Repetitive transcranial magnetic stimulation (rTMS) is associated with increased abstinence in substance use disorders and comorbid depression.

BACKGROUND: Substance use disorders (SUDs) are associated with high rates of comorbid depression. Finding effective treatments for many of the substances of abuse is still an area of developing research. Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression, but its effects in SUDs are less conclusive. Therefore, we aimed to investigate the effect of rTMS in patients with SUDs and comorbid major depressive disorder (MDD). METHODS: We conducted a retrospective observational study of 55 patients with SUDs and comorbid MDD who were eligible for rTMS. Craving was measured using the Brief Substance Craving Scale (BSCS). Severity of MDD was measured using the Clinical Global Impression-Severity (CGI-S) scale. RESULTS: We found a statistically significant difference between baseline and posttreatment scores in patients receiving rTMS on both CGI-S scores and BSCS scores. The number of rTMS sessions significantly predicted increased days of abstinence in the community, even after controlling for confounders. CONCLUSIONS: Patients with SUDs and MDD who received rTMS significantly improved in the areas of severity of depression and craving. The number of rTMS sessions significantly predicted increased abstinence.

Validation of the Mini-Addenbrooke's Cognitive Examination in Mild Cognitive Impairment in Arabic Speakers.

INTRODUCTION: Mild cognitive impairment (MCI) represents a target for early detection and intervention in dementia, yet there is a shortage of validated screening tools in Arabic to diagnose MCI. The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVE: We aimed to validate the m-ACE in Arabic speakers in Egypt with MCI to provide cut-off scores. METHODS: We included 24 patients with MCI and 52 controls and administered the Arabic version of the m-ACE. RESULTS: There was a statistically significant difference (p < 0.0001) on the total m-ACE score between MCI patients (mean 18.54, SD 3.05) and controls (mean 24.54, SD 2.68). There was also a statistically significant difference between MCI patients and controls on the total score and the fluency, visuospatial, and memory recall sub-scores of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cut-off score for MCI on the m-ACE total score was 21 out of 30 (87.5% sensitivity, 84.6% specificity, and 85.5% accuracy). CONCLUSIONS: We validated the Arabic m-ACE in Egyptian patients with MCI and provided objective validation of it as a screening tool for MCI, with good sensitivity, specificity, and accuracy that is comparable to other translated versions of the m-ACE in MCI.

Validation of the Egyptian-Arabic Version of the Addenbrooke's Cognitive Examination III (ACE-III) in Diagnosing Dementia.

INTRODUCTION: The Addenbrooke's Cognitive Examination III (ACE-III) (2012) is a brief cognitive battery that assesses five sub-domains of cognition (attention and orientation, memory, verbal fluency, language, and visuospatial abilities) which are commonly impaired in dementia. OBJECTIVE: We aimed to validate the Egyptian-Arabic ACE-III in dementia patients, and to provide cut-off scores for the ACE-III in diagnosing dementia in Egyptian-Arabic speakers. METHODS: We included 37 patients with dementia (Alzheimer's disease, n = 25, vascular dementia, n = 8, and dementia with Lewy bodies, n = 4) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between dementia patients (mean 49.81 ± 18.58) and controls (mean 84.84 ± 6.36). There was also a statistically significant difference between dementia patients and controls in all sub-score domains of the ACE-III (p < 0.001). Using a receiver operator characteristic curve, the optimal cut-off score for dementia on the ACE-III total score was 72, (89% sensitivity, 95% specificity, 92% accuracy). CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for dementia, with high sensitivity, specificity, and accuracy comparable to other translated versions of the ACE-III.

Validation of the Addenbrooke's Cognitive Examination-III in Mild Cognitive Impairment in Arabic Speakers in Egypt.

BACKGROUND AND AIMS: Mild cognitive impairment (MCI) represents an important point on the pathway to developing dementia and a target for early detection and intervention. There is a shortage of validated cognitive screening tools in Arabic to diagnose MCI. The aim of this study was to validate Addenbrooke's Cognitive Examination-III (ACE-III) (Egyptian-Arabic version) in a sample of patients with MCI, to provide cut-off scores in Egyptian-Arabic speakers. METHODS: A total of 24 patients with MCI and 54 controls were included in the study and were administered the Egyptian-Arabic version of the ACE-III. RESULTS: There was a statistically significant difference (p < 0.001) in the total ACE-III score between MCI patients (mean 75.83, standard deviation (SD) 8.1) and controls (mean 86.26, SD 6.74). There was also a statistically significant difference between MCI patients and controls in the memory, fluency, and visuospatial sub-scores of the ACE-III (p < 0.05) but not in attention and language sub-scores. Using a receiver operator characteristic curve, the optimal cut-off score for diagnosing MCI on the ACE-III total score was 81, with 75% sensitivity, 82% specificity, and 80% accuracy. CONCLUSIONS: The results of this study provide objective validation of the Egyptian-Arabic version of the ACE-III as a screening tool for MCI, with good sensitivity, specificity, and accuracy that are comparable to other translated versions of the ACE-III in MCI.

Adaptation and Validation of the Mini-Addenbrooke's Cognitive Examination in Dementia in Arabic Speakers in Egypt.

BACKGROUND: The mini-Addenbrooke's Cognitive Examination (m-ACE) is a brief cognitive battery that assesses 5 subdomains of cognition (attention, memory, verbal fluency, visuospatial abilities, and memory recall). It is scored out of 30 and can be administered in under 5 min providing a quick screening tool for assessment of cognition. OBJECTIVES: We aimed to adapt the m-ACE in Arabic speakers in Egypt and to validate it in dementia patients to provide cutoff scores. METHODS: We included 37 patients with dementia (Alzheimer's disease [n = 25], vascular dementia [n = 8], and dementia with Lewy body [n = 4]) and 43 controls. RESULTS: There was a statistically significant difference (p < 0.001) on the total m-ACE score between dementia patients (mean 10.54 and standard deviation [SD] 5.83) and controls (mean 24.02 and SD 2.75). There was also a statistically significant difference between dementia patients and controls on all sub-score domains of the m-ACE (p < 0.05). Performance on the m-ACE significantly correlated with both the Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-III (ACE-III). Using a receiver operator characteristic curve, the optimal cutoff score for dementia on the m-ACE total score was found to be 18 (92% sensitivity, 95% specificity, and 94% accuracy). CONCLUSIONS: We adapted the m-ACE in Arabic speakers in Egypt and provided objective validation of it as a screening tool for dementia, with high sensitivity, specificity, and accuracy.

Prevalence and treatment of common mental disorders in the English national population, 1993-2007.

BACKGROUND: The National Psychiatric Morbidity Surveys include English cross-sectional household samples surveyed in 1993, 2000 and 2007. AIMS: To evaluate frequency of common mental disorders (CMDs), service contact and treatment. METHOD: Common mental disorders were identified with the Clinical Interview Schedule - Revised (CIS-R). Service contact and treatment were established in structured interviews. RESULTS: There were 8615, 6126 and 5385 participants aged 16-64. Prevalence of CMDs was consistent (1993: 14.3%; 2000: 16.0%; 2007: 16.0%), as was past-year primary care physician contact for psychological problems (1993: 11.3%; 2000: 12.0%; 2007: 11.7%). Antidepressant receipt in people with CMDs more than doubled between 1993 (5.7%) and 2000 (14.5%), with little further increase by 2007 (15.9%). Psychological treatments increased in successive surveys. Many with CMDs received no treatment. CONCLUSIONS: Reduction in prevalence did not follow increased treatment uptake, and may require universal public health measures together with individual pharmacological, psychological and computer-based interventions.

Prevalence of psychosis in black ethnic minorities in Britain: analysis based on three national surveys.

PURPOSE: A considerable excess of psychosis in black ethnic minorities is apparent from clinical studies, in Britain, as in other developed economies with white majority populations. This excess is not so marked in population surveys. Equitable health service provision should be informed by the best estimates of the excess. We used national survey data to establish the difference in the prevalence of psychosis between black ethnic groups and the white majority in the British general population. METHODS: Analysis of the combined datasets (N = 26,091) from the British national mental health surveys of 1993, 2000 and 2007. Cases of psychosis were determined either by the use of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), or from a combination of screening items. We controlled for sex, age, social class, unemployment, design features and other putative confounders, using a Disease Risk Score. RESULTS: People from black ethnic minorities had an excess prevalence rate of psychosis compared with the white majority population. The OR, weighted for study design and response rate, was 2.72 (95 % CI 1.3-5.6, p = 0.002). This was marginally increased after controlling for potential confounders (OR = 2.90, 95 % CI 1.4-6.2, p = 0.006). CONCLUSIONS: The excess of psychosis in black ethnic minority groups was similar to that in two previous British community surveys, and less than that based on clinical studies. Even so it confirms a considerable need for increased mental health service resources in areas with high proportions of black ethnic minority inhabitants.

Prevalence and economic burden of dementia in the Arab world.

BACKGROUND: The growing prevalence of dementia is a global concern, especially in the Arab world, where updated economic impact data are scarce. Understanding its prevalence and cost is crucial for effective policies and support systems. AIMS: To estimate dementia prevalence and cost in Arab countries for 2021. METHOD: United Nations population data and dementia prevalence estimates were used to calculate total cases. Direct costs were based on gross domestic product (GDP) per capita (purchasing power parity) and income classification. Indirect caregiver support costs were estimated using average monthly wages and two distinct scenarios. RESULTS: The highest dementia prevalence among those aged more than 60 years was in Lebanon (4.88%), Tunisia (4.43%) and Algeria (4.19%). The total direct cost in the Arab region was $8.18 billion for those over 50 years old. Indirect costs ranged from $2.25 billion (best case) to $5.67 billion (worst case), with a mean value of $3.98 billion. Total dementia care costs (direct and indirect) under the mean scenario for the entire Arab world amounted to $12.17 billion, with costs as a percentage of GDP ranging from 0.05% (Sudan) to 0.44% (Lebanon). CONCLUSIONS: This study highlights dementia as a growing public health issue in the Arab world, with 1 329 729 individuals affected in 2021 and total costs between $10.43 billion and $13.90 billion. The findings emphasise the urgent need for investment in research and specialised services for older adults, particularly those with dementia.

Effects of age, education, and gender on verbal fluency in healthy adult Arabic-speakers in Egypt.

The objective of this study is to establish the effects of age, gender, and education and to provide preliminary normative data for letter and category fluency tasks in the Egyptian Arabic-speaking population. We evaluated 139 cognitively healthy volunteers aged 20-93 by adapting the letter and category verbal fluency tasks for the Egyptian population. On the letter fluency task, mean number of words generated in one-minute beginning with the Arabic letter "Sheen" (pronounced "sh") was 8.14 words per minute (SD = 3.25). Letter fluency was significantly influenced by education. On category fluency tasks, mean number of animal names generated in one minute was 14.63 words (SD = 5.28). Category fluency was significantly influenced by age and education. We were able identify that age significantly affects category fluency while education significantly affected both letter and category fluency. We were also able to provide preliminary normative data for both tasks in the Egyptian population.

Comparison of cognitive decline between dementia with Lewy bodies and Alzheimer's disease: a cohort study.

OBJECTIVES: Dementia with Lewy bodies (DLB) accounts for 10%-15% of dementia cases at autopsy and has distinct clinical features associated with earlier institutionalisation and a higher level of carer distress than are seen in Alzheimer's disease (AD). At present, there is on-going debate as to whether DLB is associated with a more rapid cognitive decline than AD. An understanding of the rate of decline of cognitive and non-cognitive symptoms in DLB may help patients and carers to plan for the future. DESIGN: In this cohort study, the authors compared 100 AD and 58 DLB subjects at baseline and at 12-month follow-up on cognitive and neuropsychiatric measures. SETTING: Patients were recruited from 40 European centres. PARTICIPANTS: Subjects with mild-moderate dementia. Diagnosis of DLB or AD required agreement between consensus panel clinical diagnosis and visual rating of 123I-FP-CIT (dopamine transporter) single photon emission computed tomography neuroimaging. OUTCOME MEASURES: The Cambridge Cognitive Examination including Mini-Mental State Examination and Neuropsychiatric Inventory (NPI). RESULTS: The AD and DLB groups did not differ at baseline in terms of age, gender, Clinical Dementia Rating score and use of cholinesterase inhibitors or memantine. NPI and NPI carer distress scores were statistically significantly higher for DLB subjects at baseline and at follow-up, and there were no differences between AD and DLB in cognitive scores at baseline or at follow-up. There was no significant difference in rate of progression of any of the variables analysed. CONCLUSIONS: DLB subjects had more neuropsychiatric features at baseline and at follow-up than AD, but the authors did not find any statistically significant difference in rate of progression between the mild-moderate AD and DLB groups on cognitive or neuropsychiatric measures over a 12-month follow-up period.