Lithium augmentation in sertraline-resistant depression: a preliminary dose-response study

Eleven patients with DSM-III-R major depression who were treatment-resistant to sertraline were allocated for lithium augmentation therapy. In conjunction with their sertraline, 6 received lithium carbonate 400 mg at night and 5 received 800 mg at night. A total of 7 patients responded within 1 week. The degree of response was not related to the serum lithium level. Patients with lithium levels as low as 0.3 mEq/l responded. No significant side effects were reported.     

The meanings of delusions in dementia: a preliminary study

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate their etiology. Participants were 74 nursing home residents aged 65 and over, diagnosed with dementia, from nine nursing homes in Israel. Participants with delusions were found to have significantly more difficulties in performing ADLs, and poorer vision and hearing. Based on assessment using the BEHAVE-AD, six categories of delusions were examined: 1. One's house is not one's home, 2. Theft, 3. Danger, 4. Abandonment, 5. Misidentification, and 6. Other non-paranoid. Common themes appeared across delusions including reality, disorientation, re-experience of past events, loneliness and insecurity, boredom, and trigger. Current results suggest that delusions may not represent psychotic symptoms for most participants, because they sometimes represented reality, or were neither firm nor incontrovertible. Thus, utilizing the term delusion relegates the person's behavior to the domain of severe psychiatric phenomena and precludes understanding its true meaning.     

Societal burden and economics of vascular dementia: preliminary results from a Swedish-population-based study

Knowledge about the health economic implications of vascular dementia (VaD) is insufficient. The impact of cardiovascular comorbidities must also be taken into consideration when resource utilization and costs in patients with VaD are analyzed. It is also of great importance that the analysis be done from a societal perspective. In the rural Nordanstig cohort of the Kungsholmen project in Sweden, the major cost drivers in the RUD (Resource Utilization in Dementia) instrument were used. The cost from a societal perspective was 23% higher for patients with VaD compared with patients with Alzheimer's disease ( p = .02).     

Folic acid supplementation in dementia: a preliminary report

Recent work on high plasma homocysteine levels in patients at risk for developing Alzheimer's disease has led to the hypothesis that folic acid supplementation might reduce risk in such patients. The authors report on the effects of folic acid 10 mg/day versus placebo on 11 patients (only 7 completers) with dementia and low-normal folic acid levels. This is the first study evaluating folic acid or placebo in patients with dementia. Subjects had low-normal baseline folic acid levels. The magnitude of change between baseline and second testing was not statistically significant between the 2 groups. However, there was a trend for the folate group to perform worse on two specific cognitive measures, suggesting a possible trend toward worsening of some cognitive abilities after the folic acid. The folic acid in very high doses was well tolerated. Larger studies are necessary before empirically administering folic acid to patients already suffering from dementia.     

Inappropriate sexual behaviors in dementia: a preliminary report

We investigated types of inappropriate sexual behavior (ISB) and patient characteristics in geriatric patients with dementia. The study group consisted of 133 consecutive geropsychiatric demented patients admitted to our ward. All patients underwent standardized diagnostic procedures for dementia, and ISB was assessed by a questionnaire completed by patients' caregivers and records during hospitalization. Patients were then subdivided on the basis of the presence or absence of ISB. Of the 133 demented patients, 20 (15.0%) were reported to demonstrate ISB at home or during hospitalization. Patients with ISB had various types of dementia. There were no significant differences in patients with and without ISB in regard to age, age of onset, gender, educational level, or Mini-Mental State Examination scores. ISB is not unusual in dementia patients and can be found in different types of dementia. Medical care providers need to be trained to discuss sexual issues with caregivers and offer ideas and training to help cope with patients with ISB.     

Education and dementia: a meta-analytic study

Considerable controversy exists about the role of education in the risk of dementia. Individual studies have not been conclusive so far. To examine the hypothesis that lower education is associated with a higher risk of dementia, we carried out a meta-analysis. Observational studies published as of October 2005 that examined the association between education and risk of dementia were systematically reviewed. Relative risks (RRs) and odds ratios were extracted from cohort and case-control studies. We first compared the risk of dementia in subjects with high level of education with the risk of dementia in those with low educational level. In a subsequent analysis, we compared the risk of persons with high education with the risk of subjects with education level other than high (medium, low). We weighted log RRs for cohort studies or odds ratios by the inverse of their variances. Nineteen studies were included in our meta-analysis (13 cohort and 6 case-control studies). RRs for low versus high education level were: Alzheimer's disease (AD) 1.80 (95% CI: 1.43-2.27); non-AD dementias, 1.32 (95% CI: 0.92-1.88), and all dementias 1.59 (95% CI: 1.26-2.01). For low and medium versus high education level, the RRs were: AD 1.44 (95% CI: 1.24-1.67); non-AD 1.23 (95% CI: 0.94-1.61), and all dementias 1.33 (95% CI: 1.15-1.54). These results confirm that low education may be a risk factor for dementia, especially for AD.     

"Denkfaulheit" in frontotemporal dementia: a preliminary analysis

The initial recognition of frontotemporal dementia is often difficult. Frontotemporal dementia presents with subtle personality changes in the absence of a definitive biomarker. The authors report an analysis of cognitive shallowness, or "Denkfaulheit," in patients with frontotemporal dementia early in its course.     

Frontotemporal dementia: a clinical-pathological study

We report a 44-year-old female patient without any familial history of dementia presenting with increasing disturbances in behaviour and language followed by a progressive cognitive deterioration. Neuropsychological evaluation revealed a significant impairment on frontal lobe tests. A brain PET scan disclosed a severe frontal hypometabolism. The tentative diagnosis of frontotemporal dementia was made. Her condition rapidly worsened and she died 2 years after the beginning of her disease. Gross examination of the brain showed a selective symmetrical atrophy of both frontal and anterior part of the temporal lobes. Microscopical examination revealed severe neuronal loss in the frontal and anterior temporal cortex associated with gliosis and microvascular spongiosis in the superficial cortical layers in the absence of any specific neuronal or glial inclusions. These neuropathological findings were consistent with the diagnosis of dementia lacking distinctive histology. We discuss the nosology of the frontotemporal dementias, the diagnostic value of PET scan, the recent genetical developments which strongly support the pathogenic role of tau and we emphasize the importance of immunohistochemical examination for a definite neuropathological diagnosis.     

Frontotemporal dementia with tauopathy: A review and preliminary immunohistochemical study of tau kinases and phosphatases

Recent work has shown that frontotemporal dementia and Parkinsonism linked to chromosome 17 (FTDP-17) is caused by tau gene mutations. Several different exonic and intronic mutations in the tau gene heve been found in many families with FTDP-17. Patients with tau gene mutations show a wide variety of clinicopathological conditions, such as frontotemporal dementia, corticobasal degeneration, multiple system tauopathy with presenile dementia, pallido-ponto-nigral degeneration, disinhibition-dementia-parkinsonism-amyotrophy complex, and progressive sub-cortical gliosis. A Japanese family of frontotemporal dementia with a missense mutation S305N in exon 10 of the tau gene is reported. Post-mortem examination of the brain revealed ring-shaped neurofibrillary tangles (NFT) partially surrounding the nucleus, which were most prominent in the frontal, temporal, insular, and postcentral cortices, as well as in the dentate gyrus. Cortical NFT were restricted primarily to layer II. The missense mutation S305N did not reduce the ability of tau to promote microtubule assembly. Instead, it increased splicing of exon 10. Weak immunoreactivities of kinases for tau phosphorylation were found in late-stage NFT in the dentate gyrus, whereas strong immunoreactivities were seen in early stage NFT in the temporal cortex. PP2B was present in temporal NFT. Although anti-PP2A antibody labeled neurons, NFT were not stained, which suggests that the activity of this phosphatase might be decreased in NFT.     

Brain structural and perfusion changes in amyotrophic lateral sclerosis-frontotemporal dementia patients with cognitive and motor onset: a preliminary study

Brain Imaging and Behavior - Amyotrophic lateral sclerosis-frontotemporal dementia (ALS-FTD) is rare but exhibits worse prognosis than either ALS or FTD alone. However, cognitive onset ALS-FTD...     

Multi-infarct dementia: a computed tomographic study

CT Scan of 30 patients with multi-infarct dementia (MID) were compared with age- and sex-matched controls. Infarcts were seen in 93% of MID cases and 10% of controls. A marked difference in the occurrence of white matter low attenuation was seen between the groups. All the parameters of cerebral atrophy studied showed a statistically significant correlation with the presence of dementia.     

E-learning about dementia: a randomized study

BACKGROUND: Curricular medical training on dementia at the Department of Psychiatry and Psychotherapy at the University of Erlangen comprises of a traditional lecture. This setting was compared with two different E-Learning formats using a randomized study design. METHODS: 104 students (average age 26.3 +/- 3.6 years) were randomized into 3 groups: Interactive e-Learning; virtual lecture (slides and audio) and standard lecture (control group; 90 minutes). RESULTS: Overall, the response rate was 40.4 %. Assessment of formal knowledge using a multiple-choice test yielded no differences between the three groups. In the students' evaluation, the interactive e-learning showed the best results (1.86 +/- 0.69), followed by the standard lecture (2.0 +/- 0.71) and the virtual lecture (2.6 +/- 0.8). Nevertheless, the students would not prefer e-learning to the standard lecture when both methods are directly compared. CONCLUSION: Our findings suggest that e-learning is equivalent to a standard lecture when formal knowledge is assessed. Evaluation results are best for interactive e-learning formats. The detailed reasons for the preference of different learning styles should be further investigated.     

Wandering in dementia: a longitudinal study

OBJECTIVE: This article analyzes the natural history of wandering behavior throughout the course of dementia. DESIGN: Prospective, 10-year, longitudinal study of wandering behavior in dementia, with autopsy follow-up. SETTING: Participants with dementia, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: Eighty-six people with dementia who were living at home with a carer and who were able to walk unaided at entry to study. Measures: At 4-monthly intervals, the carers were interviewed using the Present Behavioural Examination to assess wandering behavior in detail; participants with dementia were assessed cognitively. Nine types of "wandering" behavior were distinguished. RESULTS: Changes in wandering behavior were not generally related to gender, age, or time since onset of dementia. Onset of different types of wandering behavior showed some relationship with cognitive state. Various forms of increased walking first appeared during moderate dementia, each type typically persisting for 1 to 2 years. Late dementia was characterized by decreased walking and immobility. CONCLUSIONS: Wandering behavior in dementia can cause great problems for carers. There are different causes for such changes, some of which are related to cognitive ability, for example increased confusion results in ineffectual "pottering" and getting lost. Increased walking at night corresponds with disruption of diurnal rhythm.