Disorders In Old Age Research Articles

Circulating amino acid signature in older people with Parkinson's disease: A metabolic complement to the EXosomes in PArkiNson Disease (EXPAND) study.

Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder in old age. Neurotoxicity of dopaminergic neurons triggered by aggregation of misfolded α-synuclein is a major pathogenic trait of PD. However, growing evidence indicates that peripheral processes, including metabolic changes, may precede and contribute to neurodegeneration. The present study was undertaken to identify a metabolic signature of PD through the quantification of serum amino acids and derivatives. Twenty older adults with PD (11 men and 9 women; mean age 73.1 ± 10.2 years) and 30 age-matched controls (14 men and 16 women; mean age 74.6 ± 4.3 years) were enrolled. A panel of 37 serum amino acids and derivatives was assessed by ultra-performance liquid chromatography/mass spectrometry. Partial least squares - discriminant analysis (PLS-DA) followed by double cross-validation was used to characterize the relationship between amino acid profiles and PD. The optimal complexity of the PLS-DA model was found to be three latent variables. The proportion of correct classifications was 99.3 ± 2.5% for participants with PD and 94.7 ± 3.0% for non-PD controls. Higher levels of β-amino butyric acid, cystine, ornithine, phosphoethanolamine, and proline defined the circulating amino acid profile of older people with PD. Controls were characterized by higher concentrations of 3-methyl-histidine, citrulline, and serine. Our findings indicate the existence of a distinct metabotype in older persons with PD. Future studies will have to establish whether changes in amino acid metabolism are involved in the pathogenesis of PD. This knowledge may be harnessed to identify novel disease biomarkers as well as new targets for interventions.

Association Between Cognitive Impairment and Vitamin B12, Folate, and Homocysteine Status in Elderly Adults: A Retrospective Study.

Cognitive disorders in old age have a serious impact on the health and social aspects of patients and their families. The scope of this paper is to explore the role of cobalamin and folate that has been linked to cognitive decline, not only as a deficiency state depending on malnutrition, but also a determinant in cognitive impairment. A 6-year observational, retrospective study was conducted by collecting the routine blood analyses and cognitive screening scores of patients aged 60 years or older, followed at our Centre for the Diagnosis and Treatment of Cognitive Disorders. In a linear regression with a multi-vitamin model, higher folate concentrations were correlated with better cognitive performances through MMSE score, even after correction for sex, age, and years of education (beta = 0.144, p = 0.001). Estimated MMSE marginal means for folate versus homocysteine showed that folate deficiency was associated with worse cognitive performances, with a more severe cognitive impairment when hyperhomocysteinemia was present. The assessment of B-vitamin status among elderly adults can contribute to an economic and practical approach to the prevention and management of cognitive decline. Future studies focused to define optimal vitamin status are warranted.

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project)

BackgroundDepression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates.MethodsThe aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design.DiscussionOur main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression.Trial registrationDRKS, DRKS00015686, Oct. 10, 2018.

Lifespan Intellectual Factors, Genetic Susceptibility, and Cognitive Phenotypes in Aging: Implications for Interventions

Along with rapid global population aging, the age-related cognitive disorders such as mild cognitive impairment (MCI) and dementia have posed a serious threat to public health, health care system, and sustainable economic and societal development of all countries. In this narrative review, we seek to summarize the major epidemiological studies from the life-course perspective that investigate the influence of genetic susceptibility [e.g., apolipoprotein (APOE) ε4 allele] and intellectual or psychosocial factors (e.g., educational attainments and leisure activities) as well as their interactions on cognitive phenotypes in aging. Numerous population-based studies have suggested that early-life educational attainments and socioeconomic status, midlife work complexity and social engagements, late-life leisure activities (social, physical, and mentally-stimulating activities), certain personality traits (e.g., high neuroticism and low conscientiousness), and depression significantly affect late-life cognitive phenotypes. Furthermore, certain intellectual or psychosocial factors (e.g., leisure activities and depression) may interact with genetic susceptibility (e.g., APOE ε4 allele) to affect the phenotypes of cognitive aging such that risk or beneficial effects of these factors on cognitive function may vary by carrying the susceptibility genes. Current evidence from the randomized controlled trials that support the cognitive benefits of cognitive training among cognitive healthy older adults remains limited. The cognitive reserve hypothesis has been proposed to partly explain the beneficial effects of lifetime intellectual and psychosocial factors on late-life cognitive function. This implies that, from a life-course perspective, preventive intervention strategies targeting multiple modifiable intellectual and psychosocial factors could interfere with clinical expression of cognitive disorders in old age and delay the onset of dementia syndrome, and thus, may help achieve healthy brain aging.

Sleep disorders and frailty status in older people: a narrative review

The aim of this study is to review the impact of sleep-related disorders on the level of elder frailty, and, conversely, the possible correlation between the level of fragility detected and eventually related poor sleep. A narrative review have been conducted. Comprehensive database searches of MEDLINE, Cochrane, EMBASE, Cinahl were undertaken. Both prospective, cross selectional and retrospective observational cohort studies, published from 2000 to 2015, have been included. Appraisal and analysis using the STROBE statement have been undertaken. 8 studies are included. Increasing evidence supports possible bidirectional correlation between elder frailty and poor sleep, excessive daytime sleepiness and decreased sleep efficiency. Potential outcomes relevant to these sleep disorders in old age include mortality, depression and altered functional autonomy. Interventions on the circadian rhythm could have significant clinical implications in the frail elderly. The nursing interest should be geared to the use of validated tools, in order to detect the first signs of any sleeping disorder, in order to postpone or overcome the outcomes derived. The planning of stimulating activities, to facilitate moments of aggregation, would only increase the desire of belonging, as continuous cognitive stimulation.

Outcomes of Implementation of Sacral Nerve Stimulation in Incontinent Patients in Shiraz.

Background:Fecal incontinence is a common disorder in old age; however, it may not threaten life, but it can cause morbidity and many problems. Sacral nerve stimulation (SNS) is a minimally invasive surgical procedure performed by chronic electrical stimulation of the nerves in the sacral plexus through a lead implanted at the S3 foramen. This study aimed to evaluate the outcomes of SNS in Shiraz.Materials and Methods:Data from patients who underwent implantation of an SNS device from 2012 to 2018 were reviewed in Shiraz. Thirty patients who had incontinence were evaluated by a committee. Pre- and postoperative assessments of the severity of incontinence were performed using Wexner Incontinence Score. Statistical analysis was performed using paired t-test.Results:Twenty-seven patients proceeded to insertion in the temporary SNS, and of these, 16 were elected to have a permanent SNS. Finally, seven patients were satisfied with their treatment. There was a significant reduction in the pre- and post-SNS Wexner Incontinence Scores from a median of 15–10, respectively (P < 0.05).Conclusion:In our study, 16 patients underwent SNS protocol, and 43.7% of them showed a good response and recovered. It is recommended as a method for the treatment of fecal incontinence. Permanent SNS is effective, showing a significant improvement in fecal incontinence scores.

Non-delusional hypochondriac disorders in old age

This review aims to present main concepts of hypochondria and 'hypochondriac mood' in old age. Attention is paid to historical and modern positions of old age hypochondria as a meta-syndromic pathology and as an independent mental disorder. Relationships of hypochondriac manifestations with affective variations and anxiety disorders, as well as somatic diseases, organic degenerative brain diseases and vascular disorders are discussed.

Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life.

The peripheral hearing alterations and central auditory processing disorder (CAPD) associated with age-related hearing loss (ARHL), may impact cognitive disorders in older age. In older age, ARHL is also a significant marker for frailty, another age-related multidimensional clinical condition with a nonspecific state of vulnerability, reduced multisystem physiological reserve, and decreased resistance to different stressors (i.e. sensorial impairments, psychosocial stress, diseases, injuries). The multidimensional nature of frailty required an approach based on different pathogeneses because this clinical condition may include sensorial, physical, social, nutritional, cognitive, and psychological phenotypes. In the present narrative review, the cumulative epidemiological evidence coming from several longitudinal population-based studies, suggested convincing links between peripheral ARHL and incident cognitive decline and dementia. Moreover, a few longitudinal case-control and population-based studies also suggested that age-related CAPD in ARHL, may be central in determining an increased risk of incident cognitive decline, dementia, and Alzheimer’s disease (AD). Cumulative meta-analytic evidence confirmed cross-sectional and longitudinal association of both peripheral ARHL and age-related CAPD with different domains of cognitive functions, mild cognitive impairment, and dementia, while the association with dementia subtypes such as AD and vascular dementia remained unclear. However, ARHL may represent a modifiable condition and a possible target for secondary prevention of cognitive impairment in older age, social isolation, late-life depression, and frailty. Further research is required to determine whether broader hearing rehabilitative interventions including coordinated counseling and environmental accommodations could delay or halt cognitive and global decline in the oldest old with both ARHL and dementia.

Early onset substance abuse disorders and addictive diseases in old age

During the past 20 years substance-related and addictive disorders in old age have markedly increased and this increase is going to continue. It is quite common to make adistinction between early onset (EO) and late onset (LO) of these disorders. EO-addicts are in a more disadvantageous position due to constitutional and psychosocial burdens and the cumulating harmful medical, mental and social consequences of addiction place them at a further disadvantage during the course of the disorder. In old age they are at a disadvantage compared to others of the same age with LO addiction problems because of more and more severe chronic medical conditions, psychiatric comorbidity, less personal and social resources, dysfunctional coping style, and social problems. They present with lower treatment adherence and the treatment is difficult due to the combination of typical addictive behavior, psychiatric comorbidity, somatic diseases and in many cases also cognitive impairment. Treatment goals must be mostly individually defined and abstinence is rarely arealistic goal. Even the treatment has to be carried out mostly individually and often unconventionally. This article gives a review of the characteristic features of the course, presentation and adverse consequences of addictive disorders in EO addicts who have reached old age. The article covers alcohol, prescription drugs, illicit drugs and smoking as well as behavioral addictions.

Attitude toward own aging as a risk factor for cognitive disorder in old age: 12-year evidence from the ILSE study.

Previous research has demonstrated the harmful impact of subjective aging processes (e.g., negative age self-stereotyping) on normal cognitive aging in different domains of cognitive functioning, such as memory, executive function, and fluid abilities. Recently, subjective aging has also been linked to important biomarkers of Alzheimer's disease (AD) and dementia-related outcomes, indicating associations with pathological cognitive aging. With data from the Interdisciplinary Longitudinal Study of Adult Development and Aging (ILSE), the present study extends this research by examining the long-term effect of attitude toward own aging (ATOA) on expert-based clinical diagnosis of mild cognitive impairment (MCI) and AD in old age. In the study, 260 initially cognitively healthy participants with a mean age of 62.5 years were followed for 12 years. In the course of the study, 103 participants developed MCI and 14 received diagnosis of AD. Logistic regression models showed that baseline ATOA predicted future clinical diagnoses of MCI and AD 12 years later, while controlling for sociodemographic, genetic, and health variables. Although theoretically suggested, evidence for a mediating role of leisure-activity level and control beliefs was scarce. Our findings add to the emerging literature supporting negative views of aging as a risk factor for cognitive disorder in old age. (PsycINFO Database Record

PATTERN AND DETERMINANTS OF PSYCHOGERIATRIC DISORDERS AMONG THE ATTENDEES OF OLD AGE PSYCHIATRIC UNIT, BAGHDAD, IRAQ

Background: Mental disorders in old age are frequent. Objective: To determine the diagnostic pattern of mental disorders in elderly patients aged ≥ 60 years, attending the Old Age Psychiatry Unit, Ibn-Rushed Psychiatric Teaching Hospital, Baghdad, Iraq. Methods: A retrospective study to all attendees to the Old Age Psychiatry Unit between January 2009 and November 2011 was carried out. Data collected included diagnoses, comorbid disorders, treatment received, and socio demographic characteristics. Results: Analysis of 907 patients was done; the mean age 68 ± 6.3 years, 67.5% age range 60 – 69 years, 70% married, 50% without income (unemployed and housewives), 52% illiterate, and 98.5% live with their families. Depression was 46.9%, schizophrenia 23.2%, and 20.7% dementia. 48% of clients had comorbid illness. All patients had at least one pharmacological medication. Diagnoses high statistical significant association with gender (P=0.000), marital status (P=0.001), occupation (P=0.000), and education level (P=0.000). Conclusion: Mental disorders in old age are frequent. Many old age people were with limited access to mental health services. Mental health services must be designed to meet the needs of older people at all points of the mental health continuum. Keywords: Pattern, determinants, elderly, psychiatry, Iraq Citation: Al Abbudi SJR, Ezzat KI. Pattern and determinants of psychogeriatric disorders among the attendees of Old Age Psychiatric Unit, Baghdad, Iraq. Iraqi JMS. 2018; Vol. 16(1): 22-29. doi: 10.22578/IJMS.16.1.5

The Elderly and the City: Lack of Knowledge on Violence Perception and Consequences on Daily Life.

Introduction:Two main demographic phenomena have substantially changed the condition of elderly: the growth of the urban population and the increase in longevity.Objective:The aim of the present review is to investigate how the elderly living in the cities perceive the sense of insecurity compared to those who reside in rural areas, and their Quality of Life (QoL).Method:Studies published from January 2011 to August 2017 were identified on Google and PubMed combining the following terms: “elderly urban/rural QoL” or “old age urban/rural QoL”.Results:We found 18 different papers published. However, there was only one study on how the elderly perceive the violence in the city. Studies on quality of life were not univocal. Studies on depressive disorders in old age were most homogeneous showing a condition worsening in the cities. A study on the perception of violence in US showed in residents of cities and neighborhoods with the entertainment arena and casinos an increase of criminality perception. In contrast, the crime decreased in both above-mentioned neighborhoods.Conclusion:The condition of elderly in the cities is changed considerably in the recent years. It is estimated that this trend will increase in the coming years. We do not know how older people are experiencing these changes and how they perceive the persistence of violence in the cities. Future researches must satisfy this need by addressing the issue with appropriate methodological tools. This is a public health priority.

A qualitative study on older primary care patients\u2019 perspectives on depression and its treatments - potential barriers to and opportunities for managing depression

BackgroundDepression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare.MethodsQualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis.ResultsThe study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression.ConclusionsThis study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder.

Sensory impairments and cognitive disorders in older age

Age-related and neuropathological changes in the olfactory, visual, auditory, and motor systems suggesting that sensory and motor changes may precede the cognitive symptoms of Alzheimer’s disease (AD) by several years and may signify increase the risk of developing AD. In particular, peripheral age-related hearing impairment and social isolation have been identified as potentially modifiable dementia risk factors. The impact of age-related hearing and vision impairments on cognition appeared to be especially important among the oldest old suggesting a strong link of these connections with frailty, a critical intermediate status of the aging process at higher risk for negative health-related outcomes. The link among age-related hearing and vision impairments and cognition suggested the potential for correcting hearing and vision losses so that older subjects can function better cognitively with improved social involvement, quality of life, and lifetime cognitive health.

Anxiety Disorders in Old Age: Psychiatric Comorbidities, Quality of Life, and Prevalence According to Age, Gender, and Country

Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life. The study used a cross-sectional multicenter survey. The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel. Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+). The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder. The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.

Swallowing disturbances and psychiatric profile in older adults: The GreatAGE study

IntroductionSeveral studies have reported controversial links between swallowing disturbances (SD) and psychiatric disorders in older age. The available data on the epidemiology of SD in the general population are scarce and often conflicting, because of numerous methodological factors source of possible counfounders.ObjectivesWe aimed to screen the presence of psychiatric and cognitive disorders associated with SD in a random sampling of the general population ≥ 65.MethodsA sample of 1127 elderly individuals collected in a population-based study (GreatAGE) in Castellana Grotte (53,50% males, mean age 74.1 ± 6.3 years), South-East Italy, were mailed a validated self-report questionnaire to assess SD (Eating Assessment Tool-EAT10). Psychiatric disorders and symptoms [assessed with Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, Geriatric Depression Scale-30 (GDS-30) and Symptom Checklist Revised-90 (SCL-90R)], cognitive functions were assessed with a comprehensive neuropsychological battery, neurological exam, and demographics were compared in participants with and without SD using t-tests and Mann–Whitney U-test.ResultsThe prevalence rates of SD amounted at 5.97%. Psychiatric diagnosis (24.22% of the sample) was statistically significant associated with SD (EAT ≥ 3, P = 0.038), and a trend was found for major depressive disorder and generalized anxiety disorder. Among SCL-90R domains, only anxiety showed a significant association with EAT ≥ 3 (P = 0.006). GDS-30 score was found to be higher in subjects with SD (P = 0.008). Cognitive functions did not differ between the two groups except for an increasing trend for Clinical Dementia Rating Scale in EAT ≥ 3 (P = 0.058).ConclusionsThese preliminary results showed an association between SD in older age and late-life major depression and anxiety disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool.

BackgroundAssessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.Methods and findingsThe construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.ConclusionsThis evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

Cardiovascular risk factors and glucose tolerance in midlife and risk of cognitive disorders in old age up to a 49-year follow-up of the Helsinki businessmen study

Purpose: The purpose of this study is to compare midlife predictors of old age dementia with or without concomitant atherosclerotic cardiovascular disease (ASCVD).Design: In the Helsinki Businessmen Study (men born in 1919–1934, n = 3309), death certificates (n = 1885) during up to 49-year follow-up (through 31 December 2013) were screened for dementia (n = 365) and ASCVD, and categorized as (1) AD without ASCVD (“pure” AD, n = 93), (2) AD + ASCVD (n = 126), (3) vascular dementia (VD, n = 82), (4) other or undefined etiology (n = 64). Using Cox analyses, death without dementia and dementia types were compared for the prediction by midlife ASCVD risk factors. Men without diagnosed dementia during follow-up were used as reference.Results: ASCVD risk factors predicted death without dementia during follow-up. Midlife cholesterol was higher in AD + ASCVD and VD as compared with men surviving to old age without known dementia. None of the midlife factors including cholesterol and glucose tolerance predicted pure AD, but midlife cholesterol predicted AD + ASCVD, both as a continuous (hazard ratio [HR] per SD 1.24, 95% CI, 1.04–1.47), and dichotomous variable (cutpoint 6.5 mmol/L; HR 1.67, 95% CI, 1.16–2.40).Conclusion: Midlife cholesterol predicted dementia with vascular features, but midlife vascular risk factors and glucose intolerance were not related to pure Alzheimer disease without concomitant atherosclerotic cardiovascular disease.Key messagesHeterogenous etiology of dementia, which in old age is usually a clinical diagnosis, may confound the role of long-term risk factors.In a longitudinal study with autopsy records, midlife cholesterol predicted dementia with features of atherosclerotic cardiovascular disease but not “pure“ Alzheimer diseaseGlucose tolerance in midlife was not associated with pure Alzheimer’s disease.

Diagnostics and multimodal treatment of depression in old age : New developments

Depressive disorders in elderly persons are frequent and can either first be manifested at a younger age and show a recurrent pattern during later life (ICD10, F33.*) or have an onset beyond 60years, which is termed late onset depression (LOD). This LOD has a higher tendency to chronification and implies an increased risk of progression, especially to vascular dementia. The multifactorial genesis of depression in old age includes psychosocial, vascular and metabolic factors and requires multimodal therapy modules at the biological and psychosocial level, which is now increasingly being empirically proven. Depressive disorders with executive and cognitive deficits have to be considered adefined entity with respect to prognosis and treatment. As afirst step of treatment watchful waiting is appropriate, especially in depressive adjustment disorders triggered by acute psychosocial stressors (e.g. loss of relatives and conflicts). After 2-4weeks pharmacological antidepressant therapy should be initiated, at least in amoderate depressive episode. Furthermore, the revised national guidelines for depressive disorders also explicitly recommend psychotherapy as an alternative or supplement to pharmacotherapy in the elderly. Several forms of psychotherapy are emphasized: cognitive behavioral therapy, interpersonal therapy and in particular problem solving, as this is aform of treatment that can also be carried out by other professional groups, thus alleviating the treatment gap caused by the lack of psychotherapists. In summary, adepressive disorder in old age should not induce therapeutic nihilism: after stepped diagnostic assessments, multimodal therapies are individually adapted to the physical, cognitive and social resources of the patients.

Особенности прагматической функции речи в позднем возрасте: принципы диагностики и пути восстановления

The article shows that taking into account the change in the pragmatic function of the language at a later age can not only improve the health conserve behavior and improve treatment adherence, but also plays an important role in the recognition of qualifications and effective treatment of mental, cognitive, and neurodegenerative disorders. Based on the analysis of foreign studies systematic techniques are often used for the diagnosis of pragmatic competence and presents step-by-step algorithm for estimating of socio-cognitive disorders in old age. It is shown that in normal aging we can observe selective, reversible changes in the verbal, para - and extralinguistic components of the pragmatic functions of language, and metapragmatic abilities. Systematic General symptoms of deficiency in pragmatic functions of language are neatly systematized. The analysis of the causes of changes in pragmatic competence at an elderly age was carried out with the help of deficit and resource approaches. We presented a range of pharmacological and non-pharmacological interventions aimed at improving the pragmatic function of language in old age.