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A systematic review was conducted to investigate whether bilingualism has a protective effect against cognitive decline in aging and can protect against dementia. We searched the Medline, ScienceDirect, Scopus, and ERIC databases with a cut-off date of 31 March, 2019, thereby following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Our search resulted in 34 eligible studies. Mixed results were found with respect to the protective effect of bilingualism against cognitive decline. Several studies showed a protective effect whereas other studies failed to find it. Moreover, evidence for a delay of the onset of dementia of between 4 and 5.5 years in bilingual individuals compared to monolinguals was found in several studies, but not in all. Methodological differences in the set-up of the studies seem to explain these mixed results. Lifelong bilingualism is a complex individual process, and many factors seem to influence this and need to be further investigated. This can be best achieved through large longitudinal studies with objective behavioral and neuroimaging measurements. In conclusion, although some evidence was found for a cognitive reserve-enhancing effect of lifelong bilingualism and protection against dementia, to date, no firm conclusions can be drawn., Competing Interests: The authors declare no conflict of interest.

In a recent article of the Journal of Alzheimer's Disease, Hack et al. (2019) argue that linguistic ability rather than multilingualism is a significant predictor of dementia. In their longitudinal study, they investigated 325 religious sisters who were older than 75 years of age. Self-reports were used in order to determine multilingualism. They found that speaking two or three languages did not delay the onset of dementia. However, they did find that individuals speaking four or more languages were less likely to suffer from dementia than those speaking only one language and concluded that having linguistic ability was a more significant predictor of dementia than being multilingual. However, more research is needed in order to identify the characteristics of multilingualism most salient for the risk of dementia. In this commentary, we raise several important methodological and statistical issues that are likely to have affected the findings of Hack et al.'s study. As a result, although their study makes an important contribution to the research field, drawing a conclusion at this time that linguistic ability is more a predictor of dementia than multilingualism would be premature; moreover, their preliminary results cannot be generalized to the general population.

Background: Pharmacological treatment is still the key intervention in the disease management of long-term patients with schizophrenia; however, how it affects sleep and whether gender differences exist remains unclear. Methods: Forty-six long-term outpatients with schizophrenia entered the study. The numbers of antipsychotics, sleep medications, antidepressants, and anxiolytics were analyzed. Moreover, all patients were tested using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Correlation analyses were conducted between the medication used and the scores on the two subjective sleep inventories. Results: A large variability, ranging from 0 to 8, in the total number of psychiatric drugs per person was found between the patients. Despite ongoing pharmacological treatment, the patients scored high on the PSQI, but not on the ESS; this indicates that they report problems with sleep, but not with daytime sleepiness. A significant positive correlation between the use of antipsychotics and the ESS score, but not the PSQI score, was found; moreover, no gender differences were found. Conclusions: A large variability exists in the pharmacological treatment of long-term patients with schizophrenia. To date, patients' sleep problems have been insufficiently treated, and gender differences have not been adequately accounted for in the pharmacological treatment of schizophrenia. More and larger international clinical studies are warranted to verify the findings of the present preliminary pilot study before any firm conclusions can be drawn and before any changes to the drug treatment of male and female patients with schizophrenia can be recommended., Competing Interests: The authors declare no conflict of interest.

Background: Schizophrenia is a severe psychiatric disorder that has a large impact on patients' lives. In addition to Western medicine, the use of additional treatments, such as acupuncture, in treating the positive, negative, and cognitive symptoms is increasing. Methods: We conducted a systematic review on the use of acupuncture as an add-on treatment for patients with schizophrenia that are in regular care, with a special focus on the treatment of the often accompanying sleep disorders. In this study, we searched the Medline, ScienceDirect, Cochrane Library, Scopus, and ERIC databases with a cut-off date of 31 December 2017, thereby following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Results: Our search resulted in 26 eligible studies with 1181 patients with schizophrenia who received acupuncture treatment. Most studies showed limited evidence for the use of acupuncture as add-on therapy in the treatment of the positive, negative, and cognitive symptoms, but beneficial effects have been reported in the treatment of the accompanying sleep disorders. Conclusions: Limited evidence was found for the use of acupuncture as add-on therapy in the treatment of patients with schizophrenia; however, positive results were found in the treatment of sleep disorders, but this result needs to be confirmed in large, randomized, controlled trials., Competing Interests: The authors declare no conflict of interest.

Sleep is known to be markedly disturbed in patients with depression, but in patients with schizophrenia these problems are underestimated. This research aimed to determine if a relationship existed between sleep problems in patients with schizophrenia and with depression and their reduced working memory (WM) performance. Thirty outpatients with schizophrenia, 30 outpatients with depression, and 30 healthy control participants were enrolled in this study. All participants completed a sleep questionnaire (i.e., Pittsburgh Sleep Quality Index (PSQI)), two simple WM tasks tapping only its storage component (i.e., digit span forward and backward task), and two complex WM tasks tapping both its storage and processing components (i.e., letter-number sequencing and reading span task). The results showed that neither psychiatric group differed from the healthy controls on simple WM tasks. Patients with schizophrenia did not differ from those with depression in the performance of simple or complex WM tasks. However, patients with schizophrenia, and, to a lesser degree, patients with depression performed significantly worse than the healthy control participants on complex WM tasks, which was visible in lower WM scores for patients with depression and in slower information processing, as well, for patients with schizophrenia. Finally, a significant negative relationship was found between the PSQI score and the reading span task scores; thus, participants with worse performance tended to report more sleep problems. To conclude, sleep needs to receive more priority when treating patients with depression and especially patients with schizophrenia because better sleep improves (working) memory performance and daily functioning., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background . The use of acupuncture in the treatment of sleep disorders in patients with chronic schizophrenia is investigated. Case Presentation . We report the case of a 44-year-old female outpatient of German origin who had been suffering from long-term schizophrenia and sleep disorders. The patient was treated with manual acupuncture weekly for 12 weeks, and a psychological assessment was performed before, immediately after, and three months after the acupuncture treatment period. In addition, actiwatch data were collected for 14 days both before and after the acupuncture treatment period. Conclusion . Acupuncture treatment led to a decrease in general psychopathology, less severe sleep problems, and markedly improved cognitive functioning (working memory) in the patient; however, the positive and the negative symptoms remained stable. The actiwatch data revealed a beneficial effect of acupuncture, showing better sleep latency, a trend towards better sleep efficiency, and a decrease in the number of minutes that the patient was awake during the night after acupuncture treatment. In sum, this study showed that acupuncture might be beneficial in the treatment of sleep disorders in patients suffering from chronic schizophrenia, but future, large, randomized (placebo), controlled, clinical trials are needed in order to replicate the present preliminary findings., Competing Interests: The authors declare that they have no competing interests regarding the content and publication of this paper.

Objective: This systematic review assessed clinical evidence for the use of acupuncture as an add-on treatment in patients with depression and schizophrenia and for its underlying working mechanisms., Data Sources: Four databases (Medline, Scopus, ERIC, and the Cochrane Library) were searched with a cutoff date of March 31, 2014., Study Selection: Systematic reviews and meta-analyses of acupuncture treatment for depression and schizophrenia were considered for inclusion. The scarcity of acupuncture research involving schizophrenia led to the inclusion of randomized controlled trials and case studies., Data Extraction: The primary and secondary aims of this study were to evaluate the effects of acupuncture in treating patients with depression or schizophrenia and the possible working mechanisms underlying acupuncture through a systematic literature review., Data Synthesis: The overall clinical results on using acupuncture to treat depression are promising, but only limited evidence for its effectiveness in treating schizophrenia was found. Acupuncture improves the quality of life, particularly that of sleep, in psychiatric patients. Brain research has revealed that acupuncture has a modulating and normalizing effect on the limbic-paralimbic-neocortical network (LPNN), including the default mode network. Because the LPNN is related to sleep and emotions, this might explain the improved qualities of life and sleep after acupuncture., Conclusions: From the evidence found in this study, acupuncture seems to be an effective add-on treatment in patients with depression and, to a lesser degree, in patients with schizophrenia, but large well-designed studies are needed to confirm that evidence., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Psychiatric disorders can be described and treated from both a Western (allopathic) and an Eastern perspective, which should be taken into account when conducting research. Patients with schizophrenia or depression are likely to be undergoing Western treatment when they are referred to an acupuncturist for (add-on) treatment, and knowledge of both types of treatments is necessary to integrate them successfully. In this study, the different Traditional Oriental Medicine (TOM) diagnostic patterns in patients with a Western diagnosis of schizophrenia, depression, or sleep disorders are described from a literature and a clinical perspective. The data on 30 depression and 30 schizophrenia patients from a German study are presented. Our results show that if a psychiatric group, sorted in accordance to Western diagnostic principles, is diagnosed on the basis of TOM diagnostic patterns, it can be categorized into different groups of patients with psychiatric disorders; this finding has far-reaching consequences in scientific research on acupuncture. Moreover, we found a high prevalence of sleep disorders in patients with both schizophrenia and depression, which could be explained from the perspective of a TOM diagnostic pattern. Finally, we discuss sleep quality as a treatment objective that may play a crucial role in mediating acupuncture-induced treatment effects in patients with schizophrenia and depression., (Copyright © 2015. Published by Elsevier B.V.)

Unlabelled: This report describes the use of acupuncture as an add on treatment for a patient with chronic schizophrenia. The 63-year-old woman suffered from persistent hallucinations and even physical pain as a result of the hallucination of a black bird that kept pecking her back. The patient received 12 weekly acupuncture treatments. A clinical diagnostic interview and psychological testing (on sleep quality, depression, and on positive and negative symptoms) were conducted before, immediately after and 3 months after the acupuncture treatment. The results of the diagnostic interview gave important insights into the treatment effects. The patient experienced improved daily functioning and noticed a change in hallucinations. Although the hallucinations still occurred, she felt less disturbed by them. Interestingly, pain decreased markedly. In addition, the results showed that the overall score of the positive and negative symptoms did not change immediately; however, a decrease in symptoms occurred 3 months after acupuncture treatment. Moreover, the patient described an immediate improvement in sleep; this was confirmed by a daytime sleepiness questionnaire. The patient was not able to complete a (longer) test on sleep quality beforehand but did so after the treatment period. Finally, a delayed improvement in the depression scale was found. Although larger clinical intervention studies on acupuncture and schizophrenia are needed, the results of this case study indicate that acupuncture may be beneficial as an add on treatment tool in patients with schizophrenia., Trial Registration Number: 3132., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background and Objective: The increasing resistance of oral pathogens against antibiotic measures urgently requires new therapeutic strategies. In this context, antimicrobial photodynamic therapy (aPDT) may play a crucial part in the future. The aim of the present study was to compare the antibacterial efficiency of aPDT using the photosensitizer safranine O with that of chlorhexidine (0.2% CHX) on an ex vivo biofilm., Methods: First the antibacterial activity of both measures against planktonic cultures of Streptococcus gordonii ATCC 33399, Streptococcus mutans ATCC 25175, Fusobacterium nucleatum ATCC 10953, Aggregatibacter actinomycetemcomitans ATCC 33384 and Porphyromonas gingivalis ATCC 33277 was observed. Then a patient specific ex vivo biofilm was established from plaque and saliva samples of patients (n = 19) with chronic periodontitis. The antibacterial effects of aPDT and of 0.2% CHX were determined on the ex vivo biofilms cultivated for 24 and 72 hours. After cultivation of the treated samples on blood agar (2 days) the results were quantified by counting the colony forming units (cfu/ml)., Results: Photodynamic treatment with safranine O showed a distinct antibacterial effect on F. nucleatum and P. gingivalis. Whereas S. gordonii was suppressed completely by aPDT, treatment with 0.2% CHX caused only a partial reduction. In the ex vivo biofilm model (24-hour biofilm), aPDT caused a significantly higher bacterial killing than treatment with 0.2% CHX. Compared to the untreated control, there was no significant difference on the 72-hour biofilm for both methods., Conclusions: The results show that oral-pathogenic species in planktonic solution can be suppressed significantly by aPDT with safranine O. Especially for bacteria in a 24-hour ex vivo biofilm, this method is more effective than treatment with 0.2% CHX. Both antibacterial treatments did not show any significant effect on the biofilm cultivated for 72 hours., (© 2014 Wiley Periodicals, Inc.)

Objective: Recent studies have shown that inflammatory diseases can be influenced by nutritional factors. For this reason, this study was designed to evaluate the food intake of patients with periodontal disease in comparison to healthy subjects using a 7-day food record (7-DFR)., Method and Materials: The study population consisted of 42 patients with chronic periodontitis and 38 healthy subjects (controls). Periodontitis was diagnosed by using the Plaque Index, Sulcus Bleeding Index, and measurement of probing depth. All participants completed a 7-DFR, which was analyzed with DGE-PC Professional 2.7. To confirm the nutritional analysis, the vitamin C plasma level of each participant was measured. Additionally, the oral discomfort of patients with periodontal disease was ascertained by using an additional questionnaire., Results: Analysis of the 7-DFR revealed that patients with periodontitis had significantly lower intake rates of vitamin C, folic acid, magnesium, and fiber than those of healthy controls. The mean vitamin C plasma levels were significantly lower in patients with periodontitis (0.63 mg/dL) compared with healthy control subjects (1.13 mg/dL, P < .05). Evaluation of the questionnaire showed that approximately 50% of patients experienced discomfort while eating., Conclusion: The present study shows that patients with periodontitis have a reduced intake of vitamin C, folic acid, magnesium, and fiber compared with healthy subjects. This is possibly an outcome of oral discomfort during mastication. To avoid an insufficient nutrient supply for a patient with periodontal disease, the patient's choice of foods should be closely monitored.

Objective: The photodynamic therapy (PDT) is an alternative method to suppress oral pathogens by the activation of a photosensitizer with laser light. The aim of this study was to investigate the phototoxic effect of three ruthenium-based photosensitizers on Fusobacterium nucleatum and Porphyromonas gingivalis., Methods: In this in vitro study F. nucleatum and P. gingivalis were incubated with three photosensitizers: (i) a hydrophobic tris-(4,7-diphenyl-1,10-phenanthroline)-ruthenium(II)-dication (RD3), (ii) a hydrophilic tris-[(1,10-phenanthroline-4,7-diyl)-bis-(benzenesulfonato)]-ruthenate tetra-anion (RSD3) and (iii) a lower hydrophilic tris-(2,2'-bipyridine)-ruthenium(II) dication (RBY). The subsequent irradiation was done with blue-band halogen light (450-485nm) for 20s using a conventional polymerizer. Control samples consisted of bacterial cell suspension irradiated and non-irradiated in the absence of photosensitizer or incubated with the photosensitizer without irradiation. Bacterial inactivation was determined by the numbers of colony-forming units (cfu/ml) after anaerobic cultivation., Results: The RD3 photosensitizer reduced the viability of F. nucleatum by 4-log10 and of P. gingivalis completely after irradiation for 20s. The viability loss correlated significantly with the concentration of the RD3 photosensitizer and reached a peak at a concentration of 12.5μM (p<0.05). The RSD3 and RBY photosensitizers had distinctly lower phototoxic effects in comparison to RD3., Conclusion: The RD3 photosensitizer showed a phototoxic effect on F. nucleatum and P. gingivalis. The results suggest that the application of the RD3 photosensitizer under visible light may be helpful as an adjunct treatment approach to the inactivation of periodontopathogenic bacteria., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: Previous studies demonstrate a relationship between a lack of vitamin C and increased risk of periodontal disease. In the present study we examine the vitamin C plasma levels and inflammatory measures in periodontitis patients before and after the consumption of grapefruit., Subjects and Methods: Fifty-eight patients with chronic periodontitis were assigned to the test group (non-smokers n=21, smokers n=17) and a diseased control group (non-smokers n=11, smokers n=9). Furthermore, 22 healthy subjects were recruited to compare vitamin C plasma levels between periodontally diseased and healthy subjects. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing pocket depths (PPD) and plasma vitamin C levels, were performed at baseline, and after two weeks of grapefruit consumption., Results: At baseline, we observed significantly reduced plasma vitamin C levels in the test group and diseased controls in comparison with the healthy controls. On principle, smokers showed lower levels of vitamin C (mean 0.39 +/- 0.17 mg dl(-1)) than non-smokers (mean 0.56+/-0.29 mg dl(-1)). After grapefruit consumption, the mean plasma vitamin C levels rose significantly in the test group compared to the diseased controls (non-smokers: 0.87+/-0.39 mg dl(-1), smokers: 0.74+/-0.30 mg dl(-1)). Furthermore the SBI was reduced in the test group (non-smokers: from 1.68+/-0.6 to 1.05+/-0.6, p<0.001), whereas PI and PPD were unaffected., Conclusion: The present results show that periodontitis patients are characterised by plasma vitamin C levels below the normal range, especially in smokers. The intake of grapefruit leads to an increase in plasma vitamin C levels and improves sulcus bleeding scores. Longer term studies are necessary to determine whether other periodontal outcomes improve with such supplementation especially in smokers.