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Sabrina Castellano,1 Carla Torrent,2 Maria Cristina Petralia,3 Justyna Godos,4 Rita Anna Cantarella,5 Andrea Ventimiglia,6 Simona De Vivo,6 Silvia Platania,1 Maria Guarnera,7 Concetta Pirrone,1 Filippo Drago,4 Eduard Vieta,2 Santo Di Nuovo,1 Dina Popovic,2,8,* Filippo Caraci4,9,* 1Department of Educational Sciences, University of Catania, Catania, Italy; 2Barcelona Bipolar Disorders Program, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; 3IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy; 4Oasi Research Institute-IRCCS, Troina 94018, Italy; 5Department of Mental Health, ASP3 Catania, Catania, Italy; 6Villa dei Gerani Clinic ASP3 Catania, Catania, Italy; 7Faculty of Human and Social Sciences, University of Enna “KORE”, Enna, Italy; 8Bipolar Disorders Program, Sheba Medical Center, Ramat Gan, Israel; 9Department of Drug Sciences, University of Catania, Catania, Italy*These authors contributed equally to this workCorrespondence: Sabrina CastellanoDepartment of Educational Sciences, University of Catania, Via Ofelia 1, Catania 95124, ItalyTel +39 0952508060Fax +39 0952508070Email sabrina.castellano@unict.itBackground: Cognitive dysfunction represents a distinct biological and clinical dimension in major depression disorders (MDD) and cognitive performance strongly affects psychosocial functioning in patients diagnosed with MDD.Objective: To assess which neurocognitive variables at baseline predict the functional outcome of MDD patients in a 1-year follow-up study as assessed by Functioning Assessment Short Test (FAST) and whether the improvement observed on affective and cognitive symptoms in our 12 week-prospective observational study after treatment with selective serotonin reuptake inhibitors (SSRIs) and selective noradrenalin reuptake inhibitors (SNRIs) can affect the following long-term psychosocial functional outcome at 1 year in the same MDD patients.Methods: We recruited a total of 31 patients (8 males; 23 females) with MDD who had previously completed a pharmacological treatment with SSRIs (n = 22) or SNRIs (n = 9) for 12 weeks, and then continued the same pharmacological treatment for 1 year. After an average 1-year follow-up, they were interviewed with the FAST to assess functional outcome. Multivariate analyses were applied to identify clinical and neurocognitive predictors of functional outcome.Results: Total Montreal Cognitive Assessment (MoCA), Digit Span forward (Span F) and backward (Span B), and 15 Rey words immediate recall (Rey I) scores significantly correlated with FAST. However, after performing regression models only Rey immediate recall score was useful to predict long-term functional outcome (Pearson correlation coefficient R= − 0.68, p

Javier Mar,1–4 Arantzazu Arrospide,2–4 Myriam Soto-Gordoa,5 Álvaro Iruin,4,6 Mikel Tainta,7,8 Andrea Gabilondo,4,6 Lore Mar-Barrutia,9 Montserrat Calvo,10 Maider Mateos,10 Oliver Ibarrondo2,41Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, España; 2AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, España; 3Economic Evaluation Department, Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Spain; 4Economic Evaluation Department, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; 5Departamento de Ingeniería de Organización, Mondragón Unibertsitatea, Arrasate-Mondragón, España; 6Psychiatry Service, Gipuzkoa Mental Health Network, Donostia-San Sebastián, España; 7Psychiatry Service, CITA Alzheimer Foundation, Donostia-San Sebastián, España; 8Neurology Service, OSI Goierri-Alto Urola, Zumárraga, España; 9Psychiatry Service, Hospital Bellvitge, Hospitalet de Llobregat, España; 10Health Department, Basque Government, Vitoria-Gasteiz, EspañaBackground: Dementia-related neuropsychiatric symptoms (NPS) are the main determinant of family stress and institutionalization of patients. This study aimed to identify inequalities by gender and socioeconomic status in the management of NPS in patients diagnosed with dementia.Methods: An observational study was carried out to study all the cases of dementia in the corporate database of the Basque Health Service (29,864 patients). The prescription of antipsychotics and antidepressants and admission to a nursing home were used to establish the presence of NPS. The socioeconomic status of individuals was classified by a deprivation index. Logistic regressions were used to identify drivers for drug prescriptions and institutionalization.Results: NPS are poorly recorded in the clinical databases (12%). Neuropsychiatric symptoms were severe enough in two thirds of patients with dementia to be treated with psychoactive medication. Institutionalization showed an increase from those who did not receive medication to those who had been prescribed antidepressants (OR: 1.546), antipsychotics (OR: 2.075) or both (OR: 2.741). The resulting inequalities were the increased prescription of antidepressant drugs in women and more nursing-home admissions for women who were the least socioeconomically deprived and men who were the most deprived.Conclusions: In large clinical databases, psychoactive drugs prescriptions can be useful to underscore the considerable burden of dementia-related NPS. Specific tools are needed to monitor social and health care programs targeted to dementia-related NPS from a population perspective. Programs aimed at reducing the family burden of care of dementia patients at home become the key elements in reducing inequalities in these patients’ care. Socioeconomic status is the most important driver of inequality, and gender inequality may simply be hidden within the social environment. Integrated programs boosting the continuity of care are an objective for which compliance could be measured according to the NPS coding in the electronic health record.Keywords: neuropsychiatric symptoms, prevalence, dementia, antidepressant drugs, antipsychotic drugs, nursing home, inequalities, deprivation index

Giulia Perini,1,2 Matteo Cotta Ramusino,1,2 Elena Sinforiani,1 Sara Bernini,1 Roberto Petrachi,3 Alfredo Costa1,21Center of Cognitive and Behavioral Disorders, IRCCS Fondazione Mondino, National Institute of Neurology, Pavia, Italy; 2Department of Brain and Behavior, University of Pavia, Pavia, Italy; 3Unit of Mood Disorders, Psychiatry Service, ASST, Acqui Terme, Alessandria, ItalyAbstract: In the past, little or no attention was paid to cognitive disorders associated with depression (a condition sometimes termed pseudodementia). However, recent years have seen a growing interest in these changes, not only because of their high frequency in acute-stage depression, but also because they have been found to persist, as residual symptoms (in addition to affective and psychomotor ones), in many patients who respond well to antidepressant treatment. These cognitive symptoms seem to impact significantly not only on patients’ functioning and quality of life, but also on the risk of recurrence of depression. Therefore, over the past decade, pharmacological research in this field has focused on the development of new agents able to counteract not only depressive symptoms, but also cognitive and functional ones. In this context, novel antidepressants with multimodal activity have emerged. This review considers the different issues, in terms of disease evolution, raised by the presence of cognitive disorders associated with depression and considers, particularly from the neurologist’s perspective, the ways in which the clinical approach to cognitive symptoms, and their interpretation to diagnostic and therapeutic ends, have changed in recent years. Finally, after outlining the pharmacodynamics and pharmacokinetics of the first multimodal antidepressant, vortioxetine, it reports the main results obtained with the drug in depressed patients, also in consideration of the ever-increasing evidence on its different mechanisms of action in animal models.Keywords: depression, major depressive disorder, pseudodementia, antidepressant drugs, vortioxetine, SSRIs