Serial position effects in patients with mild cognitive impairment and early and moderate Alzheimer's disease compared with healthy comparison subjects.

BACKGROUND/AIMS: This study aimed to investigate whether the serial position effects in memory can differentiate patients with different subtypes of mild cognitive impairment (MCI) from healthy controls and patients with different stages of Alzheimer's disease (AD). METHODS: The serial position effects was tested with the CERAD word list task in 184 persons (39 healthy control subjects, 15 amnestic MCI single domain subjects, 23 amnestic MCI multiple domain subjects, 31 nonamnestic MCI subjects, 45 early or mild AD patients, and 31 moderate AD patients). RESULTS: With progression of dementia, memory deficits increased and the impairment in the primacy effect during the learning trials advanced, whereas the recall of recent items was less impaired. The serial position profile of nonamnestic MCI patients resembled that of healthy control subjects, whereas amnestic MCI patients showed poorer performance in all 3 positions but no significant difference as a function of serial word position. CONCLUSION: Analyses of the serial position effect may be a useful complement to clinical neuropsychological measures for distinguishing amnestic MCI patients from normal aging and patients with different stages of dementia.

[Correlation of mental activity with cognitive functions in mild cognitive impairment and early stage dementia]. / Korrelation mentaler Aktivitäten mit kognitiven Funktionen in der Frühdiagnostik demenzieller Erkrankungen.

INTRODUCTION: Mental activities have been suggested to influence the risk and course of dementia. This study was performed in order to assess the association of various mental activities with diagnosis and cognitive functions in an elderly population. METHODS: A total of 191 memory clinic patients (mean age 71.7 ± 10.7 years) were included in this study. Participants completed a standardized neuropsychological test battery, a clinical interview, and a semistructured interview to assess mental activities. RESULTS: Of the 191 patients, 39 were diagnosed as cognitively intact, 72 had mild cognitive impairment, and 80 mild Alzheimer's disease. Group comparisons of mental activity scores revealed differences for the variables art, culture, media consumption, travelling, and cognitive activities. Correlation analysis showed a significant association of culture, media consumption, travelling, and cognitive activities with cognitive functions. CONCLUSION: Our results suggest that mental activities may influence the extent of cognitive impairment and possibly the risk for Alzheimer's disease.

[Association of Mild Cognitive Impairment (MCI) and depression]. / Zusammenhang zwischen Mild Cognitive Impairment (MCI) und Depression.

OBJECTIVE: Mild Cognitive Impairment is a heterogeneous entity. Incidence and prevalence of MCI are highly dependent on the diagnostic criteria applied. Geriatric depression is more frequently associated with cognitive deficits and somatic complaints than depression in younger age. Consequently, depressive symptoms in the elderly are often misinterpreted and not treated adequately. The aim of this review is to point out possible explanations for the high incidence of depression in patients with MCI and to compare prior studies who worked on this interrelation. METHODS: We review the existing literature on the relationship between MCI and depression. RESULTS: There is no consensus on the question whether depression is the consequence or the cause for cognitive impairment in older people. The comparability of prior studies which dealt with the relationship between depression and MCI is limited due to the use of different diagnostic criteria and depression scales. CONCLUSION: It can be concluded that there is an association between MCI and depression which leads to a worse clinical outcome of depression and maybe a faster progression of cognitive decline.

Sex differences in brain activation pattern during a visuospatial cognitive task: a functional magnetic resonance imaging study in healthy volunteers.

Sex differences in mental rotation tasks, favoring men, have been noted in behavioral studies and functional imaging studies. In the present study ten female and ten male volunteers underwent functional magnetic resonance imaging in a conventional block design. Regions of activation were detected after performance of a mental rotation task inside the scanner. In contrast to previous studies, confounding factors such as performance differences between genders or high error rates were excluded. Men showed significantly stronger parietal activation, while women showed significantly greater right frontal activation. Our results point to gender specific differences in the neuropsychological processes involved in mental rotation tasks.

Brain activation pattern during a verbal fluency test in healthy male and female volunteers: a functional magnetic resonance imaging study.

Sex differences in executive speech tasks, favoring women, have been noted in behavioral studies and functional imaging studies. In the present study ten female and ten male volunteers underwent functional magnetic resonance imaging in a conventional block design. All subjects were selected on the basis of high performance on the verbal fluency task. Regions of activation were detected after performance of a covert lexical verbal fluency task inside the scanner. Men and women who did not differ significantly in verbal fluency task performance showed a very similar pattern of brain activation. Our data argue against genuine between-sex differences in cerebral activation patterns during lexical verbal fluency activities when confounding factors like performance differences are excluded.

[Gender differences in cognitive functions]. / Geschlechtsunterschiede kognitiver Leistungen -- populärwissenschaftliche Stereotypien oder evidenzbasierte Studienergebnisse?

Gender differences in neuropsychological functioning of patients with psychiatric disorders have been studied extensively in the last years. The available studies provide conflicting results, which can be attributed to the complexity of variables influencing cognitive sex differences. In this article we review the literature about gender differences in cognitive functions in healthy men and women and discuss the relevance of hormones, socio-cultural factors, educational factors and training on the occurrence of these sex differences. Furthermore we summarize the results from functional MRI experiments, which is a useful tool for noninvasively localizing areas in the brain involved in specific cognitive functions.

Weather and suicide: the present state of knowledge on the association of meteorological factors with suicidal behaviour.

OBJECTIVE: To review the available literature on the association between daily and longer-term weather data and the incidence of attempted and completed suicide. METHOD: A computerized search supplemented by a cross-check of the references sections of the thereby identified papers was performed. RESULTS: A total of 27 studies looking for a relationship between attempted or completed suicide and weather or climate data were found. Most of the papers reported a statistical association of suicidal acts with at least one weather factor. However, the results are not conclusive and in part contradictory. CONCLUSION: Possibly due to the high variance in methodological approaches of the studies it is not possible to identify a specific weather condition associated with a generally higher risk for suicide. Weather and seasonal effects may interact with each other. Environmental effects on brain function and weather-related interactions of people may be involved in the occurrence of suicidal behaviour.

[Placebo-controlled antidepressant drug trials. Considering the ethical implications]. / Plazebokontrollierte Antidepressiva-Studien. Uberlegungen zur Frage der ethischen Beurteilung.

For the approval of a new antidepressant for clinical use drug authorities still demand the proof of a significantly superior efficacy of the compound over placebo shown in controlled comparison studies. On the other side serious ethical concerns have been raised upon the use of placebos in clinical trials with depressed patients in that this would implicitly mean a withholding of an efficacious treatment from patients in the control groups of such trials. This article summarises frequently quoted arguments for and against placebo use in antidepressant clinical trials focussing on the specific issues involved in the therapeutic effect of antidepressants and placebos in depressed patients and discusses measures that might contribute to study designs that may better evaluate the true efficacy of a new drug while keeping the risk for the individual patient at the lowest possible level. A worldwide solution of the problem is clearly called for. A ban of placebos in antidepressant trials as it might be derived from the Declaration of Helsinki should be postponed until antidepressants with a more convincing superiority over placebo have been developed.

[Long-term treatment of depressive illnesses]. / Langzeitbehandlung depressiver Erkrankungen.

Depressive and bipolar disorders are affective disorders of chronic nature characterized by the occurrence of depressive episodes with or without manic episodes. Pharmacologic treatment must not be stopped with remission, i.e. cessation of depressive symptoms. Relapse prevention must be carried on over 4-6 months, in many cases maintenance therapy has to be continued for years if not lifelong. Treatment strategies include antidepressants, lithium and anticonvulsants for all of which efficacy in long-term treatment of depression has been shown. In this phase of therapy information and motivation--besides periodical clinical and drug level checks--in order to establish compliance in patients remain important tasks of treating physicians.

Association of meteorological factors with suicide.

OBJECTIVE: To identify weather factors associated with an increased risk of suicide. In a number of prior studies an influence of meteorological conditions on the incidence of suicide or attempted suicide has been suggested. METHOD: Official data on the suicide cases of the state of Tyrol, Austria, assessed over a period of 6 years (n = 702) were correlated with a number of meteorological factors assessed at eight weather stations. RESULTS: The risk of committing suicide was significantly higher on days with high temperatures, low relative humidity or a thunderstorm and on days following a thunderstorm. The multiple logistic regression analysis left "temperature" and "thunderstorm on the preceding day" as significant factors, even after adjustment for sociodemographic and geographical variables. CONCLUSION: Within the interaction of psychological and environmental influences in the development of suicidal ideation and behaviour, specific meteorological conditions may additionally contribute to the risk of suicide in predisposed individuals.

[Railroad suicides and attempted suicides in Austria 1990-1994. Extending the hypothesis mass media transmission of suicidal behavior]. / Eisenbahnsuizide und-suizidversuche in Osterreich von 1990-1994. Erweiterung der Hypothese medialer Vermittlung suizidalen Verhaltens.

Suicide on railways (either by being run over by or jumping in front of a train) is one of the "hardest' suicide methods. In Austria, 617 suicides or attempted suicides on railways were registered between 1990 and 1994. This amounts to 5.73% of all suicides committed in this period with women showing a higher percentage than men. In both men and women there was a predominance of younger age groups; the mean age was higher in women than in men (48.0 vs 40.4 years). There was a significant increase in suicides or attempted suicides on railways after a television report on the stress suffered by train drivers concerning possible suicides. Persuading the mass media to treat the subject of "suicide' with reserve and with greater caution, even when not presenting a distinct suicide model, may be of importance in general suicide prevention.

Suicide in south Tyrol 1980-1992: influence of affiliation to different language groups.

National suicide rates differ widely throughout Europe. The reasons for this are still unclear. Besides differences in actual suicide figures, different assessment methods and certification strategies have been suggested. This study examines the ethnic influence on suicide rates of South Tyrol, an Italian province bordering on Austria. The region has historically been under the cultural influence of both countries, with its population composed of three ethnic groups: the German-, Italian- and Ladinian-language groups. The study shows a significant correlation between the male suicide rate and the proportion of the German-language group. The ethnic suicide rates of Italian- and German-speaking people in South Tyrol were found to approximate each other, in comparison with the national rates for Italy and Austria, as a possible result of cultural interaction.

In-patient suicide in psychiatric hospitals.

OBJECTIVE: In-patient suicides continue to be a matter of concern in hospital psychiatry. In-patients at risk for suicide need to be identified. METHOD: In-patient suicides in two psychiatric hospitals were assessed over a time-span of 8 years. Cases were detected by comparing police suicide data with the hospitals' admission and discharge records. Further information was then gathered from patients' records. RESULTS: During the period under investigation 44 in-patients committed suicide, the majority of them being diagnosed with affective disorders (45.4%) or schizophrenia (27.3%). The most commonly used method was 'jumping in front of a vehicle' (34.1%); 79.5% were treated in an open ward at the time of their suicide, 15.9% in a locked unit. The majority of open ward suicides happened outside the hospital; 39.4% of patients had left the ward without giving notice. CONCLUSION: Additional cautionary measures are warranted especially for patients in open wards.

[Anxiety neurosis--avoidant behavior--depression. A comparison between panic disorder and generalized anxiety disorder]. / Angstneurose--Vermeidungsverhalten--Depression. Ein Vergleich zwischen Panikstörung und generalisierter Angststörung.

30 patients with "Anxiety disorder" were investigated with regard to their psychosocial experiences, their family history, the course of their illness, and their interpersonal relationships using a semi-structured interview. Patients with panic disorder significantly more frequently reported real fright of a parent than did patients with generalized anxiety disorder. Both groups showed a high degree of secondary depression and avoidance behavior in the course of their illness. Chronic anxiety was more frequent in patients with generalized anxiety disorder. The difference in the perception and judgement of anxiety clearly demonstrates the significance of attribution. Since the patient with panic disorder externalizes his anxiety, he has periods of complete remission, whereas the patient with generalized anxiety disorder internalizes his anxiety, thus experiencing it as an ego-syntonic feature, with which he cannot cope.

Intravenous versus oral administration of amitriptyline in patients with major depression.

Antidepressants can be administered by different routes. Advantages for either the oral or the intravenous administration have been suggested from pharmacokinetic as well as from clinical points of view. Controlled comparison studies of the two routes do not provide unequivocal recommendations. In this investigation, amitriptyline was studied over a 4-week period consisting of a 2-week, double-blind/double-dummy phase with either oral (150 mg/day), high-dose intravenous (150 mg/day), or medium-dose intravenous (100 mg/day) treatment and a 2-week phase of open oral treatment in 80 patients with major depression. A psychopathologic assessment was made using the Hamilton Rating Scale for Depression, the Clinical Global Impressions Scale, the von Zerssen's "Befindlichkeitsskala," an adjective checklist, and a Visual Analog Scale. No significant differences were found concerning the mean scores of the rating scales or time of onset of action in the physicians' ratings. In the patients' self-ratings, there was an earlier therapeutic effect in the high-dose intravenous group. The number of improvers after 7 days was significantly higher in the high-dose intravenous group compared with both other groups. After 14 days, no significant differences in the numbers of improvers and responders between groups were detected. The results of this study do not clearly favor one of the tested options. The main differences found in this study seem to be dose-related rather than differentiating between oral and intravenous routes of administration.

No benefit derived from repetitive transcranial magnetic stimulation in depression: a prospective, single centre, randomised, double blind, sham controlled "add on" trial.

Repetitive transcranial magnetic stimulation (rTMS) has been reported to demonstrate slight effects in the treatment of depression. Hence, a novel bilateral versus unilateral and sham stimulation design was applied to further assess rTMS' antidepressant effects. Forty one medication free patients with major depression, admitted to a psychiatric unit specialising in affective disorders, were consecutively randomised into 3 groups. Group A1 (n = 12) received unilateral active stimulation consisting of high frequency (hf) rTMS over the left dorsolateral prefrontal cortex (LDLPC) and subsequent sham low frequency (lf) rTMS over the right dorsolateral prefrontal cortex (RDLPC). Group A2 (n = 13) received simultaneous bilateral active stimulation consisting of hf-rTMS over the LDLPC and lf-rTMS over the RDLPC. Group C (n = 13) received bilateral sham stimulation. Stimulation was performed on 10 consecutive workdays. All patients received antidepressant medication on the first day of stimulation, which was continued during and after the stimulation period. As no significant difference in antidepressant outcome between group A1 and A2 was found, the two groups were pooled. The time course of the outcome variables Hamilton depression rating scale (HDRS(21)) and Beck depression inventory (days 0, 7, 14, 28) by repeated measures analysis of variance revealed no significant group differences (in terms of a group by time interaction), whereas there was a significant effect of time on all three outcome variables in all groups. The results suggest that rTMS as an "add on" strategy, applied in a unilateral and a bilateral stimulation paradigm, does not exert an additional antidepressant effect.