A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without mild to moderate dementia.

Depression is the most common psychiatric disorder among the elderly and in old age may interact with emotional and cognitive functioning. Depression in old age has been shown to be associated with degenerative changes in the brain. It is, therefore, important that in this patient population antidepressants with a favourable tolerability profile, such as the selective serotonin reuptake inhibitors (SSRIs), are examined for both antidepressant efficacy and effect on cognitive function and emotional impairment. This randomised, double-blind study compared the efficacy and tolerability of citalopram and mianserin in 336 elderly, depressed patients with or without dementia. Patients received either citalopram 20-40 mg/day or mianserin 30-60 mg/day for 12 weeks. The treatments were equivalent with respect to change in Montgomery-Asberg Depression Rating Scale (MADRS) total score; patients in both treatment groups responded well. Patients with dementia showed a smaller decrease in total MADRS score than patients without dementia. Both treatments were well tolerated with a relatively low incidence of adverse events. Fatigue and somnolence were more frequent with mianserin, while insomnia was more frequent with citalopram. Overall, this study showed that the two treatments were equivalent in efficacy, and that citalopram is an effective, well-tolerated and non-sedative treatment for elderly depressed patients with or without dementia.

[Use of special Ginkgo biloba extract for cognitive disorders in the elderly]. / Der Einsatz von Ginkgo biloba-Spezialextrakt bei Hirnleistungsstörungen im Alter.

All dementias had been suggested to be the result of a vessel-disease, now it is known that the greatest part belongs to the dementias of Alzheimer's type but furtheron there exists no possibility for curing or stopping. Since Ginkgo biloba extract is available it is used in this diagnosis. Experimental and clinical studies have shown a widespread possibility to act in this disease and even a neuroprotective potential can be postulated.

Platelet monoamine oxidase B activity in dementia. A 4-year follow-up.

Platelet monoamine oxidase B (MAO-B) activity has been found to increase significantly in demented patients. For the first time, a 4-year follow-up of platelet MAO-B activity and Mini-Mental State (MMS) was performed in patients with probable dementia of the Alzheimer type (DAT) and age-matched controls. MAO-B activity of DAT patients increased significantly 2 years after the beginning of the study as compared with controls and remained significantly higher for the entire period of the examinations (p < 0.0001). The decrease of the MMS scores did not correlate with the time course of the increase of platelet MAO-B activity (Spearman rank correlation test). The decline of the MMS scores of DAT patients preceded the elevation of MAO-B activity. Since degenerative processes in brain areas which are responsible for cognitive function and are reflected by the MMS scores rather affect cerebral cholinergic than monoaminergic neurotransmitter systems, degeneration of the latter at late stages of DAT might be reflected by increased platelet MAO-B activity.

Calculation abilities in dementia of Alzheimer's type and in vascular dementia.

Calculation abilities tested by 12 additive and 12 multiplicative tasks were investigated in 19 patients suffering from vascular dementia and in 23 patients suffering from dementia of Alzheimer's type as well as in 17 age-matched controls. Arithmetic impairment expressed by the number of correct results showed a significant correlation with the degree of dementia, measured by the Mini-Mental State Examination. An error type analysis was performed, but was of no help in the differential diagnosis of dementia. Calculation abilities are similarly impaired in both vascular dementia and dementia of Alzheimer's type.

Ideomotor apraxia in Alzheimer's disease.

Ideomotor apraxia, tested on verbal command and by imitation, was checked in 23 patients suffering from dementia of Alzheimer's type of different severity and in 17 age-matched controls. A significant deterioration of ideomotor praxis could be shown even in mild dementia. Correlations of ideomotor apraxia and aphasia, tested by the Token test were found to be significant.

Release signs in Parkinson's disease with and without dementia.

Release signs have been described in both age-associated diseases and in the healthy elderly. We investigated the palmomental, snout, grasp, corneomandibular and glabellar reflexes in demented and non-demented Parkinson-patients compared to Alzheimer's disease and age-matched controls. The palmomental reflex and a persisting glabellar reflex were linked to parkinsonism irrespective of dementia and were found also in Alzheimer's disease. A corneomandibular reflex was observed more frequently in demented than non-demented Parkinson-patients and in Alzheimer's disease. The snout-reflex was present in nearly all individuals irrespective of diagnosis. Thus, various release signs react quite differentially to degenerative brain disease and dementia.

[Differential diagnosis of dementia diseases. A prospective clinical study with neuropathologic diagnostic verification]. / Die Differentialdiagnose der Demenzerkrankungen. Eine prospektive klinische Untersuchung mit neuropathologischer Diagnosestellung.

We present clinico-pathological correlations for a consecutive series of 44 demented patients in the Vienna longitudinal study on dementia. Prospective clinical diagnosis used the DSM-III-R and the NINCDS-ADRDA criteria. Not only the clinical, but also the neuropathological diagnosis of DAT is based on exclusion criteria, and depends on the interpretation of minimal vascular lesions. Although we did not exclude atypical cases from the study, 80% of diagnoses could be validated at autopsy. Nevertheless, our set of clinical criteria needs further validation in patients in the earliest stages of dementia.

[Alzheimer dementia. A clinical long-term study with quantitative neuropathology]. / Die Demenz vom Alzheimer-Typ. Eine klinische Längsschnittstudie mit quantitativer Neuropathologie.

Alzheimer's disease causes about 80% of dementias in old age. The pathological hallmarks of Alzheimer's disease are senile plaques (SP) and neurofibrillary tangles (NFT), which to a lesser degree can also be found in the brains of mentally intact elderly. The question whether SP or NFT or any other process are primarily correlated to severity of dementia can only be answered in prospective longitudinal clinical and neuropsychological studies with quantitative neuropathological investigation. We report the correlations between mini-mental-state scores and lesion counts in 3 isocortical and 3 hippocampal areas in a consecutive series of 19 Alzheimer's patients studied prospectively in the Vienna Longitudinal Study on Dementia. Lesion counts increased at very late stages of dementia and were rather low in mild to moderate severity of dementia. Mildly demented patients with very slow progression of dementia also had rather high lesion counts. Neurofibrillary changes in NFT and neuritic plaques were correlated with severity of dementia, but diffuse plaques, i.e. SP without neuritic degeneration, were not at all correlated with severity of dementia. We speculate that NFT and SP do not represent the primary process which leads to dementia.

Depression in dementia of the Alzheimer type and in multi-infarct dementia.

The authors used the Hamilton Rating Scale for Depression and a rating of depressed mood to investigate the prevalence of depression in 55 patients with Alzheimer's disease, 37 patients with multi-infarct dementia, and 30 nondemented comparison subjects. The prevalence of depressed mood depended on the severity of dementia as measured by the Mini-Mental State examination and was significantly lower among patients in more severe stages of Alzheimer's disease but not among patients with severe multi-infarct dementia.

Course characteristics in the differentiation of dementia of the Alzheimer type and multi-infarct dementia.

Clinico-pathological studies have shown that the clinical diagnosis of multi-infarct dementia (MID) is even more difficult than that of dementia of the Alzheimer type (DAT). The study evaluated the significance of course characteristics for the diagnosis of MID and DAT. Course characteristics were rated when 57 demented patients were admitted to our neurogeriatric department. Diagnosis of MID and DAT, respectively, was established after a follow-up study with repeated neurological, psychiatric and neuropsychological investigations. In 21 cases diagnosis was confirmed by postmortem neuropathology. MID lacked the typical course of the disease in about two thirds of patients, while most DAT patients presented with the typical course of primary degenerative dementia. Features of the "typical" clinical course of MID (abrupt onset, stepwise deterioration) helped to exclude DAT, whereas MID could not be excluded on the basis of a history of insidious onset and gradual decline.

Memory deficits in advanced Parkinson's disease.

Apart from global dementia various isolated cognitive deficits have been described in Parkinson's disease (PD). We investigated 31 non-demented Parkinsonian patients in their late stages of disease and 50 control subjects with regard to verbal memory. Eleven patients suffered from an isolated verbal memory deficit as defined by two list learning tasks using the Buschke selective reminding procedure. The isolated memory impairment did not depend on depression but was associated with longer duration of PD. Twelve demented PD patients were comparable to PD patients with isolated memory impairment with regard to age at onset and duration of PD. We speculate that the isolated memory impairment in PD is associated with isolated neuronal loss in the nucleus basalis of Meynert, without cortical or limbic pathology of the Alzheimer's type.

The A-K-T ("Alters-Konzentrations-Test") a new psychometric test for geriatric patients.

The A-K-T is a newly developed concentration test for geriatric patients. First results in demented patients show the test to be a good indicator of severity of dementia. Since the method is non-verbal, it can be applied to aphatic patients too. But, comparing results of patients suffering either from dementia of Alzheimer's type, multi-infarct dementia or Parkinson's disease with dementia, we are not able to objectify specific deficits of a certain dementing disease.

Terguride: partial dopamine agonist in the treatment of Parkinson's disease.

In an open trial, 15 patients with PD (mostly stage V) were treated with the partial DA agonist, terguride, a derivative of lisuride. To the basic therapy, consisting of L-dopa plus benserazide and amantadine, a slowly increasing dosage of TDHL up to a maximum of 1.5 mg/day t.i.d. was added. There were 3 drop-outs; 12 patients completed the trial which lasted for 12 weeks. At this time a significant improvement in total score, bradykinesia, and functional score was seen, as well as a marked improvement in tremors score in the patients who showed this symptom (Columbia Rating Scale). As side-effects, dyskinesias occurred in two patients, psychotic symptoms in one, and marked orthostatic symptoms in one patient. No significant differences before and after 12 weeks TDHL treatment were found in the concentrations of noradrenaline, adrenaline, serotonin, and 5-hydroxy-indole-acetic-acid in plasma. It is concluded that TDHL is effective even in advanced stages of PD, and it is speculated that partial DA agonists may become important in the treatment of PD and might possibly have an advantage over "classical" DA agonists.

[Diurnal variations of human serum amino acid concentration]. / Tagesschwankungen der Aminosäurenkonzentration im Blutserum des Menschen.

In 5 healthy persons, as well as in 9 hospitalized patients with Parkinsonism and without metabolic disorders, diurnal variations of the concentrations of amino acids are determined in blood serum. It has been found that in addition to the peaks due to the digestion after meals, another peak in concentrations appeared. This peak was found between 2 and 4 a.m. and did not appear simultaneously for all amino acids. During this time, the urinary excretion of amino acids was also high.