Search

Background:In clinical practice, Second Generation Antipsychotics (SGAs) are often used as first-line treatment for the Behavioral and Psychological Symptoms of Dementia (BPSD) in older adults due to their fewer neurological adverse events and similar effectiveness compared with First Generation Antipsychotics (FGAs). SGAs, however, are associated with more severe metabolic side effects (weight gain, hyperglycemia, diabetes risk, and hyperlipidemia) than FGAs are. In general, older patients, especially those affected by dementia, are at increased risk for malnutrition, and tend to have lower basal metabolism and reduced liver and kidney function. However, little is known about the metabolic side effects of antipsychotic drugs in this population.Methods:A comprehensive review of the literature published between January 1996 and December 2012 investigating the metabolic side effects related to FGAs and SGAs use in old patients affected by dementia.Results:Antipsychotic drugs currently used to treat BPSD in subjects with mild to moderate dementia are associated with weight gain. Currently, there are insufficient data to support a causal relationship between the use of FGAs and SGAs and changes in glucose homeostasis or lipid metabolism in older persons affected by severe dementia (MMSE <14).Conclusion:A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals. [ABSTRACT FROM AUTHOR]

A total of 7,389 dementia-free elderly (60-102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ≤ 2 standard deviations than the age- and education-corrected mean score obtained by the nondemented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI = 1.6, 1.2-2.2), stroke (OR, 95%CI = 1.9, 1.4-2.6), and depressive symptoms (OR, 95%CI = 1.9, 1.4-2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI = 1.8, 1.1-2.9), low Socio Economic Status (SES) (OR, 95%CI = 1.5, 1.1-2.1), and unmarried status (OR, 95%CI = 1.7, 1.2-2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9-12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND. [ABSTRACT FROM AUTHOR]

Background: Differential item functioning (DIF) exists when test item responses by members of different demographic groups are statistically different when controlling for ability. DIF may indicate item bias. Our objective was to determine whether items from the Italian Mini-mental State Examination (MMSE) had DIF related to educational attainment, age, gender and occupation. We were also interested in exploring the significance of DIF in screening tests.Methods: In a two-stage study from Granarolo, Italy, residents over age 61 (n = 495) were evaluated with the Italian MMSE. Those with MMSE scores of 28 or lower were further evaluated for dementia. MMSE results were coded in 10 item bundles. We used ordinal logistic regression to determine whether item bundles had DIF.Results: Six of the 10 MMSE item bundles had DIF in educational attainment subgroups. Four of these six bundles also had DIF related to age. Items that required literacy were much harder for those with lower educational attainment.Conclusions: DIF related to education appeared at as few as 3 years of formal schooling. These findings suggest cautious interpretation of data from studies using the Italian MMSE in populations with heterogeneous educational backgrounds. DIF is especially troublesome for two-stage studies that use screening tests. [ABSTRACT FROM AUTHOR]

Dementia is a common and disabling disorder in the elderly. Because of the worldwide aging phenomenon, existing in both developed and developing countries, dementia has a growing public health relevance. This article reviews the prevalence and incidence data for dementia reported in the international literature in the last 10 years. Results from 36 prevalence and 15 incidence studies have been examined. Prevalence is equal to 0.3 to 1.0 per 100 people in individuals aged 60 to 64 years, and increases to 42.3 to 68.3 per 100 people in individuals 95 years and older. The incidence varies from 0.8 to 4.0 per 1000 person years in people aged 60 to 64 years, and increases to 49.8 to 135.7 per 1000 person years when the population was older than 95 years. The international comparison allows the following conclusions: both prevalence and incidence show little geographical variation, as differences between countries seem to reflect methodological rather than real differences [the low prevalence of dementia in Africa needs to be confirmed by incidence data]; both incidence and prevalence figures increase with age even in the advanced ages; regarding dementia types, most of the inconsistency in results from different studies is due to vascular dementia rather than to Alzheimer's disease (AD); it is still unclear if the reported higher frequency of vascular dementia in Asian populations is due to differential distribution of genetic and/or environmental factors, or due to methodological differences; different dementia types might have different age distributions. [ABSTRACT FROM AUTHOR]

This paper reports the results of the cross-sectional phase of a long-term follow-up investigation, carried out on a sample representative of the broad population of HIV-1 infected patients, with the objective of evaluating the possible neurocognitive effects of zidovudine and 2′, 3′-dideoxyinosine, compared to a group of people who refused antiretroviral therapy. The sample was composed of 88 people, 42 of whom were treated with ZDV at a daily dose of 500–600 mg, 19 with ddI at a daily dose of 400 mg, and 27 with no therapy. To assess the relevance of different antiretroviral therapies on cognitive performance adjusting for demographic and clinical characteristics, a stepwise logistic regression analysis was performed with neuropsychological performance as the dependent variable and age, education, sex, at-risk behaviour, CD4 count, presence of prominent depressive and anxious symptoms, HIV-1 serostatus and type of antiretroviral treatment as independent variables. The results confirm that people with AIDS and AIDS-related complex treated with ZDV and ddI show a better neuropsychological performance when compared to non-treated patients. By examining the mean performance on each of the previous neuropsychological tests, we found that the most impaired functions in untreated patients were related to short-term memory, long-term memory, vocational competence, and ultimate adjustment. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic Drug Monitoring (TDM) has several indications in psychiatry including patients with physical comorbidities, suspected non-compliance, severe adverse effects and tailored pharmacotherapy. Antidepressants (AD) are frequently prescribed in patients with Eating Disorders (ED) to reduce binge-eating and compensatory behaviours or to treat comorbid depression and anxiety. Objectives: TDM by means of minimally-invasive biosampling approaches may represent a useful tool in this population, considering the limited efficacy of ED's pharmacological treatment and the high rate of adverse effects. Methods: Nineteen ED outpatients on AD treatment with a Body Mass Index (BMI) <20 kg/m2 or >30 kg/m2 agreed to take part in the present study. Participants were treated with Sertraline (N=5), Fluoxetine (N=5), Vortioxetine (N=5), Citalopram (N=2), Escitalopram (N=1), Fluvoxamine (N=1). Oral fluid samples were collected from patients, together with whole blood dried microsamples, obtained by finger puncture using Volumetric Absorptive Microsampling techniques. Results: Preliminary results showed a significant correlation between plasmatic and salivary concentrations for Vortioxetine only; moreover, extreme BMI did not seem to significantly influence the AD' plasmatic concentrations, when corrected for dosage. Conclusions: Further analyses may permit to validate for the first time the use of these recent microsampling procedures for AD treatment. By increasing the population size, we aim to demonstrate that TDM may represent a valid tool to better understand the limited efficacy of AD in ED patients. Minimally-invasive biosampling approach is well tolerated in patients with belenophobia and, in our experience, is highly appreciated by all patients: it may represent in future a valid support for Precision Medicine. [ABSTRACT FROM AUTHOR]

The serotonin transporter gene promoter polymorphism (5-HTTLPR) has been repeatedly associated with antidepressant response in mood disorder patients, but findings are not consistent across studies. A meta-analysis was performed on 15 studies including data of 1435 subjects. We tested three phenotypes: remission rate, response rate and response rate within 4 weeks using the cochrane review manager. We observed a significant association of the s/s variant of 5-HTTLPR with remission rate (P<0.0001) and both s/s and s/l variants with response rate (P=0.0002). Response rate within 4 weeks was associated in both models (P=0.003–P<0.00001). This effect is quite robust to ethnic differences although a significant heterogeneity is present in Asian samples.Molecular Psychiatry (2007) 12, 247–257. doi:10.1038/sj.mp.4001926; published online 5 December 2006 [ABSTRACT FROM AUTHOR]