Cognitive and behavioral effects of lamotrigine and topiramate in healthy volunteers.

BACKGROUND: The relative cognitive and behavioral effects of lamotrigine (LTG) and topiramate (TPM) are unclear. METHODS: The authors directly compared the cognitive and behavioral effects of LTG and TPM in 47 healthy adults using a double-blind, randomized crossover design with two 12-week treatment periods. During each treatment condition, subjects were titrated to receive either LTG or TPM at a target dose of 300 mg/day for each. Neuropsychological evaluation included 17 measures yielding 41 variables of cognitive function and subjective behavioral effects. Subjects were tested at the end of each antiepileptic drug (AED) treatment period and during two drug-free conditions (pretreatment baseline and 1 month following final AED withdrawal). RESULTS: Direct comparison of the two AEDs revealed significantly better performance on 33 (80%) variables for LTG, but none for TPM. Even after adjustment for blood levels, performance was better on 19 (46%) variables for LTG, but none for TPM. Differences spanned both objective cognitive and subjective behavioral measures. Comparison of TPM to the non-drug average revealed significantly better performance for non-drug average on 36 (88%) variables, but none for TPM. Comparison of LTG to non-drug average revealed better performance on 7 (17%) variables for non-drug average and 4 (10%) variables for LTG. CONCLUSIONS: Lamotrigine produces significantly fewer untoward cognitive and behavioral effects compared to topiramate (TPM) at the dosages, titrations, and timeframes employed in this study. The dosages employed may not have been equivalent in efficacy. Future studies are needed to delineate the cognitive and behavioral effects of TPM at lower dosages.

Visual exploration of facial emotion by healthy older adults and patients with Alzheimer disease.

OBJECTIVE: The purpose of this study was to investigate eye movement patterns of patients with Alzheimer disease (AD) and healthy older adults while viewing photographs of facial expression. BACKGROUND: Individuals with Alzheimer disease appear to have deficits in emotion perception, but the underlying mechanisms are not understood well. It is not known whether individuals with AD visually explore facial stimuli and extract information needed to make emotion identification from faces in the same way as do healthy older adults. METHOD: Seventeen AD patients and 15 older adult control patients were shown faces that depicted different emotions and were asked to identify the emotion displayed from two alternatives. The eye movements of participants were recorded during the emotion identification task. RESULTS: No differences were seen between AD patients and older adult controls regarding their accuracy of emotion identification. However, AD patients differed from older adult controls on eye movement patterns during the emotion identification task. Alzheimer disease patients fixated less on the face and, in particular, on the eyes. Alzheimer disease patients also spent more time viewing areas off the face. There was no relationship between the severity of cognitive impairment and emotion identification or eye movement patterns. CONCLUSIONS: Although the AD patients and older adult controls showed similar accuracy for the emotion identification task, their visual processing strategies differed. Relative to older adult controls, AD patients fixated less on discriminating regions and attended more to irrelevant aspects of stimuli. The eye movement differences were particularly evident in AD patients who did more poorly for the emotion identification task. These differences were not attributable to the global cognitive deterioration accompanying AD, but suggested a specific deficit in visual processing abilities.

Confirmation of an association between family history of affective disorder and the depressive syndrome in Alzheimer's disease.

OBJECTIVE: The authors' goal was to replicate an earlier finding of a familial liability for depression in Alzheimer's disease. METHOD: The family histories of depression and dementia were compared in 28 patients experiencing a first episode of major depression after onset of Alzheimer's disease and 74 nondepressed patients with Alzheimer's disease. RESULTS: Significantly more families of depressed dementia patients included depressed first-degree relatives. There was no difference between Alzheimer's disease patients with and without depression in the proportion of families with a history of dementia. CONCLUSIONS: Major depression in Alzheimer's disease is associated with a familial liability for depression that is independent of any familial liability for dementia.

Sources of stress for family caregivers of institutionalized dementia patients.

Although many caregivers place their relative in a nursing home in an attempt to reduce their own burden, caregiving stress often continues after institutionalization. This research examined sources of stress for 66 caregivers who cared for their impaired relative at home and later placed that individual in a nursing home. We hypothesized that although these caregivers no longer had primary responsibility for direct care, they would continue to experience distress because of the stressors associated with the nursing home. Results ran counter to our expectations. Although many caregivers reported stressors related to nursing home care, stressors stemming from the patient's Alzheimer's disease (AD) symptoms accounted for more variance in caregivers' levels of anxiety and depression, and in the quality of their interpersonal relations. Even though caregivers were assisted in their caregiving responsibilities by the nursing home staff, their relative's AD symptoms continued to prompt distress.

Stressors and well-being among caregivers to older adults with dementia: the in-home versus nursing home experience.

We examined differences in stressors and well-being for caregivers who care for a relative with dementia at home and those who had placed their relative in a nursing home. The groups did not differ in depression or somatic complaints, but nursing home caregivers had fewer social and interpersonal disruptions. Controlling for caregiving problems, nursing home caregivers reported more stressors due to ADL (activities of daily living) assistance, their relatives' behavioral and cognitive functioning, and lack of caregiving support from family and friends.

Chronic stress and immunity in family caregivers of Alzheimer's disease victims.

Although acute stress has been associated with transient immunosuppression, little is known about the immunologic consequences of chronic stress in humans. In order to investigate possible health-related consequences of a long-term stressor, we obtained blood samples for immunologic and nutritional analyses and psychologic data from 34 family caregivers of Alzheimer's disease (AD) victims and 34 sociodemographically matched comparison subjects. Family caregivers for AD victims were more distressed than comparison subjects without similar responsibilities. Greater impairment in the AD victim was associated with greater distress and loneliness in caregivers. Caregivers had significantly lower percentages of total T lymphocytes and helper T lymphocytes than did comparison subjects, as well as significantly lower helper-suppressor cell ratios; caregivers also had significantly higher antibody titers to Epstein-Barr virus than did comparison subjects, presumably reflecting poorer cellular immune system control of the latent virus in caregivers. The percentages of natural killer cells and suppressor T lymphocytes did not differ significantly. These data suggest that chronically stressed AD family caregivers do not show immunologic or psychologic adaptation to the level of their well-matched age peers.

Marital quality, marital disruption, and immune function.

Marital disruption is associated with significant increases in a variety of psychologic and physical disorders. In order to examine psychologic and physiologic mediators, self-report data and blood samples were obtained from 38 married women and 38 separated/divorced women. Among married subjects, poorer marital quality was associated with greater depression and a poorer response on three qualitative measures of immune function. Women who had been separated 1 year or less had significantly poorer qualitative and quantitative immune function than their sociodemographically matched married counterparts. Among the separated/divorced cohort, shorter separation periods and greater attachment to the (ex)husband were associated with poorer immune function and greater depression. These data are consistent with epidemiologic evidence linking marital disruption with increased morbidity and mortality.