Somatic comorbidity and the progression of cognitive impairment.

Background: There are usually multiple factors underlying dementia in old age. Somatic comorbidity is one important element that influences the progression of cognitive impairment. Objective: The goal of this study was to assess the relationship between the progression of cognitive impairment and the presence and severity of comorbidities based on a four-year observation. Material: Out of 128 patients from the Clinic for Outpatients in Gdansk, who were recruited into the study based on the criteria of the Working Group on Mild Cognitive Impairment, a total of 93 participants completed the four-year observation. Only the data from participants who completed the full period of observations were analysed. The mean age of the group was M = 75.93 (SD = 9.43). The level of progression of cognitive impairment was measured using the Clinical Dementia Rating Scale - Sum of Boxes, the severity of comorbidities was measured using the modified Cumulative Illness Rating Scale, and, additionally, at the time of inclusion in the study, participants were assessed using the MMSE scale and the Activity Scale, and sociodemographic data were collected. The Generalized Estimating Equations method was employed to fit a marginal model for analyzing the data collected in a repeated measures design. The tested model elucidated the role of the overall severity of comorbidities in explaining the progression of cognitive impairment, while controlling for everyday activity and basic demographic variables. Results: During the four-year observation, a significant decline in cognitive function (B = 1.86, p < 0.01) was observed in the examined sample. The statistical analysis revealed that individuals with higher overall severity of comorbidities exhibited significantly more pronounced progression of cognitive impairment over time. Regarding particular comorbidities, metabolic diseases were found to be associated with a poorer prognosis (rho = 0.41, p < 0.05). Furthermore, a time physical activity interaction was identified as predicting cognitive impairment, indicating that individuals who were more physically active at the beginning of the study exhibited significantly less pronounced progression of cognitive impairment over the course of the 4 years. Conclusion: This study suggests the important roles of comorbidities and physical activity for the prognosis of mild cognitive impairment.

Use of sertraline and agomelatine in hemodialysis patients: A case series report.

OBJECTIVE: Major depressive disorder (MDD) is one of the most common psychiatric issues in hemodialysis population. However, the research on proper diagnostic tools and its treatment is still insufficient. The study was performed to investigate the safety and effectiveness of sertraline and agomelatine in a group of hemodialysis patients. PATIENTS AND METHODS: 78 adult patients from one dialysis centre in Poland were included into the study. The Beck Depression Inventory II (BDI-II) was used to screen for depressive symptoms and was followed by the clinical interview with the psychiatrist. Nine patients diagnosed with major depressive disorder received antidepressant treatment with sertraline or agomelatine, according to the best clinical practice. The additional treatment with vortioxetine was used if the initial one was not effective. The time of observation was 24 weeks. The psychiatric follow up as well as the laboratory data were obtained during the course of observation. RESULTS: All patients receiving sertraline achieved remission of depressive symptoms. In patients receiving agomelatine no remission was observed despite dose augmentation. The side effects of antidepressants were mild and did not result in treatment discontinuation. No abnormalities in liver enzymes levels were observed. In five cases the significant decrease of haemoglobin level was noticed, with no cases of bleeding reported. CONCLUSION: In patients receiving sertraline the antidepressant effect was satisfactory. No remission of depressive symptoms was observed in patients taking agomelatine. The side effects of antidepressants were mild and transient. Further research on depression treatment in hemodialysis patients is needed, including newer medications.

Aggressive behavior and prognosis in patients with mild cognitive impairment.

The diagnosis of mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. When evaluating the further prognosis of MCI, the occurrence of neuropsychiatric symptoms, particularly aggressive and impulsive behavior, may play an important role. Objective: The aim of this study was to evaluate the relationship between aggressive behavior and cognitive dysfunction in patients diagnosed with MCI. Methods: The results are based on a 7-year prospective study. At the time of inclusion in the study, participants, recruited from an outpatient clinic, were assessed with Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). A reassessment was performed after 1 year using the MMSE scale in all patients. The time of next MMSE administration was depended on the clinical condition of patients took place at the end of follow-up, that is, at the time of diagnosis of the dementia or after 7 years from inclusion when the criteria for dementia were not met. Results: Of the 193 patients enrolled in the study, 75 were included in the final analysis. Patients who converted to dementia during the observation period exhibited a greater severity of symptoms in each of the assessed CMAI categories. Moreover, there was a significant correlation between the global result of CMAI and the results of the physical nonaggressive and verbal aggressive subscales with cognitive decline during the first year of observation. Conclusions: Despite several limitations to the study, aggressive and impulsive behaviors seem to be an unfavorable prognostic factor in the course of MCI.

O diagnóstico de comprometimento cognitivo leve (CCL) está associado a um risco aumentado de desenvolver demência. Ao avaliar o prognóstico adicional do CCL, a ocorrência de sintomas neuropsiquiátricos, particularmente o comportamento agressivo e impulsivo, pode desempenhar um papel importante. Objetivo: Avaliar a relação entre comportamento agressivo e disfunção cognitiva em indivíduos com diagnóstico de CCL. Métodos: Nossos resultados são baseados em um estudo prospectivo de sete anos. No momento da inclusão no estudo, os participantes, recrutados em um ambulatório, foram avaliados com o Mini-Exame do Estado Mental (MEEM) e o Inventário de Agitação de Cohen-Mansfield (CMAI). A reavaliação foi realizada após um ano com a escala MEEM em todos os pacientes. O momento da próxima administração do MEEM dependeu da condição clínica dos indivíduos e ocorreu no final do acompanhamento, ou seja, no momento do diagnóstico da demência ou após sete anos da inclusão, quando os critérios para demência não foram atendidos. Resultados: Dos 193 pacientes incluídos no estudo, 75 foram incluídos na análise final. Os indivíduos que converteram para demência durante o período de observação exibiram uma maior gravidade dos sintomas em cada uma das categorias avaliadas pelo CMAI. Além disso, houve uma correlação significativa entre o resultado global do CMAI e os resultados das subescalas de agressão física e verbal com declínio cognitivo durante o primeiro ano de observação. Conclusões: Apesar das várias limitações do estudo, os comportamentos agressivos e impulsivos parecem ser um fator prognóstico desfavorável no curso do CCL.

Aggressive behavior and prognosis in patients with mild cognitive impairment / Comportamento agressivo e prognóstico em pacientes com comprometimento cognitivo

ABSTRACT The diagnosis of mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. When evaluating the further prognosis of MCI, the occurrence of neuropsychiatric symptoms, particularly aggressive and impulsive behavior, may play an important role. Objective: The aim of this study was to evaluate the relationship between aggressive behavior and cognitive dysfunction in patients diagnosed with MCI. Methods: The results are based on a 7-year prospective study. At the time of inclusion in the study, participants, recruited from an outpatient clinic, were assessed with Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). A reassessment was performed after 1 year using the MMSE scale in all patients. The time of next MMSE administration was depended on the clinical condition of patients took place at the end of follow-up, that is, at the time of diagnosis of the dementia or after 7 years from inclusion when the criteria for dementia were not met. Results: Of the 193 patients enrolled in the study, 75 were included in the final analysis. Patients who converted to dementia during the observation period exhibited a greater severity of symptoms in each of the assessed CMAI categories. Moreover, there was a significant correlation between the global result of CMAI and the results of the physical nonaggressive and verbal aggressive subscales with cognitive decline during the first year of observation. Conclusions: Despite several limitations to the study, aggressive and impulsive behaviors seem to be an unfavorable prognostic factor in the course of MCI.

RESUMO O diagnóstico de comprometimento cognitivo leve (CCL) está associado a um risco aumentado de desenvolver demência. Ao avaliar o prognóstico adicional do CCL, a ocorrência de sintomas neuropsiquiátricos, particularmente o comportamento agressivo e impulsivo, pode desempenhar um papel importante. Objetivo: Avaliar a relação entre comportamento agressivo e disfunção cognitiva em indivíduos com diagnóstico de CCL. Métodos: Nossos resultados são baseados em um estudo prospectivo de sete anos. No momento da inclusão no estudo, os participantes, recrutados em um ambulatório, foram avaliados com o Mini-Exame do Estado Mental (MEEM) e o Inventário de Agitação de Cohen-Mansfield (CMAI). A reavaliação foi realizada após um ano com a escala MEEM em todos os pacientes. O momento da próxima administração do MEEM dependeu da condição clínica dos indivíduos e ocorreu no final do acompanhamento, ou seja, no momento do diagnóstico da demência ou após sete anos da inclusão, quando os critérios para demência não foram atendidos. Resultados: Dos 193 pacientes incluídos no estudo, 75 foram incluídos na análise final. Os indivíduos que converteram para demência durante o período de observação exibiram uma maior gravidade dos sintomas em cada uma das categorias avaliadas pelo CMAI. Além disso, houve uma correlação significativa entre o resultado global do CMAI e os resultados das subescalas de agressão física e verbal com declínio cognitivo durante o primeiro ano de observação. Conclusões: Apesar das várias limitações do estudo, os comportamentos agressivos e impulsivos parecem ser um fator prognóstico desfavorável no curso do CCL.

Cardiovascular factors in dementia. / Czynniki sercowo - naczyniowe w zaburzeniach otepiennych.

Dementia affects a significant portion of the population of elderly people and thus has become one of the most important health problems. At the same time, people with dementia are more likely to be also affected by concomitant diseases. Cardiovascular factors seem to be of particular importance. It has been shown that problems regarding blood pressure as well as lipid and carbohydrate metabolism play a crucial role for the rate of cognitive deterioration in elderly individuals in both vascular cognitive impairments and primary degenerative impairments (e.g., Alzheimer's disease). A clear relationship is observed between vascular pathology and degenerative processes in the brain. The period of life in which the exposure to cardiovascular factors occurs seems to be key, and these relationships are best documented in middle age. With aging, their importance as factors accelerating the progression of cognitive impairments seems to diminish, especially in Alzheimer-type dementia. Research on the importance of comorbidity in dementia processes may be crucial for the development of prevention and therapy programs for dementia.

Use of Sertraline in Hemodialysis Patients.

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.

Cognitive functions and thyroid hormones secretion disorders. / Wplyw zaburzen sekrecji hormonów tarczycy na funkcje poznawcze.

The functioning of the thyroid gland is of great importance for the formation, maturation and activity of the central nervous system. The association of clinical thyroid dysfunction with mental disorders, including cognitive impairment, seems to be well documented. Abnormal concentrations of thyroid hormones can lead to deterioration of cognitive processes through changes in neurotransmission, intensification of oxidative stress, or impact on ß-amyloid transformation and glucose metabolism in the central nervous system. Doubts concern mainly subclinical forms of thyroid dysfunction. According to some data, they are supposed to be related to the state of cognitive functions and to be one of the factors accelerating the mechanisms leading to degeneration of the brain tissue and, consequently, development of dementia. The results of studies on the correlation of thyroid activity with cognitive functions and the possible beneficial effects of hormonal supplementation on cognitive processes, however, bring contradictory results, which may be at least partly due to large methodological problems. One should also not exclude a reverse correlation, where the ongoing neurodegenerative process would affect thyroid function, e.g., by the changed production and secretion of thyroliberin. Despite several decades of intensive research, the explanation of this relationship is still far from conclusive.

Social Isolation During COVID-19 Pandemic. Perceived Stress and Containment Measures Compliance Among Polish and Italian Residents.

BACKGROUND: In this study, we analyze the association of social isolation in the first phase of the pandemic with perceived stress among residents of Poland and Italy with a look at how these populations adjust to and comply with implemented regulations, guidelines, and restrictions. MATERIALS AND METHODS: Internet survey with Perceived Stress Scale (PSS-10) and questions regarding mobility patterns, attitude, and propensity to adjust toward the implemented measures and current health condition was made among Polish and Italian residents (Cronbach's alpha 0.86 and 0.79, respectively). The sample size was 7,108 (6,169 completed questionnaires in Poland and 939 in Italy). RESULTS: The Polish group had a higher stress level than the Italian group (mean PSS-10 total score 22,14 vs 17,01, respectively; p < 0.01). There was a greater prevalence of chronic diseases among Polish respondents. Italian subjects expressed more concern about their health, as well as about their future employment. Italian subjects did not comply with suggested restrictions as much as Polish subjects and were less eager to restrain from their usual activities (social, physical, and religious), which were more often perceived as "most needed matters" in Italian than in Polish residents. CONCLUSION: Higher activity level was found to be correlated with lower perceived stress, but the causality is unclear. Difference in adherence to restrictions between Polish and Italian residents suggests that introducing similar lockdown policies worldwide may not be as beneficial as expected. However, due to the applied method of convenience sampling and uneven study groups, one should be careful with generalizing these results.

A Polish and German Population Study of Quality of Life, Well-Being, and Life Satisfaction in Older Adults During the COVID-19 Pandemic.

Introduction: Psychological studies undertaken during the COVID-19 pandemic rarely include people in their 60s or older. In our study, we studied the predictors of quality of life, well-being, and life satisfaction (including risky behavior, trait anxiety, feeling of threat, sleep quality, and optimism) during the pandemic in older people from Germany and Poland and compared them to three different age groups. Methods: A total of 494 adults in four groups-60+ (N = 60), 50-60 (N = 139), 36-49 (N = 155), <35 (N = 140)-completed validated self-report questionnaires assessing: socio-demographic data, quality of life, trait anxiety, risk tolerance, Coronavirus threat, optimism regarding the pandemic, difficulty relaxing, life satisfaction, well-being, and sleep quality during the pandemic period. Results: Older people rated their quality of life higher than did young (mean difference=0.74, SE=0.19, p < 0.01) and middle-aged (mean difference=0.79, SE=0.18, p < 0.01) participants, rated their life satisfaction higher than young (mean difference=1.23, SE = 0.31, p < 0.01) and middle-aged (mean difference=0.92, SE = 0.30, p < 0.05) participants, and rated their well-being higher than young (mean difference=1.40, SE = 0.31, p < 0.01) and middle-aged (mean difference=0.91, SE = 0.31, p < 0.05) participants. They also experienced lower levels of trait anxiety and Coronavirus threat (mean difference=-9.19, SE = 1.90, p < 0.01) than the younger age groups. They experienced greater risk tolerance (mean difference=1.38, SE=0.33, p < 0.01), sleep quality (F =1 .25; eta 2 = 0.01), and optimism (F = 1.96; eta 2 = 0.01), and had less difficulty relaxing during the pandemic (F = 3.75; eta 2 = 0.02) than middle-aged respondents. Conclusions: Quality of life, life satisfaction, and well-being during the pandemic is affected by age, trait anxiety, and Coronavirus threat. Older people rated their quality of life, life satisfaction, and well-being during pandemic higher than young people, and experienced lower levels of trait anxiety and Coronavirus threat than the younger age groups. They experienced greater risk tolerance, sleep quality, and optimism, and had less difficulty relaxing than middle-aged respondents.

Use of Methylphenidate in Excessive Daytime Sleepiness in Alzheimer's Patients Treated with Donepezil: Case Series.

Sleep disorders, inversion of sleep rhythm, excessive daytime sleepiness, and sleeplessness at night are common in Alzheimer's disease (AD). Sleep disorders in AD have a diverse pathogenesis and their incidence increases as the disease progresses. Some publications indicate possible beneficial effects of methylphenidate on sleep. We presented two cases of patients with diagnosed AD accompanied by sleep disorders which had a significant impact on their functioning. The pathogenesis of sleep disorders was different in those two cases. In both case studies, the use of methylphenidate brought an immediate clinical effect, improving sleep at night and functioning during the day.

Neuropsychiatric symptoms and faster progression of cognitive impairments as predictors of risk of conversion of mild cognitive impairment to dementia.

INTRODUCTION: The aim of this research, based on 7 years of observations, was to assess the relationship between the dynamics of changes in the realm of cognitive functions in the early stages of observations and the presence of neuropsychiatric symptoms as well as further progression of cognitive function impairments in people diagnosed with mild cognitive impairment (MCI). MATERIAL AND METHODS: One hundred and ninety three individuals were included in the study, all of whom referred themselves to the Mental Health Clinic and were diagnosed with MCI based on the criteria of the Working Group on MCI. It was assumed that these individuals would be subjected to systematic psychiatric and neuropsychological observation until they were diagnosed with dementia. This report concerns a completed 7-year period of these observations. Participants were assessed based on the following scales: MMSE, NPI and GDS. RESULTS: The obtained results indicate statistically significant differences between groups of subjects at the time of inclusion in the study, regarding the frequency of occurrence and severity of the following categories of impairments: thought impairments (p < 0.001), arousal/aggression (p < 0.001), depression/dysphoria (p < 0.001), disinhibition (p < 0.03), irritability/lability (p < 0.001), abnormal motor behaviors (p < 0.02), as well as sleep and night-time behavior disorders (p < 0.01) Moreover, individuals who developed dementia during observation exhibited greater progression in cognitive function impairment assessed with the MMSE scale in the first year of observation (p < 0.01). CONCLUSIONS: The accruing of cognitive function impairments and the presence of neuropsychiatric symptoms seem to be important risk factors for the development of dementia.

The Effects of Intellectual, Physical, and Social Activity on Further Prognosis in Mild Cognitive Impairment.

BACKGROUND Our goal was to specify the relationship between the level of activity (intellectual, physical, and social) in persons diagnosed with mild cognitive impairment (MCI) and the further progression of cognitive dysfunction. MATERIAL AND METHODS We examined 193 patients diagnosed with MCI (according to the criteria of the Working Group on Mild Cognitive Impairment) and under treatment at our Mental Disorders Clinic. It was assumed that these persons would remain under systematic psychiatric observation until dementia was diagnosed. The present study results from a seven-year observation period. The mini-mental state examination (MMSE), the Activity Scale (with the intellectual, physical, and social subscales), and the Instrumental Activities of Daily Living (IADL) scale were used to evaluate the participants' status at baseline. The MMSE was re-administered after one year and again at the end of the observation (either upon diagnosis of dementia or after seven years). At each meeting with the participant, the clinical diagnosis was verified to determine if the patient had dementia or not. Of the 193 people initially qualified for the study, 75 were available for the final analysis. RESULTS It was found that there was no statistically significant difference in the baseline MMSE scores between the persons with stable MCI and the persons who had progressed to dementia. However, statistically significant differences in the level of activity at baseline on both the global IADL scale and the Activity Scale between those with stable MCI and those who had progressed to dementia were found. These differences were manifested in the IADL subscales for telephone use, shopping, transportation, and personal finances, and in the physical activity subscale. CONCLUSIONS An evaluation of intellectual, physical, and social activity can be useful in determining the prognosis for the future course of MCI.

The algorithm for Alzheimer risk assessment based on APOE promoter polymorphisms.

BACKGROUND: Over the past two decades, the APOE gene and its polymorphisms have been among the most studied risk factors of Alzheimer disease (AD) development; yet, there are discrepancies between various studies regarding their impact. For this reason, the evaluation of the APOE genotype has not been included in the current European Federation of Neurological Societies guidelines for AD diagnosis and management. This aim of this study was to add to this discussion by assessing the possible influence of multiple polymorphisms in the promoter region of the APOE gene and genotypes of its allele E on the risk for dementia. METHODS: We performed a comprehensive analysis of APOE gene polymorphisms, assessed the detected genotypes and correlated molecular findings with serum apolipoprotein E concentrations. The study comprised 110 patients with AD and 110 age-matched healthy individuals from the Polish population. RESULTS: Four polymorphisms of the APOE gene had minor allele frequency exceeding 5% and were included in the analysis: -491A/T (rs449647), -427T/C (rs769446), -219T/G (rs405509) in the promoter region and +113G/C (rs440446) in intron 1. A protective effect of the -219G allele on AD development was observed. Also, the -491T and -219G alleles were found to be underrepresented in the carriers of the APOE E4 variant. On the basis of the genotype and linkage disequilibrium studies, a relative score was attributed to given genotypes with respect to the estimated probability of their protective effects against AD, giving rise to the 'preventive score'. This 'preventive score', based on the total sums of the relative scores, expresses the protective effect deriving from the synergistic action of individual single-nucleotide polymorphisms. The 'preventive score' was identified as an independent predictive factor. CONCLUSIONS: We propose a novel, more complex approach to AD risk assessment based on the additive effect of multiple polymorphic loci within the APOE promoter region, which on their own may have too weak an impact to reach the level of significance. This has potentially practical implications, as it may help to improve the informative potential of APOE testing in a clinical setting. Subsequent studies of the proposed system in large, multi-ethnic cohorts are necessary for its validation and to assess its potential practical value for clinical applications.

Influence of Perinatal Depression on Labor-Associated Fear and Emotional Attachment to the Child in High-Risk Pregnancies and the First Days After Delivery.

BACKGROUND: The aim of this study was to analyze the influence of the level of perinatal depression on the labor-associated fear and emotional attachment of children born to women during high-risk pregnancies and in the first days after delivery. MATERIAL/METHODS: 133 women aged between 16 and 45 years took part in the study. The first group included 63 pregnant women (mean age=28.59, SD=5.578) with a high-risk pregnancy (of maternal origin, for example, cardiologic disorders and diabetes). The second group included 70 women (mean age=27.94, SD=5.164) who were in the first days post-partum. Research methods included: Analysis of medical documentation; Clinical interview; the Edinburgh Postnatal Depression Scale (EPDS); the Questionnaire of Labor-Associated Anxiety (KLP), the Maternal-Fetal Attachment Scale (MFAS). RESULTS: Women after delivery displayed a higher level of concern for the child's health and life when compared to the high-risk pregnancy group. The results indicated the appearance of a postnatal fear, the level of which is connected with the perception of the role of the mother. This fear is lower in women prior to childbirth than it is after. There has also been noted a statistically significant relationship between the appearance of depression and attachment to the child. Those women with depression show less attachment to their child than is the case for those who do not suffer from depression. CONCLUSIONS: The appearance of a high level of depression amongst women from the high-risk pregnancy group during the first days post childbirth was accompanied by perinatal depression and a weaker attachment to the child.

Vascular Factors and Cognitive Dysfunction in Alzheimer Disease.

BACKGROUND: The purpose of the present study was to assess the influence of vascular factors on the degree of intensity and rate of progression of cognitive disorders in the course of Alzheimer Disease (AD). MATERIAL AND METHODS: The research group consisted of 39 persons, all of whom were diagnosed with AD according to the NINCDS/ADRDA criteria. We divided these patients into 2 subgroups, based on the vascular factors measured by the modified Hachinski Ischemic Scale (Ha-mod): group A, without the vascular component (HA-mod score of 0-1 point), and group B, with the vascular component (a score over 1 point). Cognitive functions were evaluated at baseline and again 2 years later, using the Cognitive Part of the Alzheimer Disease Assessment Scale (ADAS-cog). RESULTS: We found that the patients from subgroup B, with the stronger vascular component, demonstrated the highest intensity of cognitive disorders at baseline, both in terms of the overall ADAS-cog score, and in the subscores for ideational praxis, orientation, spoken language ability, comprehension of spoken language, and word-finding difficulty in spontaneous speech. Another variable which was connected with the intensity of dementia was age. After 2 years, however, the rate of progression of cognitive disorders was not significantly different between the 2 groups. CONCLUSIONS: The severity of vascular factors correlates directly with the intensity of cognitive disturbances. At the 2-year follow-up examination, however, no correlation was observed in the research group between greater vascular involvement and more rapid progression of cognitive disorders, as measured by the ADAS-cog scale.

[Neurobehavioral manifestation in early period of Alzheimer disease and vascular dementia]. / Objawy neurobehawioralne we wczesnych postaciach otepien typu Alzheimera i naczyniopochodnych.

INTRODUCTION: AD and VD are preceded by a preclinical stage. Small but tangible cognitive impairments sometimes occur many years before the onset and diagnosis ofdementia. The ongoing degenerative process can be conductive to behavioural and psychological symptoms. AIM: The aim of the study was to investigate the rates of neurobehavioral symptoms in the preclinical stages of AD and VD. METHODS: Two hundred and ninety one residents of nursery homes were included in the study. Participants of the study did not display symptoms of dementia in accordance with DSM IV criteria and obtained at least 24 points on the MMSE scale and were on the first or second level of the Global Deterioration Scale. Participants were screened for behavioural and psychological symptoms with the NPI-NH scale, while their cognitive functioning was evaluated by means of the ADAS-cog. Participants of the study were evaluated with the MMSE scale annually. Participants who obtained less than 24 points on the MMSE scale were evaluated by a senior psychiatrist. Diagnosis of dementia was done on the basis of DSM criteria. Alzheimer's Disease was diagnosed on the basis of NINCDS-ADRDA criteria and vascular dementia on the NINDS-AIREN criteria. The study was carried out over a period of seven consecutive years. RESULTS: A hundred and fifty people were included in the final analysis--in 111 of them were found not to be afflicted with dementia, 25 were found to have AD and in 14 VD was diagnosed. The control group differed from the AD and VD group with respect to the initial level of cognitive impairment (ADAS-cog) and the intensity of behavioural and psychological symptoms (NPI -NH scale). Particular items of the NPI -NH scale differentiated the two groups to a different degree. In people with AD the greatest differences were observed with respect to agitation/aggression, mood swings, irritability/emotional liability and the rates of anxiety. People with VD, similarly to people with AD, significantly differed from the control group with respect to mood disorders and irritability/emotional liability, as well as disinhibition and anxiety. People with VD were found not have high rates of agitation/aggression. In the AD group, the shorter the period between the evaluation with the NPI-NH scale and the diagnosis of AD was the greater the rates of agitation/aggression, anxiety, and elevated mood/euphoria were. CONCLUSION: In preclinical stages of both AD and VD behavioural and psychological symptoms occur very frequently. The closer the diagnosis of dementia is the greater the possibility of behavioural and psychological symptoms occurring, especially in AD.

Neuropsychiatric symptoms in patients with Alzheimer's disease with a vascular component.

OBJECTIVE: Vascular changes are observed in most cases of Alzheimer's disease (AD). Observations of AD and vascular disease (VD) allow us to surmise that vascular changes may not only affect cognitive impairment in AD but may also have a negative influence on the neuropsychiatric symptoms which often occur in the course of the disease. The aim of the study was to evaluate the impact of vascular factors on the neuropsychiatric symptoms in Alzheimer's Disease. MATERIAL AND METHODS: The study included 48 people with a preliminary diagnosis of Alzheimer's Disease on the basis of NINCDS/ADRDA criteria. The evaluation of impairments in cognitive functioning was carried out by means of the Alzheimer Disease Assessment Scale - the cognitive part (ADAS - cog), whereas the behavioural and psychological symptoms were evaluated by means of the Neuropsychiatric Inventory - the version adapted for residents of nursing homes for the elderly (Neuropsychiatric Inventory - Nursing Home Version) (NPI - NH). The score on the Hachinski scale was the basis for dividing the study participants into two groups - those with a mild vascular component (0-1 points on the Hachinski scale) and those with a severe vascular component (2-4 points). RESULTS: The analyzed groups did not differ with respect to the intensity of cognitive impairments (ADAS-cog) or age of the participants. Scores obtained on the NPI - NH scale as well as some of its elements (depression/dysphoria and anxiety) had a discriminating value. Studies show that vascular factors are a serious risk factor for neuropsychiatric symptoms in AD. CONCLUSIONS: Vascular factors in Alzheimer's Disease influence the presence of neuropsychiatric symptoms. In the course of angiogenic dementia a greater frequency in depressive disorders was shown. The most visible differences between individuals with a greater and lesser burden of vascular factors was in the realm of depressive and dysphoric disorders.

Efficacy and safety of duloxetine in the treatment of older adult patients with generalized anxiety disorder: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: This was a flexible-dosed study to evaluate the efficacy and safety of duloxetine 30-120 mg once daily in the treatment of generalized anxiety disorder (GAD) in older adult patients. METHODS: Patients with GAD, who were at least 65 years of age, were randomly assigned to double-blind treatment with either duloxetine (N = 151) or placebo (N = 140). The primary efficacy measure was the Hamilton Anxiety Rating Scale (HAM-A) total score, and the primary endpoint was at week 10. Global functioning was assessed by the Sheehan Disability Scale (SDS). Safety and tolerability was assessed by the occurrence of treatment-emergent adverse events, serious adverse events, laboratory analyses, and vital signs. Analyses were conducted on an intent-to-treat basis. RESULTS: The overall baseline mean HAM-A total score was 24, and SDS global score was 14. Completion rates were 75% for placebo and 76% for duloxetine. At week 10, duloxetine was superior to placebo on mean changes from baseline in HAM-A total scores (-15.9 vs. -11.7, p < 0.001) and in SDS global scores (-8.6 vs. -5.4, p < 0.001). Treatment-emergent adverse events occurred in ≥5% of duloxetine-treated patients and twice the rate than with placebo including constipation (9% vs. 4%, p = 0.06), dry mouth (7% vs. 1%, p = 0.02), and somnolence (6% vs. 2%, p = 0.14). CONCLUSION: Duloxetine treatment was efficacious in the improvement of anxiety and functioning in older adult patients with GAD, and the safety profile was consistent with previous GAD studies.