ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review will provide an update on the role that alcohol plays in the presentation and management of mental disorders in the elderly.Recent findingsRecent community surveys from several countries have explored the relationship between the level of alcohol consumption or alcohol use disorder and the concurrence of mental health disorders in the elderly. A consistent finding is that mild to moderate alcohol consumption is protective against the development of dementia in the elderly. In other studies very heavy drinking or alcohol use disorders are associated with functional impairment, depression and suicide. Recent reviews indicate that the relationship between levels of alcohol consumption and problems such as falls and cognitive deterioration remains controversial. The elderly appear to respond to relapse prevention strategies and pharmacotherapy equally as well as those in the younger age groups.SummaryWhile mild to moderate levels of alcohol consumption have a protective effect on the occurrence of dementia, the concurrence of alcohol use disorders, depression and suicide in the elderly has important implications for prevention and treatment. Pharmacotherapy and relapse prevention strategies should be made available to the elderly with alcohol use disorders.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewCerebrovascular lesions may produce cognitive deficits ranging from subtle impairment of language to full-blown dementia. This article reviews recent research into the prevalence, clinical aspects, and mechanism of post-stroke cognitive deficits.Recent findingsAbout half of those individuals with vascular cognitive impairment may develop dementia within the 5-year period after the stroke. Dementia solely due to cerebrovascular lesions is found only in 3-4% of patients with clinical dementia, and most patients meeting clinical criteria for vascular dementia also show the neuropathology of Alzheimer's disease. Microvascular lesions may play an important role in mixed dementia by lowering the threshold at which Alzheimer's disease neuropathology becomes clinically manifest. Whereas cerebral ischemia may increase amyloidogenesis in hypoperfused areas of the brain, the overexpression of amyloid may produce further vascular pathology and ischemia.SummaryThe review highlights the importance of cerebrovascular damage in the mechanism of cognitive impairment and overt dementia, and suggests the adoption of a classification of cerebrovascular cognitive impairment based on the relationship between the site of the brain lesion and the pattern and progression of cognitive deficits.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewDiseases of the basal ganglia are common in the elderly. Although motor disturbances are usually the presenting symptom, neuropsychiatric symptoms are frequent and have important clinical consequences. This paper reviews recent studies of hallucinations, depression and dementia in Parkinson's disease and related disorders.Recent findingsDementia eventually develops in the majority of Parkinson's disease patients, and is associated with a twofold increase in mortality. Studies comparing clinical and pathological features of Parkinson's disease and dementia with Lewy bodies suggest that Parkinson's disease patients with dementia are indistinguishable from patients diagnosed with dementia with Lewy bodies, except for the sequence of symptom onset, suggesting a similar biological abnormality in the two syndromes. Visual hallucinations in Parkinson's disease are associated with impaired object recognition, recognition memory and reality monitoring, and with rapid-eye-movement sleep disturbances. One trial showed an improvement of cognition in Parkinson's disease with dementia on donepezil, and open-label studies suggested that cholinergic drugs may also improve hallucinations. A negative study with sertraline supported other research, indicating that serotonergic disturbances may not be the key aetiological factor of depression in Parkinson's disease. Studies of neuropsychiatric features in patients with atypical parkinsonian disorders suggest that these common symptoms may provide diagnostic information.SummaryEmerging evidence demonstrates a high prevalence and important clinical consequences of neuropsychiatric symptoms in elderly patients with basal ganglia disorders, particularly Parkinson's disease. Such findings provide clues to the underlying pathophysiology and potential treatment of these features. Large-scale clinical trials are warranted for the treatment of dementia and depression in Parkinson's disease.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis article reviews findings regarding the health impact of being an informal (i.e. unpaid) caregiver, outlines a potential physiological pathway through which health may be affected, and summarizes interventions designed to reduce the negative health consequences for such caregivers.Recent findingsCaregivers are at increased risk of depression and feelings of burden, have increased risk of high blood pressure and associated physiological indicators associated with this risk, and ultimately are at increased risk of mortality. Disturbances in the sympathetic nervous system may mediate these effects. Psychosocial, respite-based, and other interventions designed to alleviate caregiver stress have primarily focused on psychological outcomes. These studies have been generally positive; however, effect sizes have been modest, and physical outcomes have been largely ignored.SummaryCaregiving is associated with a range of negative emotional and physical outcomes that result in excess morbidity and mortality. Interventions designed to reduce these negative outcomes have been moderately successful. More specific information is required regarding which caregivers under what circumstances benefit from such interventions.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of the reviewRecent progress in the field of vascular dementia is summarized, including a conceptual redefinition, and advances in the understanding of its pathogenesis, diagnosis, treatment and prevention.Recent findingsVascular dementia is second only to Alzheimer's disease in frequency, according to population-based epidemiological studies, including neuropathological data. Projections based on growth of the elderly population and a rising incidence of ischemic heart disease and stroke suggest that vascular dementia may become the commonest form of dementia. Vascular factors in Alzheimer's disease continue to be an area of major research effort. Lacunes carry a poor long-term prognosis; silent lesions found on magnetic resonance imaging more than double the risk of dementia. Common manifestations of vascular dementia include executive dysfunction, abnormal gait, apathy and depression (‘vascular depression’). A new therapeutic indication of cholinesterase inhibitors may result from positive results of phase III trials in vascular dementia. Diagnosis of vascular cognitive impairment should lead to prevention of dementia by appropriate control of risk factors and vascular brain burden.SummaryVascular dementia is an important and often overlooked form of dementia in the elderly. Cholinergic treatment may improve prognosis. Primary prevention of vascular dementia and Alzheimer's disease appears to depend on early identification and appropriate control of vascular risk factors. Secondary prevention, after clinical stroke or silent lacunes, must include energetic therapy to prevent stroke recurrence.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review is a comprehensive summary of recent work in the field of neuropsychology that is relevant to geriatric psychiatry.Recent findingsRecent research identified neuropsychological predictors of functioning in geriatric samples, elucidated the neuropathology and neuropsychology of geriatric depression, further clarified the association between dementia and depression, contributed to advancements in the early detection and diagnosis of dementia, investigated emotion processing in aging, and adapted neuropsychological tests for severely impaired samples. There were encouraging trends indicating that neuropsychological investigations are becoming increasingly culturally diverse.SummaryRecent research in neuropsychology will facilitate both the prediction of important clinical outcomes in geriatric samples and accurate differential diagnosis of psychiatric patients.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review considers the evidence for the contribution of hyperhomocysteinemia to cognitive impairment, the dementias and Parkinson's disease, focusing on published literature from April 2002 to April 2003.Recent findingsHomocysteine is a sulphur-containing amino acid that is involved in cycles related to one-carbon metabolism within the body, and elevations in its level can result from multiple aspects of these cycles. Elevated homocysteine impairs methylation, crucial to DNA synthesis and repair, is toxic to the vascular system, is cytotoxic and is directly neurotoxic. These effects interact with ageing-related pathology and toxins to augment neurodegenerative processes. Controversies remain in the ascertainment of homocysteine levels and in the salience of its contribution to cognitive impairment, the dementias and Parkinson's disease. However, cross-sectional studies generally agree homocysteine levels greater than 14 μmol/l are associated with increased risk of cognitive impairment. Hyperhomocysteinemia is associated with an increased risk of cognitive impairment after stroke, and is a contributory factor to the cognitive deficits of vascular dementia and AD. Elevated homocysteine levels have been demonstrated in L-dopa treated Parkinson's disease patients in associated with vascular risk. Hyperhomocysteinemia is also associated with increased brain atrophy in healthy elderly.SummaryThere is an increasingly solid case for the association between hyperhomocysteinemia, as a marker of disturbed one-carbon metabolism, and cognitive impairment. The findings from preliminary investigations of vitamin supplementation to lower homocysteine in candidate conditions such as stroke and dementia are encouraging, but evidence is needed from large randomized controlled trials before supplementation can be advocated.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe article reviews publications on the history of psychiatric patients and symptoms between April 2002 and May 2003.Recent findingsFindings are grouped under the following headings: concepts and general themes; countries and institutions; nursing; clinicians and therapies; and technology.SummaryThe history of psychiatry is a rapidly expanding field of investigation. This is reflected by the rich diversity of subjects, methodologies and academic background of researchers in this field. This review highlights some of the newer themes and the ways in which interdisciplinary research leads to new approaches. Several of the most important publications in the period under discussion are focused on the nature and boundaries of psychiatry and on the identity of the psychiatrist as a professional. More than in previous periods the moral and politicial dimensions of this issue were the subject of discussion.

ISSN:0951-7367    

出版商:OVID    

年代:2003

数据来源: OVID