Brain atrophy parameters of very old subjects in a population - based sample with and without dementia syndrome.

Atrophy parameters of the brain vary with age in healthy subjects. The aim of the study was to determine the range of atrophy parameters in subjects with very old age. Population-based data are especially necessary in order to evaluate atrophy parameters of healthy old persons in clinical settings and for the diagnosis of dementia diseases. 254 subjects in a population-based sample were investigated by a cranial computerized tomography (cCT). Age ranged from 70 to 99, 78 were 80-89 years old and 43 over 90 years of age; 24 demented subjects were diagnosed according to DSM-III-R. A planimetric analysis of the extracerebral CSF-space (ECSF) and relative area of the ventricles (VBR) was performed. VBR and ECSF were used as primary atrophy parameters. The VBR, ECSF and other structural brain parameters for subjects of very old age are described after exclusion of dementia cases according to clinical diagnosis. A statistically significant age effect could be demonstrated as well as a dementia effect for the younger age groups (70-89). No difference in the atrophy parameters between the diagnostic groups, however, were found for the oldest groups (90 and older); for the very old subjects the scores of demented and non-demented participants were entirely within the same range. The age effect on atrophy parameters in non-demented subjects in very old age reaches the range of atrophy parameters, which is found in dementia. The question remains wheather the reason for this is a benign senescent brain atrophy or whether the amount of atrophic changes in very old age may explain the enhanced vulnerability for the development of dementia syndromes in very old age and the steeply increasing incidence of dementia or whether there is an incipient brain atrophy in more or less all very old subject and they will develop dementia if they do not die before-hand.

[Olanzapine in the treatment of depressive disorders with psychotic symptoms]. / Olanzapin in der Behandlung depressiver Störungen mit psychotischer Symptomatik.

We report on the successful treatment of two female patients with psychotic depression with the new atypical neuroleptic drug olanzapine. A 75-year-old female inpatient suffering from recurrent endogenous depression with tactile hallucinations and coenesthesia was refractory to a systematic sequential antidepressant treatment strategy during a 39-week period. After addition of the new atypical neuroleptic olanzapine to the SSRI citalopram, she showed immediate and ongoing symptom relief. In the second case of a 57-year-old female inpatient suffering from delusional depression, we observed marked symptom relief and correction of the delusions of impoverishment. Olanzapine is discussed with regard to its receptor-binding profile (antagonism to 5-HT2A- and D1-D4 receptors) as a potential neuroleptic drug in the treatment of affective disorders with psychotic symptoms.

Age and dementia effect on neuropsychological test performance in very old age--influence of risk factors for dementia.

In old age a large part of the variance in cognitive performance in population samples is explained by normal aging; in addition many subjects over 80 years are demented and therefore dementia also explains a part of cognitive variability. The question is whether the different factors for dementia (such as ApoE4, external atrophy parameter of the cranial computer tomography [cCT], education, sex or serum zinc level) influence the relation between age or dementia and Mini Mental State (MMSE) performance. In an epidemiological study data were analyzed of N = 239 subjects for the above factors. Most statistically significant variables of the MMSE do not change the amount of the partial correlation coefficient between the parameters age or dementia and MMSE. The external atrophy, however, diminishes the magnitude of the partial correlation between age and MMSE. In contrast the dementia-MMSE relation is unchanged. This points to a generally similar factor structure of cognitive aging and dementia in old age, but differences exist with respect to the importance of the external atrophy parameter of the brain. Most factors investigated explain separate parts of variance of cognitive performance in old age.