Vascular Schizophrenia-like Psychosis in Older Adults.

BACKGROUND: The aims of this study were to analyze prevalence and severity of vascular risk factors in older patients referred to our clinic due to onset of Very Late-Onset Schizophrenia-Like Psychosis (VLOSLP) and to create a specific phenotype based on pathophysiological insight rather than age of onset. METHODS: In a longitudinal study, 103 (M = 39, F = 64; mean age of 80.32 ± 7.65 years) patients were evaluated with cognitive, neuropsychiatric, and functional assessment scales. Blood concentration of hemoglobin (Hb), mean corpuscular volume (MCV), platelets, total protein test (TPT), creatinine, azotemia, glycemia, total cholesterol (TC), triglycerides (TG), uric acid (UA), sodium (Na), potassium (K), chlorine (Cl), calcium (Ca), folate, vitamin B12 (Vit-B12), and homocysteine were measured. Presence/absence of tobacco use, alcohol consumption, psychoactive substance use, hypertension, hyperlipidemia, diabetes mellitus, and history of vascular disease were collected. RESULTS: Females were more apathetic than males (NPI-Apathy: p = 0.040). Males had a significantly higher level of Hb (p = 0.019) and UA (p = 0.001), and a lower level of platelets (p = 0.004) and Ca (p = 0.003), and used more tobacco (p = 0.046) and alcohol (p = 0.024) than females. Comparing patients < 80 and ≥80 years, we found differences in frequency of vascular risk factors among men (p = 0.027). In total, 102 patients were treated for psychosis (59.16% of them were using atypical antipsychotics). CONCLUSIONS: The results of this study could be useful for a progressive demonstration of the causal relationship between cardiac and cerebral vascular events and VLOSLP.

CT-Detected MTA Score Related to Disability and Behavior in Older People with Cognitive Impairment.

Our study aims to investigate the relationship between medial temporal lobe atrophy (MTA) score, assessed by computed tomography (CT) scans, and functional impairment, cognitive deficit, and psycho-behavioral disorder severity. Overall, 239 (M = 92, F = 147; mean age of 79.3 ± 6.8 years) patients were evaluated with cognitive, neuropsychiatric, affective, and functional assessment scales. MTA was evaluated from 0 (no atrophy) to 4 (severe atrophy). The homocysteine serum was set to two levels: between 0 and 10 µmol/L, and >10 µmol/L. The cholesterol and glycemia blood concentrations were measured. Hypertension and atrial fibrillation presence/absence were collected. A total of 14 patients were MTA 0, 44 patients were MTA 1, 63 patients were MTA 2, 79 patients were MTA 3, and 39 patients were MTA 4. Cognitive (p < 0.0001) and functional (p < 0.0001) parameters decreased according to the MTA severity. According to the diagnosis distribution, AD patient percentages increased by MTA severity (p < 0.0001). In addition, the homocysteine levels increased according to MTA severity (p < 0.0001). Depression (p < 0.0001) and anxiety (p = 0.001) increased according to MTA severity. This study encourages and supports the potential role of MTA score and CT scan in the field of neurodegenerative disorder research and diagnosis.

Relationship of Homocysteine Plasma Levels with Mild Cognitive Impairment, Alzheimer's Disease, Vascular Dementia, Psychobehavioral, and Functional Complications.

BACKGROUND: Alzheimer's disease (AD) may be a vascular disorder with neurodegenerative consequences opening possibility of preventing AD by targeting vascular risk factors including homocysteine. OBJECTIVE: The study aims were to assess homocysteine distribution in different forms and severity of cognitive impairment (CogI) [mild cognitive impairment (MCI), probable AD (Prob-AD), possible AD (Poss-AD), and vascular dementia (VaD)] and in NoCogI, and to estimate possible association between hyperhomocysteinemia levels with functional deficit severity and psychobehavioral complications. METHODS: In total, 929 (M = 366, F = 563; mean age of 72.55±6.24 years) patients were evaluated with cognitive, neuropsychiatric, affective, and functional assessment scales. Homocysteine serum was set on two levels: between 0 and 10µmol/L and > 10µmol/L. For each patient, blood concentration of folate, vitamin B12, hemoglobin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), cholesterol, triglycerides, and glycemia were measured. RESULTS: CogI patients demonstrated significantly a higher frequency of homocysteine > 10 (p = 0.003), than NoCogI patients. Patients with moderate and severe dementia had a higher frequency of homocysteine > 10 (p < 0.0001), than MCI and mild dementia. Poss-AD and VaD had a higher frequency of homocysteine > 10 (p = 0.003), than Prob-AD patients. Homocysteine > 10 frequency is directly proportional to increased neuropsychiatric symptom severity (p < 0.0001), and functional impairment severity respectively for ADL (p < 0.0001) and IADL (p < 0.0001). CONCLUSION: Higher homocysteine level seems to be significantly related to cognitive impairment frequency and severity, possible AD and VaD, neuropsychiatric symptom severity, and functional impairment severity.

[Prevalence of malnutrition among institutionalized elderly subjects in Trieste, Northen Italy)]. / Valutazione dello stato nutrizionale di anziani ospiti di strutture residenziali a Trieste.

AIM: to evaluate nutritional status in a representative sample of guests of residential homes for the elderly using the Mini Nutritional Assessment (MNA, Nestlè®) and compare results with data from literature. DESIGN: cross-sectional study of prevalence using cluster sampling in two stages. SETTING AND PARTICIPANTS: the investigation focused on a sample of 420 guests of 37 facilities for the elderly, out of 2,967 residents in 89 facilities in the province of Trieste. The target population was characterised by age 65 years, with different degrees of self-sufficiency. Data were collected during 2010. MAIN OUTCOME MEASURES: nutritional status as defined by the MNA (good, bad, risk of malnutrition). RESULTS: the prevalence of malnutrition and risk of malnutrition are respectively 14.1% (CI95% 10.2-18.0) and 48.6% (CI95%43.4-53.8).The prevalence of malnutrition is higher among people residing in facilities for non self-sufficient guests: 21.4%(14.9 to 27.9) versus 9.5%(4.7 to 14.3) among people residing in facilities for self-sufficient guests. The intracluster correlation coefficients (ICC) and the relative standard error (ES) for the variables "normal nutritional status", "risk of malnutrition " and "bad nutrition" are respectively 0.19 (0.05); 0.02 (0.03); 0.05 (0.04). CONCLUSION: the prevalence of malnutrition and risk of malnutrition in residential facilities for the elderly in the province of Trieste is in line with the literature. The adoption of systematic nutritional screening, under the supervision and the support of the Prevention Departments, would allow a timely adoption of preventive and targeted therapeutic interventions.

Validation of a test of road law and road craft knowledge with older or functionally impaired drivers.

OBJECTIVE: The number of functionally impaired drivers being assessed is increasing the urgency to develop a standardized off-road driver assessment battery. We examined the validity of the Road Law and Road Craft Test (RLRCT) and a version of the Melbourne Slide Test to determine whether they should be included in the Occupational Therapy Driver Off-Road Assessment (OT-DORA) battery, which is under development. METHOD: We conducted a file audit of 118 data sets with individual item scores for the RLRCT and Melbourne Slide Test. RESULTS: The RLRCT test with one item removed provides clinicians with a valid indication of clients' off-road driving skills. The Melbourne Slide Test added no new information over that provided by the RLRCT and can be excluded from the battery. CONCLUSION: The revised 14-item RLRCT should be included in the OT-DORA battery. Further research is required to develop the OT-DORA battery as a valid and reliable measure of off-road driver skill.

Assessing sleep during pregnancy: a study across two time points examining the Pittsburgh Sleep Quality Index and associations with depressive symptoms.

BACKGROUND AND PURPOSE: Sleep quality seems to be an antecedent to depressive symptoms during pregnancy. We sought to 1) examine the psychometrics of the Pittsburgh Sleep Quality Index (PSQI) in pregnancy; 2) examine whether sleep quality predicted increases in depressive symptoms; and 3) compare PSQI scores across 3 or 2 levels of depressive symptoms. METHODS: Each of the 252 participants completed the Beck Depression Inventory (short form) and a sleep quality measure at mid and late pregnancy. RESULTS: PSQI total scores showed good internal consistency and construct validity. An improved model of the internal structure of the PSQI in pregnancy was found with 1 factor labeled Sleep Efficiency, a second labeled Night and Daytime Disturbances, and an Overall Sleep Quality component associated with, but separate from, both of these 2 factors. Although PSQI scores showed moderate stability over time, sleep disturbance scores increased in late pregnancy. Importantly, PSQI prospectively predicted increases in depressive symptoms. CONCLUSIONS: Findings suggest that the PSQI is useful in pregnancy research. Findings also support the idea that sleep problems are prospective risk factors for increases in depressive symptoms during pregnancy. Practitioners are advised to screen for sleep quality during early pregnancy.

The episodic buffer and learning in early Alzheimer's disease.

The role of working memory, specifically the episodic buffer, in the learning performance of patients with very mild (n = 18) and mild (n = 12) Alzheimer's disease as compared with healthy older adults (n = 29) was investigated using a series of word-lists that were manipulated (clustered, unclustered) to explore the impact of strategic organizational skills under varying attention conditions (full, divided). Results indicated that the learning performance for all three groups under full attention was better than that under divided attention, but only for the clustered word-lists. Moreover, in contrast to the mild Alzheimer's disease group, both the healthy older controls and the very mild Alzheimer's disease group demonstrated better performance on clustered word-lists than on unclustered lists, suggesting active strategic organizational skills, even at delayed free recall. The overall pattern of results indicates a staging of working-memory impairment in early Alzheimer's disease.

Sleep quality and depression during pregnancy: a prospective study.

For the first time, the relationship between depressive symptoms and sleep quality was explored prospectively during pregnancy. Participants (n = 273) completed the Pittsburgh Sleep Quality Index and Beck Depression Inventory at three 8-week intervals, starting from 15-23 weeks gestation. In addition to sleep quality and depression remaining relatively stable during pregnancy, findings revealed that sleep quality earlier in pregnancy predicted higher levels of depressive symptoms at later stage in pregnancy (after controlling for prior depression levels). In contrast, there was no evidence to suggest that depressive symptoms earlier in pregnancy impacted on sleep quality later on. Given that depressive symptomatology can lead to major depression and given the prevalence of pre- and postnatal depression, our findings suggest that screening for sleep problems during pregnancy may be of clinical significance.

Working memory and learning in early Alzheimer's disease.

Cognitive deficits associated with early Alzheimer's disease (AD) have been recently operationalised in terms of an acquisition deficit and the research supporting this view is presented. However, there is still debate concerning the nature of this deficit and how underlying cognitive processes may be detrimentally affecting the ability to acquire new information in early AD. This review argues that the pattern of cognitive deficits contributing to the acquisition impairment in early AD patients may be readily interpreted within the context of a working memory model. Isolating the component processes of working memory that underlie the acquisition deficit in early AD patients will aid in the design of clinical applications that are focussed at enhancing the ability to acquire new information in everyday life.