Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática
La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa progresiva que afecta el 50 % de las personas mayores de 85 años y es una de las más comunes en la edad adulta y la causa más frecuente de demencia en los países desarrollados. El objetivo fue determinar cuáles han sido los marcador...
- Autores:
-
Bonilla Santos, Jasmin
Zea Romero, Erika Yisseth
González Hernández, Alfredis
Cala Martínez, Dorian Yisela
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2021
- Institución:
- Universidad Cooperativa de Colombia
- Repositorio:
- Repositorio UCC
- Idioma:
- OAI Identifier:
- oai:repository.ucc.edu.co:20.500.12494/47197
- Acceso en línea:
- https://hdl.handle.net/20.500.12494/47197
- Palabra clave:
- Enfermedad de Alzheimer
Deterioro Cognitivo Leve
Marcador
Biomarcador
Revisión sistemática
Alzheimer's disease
Mild Cognitive
Impairment
Marker
Biomarker
Systematic review
- Rights
- openAccess
- License
- Atribución
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dc.title.spa.fl_str_mv |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
title |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
spellingShingle |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática Enfermedad de Alzheimer Deterioro Cognitivo Leve Marcador Biomarcador Revisión sistemática Alzheimer's disease Mild Cognitive Impairment Marker Biomarker Systematic review |
title_short |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
title_full |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
title_fullStr |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
title_full_unstemmed |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
title_sort |
Marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. Una revisión sistemática |
dc.creator.fl_str_mv |
Bonilla Santos, Jasmin Zea Romero, Erika Yisseth González Hernández, Alfredis Cala Martínez, Dorian Yisela |
dc.contributor.author.none.fl_str_mv |
Bonilla Santos, Jasmin Zea Romero, Erika Yisseth González Hernández, Alfredis Cala Martínez, Dorian Yisela |
dc.subject.spa.fl_str_mv |
Enfermedad de Alzheimer Deterioro Cognitivo Leve Marcador Biomarcador Revisión sistemática |
topic |
Enfermedad de Alzheimer Deterioro Cognitivo Leve Marcador Biomarcador Revisión sistemática Alzheimer's disease Mild Cognitive Impairment Marker Biomarker Systematic review |
dc.subject.other.spa.fl_str_mv |
Alzheimer's disease Mild Cognitive Impairment Marker Biomarker Systematic review |
description |
La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa progresiva que afecta el 50 % de las personas mayores de 85 años y es una de las más comunes en la edad adulta y la causa más frecuente de demencia en los países desarrollados. El objetivo fue determinar cuáles han sido los marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve (DCL) y la EA más estudiados en los últimos 10 años. Se buscaron estudios en las bases de datos Scopus, Pubmed y Sciencedirect. Se identificaron 187 artículos, de los que finalmente se seleccionaron 23 con texto completo. Los estudios correspondieron a marcadores cognitivos (15 estudios), biológicos (8 estudios), anatómicos (3 estudios) y conductuales (2 estudios). Los marcadores identificados permitirán orientar el diseño de programas de detección temprana y futuras intervenciones que disminuyan los efectos neuropatológicos y las alteraciones significativas en la calidad de vida. |
publishDate |
2021 |
dc.date.issued.none.fl_str_mv |
2021-09-18 |
dc.date.accessioned.none.fl_str_mv |
2022-11-24T15:58:25Z |
dc.date.available.none.fl_str_mv |
2022-11-24T15:58:25Z |
dc.type.none.fl_str_mv |
Artículo |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
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dc.identifier.issn.spa.fl_str_mv |
1019-8113 |
dc.identifier.uri.spa.fl_str_mv |
doi: 10.46997/revecuatneurol30200057 |
dc.identifier.uri.none.fl_str_mv |
https://hdl.handle.net/20.500.12494/47197 |
dc.identifier.bibliographicCitation.spa.fl_str_mv |
Bonilla-Santos, Jasmín, Zea-Romero, Erika Yisseth, Cala-Martínez, Dorian Yisela, & González-Hernández, Alfredis. (2021). Marcadores Cognitivos, Biológicos, Anatómicos Y Conductuales Del Deterioro Cognitivo Leve Y La Enfermedad De Alzheimer. Una Revisión Sistemática. Revista Ecuatoriana de Neurología, 30(2), 57-67. https://doi.org/10.46997/revecuatneurol30200057 |
identifier_str_mv |
1019-8113 doi: 10.46997/revecuatneurol30200057 Bonilla-Santos, Jasmín, Zea-Romero, Erika Yisseth, Cala-Martínez, Dorian Yisela, & González-Hernández, Alfredis. (2021). Marcadores Cognitivos, Biológicos, Anatómicos Y Conductuales Del Deterioro Cognitivo Leve Y La Enfermedad De Alzheimer. Una Revisión Sistemática. Revista Ecuatoriana de Neurología, 30(2), 57-67. https://doi.org/10.46997/revecuatneurol30200057 |
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https://hdl.handle.net/20.500.12494/47197 |
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Revista Ecuatoriana de Neurología |
dc.relation.references.spa.fl_str_mv |
Tan ZS, Beiser AS, Fox CS, Au R, Himali JJ, Debette S, et al. Association of metabolic dysregulation with volumetric brain magnetic resonance imaging and cognitive markers of subclinical brain aging in middle-aged adults: The Framingham offspring study. Diabetes Care. 2011; 34:1766-70. https://doi.org/10.2337/dc11-0308 [ Links ] Barrera-Ocampo A, Lopera F. Inmunoterapia beta-amiloide: ¿la esperanza para la enfermedad de Alzheimer? Colombia Medica. 2016; 47:203-12. http://www.scielo.org.co/pdf/cm/v47n4/es_1657-9534-cm-47-04-00203.pdf [ Links ] Laczó J, Andel R, Nedelska Z, Vyhnalek M, Vlcek K, Crutch S, et al. Exploring the contribution of spatial navigation to cognitive functioning in older adults. Neurobiology of Aging. 2017; 51:67-70. https://doi.org/10.1016/j.neurobiolaging.2016.12.003 [ Links ] Sapkota S, Huan T, Tran T, Zheng J, Camicioli R, Li L, et al. Alzheimer's biomarkers from multiple modalities selectively discriminate clinical status: Relative importance of salivary metabolomics panels, genetic, lifestyle, cognitive, functional health and demographic risk markers. Frontiers in Aging Neuroscience. 2018;10:1-13. https://doi.org/10.3389/fnagi.2018.00296 [ Links ] Patterson C. World Alzheimer report 2018: the state of the art of dementia research: new frontiers. Alzheimer’s Disease International (ADI); 2018. [ Links ] Edmonds EC, Bangen KJ, Delano-Wood L, Nation DA, Furst AJ, Salmon DP, et al. Patterns of Cortical and Subcortical Amyloid Burden across Stages of Preclinical Alzheimer's Disease. Journal of the International Neuropsychological Society. 2016;22:978-90. https://doi.org/10.1017/S1355617716000928 [ Links ] Hazlett KE, Figueroa CM, Nielson KA. Executive functioning and risk for alzheimer's disease in the cognitively intact: Family history predicts Wisconsin card sorting test performance. Neuropsychology. 2015; 29:582-91. https://doi.org/10.1037/neu0000181 [ Links ] López ME, Turrero A, Cuesta P, López-Sanz D, Bruña R, Marcos A, et al. Searching for Primary Predictors of Conversion from Mild Cognitive Impairment to Alzheimer's Disease: A Multivariate Follow-Up Study. Journal of Alzheimer's Disease. 2016;52:133-43. https://doi.org/10.3233/JAD-151034 [ Links ] Tripathi R, Kumar K, Balachandar R, Marimuthu P, Varghese M, Bharath S. Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India. Annals of Indian Academy of Neurology. 2015;18:177-80. https://doi.org/10.4103/0972-2327.150566 [ Links ] Weinstein G, Beiser AS, Decarli C, Au R, Wolf PA, Seshadri S. Brain imaging and cognitive predictors of stroke and alzheimer disease in the framingham heart study. Stroke. 2013;44:2787-94. https://doi.org/10.1161/STROKEAHA.113.000947 [ Links ] Parra MA, Baez S, Allegri R, Nitrini R, Lopera F, Slachevsky A, et al. Dementia in Latin America: Assessing the present and envisioning the future. Neurology. 2018;90:222-31. https://doi.org/10.1212/WNL.0000000000004897 [ Links ] Alvarez-Duque M, Leal-Campanario R, Lopera-Restrepo F, Madrigal-Zapata L, Villegas-Lanau A. (2018). Heterogeneidad Sintomatológica. Perfiles de Pacientes Diagnosticados con Demencia Tipo Alzheimer en Antioquia (Colombia). Vol. 27, No 2/ Revista Ecuatoriana de Neurología. Pag 11-19 [ Links ] Bilgel M, An Y, Lang A, Prince J, Ferrucci L, Jedynak B, et al. Trajectories of Alzheimer disease-related cognitive measures in a longitudinal sample. Alzheimer's and Dementia. 2014;10:735-42. https://doi.org/10.1016/j.jalz.2014.04.520 [ Links ] Killin L, Abrahams S, Parra MA, Della Sala S. The effect of age on the FCSRT-IR and temporary visual memory binding. International Psychogeriatrics. 2018;30:331-40. https://doi.org/10.1017/S104161021700165X [ Links ] Schoemaker D, Poirier J, Escobar S, Gauthier S, Pruessner J. Selective familiarity deficits in otherwise cognitively intact aging individuals with genetic risk for Alzheimer's disease. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring. 2016;2:132-9. https://doi.org/10.1016/j.dadm.2015.11.007 [ Links ] Segkouli S, Paliokas I, Tzovaras D, Giakoumis D, Karagiannidis C. Design of novel screening environments for Mild Cognitive Impairment: Giving priority to elicited speech and language abilities. 9th International Conference on Pervasive Computing Technologies for Healthcare. 2015:137-40. https://doi.org/10.4108/icst.pervasivehealth.2015.258945 [ Links ] World Health Organization & International Programme on Chemical Safety. Biomarkers in Risk Assessment: Validity and Validation. World Health Organization; 2001. http://hdl.handle.net/20.500.11822/29529 [ Links ] Pérez-Martínez D, Puente-Muñoz A. (2020). Bacterias, Endotoxinas y Neuroinflamación Crónica: ¿Una Etiopatogenia Para las Enfermedad de Alzheimer? Vol. 29, No 1, Revista Ecuatoriana de Neurología. 137-144 [ Links ] Jack CR, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer's disease. Alzheimer's and Dementia. 2018;14:535-62. https://doi.org/10.1016/j.jalz.2018.02.018 [ Links ] Jansen WJ, Ossenkoppele R, Knol DL, Tijms BM, Scheltens P, Verhey FRJ, et al. Prevalence of cerebral amyloid pathology in persons without dementia: A meta-analysis. JAMA - Journal of the American Medical Association. 2015;313:1924-38. https://doi.org/10.1001/jama.2015.4668 [ Links ] Selkoe DJ, Hardy J. The amyloid hypothesis of Alzheimer's disease at 25 years. EMBO Molecular Medicine. 2016;8:595-608. https://doi.org/10.15252/emmm.201606210 [ Links ] Honea RA, Cruchaga C, Perea RD, Saykin AJ, Burns JM, Weinberger DR, et al. Characterizing the Role of Brain Derived Neurotrophic Factor Genetic Variation in Alzheimer's Disease Neurodegeneration. PLoS ONE. 2013;8:1-9. https://doi.org/10.1371/journal.pone.0076001 [ Links ] Santos CY, Johnson LN, Sinoff SE, Festa EK, Heindel WC, Snyder PJ. Change in retinal structural anatomy during the preclinical stage of Alzheimer's disease. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring. 2018;10:196-209. https://doi.org/10.1016/j.dadm.2018.01.003 [ Links ] Niccolai LM, Triebel KL, Gerstenecker A, McPherson TO, Cutter GR, Martin RC, et al. Neurocognitive Predictors of Declining Financial Capacity in Persons with Mild Cognitive Impairment. Clinical Gerontologist. 2017;40:14-23. https://doi.org/10.1080/07317115.2016.1228022 [ Links ] Halpin SN, Dillard RL, Puentes WJ. Socio-Emotional Adaptation Theory: Charting the Emotional Process of Alzheimer's Disease. Gerontologist. 2017;57:696-706. https://doi.org/10.1093/geront/gnw046 [ Links ] Penna S. Cognitive and emotional dysfunction in mild cognitive impairment. Clinics in Geriatric Medicine. 2013;29:773-89. https://doi.org/10.1016/j.cger.2013.07.004 [ Links ] Bellassen V, Iglói K, de Souza LC, Dubois B, Rondi-Reig L. Temporal order memory assessed during spatiotemporal navigation as a behavioral cognitive marker for differential Alzheimer'S disease diagnosis. Journal of Neuroscience. 2012;32:1942-52. https://doi.org/10.1523/JNEUROSCI.4556-11.2012 [ Links ] Grilli MD, Woolverton CB, Crawford M, Glisky EL. Self-reference and emotional memory effects in older adults at increased genetic risk of Alzheimer’s disease. Aging, Neuropsychology, and Cognition. 2018;25:186-99. https://doi.org/10.1080/13825585.2016.1275508 [ Links ] Niedźwieńska A, Kvavilashvili L. Reduced mind-wandering in mild cognitive impairment: Testing the spontaneous retrieval deficit hypothesis. Neuropsychology. 2018;32:711-23. https://doi.org/10.1037/neu0000457 [ Links ] Kandel BM, Avants BB, Gee JC, McMillan CT, Erus G, Doshi J, et al. White matter hyperintensities are more highly associated with preclinical Alzheimer's disease than imaging and cognitive markers of neurodegeneration. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring. 2016;4:18-27. https://doi.org/10.1016/j.dadm.2016.03.001 [ Links ] Kao HW, Liou M, Chung HW, Liu HS, Tsai PH, Chiang SW, et al. High agatston calcium score of intracranial carotid artery: A significant risk factor for cognitive impairment. Medicine. 2015;94:1-5. https://doi.org/10.1097/MD.0000000000001546 [ Links ] Tu MC, Lo CP, Huang CF, Hsu YH, Huang WH, Deng JF, et al. Effectiveness of diffusion tensor imaging in differentiating early-stage subcortical ischemic vascular disease, Alzheimer's disease and normal ageing. PLoS ONE. 2017;12:1-19. https://doi.org/10.1371/journal.pone.0175143 [ Links ] Niedźwieńska A, Kvavilashvili L, Ashaye K, Neckar J. Spontaneous retrieval deficits in amnestic mild cognitive impairment: A case of focal event-based prospective memory. Neuropsychology. 2017;31:735-49. https://doi.org/10.1037/neu0000378 [ Links ] |
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Bonilla Santos, JasminZea Romero, Erika YissethGonzález Hernández, AlfredisCala Martínez, Dorian Yisela 30 (2)2022-11-24T15:58:25Z2022-11-24T15:58:25Z2021-09-181019-8113doi: 10.46997/revecuatneurol30200057https://hdl.handle.net/20.500.12494/47197Bonilla-Santos, Jasmín, Zea-Romero, Erika Yisseth, Cala-Martínez, Dorian Yisela, & González-Hernández, Alfredis. (2021). Marcadores Cognitivos, Biológicos, Anatómicos Y Conductuales Del Deterioro Cognitivo Leve Y La Enfermedad De Alzheimer. Una Revisión Sistemática. Revista Ecuatoriana de Neurología, 30(2), 57-67. https://doi.org/10.46997/revecuatneurol30200057La enfermedad de Alzheimer (EA) es una enfermedad neurodegenerativa progresiva que afecta el 50 % de las personas mayores de 85 años y es una de las más comunes en la edad adulta y la causa más frecuente de demencia en los países desarrollados. El objetivo fue determinar cuáles han sido los marcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve (DCL) y la EA más estudiados en los últimos 10 años. Se buscaron estudios en las bases de datos Scopus, Pubmed y Sciencedirect. Se identificaron 187 artículos, de los que finalmente se seleccionaron 23 con texto completo. Los estudios correspondieron a marcadores cognitivos (15 estudios), biológicos (8 estudios), anatómicos (3 estudios) y conductuales (2 estudios). Los marcadores identificados permitirán orientar el diseño de programas de detección temprana y futuras intervenciones que disminuyan los efectos neuropatológicos y las alteraciones significativas en la calidad de vida.Alzheimer's disease (AD) is a progressive neurodegenerative disease that affects 50% of people over 85 years of age and is one of the most common in adulthood and the most common cause of dementia in developed countries. The objective was to determine which have been the most studied cognitive, biological, anatomical and behavioral markers of mild cognitive impairment (MCI) and AD in the last 10 years. Observational studies were searched in the Scopus, Pubmed and Sciencedirect databases. 187 articles were identified, of which 23 with full text were finally selected. The studies corresponded to cognitive (15 studies), biological (8 studies), anatomical (3 studies) and behavioral (2 studies) markers. The identified markers will help guide the design of early detection programs and future interventions that reduce neuropathological effects and significant alterations in quality of lifehttp://scienti.colciencias.gov.co:8081/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001016628Psicosaberesjasmin.bonillas@campusucc.edu.cohttps://scholar.google.es/citations?user=-n4q0yUAAAAJ&hl=es57-67Universidad Cooperativa de Colombia, Facultad de Ciencias Sociales, Psicología, NeivaPsicologíaNeivahttp://revecuatneurol.com/wp-content/uploads/2021/09/2631-2581-rneuro-30-02-00057.pdfRevista Ecuatoriana de NeurologíaTan ZS, Beiser AS, Fox CS, Au R, Himali JJ, Debette S, et al. Association of metabolic dysregulation with volumetric brain magnetic resonance imaging and cognitive markers of subclinical brain aging in middle-aged adults: The Framingham offspring study. Diabetes Care. 2011; 34:1766-70. https://doi.org/10.2337/dc11-0308 [ Links ]Barrera-Ocampo A, Lopera F. Inmunoterapia beta-amiloide: ¿la esperanza para la enfermedad de Alzheimer? Colombia Medica. 2016; 47:203-12. http://www.scielo.org.co/pdf/cm/v47n4/es_1657-9534-cm-47-04-00203.pdf [ Links ]Laczó J, Andel R, Nedelska Z, Vyhnalek M, Vlcek K, Crutch S, et al. Exploring the contribution of spatial navigation to cognitive functioning in older adults. Neurobiology of Aging. 2017; 51:67-70. https://doi.org/10.1016/j.neurobiolaging.2016.12.003 [ Links ]Sapkota S, Huan T, Tran T, Zheng J, Camicioli R, Li L, et al. Alzheimer's biomarkers from multiple modalities selectively discriminate clinical status: Relative importance of salivary metabolomics panels, genetic, lifestyle, cognitive, functional health and demographic risk markers. Frontiers in Aging Neuroscience. 2018;10:1-13. https://doi.org/10.3389/fnagi.2018.00296 [ Links ]Patterson C. World Alzheimer report 2018: the state of the art of dementia research: new frontiers. Alzheimer’s Disease International (ADI); 2018. [ Links ]Edmonds EC, Bangen KJ, Delano-Wood L, Nation DA, Furst AJ, Salmon DP, et al. Patterns of Cortical and Subcortical Amyloid Burden across Stages of Preclinical Alzheimer's Disease. Journal of the International Neuropsychological Society. 2016;22:978-90. https://doi.org/10.1017/S1355617716000928 [ Links ]Hazlett KE, Figueroa CM, Nielson KA. Executive functioning and risk for alzheimer's disease in the cognitively intact: Family history predicts Wisconsin card sorting test performance. Neuropsychology. 2015; 29:582-91. https://doi.org/10.1037/neu0000181 [ Links ]López ME, Turrero A, Cuesta P, López-Sanz D, Bruña R, Marcos A, et al. Searching for Primary Predictors of Conversion from Mild Cognitive Impairment to Alzheimer's Disease: A Multivariate Follow-Up Study. Journal of Alzheimer's Disease. 2016;52:133-43. https://doi.org/10.3233/JAD-151034 [ Links ]Tripathi R, Kumar K, Balachandar R, Marimuthu P, Varghese M, Bharath S. Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India. Annals of Indian Academy of Neurology. 2015;18:177-80. https://doi.org/10.4103/0972-2327.150566 [ Links ]Weinstein G, Beiser AS, Decarli C, Au R, Wolf PA, Seshadri S. Brain imaging and cognitive predictors of stroke and alzheimer disease in the framingham heart study. Stroke. 2013;44:2787-94. https://doi.org/10.1161/STROKEAHA.113.000947 [ Links ]Parra MA, Baez S, Allegri R, Nitrini R, Lopera F, Slachevsky A, et al. Dementia in Latin America: Assessing the present and envisioning the future. Neurology. 2018;90:222-31. https://doi.org/10.1212/WNL.0000000000004897 [ Links ]Alvarez-Duque M, Leal-Campanario R, Lopera-Restrepo F, Madrigal-Zapata L, Villegas-Lanau A. (2018). Heterogeneidad Sintomatológica. Perfiles de Pacientes Diagnosticados con Demencia Tipo Alzheimer en Antioquia (Colombia). Vol. 27, No 2/ Revista Ecuatoriana de Neurología. Pag 11-19 [ Links ]Bilgel M, An Y, Lang A, Prince J, Ferrucci L, Jedynak B, et al. Trajectories of Alzheimer disease-related cognitive measures in a longitudinal sample. Alzheimer's and Dementia. 2014;10:735-42. https://doi.org/10.1016/j.jalz.2014.04.520 [ Links ]Killin L, Abrahams S, Parra MA, Della Sala S. The effect of age on the FCSRT-IR and temporary visual memory binding. International Psychogeriatrics. 2018;30:331-40. https://doi.org/10.1017/S104161021700165X [ Links ]Schoemaker D, Poirier J, Escobar S, Gauthier S, Pruessner J. Selective familiarity deficits in otherwise cognitively intact aging individuals with genetic risk for Alzheimer's disease. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring. 2016;2:132-9. https://doi.org/10.1016/j.dadm.2015.11.007 [ Links ]Segkouli S, Paliokas I, Tzovaras D, Giakoumis D, Karagiannidis C. 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Neuropsychology. 2017;31:735-49. https://doi.org/10.1037/neu0000378 [ Links ]Enfermedad de AlzheimerDeterioro Cognitivo LeveMarcadorBiomarcadorRevisión sistemáticaAlzheimer's diseaseMild CognitiveImpairmentMarkerBiomarkerSystematic reviewMarcadores cognitivos, biológicos, anatómicos y conductuales del deterioro cognitivo leve y la enfermedad de Alzheimer. 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