Antidepressant drugs in the elderly: Are the indications as long term as the treatment?

In a community study of 761 people aged 70 years and over 45 (5·9%) were found to be taking long term tricyclic antidepressants. Forty four were compared with matched controls. There was no evidence that tricyclic antidepressants were being used to compensate for poor physical health or function. Twenty subjects had a clear history of depression; three of these required additional treatment and five might have coped without continued drug treatment. Twelve of the remainder had started treatment with tricyclic antidepressants as hypnotics and 11 as a trial because of suspected depression. They had continued taking the drugs over a long period.Regular review of both the adequacy of and the necessity for continued treatment with tricyclic antidepressants in the elderly is recommended.     

Association of plasma Aß peptides with blood pressure in the elderly

Background

Aß peptides are often considered as catabolic by-products of the amyloid ß protein precursor (APP), with unknown physiological functions. However, several biological properties have been tentatively attributed to these peptides, including a role in vasomotion.We assess whether plasma Aß peptide levels might be associated with systolic and diastolic blood pressure values (SBP and DBP, respectively).

Methodology/Principal Findings

Plasma Aß_1-40 and Aß_1-42 levels were measured using an xMAP-based assay in 1,972 individuals (none of whom were taking antihypertensive drugs) from 3 independent studies: the French population-based 3C and MONA-LISA (Lille) studies (n = 627 and n = 769, respectively) and the Australian, longitudinal AIBL study (n = 576). In the combined sample, the Aß_1-42/ Aß_1-40 ratio was significantly and inversely associated with SBP (p = 0.03) and a similar trend was observed for DBP (p = 0.06). Using the median age (69) as a cut-off, the Aß_1-42/Aß_1-40 ratio was strongly associated with both SBP and DBP in elderly individuals (p = 0.002 and p = 0.03, respectively). Consistently, a high Aß_1-42/ Aß_1-40 ratio was associated with a lower risk of hypertension in both the combined whole sample (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.56-0.90) and (to an even greater extent) in the elderly subjects (OR, 0.53; 95% CI, 0.37–0.75). Lastly, all these associations appeared to be primarily driven by the level of plasma Aß_1-40.

Conclusion

The plasma Aß_1-42/Aß_1-40 ratio is inversely associated with SBP, DBP and the risk of hypertension in elderly subjects, suggesting that Aß peptides affect blood pressure in vivo. These results may be particularly relevant in Alzheimer''s disease, in which a high Aß_1-42/Aß_1-40 plasma ratio is reportedly associated with a decreased risk of incident disease.     

Case finding in the elderly: does the primary care team already know enough?

The needs of an elderly population in one general practice were assessed by the primary health care team. A simple questionnaire was filled in as far as possible by members of the team on known social and functional criteria for each patient aged over 75. The questionnaire was complete for 100 of 118 elderly patients. The information was accurate for over 95% of the criteria as verified by information held by the health authority. This information will now be used for yearly reviews of each patient based on opportunistic contacts. This is a simple method of collating information that is already known. If such information was available to health authorities it would give them an idea of the type and extent of the support services needed for elderly people.     

Atypical presentation of depression in the elderly: fact or fiction?

Depression in the elderly is often thought to have a different clinical presentation in many patients. This so-called atypical depression is characterised by less sadness and feelings of guilt and more somatic symptoms, impaired cognition and behavioural symptoms. Studies that compare depressive signs and symptoms in elderly and younger patients are reviewed. Published studies do not support the suggestion that major depression in the elderly often have a different clinical presentation. Vascular depression and depression in patients with severe dementia may be exceptions. Conceptual and methodological issues that play an important role are discussed.     

Stannous fluoride in dentifrice: an effective anti‐plaque agent in the elderly?

Objective: The aim of this study was to examine differences in plaque accumulation in elderly patients using two toothpastes, with either 0.2% sodium fluoride (NaF) or 0.4% stannous fluoride (SnF₂), but otherwise identical. Background data: The prevalence of denate elderly is increasing. Plaque both causes caries and is associated with an increased mortality rate in frail elderly patients with pneumonia. Therefore, the effective removal of plaque is important. Ingredients with an anti‐plaque effect, such as SnF₂, that can be used in toothpaste, are effective in plaque inhibition Materials and methods: Thirty‐two frail elderly women, 82–98 years of age (mean, 88 years) and living in a residential home, participated in a double‐blind crossover study. They brushed their teeth for 4 weeks with each toothpaste. Treatment outcome was a change in the plaque index (PI) on four anterior teeth and four molars. Results: anova showed statistically significant differences between the treatments (F = 4.21, p = 0.02). A post hoc test showed that SnF₂ produced a statistically significantly lower PI than did NaF. Conclusion: SnF₂ in toothpaste may be effective in inhibiting plaque accumulation in the elderly.     

Is an elongated stylohyoid process prevalent in the elderly? A radiographic study in a Brazilian population

Background: Elongation and calcification of the stylohyoid ligament complex may be correlated with Eagle's syndrome. The styloid complex pathogenesis is still being debated. Objective: The aim of this study was to investigate the prevalence of stylohyoid ligament complex elongation in panoramic radiographs of 2252 patients in a Brazilian adult, partially edentulous population, of both sexes. Methods: The radiographs, taken in the Semiology Department at the Dental School in Brazil, were randomly selected from January 1997 to December 2000. The stylohyoid ligament complexes were measured from the cranial base up to the osseous tip of each process. Mineralisation of the complex of more than 25 mm in length on the radiograph was considered to be abnormal. The same operator made all the measurements. The lengths of the areas of mineralisation were recorded, and whether the condition was bilateral was noted. Results: This abnormality was present in both sexes. A calcified complex was found in 451 of the 2252 patients. The majority of these calcified complexes (n = 248; 54.9%) were bilateral. Three hundred and fifty‐six (39.5%) of them were longer than 25 mm (and so were abnormal), and the length varied from 26.1 to 65 mm. (average length = 27.8 mm). Forty (4.4%) of the abnormalities were longer than 50 mm, and of these 36 (90%) were in the 40–59 year age group. The mean length of a mineralised stylohyoid ligament complex in patients in the 60–79 year age group was 32.75 mm. Conclusion: The results suggested that an anatomical variant of the stylohyoid ligament complex was more frequently found in the elderly female population, although this abnormality was present in both sexes. There was a greater tendency for the abnormality to be present in patients between 60 and 79 years of age.     

Elevated glucose levels in the elderly: is there a need for intensive treatment?

Diabetes mellitus is a frequently occurring disease which is often found in combination with other diseases in older people. An interval of more than ten years is often seen between the first signs of diabetes and the diagnosis. The causes and consequences of insufficient production of insulin and the available diagnostic and therapeutic possibilities, with attention for hypoglycemia in older people, are discussed. In the early phase of diabetes glucose levels are only incidentally elevated and patients have no complaints. Elevated blood glucose values aggravate other diseases and decrease the effectivity of treatment for these diseases. Treatment can prevent or postpone secondary complications leading to improved quality of life. A plea is made for (regular) testing of blood glucose and adequate action when elevated values are found in older people.     

Arsenic and selenium measurements in nail and hair show important relationships to Alzheimer’s disease in the elderly

Background and research questionThe relationships of Arsenic (As) and selenium (Se) to Alzheimer’s Disease (AD) are not clearly known. This case-control observational study aims to investigate the possible relationship of these elements to the diagnosis and pathophysiology of the disease.MethodsThis case-control observational study was performed using 40 AD patients in different clinical stages and 40 healthy control subjects, living in a similar environment with low As exposure. The levels of As and Se in nail and hair were measured with Inductively Coupled Plasma Mass Spectrometry. The results were analysed with regards to clinical condition, age, disease duration, sex, education, living environment, and the relationship of the two elements using Mann Whitney U test and Spearman Rho or Pearson correlation tests as appropriate.ResultsThe levels of As and Se were not related to age, disease duration, sex, education, or living environment in the study groups (p > 0.05). The levels of As and Se in hair and nail samples of all patients and patient subgroups were higher than those in the healthy subjects (p < 0.001). A positive correlation was found between the levels of As and Se in both hair and nail samples only in the patient group (p < 0.01).ConclusionAccording to the results, As and Se levels probably increase due to some metabolic or genetic factors affecting both of them together. There may be an increase in the unregulated pool (selenomethionine) and a decrease in the regulated pool of Se (selenosycteine) in AD. Our findings need verification and the subject seems to deserve more elaborate evaluations including genetic analyses and analysis of different chemical forms of these elements.