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A 65-year-old male patient with depression and psychosis sustained a traumatic brain injury (TBI) after a suicide attempt involving a motor vehicle. Immediately post-injury, the patient's psychiatric symptoms completely resolved, and cognitive function improved, with minimal neurological deficits. We describe the first case, to our knowledge, of a patient with a paradoxical complete and spontaneous resolution of multiple psychiatric symptoms (depression, psychosis, and suicidal ideation) immediately following a closed-head, left hemispheric TBI. [ABSTRACT FROM AUTHOR]

Background and Objectives Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examine the context-specific factors relevant to its effective implementation in settings that support older adults with dementia. Research Design and Methods A qualitative descriptive approach was used to explore the perspectives of Alzheimer Society (AS) staff in their work of supporting people with dementia and family carers within the context of driving cessation. Individual in-depth interviews were conducted with 15 AS staff members in 4 Canadian provinces. Data were examined using interpretative thematic analysis. Results The study results revealed an overarching paradox that despite the importance of driving cessation in people with dementia, it continues to be largely avoided at the individual and system levels. This is explored via the themes of (a) paradox of importance and avoidance identified in AS settings; (b) lack of awareness and understanding about dementia and driving among people with dementia and family carers; (c) distress and avoidance rooted in ongoing system issues; and (d) moving driving cessation to the "front burner." Discussion and Implications Viewed through the emerging social health paradigm, which focuses on the social and emotional consequences of dementia, our results highlight the urgent need to mobilize our communities, medical education systems, and transportation authorities to finally resolve the dementia and driving cessation paradox. [ABSTRACT FROM AUTHOR]

Clinicians face challenges in deciding which older patients with dementia to report to transportation administrators. This study used a qualitative thematic analysis to understand the utility and limitations of implementing a computer-based Driving in Dementia Decision Tool in clinical practice. Thirteen physicians and eight nurse practitioners participated in an interview to discuss their experience using the tool. While many participants felt the tool provided a useful 'virtual second opinion', specialist physicians felt that the tool did not add value to their clinical practice. Barriers to using the Driving in Dementia Decision Tool included lack of integration with electronic medical records and inability to capture certain contextual nuances. Opinions varied about the impact of the tool on the relationship of clinicians with patients and their families. The Driving in Dementia Decision Tool was judged most useful by nurse practitioners and least useful by specialist physicians. This work highlights the importance of tailoring knowledge translation interventions to particular practices. [ABSTRACT FROM AUTHOR]

Objective: The aim of this project was to review the literature on interventions aimed at facilitating driving cessation in older adults, with and without dementia.Methods: A literature search was performed using the databases MEDLINE, CINAHL, Cochrane Central, Embase, and PsycINFO, from 1994 to September 2014. Two independent raters screened articles for inclusion and extracted study data. We only included articles if they directly addressed the topic of intervention approaches to facilitate the process of driving cessation in older adults or to support the adaptation of older adults who have had to stop driving and included a control group.Results: Of an initial 477 unique records identified, 111 pertained to driving cessation in older adults, and only three articles were controlled trials of intervention approaches related to driving cessation. One article described an intervention for retired drivers with dementia, while another was aimed at caregivers of drivers with dementia, and the third included retired and retiring drivers without dementia. Outcomes such as reduced depressive symptoms, increased trips out of home, and efficacy in dealing with the driving cessation process were positive, but the specific outcome measures and magnitude of effects varied across studies.Conclusions: Although the results summarized in this review point toward potentially promising effects of interventions for facilitating driving cessation in older adults, these findings must be interpreted with caution given the significant methodological limitations of the studies, including small samples, participant attrition, lack of blinding, and non-validated outcome measures. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: Training future clinician-researchers remains a challenge faced by Canadian psychiatry departments. Our objectives were to determine the prevalence of residents interested in pursuing research and other career options as part of their practice, and to identify the factors associated with interest in research.Method: Data from a national online survey of 207 Canadian psychiatry residents from a total of 853 (24.3% response rate) were examined. The main outcome was interest in research as part of residents' future psychiatrist practice. Bivariate and multivariate analyses were performed to identify demographic and vocational variables associated with research interest.Results: Interest in research decreases by 76% between the first and fifth year of psychiatry residency (OR 0.76 per year, 95% CI 0.60 to 0.97). Training in a department with a residency research track did not correlate with increased research interest (χ2 = 0.007, df = 1, P = 0.93).Conclusions: Exposing and engaging psychiatry residents in research as early as possible in residency training appears key to promoting future research interest. Psychiatry residency programs and research tracks could consider emphasizing research training initiatives and protected research time early in residency. [ABSTRACT FROM AUTHOR]

An introduction is presented that discusses issue articles on neuropsychiatric symptoms of dementia in relation to geriatric psychiatry, mild cognitive impairment (MCI), and patient safety and quality of life in relation to the use of antipsychotics.

Highlights: [•] In this large sample of healthy older drivers, there was a modest association between performance on tests of psychomotor speed, mental flexibility and executive functioning and self-reported driving comfort, abilities, and restrictions. [•] Specifically, worse performance on Trails A and B were generally associated with modestly reduced driving frequency and perceived driving abilities and comfort, as well as a tendency to avoid more difficult driving situations. [•] There was no relationship between a global cognitive test, the Montreal Cognitive Assessment (MoCA), and the self-reported driving measures. [•] The modest relationship with Trails A and B and the lack of relationship with the MoCA may be due to the largely cognitively intact sample, a reduced awareness of and compensation for cognitive problems, or both. [Copyright &y& Elsevier]

It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, postconcussive symptoms and cognitive deficits. The purpose of this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major depression following TBI. Many studies of prevalence of depression following TBI have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dysfunction have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians to use best practice guidelines for the treatment of major depression in the absence of TBI. [ABSTRACT FROM AUTHOR]

It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, posteoncussive symptoms and cognitive deficits. The purpose cf this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major deçression following TBI. Many studies of prevalence of depression following TB! have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dys- function have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians 10 use best practice guidelines for the treatment of major depression in the absence of TBI. [ABSTRACT FROM AUTHOR]

Objectives: To determine which serotonergic system-related single nucleotide polymorphisms (SNPs) predicted variation in treatment response to citalopram in depression following a traumatic brain injury (TBI). Methods: Ninety (50 M/40 F, aged 39.9, SD = 18.0 years) post-TBI patients with a major depressive episode (MDE) were recruited into a 6-week open-label study of citalopram (20 mg/day). Six functional SNPs in genes related to the serotonergic system were examined: serotonin transporter (5HTTLPR including rs25531), 5HT1A C-(1019)G and 5HT2A T-(102)C, methylene tetrahydrofolate reductase (MTHFR) C-(677)T, brain-derived neurotrophic factor (BDNF) val66met and tryptophan hydroxylase-2 (TPH2) G-(703)T. Regression analyses were performed using the six SNPs as independent variables: Model 1 with response (percentage Hamilton Depression (HAMD) change from baseline to endpoint) as the dependent variable and Model 2 with adverse event index as the dependent variable (Bonferroni corrected p-value < 0.025). Results: MTHFR and BDNF SNPs predicted greater treatment response ( R2= 0.098, F = 4.65, p = 0.013). The 5HTTLPR predicted greater occurrence of adverse events ( R2= 0.069, F = 5.72, p = 0.020). Conclusion: Results suggest that polymorphisms in genes related to the serotonergic system may help predict short-term response to citalopram and tolerability to the medication in patients with MDE following a TBI. [ABSTRACT FROM AUTHOR]

Introduction Electroconvulsive therapy (ECT) is an effective, yet controversial treatment. Most patients receiving ECT have depression and it is likely that the majority having this treatment are older adults. However, attitudes towards ECT and knowledge of ECT in this population have never been studied in relation to the patients' cultural background. Objective To compare the attitudes and knowledge of ECT among older adults depressed patients across three culturally different populations and to explore the relationship between culture, knowledge and attitudes. Methods The study was conducted in one centre in each country. A semi-structured survey was used which included three sections: demographics characteristics, attitudes towards and knowledge of ECT. Results A total of 75 patients were recruited in this study: 30 patients from England; 30 patients from Argentina; and 15 patients from Canada. There was a significant difference in knowledge about ECT across the three countries. No significant difference was found in terms of attitudes. Knowledge was poor in all three countries. The most influential factor shaping subjects' attitudes and knowledge of ECT differed for the three countries. A weak correlation was found between knowledge of and attitudes towards ECT across all patients from the three different countries. Conclusion Attitudes towards ECT are a very complex phenomenon. We could not find evidence that a particular cultural background affects attitudes towards ECT. Generalising the results of our study is restricted by the fact that this was a pilot study that suffered from limitations including small sample size and number of settings. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Driving a motor vehicle is central to the functional autonomy of patients with psychiatric illnesses. There have been many studies of the deleterious effects of psychotropic medications such as benzodiazepines, typical antipsychotics and tricyclic antidepressants (TCAs) on human motor skills; however, in the literature little attention has been paid to how such impairment affects driving ability. Computerised driving simulators offer a laboratory-based method of assessing the effects of specific psychotropic medications on driving abilities, in a standardised, controlled and safe manner. The purpose of the present article is to review research undertaken to-date on the effects of psychotropic medications on computer-simulated driving.A search of various databases, including MEDLINE, EMBASE and PsycInfo, was conducted. Forty-one articles assessing the impact of psychotropics on computer-simulated driving were identified. The pooled total number of subjects assessed in these simulator studies was 1336 (mean sample size 30.36 [SD 35.8]). The most common outcome measures in the various studies were speed, steering, deviation from lateral position (tracking, lane drifting), reaction time or braking accuracy, driving errors (e.g. errors in turning, coordination, gap acceptance, signalling, following distance) and vehicle collisions. The results of the studies were quite variable; however, the most common drug-related impairments included those of tracking and reaction time. Benzodiazepines and TCAs were most commonly associated with impairment, although the level of impairment was dependent on the population studied, the dose and the time of testing relative to drug administration.Computer-simulated driving provides a useful tool to research psychotropic-related impairment of driving abilities. Limitations of currently available data include the lack of generalisability, standardisation and small sample sizes. [ABSTRACT FROM AUTHOR]

Primary objective: To assess the utility of the Mini-Mental Status Examination (MMSE) among the older TBI population. Methods and procedures: The MMSE and a number of other neuropsychological tests were administered to forty-three adults aged 50 and over one year following mild to moderate TBI. The sensitivity, specificity, and predictive value of the MMSE were evaluated in relation to these tests. Main outcomes and results: The domains of the MMSE generally exhibited low sensitivity while high specificity was demonstrated by Attention and Language. Positive predictive value was high only for Language but negative predictive value was moderate to high for all domains. Conclusions: These results suggest that one year following mild to moderate TBI among older adults, the MMSE should not be used to identify those with cognitive impairment; if administered, a perfect score on a component of the MMSE suggests that enhanced testing in that given domain may not reveal further impairment. A small sample size and a small number of those impaired limit our results. [ABSTRACT FROM AUTHOR]

Background: Although physicians in most provinces are mandated to report patients whose driving ability is impaired by illness, little is known about dementia-related factors associated with driving cessation. The purpose of our study was to explore factors that may affect the likelihood of driving cessation in a sample of elderly, community-dwelling patients with dementia. Methods: A 3-year prospective study, the Canadian Outcomes Study in Dementia (COSID) has enrolled 883 patients with mild-to-moderate dementia at 32 centres across Canada. Assessment tools included the Mini-Mental State Examination (MMSE) for cognition, the Global Deterioration Scale (GDS) for staging (severity), the Functional Autonomy Measurement System (SMAF) for function, and the Neuropsychiatric Inventory (NPI) for behaviour. Factors associated with the decision to quit driving after the baseline assessment were tested with Cox survival analysis. Results: Of 719 subjects who were or had been drivers, 203 (28.2%) were still driving at baseline. Over an observation period that averaged 23 months, 97 (48.5%) of 200 patients quit driving. Factors predictive of driving cessation included GDS (hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.15-2.45), MMSE score (HR 0.90, 95% CI 0.83-0.97) and NPI findings (HR 1.63 for presence of = 3 behaviours, 95% CI 1.01-2.62). Among the NPI behaviours, when they were analyzed separately, agitation led to a decreased likelihood of driving cessation (p=0.019), whereas apathy (p=0.031) and hallucinations (p=0.050) led to an increased likelihood. Interpretation: Cognitive impairment and behaviours such as agitation, apathy and hallucinations were significant predictors of driving cessation in patients with a mild to moderate degree of dementia. These findings should be considered when one counsels patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: To examine temporal trends in electroconvulsive therapy (ECT) use among all 12 million Ontario residents between January 1992 and December 2004 and to examine the differential trends in older adults, compared with younger ones.Methods: We undertook a time-series analysis to examine annual trends in the use and prevalence of ECT, using linked provincial datasets. Descriptive data were presented for the population as a whole, and then trends were described separately by age groups (younger and older). As a comparator, we similarly examined antidepressant prevalence for older adults over the same time period.Results: Overall rates of ECT prevalence were stable. Annual population rates of individuals receiving ECT increased by about 27%, from 12.3 per 100 000 population in 1992 to 15.6 per 100 000 in 1997, and then decreased to 12.5 per 100 000 by 2004. The population rates of ECT were about threefold higher among older adults, relative to the younger population. Antidepressant prevalence increased by 90.1% among older adults over the same time period. The female-to-male ratio was relatively stable over time.Conclusions: The rate of ECT has been relatively stable since the early 1990s. Older adults were much more likely to be prescribed a course of ECT than younger adults. ECT remains a commonly prescribed treatment, particularly in old age. [ABSTRACT FROM AUTHOR]

Abstract: Background: Major depression is common following traumatic brain injury (TBI), yet no studies to date have explored its relationship to psychosocial outcome in older adults with TBI. Methods: A consecutive sample of seventy-seven older patients with mild-to-moderate TBI was assessed for the presence of major depression within 2months of injury, and followed prospectively for 1year. Those with major depression were compared with those without on measures of psychosocial outcome, instrumental activities of daily living (IADL). Results: Patients with major depression (15.6%) reported higher degrees of psychological distress, psychosocial dysfunction, and post-concussive symptoms than those without, and were rated as having poorer IADL performance. Limitations: The present study was limited to a clinical population, and there were significant attrition rates. Conclusions: Major depression in the first few months after TBI in older adults has persisting adverse effects on outcome, highlighting its significance in this population, and suggesting early attention to treatment. [Copyright &y& Elsevier]

Objective The purpose of this study was to assess trends in utilization and costs of antipsychotic drugs among a population of older adults over time, with respect to the prevalence of users, shifts in prescribing patterns, and related financial implications. Design Cross-sectional time series of quarterly and annual antipsychotic utilization and cost were obtained from administrative databases for calendar years 1993 through 2002. Setting and Participants A population-based study of more than 1.4 million residents of the province of Ontario aged 65 years or older. Measurements Data sources used included the Ontario Drug Benefits (ODB) database and Statistics Canada census data. Results The prevalence of antipsychotic users increased by 34.8% over the study period from 2.2% at the beginning of 1993 to 3.0% of the elderly at the end of 2002 (p < 0.01). This was associated with a 749% increase in total cost (from $3.7 million in 1993 to $31.4 million in 2002; p < 0.01). The atypical antipsychotics, which were not available in 1993, made up 82.5% of the antipsychotics dispensed and 95.2% of costs in 2002. Conclusions The modest increase in antipsychotic prevalence in the elderly over the last ten years has been associated with a substantial increase in cost, with a significant shift towards use of the atypical antipsychotics. As the atypical antipsychotics are increasingly used for patients with dementia, which is becoming more prevalent in the aging population, an understanding of the benefits of these medications must be balanced with a detailed understanding of the material and financial implications. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Examines the importance of tau to beta-amyloid-induced neurotoxicity. Lesions of Alzheimer's disease; Complement of microtubular proteins in tau knockout hippocampal neurons; Formation of the dynamic microtubules characteristic of rapid neurite elongation.

While the cerebellum has not traditionally been seen to be involved in the pathophysiology of psychiatric disorders, over the last 20 years evidence of cerebellar abnormalities has accumulated in disorders such as schizophrenia, autism, mood disorders, dementia, and attention deficit-hyperactivity disorder. The literature is selectively reviewed here, with consideration of the implications of the available data on future research. [ABSTRACT FROM AUTHOR]

Hypothesis: There will be acute harbingers of poor outcome following mild traumatic brain injury (TBI) in the elderly. Participants: Twenty-six subjects age 60 and over were compared to 30 subjects aged 18-59, seen within 1 month, on average, following a mild TBI. Main outcome measures: Functioning was assessed using the Glasgow Outcome Scale (GOS), a global measure of outcome, as well as self-report measures of psychosocial functioning, physical symptoms and psychological distress. Results: Contrary to the hypothesis, the older group did better than their younger counterparts on the GOS (p = 0.002), and reported less psychosocial impairment (p < 0.0001), less psychological distress (p = 0.002), and less physical symptoms (p = 0.005). However, once employment was controlled for, these results only approached statistical significance. Discussion: The assumption that elderly subjects have a worse outcome following TBI needs to be reconsidered, at least within the acute recovery period. The importance of psychosocial factors as modifiers of outcome according to age are emphasized. Whether this finding holds true over a longer follow-up period is the subject of ongoing research. [ABSTRACT FROM AUTHOR]

Background Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia. Methods The presence of psychosis was assessed by clinical interview and two scales: the Neuropsychiatric Inventory and the Columbia University Scale for Psychopathology in Alzheimer's Disease. The maximum likelihood estimation technique was used to determine the best estimate of the presence of psychosis. Aggression, apathy, and functional status (activities of daily living: ADLs) were measured using structured instruments. Results Sixty-one subjects were included. The CUSPAD and NPI provided low false positive and negative rates. ANCOVA analyses showed that psychosis was significantly associated with aggression, even when controlling for apathy, depression, and ADLs. Psychosis was related to apathy only when depression was controlled for. Hallucinations were related to impaired basic ADLs, even when depression and apathy were controlled for. Conclusions Relationships were found between psychotic symptoms in dementia and aggression as well as apathy and impaired functional status. These relationships suggest pathophysiologic mechanisms and have possible treatment implications. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The elderly are at risk for traumatic brain injury (TBI), but their outcome following these injuries remains unclear. Objective: This paper critically reviews research done to date on cognitive and functional outcome following TBI in the elderly. Methods: MEDLINE and PSYCHLIT databases going back to 1965 were searched. Results: Studies suggest that TBI results in adverse cognitive and functional outcomes in the elderly. There is uncertainty as to whether TBI is a significant risk factor for Alzheimer's disease (AD). Methodological problems in these studies include selection bias, small samples, retrospective analyses, and, particularly, the failure to address the role of pre-morbid functioning. These problems limit the strength of the outcome studies, and may account for the equivocal findings on AD risk. Conclusions: It is premature to conclude from the published research to date that the elderly have a uniformly poor outcome following TBI. Directions for further research are suggested. [ABSTRACT FROM AUTHOR]

How senile plaques and neurofibrillary tangles are linked represents a major gap in our understanding of the pathophysiology of Alzheimer’s disease (AD). We have previously shown that the addition of fibrillar β-amyloid (Aβ) to mature hippocampal neurons results in progressive neuritic degeneration accompanied by the enhanced phosphorylation of adult tau isoforms. In the present study, we sought to obtain more direct evidence of the signal transduction pathway(s) activated by fibrillar Aβ leading to tau phosphorylation and the generation of dystrophic neurites. Our results indicated that fibrillar Aβ induced the progressive and sustained activation of the mitogen-activated protein kinase (MAPK) in mature hippocampal neurons. On the other hand, the specific inhibition of the MAPK signal transduction pathway by means of PD98059, a MAPK kinase (MEK) specific inhibitor, prevented the phosphorylation of tau (at Ser199/Ser202) induced by fibrillar Aβ. In addition, the inhibition of MAPK activation partially prevented neurite degeneration. Taken collectively, our results suggest that the sustained activation of the MAPK signal transduction pathway induced by fibrillar Aβ may lead to the abnormal phosphorylation of tau and the neuritic degeneration observed in AD. [ABSTRACT FROM AUTHOR]

• 7.2% of drivers reported increased speeding during COVID-19. • Significantly higher odds of increased speeding during COVID-19 for those with higher scores on Competitive Attitudes Towards Driving Scale. • Significantly higher odds of increased speeding during COVID-19 for those with higher kilometers traveled. • Significantly higher odds of increased speeding during COVID-19 for those who reported more alcohol consumption during the pandemic. Introduction: During COVID-19, increased speeding was observed in many jurisdictions. Yet, evidence is limited on what factors predicted increased speeding during the pandemic. This study's purpose was to examine speeding, and person and situation factors associated with increased speeding since the start of the pandemic. Methods: An online panel survey sampled 1,595 drivers using sex, age, and region quota sampling and weighting to approximate the Ontario, Canada adult population. Measures included: (1) person factors: socio-demographics (age, sex, region); psychological trait of risk propensity (Competitive Attitudes Toward Driving Scale (CATDS)); psychological states (distress - general and COVID-19-related); and behaviors (kilometers driven, alcohol use, police stops and collisions); and (2) COVID-19-related situation factors: perceived changes in (traffic volume, police enforcement). Results: 67.2% of respondents reported speeding; 7.2% reported increased speeding since the start of the pandemic. Bivariate analyses indicated that person factors of younger age, male sex, higher CATDS, higher distress, more alcohol use, more kilometers traveled, police stops, and collisions since the start of the pandemic were associated with increased speeding. Situation factor of perceived less traffic volume since the start of the pandemic was associated with increased speeding. Logistic regression analysis identified odds of reported increased speeding during the pandemic was significantly higher for drivers with higher scores on the CATDS, higher kilometers traveled, and more alcohol use during the pandemic. Conclusions: These findings suggest that higher risk propensity as well as the more kilometers driven and increased alcohol consumption were risk factors for increased speeding. Practical Applications: COVID-19-related factors of lower traffic volume and enforcement are less predictive of increased speeding than driver personality and pandemic-related behaviors of more driving and drinking. Interventions to reduce speeding still need to focus on these person factors through education, enforcement, and strong sanctions for speeding. [ABSTRACT FROM AUTHOR]

• We explored whether older adults were less likely to have road injuries and fatalities in the first month of shelter-in-place lockdown of the COVID pandemic. • We found a 64.7 % reduction in the proportion of injuries and fatalities. • The excess COVID-19- associated mortality in oldest adults may be indirectly partially mitigated by a reduction in mortality from motor vehicle collisions. Older adults constitute the group most vulnerable to COVID-19 mortality. As a result, in North America and elsewhere, older adults have been strongly advised to shelter in place. Older adults also represent the fastest growing segment of licensed drivers. We examined the change in injuries and fatalities sustained by younger and older drivers and pedestrians during the first month of the COVID-19 pandemic. We hypothesized that adults ages 80 years and over would have a proportionally larger reduction than the other drivers and pedestrians. Using a cohort design, we compared the proportion of drivers and pedestrians involved in injuries and fatalities attributable to individuals aged 80 years and over, as recorded in the Ministry of Transportation of Ontario (Canada) database, between the 30 days prior to shelter-in-place related to the COVID-19 pandemic and the subsequent 30 days. By way of comparison, we conducted a similar comparison for younger age cohorts (16−24 years, 25−34 years, 35−54 years, 55−64 years, and 65−79 years). Drivers aged 80 years and over represented 21 per 1000 injuries and fatalities in the 30 days prior to March 17, 2020 (95 % CI: 15−29), and 8 per 1000 injuries and fatalities in the 30 days beginning on that date (95 % CI: 2−20), a 64.7 % reduction (exp (β) post 0.353, 95 % CI 0.105−0.892). Drivers in the 35−54 year age range underwent a significant but smaller reduction of 22.9 %; no significant changes were seen for drivers in other age groups, or for pedestrians of any age. The physical distancing measures that aimed to reduce the spread of COVID-19 resulted in a marked reduction in driver injuries and fatalities in the oldest old, illustrating the impact of physical distancing recommendations in this population. The excess mortality burden faced by the oldest adults during the COVID-19 pandemic, by direct exposure to the virus, may be indirectly mitigated by the reduction in road-related deaths in this cohort. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with psychotropic medications and motor vehicle collisions in patients with dementia.

The article discusses the legal responsibility of physicians to report automobile drivers diagnosed with mild dementia to relevant licensing authorities. It is stated that drivers with medical conditions put public safety at risk thus physicians reporting dementia to health authorities is considered necessary. It informs that since on-road tests are expensive, drivers from the lower strata loose their licenses which affects the physician-patient relationship. Some solutions such as increased transport alternatives and development of tools for office based driving assessment are discussed. A chart listing the mandatory reporting legislation and recommendations in several countries including Canada, New Zealand, and the U.S. is also presented.

Introduction: An active lifestyle may protect older adults from cognitive decline. Yet, due to the complex nature of outdoor environments, many people living with dementia experience decreased access to outdoor activities. In this context, conceptualizing and measuring outdoor mobility is of great significance. Using the global positioning system (GPS) provides an avenue for capturing the multi-dimensional nature of outdoor mobility. The objective of this study is to develop a comprehensive framework for comparing outdoor mobility patterns of cognitively intact older adults and older adults with dementia using passively collected GPS data. Methods: A total of 7 people with dementia (PwD) and 8 cognitively intact controls (CTLs), aged 65 years or older, carried a GPS device when travelling outside their homes for 4 weeks. We applied a framework incorporating 12 GPS-based indicators to capture spatial, temporal, and semantic dimensions of outdoor mobility. Results: Despite a small sample size, the application of our mobility framework identified several significant differences between the 2 groups. We found that PwD participated in more medical-related (Cliff's Delta = 0.71, 95% CI: 0.34–1) and fewer sport-related (Cliff's Delta = −0.78, 95% CI: −1 to −0.32) activities compared to the cognitively intact CTLs. Our results also suggested that longer duration of daily walking time (Cliff's Delta = 0.71, 95% CI: 0.148–1) and longer outdoor activities at night, after 8 p.m. (Hedges' g = 1.42, 95% CI: 0.85–1.09), are associated with cognitively intact individuals. Conclusion: Based on the proposed framework incorporating 12 GPS-based indicators, we were able to identify several differences in outdoor mobility in PwD compared with cognitively intact CTLs. [ABSTRACT FROM AUTHOR]

• Readiness for change in mobility may be an important element in promoting smooth transitions to non-driving for older people. • Participants who reported positive attitudes towards driving relative to themselves and others were less ready for mobility transition. • Participants who reported lower agreeableness were less ready for mobility transition. For many older adults, driving is an important means of community mobility. With changes in health, aging increases the likelihood of ceasing to drive. Driving cessation is associated with a host of negative physical and mental health outcomes. Increased readiness to transition to non-driving status may mitigate some of the adverse consequences of driving cessation, making the transition to non-driving a pivotal period for intervention. We examined the relationship between attitudes towards driving (positive and negative) and readiness for mobility transition. Participants (n = 253, mean age = 79.13) completed measures of health, cognition, personality, attitudes towards driving, and readiness for mobility change. The results from the multiple hierarchical regression analysis showed that individuals who reported more positive attitudes towards driving relative to themselves (i.e., pro-self scale) and others (i.e., pro-other scale), as well as scored lower on the personality trait agreeableness, were less ready for mobility transition. The results emphasize the importance of taking into account driver attitudes, in addition to health considerations, when supporting the transition to non-driving. [ABSTRACT FROM AUTHOR]

Background: Apathy and depression are common neuropsychiatric symptoms across neurodegenerative disorders and are associated with impairment in several cognitive domains, yet little is known about the influence of sex on these relationships. Objectives: We examined the relationship between these symptoms with neuropsychological performance across a combined cohort with mild or major neurodegenerative disorders, then evaluated the impact of sex. Design, Setting and Participants: We conducted a cohort analysis of participants in the COMPASS‐ND study with mild cognitive impairment (MCI), vascular MCI, Alzheimer's disease, mixed dementia, Parkinson's disease, frontotemporal dementia, and cognitively unimpaired (CU) controls. Measurements: Participants with neurodegenerative disease and CU controls were stratified by the presence (severity ≥1 on Neuropsychiatric Inventory Questionnaire) of either depressive symptoms alone, apathy symptoms alone, both symptoms, or neither. A neuropsychological battery evaluated executive function, verbal fluency, verbal learning, working memory, and visuospatial reasoning. Analysis of covariance was used to assess group differences with age, sex, and education as covariates. Results: Groups included depressive symptoms only (n = 70), apathy symptoms only (n = 52), both (n = 68), or neither (n = 262). The apathy and depression + apathy groups performed worse than the neither group on tests of working memory (t(312) = −2.4, p = 0.02 and t(328) = −3.8, p = 0.001, respectively) and visuospatial reasoning (t(301) = −2.3, p = 0.02 and t(321) = −2.6, p = 0.01, respectively). The depression, apathy, and depression + apathy groups demonstrated a similar degree of impairment on tests of executive function, processing speed, verbal fluency, and verbal learning when compared to participants without apathy or depression. Sex‐stratified analyses revealed that compared to the male neither group, the male apathy and depression + apathy groups were impaired broadly across all cognitive domains except for working memory. Females with depression alone showed deficits on tests of executive function (t(166) = 2.4, p = 0.01) and verbal learning (t(167) = −4.3, p = 0.001) compared to the female neither group. Conclusions: This study demonstrated that in neurodegenerative diseases, apathy with or without depression in males was associated with broad cognitive impairments. In females, depression was associated with deficits in executive function and verbal learning. These findings highlight the importance of effectively treating apathy and depression across the spectrum of neurodegenerative disorders with the goal of optimizing neuropsychological outcomes. Key points: Apathy and depression are common symptoms that patients with dementia face during the course of illness, and these symptoms are associated with impairments in several cognitive domains.We examined differences in cognitive performance between patients with either apathy alone, depression alone, both, or neither across a combined cohort with mild or major neurodegenerative disorders. Further, we evaluated this relationship within each sex.Among males, apathy with or without depression was associated with broad cognitive deficits. In females, depression was associated with deficits in executive function and verbal learning.These findings highlight the importance of effectively treating apathy and depression across the spectrum of neurodegenerative disorders with the goal of optimizing neuropsychological outcomes. [ABSTRACT FROM AUTHOR]

The article discusses research conducted to investigate the physician-related predictors of reporting individuals with mild cognitive impairment and mild dementia to transportation authorities in Ontario, Canada. Researchers evaluated the case scenarios of 26 patients with either mild cognitive impairment or dementia. They found that the sex of physicians was the only predictor of reporting drivers with cognitive impairment and that female physicians were less likely than men to report drivers.

Objectives Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. Methods We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g. listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. Results Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95–0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94–0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03–1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04–1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08–1.19). Discussion Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation. [ABSTRACT FROM AUTHOR]

Background Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. Methods Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. Results A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [ SD ] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD  = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81–9.84) compared to the lowest risk group. Conclusions For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation. [ABSTRACT FROM AUTHOR]

Objectives The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50–2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85–4.06). Discussion Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation. [ABSTRACT FROM AUTHOR]

With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application. [ABSTRACT FROM AUTHOR]

Abstract: Emphysematous pyelonephritis is a rare, but potentially lethal, possible sequela of nephrolithiasis, occurring most commonly in diabetic patients. The diagnosis of emphysematous pyelonephritis relies on the radiologic finding of gas in the renal parenchyma. We present the case of a patient with sarcoidosis, diabetes, and obstructing, gas-containing ureteral stones. Gas-containing renal stones are exceedingly rare, but have been linked to serious renal infections. The case management and a brief review of the published reports follow. We propose that gas-containing stones be considered evidence of emphysematous pyelonephritis in certain clinical settings. [Copyright &y& Elsevier]

Limited studies have investigated the effects of cannabis use on driving among older adults, who represent the fastest growing segment of drivers globally. We conducted a systematic review and meta-analysis to evaluate the effects of delta-9-tetrahydrocannabinol (THC) exposure on risks of (1) motor vehicle collisions (MVC) and (2) culpability for MVCs among adults 50 years and older. Three reviewers screened 7022 studies identified through MEDLINE, EMBASE, CENTRAL, and PsycINFO. Odds Ratios (OR) were calculated using the Mantel-Haenszel method in Review Manager 5.4.1. Heterogeneity was assessed using I2. The National Heart, Lung, and Blood Institute tool was used to assess the quality of each study. Seven cross-sectional studies were included. Three studies evaluated culpability while four evaluated MVC. The pooled risk of MVC was not significantly different between THC-positive and THC-negative older drivers (OR, 95% CI 1.15 [0.40, 3.31]; I2 = 72%). In culpability studies, THC exposure was not significantly associated with an increased risk of being culpable for MVC among adults over the age of 50 (OR, 95% CI 1.24 [0.95, 1.61]; I2 = 0%). Inspection of funnel plots did not indicate publication bias. Our review found that THC exposure was not associated with MVC involvement nor with culpability for MVCs. [ABSTRACT FROM AUTHOR]

The authors discuss how much unnecessary treatment exists within health care service delivery systems and how medical professionals can identify and manage it. Topics mentioned include brief information on off-label drug use, the notion of eliminating low-value practices, and the estimated number of practices identified by the National Institute for Health and Clinical Excellence from 1999 to 2016 that are not effective or good value.

Background and Objectives The prospect of automated vehicles (AVs) has generated excitement among the public and the research community about their potential to sustain the safe driving of people with dementia. However, no study to date has assessed the views of people with dementia on whether AVs may address their driving challenges. Research Design and Methods This mixed-methods study included two phases, completed by nine people with dementia. Phase I included questionnaires and individual semistructured interviews on attitudes toward using different types of AVs (i.e. partially or fully automated). Interpretative phenomenological analysis was used to assess participants' underlying reasons for and against AV use. The participants' identified reasons against AV use informed the focus group discussions in Phase II, where participants were asked to reflect on potential means of overcoming their hesitancies regarding AV use. Results The results showed that people with dementia might place higher levels of trust in fully automated compared to partially automated AVs. In addition, while people with dementia expressed multiple incentives to use AVs (e.g. regaining personal freedom), they also had hesitations about AV use. These hesitancies were based on their perceptions about AVs (e.g. cost), their own abilities (i.e. potential challenges operating an AV), and driving conditions (i.e. risk of driving in adverse weather conditions). Discussion and Implications The findings of this study can help promote the research community's appreciation and understanding of the significant potential of AVs for people with dementia while elucidating the potential barriers of AV use by people with dementia. [ABSTRACT FROM AUTHOR]

• Systematic review conducted to establish the crash risk for drivers with sleep disorders. • 39 studies met the inclusion criteria, with 14 published in the last decade. • 18 of the 27 studies investigating MVC risk associated with sleep apnoea reported an increased risk, 7 reported no difference, and 2 two provided inconclusive findings. • All 5 studies investigating MVC risk associated with disorders of hypersomnolence and narcolepsy reported an increased risk. • Only two studies investigated MVC risk associated with insomnia, with inconsistent findings. • Weight of evidence suggests a moderately elevated MVC risk for drivers with sleep disorders (sleep apnoea; hypersomnia and narcolepsy), and lower risk with treatment. In many parts of the world, drivers with serious sleep disorders have restrictions on their licence – with the fitness-to-drive criteria varying across licensing jurisdictions. This study aimed to systematically review the literature that evaluated the available scientific evidence for the relationship between sleep disorders and two driving safety outcome measures: (i) motor vehicle crashes (MVC) and (ii) on-road driving test outcome. This review was registered with PROSPERO in July 2019 (see CRD42019144643). A systematic search of public health, psychology and transport databases was conducted on November 8th, 2019. The quality of evidence for each study was rated using the National Heart, Lung and Blood Institute Quality Assessment tools. Thirty-nine studies published between 1976 and 2015 met the inclusion criteria (n = 9 case-control; n = 24 cohort/cross-sectional; n = 6 before-after). Overall, the quality of evidence for 22 studies was rated as 'good', nine as 'fair' and eight as 'poor'. Included studies addressed: sleep apnoea and sleep-related breathing disorders (n = 35); central disorders of hypersomnolence and narcolepsy (n = 5), and insomnia (n = 2), with some studies covering multiple sleep disorders. Of the thirty-five studies specifically investigating MVC risk associated with sleep apnoea, eighteen studies reported an increased risk (n = 11 'good', n = 4 'fair', n = 3 'poor' quality), seven reported no difference in risk (n = 3 'good', n = 4 'fair' quality), and two provided inconclusive findings (n = 1 'good', n = 1 'fair' quality). Most studies suggested that increased sleep apnoea severity was associated with an increased MVC risk. Furthermore, untreated sleep apnoea was predominantly associated with increased risk, whilst decreased risk was associated with Continuous Positive Airway Pressure (CPAP) and uvulopalatopharyngoplasty (UPPP) treatments. Five studies (n = 3 'good', n = 2 'fair' quality) investigated MVC risk associated with disorders of hypersomnolence and narcolepsy, and all reported increased risk. Only two studies investigated MVC risk associated with insomnia, with inconsistent findings: one reporting increased MVC risk ('good') and one reporting no difference ('fair'). Regarding impacts on on-road driving test outcome, our comprehensive search found no studies investigating the association between sleep disorders and this driving safety outcome measure. Notwithstanding the limitations of the included studies, the weight of evidence suggests a moderately elevated MVC risk for drivers with sleep disorders (sleep apnoea; hypersomnia and narcolepsy), with the majority reporting around two and a half times higher risk, and lower risk with treatment. This evidence is consistent with current fitness-to-drive guidelines, most of which specify licence restrictions conditional upon severity, treatment compliance and effective response to treatment. The generalisability of the findings is limited as many identified studies had methodological limitations, were conducted across a wide time period, in numerous licensing jurisdictions with different requirements, and across a diverse range of participant populations. A large-scale, population-based controlled study, in multiple licensing jurisdictions with equivalent licensing and fitness-to-drive requirements, is warranted to rigorously investigate MVC risk and sleep disorders, including evaluating the possible benefit of therapies. [ABSTRACT FROM AUTHOR]

Background and Objectives Driving cessation is a complex challenge with significant emotional and health implications for people with dementia, which also affects their family care partners. Automated vehicles (AVs) could potentially be used to delay driving cessation and its adverse consequences for people with dementia and their care partners. Yet, no study to date has investigated whether care partners consider AVs to be potentially useful for people with dementia. Research Design and Methods This mixed-methods study assessed the views of 20 former or current family care partners of people with dementia on AV use by people with dementia. Specifically, questionnaires and semistructured interviews were used to examine care partners' acceptance of AV use by people with dementia and their views about the potential usefulness of AVs for people with dementia. Results The results demonstrated that care partners identified possible benefits of AV use by people with dementia such as their anticipated higher social participation. However, care partners also voiced major concerns around AV use by people with dementia and reported significantly lower levels of trust in and perceived safety of AVs if used by the person with dementia in their care compared to themselves. Care partners' concerns about AV use by people with dementia included concerns around the driving of people with dementia that AVs are not designed to address; concerns that are specific to AVs but are not relevant to the nonautomated driving of people with dementia; and concerns that arise from existing challenges around the nonautomated driving of people with dementia but may be exacerbated by AV use. Discussion and Implications Findings from this study can inform future designs of AVs that are more accessible and useful for people with dementia. [ABSTRACT FROM AUTHOR]

This study examined serum cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) oxylipins and depressive symptoms together in relation to cognitive performance in individuals with type 2 diabetes mellitus (T2DM). Clinically cognitively normal T2DM individuals were recruited (NCT04455867). Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II; total scores ≤13 indicated minimal depressive symptoms and ≥ 14 indicated significant depressive symptoms). Executive function and verbal memory were assessed. Fasting serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass-spectrometry. The study included 85 participants with minimal depressive symptoms and 27 with significant symptoms (mean age: 63.3 ± 9.8 years, 49 % women). In all participants, higher concentrations of linoleic acid derived sEH (12,13-dihydroxyoctadecamonoenoic acid; DiHOME) and CYP450 (12(13)-epoxyoctadecamonoenoic acid; EpOME) metabolites were associated with poorer executive function (F 1,101 = 6.094, p = 0.015 and F 1,101 = 5.598, p = 0.020, respectively). Concentrations of multiple sEH substrates interacted with depressive symptoms to predict 1) poorer executive function, including 9(10)-EpOME (F 1,100 = 12.137, p < 0.001), 5(6)-epoxyeicosatrienoic acid (5(6)-EpETrE; F 1,100 = 6.481, p = 0.012) and 11(12)-EpETrE (F 1,100 = 4.409, p = 0.038), and 2) verbal memory, including 9(10)-EpOME (F 1,100 = 4.286, p = 0.041), 5(6)-EpETrE (F 1,100 = 6.845, p = 0.010), 11(12)-EpETrE (F 1,100 = 3.981, p = 0.049) and 14(15)-EpETrE (F 1,100 = 5.019, p = 0.027). Associations of CYP450-sEH metabolites and depressive symptoms with cognition highlight the biomarker and therapeutic potential of the CYP450-sEH pathway in T2DM. • Pro-resolving fatty acid epoxides are generated by cytochrome p450s. • Epoxide hydrolases (e.g. sEH) produce inert or toxic diols from fatty acid epoxides. • Higher diols in serum were associated with poor cognitive performance in diabetes. • Serum epoxides were associated with poorer cognition only in those with depression. • Depression in diabetes may involve sEH, which produces markers of poor cognition. [ABSTRACT FROM AUTHOR]

Objective: Depression in patients with Alzheimer's disease (AD) is common (15% to 63%) and is associated with significant morbidity and increased mortality. Our objective was to quantitatively summarize the data on the efficacy and safety of antidepressant treatment for depression complicating AD.Method: We performed a metaanalysis of randomized, double-blind, placebo-controlled trials of antidepressants with a database search of the English literature (up to 2006) and a manual search of references in the retrieved articles. We extracted the proportion of subjects who responded and remitted, experienced adverse events (AEs), discontinued treatment due to AEs, or discontinued treatment for any reason. Cognition scores were also extracted.Results: We included 5 studies, which involved 82 subjects treated with antidepressants and 83 subjects who received placebo treatment. Antidepressants were superior to placebo for both treatment response (odds ratio [OR] 2.32; 95% confidence interval [CI], 1.04 to 5.16) and remission of depression (OR 2.75; 95% CI, 1.13 to 6.65). There were no significant differences between the 2 groups for change in cognition (weighted mean difference -0.71, 95% CI, -3.20 to 1.79), overall dropouts (OR 0.70; 95% CI, 0.29 to 1.66) or dropout due to AEs (OR 1.41; 95% CI 0.36 to 5.54). The numbers needed to treat for one additional AD patient to respond to antidepressant treatment were 5 (95% CI, 3 to 59) and 5 (95% CI, 2 to 24) for remission of depression.Conclusions: Antidepressant treatment for depression in AD is efficacious, with rates of discontinuation that are comparable to placebo. Nonetheless, clinicians must be vigilant regarding the potential side effects of antidepressants in this population. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that estrogen has beneficial effects on Alzheimer’s disease. However, the mechanisms underlying estrogen’s neuroprotective effects are not completely understood. In the present study, we analyzed first whether estrogen protects mature hippocampal neurons against fibrillar Aβ-induced neurotoxicity. 17α-Estradiol and 17β-estradiol partially prevented neuronal death induced by fibrillar Aβ. Estrogen-induced neuroprotection correlated with the formation of a more dynamic microtubular system, including an increase in the pool of unstable microtubules and the expression of juvenile microtubule-associated proteins MAP2c and MAP1b. These results provide further evidence that experimental conditions capable of increasing the pool of unstable microtubules might render mature hippocampal neurons resistant to the degeneration caused by fibrillar Aβ deposits. [Copyright &y& Elsevier]

Background: Increasing evidence implicates oxidative stress (OS) in Alzheimer disease (AD) and mild cognitive impairment (MCI). Depletion of the brain antioxidant glutathione (GSH) may be important in OS-mediated neurodegeneration, though studies of post-mortem brain GSH changes in AD have been inconclusive. Recent in vivo measurements of the brain and blood GSH may shed light on GSH changes earlier in the disease. Aim: To quantitatively review in vivo GSH in AD and MCI compared to healthy controls (HC) using meta-analyses. Method: Studies with in vivo brain or blood GSH levels in MCI or AD with a HC group were identified using MEDLINE, PsychInfo, and Embase (1947–June 2020). Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for outcomes using random effects models. Outcome measures included brain GSH (Meshcher-Garwood Point Resolved Spectroscopy (MEGA-PRESS) versus non-MEGA-PRESS) and blood GSH (intracellular versus extracellular) in AD and MCI. The Q statistic and Egger's test were used to assess heterogeneity and risk of publication bias, respectively. Results: For brain GSH, 4 AD (AD=135, HC=223) and 4 MCI (MCI=213, HC=211) studies were included. For blood GSH, 26 AD (AD=1203, HC=1135) and 7 MCI (MCI=434, HC=408) studies were included. Brain GSH overall did not differ in AD or MCI compared to HC; however, the subgroup of studies using MEGA-PRESS reported lower brain GSH in AD (SMD [95%CI] −1.45 [−1.83, −1.06], p<0.001) and MCI (−1.15 [−1.71, −0.59], z=4.0, p<0.001). AD had lower intracellular and extracellular blood GSH overall (−0.87 [−1. 30, −0.44], z=3.96, p<0.001). In a subgroup analysis, intracellular GSH was lower in MCI (−0.66 [−1.11, −0.21], p=0.025). Heterogeneity was observed throughout (I2 >85%) and not fully accounted by subgroup analysis. Egger's test indicated risk of publication bias. Conclusion: Blood intracellular GSH decrease is seen in MCI, while both intra- and extracellular decreases were seen in AD. Brain GSH is decreased in AD and MCI in subgroup analysis. Potential bias and heterogeneity suggest the need for measurement standardization and additional studies to explore sources of heterogeneity. [ABSTRACT FROM AUTHOR]

Highlights • A 21-item, three-factor version of the DBQ was confirmed in a sample of Canadian older drivers. • Older drivers' responses to this version of the DBQ were stable across four years. • Older drivers' errors, violations and lapses remained similar across four years. Abstract The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine whether older drivers' DBQ scores changed across time. Five hundred and sixty Canadian older drivers (males = 61.3%) from the Candrive/Ozcandrive longitudinal study completed the DBQ yearly for four years across five time-points that were approximately 12 months apart. In Year 1, the average age of the older drivers was 76.0 years (SD = 4.5 years; Range = 70–92 years). Findings from the study support the 21-item, three-factor DBQ structure suggested by Koppel and colleagues for an Australian sample of older drivers as being acceptable in an independent sample of Canadian older drivers. In addition, Canadian older drivers' responses to this version of the DBQ were stable across the five time-points. More specifically, there was very little change in older drivers' self-reported violations, and no significant change for self-reported errors or lapses. The findings from the current study add further support for this version of the DBQ as being a suitable tool for examining self-reported aberrant driving behaviours in older drivers. Future research should investigate the relationship between older drivers' self-reported aberrant driving behaviours and their performance on functional measures, their responses to other driving-related abilities and practice scales and/or questionnaires, as well their usual (or naturalistic) driving practices and/or performance on on-road driving tasks. [ABSTRACT FROM AUTHOR]