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Background: Apathy is frequent and persistent in Alzheimer's disease (AD), associated with poor prognosis and carer distress; yet our knowledge of risk factors remains limited., Aims: To identify risk factors associated with apathy incidence and progression in AD over time., Methods: We systematically reviewed evidence based on longitudinal studies assessing risk factors for apathy in AD up to June 2021. Two authors independently assessed article eligibility and rated quality., Results: 13,280 articles were screened, of which 13 met inclusion criteria. Studies had a mean follow-up of 2.7 years reporting on a total of 2012 participants. Most findings were based on single studies of moderate quality evidence. Risk factors increasing apathy onset were: being a carrier of the T allele of the PRND gene polymorphism, and having high levels of the IL-6 and TNFα cytokines at baseline. Risk factors for apathy worsening were: reduced inferior-temporal cortical thickness, taking antidepressants, being an ApoE ε4 carrier, living longer with AD, lower cognitive test scores, higher baseline apathy, premorbid personality traits (lower agreeableness, higher neuroticism), and higher midlife motivational abilities., Conclusions: Although results are limited by the small number of studies, this review identified specific genetic, neurobiological, AD specific, and dispositional factors that may increase risk of apathy onset and worsening in AD., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Two groups of 100 children each who underwent adenoidectomy and/or tonsillectomy were anaesthetised by halothane 1% or by a neuroleptic technique (NLA) using fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg as a fixed combination (Thalamonal). Both techniques were supplemented with nitrous oxide/oxygen 4/2 l. All children were premedicated with atropine 0.015 mg/kg, fentanyl 0.0025 mg/kg and droperidol 0.125 mg/kg i.m. Quality of premedication and postoperative behaviour and analgesia were assessed by standardised criteria. 93% of the patients arrived at the theatre sleeping or detached, 75% showed almost no reactions to venipuncture. Heart rate during surgery in both groups increased by 13%, mean arterial blood pressure in the NLA group increased by 9% and in the halothane group dropped by 5%. Postoperatively blood pressure in NLA patients returned to normal, while in the halothane group there was a transient rise by 10%. Protective reflexes and consciousness were restored in the NLA group earlier. After halothane, stridor occurred in eight cases upon extubation. Postoperative analgesia scores in NLA patients were double those in the halothane group. Moderate metabolic acidosis and slight hypercapnia were postoperatively present in both groups twice. Modified neuroleptanaesthesia proved equal to halothane anaesthesia for ENT surgery. No respiratory depression was seen. Advantages like uncomplicated quick recovery and protracted postoperative analgesia are opposed by disadvantages like inferior vegetative blockade and inferior pharmacokinetics. Close postoperative supervision in a recovery room is a prerequisite to using this NLA technique.