Transcranial sonography imaging of brainstem raphe, substantia nigra and cerebral ventricles in patients with geriatric depression.

OBJECTIVES: Geriatric depression is a special condition associated with a chronic course, treatment resistance and vascular processes. However, its neurobiology has not been fully elucidated. There is no study in geriatric depression evaluating deep brain structures with transcranial sonography (TCS) which is a low-cost, non-invasive and practical tool. The present study aimed to evaluate the changes in the echogenicity of brainstem raphe (BR), substantia nigra (SN) and ventricular diameters by TCS in association with cognitive dysfunctions in patients with geriatric depression. METHODS: Echogenicity of BR and SN were assessed and transverse diameters of the third ventricle and frontal horns of the lateral ventricles were measured by TCS in 34 patients with DSM-5 major depression and 31 healthy volunteers aged 60 and older. Cognitive functions were evaluated by using Mini Mental State Examination, Montreal Cognitive Assessment Tool, Clock Drawing Test and Subjective Memory Complaints Questionnaire. RESULTS: Although depressed patients had more subjective memory complaints than controls, they had similar cognitive performances. Reduced echogenicity (interrupted/invisible echogenic line) of BR was found to be significantly higher and the ventricular diameters were larger in the depressed group. There was no difference between the groups in terms of SN echogenicity. There was no correlation between ventricular diameters and depression severity or cognitive functions. CONCLUSIONS: Results of the present study are important in terms of pointing out neurobiological changes related to geriatric depression which are in parallel with the results of the studies in younger patients with depression. However, long-term follow-up studies are required for accurate differentiation of neurocognitive disorders.

Clinical characteristics of generalized anxiety disorder: older vs. young adults.

BACKGROUND: Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research. AIMS: The aim of the study is to compare the clinical presentation of GAD between older and young adults. METHODS: One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups. RESULTS AND CONCLUSIONS: Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other's health.

Hyperfocusing as a dimension of adult attention deficit hyperactivity disorder.

Patients with Attention Deficit Hyperactivity Disorder (ADHD) suffer not only from inability to focus but also from inability to shift attention for events that trigger their interests. This phenomenon is called "hyperfocusing". Previous literature about hyperfocusing is scarce and relies mainly on case reports. The study aimed to investigate and compare the severity of hyperfocusing in adult ADHD with and without psycho-stimulant use. ADHD (DSM-IV-TR) patients either psycho-stimulant naive (n=53) or on psycho-stimulants (n=79) from two ADHD clinics were recruited. The control group (n=65) consisted of healthy university students. A socio-demographic form, the Beck Depression Inventory, the Wender-Utah Rating Scale, the Adult ADHD Self- Report Scale and the Hyperfocusing Scale were applied to the participants. There was no difference between total Hyperfocusing Scale and Adult ADHD Self- Report Scale scores of two patient groups, but both have higher scores than controls (p<0.001). Hyperfocusing is higher in adult ADHD and there was no difference between stimulant-naive patients or patients on stimulants. Hyperfocusing can be defined as a separate dimension of adult ADHD.

[Discrepancy Between Subjective Memory Complaints and Objective Memory Deficits in Elderly Patients with Depression Compared to Mild Cognitive Impairment]. / Yaslilik Çagi Depresyonu ve Hafif Bilissel Bozuklugu Olan Hastalarda Öznel Bellek Yakinmalari ile Nesnel Bellek Bozukluklarinin Karsilastirilmasi.

OBJECTIVE: Since depression in the elderly usually presents with memory complaints and may impair memory functions, differential diagnosis of cognitive impairment is quite difficult. This study aimed to investigate the discrepancy between subjective memory complaints (SMC) and objective memory deficits in elderly patients with major depressive disorder (MDD) and mild cognitive impairment (MCI). METHOD: The study sample consisted of 30 elderly patients with a diagnosis of MCI (according to Petersen- Mayo criteria) and 29 with a diagnosis of DSM-IV-TR MDD who were admitted to the outpatient geriatric psychiatry clinic. The control group (HC) consisted of 30 healthy elderly volunteers. Turkish versions of the Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), ADAS-Cog, Subjective Memory Complaints Questionnaire (SMCQ) and Geriatric Depression Scale (GDS) were administered to all participants. RESULTS: The SMCQ scores of both MDD and MCI patients were higher than HC. However, there was no difference between HC and MDD groups in terms of the MMSE, the CDT and the ADAS-Cog scores. CONCLUSION: In elderly patients, subjective memory complaints do not seem to differentiate between depression and cognitive impairment. However, the discrepancy between SMC and cognitive performances suggest depression rather than a cognitive impairment. Further longitudinal studies should investigate the role of SMC in future cognitive impairment for elderly patients with depression.

[Hoarding Behaviour in Three Different Types of Dementia Cases]. / Farkli Demansi Olan Üç Olguda Biriktirme Davranisi.

INTRODUCTION: Hoarding behaviour, which is generally defined as collecting and keeping unnecessary, cheap objects or things that can not be used, is more common in elderly than young people. The prevelance of hoarding behaviour in dementia was reported as 22%. In this paper, three different types of dementia cases are presented in order to emphasize the clinical awareness for hoarding disorder, which is common in the elderly, especially those with dementia. CASES: The first case is a patient with a diagnosis of frontotemporal dementia who was collecting old things before the appearance of bahavioural changes like verbal and physical agitation. The second one is a patient who was admitted with complaints of forgetting, diagnosed as having Alzheimer's Disease and presented with paper hoarding behavior in his clinical follow-up. The last patient was presented with visual hallucinations, forgetting, collecting old things and depressive symptoms. He received a diagnosis of Lewy body dementia. DISCUSSION: It is prominent that all three different dementia cases hoarding behavior at early stages of dementia. It should be kept in mind that hoarding behavior which begins at late life might be a sign of dementia or it might appear in the dementia process.

[Dimensions of Agitation Based on the Cohen-Mansfield Agitation Inventory in Patients with Dementia]. / Demans Hastalarinda Cohen-Mansfield Ajitasyon Envanteri ile Degerlendirilen Ajitasyon Boyutlarinin Arastirilmasi.

OBJECTIVE: The aim of this study was to investigate the dimensions of agitation in dementia patients using the Turkish version of the Cohen-Mansfield Agitation Inventory (CMAI-T). MATERIALS AND METHODS: The study included 100 patients diagnosed as dementia, according to the DSM-IV-TR. The CMAI-T was administered to the patients' caregivers via face-to-face interviews. The Standardized Mini Mental State Examination (SMMSE) was used to assess cognitive functions. The severity of depression and the functional state of the patients were assessed using the Cornell Scale for Depression in Dementia (CSDD) and the Functional Activities Questionnaire (FAQ). Principal component analysis and varimax rotation were used to determine the factor structure of the CMAI-T. RESULTS: Factor analysis of the CMAI-T indicated a 3-factor structure: physically aggressive agitation, verbal agitation, and physically non-aggressive agitation. In 92% of the patients there was ≥1 agitation behavior during the previous 2 weeks. The CMAI-T total and factor scores were negatively correlated with the SMMSE scores, and positively correlated with the CSDD and the FAQ scores. CONCLUSIONS: The CMAI-T yielded 3 factors (physically aggressive agitation, verbal agitation, and physically non-aggressive agitation), which indicated the scale had construct validity. Agitation behaviors were associated with cognitive dysfunction, symptoms of depression and general level of functioning. Additional research is necessary to identify the predictors of these dimensions in different dementia samples, and to determine the efficacy of therapeutic interventions.