To investigate the effect of Chinese herb Danshen-Dahuang on learning and memory ability in rats with Alzheimer disease (AD) induced by D-galactose and AlCl3 and its possible mechanisms.

The AD model was produced by injecting D-galactose and AlCl3 intraperitoneally for 90 days. Since the 20th day of D-galactose and AlCl3 intraperitoneal injection, the rats in Danshen-Dahuang group had been treated with Danshen-Dahuang extraction by intragastric administration for 70 days. Subsequently,learning and memory ability of the mice was evaluated by Morris water maze and hippocampal gene expression of APP, PS1 was tested by reverse transcription polymerase chain reaction (RT-PCR).

Rats intragastric administration with Danshen-Dahuang, mice had shorter latency (P< 0.05) and less error times (P< 0.05) in water maze test compared with those in AD model group. At the same time, Danshen-Dahuang down regulated the expression of APP, PS1 mRNA (P< 0.05) in hippocampus.

Danshen-Dahuang improves the learning and memory ability of AD rats, its mechanism may be related to the downregulated expression of APP, PS1 mRNA.

To establish whether 1H - MRS aids early diagnosis of progression to Alzheimer's disease in patients with MCI.

21 patients with MCI underwent 1H - MRS using a 1.5 T GE scanner. The voxel of interest was located in the posterior cingulate. NAA/Cr, mI/Cr and NAA/mI were evaluated. Patients with MCI were compared with a group of 15 patients at various stages of AD and with 11 normal controls. Patients with MCI were followed up for four years, though by the fourth year the number of patients had fallen to 7. All subjects underwent a neurological exploration and the MMSE and ADAS neuropsychological tests.

In the four-year longitudinal study, 78% of the MCI subjects progressed to AD. The 1H -MRS of these subjects differed from that of the normal controls but no significant differences appeared in the evolution. From the outset it was closer to that of the AD subjects, especially in terms of the high levels of mI/Cr. Before the clinical appearance of dementia a sudden increase in mI was observed.

MCI subjects showed an increase in mI/Cr and a fall in NAA/Cr, as well as an increase in mI/NAA (p< 0.005).

AD subjects presented a significant reduction in NAA/Cr (p< 0.05) compared with controls. The mI/Cr and the mI/NAA presented significant increases (p< 0.005) in AD.

Though other studies are required, 1H -MRS appear to aid early diagnosis of AD in subjects with MCI.

Recent studies suggest that cholinergic dysfunction does not provide a complete account of age-related cognitive deficits and other neuronal systems like monoaminergic hypofunction are involved. In several studies selective serotonin reuptake inhibitors demonstrated promotion in neurogenesis in the hippocampus and enhanced memory and cognition. The aim of this study is to survey the effect of serotonin augmentation on cognition and activities of daily living in patients with Alzheimer's disease.

The trial was designed as a 12-week randomized, placebo-controlled, double-blind study. One hundred and twenty two patients aged 55-85 years, suffering from mild to moderate alzheimer's dementia were randomly allocated in one of the three treatment group: fluoxetine plus rivastigmine, rivastigmine alone or placebo group. Efficacy measures comprised assessments of cognition, activities of daily living and global functioning. Hamilton Depression Scale also was used to assess changes in mood throughout study.

Fluoxetine plus rivastigmine and rivastigmine groups demonstrated improvement on measures of cognitive and memory without any significant difference; however, the former group did better in their activities of daily living and global functioning. Patients taking placebo had significant deterioration in all the efficacy measures. Patients taking rivastigmine or rivastigmine plus fluoxetine had improvements in Hamilton Depression Scale without significant differences.

Concomitant use of selective serotonin enhancing agents and acetyl cholinesterase inhibitors can provide greater benefit in activities of daily living and global functioning in patients with cognitive impairment. Although our study is preliminary and larger double blind studies are needed to confirm the results.

Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most common causes of presenile dementia. Diagnosis relies on clinical evaluation based on neurologic and neuropsychological performance. Neuroimaging, including single-photon emission computed tomography (SPECT) is often obtained for confirmation. The overlap of symptoms in initial presentation such as changes in mood, personality, and behaviour may difficult the differential diagnosis. The present report aims to describe the case of a 68 year old male, with no prior psychiatric history until the age of 66, when he was first admitted for hospitalization with the diagnosis of severe depressive episode without psychotic symptoms (ICD10 F32.2). Two years later he was hospitalized for the second time, Investigation led to the diagnosis of dementia. Diagnostic categorization was difficult in the absence of imaging results consistent with clinical presentation and therapeutic response to cholinesterase inhibitors.

To describe an atypical presentation of dementia and discuss the diagnosis and therapeutic response.

We performed a Clinical file review and a comprehensive MEDLINE database search.

Behavioral and Psychological Symptoms of Dementia (BPSD) include agitation, apathy, hallucinations, and depression. These symptoms are a challenge to professional nursing care, resulting in frequent psychiatric hospitalization, which incur high costs to the national healthcare systems.

To estimate the prevalence of BPSD in nursing home residents in 16 representative nursing homes in Berlin, Germany.

In a cross-sectional clustered cohort study, BPSD were assessed using the Dementia Mood Assessment Scale (DMAS), the Neuropsychiatric Inventary (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Dementia stage severity was measured by Functional Assessment Staging (FAST) and the Mini-Mnetals State Examination (MMSE). Furthermore, the patients" history recording psychotropics and number of psychiatric hospitalizations were registered. The prevalence and incidence rates of BPSD as well the duration of hospitalization and the quantity of drug prescription were estimated.

BPSD are common above all in nursing home residents with dementia, exhibiting prevalence rates of above 60% of all nursing home residents suffering from dementia. The severity of BPSD was related to number of psychiatric hospitalizations, the amount of psychotropics prescribed, and caregiver burden (p < .05).

The high prevalence rate of BPSD reflects a significant problem in nursing home care, and is related to negative health outcomes and caregiver burden. Thus, nursing home care could be improved by minimizing the severity of BPSD, as well as the amount of drugs prescribed and the frequency of demented patients" hospitalization.

Vascular pathology has been implicated in the pathogenesis of both Alzheimer's disease and vascular dementia. While performance decrements in vascular dementia are by definition thought to be related to vascular load, performance decrements in Alzheimer's disease have not yet been studied in relationship to cardiovascular comorbidity. The aim of this study was to describe neuropsychological performance in patients with mild Alzheimer's disease and vascular dementia in relationship to cardiovascular comorbidity.

39 patients suffering form vascular dementia and 34 patients suffering form Alzheimer's disease underwent neuropsychological testing using an extended neuropsychological battery, including tests of episodic memory, working memory, naming, verbal fluency, executive functions, and language. Cardiovascular comorbidity was assessed form medical history and chart review using the Charlson comorbidity index.

Patients suffering form Alzheimer's disease and vascular dementia did not differ in terms of age, education, gender distribution, or dementia severity. Cardiovascular comorbidty was more pronounced in vascular dementia patients. In both Alzheimer's disease and vascular dementia, neuropsychological performance in tests of working memory and executive functioning was related to cardiovascular comorbidity, but the relationship was stronger in vascular dementia.

Vascular load affects neuropsychological performance in both Alzheimer's disease and vascular dementia, suggesting that cardiovascular comorbidity affects cognition across both forms of dementia.

Saccadic latency and number of saccadic intrusions were significantly (p< 0.001) higher in patients with dementia relative to healthy controls and depressed patients. There were significant correlations between MMSE total score and latency (r = -0.78, p< 0.01) or number of saccadic intrusions (r = -0.80, p< 0.001) in the demential group. In addition, both saccadic parameters were significantly associated with ADAS-cog total score of patients with dementia, whereas the subscale “orientation” showed the strongest correlation with latency (r = 0.71, p< 0.01) and intrusions (r = 0.74, p< 0.01).

There were no significant differences in saccadic eye movements between healthy controls and patients with major depression as a whole, or a subgroup of depressed patients with the worst cognitive performance (n=9).

It seems that disturbances in horizontal saccadic eye movements in patients with dementia are related to the degree of cognitive deficits in these patients. On the other hand, the lack of alterations in horizontal saccadic eye movements in depressed patients despite poor cognitive performance indicates different mechanism.

Behaviours that challenge in dementia exceed the capability of care home staff. Evidence shows medication, traditionally the first line treatment has limited benefit, may hasten cognitive decline and is associated with vascular and cardiac problems in older people. Alternatively, admission to hospital occurs despite 90% of behaviours occurring as a response to care practices or environmental factors. Instead, the reasons should be addressed focusing on when, where, why and with whom these behaviours manifest themselves.

AIMS In 2006, a five-month pilot study within the Northern Health and Social Services Board (NHSSB) (Antrim and Ballymena, Northern Ireland), using the Newcastle Model, a bio-psycho-social intervention received 20 referrals involving 11 care homes.

This new diagnostic approach formulatesbehaviours in terms of peoples’ needs, which are assumed to drive behaviours. The model is a hybrid of well-established ideas from various psychological models,but its distinguishing feature lies in the unique integration of teaching, supervision and intense support provided to care home staff. The NeuroPsychiatric Inventory Caregiver Distress (NPI-D) measures frequency and severity of behaviours and level of distress this causes staff. This was administered pre and post intervention.

Four hospital admissions were averted which, based on the average length of stay, would have cost an estimated £81,500. NPI-D scores decreased following interventions.

The potential of this pilot study was noted by the Institute of Healthcare Management Quality Awards prompting the NHSSB to fund a Behaviour Sciences Nursing Service. A clinical effectiveness and full cost effectiveness analysis is now planned.

Psychiatric symptoms are very prevalent in FTD, in particular in its behavioural variant. Among these, hypochondrial symptoms can be found, usually along the course of the disease.

A 70-year-old previously healthy woman was seen for progressive behavioural disturbances. Nine years before she started complaining of having almost all possible diseases. Every time that she saw a documentary or any news describing a disease, she said she had all its symptoms, so she must have the disease. The family started to find this strange, as every time she sake medical help, everything was fine. Even more strange was when she feared having completely inadequate diseases, like the “blue baby syndrome”. Several months after, she started having incomprehensible fears, refused to be left alone, locked all dors and windows and did not want to go outside because she was afraid that someone would harm her. Over the next years the full-blown FTD picture developed, with reduction of speech output, verbal and sexual disinhibition, impulsivity, hyperphagia and aggressivity, with total lack of insight. Upon examination she was coprolalic, inadequate, perseverant and had frontal release signs. MRI showed bilateral frontotemporal atrophy and PET revealed frontotemporal hypometabolism.

Although hypochondrial symptoms are one of the affective classical symptoms in FTD, they are unusual in first stages of disease, and has not been, to our knowledge, reported as a presenting sign. These findings highlight the need to bear in mind this diagnosis in all patients presenting with novel psychiatric symptoms in late life.

Assess effects of antidepressant compliance on healthcare and workplace costs.

Using workplace survey data for 2 large employers’ healthcare claims (2004-2006), patient selection criteria considered depression diagnosis and antidepressant claims history. Employed respondents working in the past month were categorized by Medication Possession Ratio into compliance groups by quartiles; bottom/top quartiles were defined as compliant/non-compliant. Direct (medical/drug) costs were measured as insurer payments to providers; indirect (absenteeism/presenteeism) costs were based on one-month recall of workplace performance (hours worked/missed, self-rated performance), estimated as (hours missed x self-reported hourly income). Annualized, inflation-adjusted (2006) costs were compared between compliant/non-compliant groups using multivariate models controlling for baseline characteristics. Analyses were conducted for all patients and a subsample of diagnosed depression patients.

Among all patients (n=1,224), medical costs were numerically lower for compliant vs. non-compliant patients ($4,857 vs. $5,926, p=0.221); drug costs were significantly higher for compliant patients ($2,329 vs. $1,570, p=0.001). Indirect costs were not statistically different between compliant/non-compliant patients ($22,278 vs. $20,714, p=0.237). Among the depression subgroup (N=488), medical costs were numerically lower for compliant vs. non-compliant patients ($5,005 vs. $7,630, p=0.152) while drug costs were numerically higher for compliant patients ($2,550 vs. $1,829, p=0.153). Absenteeism costs were 30% lower for compliant patients ($7,725 vs. $11,040, p=0.038); presenteeism costs were not significantly different ($19,079 vs. $17,457, p=0.441).

Absenteeism costs decrease significantly with compliance among depressed patients as do medical costs (not significantly). Further research is warranted regarding reason for poor antidepressant compliance and influence of compliance on costs.

Sexual dysfunction is an important under-estimated side effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. Thus, the aim of the present meta-analysis is to quantify sexual dysfunction caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.

A literature search was conducted using Medline, Isi web of Knowledge and references of selected articles. Selected studies performed on patients without previous sexual dysfunction were entered in the Cochrane Collaboration Review Manager Software (RevMan version 4.2). Our primary outcome measure was the rate of total treatment emergent sexual dysfunction. Our secondary outcome measures were the rates of treatment emergent desire, arousal and orgasm dysfunction.

Our analyses indicated significantly higher rates of treatment emergent sexual dysfunction as well as specific phases dysfunction compared to placebo for the following drugs: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, venlafaxine, clomipramine, imipramine and phenelzine, whereas no significant difference with placebo was found for the following antidepressants: amineptine, bupropion, moclobemide, mirtazapine and nefazodone. Nonetheless sufficient evidences (>100 subjects) are available only for bupropion, citalopram, fluoxetine, paroxetine, sertraline and venlafaxine.

Present evidence on treatment emergent sexual dysfunction caused by antidepressant is sufficiently studied only for few drugs. Furthermore some statistical limiting assumptions, as the inclusion of open label or small studies and the presence of an evident publication bias, could reduce the significativity of our findings. Thus, treatment emergent sexual dysfunction should be more deeply investigated.

The aim of the present review and meta analysis is to evaluate the efficacy of new noradrenergic antidepressants (NAD) in the treatment of panic disorder (PD).

A literature search was conducted using MEDLINE, ISI web of knowledge and references of selected articles. Data from fourteen papers focusing on venlafaxine, mirtazapine and reboxetine were entered in RevMan 4.2.10 Our primary outcome measures were the rate of response, remission and side effects of NAD compared to placebo. Further analysis included the end-point mean number of panic attacks, the Panic and Anticipatory Anxiety Scale and the Hamilton Scale for Anxiety’ values.

We found a significant higher rate of response (OR = 3.2, 95% CI=2.61 to 3.92), remission (OR = 2.14, 95% CI=1.72 to 2.66) and side effects (OR = 1.41, 95% CI=1.11 to 1.78) for NAD compared to placebo, even though the studies were very heterogeneous. Analysis performed on the three drugs individually showed higher rate of response for patients treated with venlafaxine and mirtazapine whereas no statistical difference was found between reboxetine and placebo. The number of panic attacks and the values of all scales measuring the intensity of panic disorder at the end of trial were significantly lower for patients treated with a NAD.

Although the small sample size of some studies and limiting statistical assumptions could reduce the significativity of our findings, both venlafaxine and mirtazapine showed a significant efficacy for the treatment of PD which was comparable to selective serotonine reuptake inhibitors. Further studies on reboxetine are needed.