Cost of Alzheimer's disease

The progressive deterioration associated with Alzheimer's disease (AD) results in high economic cost to the patients, caregivers, and the society as a whole. Cost-of-AD studies conducted over the last decade have produced discrepant results, mainly as a consequence of the different methodologies employed. The present review is an attempt to present the methodology of the cost studies in AD and provide the reader with the tools necessary for a critical assessment of the results.

PIXE ANALYSIS OF ATMOSPHERIC AEROSOLS IN THE CITY OF BUENOS AIRES

Lead pollution present in atmospheric aerosols in the city of Buenos Aires was measured in 1989, using Heavy Ion PIXE. Since then, environmental conditions have changed significantly. The usage of unleaded gasoline was introduced, and the utilisation of compressed natural gas as car fuel has increased. Recently, a new sampling campaign of atmospheric aerosols has started, partly in collaboration with the Greenpeace Foundation. The present studies reveal that lead pollution in Buenos Aires has significantly decreased since 1989. The concentrations of other elements are determined as well.

Familial sinistrality and handedness in patients with first episode schizophrenia: the EUFEST study

The population with schizophrenia is characterised by a leftward shift in handedness-sinistrality. However, findings are inconsistent in chronic patients, and familial sinistrality (FS), defined as the presence of left-handed close relatives, might contribute to the discrepancies. Therefore the aim of this study was to investigate the strength of manual lateralisation in patients with first episode schizophrenia, taking into account familial sinistrality. The Edinburgh Inventory (EI) allowed us to categorise 179 patients from the EUFEST study and 189 controls presenting "strong handedness" (SH: EI absolute value between ∣81∣ and ∣100∣) or "weak-handedness" (WH: EI value between -80 and +80). The nominal logistic regression did not show an FS effect, but a nearly significant interaction between illness and FS (p =.07). There were fewer participants without FS presenting SH among patients (99/151: 65.6%) than among controls (134/164: 81.7%, p =.001). In contrast, the number of participants with FS presenting SH was similar between controls (68%) and patients (75%, p =.57). The presence of left-handed relatives (FS + ) tended to reduce manual lateralisation, but only in controls. This supports the notion that reduced manual lateralisation in schizophrenia is related to the illness rather than to familial left-handedness.

FC02-01 - Risk for hospitalization for schizophrenia and affective disorders among full and half siblings of probands with schizophrenia: A population-based study

Introduction

Compared to the general population, siblings of patients with schizophrenia have a higher risk of developing schizophrenia.

Objectives

This study analyzed population-based data to examine the risk of hospitalization for schizophrenia and affective disorders among full vs. half siblings of patients with schizophrenia, and among persons with 1 or more siblings with schizophrenia vs. those with 2 or more.

Aims

This study assessed the familial influence of schizophrenia on the development of schizophrenia and other mental disorders in siblings.

Methods

The full (n = 12,555) and half (n = 2,707) siblings of 6,115 patients with schizophrenia (ICD F20.0–20.9) were identified from the Israeli Psychiatric Hospitalization Registry. Age and gender matched controls (n = 61,048) were identified from the Israeli Population Registry. The sample's psychiatric hospitalizations were recorded from the registry.

Results

Compared to controls, risk for schizophrenia was higher among persons with one or more (OR = 9.36, 95%CI: 7.73–11.33) or 2 or more (OR = 13.76, 95%CI: 8.84–24.15) full siblings with schizophrenia. Similarly, persons with one or more (OR = 7.91, 95%CI: 5.15–12.14) or 2 or more (OR = 8.44, 95%CI: 3.57–19.94) half siblings with schizophrenia had a higher risk of schizophrenia. Similarly, risk for hospitalization for affective disorders was higher among persons with one or more (OR = 7.29 95%CI: 5.60–9.49) or 2 or more (OR = 10.25, 95%CI: 5.50–19.10) full siblings with schizophrenia.

Conclusions

This population-based study strengthens existing knowledge that schizophrenia has a strong familial, perhaps genetic component; and the greater the familial load, the greater the risk. Familial schizophrenia also increases risk for affective disorders, emphasizing the overlap between these disorders.

Generalizability of the results of efficacy trials in first-episode schizophrenia: comparisons between subgroups of participants of the European First Episode Schizophrenia Trial (EUFEST)

OBJECTIVE

Most randomized drug trials in schizophrenia exclude patients with comorbidities such as suicidality or substance use, which may limit the generalizability of the results. We aimed to evaluate the generalizability of the results of these trials in participants of a randomized clinical trial with broad inclusion criteria.

METHOD

In 50 sites in 14 countries, 498 patients with first-episode psychosis (DSM-IV schizophrenia, schizoaffective disorder, or schizophreniform disorder) were recruited between December 2002 and January 2006 in an open, randomized clinical drug trial with 12 months of follow-up. Baseline characteristics and follow-up data were compared between patients with versus patients without baseline suicidality and/or substance use.

RESULTS

Of the 489 participants with data on baseline suicidality and substance use, 153 (31%) patients were suicidal and/or using substances. Groups differed on only a few of the many baseline characteristics tested: comorbid patients were younger (25.1 vs 26.5 years of age; P < .01), less often female (25% vs 47%; P < .001) or married (4% vs 17%; P < .001), had fewer years of education (11.8 vs 12.8; P < .001), and experienced lower levels of overall psychosocial functioning (Global Assessment of Functioning; 38.4 vs 40.8; P <or= .05) and higher levels of depression (Calgary Depression Scale for Schizophrenia; 6.1 vs 4.6; P < .001). At follow-up, comorbid patients showed shorter time to (re)hospitalization and reported higher levels of depression than patients without comorbidity (hazard ratio = 2.02, P = .004; chi(2)(7) = 17.25, P = .016, respectively), without differences on other outcome measures.

CONCLUSIONS

Although it appears that the generalizability of antipsychotic treatment trials in first-episode patients is not seriously affected by the exclusion of patients with suicidal symptoms and/or substance use, researchers should be cautious about the exclusion of such patients.

TRIAL REGISTRATION

controlled-trials.com Identifier: ISRCTN68736636.

Assessment of thyroid system disruption in Rana pipiens tadpoles chronically exposed to UVB radiation and 4-tert-octylphenol

Many studies have considered recent increases in ultraviolet B radiation (UVBR) and endocrine disrupting chemicals polluting the environment as possible contributing factors to the reduction in amphibian populations. It has been demonstrated that exposure of amphibians to estrogenic chemicals or UVBR can affect the timing of larval development and metamorphosis. However, amphibians in the wild are exposed to multiple environmental stressors simultaneously. Therefore, our study examines the effects of UVBR and the estrogenic chemical 4-tert-octylphenol (OP), alone and in combination, on the thyroid system of Rana pipiens tadpoles, which is the main regulator of amphibian metamorphosis. Results demonstrate that thyroid gland histomorphology measurements in Gosner stage 31 tadpoles continuously exposed to UVBR (0.21W/m(2)) were not different than those measured in animals from the control group. In a separate experiment, tadpoles exposed to environmentally relevant levels of UVBR (0.22W/m(2)) and/or OP (0.01nM or 10nM) exhibited significantly delayed development starting from Gosner stage 29, given that fewer tadpoles developed past stage 29 in these groups. In addition, significantly fewer UVBR-treated tadpoles developed past stage 34 and metamorphosed. Samples were collected from stages 29 and 34 tadpoles for gene expression analysis in tail tissue and measurements of T3 (triiodothyronine) whole body levels (minus tail). UVBR and/or OP exposure did not affect T3 levels in stages 29 and 34 tadpoles. However, a decrease in deiodinase type 2 (D2) or increase in deiodinase type 3 (D3) mRNA levels was observed in groups of tadpoles with slowed developmental rates at those developmental stages. Given that D2 activates and D3 inactivates thyroid hormones (TH), UVBR/OP mediated disruptions in development are likely caused by dysfunctions in the localized metabolism of THs through alterations in the expression of these enzymes in peripheral tissues. This is the first study to our knowledge reporting a potential thyroid-based mechanism of action for the developmental delays in amphibians exposed to UVBR and/or OP.