Acceptance of psychosocial bridging measures in context of dementia.

Participants from an outpatient treatment program for cognitive disorders have been offered bridging measures because of limited access to the outpatient clinic during a Covid-19-caused lock-down. The aim of this study was to assess perceived stress, acceptance, and appreciation of the measures among patients and their caregivers compared to the previous bridging measure. Forty participants were offered treatment in person or online depending on their cognitive performance level. To evaluate acceptance, data collected from clinical routine was incorporated into a treatment observation. The evaluation of bridging measures by 25 participants was positive. Perceived stress was moderate to high among participants and has increased significantly compared to previous special treatment. Perceived stress in older patients had increased over the course of the pandemic. Bridging measures represented a treatment alternative and may offer previously untapped potential for location-independent psychosocial treatments in order to ameliorate both the patients' and their caregivers' convenience.

[Acceptance by and evaluation of unidirectional hearing systems by patients in outpatient and (partial) inpatient geriatric psychiatric care]. / Akzeptanz und Bewertung unidirektionaler Höranlagen im Rahmen ambulanter sowie (teil-)stationärer gerontopsychiatrischer Versorgung.

AIM OF STUDY: The aim of the present study was to investigate the use and subjective benefit of specific temporary hearing-improvement measures (unidirectional hearing aids) in hearing-impaired, geriatric psychiatric patients. Simultaneously, employees evaluated the handling and acceptance of the hearing-improving measures. MATERIAL AND METHOD: Between October 2022 and July 2023, subjective hearing ability and use of conventional hearing aids were recorded in outpatients and in those in partial inpatient care (n=151) based on a self-assessment questionnaire. After using unidirectional hearing aids in diagnostics and treatment for four to six weeks, the hearing ability of 21 patients who had not used the hearing-improving measures was surveyed again and the experiences of active users (n=34) and employees (n=24) with the hearing-improving measures were analyzed via questionnaires. RESULTS: Of the 151 included patients (79.2 years, 62.1% female), 147 patients and 24 employees (79.2% female) took part in the study. Subjective hearing impairments were reported by 50 patients (34.0%). The hearing of 93 patients (63.2%) had already been assessed once. Treatment with conventional hearing aids was recommended for 34 of those surveyed (23.1%). Likewise, 34 patients (23.1%) took advantage of the offer of hearing-improving measures. All 34 users and all participating employees rated the hearing-improving measures used as mostly positive. CONCLUSION: Hearing impairment in geriatric psychiatric patients is common and often not adequately treated with conventional hearing aids, yet hearing-improving measures are only used to a limited extent. Mostly positive results among the users of hearing-improving measures favor their implementation in patients in routine outpatient and (partial) inpatient geriatric psychiatric care.

Lithium Therapy in Old Age: Recommendations from a Delphi Survey.

INTRODUCTION: While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients. METHODS: Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement. RESULTS: Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li. CONCLUSION: According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

[Identification of polypharmacy-associated risks among nursing home residents]. / Risikoidentifikation bei Polypharmazie in einer Pflegeheimpopulation.

INTRODUCTION: Multimorbidity in old age is one reason for intensified pharmacotherapy. At the same time, an increase in medications could augment multimorbidity, especially when drug interactions leading to undesired drug effects occur. METHODS: In this cross-sectional study 918 mentally ill seniors living in nursing homes (mean age 79.3 (±11.6) years; 31.8% male) were included. Two different approaches to assess risks due to pharmacotherapy were applied: first mediQ, an online-based clinical decision support software (CDSS) and the PRISCUS list, which indicates potentially inappropriate medication. PRISCUS is the German equivalent to the American Geriatrics Society Beers criteria. RESULTS: Of the patients in the study 76.3% were at clinical risk, 2.2% at potentially high risk for drug interactions regarding the entire medication as tested by mediQ, and about 25% of the studied population received potentially inappropriate medication according to the PRISCUS list. CONCLUSION: This difference clearly underlines the cumbersome complexity of identifying patients at risk by using these exemplary devices. The focus of avoiding undesired drug side effects should be taking medication only after thorough verification of clinical indications and under close monitoring. The CDSS or negative lists may support this process.

Exposure to 1-Butanol Exemplifies the Response of the Thermoacidophilic Archaeon Sulfolobus acidocaldarius to Solvent Stress.

Sulfolobus acidocaldarius is a thermoacidophilic crenarchaeon with optimal growth at 80°C and pH 2 to 3. Due to its unique physiological properties, allowing life at environmental extremes, and the recent availability of genetic tools, this extremophile has received increasing interest for biotechnological applications. In order to elucidate the potential of tolerating process-related stress conditions, we investigated the response of S. acidocaldarius toward the industrially relevant organic solvent 1-butanol. In response to butanol exposure, biofilm formation of S. acidocaldarius was enhanced and occurred at up to 1.5% (vol/vol) 1-butanol, while planktonic growth was observed at up to 1% (vol/vol) 1-butanol. Confocal laser-scanning microscopy revealed that biofilm architecture changed with the formation of denser and higher tower-like structures. Concomitantly, changes in the extracellular polymeric substances with enhanced carbohydrate and protein content were determined in 1-butanol-exposed biofilms. Using scanning electron microscopy, three different cell morphotypes were observed in response to 1-butanol. Transcriptome and proteome analyses were performed comparing the response of planktonic and biofilm cells in the absence and presence of 1-butanol. In response to 1% (vol/vol) 1-butanol, transcript levels of genes encoding motility and cell envelope structures, as well as membrane proteins, were reduced. Cell division and/or vesicle formation were upregulated. Furthermore, changes in immune and defense systems, as well as metabolism and general stress responses, were observed. Our findings show that the extreme lifestyle of S.acidocaldarius coincided with a high tolerance to organic solvents. This study provides what may be the first insights into biofilm formation and membrane/cell stress caused by organic solvents in S. acidocaldariusIMPORTANCEArchaea are unique in terms of metabolic and cellular processes, as well as the adaptation to extreme environments. In the past few years, the development of genetic systems and biochemical, genetic, and polyomics studies has provided deep insights into the physiology of some archaeal model organisms. In this study, we used S. acidocaldarius, which is adapted to the two extremes of low pH and high temperature, to study its tolerance and robustness as well as its global cellular response toward organic solvents, as exemplified by 1-butanol. We were able to identify biofilm formation as a primary cellular response to 1-butanol. Furthermore, the triggered cell/membrane stress led to significant changes in culture heterogeneity accompanied by changes in central cellular processes, such as cell division and cellular defense systems, thus suggesting a global response for the protection at the population level.

Structural insights into the NAD+-dependent formate dehydrogenase mechanism revealed from the NADH complex and the formate NAD+ ternary complex of the Chaetomium thermophilum enzyme.

The removal of carbon dioxide from the waste streams of industrial processes is a major challenge for creation of a sustainable circular economy. This makes the synthesis of formate from CO2 by NAD+ dependent formate dehydrogenases (FDHs) an attractive process for this purpose. The efficiency of this reaction is however low and to achieve a viable industrial process an optimised engineered enzyme needs to be developed. In order to understand the detailed enzymatic mechanism of catalysis structures of different cofactor and substrate complexes of the FDH from the thermophilic filamentous fungus, Chaetomium thermophilum have been determined to 1.2-1.3 Å resolution. The substrate formate is shown to be held by four hydrogen bonds in the FDH catalytic site within the ternary complex with substrate and NAD+and a secondary formate binding site is observed in crystals soaked with substrate. Water molecules are excluded from the FDH catalytic site when the substrate is bound. The angle between the plane of the NAD+ cofactor pyridine ring and the plane of the formate molecule is around 27°. Additionally, structures of a FDH mutant enzyme, N120C, in complex with the reduced form of the cofactor have also been determined both in the presence and absence of formate bound at the secondary site. These structures provide further understanding of the catalytic mechanism of this fungal enzyme.

Trehalose as glucose surrogate in proliferation and cellular mobility of adult neural progenitor cells derived from mouse hippocampus.

The disaccharide trehalose (TRE) represents a natural energy supply for distinct non-mammalian species. Evidence has shown that TRE impacts on various properties including the stabilization of protein structure and cell membranes, which are important neuroprotective features against neurodegeneration. In this study, we tested the specific effect of TRE on cell proliferation and mobilization using an established experimental paradigm of adult neural progenitor cells (NPCs) derived from murine hippocampus. NPC proliferation, both measured by growth curve analysis over 25 days and by bromodeoxyuridine (BrdU) incorporation, was not altered by adding TRE instead of GLC to the culture media. Using Boyden chamber experiments, the mobility in regular glucose-containing media did not differ from glucose-free TRE-supplemented media. Our observation suggests that TRE has the capacity to replace glucose (GLC) as energy source in neural cells in our experimental paradigm.

[Bipolar affective disorders in senescence]. / Bipolare affektive Störungen im höheren Lebensalter.

Diagnostic and therapeutic measures in patients with bipolar disorders are significantly different depending on the age of those affected. Given the demographic changes and the fact that approximately one quarter of patients with bipolar disease are in old age, it is important for geriatricians to be aware of the specific aspects of bipolar disease. This review article presents the diagnostics of bipolar disorders in old people. Interactions with somatic comorbidities, which may lead to the occurrence of secondary mania, just to mention one of the characteristics of old age, are elaborated. Furthermore, age-specific differences also necessitate altered or adjusted therapy regimens, which deviate from those of younger patients.

Effect of replacing maize grain and soybean meal with a xylose-treated wheat grain on feed intake and performance of dairy cows.

This study evaluated wheat grain which was treated with xylose in aqueous Ca-Mg lignosulphonate solution at elevated temperatures (WeiPass®) in order to reduce ruminal degradation of starch and crude protein. The two tested isoenergetic and isonitrogenous diets contained on dry matter (DM) basis either 16% maize grain and 6.4% soybean meal (Diet CON) or 17.8% xylose-treated wheat and 4.6% soybean meal (Diet Wheat). Thirty-six German Holstein dairy cows were assigned to one of the two groups according to parity, body weight after calving, and milk yield during the previous lactation. Data collection started at 21 d before the expected calving date until 120 d in milk. The average of DM intake, energy-corrected milk (ECM) yield, and milk fat and protein yields (all given as kg/d) were 18.9, 28.7, 1.25, and 1.02 for Diet CON and 19.3, 32.5, 1.36, and 1.11 for Diet Wheat, respectively. Only ECM and milk protein yields were greater (p < 0.05) for cows receiving Diet Wheat. In conclusion, the xylose-treated wheat grain can replace maize grain and part of soybean meal in diets for lactating dairy cows and may be an alternative feedstuff depending on overall ration composition and availability and costs of grain sources.