peres FA, Lapa AT, Marques-Neto JF, Appenzeller S. Neurologic involvement in scleroderma: a systematic review. Semin Arthritis Rheum. 2013;43(3):335-47.

 

Yilmaz N, Mollahasanoglu A, Gurvit H, Can M, Tuncer N, Inanc N, Yavuz S. Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis. Cogn Behav Neurol. 2012;25(2):57-62.

 

Georgina Aguilera-Pickens, Carlos Abud-Mendoza. Neuropsychiatric Manifestations in Systemic Lupus Erythematosus: Physiopathogenic and Therapeutic Basis, Reumatol Clin. 2013; 9:331-3.

 

Borchers AT, Aokia CA, Naguwa SM, Keen CL, Shoenfeld Y, Gershwin ME. Neuropsychiatric features of systemic lupus erythematosus. Autoimmun Rev. 2005;4:329-44. 

 

Monastero R, Bettini P, Del Zotto E, Cottini E, Tincani A, Balestrieri G, et-al. Prevalence and pattern of cognitive impairment in systemic lupus erythematosus patients with and without overt neuropsychiatric manifestations. J Neurol Sci. 2001;184:33-9.

 

Abreu MR, Jakosky A, Folgerini M, Xavier RM, Brenol JT, Kapczinsky F. Neuropsychiatric systemic lupus erythematosus correlation of brain MR imaging, CT, and SPECT. J Clin Imaging. 2005;29:215-21.

 

Blanc F, Longato N, Jung B, Kleitz C, Di Bitonto L, Cretin B, Collongues N, Sordet C, Fleury M, Poindron V, Gottenberg JE, Anne O, Lipsker D, Martin T, Sibilia J, de Seze J. Cognitive Dysfunction and Dementia in Primary Sjögren’s Syndrome. ISRN Neurol. 2013 19;2013:501327.

 

Ferrer I. Cognitive impairment of vascular origin: neuropathology of cognitive impairment of vascular origin. J Neurol Sci. 2010, 15;299(1-2):139-49.

 

Giuliodori G1, Fraticelli P, Bartolini M, Cagnetti C, Baruffaldi R, Rocchi MB, Provinciali L, Gabrielli A, Silvestrini M. Cognitive and cerebral hemodynamic impairment in scleroderma patients. Eur J Neurol. 2009;16(12):1285-90.

 

Cutolo M, Nobili F, Sulli A, Pizzorni C, Briata M, Faelli F, Vitali P, Mariani G, Copello F, Seriolo B, Barone C, Rodriguez G. Evidence of cerebral hypoperfusion in scleroderma patients. Rheumatology (Oxford). 2000; 39(12):1366-73.

 

Dean W, Morgenthaler J. Smart drugs and nutrients. How to improve your memory and increase your intelligence using the latest discoveries in Neuroscience. United State, B & J Publications, 1991. 

 

Wang P, Wang Y, Feng T, Zhao X, Zhou Y, Wang Y, Shi W, Ju Y; NICE Study Investigators.Rationale and design of a double-blind, placebo-controlled, randomized trial to evaluate the safety and efficacy of nimodipine in preventing cognitive impairment in ischemic cerebrovascular events (NICE). BMC Neurol. 2012;12:88.

 

Cotroneo AM, Castagna A, Putignano S, Lacava R, Fantò F, Monteleone F, Rocca F, Malara A, Gareri P. Effectiveness and safety of citicoline in mild vascular cognitive impairment: the IDEALE study. Clin Interv Aging. 2013;8:131-7.