Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis.

BACKGROUND: This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers. METHODS: A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots. RESULTS: Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA's performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation. CONCLUSION: This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.

The role of cognitive emotion regulation strategies in predicting the resilience, symptom severity, and quality of life of patients with irritable bowel syndrome.

BACKGROUND: Psychosocial stressors contribute to the development of irritable bowel syndrome (IBS) and exacerbate the symptoms. The capability to cope with stress is an essential element in the management of IBS. This study assessed nine cognitive emotion regulation strategies (CERS) and their role in predicting symptom severity, quality of life (QOL), and resilience in IBS subjects. METHODS: The scores regarding nine subscales of CERS were obtained by cognitive emotion regulation questionnaire (CERQ) and compared between study patients based on the severity and subtypes of IBS using one-way ANOVA. To evaluate the predictive role of CERS, logistic regression was performed. The correlation between CERS and the QOL was assessed by Pearson correlation analysis. The score of resilience was measured by Connor-Davidson Resilience Scale (CD-RISC). RESULTS: We recruited 100 patients diagnosed with IBS based on ROME IV criteria. Among nine subscales of CERS, patients with more severe symptoms scored higher in catastrophizing (p < 0.001) and blaming others (p = 0.015) while lower in positive reappraisal (p = 0.028). Blaming others was the only predictor of resilience and severity of IBS in our patients (odds ratio (OR): -2.103, p=0.028, and OR:1.715, p = 0.049, respectively). We observed significant negative correlations between the quality of life and rumination (r= -0.202, p=0.044), self-blame (r= -0.241, p=0.016), catastrophizing (r= -0.342, p<0.001), and blaming others (r= -0.219, p=0.028). CONCLUSION: Maladaptive strategies are more common in IBS patients with more severe symptoms and have negative correlations with the QOL. Blaming others has the potential to predict the resilience and severity of symptoms in IBS patients.

Secure federated learning for Alzheimer's disease detection.

Machine Learning (ML) is considered a promising tool to aid and accelerate diagnosis in various medical areas, including neuroimaging. However, its success is set back by the lack of large-scale public datasets. Indeed, medical institutions possess a large amount of data; however, open-sourcing is prevented by the legal requirements to protect the patient's privacy. Federated Learning (FL) is a viable alternative that can overcome this issue. This work proposes training an ML model for Alzheimer's Disease (AD) detection based on structural MRI (sMRI) data in a federated setting. We implement two aggregation algorithms, Federated Averaging (FedAvg) and Secure Aggregation (SecAgg), and compare their performance with the centralized ML model training. We simulate heterogeneous environments and explore the impact of demographical (sex, age, and diagnosis) and imbalanced data distributions. The simulated heterogeneous environments allow us to observe these statistical differences' effect on the ML models trained using FL and highlight the importance of studying such differences when training ML models for AD detection. Moreover, as part of the evaluation, we demonstrate the increased privacy guarantees of FL with SecAgg via simulated membership inference attacks.

The burden of traumatic brain injury on caregivers: exploring the predictive factors in a multi-centric study.

BACKGROUND: Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide. With survivors often exhibiting degrees of function loss, a significant burden is exerted on their caregivers. The purpose of this study was to explore the predictive factors of caregiver burden among caregivers of patients with TBI. METHODS: Sixty-eight family members of individuals with a TBI who had been admitted to three hospitals were assessed in terms of caregiver burden using the Zarit Burden Interview. The association of caregiver burden with patients' baseline cognitive function according to the Montreal Cognitive Assessment (MoCA) test, as well as caregivers' sociodemographic characteristics, were evaluated using multiple regression analysis. RESULTS: Based on the multiple regression model, the MoCA score of the patients (std ß=-0.442, p < 0.001), duration of caregiving (std ß = 0.228, p = 0.044), and higher education of the caregivers (std ß = 0.229, p = 0.038) were significant predictors of caregiver burden. CONCLUSION: Overall, our findings highlight the importance of taking caregivers' psychosocial needs into account. Long-term caregivers of TBI patients with cognitive impairment should be viewed as vulnerable individuals who could benefit from psychosocial intervention programs, to improve their well-being and enabling them to enrich their care of the TBI patient.

Dementia prevalence among hospitalized older patients: a multicenter study in Iran.

Dementia poses a significant societal and health challenge in the 21st century, with many hospitalized patients experiencing dementia without a documented diagnosis. Objective: To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. Methods: The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. Results: The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Conclusions: Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.

A demência representa um grande desafio social e de saúde no século 21, com muitos pacientes hospitalizados sofrendo de demência sem um diagnóstico documentado. Objetivo: Avaliar a prevalência de demência e seus fatores de risco associados entre pacientes idosos hospitalizados. Métodos: O estudo incluiu pacientes idosos (≥ 60 anos) internados em um hospital geral em três grandes cidades iranianas. Os pesquisadores utilizaram a escala de Atividades da Vida Diária-Atividades Instrumentais da Vida Diária (Activities of Daily Living-Instrumental Activities of Daily Living ­ ADL-IADL), a Escala de Depressão Geriátrica, o teste Mini-Cog, o teste dos 4 As (4AT) e o Pontuação do Teste Mental Abreviado (Abbreviated Mental Test Score ­ AMTS). Dos 420 idosos selecionados, 228 (54,3%) eram do sexo feminino. Resultados: A média de idade dos participantes foi de 71,39 anos (desvio padrão ±7,95), sendo 30,7% diagnosticados com transtorno neurocognitivo maior (demência). A probabilidade de demência apresentou correlações estatisticamente significativas com sexo, idade, número de filhos e ocupação. Conclusões: A triagem de idosos para comprometimento cognitivo na admissão hospitalar tem o potencial de prevenir resultados adversos e melhorar a qualidade do tratamento para pacientes que lidam simultaneamente com demência.

Validity and reliability of the Persian version of Mini-Addenbrooke's Cognitive Examination among Iranian highly educated older adults.

BACKGROUND: Limited studies have examined psychometric properties of dementia screening tools in university-educated older adults. We aimed to examine this population's diagnostic accuracy of the Iranian version of Mini-Addenbrooke's Cognitive Examination (M-ACE). MATERIALS & METHODS: Eighty-seven participants with over 60 years with university education were divided into three groups: Major neurocognitive disorder, mild neurocognitive disorder, and healthy control. The Iranian version of M-ACE, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale and Diagnostic and Statistical Manual of Mental Disorders 5th edition-Text Revision (DSM-5) were used. RESULTS: A high internal reliability of questionnaire was confirmed by Cronbach's alpha coefficient. One-way ANOVA and post hoc analysis confirmed a significant difference between study groups. The scores of M-ACE were found to have a high positive correlation with MMSE, IADL, ADL, and a moderate correlation with GDS. The optimal cutoff score of M-ACE to screen for mild and major neurocognitive disorders were 27.5 and 20.5, respectively. CONCLUSION: The M-ACE was a concise and reliable tool used to identify neurocognitive disorders in highly educated older adults, but they should be evaluated at a higher traditional cut score in earlier stages.

Dementia prevalence among hospitalized older patients: a multicenter study in Iran / Prevalência de demência entre pacientes idosos hospitalizados: um estudo multicêntrico no Irã

ABSTRACT Dementia poses a significant societal and health challenge in the 21st century, with many hospitalized patients experiencing dementia without a documented diagnosis. Objective: To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. Methods: The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. Results: The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Conclusions: Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.

RESUMO A demência representa um grande desafio social e de saúde no século 21, com muitos pacientes hospitalizados sofrendo de demência sem um diagnóstico documentado. Objetivo: Avaliar a prevalência de demência e seus fatores de risco associados entre pacientes idosos hospitalizados. Métodos: O estudo incluiu pacientes idosos (≥ 60 anos) internados em um hospital geral em três grandes cidades iranianas. Os pesquisadores utilizaram a escala de Atividades da Vida Diária-Atividades Instrumentais da Vida Diária (Activities of Daily Living-Instrumental Activities of Daily Living - ADL-IADL), a Escala de Depressão Geriátrica, o teste Mini-Cog, o teste dos 4 As (4AT) e o Pontuação do Teste Mental Abreviado (Abbreviated Mental Test Score - AMTS). Dos 420 idosos selecionados, 228 (54,3%) eram do sexo feminino. Resultados: A média de idade dos participantes foi de 71,39 anos (desvio padrão ±7,95), sendo 30,7% diagnosticados com transtorno neurocognitivo maior (demência). A probabilidade de demência apresentou correlações estatisticamente significativas com sexo, idade, número de filhos e ocupação. Conclusões: A triagem de idosos para comprometimento cognitivo na admissão hospitalar tem o potencial de prevenir resultados adversos e melhorar a qualidade do tratamento para pacientes que lidam simultaneamente com demência.

Agomelatine augmentation of sertraline in the treatment of moderate to severe obsessive-compulsive disorder: a randomized double-blinded placebo-controlled clinical trial.

BACKGROUND: As 40-60% of the patients with obsessive-compulsive disorder (OCD) do not adequately respond to the first-line treatment, finding an effective second-line treatment is required. Our aim was to assess the efficacy and safety of agomelatine (a selective melatonin receptor agonist and a 5-hydroxytryptamine (HT)2 C antagonist) augmentation of sertraline in the treatment of patients with moderate to severe OCD. METHODS: In this 12-week randomized, double-blinded, placebo-controlled, parallel-group clinical trial, 65 patients with moderate to severe OCD according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) criteria and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of over 21, were included. They were assigned with sertraline (100 mg/day for the first 4 weeks and 200 mg/day for the next 8 weeks) and either agomelatine (25 mg/day) or placebo. The primary outcome was OCD symptoms measured by the Y-BOCS. RESULTS: Fifty patients (24 in agomelatine group and 26 in placebo group) completed the trial. The Y-BOCS scores in total (MD (95% CI) = 12.25 (11.00, 13.49) (P < 0.001) vs. MD (95% CI) = 12.46 (6.65, 15.74) (P < 0.001)), the obsession subscale (MD (95% CI) = 5.04 (4.19, 5.88) (P < 0.001) vs. MD (95% CI) = 5.00 (3.84, 6.16) (P = 0.0001)), and compulsion subscale (MD (95% CI) = 7.21 (6.34, 8.07) (P < 0.001) vs. MD (95% CI) = 7.460 (6.50, 8.42) (P < 0.001)) significantly decreased in both groups. Although, at the end of the trial, no significant difference was observed between the scores of the two groups in total (MD (95% CI) = 0.480 (-1.23, 2.19) (P = 0.78)), the obsession subscale (MD (95% CI) = 1.020 (-0.15, 2.19) (P = 0.38)), and the compulsion subscale (MD (95% CI) = 0.540 (-0.34, 1.42) (P = 0.54)). No major adverse effects were recorded, and the frequency of side effects was not significantly different between the groups. CONCLUSION: Agomelatine in augmentation with sertraline is safe and tolerable in patients with moderate to severe OCD. However, our study does not support its efficacy in improving OCD symptoms, compared to placebo. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials on 14/07/2020 ( www.irct.ir ; IRCT ID: IRCT20170123032145N5).

Effects of bariatric surgery on cognitive function in older adults: a prospective longitudinal study.

BACKGROUND: Obesity is now well-recognized as an independent risk factor for cognitive decline. Although extensive research has been conducted on cognitive outcomes following bariatric surgery in young adults, very little is known about the impact of advanced age on the cognitive benefits of weight-loss procedures. OBJECTIVES: This study aimed to assess cognitive function in older Iranian patients before and after bariatric surgery. SETTING: University Hospital METHODS: In this prospective longitudinal study, 24 older adults were examined before and 4 months after bariatric surgery using the Digit Span Test (DGS), the computerized version of the Wisconsin Card Sorting Test-64 (WCST-64), and the paper-and-pencil versions of the Trail Making Test (TMT), parts A and B, spanning the 4 cognitive domains of attention, working memory, processing speed, and executive functioning. The bariatric surgery group was simultaneously compared to a waiting list control group. RESULTS: At 4 months of follow-up, comparisons between the groups revealed that the surgical group performed significantly better than the control group on the forward DGS, WCST, and TMT parts A and B. In contrast, there was no significant difference between groups on the backward DGS. Further within-group comparisons demonstrated significant improvements from baseline in forward DGS, WCST, and TMT components A and B. Nevertheless, the same variables did not alter significantly over time in the control group. CONCLUSIONS: The study suggests measurable cognitive benefits following bariatric surgery in older adults.

First-episode mania after COVID-19: A case series in Iran.

Background: Increasing reports of manic episodes in patients during acute infection with COVID-19 have been documented since the pandemic began, including individuals without a previous personal or family history of bipolar disorder. As infections and autoimmunity have putative roles in bipolar disorder, we aimed to document the clinical presentations, associated stressors, family aggregation patterns, and brain imaging and electroencephalographic correlates with a series of patients with episodes of mania that emerged shortly after COVID-19 infections. Methods: We obtained all relevant clinical information from 12 patients whose first manic episode started within a month of COVID-19 infection and were treated at Rasool-e-Akram hospital and Iran psychiatric hospital, two tertiary medical centers in Tehran, Iran, in 2021. Results: Patients had a mean age of 44. The interval between the onset of symptoms of COVID and mania ranged between 0 and 28 days (mean: 16.25, median: 14 days); it was observed to be shorter in patients with a family history of mood disorders but not in those receiving corticosteroids. Alongside a descriptive overview of our sample, we provide detailed narrative descriptions of two of the cases for illustrative purposes and discuss our observations in the context of other cases reported elsewhere and the state-of-the-art regarding infectious diseases, COVID-19, and bipolar disorder as reported in previous literature. Conclusion: Our case series documents observational and naturalistic evidence from a dozen of cases of mania in the context of acute COVID-19, which, while limited, calls for analytical research of the phenomenon, and points at a family history of bipolar disorder and the use of corticosteroids as factors for particular focus.

Pulmonary embolism or COVID-19 pneumonia? A case report.

Pulmonary embolism (PE) is the most severe clinical presentation of venous thromboembolism (VTE), which can be challenging to diagnose due to its non-specific symptoms. The overlapping clinical symptoms of Coronavirus disease 2019 (COVID-19) and PE may make distinguishing between the two difficult. Thus, the diagnosis of PE may be delayed or missed, with grave consequences for the patient's outcome and safety. We herein present the case of a 63-year-old Iranian female admitted to our hospital showing symptoms of delirium superimposed on dementia. Soon after her admission, she developed a fever and respiratory symptoms. However, overestimating the likelihood of COVID-19 pneumonia and attributing the patient's symptoms to this disease led to a delayed diagnosis and treatment of pulmonary embolism, resulting in the patient's death. During the COVID-19 pandemic, a high index of suspicion is required for the timely diagnosis of PE, especially in patients with identifiable risk factors. This is specifically true for older patients who cannot express their symptoms due to neurocognitive disorders.

Higher anxiety and perceived trauma among COVID-19 patients: a prospective comparative study.

BACKGROUND AND PURPOSE: Psychiatric disorders such as anxiety, depression, and traumatic stress are not rare during infectious outbreaks, as the COVID-19 pandemic has posed a great concern to the general population. In this study, we aimed to investigate whether experiencing psychiatric symptoms during COVID-19 is the result of the burden of carrying an illness or the COVID-19 itself. METHOD: Two hundred ten subjects and three different groups of participants (COVID-19 patients, university staff, and orthopedic patients) were recruited. They answered a demographic questionnaire, Yale-Brown Obsessive-Compulsive Scale (YBOCS) test for OCD symptoms, Impact of Event Scale-Revised (IES-R) for perceived trauma, Beck Anxiety Inventory (BAI) for anxiety, and Beck Depression Inventory (BDI) for depression assessments using phone or face-to-face interviews. RESULT: At least one OCD symptom was observed in 85.7% of the subjects. However, there was no significant difference between the 3 groups (p = 0.2194). Perceived trauma was significantly higher among COVID-19 patients followed by university staff and orthopedic patients (23.73, 16.21, 11.51 mean IES-R scores respectively, p = 8.449e-14). COVID-19 patients also showed higher anxiety (mean BAI score: 17.00) than the university staff and orthopedic patients' group (9.22 and 5.56 respectively) (p = 6.175e-08). BDI score did not show much variation for depression, the mean score was 9.66, 9.49, and 6.7 for the COVID-19 patients, university staff, and orthopedic patients respectively, (p = 0.2735). CONCLUSION: Perceived trauma and anxiety symptoms are significantly higher in COVID-19 patients and the symptoms of OCD and depression do not differ between COVID-19 and non-COVID-19 people, so the necessity of screening and following treatment of patients with COVID-19 should be kept in mind. TRIAL REGISTRATION: IR.IUMS.FMD.REC.1399.761.

Validity and reliability of the Farsi version of the ascertain dementia 8-item (AD8-F) informant interview in Iranian patients with mild neurocognitive disorder.

BACKGROUND: For screening and distinguishing between mild neurocognitive disorder (mNCD) and normal cognitive age-related changes in primary care centers, a simple and practical tool is necessary. Therefore, this study aims to determine the validity and reliability of the Farsi version of the Ascertain Dementia 8-item (AD8-F) informant interview in patients with mNCD. METHODS: This is a study of the psychometric properties of the Farsi AD8. The participants include sixty informant-patient dyads with mNCD and sixty controls with normal cognition. The AD8 was compared to the mini-mental state examination (MMSE) and the Mini-Cog. As a gold standard, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for mNCD was used. The reliability was measured using internal consistency and test-retest. Validity was assessed by evaluating the content, concurrent, and construct validity. Data were analyzed via Cronbach's α, Pearson correlation, independent t-test, and analysis of variance (ANOVA) and area under the curve (AUC) by statistical package for the social sciences (SPSS) v.23. RESULTS: Cronbach's α was 0.71. Test-retest reproducibility was 0.8. The AD8 had inverse correlations with the Mini-Cog (r = - 0.70, P < 0.01) and MMSE (r = - 0.56, P < 0.01). The area under the curve was 0.88. The optimal cutoff score was > 2. Sensitivity and specificity were 80 and 83%, respectively. The positive predictive value was 83%. The negative predictive value was 81%. CONCLUSION: Our results suggest that this tool can be used as a screening tool to detect a mild neurocognitive disorder in primary care centers.

Evidence for Anti-inflammatory Effects of Adalimumab in Treatment of Patients With Major Depressive Disorder: A Pilot, Randomized, Controlled Trial.

BACKGROUND: Literature has suggested that major depressive disorder (MDD) is accompanied by higher concentrations of inflammatory biomarkers, which could sabotage response to conventional treatments. AIMS: This study aimed to evaluate the efficacy and safety of adalimumab adjunct to sertraline in adults with MDD and increased levels of systemic inflammation. METHODS: In a 6-week, randomized, double-blind, placebo-controlled trial, 36 patients with MDD and high-sensitivity C-reactive protein ≥3 mg/L were equally assigned to receive sertraline plus either adalimumab or placebo. Participants were assessed using the Hamilton Depression Rating Scale (HAM-D) at baseline, week 3, and week 6. Moreover, serum concentrations of inflammatory biomarkers were measured at baseline and trial end point. Finally, patients were assessed for any adverse event during the trial. RESULTS: Fifteen patients in each group completed the trial course. All baseline characteristics of participants were similar between the groups. Adalimumab adjunct to sertraline resulted in a greater improvement in HAM-D score compared with placebo over the trial period ( P < 0.001). Participants receiving adalimumab significantly experienced greater response to treatment (≥50% reduction in the HAM-D score) than those receiving placebo ( P = 0.042). Furthermore, after 6 weeks of adalimumab combination therapy with sertraline, inflammatory biomarkers significantly decreased ( P ≤ 0.001), whereas no significant alteration was found in the placebo group. No serious adverse event was documented in the treatment arms. CONCLUSIONS: Adalimumab adjunctive therapy remarkably improves depressive symptoms of patients with MDD. Further investigations with larger sample sizes and longer follow-up periods are required to confirm the findings.

The effectiveness of pregabalin with or without agomelatine in the treatment of chronic low back pain: a double-blind, placebo-controlled, randomized clinical trial.

BACKGROUND: Although various pharmacological and nonpharmacological treatments are available for the chronic low back pain (CLBP), there is no consensus on the best optimal treatment for this condition. This study aimed to investigate the efficacy of co-administration of pregabalin and agomelatine versus pregabalin with placebo to treat CLBP. METHODS: Forty-six CLBP patients without the surgical indication referred to the outpatient orthopedic clinic of Rasoul-e-Akram Hospital, Tehran, Iran, were randomly divided into two study groups: Group A [pregabalin (75 mg twice per day) + placebo] and Group B [pregabalin (75 mg twice per day) + agomelatine (25 mg per night)]. Patients were evaluated at weeks 0, 4, and 8. Outcome measures were the Persian versions of the Brief Pain Inventory (BPI) interference scale, Roland-Morris Disability Questionnaire (RMDQ), The Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Survey (SF-36), and General Health Questionnaire-28 (GHQ-28) were used. RESULTS: At weeks 4 and 8 after the intervention, all evaluated measures showed significant improvement in both study groups (P < 0.01). The mean improvement of GHQ-28 was 3.7 ± 1.22 in group A and 13.1 ± 4.71 in group B. This difference was statistically significant (P = 0.003). Other outcomes did not vary substantially between the two research groups. Agomelatine treatment was well tolerated, with no significant adverse effects seen in patients. Liver tests of all patients were routine during the study period. Major adverse effect was not seen in any patient. The prevalence of Minor side effects was not significantly different between two study groups. CONCLUSION: Compared with the pregabalin and placebo, co-administration of pregabalin and agomelatine had no added effect on improving pain scores in CLBP patients. However, the patients' general health was significantly improved after the combined administration of pregabalin and agomelatine. TRIAL REGISTRATION: The study protocol was registered in the Iranian Registry of Clinical Trials before starting the study (NO.IRCT20200620047852N1, Registration date: 23/06/2020).

Granisetron-mediated augmentation of sertraline therapeutic effect in obsessive-compulsive disorder: a double-blind placebo-controlled, randomized clinical trial.

BACKGROUND: Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually relieve the severity of symptoms by as much as 20-30%, and satisfactory treatment is obtained in 40-60% of patients with OCD. Nevertheless, the remaining symptoms continue to impair the patients' function. Therefore, it is necessary to investigate possible strategies to improve the mitigation of symptoms. In this study, the main objective was to examine and investigate the effectiveness of granisetron, which is a serotonin 5-hydroxytryptamine receptor type 3 (5-HT3) antagonist, as an adjunct therapy to selective serotonin reuptake inhibitors, for the purpose of ameliorating OCD symptoms. METHODS: fifty-eight patients diagnosed with OCD, based on Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, who had a Yale-Brown obsessive-compulsive scale (Y-BOCS) score of more than 21 were recruited in a double-blinded, parallel-group, placebo-controlled, clinical trial of 10 weeks to receive either granisetron (1 mg twice daily) and sertraline (100 mg daily initially followed by 200 mg daily after week 4) or placebo and sertraline. The primary outcome was OCD symptoms measured by the Y-BOCS. RESULTS: Y-BOCS total score significantly dropped in both groups (28.9 to 17.7 for granisetron plus sertraline and 27.5 to 19.3 for placebo plus sertraline group with a slightly greater drop for granisetron plus sertraline group), while the granisetron plus sertraline group experienced a significantly greater reduction in obsession scores (Greenhouse-Geisser F(2.32,97.57) = 4.52,p-value = 0.01). Moreover, in comparison with the placebo plus sertraline group, the proportion of the patients showing complete response was considerably higher among the granisetron plus sertraline group (P-value < 0.01). No major adverse effects were observed in any of the groups. CONCLUSION: The results suggest that granisetron augmentation of sertraline may increase the rate of response in patients with moderate to severe non-refractory OCD. Further studies are suggested in this regard.

Chronic fatigue syndrome and cognitive deficit are associated with acute-phase neuropsychiatric manifestations of COVID-19: A 9-month follow-up study.

The preva lence of long-COVID symptoms is rising but it is not still possible to predict which patients will present them, and which types of symptoms they will present. We followed up 95 patients with confirmed COVID-19 for 9 months to identify and characterize long-COVID symptoms. Easy fatigability was the most common symptom (51.04%), followed by anxiety (38.54%), dyspnea (38.54%), and new-onset headache (38.54%). There was no association between COVID-19 severity in the acute phase and the number of long-COVID symptoms (F(1,93) = 0.75, p = 0.45), and cognitive function (MoCA) scores (F(1,90) = 0.073, p = 0.787) at follow-up. Being female (F(1,92) = - 2.27, p = 0.02), having a higher number of symptoms (F(1,93) = 2.76, p = 0.0068), and experiencing constitutional neuropsychiatric symptoms (F(1,93) = 2.529, p = 0.01) in the acute phase were associated with having chronic fatigue syndrome at follow-up. Moreover, constitutional neuropsychiatric symptoms in the acute phase were associated with a lower MoCA score (F(1,93) = 10.84, p = 0.001) at follow-up. Specific clinical presentations such as constitutional neuropsychiatric symptoms in the acute phase might be predictors of debilitating long-COVID symptoms such as chronic fatigue syndrome and cognitive deficits.

Memantine augmentation of sertraline in the treatment of symptoms and executive function among patients with obsessive-compulsive disorder: A double-blind placebo-controlled, randomized clinical trial.

BACKGROUND: Medications currently recommended for the treatment of Obsessive-Compulsive Disorder (OCD) usually decrease the severity of the symptoms by 20-30%; however, 40-60% of OCD patients do not achieve a satisfactory response. Our main objective was to investigate the effectiveness of memantine, a non-competitive N-Methyl-D-aspartate (NMDA) receptor antagonist, as an adjunct therapy to sertraline, a selective serotonin reuptake inhibitor (SSRI), to improve severity of symptoms and executive function among patients with obsessive-compulsive disorder. METHODS: Seventy patients with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, and a Yale-Brown obsessive compulsive scale (Y-BOCS) score of more than 21 were recruited to the study. They received sertraline (100 mg daily initially followed by 200 mg daily after week 4) and either memantine (10 mg twice daily) or placebo in a placebo controlled, double-blinded, parallel-group, clinical trial of 12 weeks. The primary outcome was OCD symptoms measured by the Y-BOCS. Moreover, executive function of participants was measured by the Wisconsin Card Sorting Test (WCST). RESULTS: The total score, and obsession and compulsion subscales of Y-BOCS significantly dropped in both groups with no significant difference between the two groups. However, memantine group showed a greater response in the number of completed categories subscale of the WCST (p value<0.001). We did not observe any major adverse effects in any of the groups. CONCLUSION: Memantine has an acceptable safety and tolerability in patients with OCD and might have a positive effect on their executive function. Nevertheless, the current results don`t support the efficacy of memantine as an adjunctive agent to sertraline for symptoms in patients with OCD. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials on 04/10/2019 ( www.irct.ir ; IRCT ID: IRCT20170123032145N4).

Perceived burden of dementia care, clinical, psychological and demographic characteristics of patients and primary caregivers in Iran.

Caregiving for dependent older adults with dementia has become an important public health issue. However, not much is known about the caregiver experience for caregivers of patients with dementia in Iran. This study was designed to examine the relationship between variables pertaining to primary caregivers and patients and the level of perceived caregiver burden. The participants of this cross-sectional study were 60 caregiver and care-recipient pairs presented to Rasoul-e Akram hospital and Brain and Cognition Clinic, in Tehran, Iran. A sociodemographic questionnaire, the Zarit Caregiver Burden Interview (ZBI), the General health questionnaire-28 (GHQ-28), the NEO Five-Factor Inventory (NEO-FFI), the Spiritual Well-Being Scale (SWBS), the Neuropsychiatric Inventory (NPI), and the Mini-Mental State Examination (MMSE) were used. Descriptive statistics, correlation coefficients, T-test, and multiple linear regression analyses were used in this study. Years of caregiving, hours of caregiving/week, total and subscale GHQ-28 scores, existential well-being subscale score on SWBS, and total NPI score were found to be significantly associated with the level of caregiving burden (p < 0.05). In addition, among the caregivers' personality traits, neuroticism and agreeableness predicted caregiver burden. Other sociodemographic factors and MMSE scores were not found to be significantly related to caregiver burden. A better understanding of the indicators of caregiver burden can help physicians, policy makers, and mental health managers to tailor the most appropriate preventative and remedial interventions for family caregivers.