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Objectives: Assessing for recovery in delirium is essential in guiding ongoing investigation and treatment. Yet, there is little scrutiny and no research or clinical consensus on how recovery should be measured. We reviewed studies which used tests of neuropsychological domains and functional ability to track recovery of delirium longitudinally in acute hospital settings. Methods/Design: We systematically searched databases (MEDLINE, PsycInfo, CINAHL, Embase, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials), from inception to October 14th, 2022. Inclusion criteria were: adult acute hospital patients (≥18 years) diagnosed with delirium by a validated tool; 1+ repeat assessment using an assessment tool measuring domains of delirium/functional recovery ≤7 days from baseline. Two reviewers independently screened articles, performed data extraction, and assessed risk of bias. A narrative data synthesis was completed. Results: From 6533 screened citations, we included 39 papers (reporting 32 studies), with 2370 participants with delirium. Studies reported 21 tools with an average of four repeat assessments including baseline (range 2–10 assessments within ≤7 days), measuring 15 specific domains. General cognition, functional ability, arousal, attention and psychotic features were most commonly assessed for longitudinal change. Risk of bias was moderate to high for most studies. Conclusions: There was no standard approach for tracking change in specific domains of delirium. The methodological heterogeneity of studies was too high to draw firm conclusions on the effectiveness of assessment tools to measure delirium recovery. This highlights the need for standardised methods for assessing recovery from delirium. Key points: Assessing for recovery is an essential part of delirium care, to guide clinicians' ongoing investigation and treatment and to provide accurate information to patients and carers.It is unclear what assessment tools are used to measure delirium recovery on a longitudinal basis, specifically which neuropsychological and functional domains should be assessed.A total of 21 assessment tools measuring 15 different symptom domains of delirium were used in the included studies, however, there was no standard approach for tracking change in these domains over time.The symptom domains most frequently assessed for longitudinal change in the included studies were general cognition, functional ability, arousal, attention and psychotic features. [ABSTRACT FROM AUTHOR]

Background: Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two‐thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co‐occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD. Method: Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual‐Fifth Edition, International Classification of Diseases—10th Revision (ICD‐10), or ICD‐11, and studies include individuals aged 60 years or older. Results: Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD. Conclusions and implications: Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed. Key points: Major depressive disorder and alcohol use disorders are the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD.Based on this, screening for trauma and PTSD should be included in older adults with depression and substance useQualitative epidemiological studies on psychiatric comorbidities, such as personality disorders, in older adults with PTSD are limited and needed. [ABSTRACT FROM AUTHOR]

Objectives: Problem adaptation therapy (PATH) is a relatively new psychotherapy that recognises the importance of simultaneously targeting cognitive impairment and functional disability in the treatment of late‐life depression. This is the first systematic review to examine the effectiveness of PATH. Methods: Ageline, Embase, Medline, PsycINFO, Scopus and ProQuest databases were searched from 2010 until 5 April 2024, for studies that evaluated PATH for older people. Where possible, effect sizes (Hedges' g) with 95% confidence intervals and p values were calculated and pooled using a random effects model. The reporting quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tools and certainty of the evidence behind each result assessed with The Grading of Recommendations Assessment, Development and Evaluation method. Results: Twelve papers, from seven independent studies and a pooled sample of 579 older adults with multiple comorbidities, were included in this review. PATH participants experienced immediate reductions in depression symptom ratings (gw = 0.72, p < 0.01, Nstudies = 5), alongside small improvements in disability (gw = 0.61, p = 0.04, Nstudies = 4) compared to peers that received supportive therapy, brief psychoeducation, or usual care. The overall evidence quality was, however, characterised by bias, inconsistency, and imprecision in effect estimates. Positive participant feedback and low dropout rates (15%–31%) suggested treatment satisfaction, although these data were not routinely provided. Conclusions: PATH may be a viable treatment for older people living with mental and cognitive disorders, however there is a need for more rigorous research incorporating follow‐up assessments to consolidate the effectiveness of PATH relative to other treatments. Incorporating measures of treatment fidelity are also critical to interpreting and generalising these data. The protocol for this study was prospectively published on the Open Science Framework (https://osf.io/gx57a). [ABSTRACT FROM AUTHOR]

Objectives: This systematic review and meta‐analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors. Methods: We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta‐analysis. Subgroup analyses and meta‐regression were employed to explore potential moderating variables and heterogeneity. Results: The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%–59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%–47.6%). Subgroup analyses and meta‐regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools. Conclusions: This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population. Key points: Informal carers of people with dementia contend with unique circumstances that render them susceptible to both loneliness and social isolation.There is a significant prevalence of loneliness and social isolation in informal carers of individuals with dementia.Several significant moderators influence the prevalence of loneliness and social isolation among informal carers of individuals with dementia.Moderator analysis can guide targeted interventions and support systems for at‐risk informal carers of people with dementia to alleviate loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Objective: Circadian rhythm disturbances, like sundowning, are seen in dementia. Because the circadian rhythm is regulated by the biological clock, melatonin might be effective in the treatment of these disturbances. We systematically studied the effect of melatonin treatment in patients with dementia. In addition, we elaborate on the possible effects one might expect of melatonin treatment in patients with delirium, since dementia and delirium are strongly related. Moreover, some evidence exists that sundowning in patients with dementia and the alterations in the sleep/wake cycle, seen in patients with delirium both originate from circadian rhythm disturbances. Design: A systematic search of the literature, published between 1985 and April 2009, was performed using PubMed and other databases. All papers on melatonin treatment in dementia were retrieved. Effects of melatonin on circadian rhythm disturbances were scored by means of scoring sundowning/ agitated behaviour, sleep quality and daytime functioning. Results: Nine papers, including four randomised controlled trials (RCTs) (n¼243), and five case series (n¼87) were reviewed. Two of the RCTs found a significant improvement on sundowning/agitated behaviour. All five case series found an improvement. The results on sleep quality and daytime functioning were inconclusive. Conclusion: Sundowning/agitated behaviour improves with melatonin treatment in patients with dementia. There are several arguments that sundowning in patients with dementia and the alterations in the sleep/wake cycle in patients with delirium have a common background, namely a disturbance of the circadian rhythm. This suggests that melatonin treatment could also have the same positive effects in patients with delirium. [ABSTRACT FROM AUTHOR]

Objective: The aim of this review is to determine whether automated computerised tests accurately identify patients with progressive cognitive impairment and, if so, to investigate their role in monitoring disease progression and/or response to treatment.Methods: Six electronic databases (Medline, Embase, Cochrane, Institute for Scientific Information, PsycINFO, and ProQuest) were searched from January 2005 to August 2015 to identify papers for inclusion. Studies assessing the diagnostic accuracy of automated computerised tests for mild cognitive impairment (MCI) and early dementia against a reference standard were included. Where possible, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess risk of bias.Results: Sixteen studies assessing 11 diagnostic tools for MCI and early dementia were included. No studies were eligible for inclusion in the review of tools for monitoring progressive disease and response to treatment. The overall quality of the studies was good. However, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that statistical analysis was not possible.Conclusion: Some tests have shown promising results for identifying MCI and early dementia. However, concerns over small sample sizes, lack of replicability of studies, and lack of evidence available make it difficult to make recommendations on the clinical use of the computerised tests for diagnosing, monitoring progression, and treatment response for MCI and early dementia. Research is required to establish stable cut-off points for automated computerised tests used to diagnose patients with MCI or early dementia. [ABSTRACT FROM AUTHOR]

Objective: To explore why people from minority ethnic (ME) groups with dementia present later to specialist diagnostic and therapeutic dementia services. We systematically reviewed the literature exploring how and why ME people with dementia present to specialist services. Method: We included qualitative and quantitative studies that explored pathways to dementia specialist care in ME groups or determinants of whether ME people with dementia accessed specialist services. Included studies were independently evaluated for quality by two authors. Results: We found 3 quantitative and 10 qualitative papers meeting our inclusion criteria. Barriers to accessing specialist help for dementia included: not conceptualising dementia as an illness; believing dementia was a normal consequence of ageing; thinking dementia had spiritual, psychological, physical health or social causes; feeling that caring for the person with dementia was a personal or family responsibility; experiences of shame and stigma within the community; believing there was nothing that could be done to help; and negative experiences of healthcare services. Recognition of dementia as an illness and knowledge about dementia facilitated accessing help. Conclusions: There are significant barriers to help seeking for dementia in ME groups. These may explain why people from ME groups often presented to therapeutic and diagnostic services at a late stage in their illness. Further study is needed to elucidate the role that ethnicity and culture play in the help-seeking pathway for dementia, and to design and test interventions to improve equity of access to healthcare services. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objects: Dementia has physical, social and economic impacts, causing considerable distress for people with age‐related cognitive impairment (PWACI) and their caregivers. Electronic health (e‐health) interventions can provide convenient education to improve the coping competence of caregivers and have become an important approach to supporting them. Understanding the economic evidence of e‐health interventions will facilitate the decision making and implementation of integrating e‐health into routine health services. The present review aimed to appraise economic evidence related to e‐health interventions for PWACI and their caregivers. Methods: We systematically searched multiple cross‐disciplinary databases from inception to February 28, 2023. Two reviewers independently selected the trials, assessed the quality, and checked the data. A descriptive‐analytical narrative method was used to analyze the review findings. Results: Thirteen studies were analyzed, including 12 randomized controlled trials and one quasi‐experimental study. All included studies were conducted in developed countries. The included studies reported limited economic information. There were six cost‐effectiveness analysis, five cost‐consequence analysis and one partial economic evaluation. The included studies were heterogeneous, and varied in quality. The results demonstrated that e‐health multicomponent interventions can reduce the cost of health service utilization in short term (10–104 weeks). Conclusions: Few studies calculated the incremental cost‐effectiveness ratio to evaluate the cost‐effectiveness of e‐health interventions. Preliminary evidence indicates that e‐health interventions can reduce the cost of health service utilization in the short term, but the cost‐effectiveness of e‐health interventions hasn't been identified. More robust evidence is needed to clarify the value of e‐health interventions for PWACI and their caregivers. Key points: This review identifies the characteristics of e‐health interventions for PWACI and their caregivers in economic evaluations through cost‐effectiveness analysis and cost‐consequence analysis.Preliminary evidence suggests that e‐health interventions can reduce the cost of health service utilization in the short term (10–104 weeks), but the cost‐effectiveness should be identified further.The results of this study contribute to the understanding of the economic effects of e‐health based on existing evidence and provide more robust evidence‐based practices.More long‐term and high‐quality economic evaluation trials are warranted to determine the value of e‐health interventions for PWACI and their caregivers. [ABSTRACT FROM AUTHOR]

Objectives: Neuropsychiatric symptoms (NPS) are highly prevalent in individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI), and are strongly linked to accelerated cognitive decline and dementia onset. While mindfulness‐based interventions have shown promise in improving psychological well‐being in clinical and community settings, their efficacy for individuals in these pre‐dementia stages remains unclear. This meta‐analysis examined the effects of mindfulness‐based interventions on NPS and psychological outcomes in these preclinical cohorts. Methods: Eligible studies were retrieved from PubMed, EMBASE, JBI EPB, Web of Science, and Cochrane library. Two independent researchers conducted the literature search and data extraction. Cochrane Risk‐of‐Bias Assessment Tool was used to assess the methodological quality of included studies. Quality of evidence was evaluated using the GRADE approach. Intervention effects were estimated by Hedge's g and 95% confidence interval (CI). Results: A total of 18 randomized controlled trials (including 974 participants from 21 studies) were included in the meta‐analysis. The results demonstrated statistically significant immediate post‐intervention effects of mindfulness‐based interventions on anxiety (g = −0.30, 95% CI −0.49 to −0.11), stress (g = −0.58, 95% CI −0.91 to −0.24), and quality of life (g = 0.50, 95% CI 0.12–0.87). However, no significant effects were found for depression, apathy, mindfulness, and stress‐related biomarkers. Follow‐up data analysis also did not reveal significant effects for depression and anxiety. Conclusions: The findings of this meta‐analysis suggest that mindfulness‐based interventions may improve anxiety, stress, and quality of life in individuals with SCD and MCI. However, more rigorous randomized controlled trials with larger sample sizes and evaluation using physiological parameters are needed to establish more definitive conclusions. Future interventions could consider incorporating cognitive training and health education to address the specific needs of the pre‐dementia population. Registration Number: PROSPERO: CRD42022359906. Key points: Neuropsychiatric symptoms are highly prevalent in individuals with subjective cognitive decline and mild cognitive impairment, and strongly associated with an increased risk of developing dementia.The effectiveness of mindfulness‐based interventions for individuals in the pre‐dementia stages is still uncertain, despite their widespread use in improving psychological well‐being among clinical and community populations.Mindfulness‐based interventions showed immediate beneficial effects on anxiety, stress, and quality of life compared to control treatments.More rigorous and large‐scale randomized controlled trials, evaluated using physiological parameters, are needed to ensure the robustness of study findings and draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Objective: High‐frequency, repetitive transcranial magnetic stimulation (rTMS) targeted over the dorsolateral prefrontal cortex (DLPFC) is widely used in research to promote neuroplasticity and cognitive enhancement. RTMS is a promising intervention to tackle cognitive decline in people with age‐related neurodegenerative diseases. However, there is currently no systematic evidence examining the effects of DLPFC‐targeted, high‐frequency rTMS on cognitive function in this population. The aim of this systematic review was to evaluate the efficacy and moderators of this treatment intervention. Methods: A comprehensive literature search of five electronic databases was performed to identify articles published before October, 2022. Following PRISMA guidelines, the identified articles were screened, data was extracted, and the methodological quality was assessed using the Cochrane tool, Risk of Bias 2. Meta‐analyses were performed using R Studio (v.4.1.2). Results: Sixteen studies involving 474 participants met the inclusion criteria, of which 8 studies measured global cognitive function. The results from the random‐effects meta‐analysis showed rTMS significantly improved global cognitive function relative to control groups shown by a large, significant effect size (g = 1.39, 95% CI, 0.34–2.43; p = 0.017). No significant effects were found between subgroups or for individual cognitive domains. Conclusions: High‐frequency rTMS, targeted over the DLPFC, appears to improve global cognitive function in people with age‐related neurodegenerative diseases. However, these results should be interpreted with caution due to the small number of studies included, and high between‐study heterogeneity. Key points: High‐frequency repetitive TMS over the dorsolateral prefrontal cortex significantly improved global cognitive function in people with age‐related neurodegenerative diseases, compared to control/sham stimulation. [ABSTRACT FROM AUTHOR]

Objectives: More people with dementia live in low‐ and middle‐income countries (LMICs) than in high‐income countries, but best‐practice care recommendations are often based on studies from high‐income countries. We aimed to map the available evidence on dementia interventions in LMICs. Methods: We systematically mapped available evidence on interventions that aimed to improve the lives of people with dementia or mild cognitive impairment (MCI) and/or their carers in LMICs (registered on PROSPERO: CRD42018106206). We included randomised controlled trials (RCTs) published between 2008 and 2018. We searched 11 electronic academic and grey literature databases (MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Global Health, World Health Organization Global Index Medicus, Virtual Health Library, Cochrane CENTRAL, Social Care Online, BASE, MODEM Toolkit) and examined the number and characteristics of RCTs according to intervention type. We used the Cochrane risk of bias 2.0 tool to assess the risk of bias. Results: We included 340 RCTs with 29,882 (median, 68) participants, published 2008–2018. Over two‐thirds of the studies were conducted in China (n = 237, 69.7%). Ten LMICs accounted for 95.9% of included RCTs. The largest category of interventions was Traditional Chinese Medicine (n = 149, 43.8%), followed by Western medicine pharmaceuticals (n = 109, 32.1%), supplements (n = 43, 12.6%), and structured therapeutic psychosocial interventions (n = 37, 10.9%). Overall risk of bias was judged to be high for 201 RCTs (59.1%), moderate for 136 (40.0%), and low for 3 (0.9%). Conclusions: Evidence‐generation on interventions for people with dementia or MCI and/or their carers in LMICs is concentrated in just a few countries, with no RCTs reported in the vast majority of LMICs. The body of evidence is skewed towards selected interventions and overall subject to high risk of bias. There is a need for a more coordinated approach to robust evidence‐generation for LMICs. Key points: While the majority of people with dementia reside in low‐ and middle‐income countries (LMICs), it is not known what types of interventions have been studied in these settings and how effective they are.We conducted the first comprehensive mapping study of interventions for people with dementia or mild cognitive impairment (MCI) and/or their carers in LMICs.This high‐level overview of dementia intervention research in LMICs identified the following gaps: dementia intervention research is highly concentrated in just a few LMICs, and skewed towards Traditional Chinese Medicine, Western pharmaceuticals, and supplements, with comparatively little evidence generated on interventions for carers.Lack of robust and locally relevant evidence on effective interventions presents a substantial challenge to designing evidence‐based treatment and care systems that help people with dementia or MCI and their carers to live better lives. [ABSTRACT FROM AUTHOR]

Objectives: Identification of inappropriate medications in people living with severe dementia is a complex task which has the potential to reduce avoidable adverse events and increase quality of life. This scoping review (i) identifies published tools intended to aid deprescribing in people living with severe dementia and (ii) describes evaluations of their usefulness in clinical practice. Methods: A scoping review was undertaken, with Medline, Medline in Process, EMBASE, Cochrane Library, CINAHL, Scopus and Web of Science databases, from inception to April 2023, identifying tools for deprescribing in severe dementia. A tool was considered as any resource for deprescribing, including clinical study, scientific publication, health guideline, website, algorithm, model or framework. Two reviewers assessed the eligibility of articles through abstract and full text review. Data extracted from included studies were summarized through narrative synthesis. Results: Twelve studies were identified from 18,633 articles screened. Tools were categorized into three groups: deprescribing interventions (n = 2), consensus‐based deprescribing criteria (n = 5), and medication‐specific recommendations (n = 5). Six studies developed tools using expert opinion and ten tools were tested in people living with severe dementia. Only one of the four studies that evaluated patient outcomes (cognitive change and adverse events) identified clear clinical benefit from medication withdrawal. Conclusions: Clinical application of current deprescribing tools is limited due to the lack of evidence‐based research on the clinical effects of individual medication deprescribing in people with severe dementia. Further research on patient outcomes, including cognitive change and adverse events, will help clarify the role of these tools in clinical care. Key points: Twelve studies were identified describing deprescribing tools for use in people living with severe dementia.Few tools provided evidence‐based recommendations, with many tools designed through expert opinion.Most tools tested in study populations that observed patient outcomes could not conclude clear clinical benefit from medication withdrawals. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative delirium (POD) is a common postsurgical complication. The early identification of its risk factors is the first step toward reducing POD. The predictive factors for POD in patients after major abdominal surgery remain obscure. Therefore, this meta‐analysis aimed to comprehensively summarize the risk factors of POD after major abdominal surgery. Methods: POD studies published between January, 1900 and June 2022 were obtained by searching PubMed, Cochrane Library, Web of Science, Embase, and Medline. Two authors independently reviewed the studies to extract the risk factors and assessed the quality of related articles using the Newcastle‐Ottawa Scale. Data were recorded, and a meta‐analysis was performed using Review Manager version 5.4.1. Results: Ten studies including total 2900 patients undergoing major abdominal surgery, were eligible for analysis, 608 of whom developed POD, for a cumulative incidence of 21%. This pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini‐Mental State Examination score, cognitive impairment, preoperative Katz‐ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin‐like growth factor‐1 levels, and longer duration of anesthesia. Conclusion: POD is common in patients undergoing major abdominal surgery. This meta‐analysis identified risk factors that may aid the early detection of POD and play a prominent role in preventing POD. Key points: Our report was the first to comprehensively summarize the related risk factors for postoperative delirium (POD) after major abdominal surgery; the results of this pooled analysis suggested the statistically significant risk factors for POD were age, higher American Society of Anesthesiologists grade, lower preoperative Mini‐Mental State Examination score, cognitive impairment, preoperative Katz‐ADL score <6, preoperative and postoperative hypoalbuminemia, lower preoperative insulin‐like growth factor‐1 levels, and longer durations of anesthesia, which may better predict the risk of POD. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of educational interventions about dementia, directed at primary care providers (PCPs). Design: We searched Medline, Embase, PsycInfo, Cinahl and the Cochrane library for relevant articles. Two researchers independently assessed the citations identified against the following inclusion criteria: educational intervention on dementia directed at PCPs and study designs being randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) or interrupted time series (ITS) analyses. Outcomes of interest were PCPs’ knowledge and attitude on dementia, and quality of dementia care at PCP and patient level. Results: Of 3953 citations identified, six articles representing five studies (four cluster RCTs and one CBA) were eligible, describing educational interventions directed at 1904 PCPs. Compliance to the interventions varied from 18 to 100%. Systematic review of the studies showed moderate positive results. Five articles reported at least some effects of the interventions. A small group workshop and a decision support system (DSS) increased dementia detection rates. An interactive 2-h seminar raised GPs’ suspicion of dementia. Adherence to dementia guidelines only improved when an educational intervention was combined with the appointment of dementia care managers. This combined intervention also improved patients’ and caregivers’ quality of life. Effects on knowledge and attitudes were minor. Conclusion: Educational interventions for PCPs that require active participation improve detection of dementia. Educational interventions alone do not seem to increase adherence to dementia guidelines. To effectively change professionals’ performance in primary dementia care, education probably needs to be combined with adequate reimbursement or other organizational incentives. Copyright # 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to conduct a meta-analysis of epidemiological and case control studies to determine whether arterial hypertension is specifically associated with an increased risk of vascular dementia (VaD). Design: Longitudinal and cross-sectional prospective studies using operationalised criteria to define VaD and hypertension, with a normal control comparison group were systematically reviewed. Cochrane Library, Embase, Medline, and PsycInfo data sources were searched along with reference lists of included articles and reviews. Original, prevalence or incidence studies were included if operationalised criteria for hypertension and VaD as well as number of cases with and without hypertension in VaD and nondemented groups were provided. Intervention studies and post-stroke and CADASIL studies were excluded. Results: Eleven studies recruiting either volunteers or clinical patients, or which were population-based, examined a total of 768 people with VaD and 9857 control cases. A meta-analysis of the six longitudinal studies showed that hypertension was significantly associated with increased risk of incident VaD (odds ratio, OR: 1.59, CI: 1.29–1.95, p<0.0001). A similar association between hypertension and the risk of prevalent VaD was found in the five cross-sectional studies (OR: 4.84, CI: 3.52–6.67, p<0.00001). Conclusions: Hypertension significantly increases the risk of vascular dementia. The current metaanalysis highlights the potential importance of rigorous treatment of hypertension as a key measure to help prevent the development of VaD. [ABSTRACT FROM AUTHOR]

Objective: ApoE4 is a risk factor for the development of Alzheimer’s disease, and has a functional role suggesting its importance in the neuropathology of dementia. We present a meta-analysis to investigate whether ApoE4 also affects the clinical progression of dementia in terms of cognitive decline or mortality. Methods: We searched Medline, Embase and PsychINFO from 1990 until April 2009, for case control or cohort studies which investigated the effect of ApoE4 on progression of dementia. We identified 427 studies; 17 were suitable for inclusion. In total, there were 1733 participants with dementia at baseline, of whom 975 were heterozygous or homozygous for ApoE4. Results: There was no significant difference in cognitive decline (random-model effect size = 0.02; 95% C.-I.: -0.09 to 0.14; p = 0.67) or mortality (random-model pooled odds ratio = 0.74; 95% C.-I.: 0.36 to 1.53; p = 0.41) based on the presence of ApoE4. There was no significant heterogeneity between studies using cognitive decline as an outcome. In meta-regressions of cognitive decline, duration of symptoms, age, gender and frequency of participants with ApoE4 in the samples did not contribute to outcome. Conclusion: Different ApoE alleles do not modify the speed of clinical progression of dementia in a way that would be detectable in a sample of 1700 patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy and tolerability of citalopram when compared to other antidepressants for late-life depression (LLD). Methods: We searched electronic databases and trial registries to identify randomized controlled trials comparing citalopram to other antidepressants for LLD. Study quality was assessed using the Cochrane collaboration risk of bias tool. We summarized the efficacy of citalopram compared to other antidepressants by examining rates of depression remission, depression response and change in depression symptom scores. Medication tolerability was assessed through trial withdrawals due adverse events and withdrawals due to any cause. We used meta-analysis to determine the odds ratios (OR) of efficacy and tolerability outcomes for citalopram compared to other antidepressants. Results: Seven studies comparing citalopram (N¼647) to other antidepressants (N¼641) for LLD were identified including four studies with tricyclic comparators and three studies with non-tricyclic comparators. Most of the studies had methodological limitations that placed them at risk for potential bias. The majority of studies reported no significant differences between citalopram and comparator medications for depression efficacy or tolerability outcomes. Meta-analysis did not find any significant differences between citalopram and other antidepressants for depression remission [OR¼0.84; 95%CI: 0.56–1.28] or for trial withdrawals due to adverse effects [OR¼0.70; 95%CI: 0.48–1.02]. Conclusions: Currently there are few studies directly comparing citalopram to other antidepressants for LLD. The small number of studies and methodological issues in many studies limit any conclusions about the relative efficacy and tolerability of citalopram compared to other antidepressants. Well designed studies comparing citalopram to other antidepressants for LLD are required. [ABSTRACT FROM AUTHOR]