Major depression is often associated with cardiovascular diseases, due to the common ethiopathogenic mechanism: increased sympathetic activity. Mild cognitive impairment is associated with major depression and cardiovascular diseases are a predisposing factor leading to cognitive decline.

of this study is to determine the association of biological markers of sympathetic hyperactivity with cognitive decline in the context of a major depression associated with cardiovascular diseases.

60patients with major depression and cardiovascular pathology were included (16 over 65years and 44 under65). The intensity of depression was evaluated with MADRS and the intensity of cognitive decline was evaluated with MMSE. Paraclinical tests (cortisolemia, fibrinogen,CRP) were also performed.

Increased systolic blood pressure is significantly associated with high MADRSscores and low MMSEscores in the elderly(p=0.004, p=0,035, CI=95%) and in adults(p< 0.05,p=0.034,CI=95%). Increased diastolic blood pressure is significantly associated only with MADRSscores in adults(p=0.019,CI=95%) and it is not correlated with MMSE, neither in adults nor in the elderly.

Increased cortisolemia is significantly associated with the intensity of cognitive decline (p=0.027,CI=95%) and with the intensity of depression (p< 0.05,CI=95%) in adults but the correlation in the elderly is not significant (p>0.05,CI=95%, in both cases). Fibrinogen is not carelated with cognitive decline and with depression but CRP is associated more strongly with the adults (p=0.003,CI=95%) than with the elderly (p=0.041,CI=95%).

Increased systolic blood pressure and CRP are associated with cognitive decline in adults and in the elderly. Hypercortisolemia is significantly associated with mild cognitive impairment only in adults.

To evaluate the cognitive status in an elderly population including both community-dwellers and institutionalised subjects.

462 subjects (mean age 85.1±6.9 years, 53.2% females) living in the Faenza district (Ravenna, Northern Italy) were interviewed and clinically evaluated. The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was administered to all participants to collect socio-demographic and clinical information. The cognitive status was evaluated using the cognitive assessment included in the CAMDEX (CAMCOG) and the Mini-Mental State Examination (MMSE) (adjusted by sex and age). Cut-offs were as follow: CAMCOG scores < 80; MMSE scores < 24.

The CAMCOG identified 245 subjects (53.0%) as cognitively impaired; 132 persons (28.6%) had a MMSE score < 24 and were impaired in the activities of daily living. Prevalence of dementia (DSM-IV criteria) was 19.1% (N=88), including 11 cases of ‘questionable’ dementia. Demented subjects were more likely to be women (65.9%), were less educated (p< 0.05) and older than non-demented (p< 0.001). Demented subjects scored significantly lower than non-demented subjects in any cognitive domain at CAMCOG (p< 0.001).

Cognitive domains: mean score and standard deviation (p< 0.001).

Non-demented vs Demented

All subjects: 78.4(±15.9) vs 28.7(±21.7)

Males: 81.1(±13.0) vs 35.0(±19.9)

≤85: 83.3(±12.3) vs 38.0(±20.5)

>85: 75.7(±13.2) vs 34.0(±20.2)

Females all: 75.7(±18.0) vs 24.3(±21.9)

≤85: 82.5(±12.4) vs 58.5(±10.8)

>85: 67.0(±20.2) vs 18.4(±17.5)

Among demented subjects, only 4.5% were treated with acetylcholinesterase inhibitors (p=0.046); 10.2% used other anti-dementia medications (p=0.067).

Despite of the high prevalence of dementia, only few subjects affected by dementia were properly treated.

We hypothesized that patients with Alzheimer's disease (AD) not treated with anti-dementia therapy are institutionalized at the earlier AD stages compared to the ones who took nosotropic therapy timely.

100 outpatients with AD were treated with AChE-inhibitors in the Moscow Alzheimer's center. The controls were AD patients, hospitalized in gerontopsychiatric units of the Moscow Psychiatric Hospital №15 and not treated with anti-dementia drugs before.

The mean duration of dementia syndrome in the main group was 73.2±27.6 months compared to 21.6±13.2 months in the control group. The mean duration of the hospitalization in the control group proved to be 6.3±5.6 months (i.e. 29% of dementia syndrome duration). We suggest, that without the antidementia therapy patients of the main group could be hospitalized also for 29% of the duration of dementia syndrome (≥ 21.2 months). The cost of one bed day in Moscow hospitals in 2009 year is 31.2 EUR, thus total expenses for a hospital treatment of one patient with AD for 21.2 months would be 19902.6 EUR (given). The expenses for a treatment of one patient in out-patient clinic for 21.2 months excluding medical staff salary range from 1605.3 EUR (memantine) to 2422 EUR (AChE-inhibitors). Therefore, treatment of AD patients in outpatient clinic instead of hospitalization allows to save 17480.6-18297.3 EUR for public health service budget for each patient.

Long-term anti-Alzheimer therapy allows to postpone institutionalization. Economic expenses resulted from AD-patients institutionalization more than 8 times exceed the cost of the appropriate therapy in outpatient clinic.

This study investigated the efficacy of memantine alone or in combination for the treatment of patients with Alzheimer's disease (AD) in a naturalistic setting, specifically for the cognitive and behavioural symptom domains.

Open-label, 6-month observational study, conducted at 110 sites in Greece. Efficacy was based on the MMSE and NPI scales at baseline, 3 months, and 6 months. Statistical analysis was made on a modified intent-to-treat dataset (ITT: at least one valid post-baseline measurement) using last observation carried forward (LOCF), and observed cases (OC, defined as patients assessed at all 3 visits).

1,469 patients were enrolled. Their mean age was 75.7±6.5 years and the majority were women (52.7%). At baseline the average scores were 17.6 (±5.3) for the MMSE and 30.6 (±25.9) for the NPI. 285 patients (19.4%), received combination treatment (a second AD medication) during the observation period.

Both cognitive and behavioral symptoms were improved at the end of the study, as measured by the MMSE and NPI scales (repeated measures analysis of variance Hotelling's test, p-value< 0.001, both ITT, LOCF and OC analyses). After 3 and 6 months, cognitive function improved for 50.3% and 55.8% of the patients (ITT, LOCF), while behavioral symptoms improved for 56.8% and 62%, respectively.

Memantine was well tolerated, with 3.5% (52) of patients withdrawing from the study for any reason and 7.6% reporting adverse events.

Memantine treatment resulted in significant improvement of cognitive and behavioral symptoms in patients with AD and was well tolerated based on patient withdrawals.

The objective of the study was to explore whether IETM participate in the development 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; The express of amyloid β-protein precursor (APP), presenilin 1 (PS1) and β-site APP-cleaving enzyme (BACE) in hippocampus of Alzheimer disease's rats were detected by RT-PCR.

Compared with the normal control, the level of LPS in the sera and the express of APP, PSI, BACE mRNA in the hippocampus 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. This result suggests that IETM play an important role in the development of Alzheimer disease.

The present work was undertaken in order to investigate the effects of systemic lipopolysaccharide endotoxin administration (250 μg/kg) on spatial memory formation and oxidative stress in rats subjected to right-unilateral lesion of the dopaminergic neurons of the substantia nigra by means of 6- hydroxydopamine (6-OHDA) compared to normal and lipopolysaccharide alone treated rats.

Thirty male Wistar rats weighing 200 ± 50 at the start of the experiment were used. The substantia nigra was right-unilateral lesioned by stereotaxic microinjections of 8 micrograms (free base) 6-OHDA. The rats were pretreated 30 min before the 6-OHDA infusion with 25 mg/kg desipramine to protect noradrenergic projections. Sham-operated rats received only an injection of desipramine, followed by vehicle in the substantia nigra. Lipopolysaccharide (LPS from Escherichia coli serotype 0111:B4, Sigma) was dissolved in pyrogen-free 0.9% NaCl at the concentration of 250 μg/kg and intraperitonealy injected in normal and 6-OHDA-lesioned rats for a period of 7 continuous days. 7 days after continuous LPS administration we assessed memory formation by means of Y-maze and radial arm-maze task, and the endogenous antioxidants activity in rat temporal cortical area.

Systemic lipopolysaccharide administration significantly decreased spontaneous alternation in Y-maze task, working memory and reference memory in radial arm-maze task, suggesting impairment of both short-term memory and long term-memory, respectively. Furthermore, lipopolysaccharide administration significantly decreased activity of the biochemical markers of endogenous antioxidants in rat temporal cortical area.

Our results further validate that lipopolysaccharide may exacerbate the development of neurological dysfunctions associated with Parkinson's disease.

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.