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Összefoglaló. Bevezetés: Az öngyilkosság régóta jelentos probléma hazánkban. Célkituzés: Az elmúlt 20 év során elkövetett, befejezett öngyilkosságok elemzése három idointervallumban (2000-2006, 2006-2010, 2010-2019) nemek, korcsoportok, az elkövetési mód, a családi állapot és a munkanélküliség szempontjából. További célunk volt a pszichiátriai ellátást negatívan érinto, 2007. évi egészségügyi reform suicid halálozással való összefüggéseinek vizsgálata. Módszer: A suicid halálozást a Központi Statisztikai Hivatal adatainak felhasználásával elemeztük. Az évenkénti suicid rátát 100 000 lakosra adtuk meg. Az adatok statisztikai feldolgozásához az Excel 2011-es, az SPSS 23-as és az amerikai NIH Jointpoint programjának 4.8.0.1-as verzióját használtuk. Eredmények: 2000 és 2019 között 51,4%-kal csökkent a suicid halálozás (nok: 15,57 vs. 7,69/100 000 fo; férfiak: 51,5 vs. 24,73/100 000 fo, összlakosság: 32,61 vs. 15,85/100 000 fo). A legnagyobb mértékben a férfiak és a középkorúak körében csökkent a mortalitási ráta, a legkevésbé a fiatal, egyedülálló noknél. A leggyakoribb elkövetési mód változatlanul az akasztás (58,4%). A 20 évig tartó rátacsökkenés 2006 után több évre megtorpant, és egészen 2010-ig nagyjából konstans maradt (24,43 vs. 24,88/100 000 fo). Azt feltételezzük, hogy ennek hátterében jelentos részben a pszichiátriai ellátórendszert negatívan érinto, 2007-ben bevezetett egészségügyi reform állt. Ez a megtörés kimutatható volt szinte minden korcsoportnál, a leggyakoribb elkövetési módoknál, és egyaránt érintette a hajadonokat/notleneket, a házasokat, az özvegyeket és az elváltakat. Csak 2010 után kezdodött újra a suicid mortalitás szignifikáns csökkenése. Az utolsó 10 év alatt 36,3%-kal csökkent a suicid mortalitás (24,88 vs. 15,85/100 000 fo), ami kiemelkedo eredmény az európai országok körében. Következtetés: Egy elhibázott, a pszichiátriai ellátórendszert sújtó egészségügyi reform következményeként az addig egyenletesen csökkeno suicid halálozás üteme 2006 után megtört, és néhány évig stagnált. Több évig tartott, mire bizonyos mértékig rendezodött a pszichiátriai ellátórendszer, és ennek köszönhetoen 2010 után ismét folyamatosan és szignifikánsan csökkent a suicid mortalitás. Orv Hetil. 2021; 162(32): 1283-1296. INTRODUCTION: In Hungary, suicide has been a major public health issue for a long time. OBJECTIVE: Our objective was to examine data on completed suicide cases in Hungary from a 20-year period divided into three intervals (2000-2006; 2006-2010; 2010-2019) grouped by sex, age, methods of commitment, marital and employment statuses. An auxiliary aim was to assess the associations between the healthcare reform in 2007 (with unfavourable impacts on the psychiatric care system) and suicide mortality. METHOD: Data on suicide were provided by the Hungarian Central Statistical Office. In all cases, the yearly suicide rates were given for 100 000 inhabitants. For statistical calculations, we used Excel 2011, SPSS v. 23 and NIH Joinpoint Regression Program v. 4.8.0.1. RESULTS: Between 2000 and 2019, there was a 51.4% reduction in the suicide mortality (females: 15.57 vs. 7.69/100 000; males: 51.5 vs. 24.73/100 000; total population: 32.61 vs. 15.85/100 000). The greatest declines occurred among males and middle-aged. At the same time, the rate of young single females declined only slightly. The most common method of commitment remained hanging (58.4%). During the 20-year-long period investigated, there was a temporary halt between 2006 (24.43/100 000) and 2010 (24.88/100 000) in the otherwise steadily declining trend of the rate. One of the major underlying causes of this plateau is presumed to be the healthcare reform commenced in 2007 with negative impacts on psychiatric services. This plateau was observable in almost all subpopulations irrespective of their age, marital status and the suicide method they used. The decline of the rate restarted only after 2010. In the last 10 years, suicide mortality has decreased by 36.3% (from 24.88 to 15.85/100 000) in Hungary, which is a very good result in a European comparison. CONCLUSION: Due to an unsound health reform threatening the psychiatric care, the previously experienced declining trend of the suicide rate halted in 2006 and has remained almost unchanged for a few years during which psychiatric services could be restored in some degree. From 2010, as a consequence of this restoration, the marked decline of the suicide rate restarted and has been remained stable. Orv Hetil. 2021; 162(32): 1283-1296.
Subject(s)
Suicide, Completed , Suicide , Causality , Female , Health Care Reform , Humans , Hungary/epidemiology , Male , Middle AgedABSTRACT
Aims: In the last decades, the number of infertile males increased worldwide which gained more focus. The extent to which a person or a couple is able to cope adaptively with the problem of infertility depends on the combined effect of several variables. Our aim was to apply counselling among males suffering from infertility problems. During the therapy - besides providing information - we aim to elaborate the effects of the treatment and experiences, to process information, to develop adaptive coping strategies against stress and to indirectly or directly change health behaviours influencing reproduction.Methods: Only patients with male factor infertility were involved. They were divided into an observed group (n = 57) and a control (n = 51) group after a thorough physical examination and assessment of their reactions to, and awareness of, the disease.Results: The group that received the interventions had an intense awareness of the diagnosis and aims and nature of the indicated treatment. They employed purposeful problem-solving coping strategies, reported being satisfied with the infertility treatment.Conclusions: The counselling of clients with infertility problems a more favourable mental well-being can be established by the active participation of professional helpers. Patients might receive effective, targeted and problem-specific help.Abbreviations: ART: Assisted Reproductive Technology.
Subject(s)
Adaptation, Psychological , Infertility, Male , Counseling , Humans , Infertility, Male/therapy , Male , Mental Health , Reproductive Techniques, AssistedABSTRACT
BACKGROUND/AIM: Anti-cancer therapies may deteriorate cognitive functioning, affective functioning and psychological well-being. MATERIALS AND METHODS: In this prospective longitudinal pilot study, premenopausal and postmenopausal patients received adjuvant endocrine therapy (ET) (tamoxifen with or without LHRH analog or aromatase inhibitor) or were observed only (control group). At baseline testing and 6, 12 and 24 months thereafter, cognitive, depression and anxiety tests and quality of life (QOL) measurements were performed. RESULTS: Overall, 46 cases were evaluated. None of the studied cognitive parameters differed between the subgroups or changed by time. No differences were found regarding anxiety, depression or QOL measures either. Baseline cognitive test and QOL results were in association with later anxiety and depression. CONCLUSION: No cognitive impairment was found during the two years of ET. Baseline cognitive scores and QOL dimensions proved good predictors of later anxiety and depression.
Subject(s)
Breast Neoplasms/psychology , Cognition , Adult , Aged , Antineoplastic Agents, Hormonal/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Humans , Middle Aged , Neuropsychological Tests , Pilot Projects , Postmenopause , Premenopause , Quality of LifeABSTRACT
INTRODUCTION: Interdisciplinary studies confirm that surgical fear experienced by patients can have a substantial effect on the outcome of the surgery and the healing process after surgery. AIM: The aim of this study was to assess the reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in cancer patients. METHOD: 149 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, the Visual Analogue Scale and the Surgical Fear Questionnaire. RESULTS: The scale showed excellent internal consistency (Cronbach-alfa = 0.878; 0.885). The Surgical Fear Questionnaire scores moderately correlated with anxiety, depression and anticipated pain after surgery. CONCLUSION: The reliability and validity of the Hungarian version of the Surgical Fear Questionnaire in the sample were excellent. The questionnaire turned out to be a useful psychometric tool in the measurement of surgical fear. Orv Hetil. 2018; 159(47): 1988-1993.
Subject(s)
Fear , Pain, Postoperative/psychology , Surgical Procedures, Operative/psychology , Surveys and Questionnaires/standards , Female , Humans , Hungary , Male , Pain Measurement , Reproducibility of Results , Self ReportABSTRACT
Background: Episodic memory disturbances were found to constitute a potential trait marker for major depression (MD). The recall of positive or rewarding information in a relational context is specifically impaired. Eye-movement recording constitutes a novel, direct approach to examine implicit memory performance. Here we aimed to assess the effect of emotional context and implicit virtual monetary reward or loss on viewing patterns in association with relational memory in a 6-months follow-up study in MD. Materials and Methods: Twenty-eight patients with MD and 30 healthy participants were trained to associate a face (happy/sad/neutral) with a background scene. After each pair a virtual monetary reward or loss appeared briefly. During testing, scenes were presented as a cue and then overlaid with three previously studied faces. Participants were asked to recall the matching face if present (Match trials), with eye-movements and subsequent forced-choice recognition being recorded. Results: Explicit recognition of the matching face was impaired in the MD group as compared to controls. In correlation with this, viewing of the matching face was significantly reduced in the MD group. We found a significant interaction of group (MD vs HC) with the relational memory condition (Match and Non-match), facial emotion and monetary reward and loss. MD patients attended longer to previously rewarded stimuli, but significantly less to sad faces in the Match condition. The relational memory impairment persisted at follow-up and correlated with symptom severity both at baseline and follow-up. Viewing patterns associated with previous virtual reward were associated with clinical symptoms at follow-up. Conclusion: Our current results provide novel evidence for a specific relational memory impairment in MD as supported by abnormal eye-movement behavior and a deficit in explicit recognition. MD patients showed an attentional bias to rewarded stimuli and decreased viewing of sad faces when relational memory information was present.
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BACKGROUND AND AIMS: Mental disorders with psychotic features are overlapping in many ways and there are a growing number of comparative studies in the last decades regarding this. Cognitive deficit is well underpinned in schizophrenia, but fewer studies are conducted in this area including patients with bipolar affective disorder. Therefore the aim of the present study was to investigate the cognitive performance of these two patient groups and healthy controls. The Wisconsin Card Sorting Task is a very sensitive measure of the shifting function. Schizophrenic patients perform consistently poorer on this task than healthy controls, while there are not much data about individuals with bipolar affective disorder. METHODS: The Wisconsin Card Sorting Task and clinical symptom rating scales were administered to 26 patients with schizophrenia, 24 with bipolar affective disorder and 21 healthy controls. RESULTS: Significant differences were found among the performance of the three groups using four different dimensions of the Wisconsin Card Sorting Task. The schizophrenic group made more perseverative errors and achieved less conceptual level responses and completed fewer categories compared to healthy controls. Patients with schizophrenia were able to complete fewer categories and had fewer conceptual level responses than the bipolar group. No significant differences were observed between patients with bipolar disorder and healthy controls. CONCLUSIONS: According to these results, patients with schizophrenia and bipolar affective disorder showed no similarities on the Wisconsin Card Sorting Task. Bipolar patients performed the task on the same level as healthy individuals did. The two mental disorders influence cognitive performance differently.
Subject(s)
Bipolar Disorder/psychology , Memory, Short-Term , Schizophrenic Psychology , Adult , Female , Humans , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
BACKGROUND: The nature of episodic memory deficit in intermediate-term abstinence from alcohol in alcohol dependence (AD) is not yet clarified. Deficits in inhibitory control are commonly reported in substance use disorders. However, much less is known about cognitive control suppressing interference from memory. The Think/No-think (TNT) paradigm is a well established method to investigate inhibition of associative memory retrieval. METHODS: Thirty-six unmedicated patients with AD and 36 healthy controls (HCs) performed the TNT task. Thirty image-word pairs were trained up to a predefined accuracy level. Cued recall was examined in three conditions: Think (T) for items instructed to-be-remembered, No-think (NT) assessing the ability to suppress retrieval and Baseline (B) for general relational memory. Premorbid IQ, clinical variables and impulsivity measures were quantified. RESULTS: AD patients had a significantly increased demand for training. Baseline memory abilities and effect of practice on retrieval were not markedly different between the groups. We found a significant main effect of group (HC vs. AD) × condition (B, T, and NT) and a significant difference in mean NT-B scores for the two groups. DISCUSSION: AD and HC groups did not differ essentially in their baseline memory abilities. Also, the instruction to focus on retrieval improved episodic memory performance in both groups. Crucially, control participants were able to suppress relational words in the NT condition supporting the critical effect of cognitive control processes over inhibition of retrieval. In contrast to this, the ability of AD patients to suppress retrieval was found to be impaired.
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AIMS AND OBJECTIVES: To examine psychological risk factors and somatic factors in patients after myocardial infarction. To study the relationship between somatic and psychological factors, their influence on subjective quality of life (well-being) and also to examine possible gender differences. BACKGROUND: There has been a growing body of evidence that psychosocial factors are risk factors for incident and recurrent myocardial infarction. DESIGN: Descriptive correlational and cross-sectional survey design. METHODS: In patients (n = 97, 67 men), the level of depression and anxiety, vital exhaustion, sleep disturbances and well-being were assessed. Left ventricular ejection fraction, left ventricular diastolic diameter, body mass index, metabolic equivalents and the number of diseased vessels were retrieved from medical records. RESULTS: Anxiety, vital exhaustion and sleep disturbances were significantly higher in women than in men. Well-being showed a significant linear correlation with body mass index, anxiety, depression, vital exhaustion and sleep disturbances scores. After adjustment for psychological risk factors and somatic parameters, only vital exhaustion and anxiety correlated significantly with well-being. However, there were gender differences in predictive variables of well-being. Anxiety in men and vital exhaustion in women showed a linear correlation with the subjective quality of life. CONCLUSION: Our study revealed that only vital exhaustion and anxiety showed a significant correlation with well-being in patients. RELEVANCE TO CLINICAL PRACTICE: During cardiac rehabilitation, it is important to detect and treat not only depression but also vital exhaustion and anxiety, because by reducing these psychological conditions, we can improve well-being.
Subject(s)
Anxiety Disorders/psychology , Fatigue/psychology , Myocardial Infarction/psychology , Quality of Life , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Myocardial Infarction/nursing , Myocardial Infarction/pathology , Myocardial Infarction/rehabilitation , Severity of Illness IndexABSTRACT
BACKGROUND: The Clock Drawing Test (CDT) is a widely-used, rapid assessment tool for the screening of cognitive decline though its evaluation and interpretation are still not uniform. The aim of present study was to investigate the difference in sensitivity and specificity of two types of CDTs and to compare the clinical benefits of quantitative and semiquantitative scoring systems. OBJECTIVE: To investigate the difference in sensitivity and specificity of two types of CDTs and to compare the clinical benefits of quantitative and semiquantitative scoring systems. METHODS: Six hundred and ninety-two participants with or without dementia completed 10-item CDTs in nursing homes in two counties in southern Hungary. The dementia was not further subclassified. The results of the two tests, CDT1 (representing five minutes to a quarter to four) and CDT2 (representing ten past five), were evaluated quantitatively and semiquantitatively. RESULTS: In the quantitative evaluation, the sensitivity and the specificity for the diagnosis of dementia at cut-off scores of 7 points were determined: 87.1% and 51.9%, respectively, for CDT1, and 81.7% and 57% for CDT2, respectively. The semiquantitative analysis revealed a sensitivity of 67.3% and a specificity of 65.3% for CDT1, and of 64.6% and 66.6% for CDT2, respectively. CONCLUSION: The results of CDT tests do not appear to depend on the positions of the clock hands and additionally suggest that the quantitative evaluation method is more sensitive than the semiquantitative method.
Subject(s)
Dementia/diagnosis , Dementia/psychology , Geriatric Assessment/methods , Neuropsychological Tests/standards , Aged , Aged, 80 and over , Cohort Studies , Dementia/epidemiology , Female , Humans , Hungary/epidemiology , Male , Middle Aged , Psychometrics/methods , Psychometrics/standardsABSTRACT
Neurotransmitter enhancement therapy with acetylcholinesterase inhibitors (AChEIs) is a clinically proven approach for patients with Alzheimer's disease (AD). Donepezil is one of the three currently approved AChEIs for treating AD symptoms delaying the decline in cognitive function. In addition to cholinergic hypofunction, there are several factors in AD pathogenesis. For example, adipocytokines released from adipose tissue are also thought to play a role in the progress of dementia. Adipokines, i.e., leptin and adiponectin, are involved in the modulation of certain cognitive functions in the brain. The goal of our study was to elucidate effects of donepezil therapy on the serum levels of certain adipokines, such as leptin and adiponectin in AD patients. Clinically diagnosed mild-to-moderate AD patients (n = 26) were involved in this open-labeled, single-center, prospective self-control study. ApoE polymorphism, serum adiponectin, leptin, LDL, HDL, triglyceride levels, and BMI were determined before and at 12 and 24 weeks intervals of donepezil treatment, respectively. Twenty-four weeks of donepezil treatment induced a linear decrease of serum leptin levels (p = 0.013) and a linear elevation of serum adiponectin levels (p = 0.007). BMI (p < 0.001) and abdominal circumference (p = 0.017) were significantly lower at 24 weeks as compared to control values. None of the other examined metabolic parameters were changed during the treatment period. This previously unrecognized serum adipokine regulating potential of donepezil may be relevant in its therapeutic, disease modifying effect in AD by transferring protective (by increasing serum adiponectin levels) and detrimental (by decreasing serum leptin levels) effects onto the neurodegenerative process at the same time.
Subject(s)
Adipokines/blood , Alzheimer Disease/blood , Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/therapeutic use , Indans/therapeutic use , Piperidines/therapeutic use , Adiponectin/blood , Aged , Aged, 80 and over , Cognition/drug effects , Donepezil , Female , Humans , Male , Neuropsychological Tests , Prospective Studies , Time FactorsABSTRACT
BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) is a heterogenous syndrome considered as a prodromal state of dementia with clinical importance in the early detection of Alzheimer's Disease. We are currently developing an MCI screening instrument, the Early Mental Test (EMT) suitable to the needs of primary care physicians. The present study describes the validation process of the 6.2 version of the test. METHODS: Only subjects (n = 132, female 95, male 37) over the age of 55 (mean age 69.2 years (SD = 6.59)) scoring at least 20 points on Mini-Mental State Examination (MMSE), mean education 11.17 years (SD = 3.86) were included in the study. The psychometric evaluation consisted of Alzheimer's Disease Assessment Scale Cognitive subscale (ADAS-Cog) and the 6.2 version of EMT. The statistical analyses were carried out using the 17.00 version of SPSS statistical package. RESULTS: The optimalised cut-off point was found to be 3.45 points with corresponding 69% sensitivity, 69% specificity and 69% accuracy measures. The Cronbach-alpha, that describes the internal consistence of the test was 0.667, which is higher as compared with the same category in the case of the ADAS-Cog (0.446). A weak negative rank correlation was found between the total score of EMT 6.2 and the age of probands (rs = -0.25, p = 0.003). Similarly, only a weak correlation was found between the education levels and the total score of EMT 6.2 (rs = 0.31, p < 0.001). Two of the subtests, the repeated delayed short-time memory and the letter fluency test with a motorical distraction task had significantly better power to separate MCI and control groups than the other subtests of the EMT. CONCLUSION: The 6.2 version of EMT is a fast and simple detector of MCI with a similar sensitivity-specificity profile to the MMSE, but this version of the test definitely needs further development.
Subject(s)
Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/psychology , Dementia/diagnosis , Dementia/psychology , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Analysis of Variance , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Depression/psychology , Educational Status , Female , Humans , Intelligence Tests , Male , Neuropsychological Tests , Psychometrics , ROC Curve , Sensitivity and SpecificityABSTRACT
INTRODUCTION: The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) has been established internationally as an instrument for the assessment of treatment efficacy and cognitive performance in clinical trials. There is no data about the validity and characteristics of ADAS-Cog in Hungarian sample. This study is a part of the Hungarian standardization process of ADAS-Cog. It is crucial to examine the cognitive performance of patients with pseudodementia caused by depression (D) because of its' similarities with Alzheimer's disease (AK). The objective of the study was to analyze the characteristics of the cognitive subscale for further validation purposes. The study aimed at analyzing the ADAS-Cog performance of patients with D and AK in a Hungarian sample to make future studies more accurate through more exact differentiation between the two diseases. METHODS: Fourty-seven normal elderly control (KNT) subjects, 66 AK patients and 39 patients with D participated in the study. The mental state and the severity of depressive symptoms of the participants were assessed by the means of ADAS-Cog, Mini Mental State Examination (MMSE) and Beck Depression Inventory. RESULTS: The ADAS-Cog is sensitive to the cognitive decline of the depressed group (sensitivity=69.2%, specificity=89.4%, AUC=0.868, p>0.001). While the performance of the two patient groups differed from the KNT, the groups are overlapping and the characteristic of the ROC curve and the optimal cut-off point (D:11.8; AK:12.1) indicates that the differentiation is mediocre. CONCLUSION: The results suggest that pseudodementia should be considered during the design of studies using ADASCog. Because the cognitive subscale can't accurately differentiate between AK and pseudodementia additional measures like BDI should be administered.
Subject(s)
Alzheimer Disease/psychology , Cognition , Cognitive Dysfunction/psychology , Depression/diagnosis , Depression/psychology , Surveys and Questionnaires/standards , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/drug therapy , Case-Control Studies , Diagnosis, Differential , Factitious Disorders/diagnosis , Factitious Disorders/psychology , Female , Humans , Hungary , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Reproducibility of Results , Sensitivity and Specificity , TranslationsABSTRACT
With the development of DSM-V and ICD-11 the definitions of psychiatric disorders are under re-evaluation. The emphasis is shifted from distinct disorders to clusters defined not only by symptomatology, but also by underlying neurobiology and cognitive deficits. Bipolar disorder I (BD-I) and schizophrenia (SZ) are of special interest since their differential diagnosis is often problematic and they partially overlap in measures ranging from genetics to neurophysiology. Event-related potentials (ERPs) are one of the most studied factors but the results are still controversial, primarily in BD-I, where ERPs reflecting different stages of auditory information processing have been much less investigated. In this study, we aimed at investigating the changes of five auditory event-related potentials (P50 and N100 suppression, duration and pitch deviant mismatch negativity (MMN) and P3b) in 20 SZ and 20 BD-I patients with a history of psychosis and 21 healthy control subjects. Our data revealed substantial differences between the two patient groups. Only patients with SZ demonstrated impaired N100 suppression, shorter duration deviant MMN latency and attenuated P3b amplitude, while prolonged pitch deviant MMN latency was found to be characteristic of the BD-I group. No shared ERP abnormalities were observed among the patient groups. Our results indicate that SZ and BD-I are characterized by highly different neurophysiological profiles when measured in the same laboratory setting.
Subject(s)
Auditory Perceptual Disorders/classification , Auditory Perceptual Disorders/etiology , Bipolar Disorder/complications , Schizophrenia/complications , Acoustic Stimulation , Adult , Contingent Negative Variation/physiology , Electroencephalography , Evoked Potentials, Auditory/physiology , Female , Humans , Male , Middle Aged , Psychiatric Status Rating ScalesABSTRACT
UNLABELLED: The cognitive subscale of the Alzheimer's Disease Assessment Scale is the most widely used test in the diagnostic and research work of Alzheimer's disease. AIMS: The aim of this study was to validate and investigate reliability of the Hungarian version of the Alzheimer's Disease Assessment Scale in patients with Alzheimer's disease and healthy control subjects. METHODS: sixty-six patients with mild and moderate Alzheimer's disease and 47 non-demented control subjects were recruited for the study. The cognitive status was established by the Hungarian version of the Alzheimer's Disease Assessment Scale and Mini Mental State Examination. Discriminative validity, the relation between age and education and Alzheimer's Disease Assessment Scale, and the sensitivity and specificity of the test were determined. RESULTS: Both the Mini Mental State Examination and the Alzheimer's Disease Assessment Scale had significant potential in differentiating between patients with mild and moderate stages of Alzheimer's disease and control subjects. A very strong negative correlation was established between the scores of the Mini Mental State Examination and the Alzheimer's Disease Assessment Scale in the Alzheimer's disease group. The Alzheimer's Disease Assessment Scale showed slightly negative relationship between education and cognitive performance, whereas a positive correlation between age and Alzheimer's Disease Assessment Scale scores was detected only in the control group. According to the analysis of the ROC curve, the values of sensitivity and specificity of the Alzheimer's Disease Assessment Scale were high. CONCLUSIONS: The Hungarian version of the Alzheimer's Disease Assessment Scale was found to be highly reliable and valid and, therefore, the application of this scale can be recommended for the establishment of the clinical stage and follow-up of patients with Alzheimer's disease. However, the current Hungarian version of the Alzheimer's Disease Assessment Scale is not sufficient; the list of words and linguistic elements should be selected according to the Hungarian standard in the future.
Subject(s)
Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Cognition , Psychiatric Status Rating Scales/standards , Humans , Hungary , Language , Psychometrics , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , TranslationsABSTRACT
Throughout the natural progression of Alzheimer's disease (AD), the body mass index (BMI) decreases. This is believed to be brought on by the disturbance in the central lipid metabolism, but the exact mechanism is yet unknown. Adipokines (adiponectin, leptin), hormones produced by the adipose tissue, change glucose and lipid metabolism, and have an anorectic effect through increasing energy consumption in the hypothalamus. The goal of our study was to examine donepezil - an acetylcholinesterase inhibitor (AChEI) currently used in AD therapy -, and to what degree it influences the serum adipokine levels and metabolic parameters of AD patients. During the self-evaluation of 26 clinically diagnosed mild to moderate AD patients, therapy with 10 mg/day donepezil was started according to current protocols. We measured serum adiponectin, leptin, LDL, HDL, trigliceride levels, and BMI and ApoE polymorphism at the beginning of our study, and at 3 and 6-months intervals respectively. All data were analyzed with SPSS 17. In comparison with pre-donepezil therapy values, at the third month interval serum adiponectin levels showed an increasing and leptin levels a decreasing tendency. At the six month interval, adiponectin levels significantly increased (p=0.007), leptin levels decreased (p=0.013), BMI (p=0.001) and abdominal circumference (p=0.017) was significantly lower at 6 months as compared to control values. We did not observe any changes in the lipid profile, and ApoE4 allele carrying showed no association with the parameters. To our knowledge, we are the first to publish that AChEI therapy with donepezil alters lipokine levels, which positively influences the currently known pathomechanism and numerous risk factors of AD. The AChEI treatment-induced weight loss should be considered in the long-term therapy of AD patients.
Subject(s)
Adipokines/blood , Alzheimer Disease/drug therapy , Alzheimer Disease/metabolism , Body Mass Index , Cholinesterase Inhibitors/therapeutic use , Indans/therapeutic use , Lipid Metabolism , Piperidines/therapeutic use , Adiponectin/blood , Aged , Aged, 80 and over , Alzheimer Disease/blood , Alzheimer Disease/diagnosis , Apolipoproteins E/genetics , Appetite , Biomarkers/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Donepezil , Drug Administration Schedule , Female , Humans , Hungary , Indans/administration & dosage , Leptin/blood , Male , Middle Aged , Nootropic Agents/therapeutic use , Outpatients , Piperidines/administration & dosage , Polymorphism, Single Nucleotide , Severity of Illness Index , Time Factors , Treatment Outcome , Triglycerides/blood , Waist CircumferenceABSTRACT
AIMS: High relapse rate and extreme difficulty to maintain abstinence are core characteristics of alcohol dependence (AD). Previous studies have demonstrated a persistent decision-making (DM) deficit in AD. We aimed to reveal specific personality features and stress-coping mechanisms presumed to compensate for ineffective DM skills. METHODS: Eighty-eight unmedicated patients with AD were enrolled. Intact general cognitive status was assured by IQ above 90. Forty-three patients had an average abstinence period of 12 weeks and were currently in an inpatient treatment program (short-term abstinence group, STA) and 45 patients were abstinent for at least 3 years (long-term abstinence group, LTA). The two groups were assessed using an integrative approach combining domains of DM, temperament and character dimensions and stress-coping measures. RESULTS: Both groups performed at chance level with no linear improvement tendency on the gambling task assessing DM adequacy. The LTA group scored significantly higher on scales of self-directedness and cooperativeness. In contrast, levels of harm avoidance, emotion-oriented coping and perceived stress were significantly higher in the STA group. CONCLUSION: Our findings provide new evidence for a persistent DM deficit with no learning effect in AD. Despite the deficit, alcohol-dependent patients can achieve LTA. STA patients perceive higher levels of stress and use non-adaptive coping strategies. We propose that the more adaptive personality profile of LTA patients contributes to the compensation of the trait-like DM deficit in alcoholism. These compensatory features represent promising new targets for preventive measures and therapeutic interventions in AD.
Subject(s)
Adaptation, Psychological , Alcoholism/psychology , Decision Making , Personality , Temperance/psychology , Adult , Alcoholism/therapy , Female , Humans , Interview, Psychological/methods , Male , Middle Aged , Time FactorsABSTRACT
INTRODUCTION: Early recognition of mild cognitive impairment (MCI) has increasing clinical relevance in the treatment process of dementia, since it is considered as prodromal period. A great variety of instruments have been developed for measuring cognitive performance of the demented patients. The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog) is one of the most frequently applied instrument to determine the severity of dementia and the efficiency of pharmacotherapy. The aim of this study is to examine the sensitivity parameters of the Hungarian ADAS-Cog in differentiating healthy elderly from MCI patients, furthermore to compare the sociodemographic data of the two groups. METHODS: Fourty-five patients with MCI and 47 healthy subjects (HS) participated in the study. Their age variated between 52 and 88 years, the mean age was 68.8 (standard deviation=8.6). The mean of the years of education was 11.8 (standard deviation=3.5). Mental state was determined by ADAS-Cog and Mini-Mental State Examination (MMSE) and Beck Depression Inventory (BDI) was used to exclude depression. Data analysis was performed with SPSS 17. RESULTS: There were no significant differences between the two groups considering the sociodemographic data. The total score of ADAS-Cog is the most sensitive index (AUC: 0.875, sensitivity: 95.6%) for determining MCI, although the ratio of false positive cases was very high (specificity: 70.2%). The cut-off scores of the ADAS-Cog in the Hungarian sample were higher than the findings in previous researches. Positive correlation between age and ADAS-Cog total score was only significant in the HS group. On the other hand, negative correlation was found between education and ADAS-Cog total score in the MCI group. CONCLUSION: These results indicate that the currently used Hungarian ADAS-Cog is able to distinguish between MCI patients and HS groups. However, the adaptation of the Hungarian version will be necessary during the further standardization process including the cultural and linguistic aspects.
