The impact of mild behavioral impairment on the prognosis of geriatric depression: preliminary results

Our study aimed to examine how the presence of Mild Behavioral Impairment (MBI) symptoms influenced the outcome of late-life depression (LLD). Twenty-nine elderly (≥ 60 years) depressive patients, including eleven (37.9%) with MBI, were recruited and followed-up on average for 33.41 ± 8.24 weeks. Psychiatric symptoms severity and global functioning were assessed, respectively, using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) scale. BPRS total score significantly decreased from baseline to follow-up (P < 0.001, d = 1.33). The presence of MBI had no significant effect on mood and cognitive symptoms improvement. On the contrary, while a significant increase in GAF score was observed in patients without MBI (P = 0.001, d = 1.01), no significant improvement of global functioning was detected in those with MBI (P = 0.154, d = 0.34) after 6-month follow-up. The presence of MBI in patients with LLD may negatively affect long-term outcome, slowing or preventing functional improvement.

Bipolar Disorder and Manic-Like Symptoms in Alzheimer's, Vascular and Frontotemporal Dementia: A Systematic Review

BACKGROUND

An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated.

OBJECTIVES

The main aim of this study is to systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer's disease (AD), vascular dementia (VaD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated to negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline.

METHODS

A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD, or FTD and BD or (hypo) mania have been included.

RESULTS

Manic symptoms seem to be associated to disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincide with or precede cognitive impairment in FTD. Overall, mood stabilizers, and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert neuroprotective activity in patients with AD.

CONCLUSION

Prevalence, course, and characteristics of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.

The impact of Mild Behavioral Impairment on the individual’s level of psychological, social, and occupational functioning

Introduction

Mild behavioral impairment (MBI) is a neurobehavioral syndrome characterized by later-life emergent neuropsychiatric symptoms, which represent an at-risk state for incident cognitive decline and dementia.

Objectives

Our obective was to prospectively evaluate the impact of MBI on global functioning in patients ≥ 50 years with a major depressive episode (MDE) at baseline.

Methods

We recruited 51 patients ≥ 50 years presenting with a MDE at the outpatient clinic of the 2^nd Psychiatric Unit of the University of Pisa. Then we selected those patients who had a follow-up of at least two months and excluded subjects with a neurodegenerative disease. The included patients (N = 25) were subdivided in a subgroup with MBI and a subgroup without MBI. The subgroups have been compared for the difference between baseline and follow-up score in global functioning according Global Assessment of Functioning (GAF) scale. Comparative analyses were conducted by means of mixed anova.

Results

There was a significant interaction effect between time and the MBI condition (F[1, 23] = 4.12, p = 0.05 η p 2 = 0.15). Descriptive statistics showed that while patients without MBI showed higher GAF score at follow-up (mean = 65.12) compared to GAF score at baseline (mean = 54.37), patients with MBI showed, on average, the same GAF score at follow-up (mean = 54.44) and at baseline (mean = 54.44).

Conclusions

In patients with MDE, the presence of MBI is related to a lack of improvement in psychological, social, and occupational functioning in the short-term

Disclosure

No significant relationships.

Prostate cancer and coexisting incidental Paget's disease--report on a case

Prostate cancer coexisting with asymptomatic Paget's disease (osteitis deformans) may be difficult to stage. The skeletal lesions of both prostate cancer and Paget's disease may closely resemble each other, as appearing on imaging. A case of clinically localized prostate cancer coexisting with incidental Paget's disease is herein reported. Prostate cancer and coexisting incidental Paget's disease both need careful evaluation and close follow-up of the skeleton by imaging, because there is a risk of the former involving the skeleton at low clinical stages and low PSA serum levels, as well as the latter developing osteosarcoma.

[The role of computed axial tomography in pancreatic emergencies (author's transl)]

The role of CT in acute diseases of the pancreas is discussed, in the light of personal experience (25 cases). In acute pancreatitis (22 cases), CT was useful in particular for: differential diagnosis between the necrotic-hemorrhagic type and the edematous type; detection of extra-pancreatic collections and evaluation of their extent; post-operative follow-up of necrotic-hemorrhagic pancreatitis. In the other more rare empergencies (3 cases), CT could recognize respectively the rupture of an infected pseudo-cyst, and intra-cystic hemorrhage, a mediastinitis due to the spread of ascitic fluid containing pancreatic enzymes into the mediastinum. CT always provided diagnostic information which the other radiological techniques did not provide; therefore in acute diseases of the pancreas CT is the method of choice.

[Current role of lymphography in the study of systemic lymphatic diseases]

The usefulness and reliability of lymphography for staging purposes in Hodgkin's disease are discussed with reference to a personal series.