Demenciák megelőzésének gyógyszeres és egyéb lehetőségei: irodalmi összefoglaló

BACKGROUND: At present 34 million people live with Alzheimer's disease around the world. This figure is expected to triple in the next 40 years. The major cause of this increase is the well-known aging of the society in Europe and in the US as well. AIMS AND METHODS: In this paper we review the results of the last 10 years, and discuss those pharmaceutical and other methods, which can be effective in the prevention of dementias. RESULTS: The most important pharmaceutical agents are beta secretase inhibitors, and active and passive immunizations. Several drugs in these groups are in phase III at the moment. The results from studies with intranasal insulin are also encouraging. As a non-drug option Mediterranean diet can be effective. However at present cognitive trainings seem to be the most effective in the prevention of dementias. These remediation therapies are based on the lifelong plasticity of the human brain. CONCLUSIONS: In summary we can conclude that there are promising drug developments in progess for the prevention of dementias, but the breakthrough has not been achieved yet. At present the best option is decreasing risk factors, that is treatment of hypertension, prevention of obesity and diabetes, and cognitive trainings are recommended for prevention

Association of ATP6V1B2 rs1106634 with lifetime risk of depression and hippocampal neurocognitive deficits: possible novel mechanisms in the etiopathology of depression

Current understanding and treatment of depression is limited to the monoaminergic theory with little knowledge of the involvement of other cellular processes. Genome-wide association studies, however, implicate several novel single-nucleotide polymorphisms with weak but replicable effects and unclarified mechanisms. We investigated the effect of rs1106634 of the ATPV1B2 gene encoding the vacuolar H+ATPase on lifetime and current depression and the possible mediating role of neuroticism by logistic and linear regression in a white European general sample of 2226 subjects. Association of rs1106634 with performance on frontal (Stockings of Cambridge (SOC)) and hippocampal-dependent (paired associates learning (PAL)) cognitive tasks was investigated in multivariate general linear models in a smaller subsample. The ATP6V1B2 rs1106634 A allele had a significant effect on lifetime but not on current depression. The effect of the A allele on lifetime depression was not mediated by neuroticism. The A allele influenced performance on the PAL but not on the SOC test. We conclude that the effects of variation in the vacuolar ATPase may point to a new molecular mechanism that influences the long-term development of depression. This mechanism may involve dysfunction specifically in hippocampal circuitry and cognitive impairment that characterizes recurrent and chronic depression

Monitoring the early signs of cognitive decline in elderly by computer games: an MRI study

BACKGROUND: It is anticipated that current and future preventive therapies will likely be more effective in the early stages of dementia, when everyday functioning is not affected. Accordingly the early identification of people at risk is particularly important. In most cases, when subjects visit an expert and are examined using neuropsychological tests, the disease has already been developed. Contrary to this cognitive games are played by healthy, well functioning elderly people, subjects who should be monitored for early signs. Further advantages of cognitive games are their accessibility and their cost-effectiveness. PURPOSE: The aim of the investigation was to show that computer games can help to identify those who are at risk. In order to validate games analysis was completed which measured the correlations between results of the 'Find the Pairs' memory game and the volumes of the temporal brain regions previously found to be good predictors of later cognitive decline. PARTICIPANTS AND METHODS: 34 healthy elderly subjects were enrolled in the study. The volume of the cerebral structures was measured by MRI. Cortical reconstruction and volumetric segmentation were performed by Freesurfer. RESULTS: There was a correlation between the number of attempts and the time required to complete the memory game and the volume of the entorhinal cortex, the temporal pole, and the hippocampus. There was also a correlation between the results of the Paired Associates Learning (PAL) test and the memory game. CONCLUSIONS: The results gathered support the initial hypothesis that healthy elderly subjects achieving lower scores in the memory game have increased level of atrophy in the temporal brain structures and showed a decreased performance in the PAL test. Based on these results it can be concluded that memory games may be useful in early screening for cognitive decline

A 3,4-methylenedioxypyrovaleron (MDPV) használatával kapcsolatos klinikai tapasztalatok öt hospitalizált páciens esete kapcsán

A new illegal psychotropic substance appeared in Hungary during the first months of 2011. Acutely hospitalized patients with psychosis disclosed using a new type of designer drug, previously unknown to clinicians. As the new drug became better known, the cases with acute intoxication were often also transported to toxicology departments. In this study we summarize 5 short case studies that demonstrate the heterogeneous symptoms associated with MDPV abuse, and draw attention to the frequently occurring delusions, and the extended risk of intravenous substance use. Present case studies include patients with and without psychiatric history, regular and occasional users, intravenous and other routes of administration. In the short run antipsychotic therapy reduced the symptoms in all cases, but there is no clear therapeutic guideline for the treatment of patients having psychiatric problems associated with these drugs at the present time. The laboratory examination is unresolved as well. Mephedrone, MDPV and recent drugs have drawn attention to the problem of designer drugs again. This article examines the interaction of drug consumption trends and changes in law, apropos of the presented cases. This information can be helpful for the future treatment of MDPV or other designer drug users. Possible research and therapeutic implications are also discussed

Altered Social Decision Making in Borderline Personality Disorder: An Ultimatum Game Study.

The authors examined social decision-making strategies in borderline personality disorder (BPD) using the Ultimatum Game (UG). They sought to extend previous findings by investigating altruistic punishment, a behavior that increases group cooperation in the long term. They tested the effect of the proposer's facial expression on responses. BPD patients (n = 47) and healthy controls (n = 43) played the responder's role in a series of computerized UG interactions, with proposers expressing positive or negative emotions. BPD patients accepted unfair offers at a higher rate compared to controls. The effect of facial expression differed in the two groups, as positive expressions increased the acceptance likelihood in the control group at stakes from 20:80 to 50:50. In the BPD group, this effect was observed only at higher stakes (40:60 and 50:50). These results suggest that BPD patients exhibit altruistic punishment to a lesser extent and are less influenced by their partners' emotional expression in the UG

Az enyhe kognitív deficitben szenvedők differenciálása az egészséges idős populációtól neuropszichológiai tesztek segítségével

OBJECTIVE: Paired Associates Learning (PAL) test assesses brain functions in those brain regions affected earliest by Alzheimer's dementia. The aim of the present study was to assess the usability of our implementation of the PAL test for screening mild cognitive impairment. METHODOLOGY: Based on Petersen criteria, 14 out of the 63 subjects were diagnosed with mild cognitive impairment. Visuospatial learning was assessed by our implementation of PAL test. The ability of the PAL test to differentiate between study groups was compared to the Addenbrook Cognitive Examination (ACE) and to the Mini Mental State Examination (MMSE). Linear logistic regression was used for statistical analysis, and the results are presented as Receiver Operating Characteristics (ROC) curves. All analyses were performed by SAS 9.2. RESULTS: All the results of neuropsychological tests differed significantly between the study groups. However, considerable difference could be detected between the tests regarding specificity and sensitivity. The PAL test reached the sensitivity of the ACE, while its specificity was slightly under the ACE. DISCUSSION: The PAL test developed in the framework of the present study is found to be able to differentiate between MCI and healthy controls. It outperformed the MMSE in terms of sensitivity and specificity, while it needs comparable time to perform. Its sensitivity, the important parameter for screening, is comparable to ACE, while it needs significantly shorter time and less assistance