title: Dementia associated with the antiphospholipid syndrome: clinical and radiological characteristics of 30 patients.
abstract: OBJECTIVE
  To analyse the clinical and radiological characteristics of patients with dementia associated with the antiphospholipid syndrome (APS).
  
  
  METHODS
  Twenty-five patients were identified by a computer-assisted (MEDLINE, National Library of Medicine, Bethesda, MD) search of the literature to locate all cases of dementia associated with APS published in English, Spanish and French from 1983 to 2003. Additionally, we included five patients from our clinics.
  
  
  RESULTS
  There were 21 (70%) females and 9 (30%) males. The mean age of patients was 49+/-15 yr (range 16-79 yr). Fourteen (47%) of the patients suffered from primary APS, 9 (30%) had systemic lupus erythematosus and 7 (23%) had 'lupus-like' syndrome. Ten (33%) patients had Sneddon's syndrome and 2 (7%) had cerebral lesions described as Binswanger's disease. Other APS-related manifestations included thrombocytopenia in 12 (40%) patients, cerebrovascular accidents in 11 (37%), heart valve lesions in 8 (27%), deep vein thrombosis in 7 (28%), migraine in 7 (23%), seizures in 4 (13%); five of the 21 (24%) female patients had nine spontaneous abortions. Lupus anticoagulant was present in 21/29 (72%) patients and anticardiolipin antibodies were present in 24/29 (83%) patients. Cortical infarcts were found in 19 (63%) patients, subcortical infarcts in 9 (30%), basal ganglia infarcts in 7 (23%) and signs of cerebral atrophy in 11 (37%). Anticoagulation was used in 14/25 (56%) patients, steroids in 12/25 (48%), aspirin in 6/25 (24%) and dypiridamole in 5/25 (20%).
  
  
  CONCLUSIONS
  Dementia is an unusual manifestation of APS but one which has a high disability impact in a patient's daily life. In order to prevent these consequences, an echocardiographic and cerebral CT or MRI evaluation are recommended in all patients with APS. Furthermore, ruling out APS should be recommended in the clinical approach to dementia, especially in young patients.
authors.affiliation: Servei de Malalties Autoimmunes, Hospital Clínic, Villarroel, 170, 08036-Barcelona, Catalonia, Spain. rcervera@clinic.ub.es.
authors.forename: J A
authors.initials: JA
authors.lastname: Gómez-Puerta
authors.forename: R
authors.initials: R
authors.lastname: Cervera
authors.forename: L M
authors.initials: LM
authors.lastname: Calvo
authors.forename: B
authors.initials: B
authors.lastname: Gómez-Ansón
authors.forename: G
authors.initials: G
authors.lastname: Espinosa
authors.forename: G
authors.initials: G
authors.lastname: Claver
authors.forename: S
authors.initials: S
authors.lastname: Bucciarelli
authors.forename: A
authors.initials: A
authors.lastname: Bové
authors.forename: M
authors.initials: M
authors.lastname: Ramos-Casals
authors.forename: M
authors.initials: M
authors.lastname: Ingelmo
authors.forename: J
authors.initials: J
authors.lastname: Font
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003704:Dementia / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed