Cerebral vascular disease (CVD) represents the second cause in years of life lost, according to the Global Burden of Disease Study 2015 study. The global report on Alzheimer's disease 2015 estimates that in Latin America there are 9.2 million cases of dementia, with a prevalence of 8.2%. Undoubtedly, Alzheimer's disease is the most frequent cause, followed by vascular dementia (VD) with 15% of the cases, although global data are unknown in Latin America. Objective:To analyze and present the current evidence on the classification, pathophysiology, diagnosis and treatment of vascular cognitive impairment. Methodology:A group of experts met in Miami, Florida, in April 2016. The group included Neurologists, Geriatricians and Psychiatrists from the following countries: Mexico, Guatemala, El Salvador, Costa Rica, Peru, Spain, Bolivia, Chile, Paraguay, Colombia, Panama, Venezuela, Italy, the United States, Dominican Republic, Honduras and Nicaragua. The Delphi method was used to review available information (provided months before the meeting), in relation to assigned topics: definition of Cognitive Vascular Impairment (CVI), risk factors, pathophysiology, diagnosis (neuropsychological and imaging) and treatment. For the allocation of evidence and recommendation of available treatments, the GRADE system was used.The working groups analyzed and discussed available evidence on CVI concerning proposed definitions, risk factors and diagnostic elements. Subsequently, the conclusions of each of the working groups were drafted, which were reviewed by each of the authors and by the rest of the study groups until a global consensus was reached. Once this process was completed, the process of external validation and preparation of the final document was carried out.The results of this consensus allow the incorporation of the opinion and experience of physicians of different specialties in Latin America regarding the vascular cognitive impairment.

Este artículo puede ser consultado en versión completa en: www.medigraphic.com/neumologia dx.doi.org/10.35366/NT192H www.medigraphic.org.mx et al. 153 Neumol Cir Torax, Vol. 78, No. 2, Abril-Junio 2019 NCT www.medigraphic.org.mx RESUMEN. La neumonía adquirida en la comunidad (NAC) es una infección frecuente, potencialmente grave que se asocia con elevada morbilidad y mortalidad, particularmente en adultos y en grupos vulnerables, a pesar de la investigación e información al respecto y del desarrollo de nuevos agentes antimicrobianos. El presente documento representa el esfuerzo de un grupo de expertos para divulgar el conocimiento sobre la prevención de la NAC a través de la vacunación neumocócica conjugada en adultos, especialmente en aquellos pacientes con comorbilidades como cardiopatías, neumopatías, diabetes mellitus, enfermedades reumáticas, cáncer e infección por el virus de la inmunodeficiencia humana (VIH), entre otras. El objetivo de este documento es dar recomendaciones sobre la vacunación neumocócica conjugada a los médicos que atienden pacientes adultos con comorbilidades como las arriba mencionadas.Palabras clave: Inmunización en adultos y adultos mayores, inmunocompromiso en adultos, neumonía adquirida en la comunidad, PCV13, prevención de la neumonía adquirida en la comunidad, vacuna neumocócica conjugada, vacunas.ABSTRACT. Community-acquired pneumonia (CAP) is a frequent and potentially serious infection associated with high morbidity and mortality, particularly in adults and vulnerable groups, despite research and information and the development of new antimicrobial agents. This document represents the effort of a group of experts to disseminate knowledge about the prevention of CAP through pneumococcal conjugate vaccination in adults, especially in patients with comorbidities such as heart, lung and rheumatic diseases, diabetes mellitus, cancer and human immunodeficiency virus infection (HIV), among others. The objective is to provide recommendations on pneumococcal conjugate vaccination to physicians who treat adult patients with comorbidities such as those mentioned above. LiMiTACiONES dE LAS RECOMENdACiONES SEñALAdASEste documento no tomó en cuenta la vacunación en la población pediátrica, sólo en adultos. ALCANCEEste documento está dirigido a médicos de diferentes especialidades que tratan pacientes adultos con comorbilidades como diabetes mellitus, neumopatías, enfermedades cardiovasculares, reumáticas, neoplásicas, VIH, entre otras. CONfORMACióN dEL gRUPO dE TRABAJOCon la perspectiva de alcanzar un mayor conocimiento en lo referente a la vacunación neumocócica en pacientes adultos, se planteó integrar un grupo de

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Background The prevalence of mild cognitive impairment (MCI) is 14 to 18%. MCI has been associated with cardiovascular risk factors. Likewise, the APOEε4 genotype is a gene that confers susceptibility to Alzheimer’s disease. However, the association between APOE genotype, cardiovascular risk and MCI in the Mexican population is not clear, probably as a result of genetic heterogeneity. Method We included patients from memory clinic (INCMNSZ) from 2017 to 2019, > 70 years. Three groups were studied: controls without cognitive impairment, with amnestic and nonamnestic MCI. Parametric and nonparametric statistics (x2, ANOVA, multivariate logistic regression analysis, Kruskal‐Wallis) were used for the analysis of statistical differences between groups. Result 131 patients were studied, 67.9% were women, the average age was 73.6 (SD 7.3) and the educational level was 12.62 (SD 4.98). Regarding the APOE genotype, 93 (71%) were e3 / e3, 35 (26.7%) e3 / e4, 3 (2.3%) e4 / e4. Three groups of cognitive function were formed: cognitively healthy controls: 59 (45%), amnestic MCI: 29 (22.1%) and nonamnestic MCI: 42 (32.1%). In the group with nonamnestic MCI, statistically significant differences were found in dyslipidemia 48% (P = 0.014), history of CVD 16.5% (P = 0.033) and anemia 8% (0.034). For the group with amnestic MCI, 44.4% hypothyroidism was found (p = 0.15). The multivariate logistic regression analysis showed that the APOE genotype did not significantly modify the association with cardiovascular risk factors and MCI. A greater effect on motor executive function was found in the group of carriers of the APOEε4 genotype (p = 0.042) Conclusion Our study found a low frequency of APOE ε4, compared to African or European populations (Pygmy population, khoisan, waiwai) where the frequency is high (possibly related to race). Previous studies have shown an association between cardiovascular risk and cognitive risk in patients with APOE ε4, however, our study does not show an association between the state of APOE and risk for cognitive impairment, possibly related to variability genetics of the Mexican population, as well as the existence of possible polymorphisms not described in this population. Few studies have shown the association between APOE ε4 polymorphism, hypothyroidism and amnestic DCL.

Background Cerebral tractography is a Magnetic Resonance Imaging technique that allows you to visualize the white matter fascicles that connect different parts of the brain. It is based on the diffusion of water in biological tissues, through which fiber tracts are evaluated in a three‐dimensional space, which allows to obtain the Anisotropy Fraction (FA) and Medium Diffusivity (DM). Tractography allows correlating the integrity of these pathways with cognitive function. The objective of our study was to identify anatomical regions with alterations in AF in mixed dementia compared to AD. Method 16 patients were included; 8 with Mixed Dementia (DMix) and 8 with Alzheimer's Disease (AD). Mean, standard deviations and frequencies were used, as well as Chi‐square and Mann‐Whitney tests. A linear regression model was used to determine the association between Tractography and performance in cognitive domains, adjusted for age and educational level. Results The mean age of the participants was 85 ± 7.9 years (p ≤.57), 69% were women (p ≤.10) and the educational level was 11 ± 6.0 years (p ≤.87). Participants with AD had a worse cognitive performance (NEUROPSI: 68.5 ± 11.6 points, p ≤.02) compared to the DMix group. When analyzing by cognitive domains, patients in the DMix group had a worse performance in phonological verbal fluency (7.0 ± 3.5 words, p ≤.05). Regarding neuroimaging, significant differences were observed in participants with DMix in the Anisotropy Fraction (AF) in the following tracts: right cerebral peduncle (0.5557 ± 0.0121, p ≤.05), left cerebral peduncle (0.5476 ± 0.0121, p ≤0.01), right external capsule (0.3346 ± 0.0163, p ≤0.01) and left cingulate gyrus (0.3756 ± 0.0241, p ≤0.05) and mean diffusivity in the right thalamic posterior radiation (0.0010 ± 0.0000, p ≤ 0.03) and left external capsule (0.0012 ± 0.0001, p ≤0.03). Conclusion Tractography allows quantifying and differentiating anatomical regions with myelin damage in mixed dementia compared to AD.