A functional neuroimaging study of appetite loss in Alzheimer's disease.

Background: Alzheimer's Disease (AD) is frequently associated with changes in appetite. This study investigated the relationship between regional cerebral perfusion and appetite loss in AD.

Methods: 64 patients with possible or probable AD were characterized as being with (n=22) or without (n=44) appetite loss based on the Neuropsychiatric Inventory (NPI) Appetite subscale.

Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine challenge.

Apathy is a common behavioral symptom of Alzheimer's disease (AD), being present in up to 70% of patients. Apathy in AD and non-AD populations has been associated with dysfunction in the dopaminergic brain reward system, suggesting that pharmacotherapeutic targeting of this system may be an effective treatment for apathy in AD. We therefore performed a randomized, double-blind, placebo-controlled crossover trial of methylphenidate in a sample of 13 apathetic AD patients (6 men, 7 women; age mean 77.

Estimation and evidence in forensic anthropology: age-at-death.

A great deal has previously been written about the use of skeletal morphological changes in estimating ages-at-death. This article looks in particular at the pubic symphysis, as it was historically one of the first regions to be described in the literature on age estimation. Despite the lengthy history, the value of the pubic symphysis in estimating ages and in providing evidence for putative identifications remains unclear.

The management of behavioural disturbances in dementia: the role of serotonergic therapies.

The behavioral and psychological signs and symptoms of dementia are common--serious disturbances that affect the quality of life for both patient and caregiver--and can lead to premature institutionalization. Recent research has focused on alterations in central serotonergic dysfunction as an important factor in the etiology of many of these disturbances, though numerous other neurotransmitter systems are also likely to be involved. The pharmacotherapy of behavioral disturbances is reviewed, focusing on serotonergic agents.

The serotonin transporter polymorphisms and major depression following traumatic brain injury.

Objective: The purpose of this study was to examine the role of the serotonin transporter gene polymorphisms on the risk of major depression following traumatic brain injury (TBI).

Methods: Seventy-five patients who had sustained a TBI and who met the Diagnostic and Statistical Manual of Mental Disorders (4th ed) (DSM-IV) criteria for mood disorder due to TBI were compared to 99 controls with TBI but no mood disorder. The severity of depression was rated using the Hamilton Depression Rating Scale (HAMD) for the depressed patients.

Effects of 2-week treatment with temazepam and diphenhydramine in elderly insomniacs: a randomized, placebo-controlled trial.

A randomized, controlled, crossover clinical study compared 14-night treatment with 15 mg temazepam, 50 mg diphenhydramine, and placebo in elderly individuals with insomnia (mean age, 73.9 years; range, 70-89 years). Primary outcome measures were subjective assessments of sleep recorded on sleep diaries.

Neurocognitive profiles in older adults with and without major depression.

Objectives: To delineate the differences between older persons with and without a diagnosis of major depression.

Methods: Participants were recruited from three outpatient clinics serving older patients at St Michael's Hospital. To be included in the study, participants had to speak English and have no evidence of significant sensory deficits that would interfere with neuropsychological testing.

Comorbid depression and anxiety in later life: patterns of association, subjective well-being, and impairment.

Objective: Very little epidemiological work has examined comorbidity between depression and anxiety disorders in community-dwelling older adults, despite the fact these disorders are known to co-occur in younger adults and that this co-occurrence is associated with greater clinical severity. In this study, the authors examine psychiatric comorbidity and associated impairment of four disorders (major depression, panic disorder, social phobia, and agoraphobia) in a community-based sample of adults aged 55 and older.

Setting: Population-based sample of older adults (N=12,792) from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.

Traumatic brain injury, Apolipoprotein E-epsilon4, and cognition in older adults: a two-year longitudinal study.

Patients with mild-to-moderate traumatic brain injury (TBI) (N=69) were compared with age-, gender-, and education-matched healthy control group subjects (N=79) on performance of neuropsychological tests at one and 2 years following injury, and informant-rated functional abilities. All subjects were assessed for the presence of the Apolipoprotein E-epsilon4 (APOE-epsilon4) allele and rated for "mild cognitive impairment" (MCI) or dementia. Traumatic brain injury patients were no different from the comparison group on measures of cognition or functional impairment.

Relationship between cardiopulmonary fitness and depressive symptoms in cardiac rehabilitation patients with coronary artery disease.

Objective: To identify independent predictors of depressive symptoms in a cohort of patients with coronary artery disease entering cardiac rehabilitation.

Design: Cross-sectional cohort study.

Patients And Methods: Consecutive patients entering a cardiac rehabilitation and secondary prevention programme underwent screening for depressive symptoms using the Center for Epidemiological Studies Depression (CES-D) scale and cardiopulmonary fitness testing to quantify peak oxygen consumption.

An open-label study of citalopram for major depression following traumatic brain injury.

Major depression is associated with substantial psychosocial dysfunction and post-concussive symptomatology following traumatic brain injury (TBI). Studies to date of anti-depressant treatment for major depression post-TBI have been limited by small sample size. The goal of the present study is to examine the rates of response and remission associated with citalopram treatment for major depression following traumatic brain injury.

Pharmacologic management of neuropsychiatric symptoms of Alzheimer disease.

Objective: To systematically review published clinical trials of the pharmacotherapy of neuropsychiatric symptoms of Alzheimer disease (AD).

Method: We searched MEDLINE and EMBASE for published English-language medical literature. Our review focused on randomized controlled trials (RCTs) and corresponding metaanalyses.

Trials and tribulations of evidence-based medicine: the case of Alzheimer disease therapeutics.

The practice of EBM has evolved since it was first defined. Even the most ardent EBM proponents have recognized the need to modify the EBM approach and now include elements such as the patient's clinical state and circumstances, the patient's preferences and actions, and the physician's clinical expertise, as well as the research evidence. Part of the clinical expertise required in this model is the ability to interpret and apply the research evidence.

Serotonin-1A receptors in frontotemporal dementia compared with controls.

Using PET neuroimaging, we demonstrated that four frontotemporal lobar dementia (FTLD) patients had significantly decreased serotonin 5-HT(1A) binding potential (BP) compared with controls in all 10 brain regions examined. These pilot data suggest that profound 5-HT(1A) BP losses may be present and contribute to symptomatology and treatment response in FTLD.

Clinical practice guidelines for severe Alzheimer's disease.

Background: Although severe Alzheimer's disease (AD) represents a prevalent, serious, and costly public health problem, few practice guidelines exist to help physicians manage this disorder.

Methods: A search of English language medical databases was performed from 1996 to the present for articles pertaining to the management of AD. The focus of this review was on studies that included patients with severe disease.

A population-based study of cholinesterase inhibitor use for dementia.

Objectives: To examine current utilization patterns of cholinesterase inhibitor (ChEI) therapy for dementia to determine treatment duration, use in long-term care, how often patients receive these drugs until death, and frequency of switching between the available ChEIs.

Design: A population-based healthcare administrative database study.

Setting: Patients aged 66 and older from the Canadian province of Ontario who received a new prescription for a ChEI between June 1, 2000, and December 31, 2002.

SLP-65 signal transduction requires Src homology 2 domain-mediated membrane anchoring and a kinase-independent adaptor function of Syk.

The family of SLPs (Src homology 2 domain-containing leukocyte adaptor proteins) are cytoplasmic signal effectors of lymphocyte antigen receptors. A main function of SLP is to orchestrate the assembly of Ca(2+)-mobilizing enzymes at the inner leaflet of the plasma membrane. For this purpose, SLP-76 in T cells utilizes the transmembrane adaptor LAT, but the mechanism of SLP-65 membrane anchoring in B cells remains an enigma.

A positron emission tomography study of 5-hydroxytryptamine-1A receptors in Alzheimer disease.

Objective: The important role of serotonin-1A (5-hydroxytryptamine-1A [5-HT(1A)]) receptors in cognition, behavior, and drug response is increasingly being recognized. Postmortem studies suggest decreased 5-HT(1A) receptors in patients with Alzheimer disease (AD), but this has not been confirmed in vivo. Our primary objective was to assess the extent of 5-HT(1A) receptor losses in mild to moderate AD.

A SPECT study of apathy in Alzheimer's disease.

Background/aims: To assess the association between regional cerebral blood flow (rCBF) and apathy in Alzheimer's Disease (AD).

Methods: SPECT and MRI scans were obtained from 51 nondepressed outpatients meeting criteria for probable AD (age 77.6 +/- 6.

Antipsychotic drug use and mortality in older adults with dementia.

Background: Antipsychotic drugs are widely used to manage behavioral and psychological symptoms in dementia despite concerns about their safety.

Objective: To examine the association between treatment with antipsychotics (both conventional and atypical) and all-cause mortality.

Design: Population-based, retrospective cohort study.

Effect of rivastigmine on delay to diagnosis of Alzheimer's disease from mild cognitive impairment: the InDDEx study.

Objective: To assess the effect of rivastigmine in patients with mild cognitive impairment (MCI) on the time to clinical diagnosis of Alzheimer's disease (AD) and the rate of cognitive decline.

Methods: The study was a double-blind, randomised, placebo-controlled trial of up to 48 months. All patients had MCI operationally defined by having cognitive symptoms, a global clinical dementia rating stage of 0.

Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a metaanalysis.

Objective: Depression in patients with Alzheimer's disease (AD) is common (15% to 63%) and is associated with significant morbidity and increased mortality. Our objective was to quantitatively summarize the data on the efficacy and safety of antidepressant treatment for depression complicating AD.

Method: We performed a metaanalysis of randomized, double-blind, placebo-controlled trials of antidepressants with a database search of the English literature (up to 2006) and a manual search of references in the retrieved articles.

Treatment of moderate to severe Alzheimer's disease: rationale and trial design.

Moderate to severe Alzheimer's disease (AD) is characterized by increasing cognitive, functional, and behavioural dysfunction that results in increased caregiver burden and, eventually, complete dependence. Despite its significance as a societal health problem, there are few treatment trials of cognitive enhancers or disease modifying agents for this stage of illness. Studies suggest the cholinesterase inhibitors, especially donepezil, may provide benefit.