Papers by Rosa Montesinos
Frontiers in Neurology
BackgroundMany low- and middle-income countries, including Latin America, lack access to biomarke... more BackgroundMany low- and middle-income countries, including Latin America, lack access to biomarkers for the diagnosis of prodromal Alzheimer's Disease (AD; mild cognitive impairment due to AD) and AD dementia. MRI visual rating scales may serve as an ancillary diagnostic tool for identifying prodromal AD or AD in Latin America. We investigated the ability of brain MRI visual rating scales to distinguish between cognitively healthy controls, prodromal AD and AD.MethodsA cross-sectional study was conducted from a multidisciplinary neurology clinic in Lima, Peru using neuropsychological assessments, brain MRI and cerebrospinal fluid amyloid and tau levels. Medial temporal lobe atrophy (MTA), posterior atrophy (PA), white matter hyperintensity (WMH), and MTA+PA composite MRI scores were compared. Sensitivity, specificity, and area under the curve (AUC) were determined.ResultsFifty-three patients with prodromal AD, 69 with AD, and 63 cognitively healthy elderly individuals were enrol...
Revista de neuro-psiquiatría, Oct 13, 2021
Demencia frontotemporal-variante conductual como diagnóstico diferencial de trastornos psiquiátri... more Demencia frontotemporal-variante conductual como diagnóstico diferencial de trastornos psiquiátricos primarios. Frontotemporal dementia-behavioral variant as a differential diagnosis of primary psychiatric disorders.
Current Alzheimer Research, Feb 1, 2023
Background: Neuropsychiatric symptoms (NPS) in patients with Alzheimer’s disease (AD) worsened du... more Background: Neuropsychiatric symptoms (NPS) in patients with Alzheimer’s disease (AD) worsened during the COVID-19 lockdowns, but their progression thereafter is unknown. We present the first longitudinal study tracking them before, during, and after restrictions. Objectives: To describe the effect of the COVID-19 mandatory lockdowns on Cognitive and Neuropsychiatric symptoms in patients with Mild Cognitive Impairment (MCI) and Alzheimer’s Disease (AD). Methods: Cohort of 48 patients with amnestic MCI and 38 with AD in Lima, Peru. They received three rounds of cognitive (RUDAS, CDR, M@T), behavioral (NPI), and functional (ADCS-ADL) assessments. We assessed the change in score means across the time points and for each domain of NPS and tracked the changes in individual patients. Results: RUDAS declined 0.9 (SD 1.0) from baseline to lockdown and 0.7 (SD 1.0) after restrictions. M@T declined 1.0 (SD 1.5) from baseline to lockdown and 1.4 (SD 2.0) after restrictions. CDR worsened in 72 patients (83.72%) from baseline to post-lockdown. NPI worsened by 10 (SD 8.3) from baseline to lockdown but improved by 4.8 (SD 6.4) after restrictions. Proportionally, 81.3% of all patients had worsened NPS during the lockdowns, but only 10.7% saw an increase thereafter. Improvement was statistically significant for specific NPS domains except hallucinations, delusions, and appetite changes. Anxiety, irritability, apathy, and disinhibition returned to baseline levels. Conclusion: Following confinement, cognition continued to decline, but NPS demonstrated either stability or improvement. This highlights the role modifiable risk factors may have on the progression of NPS.
Alzheimers & Dementia, Dec 1, 2020
Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia... more Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education. Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores. Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cutoff <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cutoff <23 (sensitivity 89%, specificity 93%). Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.
Revista Colombiana de Psiquiatría, Nov 1, 2020
Resumen Introduccion Aunque la ausencia de deterioro de la memoria se considero entre los criteri... more Resumen Introduccion Aunque la ausencia de deterioro de la memoria se considero entre los criterios diagnosticos para diferenciar la enfermedad de Alzheimer (EA) de la demencia frontotemporal variante conductual (DFTvC), la evidencia actual, en aumento, senala un importante porcentaje de casos de DFTvC con deficits de la memoria episodica. El presente estudio se diseno con el fin de comparar el perfil de desempeno de la capacidad denominativa y de la memoria episodica de los pacientes con EA y DFTvC. Metodos Estudio transversal y analitico con grupo de control (n = 32). Se incluyo a 42 sujetos con probable EA y 22 con probable DFTvC, todos mayores de 60 anos. Se utilizaron instrumentos del Uniform Data Set validados en espanol: Multilingual Naming Test (MINT), historia de Craft-21 y figura compleja de Benson, entre otros. Resultados Se observo un mayor promedio de edad entre los pacientes con EA. La capacidad denominativa fue mucho menor en los pacientes con DFTvC que en aquellos con EA, medida segun el MINT y el coeficiente de denominacion sustantivos/verbos. Todos los pacientes con DFTvC, el 73,81% de aquellos con EA y solo el 31,25% de los controles no lograron reconocer la figura compleja de Benson. Todas las diferencias fueron estadisticamente significativas (p Resultados Este estudio confirma el perfil amnesico de los pacientes con EA y revela la disminucion de la capacidad denominativa de los pacientes con DFTvC, un area del lenguaje que se afecta tipica y tempranamente con las funciones ejecutivas, segun recientes hallazgos. Conclusiones Los pacientes con EA rinden peor en las tareas de memoria episodica verbal y visual, mientras que los pacientes con DFTvC rinden peor en tareas de denominacion. Estos hallazgos abren la posibilidad de explorar los mecanismos de participacion prefrontal en la memoria episodica, tipicamente atribuida al hipocampo.
Revista de neuro-psiquiatría, Apr 1, 2015
La enfermedad de Alzheimer y la epilepsia no solo comparten la edad avanzada como un factor de ri... more La enfermedad de Alzheimer y la epilepsia no solo comparten la edad avanzada como un factor de riesgo, si no también compartirían mecanismos subyacentes en su etiología. Las crisis epilépticas generalmente fueron reportadas en estadios tardíos de la enfermedad de Alzheimer; sin embargo los pacientes con enfermedad de Alzheimer familiar con mutaciones en la PSEN1, PSEN2 y proteína precursora del amiloide tienen mayor riesgo de desarrollar crisis epilépticas aún en estadios tempranos de la enfermedad. Por otro lado la epilepsia del lóbulo temporal podría generar per sé compromiso de memoria y la esclerosis hipocampal generar reorganización de redes neuronales excitatorias e inhibitorias que daría como resultado una actividad epiléptica. Es importante reconocer e iniciar tratamiento temprano en pacientes con Enfermedad de Alzheimer y epilepsia para evitar mayor deterioro cognitivo y mejorar la calidad de vida de estos pacientes.
Journal of the Neurological Sciences, Oct 1, 2015
PubMed, Nov 13, 2012
Introduction: The development of screening tools for the assessment of cognitive status in patien... more Introduction: The development of screening tools for the assessment of cognitive status in patients with dementia must be brief yet both highly sensitive and specific in order to ensure its clinical utility. In this sense, it is important to adapt tools widely used around the world to particular populations, allowing for a more proper validity of its use in everyday clinical practice. One of the most popular general cognitive screening tools is the Addenbrooke's Cognitive Examination (ACE), which has been adapted and validated in multiple languages and populations. Objective: To assess the usefulness of the Peruvian version of the ACE in patients with dementia. Materials and methods: Healthy controls, patients with Alzheimer disease (AD) and patients with Frontotemporal Dementia (FTD) were assessed with the Peruvian version of the ACE, the ADAScog to determine dementia severity, and a complete neuropsychological battery. Results: The Peruvian version of the ACE showed very good internal consistency, strong concurrent validity as revealed by significant correlations between the ACE total score and both the MMSE and ADAScog. The ACE was able to differentiate healthy controls from patients with dementia with high discriminatory accuracy. Using a cut-off score of 86 (out of 100), the ACE was exhibited a sensitivity of 100% and a specificity of 100%.
Revista chilena de neuro-psiquiatría, Mar 1, 2020
Frontotemporal dementia-behavioral variant (FTD-bv), is an important cause of disability in adult... more Frontotemporal dementia-behavioral variant (FTD-bv), is an important cause of disability in adults under 65 years of age. It is postulated as a neurological disease with predominantly psychiatric manifestations and, therefore, constitutes a frequent differential diagnosis in psychiatric pathologies of not early onset. Although traditionally the absence of memory impairment was considered among its diagnostic criteria-as opposed to Alzheimer's disease (AD)-, several studies have found until 15% of prevalence of cases with frank mnemonic deterioration, as well as neuroimaging of one and the other can have overlap. Currently, the presence of "phenocopy syndromes"-clinical pictures similar to FTD-bv but without cognitive impairment-and cases of AD with disinhibition and behavioral symptoms, make the clinical diagnosis more complex and suggest the insufficiency of the established diagnostic criteria and the necessary adoption of paraclinical criteria. To this purpose, we present an illustrative case of FTD-bv with memory impairment and Alzheimer-like neuroimages, and we review the pertinent bibliography.
Anales de la Facultad de medicina, Dec 10, 2012
Resumen Introducción: Las calcificaciones cerebrales pueden ser unilaterales o bilaterales; las u... more Resumen Introducción: Las calcificaciones cerebrales pueden ser unilaterales o bilaterales; las unilaterales presentan como etiología las infecciones, infartos o traumatismos; las bilaterales pueden ser fisiológicas, metabólicas o idiopáticas. Caso clínico: Paciente mujer, de 48 años de edad, tiroidectomizada hace 27 años, tomaba levotiroxina; acudió por movimientos involuntarios coreicos y balísticos progresivos y dificultad para caminar. Se encontró hipotonía de hemicuerpo derecho y movimientos serpenteantes de miembro superior derecho, hipocalcemia, hiperfosfatemia y concentración baja de parathormona; la tomografia y resonancia magnética cerebrales evidenciaban calcificaciones bilaterales en ganglios basales y cerebelo. Recibió tratamiento con citrato de calcio, calcitriol y risperidona, con recuperación completa. Discusión: Los pacientes con calcificaciones de ganglios basales presentan síntomas extrapiramidales (20 a 30%), como parkinsonismo o coreoatetosis, convulsiones y trastornos neuropsiquiátricos. Las calcificaciones intracerebrales bilaterales se producen generalmente por depósito de calcio y otros minerales. El hipoparatiroidismo es una complicación frecuente en la tiroidectomía radical, con hipocalcemia, hiperfosfatemia y concentración baja de parathormona como el caso descrito. Algunos pacientes no desarrollan los síntomas de inmediato. El tratamiento mejora los síntomas sin alterar las calcificaciones, como en la paciente, en quien la mejoría sería por la normalización del calcio más que por la risperidona.
Frontiers in Aging Neuroscience, Sep 4, 2020
The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools desig... more The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Standard procedures were applied for reviewing the literature. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Results: Thirteen of 211 articles met the inclusion criteria. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI; however, the diagnostic protocols applied differed. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. No publication to date has included an illiterate population. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level. Conclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. Moreover, the diagnostic validity of the INECO frontal Custodio et al. Brief Cognitive Screenings to Dementia in Latin-America screening (IFS) test should be evaluated in populations with a low level of education. Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.
Dementia & Neuropsychologia, Mar 1, 2013
Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in ... more Latin America (LA) is experiencing a rise in the elderly population and a consequent increase in geriatric problems such as dementia. There are few epidemiological studies assessing the magnitude of dementia and dementia subtypes in LA. Objective: To identify published community-based studies on the prevalence of FTD in LA countries. Methods: A database search for door-to-door studies on FTD prevalence in LA was performed. The search was carried out on Medline, Embase, and LILACS databases for research conducted between 1994 and 2012. The main inclusion criteria were: use of any internationally accepted diagnostic criteria and investigation of community samples. Results: Four hundred and ninety two articles were found, of which 26 were initially pre-selected by title or abstract review. Five studies from 3 different countries were included. The FTD prevalence rates in community-dwelling elderly were 1.2 (Venezuela), 1.3 (Peru) and 1.7-1.8 (Brazil) per thousand persons, depending on age group. Conclusion: The FTD prevalence in LA studies showed values midway between those observed in western and in oriental populations. Despite the magnitude of this problem, epidemiological information on FTD remains scarce in LA.
Revista de neuro-psiquiatría, Jul 5, 2018
Esta obra está bajo una Licencia Creative Commons Atribución 4.0 Internacional.
bioRxiv (Cold Spring Harbor Laboratory), Apr 28, 2023
Objective: The performances of popular Genome-wide association study (GWAS) models haven't been e... more Objective: The performances of popular Genome-wide association study (GWAS) models haven't been examined yet in a consistent manner under the scenario of genetic admixture, which introduces several challenging aspects such as heterogeneity of minor allele frequency (MAF), a wide spectrum of case-control ratio, and varying effect sizes etc. Methods: We generated a cohort of synthetic individuals (N=19,234) that simulates 1) a large sample size; 2) two-way admixture [Native American-European ancestry] and 3) a binary phenotype. We then examined the inflation factors produced by three popular GWAS tools: GMMAT, SAIGE, and Tractor. We also computed power calculations under different MAFs, case-control ratios, and varying ancestry percentages. Then, we employed a cohort of Peruvians (N=249) to further examine the performances of the testing models on 1) real genetic data and 2) small sample sizes. Finally, we validated these findings using an independent Peruvian cohort (N=109) included in 1000 Genome project (1000G). Results: In the synthetic cohort, SAIGE performed better than GMMAT and Tractor in terms of type-I error rate, especially under severe unbalanced case-control ratio. On the contrary, power analysis identified Tractor as the best method to pinpoint ancestry-specific causal variants, but showed decreased power when no adequate heterogeneity of the true effect sizes was simulated between ancestries. The real Peruvian data showed that Tractor is severely affected by small sample sizes, and produced severely inflated statistics, which we replicated in the 1000G Peruvian cohort. Discussion: The current study illustrates the limitations of available GWAS tools under different scenarios of genetic admixture. We urge caution when interpreting results under complex population scenarios. .
Revista de neuro-psiquiatría, Feb 10, 2014
Características neuropsicológicas de pacientes con deterioro cognitivo leve y demencia asociada a... more Características neuropsicológicas de pacientes con deterioro cognitivo leve y demencia asociada a la enfermedad de Parkinson. Cognitive performance of Parkinson's disease patients in different cognitive stages.
Revista Peruana de Medicina Experimental y Salud Pública, Mar 31, 2011
Introducción. La prueba de dibujo del reloj versión de Manos (PDR-M) es un instrumento de evaluac... more Introducción. La prueba de dibujo del reloj versión de Manos (PDR-M) es un instrumento de evaluación cognitiva breve para la detección de demencia. Objetivos. Evaluar la validez y confiabilidad de la PDR-M para discriminar entre pacientes con demencia y sujetos controles sanos. Materiales y métodos. Se evaluaron sujetos mayores de 65 años de edad, excluyendo los que presentaban enfermedades concomitantes graves y con dificultades auditivas o visuales. Se recogieron datos demográficos y se les realizó PDR-M y Mini Mental State Examination (MMSE). A los individuos del grupo de demencia se les realizó además evaluaciones clínicas, de laboratorio, neuropsicológicas y tomografía cerebral. Se calculó la sensibilidad y especificidad de la PDR-M así como el área bajo la curva ROC. Resultados. Se evaluó 210 individuos, 103 con diagnóstico confirmado de demencia y 107 controles sanos, con edad y sexo similares en ambos grupos; y mayor nivel educativo en el grupo control. Estableciendo un punto de corte de 7 se obtuvo una sensibilidad de 99,0% y una especificidad de 83,5%. Cuando se compararon las áreas bajo la curva ROC de la PDR-M y del MMSE no se encontraron diferencias significativas. Conclusiones. La PDR-M es un instrumento breve y confiable para la detección de demencia en la población urbana de Lima en el Perú.
Revista Colombiana De Psiquiatría (english Edition), 2022
INTRODUCTION Although the absence of memory impairment was considered among the diagnostic criter... more INTRODUCTION Although the absence of memory impairment was considered among the diagnostic criteria to differentiate Alzheimer's disease (AD) from Behavioural Variant of Frontotemporal Dementia (bvFTD), current and growing evidence indicates that a significant percentage of cases of bvFTD present with episodic memory deficits. In order to compare the performance profile of the naming capacity and episodic memory in patients with AD and bvFTD the present study was designed. METHODS Cross-sectional and analytical study with control group (32 people). The study included 42 people with probable AD and 22 with probable bvFTD, all over 60 years old. Uniform Data Set instruments validated in Spanish were used: Multilingual Naming Test (MINT), Craft-21 history and Benson's complex figure, among others. RESULTS A higher average age was observed among the patients with AD. The naming capacity was much lower in patients with bvFTD compared to patients with AD, measured according to the MINT and the nouns/verbs naming coefficient. All patients with bvFTD, 73.81% of those with AD and only 31.25% of the control group failed to recognise Benson's complex figure. All differences were statistically significant (p < 0.001). RESULTS This study confirms the amnesic profile of patients with AD and reveals the decrease in naming capacity in patients with bvFTD, an area of language that is typically affected early on with executive functions, according to recent findings. CONCLUSIONS Patients with AD perform worse in verbal and visual episodic memory tasks, while patients with bvFTD perform worse in naming tasks. These findings open the possibility of exploring the mechanisms of prefrontal participation in episodic memory, typically attributed to the hippocampus.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2022
and Diaz MM () Combining visual rating scales to identify prodromal Alzheimer's disease and Alzhe... more and Diaz MM () Combining visual rating scales to identify prodromal Alzheimer's disease and Alzheimer's disease dementia in a population from a low and middle-income country. Front. Neurol. :. doi: .
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Papers by Rosa Montesinos