Estimulación cognitiva: retrasa pero no evita

“Hay dos cosas infinitas: El universo y la estupidez humana. Y del Universo no estoy seguro”

Albert Einstein

Los beneficios de la estimulación y de los fármacos son pequeños

Había muchas dudas sobre los beneficios de la estimulación cognitiva en sujetos con riesgo de desarrollar demencias y los resultados de un trabajo del Hospital Marqués de Valdecilla y la Asociación de Familiares de Alzheimer de Cantabria las resuelven en parte: la estimulación retrasa la aparición de demencia, pero no consigue evitarla. Al año del tratamiento casi todos los participantes son considerados pacientes demenciados y aquéllos con un deterioro cognitivo leve tienen un riesgo muy elevado de acabar desarrollando demencia, sobre todo Alzheimer.

Los talleres de estimulación de la memoria consiguen que los ancianos a los que se ha diagnosticado un deterioro cognitivo leve (DCL) progresen de forma más lenta hacia demencias como el Alzheimer, pero no consiguen evitarlo. El beneficio de la intervención no siempre es el mismo, pero, mayoritariamente, al año de comenzar la estimulación el individuo pasa a ser considerado un paciente demenciado. “Las personas con DCL configuran un grupo de riesgo para evolucionar a demencia”.

Ésta es una de las principales conclusiones de un estudio realizado, durante los tres últimos años, por el Servicio de Neurología del Hospital Universitario Marqués de Valdecilla, en Santander, y la Asociación de Familiares de Alzheimer de Cantabria (AFAC), que han analizado a 115 pacientes con DCL, una patología que, con frecuencia, es la antesala de una demencia más grave.

De los pacientes esudiados, 46 han desarrollado Alzheimer, dos la enfermedad de los cuerpos de Lewy, uno demencia vascular y otro más demencia mixta, según los datos presentados por dos de los responsables del estudio, comentan el neurólogo Eloy Rodríguez, de Valdecilla, y la neuropsicóloga Ana Pozueta, de AFAC. También han intervenido dos neurólogos más del hospital santanderino: José Ignacio Mateo y José Luis Vázquez.

Duración del proceso
Durante los últimos tres años, con la ayuda económica de la Obra Social de Caja Cantabria, esos 115 pacientes fueron distribuidos en cuatro grupos y parte de ellos acudieron a los talleres de estimulación cognitiva que organiza la AFAC, bajo la supervisión periódica de un neurólogo y un psicólogo. También se obtuvieron muestras de sangre de los individuos para la extracción de ADN, ARN y suero, y se determinó el genotipo APOE, así como otros polimorfismos.

Rodríguez y Pozueta destacan que los pacientes que asistieron a esos talleres presentaron mejores puntuaciones en las pruebas cognitivas realizadas en las sucesivas evaluaciones, si bien esa mejoría no se mantuvo a largo plazo.

Además, se ha observado una tendencia a que aquellos pacientes que habían acudido a los talleres de estimulación cognitiva progresaban más lentamente hacia el Alzheimer.

Así, Eloy Rodríguez explica que los datos obtenidos en este estudio no son definitivos, porque para ello se requeriría un número de pacientes mucho mayor, pero sí manifiestan una tendencia que coincide con lo que están sugiriendo otro tipo de investigaciones.

Pequeños beneficios
“Los beneficios de la estimulación son pequeños, pero es que también son pequeños los beneficios que conseguimos con los fármacos, que hoy en día son limitados y sintomáticos, probablemente porque los hemos probado en pacientes en fases tardías de la enfermedad”, ha señalado el neurólogo.

La investigación concluida deja claro también, entre otras cosas, al analizar los factores genéticos y el deterioro cognitivo, que los polimorfismos de los genes KIBRA, ICE, BDNF y DBH “no estaban asociados con el rendimiento general en los test generales (MSSE), ni tampoco con los test específicos de otros dominios cognitivos -memoria, atención función ejecutiva- en los pacientes con DCL”.

Así las cosas, el alelo g4 del gen APOE estaba asociado “con una menor puntuación en el test MSSE, pero no se relacionó con test concretos de otros dominios cognitivos en la valoración inicial de los pacientes. De hecho, el genotipo AA del gen COMT se asoció con una menor puntuación en la escala de depresión (Hamilton)”.

Respecto a factores genéticos y evolución a demencia, Ana Pozueta ha señalado que el alelo 84 del gen APOE se asocia con incremento de riesgo de conversión a demencia, mientras que el resto de polimorfismos analizados (KIBRA, ICE, BDNF, DBH y COMT) no modifican por sí solos el riesgo de evolución a demencia.

Rodríguez recuerda que en los sujetos portadores del alelo E4 del gen APOE, que presentan las variantes raras de los polimorfismos de ICE, se acelera el curso de la enfermedad, es decir, evolucionan de forma más rápida a demencia.

Retos

Eloy Rodríguez y Ana Pozueta comentan que los nuevos criterios abren una nueva era en el diagnóstico precoz del deterioro cognitivo, tras admitir en alta voz que, hasta ahora, no hay ningún tratamiento eficaz contra el Alzheimer. “Ésa es la batalla pendiente de ganar, aunque la aplicación a la práctica clínica diaria de esos nuevos biomarcadores, la experiencia y los datos de proyectos como éste de Valdecilla y AFAC serán muy útiles para los pacientes”. Mientras tanto, según ha agregado Eloy Rodríguez, hay que adiestrar al médico de familia a hacer los test, y en caso de duda remitir al paciente al especialista para realizar dos pruebas complementarias incluso en personas asintomáticas: el estudio del líquido cefalorraquídeo y una PET para determinar si la persona es positiva al depósito de amiloide.Pero también han destacado ambos profesionales los esfuerzos que se están realizando para diagnosticar la enfermedad de forma precoz, en la fase pre-clínica, cuando todavía el paciente no ha presentado síntomas y, por lo tanto, su cerebro no ha sufrido un daño grave.La pérdida de memoria es un cuadro muy habitual en la consulta, y diferenciar entre una grave de la que no lo es, resulta complicado, tanto para el médico de familia como para el neurólogo. Es algo que hay que valorar con cuidado y precisión.

Fuente: www.diariomedico.com

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