Toxicity of benzodiazepines in the treatment of insomnia disorders in older adults: a systematic literature review.

AIM: To review the literature data on the prevalence of benzodiazepines abuse and poisoning in older adults; the prevalence of polypharmacy with benzodiazepines in this demographic; and determine whether benzodiazepine anxiolytics or hypnotics were more frequently implicated in the cases of abuse and poisoning. METHODS: We searched PubMed and Scopus for relevant studies published from January 1, 2013, to May 1, 2023. Twelve studies were included in the final selection. RESULTS: The review highlights the diverse prevalence rates of benzodiazepine abuse and poisoning in the older adult population. Benzodiazepine anxiolytics were more frequently associated with negative outcomes than benzodiazepine hypnotics. Concurrent use of benzodiazepines, benzodiazepine-related medications, and opioids was reported, although these medications were not the only ones commonly used by the elderly. CONCLUSION: It is essential to increase awareness about adhering to prescribed pharmacological therapies to mitigate issues related to drug abuse and poisoning among older adults.

Validity and reliability of the Slovene version of the Morningness-Eveningness Questionnaire.

Morningness-eveningness (ME) can be defined as individual differences in sleep-wake patterns, and the time of day people feel and perform best. Various self-report instruments that measure ME have been developed. The Horne and Östberg Morningness-Eveningness Questionnaire (MEQ) has most frequently been used for classifying ME types. The aim of this study was to investigate the validity and reliability of the Slovene version of the MEQ (Slovene MEQ). Two hundred and sixty-five participants (65.3% women, 34,7% men, mean age 38,1 years, range 19-67) took the Slovene MEQ twice, 2 weeks apart (MEQ test and retest). Internal consistency of the Slovene MEQ items was high, with Cronbach's Alpha coefficients of 0.86. The test-retest reliability was also high, with intraclass correlation coefficient (ICC) of 0.96. The classification of chronotypes on middle-aged population offered a more balanced representation of the five chronotypes than those proposed by the authors Horne and Östberg . Age changes in chronotype could be confirmed in this study in the supposed direction with older adults being more morning-oriented. The criterion validity of the Slovene MEQ through the relationship of morningness and basic personality traits showed that conscientiousness and agreeableness demonstrated positive and significant correlations with morningness. A low negative correlation was observed between openness and morningness, with higher eveningness among more open participants.

Parkinson's disease dementia: clinical correlates of brain spect perfusion and treatment.

BACKGROUND: The main clinical feature of dementia in Parkinson's disease is a dysexecutive syndrome. The neuropathology of PD dementia (PDD) is likely multifactorial and affects several neuronal populations. There is evidence that Parkinson's disease dementia is associated with a cholinergic deficit, supporting the therapeutic role of cholinesterase inhibitors, which are already first-line agents in the treatment of Alzheimer's disease. The paper includes short report on a pilot study with description of cognitive and imaging profiles in patients with mild to moderate stage of Parkinson disease dementia (PDD). SUBJECTS AND METHODS: A random sample of 16 patients with clinical diagnostic criteria for probable PDD was included in the study. Patients were characterized with mild to moderate cognitive decline slightly depressive mood and moderate motor performance. Brain perfusion [(99m)Tc]ECD / SPECT and structural MRI with emphasis on evaluation of the degree of cortical atrophy and the medial temporal atrophy index was performed. All patients had detailed neuropsychological evaluation using a "cognitive process approach". Neuropsychological data were correlated voxel-wise with normalized brain perfusion images, creating whole-brain correlation maps. CONCLUSIONS: Previously reported generalized cognitive impairment in PDD with predominant executive, visouspatial and attentional deficits was confirmed. Performance on specific cognitive measures was correlated with perfusion brain SPECT findings. It could be speculated that different pathological mechanisms underlie widespread significant brain perfusion decrements in temporal, parietal and frontal regions.

Amyotrophic lateral sclerosis patients show executive impairments on standard neuropsychological measures and an ecologically valid motor-free test of executive functions.

The study aimed to evaluate the nature and extent of executive deficits in nondemented amyotrophic lateral sclerosis (ALS) patients. A total of 22 ALS patients and 21 matched controls were compared on standard neuropsychological tests of executive functions with appropriate control for motor impairment and on an ecologically valid motor-free test of executive functions, the Medication Scheduling Task (MST). Our results show that motor dysfunction can present a significant confound when using standard neuropsychological measures; however, even when accounting for motor disabilities, ALS patients show a robust pattern of cognitive dysfunctions. Additionally, MST was shown to be a sensitive measure of cognitive impairment, providing an important insight into cognitive processes relevant for patients' daily living.