Current Psychopharmacology - Volume 3, Issue 1, 2014

In the past four decades there have been numerous advances in various branches of science in general and medicine in particular that had led to increasing elderly population. Depression, cognitive impairment and dementia are among the most important mental health problems in elderly people. Both conditions have severe consequences for the patients, including diminished quality of life, functional decline, increased use of services, and high mortality. Furthermore, these diseases impact health of caregivers. The World Health Organization considers the care of these pathologies a risk factor for the development of mental disorders and burden. The aim of this thematic issue is to describe different pathologies present in elderly patients and develop these topics with an interdisciplinary approach. This thematic issue focuses on different aspects of psychogeriatrics such as onset age and clinical heterogeneity of dementias. Frontotemporal dementia (FTD) is the main differential diagnosis with early stages of Alzheimer’s disease (AD). Usually, differential diagnosis between a first depressive episode and the beginning of an early degenerative dementia with mood disorders, either AD or FTD, can be difficult. This topic is addressed in the research article of Serrano and colleagues [1], were they conclude that onset age of cognitive and/or behavioral impairment may be one of the variables influencing the clinical heterogeneity of dementias. Many of the young-onset dementias may be potentially reversible so its early identification and pathophysiology understand increase pharmacological intervention opportunities of halting the cascade of events that lead inexorably to dementia. Moreover, cognitive impairment underpins some of the clinical spectrum of the cerebrovascular disease (CVD), as well as contributes to the patient´s impaired social and behavioral functioning, and the higher mortality. Despite a general emphasis in the international literature on the primary and secondary prevention of CVD to avoid vascular dementia or their combination with Alzheimer’s disease, the controversy concerning their diagnostic criteria and optimal treatment is still open. Given its growing burden, the prevention and treatment of CVD and the spectrum of VCI are critical priorities for clinical care and research. Russo and Allegri [2] performed a selective review about the current status of vascular dementia, mild cognitive impairment due to CVD, and mixed dementia, with special emphasis on available evidence of pharmacological strategies for treatment and prevention from controlled clinical trials. Late life depression is a prevalent disorder that affects elderly population and it is frequently associated to cognitive impairment. This disease is sub diagnosed due to great variability in the sample involved, the definition of depression, the methodology used, and the experience of the evaluator. Dillon, Rodriguez and Taragano, in their review [3], analyze the different subtypes of late life depression, the diagnostic methods that can be performed and the pharmacological treatment of this disease. Elderly patients who suffer degenerative diseases generally need caregiving. Considering that the task of caregiving, this is generally carried out by a family member who becomes an easy target for diseases, especially for being subjected to a stressing process. Tartaglini and colleagues [4] studied whether the older caregivers’ health suffers affections if compared with the health conditions of those who do not take care of family members. Environmental complexity states that those individuals involved in activities that require greater cognitive demands keep their cognitive abilities undamaged despite the passing of time. Feldberg, Stefani and Allegri [5] will demonstrate how environmental complexity and the importance of engaging in recreational activities influence individuals’ lives and their cognitive healthy aging. Finally, in relation to pharmacological treatment in dementia, in the last decade, various medications have been used for the treatment of cognitive symptoms in Dementia. Many of them have few scientific evidence of their effectiveness. Pérez Leguizamón and colleagues [6] review and update the current status of the pharmacological treatment of cognitive symptoms in Alzheimer´s Disease, one of the most prevalent and disabling diseases in the elderly.

Frontotemporal dementia (FTD) is the main differential diagnosis with early stages of Alzheimer’s disease (AD). Usually, differential diagnosis between a first depressive episode and the beginning of an early degenerative dementia with mood disorders, either AD or FTD, can be difficult. Objective: To evaluate the clinical characteristics of patients with senile and presenile onset dementia, to compare their neuropsychiatric and neuropsychological profiles according to onset age and to provide clinical approach. Methods: A two year prospective-retrospective study was conducted. All patients were evaluated with a complete neuropsychiatric and neuropsychological battery, laboratory tests and neuroimaging. Healthy control subjects were also studied. Results: Included 366 subjects were divided into over or under 65 years old, and then matched for educational level. AD was the most common cause of dementia in subjects over 65 years of age, followed by depression and FTD. Subjects younger than 65 years old, showed higher prevalence of depression followed by FTD, AD, and finally primary progressive aphasia (PPA). At younger ages, the highest severity of cognitive impairment, behavioral disorder and major depression were observed. Conclusion: Onset age of cognitive and/or behavioral impairment may be one of the variables influencing the clinical heterogeneity of dementias. Many of the young-onset dementias may be potentially reversible so, its early identification and pathophysiology understand, increase pharmacological intervention opportunities of halting the cascade of events that lead inexorably to dementia. In the new era of biomarkers, their help in identifying each clinical phenotype could encourage their best use in clinical practice and help selecting more accurate pharmacological treatment.

Cognitive impairment underpins some of the clinical spectrum of the cerebrovascular disease (CVD), as well as contributes to the patient´s impaired social and behavioral functioning, and the higher mortality. When cognitive function is affected by CVD, we name it as vascular cognitive impairment (VCI). The cognitive impairment may be mild, or may be severe enough to warrant a diagnosis of dementia. Pure vascular dementia is not common. Because of that the concept of mixed dementia has been included in the clinical diagnosis of VCI. Despite a general emphasis in the international literature on the primary and secondary prevention of CVD to avoid vascular dementia or their combination with Alzheimer’s disease, the controversy concerning their diagnostic criteria and optimal treatment is still open. Given its growing burden, the prevention and treatment of CVD and the spectrum of VCI are critical priorities for clinical care and research. We performed a selective review about the current status of vascular dementia, mild cognitive impairment due to CVD, and mixed dementia, with special emphasis on available evidence of pharmacological strategies for treatment and prevention from controlled clinical trials.

Late life depression is a prevalent disorder that affects elderly population. However, it is frequently sub diagnosed due to great variability in the sample involved, the definition of depression, the methodology used, and the experience of the evaluator. Different subtypes of geriatric depression exist, each one with its own clinical characteristics. Depressive symptoms often are accompanied by cognitive impairment. Various diagnostic studies must be done to evaluate late life depression, such as depression scales, neuropsychological test, laboratory analyses and Neuroimages. As regards to treatment, antidepressants are always the first line option, especially IRSS due to its effectiveness and low rates of adverse events. Antipsychotics may provide benefit for agitated, psychotic, or resistant MDD in the elderly. Mood stabilizers are useful in bipolar depression such as lamotrigine, lithium and divalproate. This review aims to define the different subtypes of geriatric depression, describe diagnostic methods and revise recent data about pharmacological treatment.

As worldwide population ages, an increase of inhabitants who suffer neurodegenerative diseases can be observed. Considering that the task of caregiving is generally carried out by a family member, he becomes an easy target for diseases, especially for being subjected to a stressing process. This study intends to analyze whether the older caregivers’ health suffers affections if compared with the health conditions of those who do not take care of family members. The present investigation defends the fact that the person who develops the activity of caregiving has high probabilities of developing diseases. An observational, analytical, cross sectional study was made. One hundred and twenty four (124) older adults divided in two groups were cross-examined: 62 interviewees were caregivers of chronic patients and 62 were not. The total amount of candidates was given two questionnaires: one analyzed socio-demographic data and the other one health disturbances. The results showed that 48% of the sample experienced unfavorable changes in their health, and that the condition of being a caregiver somehow predicted the changes (OR 15.) As for the kind of disturbance, it can be said that 85% of the caregivers went through psychical disturbances; however, there were no significant differences found between the selfperception of the caregivers and non-caregivers health conditions. The findings confirm the established hypothesis and coincide with other investigations: the caregiver suffers unfavorable health effects despite the fact that sometimes he is not aware of those negative consequences experienced. Therefore, family caregivers are referred to as “hidden patients.” Health services should promote psycho-educational intervention programs and diagnose for proper pharmacological treatment of depression and anxiety usually with SSRIs according to co-morbid conditions of the patient.

Human beings possess a considerable reserve capacity that allows them to benefit from exposure to highly enriched environments. The hypothesis of environmental complexity states that those individuals involved in activities that require greater cognitive demands keep their cognitive abilities undamaged despite the passing of time. The aim of this review is to present an analysis of the results obtained from empirical research made between 1980 and 2014 in Europe and America, focusing on the impact that cognitive reserve has on older adults. This review will demonstrate how environmental complexity and the importance of engaging in recreational activities influence individuals’ lives and their cognitive healthy aging. Bibliography was obtained systematically, through a defined search strategy of several data bases. Ninety one scientific articles were selected in agreement with the appropriateness they keep with the objective of the present research. In regard to pharmacological treatment, there is little evidence that cholinesterase inhibitor drugs affect progression to dementia or improve cognitive performance of patients with MCI. Complementarily, mixed results have been reported from different research lines that use cognitive training. Besides, there is increasing evidence that consider the role of environment and lifestyle as protective factors for the development of Alzheimer’s disease from MCI. The review sheds some suggestions for future research related to the studied topics and for professional intervention in the area of gerontology.

Dementia is a clinical syndrome that is characterized by impairment of cognitive and functional abilities (daily life activities) as well as by neuropsychiatric symptoms. Cognitive impairment can include impairment of memory, visuospatial functions, language, and executive functions. Many neurodegenerative diseases turn over to dementia, Alzheimer´s Disease being the most frequent of them. Alzheimer´s Disease (AD) affect a large population worldwide. In the last decade, various medications have been used for the treatment of cognitive symptoms in AD. Many of them have few scientific evidence of their effectiveness. The aim of this paper is to review and update the current status of the pharmacological treatment of cognitive symptoms in Alzheimer´s Disease.

Postoperative delirium may occur as a serious complication after orthopedic surgery. In addition, risk factors such as age, mental and organic illnesses may increase the incidence of the aforementioned complication. Delirium has a negative impact on postoperative mobilization and recovery. Furthermore, it may result in longer hospital treatment. This study is a systematic literature review of articles that was conducted through a key word search of PubMed. The review includes: 1) pathogenesis, 2) risk factors in the development of postoperative delirium, and 3) the effective methods and strategies of treatment, especially in relation to patients hospitalized in orthopedics. This systematic review will discuss benzodiazepines and haloperidol, which are used to treat delirium in the prevention and treatment of postoperative delirium. The findings suggest that prevention of postoperative delirium with drugs can be an effective strategy.

Lithium treatment history goes far back before it was thoroughly described in the literature which is now available to us. However, disorders that were initially treated with lithium salts were completely unrelated to psychiatry. The article “Lithium salts in the treatment of psychotic excitement” from 1949 written by John Cade is considered to be the introduction of lithium to modern psychiatric therapy and the beginning of modern clinical psychopharmacology. In the present treatment guidelines for bipolar disorders lithium is recommended as a first-line maintenance therapy. What is worth mentioning is that the number of indications, including major depressive disorder, for instance, is growing. In addition, numerous meta-analyses focused on antisuicidal effect of lithium therapy were also performed. On the basis of the most recent literature available in this paper we presented indications for the preventive use of lithium for such disorders as mania, bipolar disorder as well as the occurrence of depressive episodes in major depressive disorder. It is worth pointing out that some studies indicate lithium to be the only medicine proved to be effective for mood stabilization. Interactions between lithium and other medicines were described in detail. In this paper we also described and discussed possible side effects of lithium therapy, including renal failure, hypothyroidism, hyperparathyroidism, weight gain and teratogenicity.

Tardive dyskinesia (TD) is a debilitating side-effect of antipsychotic treatment associated with reduced compliance and quality of life. TD prevalence is difficult to estimate accurately and is influenced by the increased use of antipsychotic drugs and the aging of the population. We assessed the prevalence, severity and characteristics of TD among schizophrenia patients at a university-affiliated psychiatric center in Israel. One hundred and twenty eight patients with schizophrenia were recruited and underwent demographic and clinical assessments. Subjects who met Schooler-Kane criteria for probable TD were compared to those without TD. Forty five subjects met probable TD criteria (prevalence: 35.2%; 95% CI 26.9% -44.1 %.). Subjects with TD were older and had a longer duration of treatment with antipsychotic medications. Diabetes mellitus, hypertension, head injuries and more severe psychiatric symptomatology did not predict TD. Patients in the TD-group had higher rates of extrapyramidal symptoms (EPS) and were more likely to receive an anticholinergic agent. The type of antipsychotic medication was not found to be associated with TD occurrence. Our findings confirm the established relationships between presence of TD and age, duration of antipsychotics treatment, anticholinergic treatment and the presence of EPS. Furthermore, our data support recent findings indicating that TD is still a prevalent disorder representing an unresolved public health issue.