Introduction

Since late-life depression is often correlated with low physical activity, the implementation of physical exercise in order to enhance functional limitations should also be considered as a feasible treatment modality. Previous research has suggested that increased physical activity might be beneficial in the prevention or treatment of depressive symptoms.

Objectives

To investigate the effectiveness of physical exercise in depressed older adults as an alternative to antidepressant medication.

Methods

An English-language literature search was conducted using Pubmed, EMBASE and Cochrane library.

Results

Some studies proposed physical exercise as a complementary or even as an alternative treatment option for late-life depression. However, conflicting results have been reported and the results must be interpreted carefully due to methodological weaknessess, including inadequate concealed randomization, small sample sizes, short follow-up duration, and poor quality of data analysis. There are clear indications to consider that physical activity can contribute to the reduction of depressive symptoms in older adults.

Conclusions

To obtain more insight of the effect of physical activity on late-life depression, further research is needed, based on well-designed studies.

Introduction

Insomnia is among the most pervasive and poorly-addressed problem of aging.

Objectives

The purpose of the present study was to estimate the prevalence of insomnia among older patients who visit Health Center of Distomo, Greece and to associate with several risk factors.

Methods

A cross-sectional study was conducted among 150 elderly, aged >65 years. An anonymous questionnaire was designed to collect the basic demographic data of the study population. The Athens Insomnia Scale (AIS) was used to quantify sleep disturbances. Statistics was processed with SPSS 22.

Results

According to AIS 39.3% of the older people screened positive for insomnia. Sleep problems were more frequently in women (p = 0.002), in older adults (p <0.001), in elderly suffering from medical conditions (p<0.05), in participants with poor social life (p = 0.011), with absence of daily physical activity (p <0.001) and daily coffee and alcohol consumption (p= 0.016 and p=0.041 respectively).

The polypharmacy (p <0.001) and especially the consumption of diuretics (p=0.007) and more than two antidepressants (p<0.001) was strongly associated with insomnia too.

Conclusions

According to our results insomnia is often among the elderly and strongly associated with several risk factors such as polypharmacy and comorbidity. Various interventions in Primary Health Care are necessary in order to increase detection rates of sleep disorders in older people.

Introduction

Loneliness is related to worse health status outcome.

Objectives

The present study aims to identify how longitudinal patterns of loneliness associated with health in old age.

Methods

A total of 1,287 individuals aged 50+ were interviewed in 2011-12, 2014-15 and 2017-18 in a follow-up study conducted over a nationally representative sample of Spain. The three-item UCLA Loneliness Scale was used to assess loneliness. Chronic loneliness was defined as the presence of loneliness in the three measurements, whereas transient loneliness expressed the presence of these feelings only at one period of study. Health status was measured with self-reported questions regarding ten domains (vision, mobility, and self-care, among others), and seven measured tests (including grip strength, walking speed and immediate and delayed verbal recall). A multilevel linear regression was used to examine association between loneliness patterns and health over time.

Results

Almost a-ten percent of participants reported feeling lonely throughout the three waves, who showed the worst health status. Both the group of chronic and transient loneliness showed a negative significant relationship with health status at follow-up, (β = -6.2, p < 0.001 and β = -2.50, p = 0.02, respectively). Nevertheless, a significant change in the relationship between loneliness pattern and health status was not observed across time.

Conclusions

Loneliness was longitudinally associated with poorer health, although health status of each loneliness pattern did not worsen over time. Different patterns of loneliness could benefit from the appropriate interventions.

Introduction

Elderly patients are especially at risk for the development of psychotic symptoms. Also some other psychiatric symptoms may correspond to primary psychiatric illnesses or medical conditions, specifically neurological disorders such as mild cognitive impairments or dementia.

Objectives

The aim of the study was to evaluate the course of patients presenting first psychiatric symptoms in the elderly.

Methods

A retrospective observational study was conducted between January 2014 and December 2018. The sample included patients over 65 years of age with no psychiatric background presenting psychiatric symptoms and attended in the Emergency department.

Results

Physical illnesses, social isolation, sensory deficits, pharmacological treatment, substance abuse and familiar psychiatric background were analyzed in every patient. We evaluated the presence of neurological disorders in the following two years.

Conclusions

Affective and emotional dysregulation such as depression, anxiety, euphoria, irritability and agitation as well as psychotic symptoms are common in preclinical and prodromal dementia syndromes. A proper evaluation and follow-up is required for improving the prognosis of these patients.

Introduction

Almost 7% of the geriatric populations are suffering from dementia in the USA where the prevalence increases exponentially with increasing age and doubles every five years of age after age 65. Major Neurocognitive Disorder, which corresponds to dementia, requires substantial impairment to be present in one or more cognitive domains (memory, language, executive functions, social judgment and coordinated motor activities), sufficient to interfere with independence in everyday activities. Besides cognitive dysfunction, Dementia patients can present with a range of heterogenous presentations called behavioral and psychological symptoms of dementia (BPSD). BPSD includes three groups of symptoms; affective, psychotic and other neuropsychiatric disturbance.

Objectives

In the clinical settings, it is challenging to determine the primary cause of cognitive impairment in psychotic patients and vice versa. So the question remains unsolved.

Methods

In order to answer the question, electronic database search of Medline, Pubmed was done using the keywords, “Psychosis”, “Dementia”, “Geriatric population”, and came up with 93 articles that include clinical study, comparative study, meta-analysis, multicenter study, observational study, review, scientific integrity review, and systematic reviews. From those 5 studies were selected for the review based on the highest level of internal validity.

Results

Studies to date suggest that mood, apathy, amotivation and anxiety symptoms are more common in mild cognitive impairment, while psychotic symptoms are more common in certain subtypes of dementia, such as Lewy body dementia.

Conclusions

Further clinical and translational studies are needed to see the temporal profile of development of psychotic symptoms and cognitive decline to decide the association pattern.

Introduction

An estimated 46.8 million people live with Dementia worldwide. Approximately 30% of patient’s with dementia will suffer with a major depressive disorder. Treatment with antidepressant medication can be problematic in older adults with dementia, and engagement with psychological therapy may be more challenging. Therefore, we undertook a review of the literature for evidence that exercise could reduce the symptoms of depression in Alzheimer’s Dementia.

Objectives

To establish if there is an evidence base for the treatment of depressive symptoms in Alzheimer’s dementia.

Methods

A literature search was undertaken in July 2019. Papers were identified from the Medline database. Search terms focused on the disease (Alzheimer’s dementia), depression and exercise and its synonyms. The search was limited to papers from after 1999, English language and randomised trials.

Results

Using the criteria above a total of 13 papers were identified. 3 papers were excluded on initial screening. Full text was accessed for the remaining 10 papers. Of these 5 of these papers were excluded as they were not limited to Alzheimer’s Dementia. The remaining 5 papers were analysed. The results of these papers were variable, with little evidence of significant improvement in depressive symptoms in dementia.

Conclusions

Currently there is a lack of evidence to recommend treatment of depressive symptoms within a dementia, with exercise. However, given the neurochemical changes associated with exercise there is good reason to believe that exercise may well improve these symptoms. Our study should be a call to arms. It is imperative there are further studies are need in the area.

Introduction

Mild and moderate cognitive impairment are considered intermediate stages between normal cognitive function and dementia. This clinical condition has a high incidence and prevalence within elderly community studies. Despite this rise of cases of cognitive impairment and dementia, to our knowledge, there is still little information about the mortality risk, and its moderators, among individuals with mild and cognitive impairment in low and middle-income countries.

Objectives

The objective of the current study, therefore, was to compare mortality in subjects with mild and moderate cognitive impairment with mortality within non-impaired cognitively subjects over 15 years of follow-up.

Methods

We followed-up1276 older adults for 13.3 year evaluated the cognitive impairment using the total score of MMSE, which was categorized into no, mild and moderate cognitive impairment, as above cutoff means – 1.0 standard deviation (SD), below cutoff means – 1.0 SD and below cutoff means – 2.0 SD, respectively. Date of death was computed by reviewing death certificates. We used Cox’s proportional hazards models to evaluate the risk of mortality in participants with cognitive impairment.

Results

Participants with both mild and moderate cognitive impairment diabetes had higher death risk than those with no cognitive impairment in the unadjusted hazard ratio(HR) model, but these associations did not remain in the final adjusted model. After sex stratification, only men with moderate cognitive impairment had mortality risk increased in the final adjusted model (HR:2.30; 95% CI:1.12-2.4.74).

Conclusions

Our findings suggest an association between moderate cognitive impairment and all-cause mortality in men in a large Brazilian cohort of elderly subjects.

Introduction

Sleep disorders are common in the elderly. This is even truer when we consider the older adults living in a retirement home. In addition to aging, other factors can lead to a poor quality of sleep.

Objectives

Our study aimed to evaluate the quality of sleep of elderly living in a retirement home and to determine the associated factors to it, in a Tunisian sample.

Methods

It was a cross-sectional study conducted in January 2019 among elderly people living in a retirement home in Sfax (Tunisia). Sleep quality assessment was performed using the Pittsburgh Sleep Quality Index (PSQI).

Results

Our study sample consisted of 30 older adults. They were 73.4 years old on average with an over-representation of males (60%). The mean number of months spent in the retirement home was 57.62 ± 77.96 months. According to PSQI scores, 53,3% of the residents had a poor quality of sleep (PSQI ˃5). The mean sleep latency time was 49 ± 74,67 minutes. Thirteen residents (43.3%) reported difficulty getting enough enthusiasm to get things done during the day and 76.7% (n=23) reported having difficulty falling asleep in less than 30 minutes, at least once a week. We found a significant association between a good sleep quality and the presence of religious practices (p=0,035).

Conclusions

Our findings confirm the reported high prevalence of poor sleep quality in retirement home population. Religious practices seem to be a protective factor that needs more attention.

Introduction

Psychosis is relatively common in the later stages of life: occurs in nearly 10% of patients over 60 years attending to psychogeriatric clinics. This is a distressing situation that persist for many years, associated with increased risks of social dysfunction, institutionalization, and death.

Objectives

Analyze the most recent literature about this subject and highlight the latest indications for diagnosis and treatment.

Methods

Bibliographic search in PubMed and ClinicalKey electronic databases, with a review of the literature in the last 5 years, with the terms “psychosis”, “elderly”, “late onset schizophrenia”.

Results

A late-onset (aged ≥60 years) variant of psychosis without dementia has been recognized, and classified as very late-onset schizophrenia-like psychosis. This people are similar to those with early onset schizophrenia in symptoms, family history and pattern of neuropsychological impairment. However, there are some differences: the prevalence of women is higher, the cognitive impairment is smaller and multimodal hallucinations are present. It is associated with sensory impairment and social isolation, but not with formal thought disorder, affective blunting or familial aggregation. The overall treatment strategy is the same as that of the young population, but lower antipsychotic doses are required.

Conclusions

The concept of very late-onset schizophrenia-like psychosis is characterized by the onset of delusions and / or hallucinations after 60 years of age in the absence of affective disorder or demonstrable brain disease such as dementia. The disease is seen as a functional psychosis with symptoms that respond to antipsychotic medications in lower doses.

Introduction

Charles Bonnet syndrome is a clinical entity characterized by the presence of visual hallucinations in patients with severe bilateral visual impairment. They occur as a result of a damage along the visual pathway and affect 10 to 40% of adults who experience significant vision loss.

Objectives

Describe a clinical case of Charles Bonnet syndrome and assess the state-of-art for contribute to better diagnosis of this entity.

Methods

Describe a case report of Charles Bonnet syndrome and perform a bibliographic search in PubMed and ClinicalKey electronic databases, with a review of the literature in the last 5 years, with the terms “Charles Bonnet syndrome”, “visually impairment”, “visual hallucinations”.

Results

This case report will focus on a 78-year-old man who, due to an accident, lost his vision about 20 years ago. He was asymptomatic until 4 weeks ago, when he began to refer complex visual hallucinations, with progressive impact on his daily activities. At emergency department the patient saying that saw several animals, which he considered strange and could not explain. Due to these complaints, he was referred for neurological evaluation, and posteriorly referred to psychiatry. Given the hallucinatory condition, the diagnostic hypothesis of Charles Bonnet's Syndrome was placed. He was treated with quetiapine 50mg id and alprazolam 0.25 mg 1/2 id, which was suspended few weeks later due to intolerance. Six months later the patient remained without medication, with hallucinatory improvement.

Conclusions

It is important to know and be aware of these situations, which can be easily confused with delirium or dementia.

Introduction

Nowadays increasing attention is paid to research a polyunsaturated fatty acids (PUFAs) subjected to peroxidation in the aging process under oxidative stress.

Objectives

Comparative analysis of the spectrum of PUFAs and the activity of individual components of the enzymatic antioxidant system in the blood of elderly people with mild cognitive impairment (MCI) Alzheimer's type (prodromal Alzheimer's disease, MCI AD) and vascular etiology (prodromal vascular dementia, MCI VaD) compared with elderly people without signs of MCI.

Methods

We conducted a comparative study of the content of six fatty acids: linolenic, docosahexoenoic , eicosopentenoic (omega-3 group); arachidonic (AA), linoleic (omega-6 group) and eruca on an "Agilent-7890" gas chromatograph (Agilent Technologies, USA) with mass-selective detector. Simultaneously, the activity of the main antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPO) and glutathione reductase (GR) was determined in erythrocyte hemolysates.

Results

In both case groups a decrease in the concentration of omega-3 PUFAs was revealed in comparison with the control group.
A sharp decrease in the concentration of AA was found in patients with MCI AD compared with patients with MCI VaD and the control group.
A decrease in the activity of the antioxidant enzyme system and the level of PUFAs in the blood of patients with MCI was revealed.

Conclusions

At the initial stage of AD with subthreshold clinical symptoms an active release of AA from phospholipids and its intensive expenditure due to the launch of an “uncontrolled cascade” occur. The decrease in AA may be one of the prognostic factors of predisposition to the development of AD.

Introduction

Assessment of geriatric patient can be challenging due to diagnostic overlap of the three D’s of Geriatric Psychiatry namely delirium, dementia and depression coupled with significant social stressors in older adulthood.

Objectives

A case of an elderly woman with 6-month history of behavioural changes is described to illustrate the challenges in diagnosis.

Methods

case report

Results

Madam A is a 79year old Chinese lady with a medical history of euthyroid multi-nodular goitre. She has no past psychiatry history. She presented with 6-month duration of depressive symptoms, visual hallucinations, paranoia, intermittent confusion and cognitive decline that started after her husband’s sudden death and exacerbated by family dispute. Her symptoms preceded a total thyroidectomy that was performed due to difficulty in breathing. Post thyroidectomy, she was hospitalized twice due to derangement in calcium level.

She was noted to have suicidal ideation and homicidal ideation towards her daughter with intellectual disability prompting psychiatric admission for safety and evaluation. She was euthyroid and calcium level was normal on admission.On mental state examination, she was fairly attentive but guarded and paranoid against nursing staff. She declined cognitive assessment. She was withdrawn and did not want to talk about her feelings. Based on clinical observation and collateral history from family, she was diagnosed to have Major Depressive Disorder with psychotic features.

Conclusions

This case illustrates the diagnostic challenges in an elderly woman due to substantial overlap of clinical syndromes of delirium, depression, dementia and grief. A comprehensive assessment including detailed time course and medical examination is helpful for accurate diagnosis.

Introduction

Sense of coherence can be defined as the coping capacity of people in the form of a feeling of confidence that one's environment is predictable and that they can deal with everyday life stressors.

Objectives

This study was designed to explore the possible association between spirituality, religiousness, and sense of coherence in older adults living in Greece.

Methods

Τwo hundred and twenty seven healthy older adults (Mage =72.23, SDage =6.57; Meducation = 7.81, SDeducation = 3.93) from two cities, an urban center in Southern Greece and a less urbanized city in Northern Greece, participated in this study voluntarily. All participants were asked to complete a demographics questionnaire, the self-reported Royal Free Interview for Spiritual and Religious Beliefs, and the Sense of Coherence Scale.

Results

Results indicated that the majority of the participants reported strong religious beliefs as their age increased. Female widowed participants expressed greater religiousness and spirituality. A statistically strong positive correlation of the Sense of Coherence score with the Spiritual Scale as measured by three questions of the Royal Free Interview was found. The total score for Sense of Coherence was negatively correlated with gender (women), marital status (widows), and increased age.

Conclusions

The findings of this study confirm previous findings of other researchers concerning a different population group residing in a rural area of Crete. Future research should include not only larger samples of older adults, but also groups of older adults as well as younger adults suffering from different diseases.

Introduction

Understanding of cognitive age-related changes is relevant in light of the growing number of elderly people, can help distinguish pathological from “benign” changes, and also emphasizes the important role of cognitive processes in maintaining functional independence and effective communication with other people.

Objectives

To study the characteristics of the course of cognitive processes and higher mental functions in healthy elderly people.

Tasks: to study the relationship between age and the state of the cognitive sphere in healthy respondents; compare the state of the cognitive sphere in the selected age groups.

Methods

We studied a sample of 44 respondents aged 52 to 95 years without cognitive decline.

The sample was divided into 2 groups, depending on age: up to 65 and over 65 years old. The first group included 10 respondents, the second - 34.
Experimental psychological methods: Addenbrook cognitive scale (ACE-III), Stroop test, Wechsler memory scale (WMS), Frontal Assesment Battery (FAB).
Statistical methods: U Mann-Whitney criterion, correlation analysis (Spearman's R), due to the lack of normal distribution of a number of indicators by the Shapiro-Wilk criterion.

Results

A significant correlation was found between cognitive test scores and age.

Comparing the 2 groups, respondents over 65 found: a decrease in memory and overall functioning according in ACE-III, a decrease in the performance of 4 indicators of the Stroop test is observed (tempo, flexibility, concentration are reduced, interference is increased). Most of the values ​​of the remaining tests remain relatively stable.

Conclusions

It was revealed which cognitive functions during normal aging are benignly reduced and which remain stable.

Introduction

Interventional programs to relieve memory impairment and memory-related complaints in older adults with mild cognitive impairment are needed.

Objectives

The purpose of the current study was to assess the efficacy of a novel cognitive training approach—named multi-strategic memory training—based on the metamemory concept in older adults with mild cognitive impairment.

Methods

Among a total of 113 older adults with mild cognitive impairment, 66 participated in the memory training program (training group) and 47 did not (control group).

Results

Repeated measures of analysis of variance revealed that compared with the control group, the training group experienced: i) a significantly greater increase in cognitive test scores of long-term delayed free recall (F_interaction = 6.04, p = .016) and fluency (F_interaction = 4.11, p = .045) and ii) significantly greater decrease in their subjective memory complaints for everyday memory (F_interaction = 7.35, p = .009).

Conclusions

These results suggest that the training program can improve verbal memory—a trained cognitive function, language processing—a non-trained cognitive function, and limit complaints in everyday instrumental memory activities of mildly impaired older adults.

Introduction

Charles Bonnet Syndrome is characterized by visual hallucinations in the absence of cognitive impairment, and often associated with visual deficits. Some risk factors for its development are advanced age, optic pathway injuries, social isolation, depression, or sleep disturbances.

Objectives

Review of the relationship between CBS and the development of dementia.

Methods

Illustrative case report. Bibliographic search in PubMed about the link between CBS and dementia. Introduced terms: CBS, dementia, Lewy Body Dementia (DLB).

Results

A 93-year-old women with history of dysthymia, was referred for complex visual hallucinations since several months, associated with behavioral impact, disturbing her sleep. There were no other psychiatric or cognitive symptoms.

The patient also had marked visual impairment due to bilateral macular degeneration.

In CT study is detected chronic microangiopathy and diffuse bilateral cortical-subcortical atrophy.

Given the absence of other psychopathology, CBS was the accepted diagnosis, and low-dose antipsychotic treatment was introduced.

Initially impact of the hallucinations diminished and insight was gained.

At follow-up, she developed Parkinsonism, repeated falls, cognitive impairment, and auditory hallucinations, being now the diagnosis compatible with LDB.

LDB core features are progressive memory deficits, Parkinsonism and repeated falls. Due to its frequent debut with isolated visual hallucinations, on cross-sectional observation both entities can be misdiagnosed, with therapeutic consequences.

Conclusions

Careful longitudinal observation is recommended to exclude DLB in elderly patients with CBS, being useful the detection of neuropsychological changes distinctive of the early stages of DLB.

Currently, the nature of the relationship between the two entities continues to be uncertain.

Introduction

Although bipolar disorder may begin after the age of 50, only 6-8% of cases occur after the age of 60. If we also take into account the influence of cerebrovascular risk factors, the approach and prognosis become more complex.

Objectives

The field of bipolar disorder in Old Age Psychiatry is broad in clinical practice but scarce in the publication of scientific evidence.

Methods

An exploratory-descriptive study that exposes a clinical case of a 68-year-old man who debuted with manic symptoms four months after having suffered a cerebral infarction, which developed as a confusional episode.

Results

The current literature is reviewed and a multidisciplinary approach is carried out, concluding that it is a bipolar disorder due to cerebral infarction with cingular involvement.

The patient improves with the initiation of treatment with valproic acid as a normotimizer, selected because of its good tolerability and ease of handling. Nevertheless, an important part of the treatment will be the control of cerebrovascular risk factors.

Regarding the acute confusional state, present in the differential diagnosis of various psychiatric presentations, it is important to consider several lobar or focal neurological syndromes that can cause a state of confusion, even in the absence of focal neurological deficits in the exploration.

Conclusions

If the onset of manic symptoms occurs in late adulthood or in the elderly, the possibility of an organic disease should be considered in greater depth.

Silent cerebral infarction may be much more common than symptomatic stroke. The definitions and classifications of cerebral vascular accidents do not contemplate psychiatric symptoms.

Introduction

Diagnosis of depression of elderly people is difficult. Patients are not always able to verbalize their condition, there is a phenomenon of "somatization" of depression often takes place, as well as cognitive dysfunction, which is especially significant in the relationship between depression and dementia (risk factor, consequence). Due to the high diagnostic significance of the occurrence of depression as an anhedonia, we compared its clinical features and severity in conditions of presence and absence of cognitive decline.

Objectives

86 depressed patients aged 61 to 70 years were surveyed. 45 patients with depressive syndrome without cognitive decline and 41 patients with organic "vascular" depression, combined with cognitive decline of cerebrovascular etiology (neurodynamic type).

Methods

Clinical-psychopathological, Psychometric (GDS-15, CSDD, MoCA, FAB, RBANS), Instrumental (MRI of the brain)

Results

There was a presence, both physical and intellectual-esthetic anhedonia of moderate severity, in patients without cognitive decline. It was accompanied by a reduction of pleasure from various activities, a loss of interests and of a decrease in emotional response. Anhedonia acted as one of the dominant symptoms of depression. Among patients with cognitive decline in vascular etiology, anhedonia was rarer, had no clear separation and was minor. Manifestations of anhedonia were limited to a slight loss of interests and a decrease in activity. The main symptoms of depression were hypothymia, expressed anxiety, and non-specific symptoms

Conclusions

There are significant differences in the prevalence and severity of anhedonia in the structure of depression, depending on the presence or absence of dementia.

Introduction

Type II diabetes mellitus (T2DM) has been associated with multiple comorbidities including changes in cognition. As rates of both diabetes and dementia continue to rise, identifying factors that contribute to the progression of dementia in individuals with T2DM has become increasingly important.

Objectives

To establish the demographic and clinical profile of patients with dementia and T2DM in an active patient caseload in a community and hospital setting.

Methods

A local case register of patients with dementia attending psychiatry of old age and geriatric services in northwest Ireland between Jan 2018-July 2019 was developed as part of a National Pilot for integrated care. Information was gathered from medical notes, nursing assessments, laboratory and imaging studies. Anonymised case register data was analysed to examine the patient group with comorbid dementia and T2DM.

Results

Of 497 total patients with dementia on the register, 68 (13.7%) had comorbid T2DM. In the subpopulation of patients with comorbid dementia and T2DM, the most common dementia subtype was mixed dementia (13.2%). There was a high prevalence of depression in this population (19.1%). Additionally, 42.6% of patients were prescribed an antidepressant. There was also a high rate of polypharmacy with 69.1% of patients on greater than five total medications. Hypertension was the most common cardiovascular comorbidity (54.4%) in this population and 19.1% of patients had evidence of microvessel ischemia on brain imaging.

Conclusions

Our results highlight the heterogenous nature of the factors affecting brain health and the need for further research into identifying targeted dementia prevention strategies.

Introduction

Lewy body dementia (DLB) is the second most prevalent neurodegenerative dementia. However, it is often not detected or misdiagnosed.
DLB diagnostic criteria (McKeith et al.2017) list four core items: visual hallucinations, motor parkinsonism, cognitive fluctuations, and REM sleep disorders. However, it often debuts with isolated visual hallucinations, leading to misdiagnosis with Charles Bonnet Syndrome (CBS), which consists in visual hallucinations in the absence of other psychopathological alterations

Objectives

Evaluate whether visual hallucination characteristics can help to make an early differential diagnosis between CBS and LBD.

Methods

Research in PubMed of literature about the characteristics of visual hallucinations. Terms introduced: LBD, CBS, visual hallucinations, diagnostic criteria.

Results

Both entities include complex visual hallucinations. They usually last minutes in LBD while in CBD can be longer and more frequent.
Whilst in CBS consciousness state is always preserved, other sensory disturbances are not present and hallucinations are experienced as unreal, lacking affective impact, in LBD these aspects can present altered: visual hallucinations usually appear related to times of wakefulness decreased level, they are often polymodal (the most distinguishing characteristic), with associated affective impact, altering reality judgment.

Conclusions

Because of the different presentation of visual hallucinations in LBD, it is not possible to make an accurately early clinical diagnosis in the absence of other symptoms, although some data may increase suspicion degree fot the diagnosis.
We recommend close follow up in CBS cases with particular attention to LBD other symptoms.

Introduction

Glioblastoma Multiforme (GBM) is the most aggressive malignant brain tumor, with the maximum incidence in patients aged more than 65 years. Clinical presentation characteristically includes focal neurological disturbances, but in a minority of cases these symptoms may be minimal/absent. Thus, it is important to be aware that psychiatric symptoms may be the first sign of the disease.

Objectives

To provide a report of psychiatric presentation of GBM.

Methods

We present two cases of patients aged more than 65 years presenting with depressive symptoms who were subsequently diagnosed with frontal GBM.

Results

Patient 1: A 82-year-old female was admitted to the ER service with insomnia, confusion regarding the daily living activities and inability to manage the medication of his spouse of whom she was caregiver. Additionally, she reported a persistent headache, that she felt as consequence of insomnia and fatigue. These symptoms have developed 1 week before. There was no history of previous psychiatric disorder. Patient 2: A 72-year-old female diagnosed with Recurrent Depressive Disorder presented to the ER service reporting abulia and social isolation. At admission she had whispered, sometimes incoherent, speech and perplexed posture. She stopped medication 3 months ago (venlafaxin 150 mg od and lorazepam 2,5 mg od). The medication were reintroduced, without benefit. Both patients undergo a complementary neuroimaging assessment and were diagnosed with frontal GBM.

Conclusions

Patients with brain tumors may still misdiagnosed as primary psychiatric disorders. Given that treatment of early-stage GBM may improve its extremely poor prognosis, its early detection becomes crucial.

Introduction

Mania affects approximately 1% of the global population. In regard to the elderly patient, the prevalence is unclear, this leading to contraindications in various case studies on this information.

Objectives

To make a differential diagnosis and to treat the mania in the elderly patient through a clinical case of a 77-year-old patient who was admitted into hospital due to a first manic episode.

Methods

Firstly an organic origin of the case was dismissed. Subsequently, a personal background screening of the patient is conducted, as well as a personality test and a cognitive test. Regarding the treatment, an antipsychotic treatment is initiated. Afterwards, as the symptoms persist, a mood stabilizer was also used.

Results

After initiating the antipsychotic and mood stabilizer treatment, the patient’s productive psychotic symptoms stopped and there were no affective symptoms.

Conclusions

A proper differential diagnosis is necessary for a manic episode experienced by the elderly patient. Introducing a mood stabilizer treatment, together with an antipsychotic treatment may result useful in such cases.

Introduction

Introduction: adults over 65 years of age have special characteristics, since they are usually patients with great comorbidity and polymedics. Their sensory and functional limitations make them dependent on third parties, even to communicate with the doctor, which can lead to a difficulty in understanding the way they should take the medication, In addition, they may often feel not enough confidence to talk about problems such as loneliness, depression, fear of death, memory loss, alcohol abuse or abuse.

Objectives

To know the most effective communication techniques between the psychiatrist and the elderly patients to improve medical attention.

Methods

A literature review of the last 5 years was carried out in the main medical search.

Results

The literature shows that often the patient and the caregiver do not understand the information about the treatment. In addition, the doctor usually addresses the caregiver, rather than the patient. The social circumstances of the elderly may also be related to the communication problems.

Conclusions

An adequate relationship between the psychiatrist and the patient improves the patient's adherence to the treatment. It is important that the doctor directs the conversation to the patient and not only to the caregiver. The doctor must create the right environment so that the patient can talk about their problems in the time they need, always guaranteeing confidentiality. It is important to consider social aspects, assess sensory and functional limitations, involve caregivers in care and ensure coordination with the team of Primary care and the other specialists.

Introduction

Neurodegenerative disorders, such as cognitive impairment and dementia, are disorders that are increasing their incidence. They are diseases that generate a great loss of autonomy and functionality, requiring specialized caregivers and numerous health resources throughout the course of the disease. On numerous occasions his debut is with cognitive symptomatology, memory disorders. But it can also debut with depressive, anxious or psychotic symptoms. Depressive disorders can present cognitive alterations so that at advanced ages it is necessary to make an adequate differential diagnosis since the early screening of disorders that occur with cognitive impairment is associated with a better prognosis.

Objectives

The objective of the study is to demonstrate the association between affective symptoms in disorders with cognitive impairment in people over 65 years of age and the need for neurocognitive tests such as MMSE from primary care.

Methods

Sample of 24 patients, treated in the first consultation with mental health for presenting affective and cognitive symptoms. We perform neuropsychological test as MMSE.

Results

24 patients, 3 men and 21 women. We performed an MMSE: Of the 21 patients >65 years old, 12 scored <23, so they are diagnosed with cognitive impairment. We performed statistical analysis obtaining statistical significance p=0.000 for patients with affective and cognitive symptoms.

Conclusions

Affective symptomatology is present in neurodegenerative disorders such as cognitive impairment and dementia and sometimes affective symptoms may appear earlier than cognitive ones. Therefore it is indicated to carry out screening test and an adequate differential diagnosis from primary care and not delay the diagnosis.

Introduction

This study aims the perspectives of older adults on their sexual unwellness.

Objectives

A qualitative research analyzed older adults’ perspectives on indicators of sexual unwellness in Portugal and Romania.

Methods

Forty seven older community-dwelling participants aged 65 to 91 years, were interviewed. All the interviews went through content analysis.

Results

Preliminary results of content analysis produced five themes for the Romanian sample: Aging (k= .90, p < .01); poor health (k = .92, p < .01); loss of partner (k = 93, p < .01); lack of libido (k = .91, p < .01); and life stressors (k = .81, p < .01); and five themes for the Portuguese sample: Lack of communication (k = .92, p < .01); lack of love (k = .89, p < .01); lack of trust in the relationship (k = 98,p < .01); lack of self-esteem (k = .90, p < .01); and life stressors (k = .9, p < .01).

Conclusions

This study underlined the perspectives of Portuguese and Romanian older adults concerning sexual unwellness. For the Romanian sample, aging was the most frequent theme, whereas for the Portuguese sample, lack of communication was the most pointed out theme.

Introduction

Diabetes is a major public health problem in Tunisia. Its prevalence increases with age. In addition, depression, at the top of mental disorders list, mainly remain undiagnosed, in particular in the elderly and consequently untreated.

Objectives

The aim of this study was to estimate depressive symptoms and related factors in elderly diabetic patients.

Methods

This is a cross-sectional study, conducted among type 2 diabetic patients aged ≥ 60 years old, attending Mahdia’s primary health center, from January 2019 to March 2019. Depressive symptoms were assessed by using the Geriatric Depression Scale (GDS).

Results

95 diabetic patients were recruited. The average age was 75 ± 7.4 years and the sex ratio was 0.9. In our sample, 68.4% of patients were categorized according to having depressive symptoms. The proportion of participants with mild and severe depression symptoms were 25.3% and 43.1%, respectively. Analytical results demonstrate many factors which were significantly associated with depressive symptoms: female gender, living alone, history of hypertension, presence of complications, and using insulin (p < 0.05).

Conclusions

Our study shows that depressive symptoms are common in elderly subjects with diabetes, and there have been many significant risk factors associated with it. So there is need for physicians to detect, confirm, and treat depression in elderly diabetic patients.

Introduction

Vagus nerve stimulation (VNS) has been associated with cognitive-enhancing effects in neurocognitive disorders (ND) in the literature, but no clear recommendation for use of this method has been yet formulated.

Objectives

To verify the quality of data regarding the efficacy and tolerability of VNS use in patients with ND and in population with risk of developing ND.

Methods

Main electronic databases (PubMed, CINAHL, PsychInfo, Cochrane, EMBASE) were searched using as keywords “VNS” and “neurocognitive disorders”, „dementia”, „cognitive deterioration”. We have selected clinical trials with any design which specified the methods used to quantify the efficacy of the intervention.

Results

A 6-month open-label pilot study with Alzeimer Dementia (AD) patients (N=10) demonstrated response in 7 cases, according to the ADAS-Cog and MMSE scores. A follow-up study (N=17) on probable AD patients showed improvement or no decline from baseline after one year, as reflected by the ADAS-Cog and MMSE. A single-blind study demonstrated improvement of associative memory performance in healthy older individuals (N=30), even after a single session. The tolerability of VNS was reported as being good by all the cited trials. The found data are derived from small-scale short-duration studies, therefore more accurate data is needed in order to validate the efficacy of VNS in neurodegenerative disorders.

Conclusions

Efficacy of VNS in ND is not yet validated, but the tolerability of this therapeutic intervention is good. For both ND patients and old age patients with risk of developing cognitive decline, larger-scale longer duration trials should be conducted.

Introduction

Subcortical lacunes, neurodegenerative processes, and gray matter atrophy are frequently detected in late-life depression, which suggest an involvement of the vascular pathology in elderly patients with depressive symptoms.

Objectives

To formulate good practices for patients with vascular depression based on our department data and literature research.

Methods

A retrospective analysis of patients admitted in our department between 2010 and 2019 with vascular depression was performed and results were compared with guidelines and expert consensus found in the literature using Google search engine, Cochrane Database of Systematic Reviews and Thomson Reuters/Web of Knowledge database.

Results

Neuroimagistic investigations and cognitive measurements using standardized instruments are useful first step recommendations in patints suspected to present for vascular depression. Blood pressure, metabolic profile, and body mass index should be considered for monitoring throughout the duration of the treatment. At least one years post-symptomatic remission of depression the patient should be treated psychopharmacologically and psychological counselling or psychotherapy should be offered. Selective serotonin reuptake inhibitors are the first line choice in this population due to their favourable metabolic profile, but attention to the pharmacokinetic interaction, especially with anticogulants, should be considered. Monitoring of the depressive symptoms should include structured clinical scales which emphasize psychological symptoms, e.g. Montgomery Asberg Depression Rating Scale or Cornell Scale for Depression in Dementia.

Conclusions

Vascular depression is a specific type of affective disorder and the case management should involve an interdisciplinary team and structured scales for symptoms monitoring.

Introduction

Quality of life is "the perception of an individual's place in the context of the culture and value system in which he lives, in relation to his goals, expectations and norms and concerns".

Objectives

To assess the quality of life of seniors residing in an institution compared to those living in a family environment.

Methods

This is a descriptive cross-sectional study conducted in seniors in retirement homes compared to whose living in a family environment. For evaluation, we use the SF12 quality of life scale. The control population was recruited from the usual meeting places of the elderly people. Inclusion criteria: seniors over 65, oral consent to participate in the study. Exclusion criteria: people with dementia or psychosis. Statistical analysis by : SPSS.

Results

The average age of the 42 people recruited living in a retirement home is 71, while the average age of people living with their families is 70.2. The male sex is predominant in both groups, with 52.1% of men in the target population and 56.6% in the population. Witnesses.The majority of seniors in retirement homes are widowed (45.8%) and divorced, while the most of seniors living with family are married(75%). with a physical score of 34.32 versus 48.68 and a mental score of 42.40 versus 47.02 respectively in both target and control populations.

Conclusions

The retirement home for some of the people in our context it is the last place of life.To provide them with well-being and fulfillment remains is a challenge for society.

Introduction

Electroconvulsive therapy (ECT) remains the most effective treatment, also among elderly populations, wherein pharmacotherapy is poorly tolerated or ineffective. However, the safety of ECT has been consistently called into question, in particular this applies to the elderly population.

Objectives

The aim was to compare the efficacy and safety of ECT in two age groups: before and after 65 years of age.

Methods

The study included 91 patients (62 under, 29 over 65 years old) with major depression treated with formula-based brief pulse ECT between 2015 and 2018. The characteristics of groups are presented in Table 1. The Hamilton Depression Rating Scale (HDRS-21) was used to evaluate clinical efficacy. Cognitive functions were assessed using: Mini Mental State Examination (MMSE), Rey's Learning Test (RAVLT), Trail Making Test, Verbal Fluency Test, Stroop Test.

Results

ECT was more effective in older patients as compared to younger (p<0.001) (Figure 1). No serious adverse events were observed, also among older patients. Increased blood pressure (24% vs 10%) and arrhythmias (20% vs 5%) were more common among older as compared to younger patients (both p<0.05). Surprisingly, memory impairment and disturbances of consciousness did not significantly differ between groups (both p>0.05). ECT treatments did not worsen any of the cognitive function in the elderly population, moreover, there was a greater improvement in MMSE (Figure 2), RAVLT and Stroop tests in older as compared to younger patients (all p<0.05).

Conclusions

ECT in the elderly population is a highly effective and safe method of treating depression.

Introduction

Changing demographics of older population has created substantial unmet need for services addressing immigrant and ethnic/racial minority elders. Workforce shortages can be reduced by task-shifting to community health workers (CHW) who speak the language and share the culture of these elders. Yet, implementation of complex disability interventions developed in clinical trials requires adaptations to be deployed by CHWs under the supervision of licensed clinicians.

Objectives

This article describes the process of adapting and improving adoption of an evidence-based intervention for mental and physical disability prevention in community settings.

Methods

We followed Barrera’s staged model of adaptation that includes periodically assessing needed adaptions. We established additional measures for easier adoption, modifications of fidelity, and barriers and facilitators for intervention maintenance and sustainability. We used feedback from key stakeholders, including 4 clinical supervisors, 18 CHWs and 165 participants, collected at three time points.

Results

Adaptations included systematization of CHW supervision process, increased flexibility in number of sessions offered according to participant’s needs, inclusion of self-care content, modification of materials to better reflect elders’ daily life experiences, and a focus on patient engagement. Areas for further inquiry and adaptation identified in our process included enhancing examples with culturally relevant metaphors, visual aids, and training CHWs in the importance of building trust.

Conclusions

This study contributes to implementation science by identifying key aspects of intervention adaptation that facilitate broader reach of service delivery through service provision by CHWs in community-based settings, with a culturally diverse elder population, and a focus on prevention of both mental and physical disability

Introduction

International Psychogeriatric Association defined the term „Behavioral and psychological symptoms of dementia“ (BPSD) as a heterogeneous range of psychological reactions, psychiatric symptoms, and behaviors occurring in people with dementia of any etiology. [1] BPSD is classified as: (1) disorders of thought content; (2) disorders of perception; (3) disorders of mood; (4) disorders of behavior. [1]

Objectives

To analyze if there are any relationships between the degree of cognitive impairment and severity of BPSD. To analyze the potentials of psychopharmacologic interventions. To determine the most common BPSD.

Methods

38 patients with dementia hospitalized in Psychiatric Hospital Sarajevo were included in the study, eligibility criteria were living with caregivers. Cognitive impairment was evaluated with Mini Mental Status Examination (MMSE) score, severity and number of BPSD were assessed using Neuropsychiatric Inventory (NPI-12). The evaluation was made in the 1st and 4th week, before and after commencing pharmacotherapy

Results

Of 38 patients, 34 met the criteria. Patients with lower MMSE score had higher baseline NPI-12 score (MMSE 0-10, NPI 55; MMSE 11-20, NPI 45; MMSE 20-26, NPI 39). NPI scores decreased significantly from baseline to week 4; 79% in the group with MMSE 0-10; 89 % for patients with MMSE 11-20; 96 % for those with MMSE 21-26. The most common symptom was agitation/aggression, registered in 26 (79 %) patients.

Conclusions

The severity and the number of BPSD, as well as the therapeutical effects, correlate with the degree of cognitive decline. The most common symptoms are disorders of behavior.

Introduction

Diogenes syndrome (DS) is a behavioral disorder which consists of a constellation of self-neglect, squalid living and withdrawn condition, often associated with excessive hoarding to which the individual is unaware.

Objectives

Differentiate DS as a feature of early cognitive impairment keeping in mind the possibility of independent frotal lobe pathology.

Methods

62 years old man admitted with deterioration of mental health. He was living in an uninhabitable home with severe neglect of hygiene. He had previously been eating out of date food. It was reported that his house has lot of hoarding and flies. He had past history of alcohol dependence. On examination pallor and extremely disheveled general appearance were noted.

Results

Investigations showed low hemoglobin (85 g/L) and low RBC count .Brain MRI showed clear evidence of small vessel disease. Addenbrook’s cognitive examination score was 61.In between he was sent to general hospital because of dehydration and UTI.Later he continues to present with repetitive perseverative behaviours and become agitated and irritable by early evening (sun downing phenomenon).Clearly he lacked capacity and insight into his cognitive difficulties. We have started him on olanzapine 2.5 mg BD and trazodone 50 mg BD.As no improvement seen, it was changed to risperidone 1 mg TDS along with ferrous sulphate 200 mg BD.

Conclusions

This case highlights the clinical complexity of DS and the multidimensional approaches which take into consideration the neurobiological vulnerabilities such as frontal lobe damage and psychosocial factors. High degree of suspicion about this possibility in such presentations of early cognitive decline needs to be considered.

Introduction

Reducing polypharmacy and enhancing rational prescribing is a theme of “Realistic Medicine” as detailed by the Chief Medical Officer in Scotland. Older adults are at greater risk of polypharmacy due to multiple medical and psychological co-morbidities.

Objectives

To pilot a specialist older adult joint psychiatric and mental health pharmacist clinic to assess, advise and monitor older adults with polypharmacy and significant mental health diagnoses, and to survey patient satisfaction with the clinic.

Methods

A monthly joint (consultant psychiatrist and specialist pharmacist) clinic was established in a primary care health centre in one Scottish health region (Fife, 365k). Patients had initial assessments and case-note reviews by the psychiatrist with medication reviews by the pharmacist. Patients re-attended 4 weeks later for explanation of the polypharmacy recommendations with implementation by general practitioners supported by their practice pharmacists. All patients had psychiatric follow-up and were issued with satisfaction questionnaires.

Results

Attendance rate of 92% (22/24), 75% female, average age 72 (range 61-80) years. 58% were attending a psychiatric day hospital, 42% had bipolar affective disorder, 50% other mood disorders, 25% alcohol-related conditions, 33% cognitive disorders and one person with dementia and delusional disorder. The average (range) medical co-morbidities were 5.7 (3-9). Patients were prescribed 2.7 (1-5) psychiatric, 8.8 (3-16) physical, 11.4 (5-20) total medications. Recommendations were to reduce/stop 2.8 (0-7) and replace 0.6 (0-2) medications/patient. All patients received additional healthcare advice. The clinic achieved high levels of patient/carer satisfaction ratings.

Conclusions

This combined specialist clinic reduced (25%) polypharmacy in an older adult population with significant mental healthcare issues.

Introduction

Frailty is an important physical co-morbidity of patients with neurocognitive disorders (NCDs). Frailty refers to increased vulnerability due to age-associated declines in physiological reserve and function across multiple organ systems. It is a condition in older people characterized by decreased capacity to cope with stressors. Management of frailty is essential for persons with NCDs.

Objectives

To determine the characteristics of built environment that supports frailty management in patients with NCDs.

Methods

We performed an analysis of professional guidelines for architecture and design of spaces for patients with NCDs living in community or institutionalized settings. Characteristics of built environment that promote frailty management in patients with NCDs were described.

Results

We identified 6 guidelines for architecture and design of spaces for persons with dementia. Architecture plays an important role in both support of autonomy of patients with NCDs and of frailty management. Architecture is both supporting and empowering the frail elderly user with NCDs, promoting orientation and mobility, helping to increase appetite and management of mood and sleep disorders, by using therapeutically the 5 architectural tools: light, shape, color, texture and sound. The therapeutic architecture dedicated to the frail elderly with NCDs focuses on his abilities, uses age-friendly principles and Universal Design. A very important aspect is accessibility.

Conclusions

Built environment can be seen as a promising tool to support frailty management in patients with NCDs. Further studies are necessary to determine specific patterns of environmental designs which promote frailty management in patients with NCDs.

Introduction

The built environment influences physical and mental health, well-being and quality of life. For older adult living in institutional settings, the main mental health problems are: neurocognitive disorders, delirium, depression, anxiety and sleep disorders.

Objectives

The present research aims to demonstrate the importance of the architecture of the nursing homes, reffering to both the principles of interior design and of the outdoor spaces, on the mental health of senior residents.

Methods

The paper investigates interdisciplinarly from the point of view of two professionals, a physician, (geriatrics-gerontology and psychiatry) and an architect, three seniors centers: Ellesmere Nursing Home (2007, UK), Alcacer do Sal Nursing Home (2010, Portugal) and Dublin Respite Center (Ireland, 2007). Case studies are used.

Results

The 3 seniors centers propose different architectures starting from the elderly user. Two of them have a height of GF+2 and one center only GF, all three using low rise. The functional scheme is clear in all 3 examples but the architectural instruments are used differently. Proper use of color for 2 examples are noted, while for one stands out negatively absence of color (white), giving the impression of hospital, although the center has certain architectural qualities. All the 3 centers have landscaped gardens, we notice the therapeutical features.

Conclusions

The built environment can encompass healing capabilities and increase the therapeutic effect of medication and psychological intervention. A built environment based on age-friendly principles positively influences the mental health of seniors.

Introduction

Anxiety is one of the most common symptoms seen in the elderly. Sub-syndromal anxiety is more prevalent than depression and cognitive disorders.

Objectives

The aim of our study was to determine the epidemiological and psychopathological differences of anxiety disorders between the adult population and the elderly population.

Methods

The GRANADEP is a cross-sectional population-based study conducted in the province of Granada. The study included eight hundred and eight ( n=809) subjects from the community environment aged between 18 and 80 years.
Data were collected between Octuber 2011 and September 2012, through face-to face interviews conducted by trained psychologists. A neuropsychological examination and psychiatric evaluation were carried out. The neuropsychological examination was carried out through the SCIP interview ( Screen for Cognitive Impairment in Psychiatry).
For the psychiatric evaluation, the MINI ( Mini International Neuropsychiatric Interview) structured diagnostic interview was used, wich explores the main psychiatric disorders of Axis I of DSM-IV and ICD-10.

Results

The prevalence was higher in the adult population than in the elderly population for all anxiety disorders, except for generalized anxiety disorder. The results were not statistically significant.

Conclusions

Based on the results obtained, it can be concluded tha anxiety disorders in the elderly occur less frequently than in the young adult. These results may be due to several causes. One of them is the association of anxiety in this age group with various medical pathologies. Another is the diversity in clinical expression

Introduction

Depession is a psychiatric syndrome frequently encountered by physicians who treat older adults. Depression is not one disease, but rather the presentation of multiple medical and psychiatric disorders

Objectives

The objective is to compare the prevalence and profile of depressive symptoms between two age groups: 18-65 years and older than 65 years.

Methods

The GRANADEP is a cross-sectional population-based study conducted in the province of Granada. Participated in the study eight hundred and nein(n= 809) subjects of the community medium with ages between 18 and 80 years.
The data collection was carried out between October 2011 and September 2012, through face-to-face interviews conducted by trained psychologists. A neuropsychological examination and a psychiatric evaluation were carried out. The neuropsychological examination was carried out through the SCIP interview ( Screen for Cognitive Impairment in psychiatry. For the psychiatric evaluation, the MINI (Mini Internacional Neuropsychiatric Interview) structured diagnostic interview was used, which explores the main psychiatric disorders of Axis I of DSM-IV an ICD-10.

Results

The prevalence of depressive disorders was higher in the elderly population, the prevalence being equal to the adult population in the case of dysthymia.

Conclusions

From the results obtained we can draw the conclusion that depression is a frequent disorder in those over 65 years. Althogh in our sample we found a higher prevalente of the different forms of major depression in the elderly compared to young adults, the differences did not reach statistical significance

Introduction

Visual hallucinations (VH) are frequent manifestations (60-80%) in patients with Lewy bodies dementia (LBD). However, their characteristics and mechanisms still remain uncertain.

Objectives

This case report aims to describe a case of visual hallucinations in a patient with Lewy bodies dementia and to determine their characteristics and mechanisms.

Methods

A patient case is presented with associated literature review.

Results

Mr RY, aged 69, with no medical history, was referred to our psychiatry department through emergency unit for the installation of VH (figures sitting and standing in the house, people walking in the bedroom, a soldier on a navy ship) since two months. the interview revealed that Mr RY presents fluctuating cognition (attention and memory impairment) and symptoms of parkinsonism (bradykinesia, rest tremor and rigidity) for more than a year. In addition, he was put on neuroleptic treatment by a psychiatrist, but in view of the worsening of the symptomatology, he consulted the emergency services.

Thus, RY was referred to the neurologist for suspicion of the diagnosis of dementia (confirmed by the tests) and the final diagnosis was LBD.

VH in LBD are commonly complex, experienced on a daily basis, lasting minutes, perceived in the central field of view, opaque and static.

VH has been reported to be in relation to the presence of altered GABAergic synapses and a higher density of Lewy bodies in the amygdala, parahippocampal gyrus, the inferior temporal gyrus and the frontal, temporal and parietal cortical areas.

Conclusions

Visual hallucinations mechanisms in LBD remain complex and in a state of discovery.

Introduction

Several studies have shown that the Maintenance Electroconvulsive Therapy (M-ECT) is a safe and effective therapy to treat elderly patients with affective and certain schizophrenia-spectrum disorders. Despite its clinical efficacy, the use of M-ECT is not as extended as it might be expected, which could be a consequence of the need of specific resources for its administration. In fact, little research has been done on the M-ECT´s cost-effectiveness, specially targeting elderly patients.

Objectives

To study the cost-effectiveness of the M-ECT Program in elderly patients with affective and schizophrenia-spectrum disorders.

Methods

Twenty-one patients (Mean age = 76.1, SD = 9.3 years old, Female = 57%) participated in the 18-month M-ECT Program. The sample consisted of 13 patients with depressive disorder, 5 patients with bipolar disorder, 2 patients with schizophrenia and 1 patient with schizoaffective disorder. A mirror-image design was carried out to analyze Pre-Post cost-effectiveness of the Program.

Results

After the M-ECT program, patients showed an improvement on the Clinical Global Impression-Severity score (M _Pre = 2.4, SD = 1.1.; M _Post = 5.3, SD = .6, p < .001). Also, it was shown a decrease in direct costs, involving ECT sessions, hospitalization in the Psychiatric Unit and Emergency rooms, from 473,418 to 223,905 euros.

Conclusions

Besides the clinical improvement, a decrement in direct costs (11,881 euros) is observed in each patient after participating in the 18-month M-ECT. Therefore, the use of the M-ECT should be extended and implemented to treat elderly patients with affective and certain schizophrenia-spectrum disorders.

Introduction

The term lipoma leads us to think that we are facing a neoplasm, but in reality it is an embryological defect with neuropsychiatric clinics in about one third of case.

Objectives

To present a clinical case about an old age patient follow up in the geriatric psychiatry team at Local Health Unit of Baixo Alentejo in Portugal, who describes headaches and depressive symptoms and in whom is found a intracranial lipoma in neuroimaging test.
To analyze the clinical and epidemiological relation among psychiatric, neurological symptoms and intracranial tumors.

Methods

It is presented the clinical case of a 68 years old man who is sent to the geriatric psychiatry team describing depressive symptoms and headaches without previous personal or familiar story in psychiatry and neurology. After neuroimaging test, it is found an small intracranial pericallosal lipoma. It was performed a neurpsycological and genetic tests.
Then, authors present a review of recent scientific literature of the last 5-years about the relation among psychiatric, neurological symptoms and intracranial lipoma. The results were collected from databases (Pubmed, Cochrane and Scopus).

Results

Half of the Intra-cranial lipomas are pericallosal. Clinical manifestations include headache (25%), epilepsy (30%), mental disorders (15%), one third being asymptomatic and normal neurological examination. Indeed, the quadrigeminal lipoma had no clinical expression, being those of this location prone to cause ataxia, hydrocephalus, gaze paralysis or enveloping the trochlear nerve.

Conclusions

It is important to know psychiatric manifestations of neurological syndromes and to do a good diferential diagnoses to better enhance the clinical and therapeutic approach.