To study the long term effects of delirium in elderly hip-surgery patients on cognitive mortality.

This is a prospective study. Medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants (n=603) from the €Haloperidol Prophylaxis for Elderly Hip-Surgery Patients at Risk for Delirium. A Randomized Placebo-Controlled Study (Kalisvaart et al., 2005). Patients with and without post-operative delirium were followed for 2 years. Mortality risk associated with delirium was estimated using a Cox proportional hazards regression model; the outcome was time to death.

A total of 75/603 patients (12.4%) died during the study period (table 1). Incidence of delirium was higher in patients who died compared with those who survived (HR 2.16, CI 1.30-3.58). They were more often at risk for delirium as indicated by higher rates of cognitive impairment and visual impairment.

Delirium after hip-surgery and delirium risk factors are associated with long-term follow-up mortality.

Neuropsychiatric literature demonstrates the high impact of cognitive deficits in patients with Multiple Sclerosis (MS), as well as the increased prevalence of anxiety and depression in patients with chronic illnesses, especially in the subgroup of MS patients. The aim of our study is to investigate the existence of an association between depression, anxiety and cognitive deficits in patients with MS.

Demographic data, MS subtypes, and years since diagnosis were documented for 60 patients with MS, who participated in our study. Patients were evaluated for depression and anxiety by the Beck's Depression Inventory (BDI) and the Spielberger's questionnaire (State-Trait Anxiety Inventory) respectively. The Symbol Digital Modalities Test (SDMT) was used to evaluate cognitive deficits.

According to our preliminary data, 60% of MS-patients scored higher than normal in the BDI. There was a significant negative correlation between years since diagnosis and SDMT (Pearson's correlation <0.01), as well as between BDI and SDMT (Pearson's correlation <0.01). No correlation was established between anxiety and both depression and SDMT.

Depression and cognitive deficits have a high prevalence in patients with MS. This is due to the severity and chronicity of MS. In our study, depression is strongly associated with cognitive deficits and years since diagnosis of MS, although it is still in progress for further data evaluation. More studies are required to elucidate the cause of this established association.

to assess changes in cognitive functioning of Coronary Artery Bypass Grafting patients including effect of hypothermia and normothermia.

Randomly selected normothermic (N, n=30) and hypothermic (H, n=21) patients were assessed 3-10 days before and 7-10 days after CABG using Bourdon Test, RAVLT, Tower of Hanoi Test, TMT: A&B, Benton Visual Retention Test, Digit Span, Digit Symbol, Verbal Fluency Test: Supermarket, Raven and Vocabulary Scales. Cognitive impairment rating (CIR) was defined as at least 1 SD scores deterioration, or change into worse category in at least 20% of tests.

Cognitive impairment was observed in 10 out of 12 tests. Changes were significantly greater in H-group in immediate recall visual memory, visual-motor coordination and working memory and in N-group in immediate verbal recall. Regarding mean changes impairment of immediate visual memory were observed in 60% of patients, whereas impairment of delayed recall auditory-verbal memory, immediate verbal memory, psychomotor speed, visual perception, language, attention -in 20-30%. The changes were similar for both methods (p=0.465). In N-group deterioration was observed in 26.7%, improvement in 5% of measures; in H-group deterioration– 28.6%, improvement- 7%. On average deterioration of at least 1 category was observed in 3 of 11 tests. CIR was met in 64.7% of the whole sample. There was no significant differences between the methods according to this criterion (N- 60%; H- 71.4%).

CABG with extracorporeal circulation influences on cognitive functioning. Results suggest impairment in the field of coordinating complex cognitive processes rather than executive functions regardless of method used during CABG.

to investigate clinical efficacy and safety of Reminyl for treating children with speech pathology.

160 children at the age of 3-7 years with severe speech disorders and mental retardation, who had been found incurable because of the ineffectiveness of the previous treatment, were administered Reminyl. The Remynil treatment was conducted in courses in the age appropriate dosage (1-2mg).

The children were divided into two groups: the 1st group comprised 95 children with speech pathology without mental retardation. The 2nd group comprised 65 children with speech impediment and mental retardation. Prior and after the treatment all the children were evaluated for speech and cognitive development by computer electroencephalography, MRI, CT of the brain. The investigation of immune and cytokinetic status was also conducted.

After three-four courses of treatment with an interval of 3 to 6 months 92% of the children were able to say separate words; their understanding of speech improved. Phrasal speech developed in 78% of the children. They all manifested the improvement of cognitive functions: visual perception, concentration, visual and auditory memory, and the operational component of cognition.

In 68 % of the children the results of computer electroencephalography revealed a considerable decrease of pathological disorders. When evaluating these disorders their clinical symptoms were taken into consideration. 29 % of the children manifested some positive dynamics in their condition. 3% of the children didn't manifest any significant changes.

The results of the study revealed high efficacy of Reminyl treatment of children with severe speech disorders.

Attention Deficit/Hyperactivity Disorder (ADHD) is clearly over represented among patients with drug addiction. Deficits in working memory (WM) are thought to be of central importance for ADHD. Previous studies indicate that WM can be improved by training.

In this pilot study we have examined if training of WM in adult patients with ADHD and a history of severe drug abuse would be possible to apply in a clinical setting. In addition, we hypothesized that the training would improve WM in this group.

Subjects: Nine patients with ADHD and a history of drug abuse were recruited. The age range was 21-52. One patient was addicted to alcohol, one to cannabis and seven patients to amphetamine. All patients had been drug-free more than two months prior to inclusion. Outcome measures: WM was assessed using four different tasks. The Self Rating Scale (CFQ) was used to score symptoms of cognitive failures in daily life. Training procedure: The treatment consisted of performing WM tasks implemented in a computer program (RoboMemo®).

Eight patients completed the treatment and remained drug-free during the training. There was a clear improvement in two WM test. Seven patients reported a subjective improvement as rated in CFQ.

This pilot study shows that computerized training of working memory can be performed in a clinical setting of adults with ADHD and drug addiction. The improvement support that patients with drug-addiction may have the same plasticity in the brain that non-addictive patients show.

Study based on analysis of data derived from liaison psychiatry services provided by Psychiatry Clinic in somatic and surgery departments of Kaunas Medical University Clinic during the period June 1 – September 31 of 2007. All elderly patients (≥ 65 years) referred by their treating doctors underwent unstructured clinical examination of consultant psychiatrist and structured interview regarding previous contacts with psychiatrists and treatment with psychotropic drugs. Pearson chi-square used to compare the equality of frequencies.

Data was obtained for 1026 elderly patients. 56 (19,5 %) patients were diagnosed any form of depression and 10 (3,5%) were diagnosed any anxiety disorder. 48 subjects (72,7%) were previously using psychotropic drugs: 39 (59,1%) were using benzodiazepines, 7 (10,6%) antidepressants and 2 (3,0%) antipsychotics. Benzodiazepines were predominant drugs (X2=50,38: p=0,0001) mostly prescribed by general practitioners. Just 7 (10,6%) subjects were previously consulted by psychiatrists and treated with antidepressants.

Despite sampling limitations of the study we can conclude that benzodiazepines are overused for the treatment of depression and anxiety disorders of elderly in Lithuania what can be due insufficient referrals to psychiatric evaluation.

The activities planning in a Residential Psychiatric Unit depends on psychopathological and biopathological profile of patients, and so we have to focus our therapies on three main items: Cognitive Impairment, Social Skills and Psychomotor Loss. In this work we propose an Activity Plan for those aging and psychiatric patients.

Psychiatric residential units show an usually old, poor collaborator, apathetic and cognitively impaired patient. We evaluated by psychological, medical and physical tests our residents in an attempt to change or palliate these conditions. According to results we assigned patients to activities. A new evaluation after six moths was planned to control real achievements.

Plan has four items:

1. I. Cognitive Stimulation: List of activities to enhance memory, attention, concentration, logical and abstract thinking, gnosia and praxia.

2. II. Psychomotor Training: we propose a plan overcoming usual apathy of these patients. It is also useful to improve social interaction.

3. III. Creative Stimulation: A plan focused on fine psychomotor skills taking into account personal abilities as knitting, embroidery, painting or writing.

4. IV. Leisure Time: play therapy, dancing, singing, trips and similar activities are proposed to complete leisure time. These are voluntary activities instead of three previous sections.

Residential Psychiatric Units are needed to plan some activities in order to palliate deficits and impairments proper of aging and psychiatric pathology.

Program shows to improve or stabilize social and cognitive skills, autonomy and environmental interaction.

After some initial resistance, our plan was well accepted and positively evaluated by patients and staff.

The number of the elderly is rapidly growing and depression is known to affect this group of people aged 60 years and above quite seriously. Pharmacotherapy in this age presents many challenges. Both bupropion, and Nortriptyline, a TCA with mild anticholinergic effect have been prescribed for the old patients suffering from depressive symptoms.

In a randomized double-blind study with 8 weeks of follow-up we selected 52 elderly outpatients who had non psychotic major depressive disorder according to DSMIV criteria and they were allocated into two groups who received nortryiptiline (at a dose of up to 150 mg per day) and bupropion (at a dose of up to225mg per day). Cognitive state was assessed using the Mini-Mental State Examination.

The out patient clinics at the Ghaem and Avicenna Hospital, Faculty of Medicine of the University of Mashad.

Both treatments were efficacious, and there were no statistically significant differences between the two antidepressant classes with regard to efficacy (pvalue<0.05).

For elderly depressed patients who completed a 8 week treatment trial, both nortriptyline and bupropion exhibited good efficacy and few side effects. There was no significant difference between the two groups in their response rate or the severity of side effects resulting from medication.

1975older people living in Razavi Khorasan province were studied using the cluster sampling method. The Persian version of GDS was completed based on filling in questionnaires and after recognition of sample size of each city. Admission and data analyzing was followed by examining the relationship between depression and place of living (rural and urban), education, gender, type of living (alone or with family), occupation, source of income, supporting system (such as charities)

The subjects' mean (±SD) age was 71.14+7.78 years (range: 60-98) and 52.9 of the subjects were women. According GDS score, 23.5% of the subjects were at risk of depression. The GDS score was significantly related to type of living (alone or with family) and source of income, and supporting system (such as charities). The percentage of depression was higher in subjects living alone than those living with others (P<0.01, respectively). There are significant differences between depression scores in elderly with family support, others, personal wealth and retirement salary (p<0.01).

Depressive symptoms are common among community-dwelling elders in Iran, and with its identical demographic characteristics, we suggest depression may be related to some factors including living alone and to source of income, and supporting system.

There are various physical, functional, psychological and social factors associated with the appearance of mental symptoms in the elderly. Our objective was to determine the relationship and influence of these different variables in the psychiatric symptomatology of the elderly who reside in the community.

Cross-sectional study of a sample of 324 patients over 65 years, representative of the elderly who reside in the community in the province of Huesca (Spain). Symptoms of depression (Yesavage GDS), cognitive impairment (MMSE), anxiety (GADS), psychotic symptoms, obsessive symptoms and hypochondriacal ideas (GMS) were measured. Social-demographic, physical and somatic, functional and social data were evaluated. Analysis was carried out in 3 phases: univariate, bivariate and multivariate with logistic regression.

At the time of the study, 46.1% of the elderly studied suffered from some psychiatric symptom. 16.4% had cognitive impairment, 15.7% anxiety, 14.3% depression, 6.1% hallucinations and delusions, 7.2% hypochondriacal ideas and 4.4% obsessive symptoms. Female gender was significantly associated with depression (PR: 3.3) and anxiety (PR: 3.9). Age was a factor associated with cognitive impairment (PR: 4.4). Depression was significantly related to severity of the physical illness (PR: 61.7 in extremely severe impairment). Solitude (PR: 16.3) and being single (PR: 13.4) were factors which were strongly associated with anxiety; living in residences was associated with psychotic symptoms (PR: 7.6).

Severity of physical illness, solitude, living in residences and female gender, among others, are related with psychiatric symptoms in community-residing elderly persons.

Mental disorders are among the most prevalent chronic diseases in the elderly worldwide and depression is the most common. Often not properly identified or treated, depression contributes to impairment in functional capacity and to considerable burden for family members and health services.

Study the prevalence of depressive symptoms and associated factors in the elderly interned in a Brazilian university hospital.

A cross-sectional study evaluated 189 participants using the Geriatric Depression Scale, the Mini-Mental State Examination and the Katz and Lawton Index, to assess dependence regarding activities of daily living (ADL).

The majority of the participants were women, aged between 60 and 92 years-old, with low educational level and personal income and nonqualified occupations. The prevalence of depressive symptoms was 56.1%, but only 3% had a psychiatric diagnosis registered in their medical records. Univariate analysis showed significant associations between depressive symptoms and low educational level and income, marital status, number of hospitalizations in the previous year, cognitive decline, dependence regarding basic and instrumental ADL and death. After logistic regression, the only variables that remained significantly associated with depression were low educational level, dependence regarding basic ADL and death.

Depressive symptoms were independently associated with low educational level and dependence regarding basic ADL. More importantly, hospitalized elderly with depressive symptoms were more likely to die. It is essential to properly diagnose and treat depression in this population, to minimize its negative impact on patients, family members and health services.