Dementia disorders are associated with poor quality of life of patients. Generic tools have been shown to hardly capture main aspects of these conditions. The aim was to validate the Spanish version of the two dementia-specific health-related quality of life scales that make up the DEMQOL system: DEMQOL and DEMQOL-Proxy.

One-hundred-nineteen subjects with dementia according to DSM-III-R/DSM-IV, and their caregivers from six centers participated in the study. The following patient-reported information was obtained by interview: demographics, subjective perception of health, comorbidity, depressive symptoms (GDS-15), functional ability (Barthel Index), and generic (WHOQOL-BREF) and dementia-specific (DEMQOL) health-related quality of life. Proxy-reported information about the patient's quality of life was obtained by interview of a family caregiver using the DEMQOL-Proxy.

The Spanish version of DEMQOL showed good psychometric properties. Acceptability was good, with 5% missing information. Internal consistency (Cronbach alpha=0.85) and test-retest reliability (ICC=0.71) were also good. A priori associations between DEMQOL and the psychological and physical domains of the WHOQOL-BREF, the GDS-15 and the Barthel Index were supported, indicating good construct validity. Associations between DEMQOL-Proxy and the measures mentioned were weaker. The factor solution for the Spanish version of DEMQOL showed a three factor solution that accounted for 44.4% of the total variance; and a four-factor solution for DEMQOL- Proxy that accounted for 53.3% of the total variance.

As per the results found, the Spanish version of DEMQOL and DEMQOL-Proxy are reliable and valid in patients with mild/moderate dementia who are living at home.

Vascular Dementia (VD) patients have increased co-morbidity and higher mortality in comparison to other patients. Neuro-degeneration, cognitive deficits and underlying medical conditions may influence the pattern of co-morbid disorders and their possible effects on mortality in VD.

To investigate whether the pattern of co-morbidity and its relevance for later death differed between hospitalised VD and elderly controls.

Diseases with a prevalence of more than 1% at hospital admission were compared between 341 hospitalised VD and 72244 control subjects aged above 70 years referred to the University of Birmingham Hospital, UK. Risk factors i.e. co-morbidities that were predictors of mortality within the seven year follow-up were identified using logistic regression and cox regression analyses. Confidence intervals of relative risks were used to compare the relevance of risk factors for later mortality between groups.

Subjects with VD suffer more with peripheral vascular disease, atrial fibrillation, type 2 diabetes mellitus, pneumonia, ischemic stroke and urinary tract infections than other hospitalised elderly patients. In contrast, myocardial infarction was less prevalent in VD subjects in comparison with hospitalised controls. The prevalence of hypertension, ischemic heart disease, angina and heart failure was not statistically different in the two groups.

Patients with Vascular Dementia have a different pattern of co-morbidity, but die from the same diseases as other hospitalised patients. Infections including pneumonia may need special attention in patients with vascular dementia who might not be able to identify or report the early symptoms.

The aim of this study is to evaluate the correlation between clinical features and imaging aspects at patient diagnosed with MCI.

The study comprises a number of 45 elderly patients diagnosed with MCI. MMSE score between 28-21 points is considered mild cognitive impairment. The patients were evaluated with MMSE (Mini Mental State Evaluation), clock drawing test (CDT), Raven QI test and computer tomography.

The average of MMSE was 23.88. The most affected items of MMSE were attention, concentration and recall. The results CDT was reduced on average by 2.57 points from the maximum of 4 points. Raven test showed that almost all the patient included presented QI under 90 points, an intelligence level under limits. The patients with lower MMSE score have more than one imaging change. All the patients with low CDT score have cortical atrophy.

In general imaging changes are correlated with MMSE and CDT scores: as the scores are lower the tomography changes are more severe.

The work reported in this paper was supported by grant PNCDI2-41-057/2007 from the Romanian Ministry of Education and Research.

Mild cognitive impairment (MCI) may be considered a pre-dementia cognitive state. The turn fromMCI to dementia is not clearly understood.It appears to be determined by the vascular risk factors of each individual.

To determine if atrial fibrillation (AF) is a risk factor for conversion from MCI to dementia in an elderly population subgroup with certifiedMCI (MMSEscore: 28-21).

There were included 123 subjects with MCI, aged over 65. They were evaluated yearly for 2 years using the Mini Mental State Examination(MMSE), ECG, CT scan and medical history.

The average age was 72.8+/4.3 yrs,with a sex ration male to female 1.27:1. Of the123 subjects17.07% (n=21) had AF at admission. The average MMSE difference was 2.3 points between the two cohorts in favor for the non-AF subjects(n=102). At1year, theAF cohort increased to 28 subjects and at two years to 33. The MMSE scores remain lower in AF cohort with an average of 7.4 points on the scale (p< 0.001,CI95%) at 2 years. In the AF cohort 75.75% (n=25) of the subjects had certified dementia by the end of the study, while in non-AF group only 12.2% (n=12)conversed to dementia with a clear statistical difference between the two groups (p< 0.001, CI95%). When other vascular risk factors were considered the strongest correlations were associated with cerebral stroke (p=0.002, CI95%), hypertension (p=0.012, CI95%) and dyslipidemia (p=0.023, CI95%). The longest the time-span from the MCI onset positively correlated to MCI-dementia conversion in both cohorts (p< 0.001, CI95%).

MCI is regarded as a precursor of dementia, but not all patients with MCIactually develop dementia. Alzheimer and vascular dementia share several pathogenic mechanisms and the involvement of vascular risk factors is determinant in the clinical course.

Atrial fibrillation may predict the conversion from MCI to dementia,but other vascular risk factors may concur to it.The time-span from MCI onset is an independent risk factor for conversion to dementia in MCI elderly subjects with a direct relation.

Neuropsychiatric symptoms are common in subjects with cognitive impairment (mild cognitive impairment and dementia). It is also widely known that there are many cognitive differences between men and women. The aim of this study is to describe the neuropsychiatric profile of elderly subjects visited in a dementia unit and to estimate the gender differences in this sample.

We conducted a retrospective study in a sample of outpatients visited for the first time in a specialized dementia unit during 2008. The clinical and socio-demographic characteristics were compiled through a structured interview and neuropsychiatric tests. Yesavage scale was used for depression assessment and psychiatric symptoms were evaluated using NPI-Q test.

144 subjects were analyzed, 72.2% were women (n=104) and 27.8% were men (n=40). Mean age at diagnosis was 79.15 +/− 6.58 years. Mean score in Yesavage was higher in women (4.34) than in men (3.9) although not statistically significant. Male subjects showed greater anxiety and aggressiveness than women (p< 0.05) analyzed with NPI-Q. Prior to the first assessment interview 73.6% of the subjects had used psychiatric drugs: women were found to take more SSRI (12,5% vs 5%) while men were using more benzodiazepines (22,5% vs 14,4%) although not statistically significant.

We have found that anxiety and aggressiveness defines male neuropsychiatric profile in our sample. More results pointed towards other different features defining genders although not statistically significant. Further studies, with larger samples and more exhaustive assessment, are needed to determine sex differences in subjects with cognitive impairment.

To explore the inter-relationship between the core and suggestive symptoms of Dementia with Lewy Bodies (DLB) and the cognitive profiles in persons with newly diagnosed mild dementia.

139 persons with mild dementia were recruited from dementia clinics in Western Norway. Symptoms were rated using standardized instruments. A two-step cluster analysis was applied to classify persons into groups according to scores on scales for hallucinations, parkinsonism, fluctuations and REM sleep behavior disorder (RBD).

Four distinct clusters were revealed: A “Lewy Body Dementia” (LBD) cluster with high scores for both hallucinations, parkinsonism and fluctuation, and a “non-LBD” cluster with low scores on all DLB symptom scales were identified. In addition, two clusters with high scores on either RBD or cognitive fluctuation scales emerged. Persons in the LBD cluster had lower scores for visuospatial cognitive abilities as compared to the non-LBD group.(p=.002)

With a cluster analysis we provide empirical support for the existence of a distinct subgroup in mild dementia with high scores on scales for hallucinations, parkinsonism and cognitive fluctuations and a distinct cognitive profile, i.e. supporting the clinical diagnosis DLB.

Apolipoprotein E allele ɛ4 is a well established risk factor for Alzheimer dementia (AD). Its presence modifies also the influence of other risk factors as well as the conversion rate of mild cognitive impairment (MCI) to overt dementia. In how far it also influences the clinical presentation of AD, is not known yet.

Patients of the memory clinic Göttingen were approached if they fulfilled the inclusion criteria: very mild or mild AD according to NINCDS-ADRDA criteria, MMSE 20-30, and at least two of three typical instrumental findings (hippocampal atrophy in MRI, bilateral temporo-parietal hypoperfusion in Neurolite-SPET, low Aβ1-42and increased tau in CSF). They underwent an extensive neuropsychological investigation. A follow-up took place within one year.

N=74 patients (38M, 36F; mean age 68.1y; MMSE 25.9 ± 2.8) and N=28 age- and sex- and education-matched controls could be recruited. N=36 patients had one (N=20) or two (N=16) APOE -ɛ4-alleles. 53 of 57 CSF analyses revealed AD-typical findings, 64 of 74 cranial MRT revealed bilateral hippocampal or global atrophy and 42 of 64 Neurolite-SPETs showed typical findings. Results of non-memory tests - language, visuospatial ability, attention - did not reveal any difference with regard to APOE genotype. Two memory tests and a memory composite score were significantly worse in the APOE -ɛ4-positive group and even worse in the homozygote group.

APOE -ɛ4 influences in a dose dependent manner the neuropsychological functioning in mild AD.

Even if medical and psychiatric co-morbidity often overlap, specific combined medical-psychiatric units do not exist in Italy and elderly who need urgent psychiatric care are usually admitted in the Acute Psychiatry Unit of general hospitals despite many difficulties. The aim of this study is to describe this phenomenon.

55 cases (>65 years) and 120 randomly selected controls (30-60 years), were picked-up among all patients hospitalized between 1st January-31st December 2008. Socio-demographic and clinical information were collected through the retrospective consultation of the case histories of all participants.

Cases were significantly different from controls in terms of psychiatric background, medical history and medical pharmacotherapy: mood disorders (38.2%) and positive medical histories (81.8%) prevailed among elderly as compared to adult controls (p< 0.001; p< 0.001 respectively). The use of drugs (other than psychotropic ones) was four-fold more frequent in the elderly (74.5% vs 16.6%; p< 0.001). Cases and controls used differently the service: elderly requiring more frequently medical pharmacotherapy (81.8% vs 27.5%; p< 0.001), specialist consults (38.2% vs 11.6%; p< 0.001), laboratory tests (76.4% vs 60%; p=0.04) and instrumental tests (chest radiography 9% vs 0.8%; p=0.01; brain neuroimaging 12.7% vs 2.5%; p=0.01).The multi-adjusted logistic regression analysis confirmed a different pattern of use of the acute psychiatric service for elderly as compared to adult controls.

Elderly have peculiar medical histories and distinguishing management needs, notably in the medical field. Our data suggested the need of a new clinical approach concerning combined psychiatric-medical inpatient acute units in Italy.

Dietary intake of ω-3 fatty acids has been associated with a decreased lower risk of Alzheimer's disease (AD). Abnormal phospholipids metabolism in the brain has been shown to play a role in the pathophysiology of major psychiatric diseases, such as schizophrenia, mood disorder. This study was conducted to determine whether essential polyunsaturated fatty acids (EPUFAs) levels in the erythrocyte membrane are correlate with severity of behavioral and psychological symptoms of dementia (BPSD), as well as cognitive function, in subjects with AD.

The protocol was approved by the Institutional Review Board of the University of Toyama School of Medicine.

Thirty out-patients (male/female = 6/24) with AD (n = 23) or amnesic mild cognitive impairment (aMCI, n = 7) participated in the study. The Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were administered to assess cognitive function and severity of BPSD respectively. Caregiver burden was assessed by the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Fatty acids levels were analyzed using a gas chromatography system.

Concentrations of EPUFAs and ω-3 fatty acids were positively correlated with MMSE score. Also, EPUFAs levels were negatively correlated with the NPI Global and caregiver scores. Specifically, EPUFAs levels predicted dysphoria, euphoria and apathy scores of NPI.

These results suggest that abnormal phospholipids metabolism provided a biological basis for BPSD and cognitive impairments of AD.

The objective of the present study was to explore the level of intestinal endotoxemia (IETM) in the model of Alzheimer disease's rats which were established by D-galactose and aluminum trichloride (AlCl3).

Adult Wistar rats were subjected to 90 days of intraperitoneal injection with D-galactose and AlCl3 to establish the Alzheimer disease's model. After the administration, the study and memory ability of the Alzheimer disease's rats were observed by Morris water maze; The level of Lipopolysaccharide (LPS) in the sera of Alzheimer disease's rats was determined by tachypleus amebocyte lysate method; The level of tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) in the sera of Alzheimer disease's rats were determined by radioimmunity method;

Compared with the normal control, the level of LPS, TNF-α and IL-1 in the sera of Alzheimer disease's rats were markedly increased (P< 0.01).

The model of Alzheimer disease's rats which were established by D-galactose and AlCl3 is accompanied IETM.

In the face of increasing health care costs, appropriate financing systems are not only required for somatic medicine but also for psychiatry. However, diagnosis-related groups (DRGs) did not lead to sufficient prediction of resource use for psychiatric inpatient care. Clinical case groupings besides groupings by diagnosis were rarely assessed so far.

We investigated whether the classical psychopathological syndromes according to the AMDP-System (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie) at admission would explain the variation of length of stay in psychiatric hospital. Using linear regressions with forward elimination, we analyzed the predictive value of the AMDP syndromes (n=998), and also of global assessment of function, illness severity and certain sociodemographic factors for the dependent variable length of stay (n=613).

Considering solely the AMDP-Syndromes within the linear regression resulted in a variance estimation of 6% with an influence of the paranoid-hallucinatoric and the psychoorganic syndrome on length of stay. Together with clinical and sociodemographic factors, we found a variance estimation of 20%, then with an influence of age, global assessment of function, severity of illness, voluntariness of admission and habiting situation, but no more the syndromes.

Our pilot study does not imply AMDP syndromes to be suitable for a case grouping to estimate length of stay. Other analytical approaches using AMDP might nevertheless lead to a better prediction, however, its use, however, shall be regarded critically.

The goal of this work was to find out if the clinical professional could distinguish hallucination like experiences between clinical and general population through the analyze of their responses.

The Revised Hallucination Scale (RHS) was administered to three groups included hallucinating schizophrenic patients, non-psychotic clinical disordered patients and a group of individuals with no psychiatric diagnoses. Also the frequency they were asked to give an example of a situation in which it had happened and to what they attributed it. Two clinical professionals analyzed the answers of all participants (blind related to the original group) and classified them in the three following groups: general, clinical non-psychotic and psychotic population.

As the results show the experience of the non-clinical group was easily distinguished by the clinical professionals since those persons did not present neither disturbs nor disability. Concerning the non-psychotic clinical group was identified a major variability in the classification, fluctuating between typical characteristics of the clinical group (e.g. anxiety) and the general population. The classification of the hallucination patients indicated a strong relation with their original group.

It is suggested that from a clinical point of view it is possible to distinguish clearly between the experiences of people hearing voices and general population. Concerning the clinical population it is more difficult to differentiate this kind of experience between psychotic and non-psychotic populations. The relevance of the results is discussed.

To access the Intelligence Wechsler Scale for Children (WISC-III) as an auxiliary resource in the diagnosis of patients with suspected mental retardation.

Thirty patients were evaluated in a university psychiatric service for children and adolescents, consulted during 2008. Those patients underwent a psychiatric evaluation and, after, subsequently the WISC III scale was administered. Patients were classified, according to their intellectual coefficients, as with or without a mental retardation score, following ICD-10 criteria. The results were transferred to a SPSS (Statistical Package for Social Sciences) spreadsheet and then analyzed in its socio-demographic and clinic variables.

Of the thirty patients, 18 (60%) were children and 12 (40%) adolescents; 22 (73,33%) were male and 8 (26,67%) female. Furthermore, the sample revealed that 20 (68,97%) patients had had an axis I diagnosis. For the participants, 7 (23,3%) had an IQ below the cutoff of 70, consistent with the mental retardation diagnosis, and agreeing with the psychiatric evaluation. The other 23 (76,7%) patients had an IQ within the normal range. From those considered intellectually deficient, 5 (71,43%) had a score for mild and 2 (28,57%) for moderate mental retardation.

This study showed that clinical diagnosis of mental retardation is difficult, especially for mild cases, when the characteristics are not very clear. The error probability is increased if an instrument such as WISC III is not administered. Therefore, WISC III is an important instrument in the diagnostic process for mental retardation, in many instances changing a first clinic impression.

There have been conflicting reports on the relationship between thyroid function and mood between studies in subjects on thyroxine and the general population not on thyroxine. We investigated this relationship in a large population study.

We analysed data on serum TSH levels and Hospital Anxiety and Depression Scale (HADS) scores from the HUNT 2 study (age ≥ 40 years). Following a test for interaction, analyses were performed separately in females on thyroxine (n=1,265) and in people not on thyroxine (males n=9,319 and females n=17,694).

More females on thyroxine had high depression and anxiety scores than females not on thyroxine (depression 18.4% vs 13.0%, p< 0.001, anxiety 23.4% vs 18.7% p< 0.001). In those not on thyroxine there was an inverse association between serum TSH and depression score in males (B coefficient = -0.61, 95% CI -0.91 to -0.24, p=0.001) though not in females (B coefficient = -0.07, -0.33 to 0.19), and an inverse association between TSH and anxiety score in both sexes (B coefficient for males = -0.68, 95% CI -1.04 to -0.32, p< 0.001; females -0.37, -0.67 to -0.08, p=0.01). By contrast, in females on thyroxine, TSH was positively associated with both depression (B coefficient = +0.27, 95% CI 0.02 to 0.51, p< 0.05) and anxiety (B coefficient = +0.29, 0.01 to 0.56, p< 0.05).

There is a different relationship between thyroid function and depression and anxiety in females on thyroxine compared to individuals with no thyroid disease.

Former studies show low treatment rates of outpatients with a diagnosis of depression. The aims of this study are to examine

1. (1) the rate of diagnosed depression in outpatient care,

2. (2) rates of treatment of depression according to individual and regional characteristics and

3. (3) effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

Prevalence of depression and outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analysed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N=780,226). Descriptive analyses were followed by logistic regression analysis (STATA, PASW) to examine predictive effects of individual and regional characteristics on getting depression-specific treatment.

Prevalence of diagnosed depression is 9.2% for persons who are statutory health insured and older than 17 years. 55% of diagnosed depressed patients do not get a depression-specific treatment within one year. Rates of a depression-specific treatment are higher for persons who are female, of middle age, with a moderate or severe depression, with a psychiatric comorbidity, without somatic comorbidity, who live in more rural areas.

The access to depression-specific treatment after a diagnosis of depression must be facilitated. Training for physicians, psychoeducation for patients and anti-stigma campaigns are necessary measures to reach this goal. The knowledge about influence of individual characteristics on getting a depression-specific treatment is important to reach the groups who get least depression-specific treatment.

The aim of study is to determine ethnics differences related to the knowledge, attitude and beliefs towards Mental Health Illness in a traditional fast developing country.

A cross-sectional survey.

Primary Health Care (PHC) Centers.Subjects: A representative sample of 3000 Qatari and other Arab expatriates above 20 years of age and 2514 subjects (83.8%) expressed their consent to study.

A specific questionnaire was designed to assess the knowledge, attitude and beliefs towards mental health illness.

Among the 2514 studied subjects, 50.3% were Qataris’(males 39.8% and females 60.2%) and 49.7% were Arab expatriates (58.6% males and 41.4% females). 50.6% Qatari and 44.5% Arabs believe that mental illness could be the result of punishment from God or, thought as it was due to the possession of evil spirits (40.5% Qatari's and 37.6% Arabs). More than half of Qatari's and Arabs think that psychiatric medication will cause addiction and consider mental illness as dangerous. 75.3% of Qatari's and 83.4% of Arabs respondents had no problem to visit a Psychiatrist for their emotional problem, and 42.3% of Qatari's and 36.4% of Arabs agreed to visit a healer for their problem. Less than half of the population are disturbed to work with someone who has mental illness and are afraid if anybody with mental illness are staying in next door. The common mental illness among Qatari's and Arab Populations described are: schizophrenia, depression, autism, anxiety, epileptic, obsession, and other reported mental illnesses.

People's knowledge and attitude about understanding the mentally sick were of negative impact.

To examine whether depression or social isolation or the combination of both is associated with high leptin levels.

In this cross-sectional study, the study population comprised 1229 subjects. Social network was assessed according to the Social Network Index initially designed for the Alameda study. Depression was assessed using the DEEX scale. Four categories were built: “socially integrated, not depressed”, “socially integrated, depressed”, “socially isolated, not depressed”, “socially isolated, depressed”. Serum leptin concentrations were assessed.Logistic regression was performed in men and women separately to investigate the influence of the three different categories “socially integrated, depressed”, “socially isolated, not depressed” and “socially isolated, depressed” in comparison with the reference category “socially integrated, not depressed”. The probability belonging to the upper 30% of leptin values was modelled. Four models were adjusted for BMI, age, lifestyle factors, psychosomatic complaints and metabolic variables.

In men, but not in women a significant effect could be seen. The combination of depressed state and social isolation was associated with a four fold increased risk of belonging to the group with the 30% highest leptin levels in men, whereas in women odds ratios did not reach significance.

Men, who were socially isolated and depressed, had an increased risk for high leptin levels. Therefore the combination of social isolation and depression, which is known to be associated with the worst outcome in cardiovascular disease, may have the potential to increase leptin levels in men.

To identify factors associated with visits by patients with schizophrenia and related disorders to community mental health services, under the Mental Health Department of Carlos Haya Hospital in Malaga, Spain.

We undertook a cross-sectional study. Data on demographic and clinical factors and service use were obtained from the public mental health services database and centralized in the “Malaga Schizophrenia Case Register (RESMA)”. The outcome measure, defined as the total number of outpatient consultations during one year, was analyzed by multilevel multivariate linear regression.

The analysis included 1097 patients with diagnoses of schizophrenia and related disorders (F20-F29, ICD-10).The adjusted model explained 46.35% of the variance. Patients who contacted both types of professional (nurses and psychiatrists) had a higher number of visits compared to patients who only contacted a psychiatrist (p< 0.001), and the individual psychiatrist attending the patients was also associated with the number of visits (p< 0.001).Clinical variables, such as a higher global level of severity (p< 0.001), a diagnosis of a persistent delusion disorder and having an inpatient episode (p< 0.001), were also associated with a higher number of visits. Patients who were receiving welfare benefits or who had no formal education or were illiterate had a higher number of visits. Patients living alone, living outside the study area and living in more rural municipalities was associated with fewer ambulatory contacts.

Among all variables, the role of psychiatrists and nurses in organized outpatient settings present the strongest association with the number of visits by similar patients.