Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia.

OBJECTIVES: We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5-year follow-up. METHODS: This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway" (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD-ADep). Linear mixed-effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale-2, and cognition measured with the Mini-Mental State Examination. RESULTS: Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD-ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. CONCLUSIONS: BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.

A raiz de la polemica originada por la difusión de un programa televisivo de opinion donde se denuncias maltratos a pacientes hospitalizados en instituciones nacionales de salud mental, la ACP emitió el siguiente comunicado que ponemos hoy como editorial de nuestra revista. [Editorial] / As a result of the controversy caused by the broadcast of a television opinion program where mistreatment of hospitalized patients in national mental health institutions is denounced, the ACP issued the following statement that we publish today as an editorial for our magazine. [Editorial]

A raiz de la polemica originada por la difusión de un programa televisivo de opinion donde se denuncias maltratos a pacientes hospitalizados en instituciones nacionales de salud mental, la ACP emitió el siguiente comunicado que ponemos hoy como editorial de nuestra revista.

As a result of the controversy caused by the dissemination of an opinion television program where mistreatment of hospitalized patients in national mental health institutions is reported, the ACP issued the following statement that we put today as the editorial of our magazine.

ASSOCIATION OF DEPRESSIVE SYMPTOMS AND SUBJECTIVE MEMORY COMPLAINTS WITH THE INCIDENCE OF COGNITIVE IMPAIRMENT IN OLDER ADULTS WITH HIGH BLOOD PRESSURE.

PURPOSE: High blood pressure is a relevant risk factor for vascular damage, leading to development of depressive symptoms and dementia in older adults. Moreover, subjective memory complaints are recognized as an early marker of cognitive impairment. However, it has been established that subjective memory complaints could also be a reflection of depressive symptoms. The objective of this paper is to assess the impact of depressive symptoms and subjective memory complaints on the incidence of cognitive impairment in older adults with high blood pressure. METHODS: This is a secondary analysis of the Mexican Health and Aging Study, a representative cohort composed by individuals aged ≥ 50 years. Participants with cognitive impairment in 2012 were excluded since the outcome was incident cognitive impairment in 2015. Four groups were created according to depressive symptomatology and subjective memory complaints status, analyses were stratified according to blood pressure status. The odds incident cognitive impairment was estimated through logistic regression models. RESULTS: A total of 6,327 participants were included, from which 6.44% developed cognitive impairment. No differences were seen regarding the development of cognitive impairment in participants without high blood pressure. However, increased risk was evident in those with both high blood pressure and depressive symptoms (OR=2.1, 95% CI 1.09 - 4.09, p =0.026) as with high blood pressure, depressive symptoms and subjective memory complaints (OR=1.91, 9% CI 1.4 - 3.2, p= 0.001). CONCLUSION: Individuals with high blood pressure have a higher risk of developing incident cognitive impairment when depressive symptoms and/or subjective memory complaints are present. Our results suggest that a sequence of events related to altered cerebral vascular dynamics is possible.

First Symptoms and Neurocognitive Correlates of Behavioral Variant Frontotemporal Dementia.

BACKGROUND: Previous works highlight the neurocognitive differences between apathetic and disinhibited clinical presentations of the behavioral variant frontotemporal dementia (bvFTD). However, little is known regarding how the early presentation (i.e., first symptom) is associated to the neurocognitive correlates of the disease's clinical presentation at future stages of disease. OBJECTIVES: We analyzed the neurocognitive correlates of patients with bvFTD who debuted with apathy or disinhibition as first symptom of disease. METHODS: We evaluated the neuropsychological, clinical, and neuroanatomical (3T structural images) correlates in a group of healthy controls (n = 30) and two groups of bvFTD patients (presented with apathy [AbvFTD, n = 18] or disinhibition [DbvFTD, n = 16]). To differentiate groups according to first symptoms, we used multivariate analyses. RESULTS: The first symptom in patients described the evolution of the disease. AbvFTD and DbvFTD patients showed increased brain atrophy and increased levels of disinhibition and apathy, respectively. Whole brain analyzes in AbvFTD revealed atrophy in the frontal, insular, and temporal areas. DbvFTD, in turn, presented atrophy in the prefrontal regions, temporoparietal junction, insula, and temporoparietal region. Increased atrophy in DbvFTD patients (compared to AbvFTD) was observed in frontotemporal regions. Multivariate analyses confirmed that a set of brain areas including right orbitofrontal, right dorsolateral prefrontal, and left caudate were enough to distinguish the patients' subgroups.∥Conclusion: First symptom in bvFTD patients described the neurocognitive impairments after around three years of disease, playing an important role in the early detection, disease tracking, and neuroanatomical specification of bvFTD, as well as in future research on potential disease-modifying treatments.