Very late-onset schizophrenia-like psychosis (VLOSLP) is one of the largest group of mental illnesses in late life after dementia and depression. The question of role of cognitive impairment and the risk of dementia development in this group is still open.

To determine the relationship between cognitive impairment and clinical features.

65 patients (62 woman, 3 man), medium age 72,5 [63,5; 78,5], medium age of onset 69 [62; 76] with schizophrenia (F20), n=23; chronic delusion disorder (F22.81), n=7, organic schizophrenia-like disorder (F06.2), n=7, schizoaffective disorder (F25), n=11, manifesting after 60 years, underwent clinical examination. The assessment was carried out using clinical-psychopathological, psychometric and statistical methods.

Based on clinical and psychopathological features, 3 clinical groups were formed. The group of patients with acute polymorphic symptoms with mental disorganization included 25 patients. The cognitive impairment was the most acute in this group and correlated with psychotic and affective symptoms. It reduced by the 28th day of investigation, but didn’t reach the normative ones, which may indicate the presence of persistent cognitive dysfunction associated with the present neurobiological changes and creates particular concern regarding the development of a neurodegenerative process in this group of patients.

The 2nd group included 30 patients with a predominance of paranoid symptoms with an “age” coloring, which, however, wasn’t the leading plot. Cognitive impairment was less pronounced compared to the first group and was stable in nature, was not associated with the degree of reduction of psychotic and affective symptoms. This allows us to consider it as a predictor of the development of psychosis.

The 3rd group included 10 patients and was characterized by the prevalence of affective and delusional symptoms with acute sensory delirium, pseudodementia at the height of the condition. The degree of cognitive decline at the beginning of the study was comparable with patients in the 2nd group. High correlations were established between the degree of reduction of productive and affective symptoms and the improvement of cognitive functions. A complete reduction of existing disorders was noted by the end of treatment, which may indicate a more congenial prognosis.

This study confirms the results of previous studies on presence cognitive impairment in patients with VLOSLP, and in addition demonstrates specific differences in cognitive profiles depending on the clinical variant of VLOSLP.

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Loneliness, social isolation, and living alone are emerging as significant risk factors for mortality, especially in older adults.

Loneliness, social isolation, and living alone are recognized as significant risk factors for mortality in older adults. This study aimed to quantify their associations with all-cause and cause-specific mortality, extending the scope of previous research by considering a broader range of social factors.

A systematic search was conducted in PubMed, APA PsycINFO, and CINAHL databases up to December 31,2023, adhering to PRISMA 2020 and MOOSE guidelines. Inclusion criteria comprised prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analyses utilized random-effects models with the Restricted Maximum Likelihood method, while subgroup and meta-regression analyses explored further relationships.

Out of 11,964 studies screened, 86 met the inclusion criteria. Loneliness was associated with a 14% increase in all-cause mortality risk, social isolation with a 35% increase, and living alone with a 21% increase. However, substantial heterogeneity was observed across studies, influenced by various factors including gender, age, geographical region, chronic diseases, and study quality. Meta-regression analysis identified predictors such as longer follow-up periods, female sex, validated social network indices, cognitive function adjustments, and study quality.

Loneliness, social isolation, and living alone significantly increase mortality risk in older adults, emphasizing the urgency of public health interventions targeting these factors to enhance health outcomes among the aging population. However, due to study variations, further research is needed to understand their cumulative effect on mortality risks and inform tailored interventions.

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According to the World Health Organization, the global population aged 60 and older is projected to nearly double between 2015 and 2050, increasing from 12% to 22%. This demographic shift presents unique challenges in the management of psychopharmacological treatment in the elderly. Factors such as multimorbidity, atypical presentations of psychiatric disorders, age-related alterations in pharmacokinetics and pharmacodynamics, and the high prevalence of polypharmacy— often defined as the concomitant use of five or more medications—complicate therapeutic approaches in this population.

This review synthesizes the current evidence on the prevalence, contributing factors, and consequences of polypharmacy in elderly psychiatric patients.

A narrative review was conducted using key terms and their combinations, including “polypharmacy”, “elderly”, “geriatric” and “psychiatry”. Relevant studies, case reports, and reviews published from 2000 to 2024 were included.

The prevalence of polypharmacy in the population varies across the literature; however, several well-established risk factors have been identified. These include age 65 years and older, living in a nursing home, comorbidities like diabetes mellitus, cardiovascular disease, metabolic syndrome, and COPD, as well as cognitive impairment. Additionally, prescription-related factors contribute to polypharmacy, such as poor quality of clinical records, automatic prescription renewals, and the involvement of multiple prescribers. The high rate of polypharmacy in older adults is associated with several challenges, including inappropriate medication use, difficulties in adhering to treatment regimens, increased risk of hospitalization, a higher likelihood of adverse effects, functional and cognitive decline, higher healthcare costs, and an increased risk of mortality. Additionally, a recent meta-analysis revealed for the first time that polypharmacy was significantly associated with the incidence of dementia and worsened its prognosis.

Advanced age is a significant risk factor for polypharmacy, often resulting in adverse outcomes such as reduced quality of life, increased morbidity, and higher mortality rates. Identifying and regularly assessing polypharmacy cases, alongside evaluating potentially inappropriate medications, are critical steps. Implementing safe prescribing practices and deprescribing strategies specifically adapted to the needs of elderly patients can effectively reduce risks and improve overall well-being in this vulnerable population.

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Hospitalization in psychiatry often marks a critical point in the management of mental health disorders. For elderly patients, this can be a first-time experience and is often associated with complex psychological, social, or medical factors. Due to the age, psychiatric symptoms may become more pronounced because of comorbidities, cognitive decline and social challenges. Understanding the profile, medical history, presenting complaints, and associated conditions of elderly patients admitted for the first time to psychiatric care is essential to improve the comprehensive care.

The objective of this study is to analyze the profile of elderly patients hospitalized for the first time in the psychiatric department, focusing on their medical history, presenting complaints, diagnoses, and comorbidities.

It’s a retrospective study. We reviewed the files of all patients aged over 65 years old who were hospitalized in the Avicenne Psychiatric Department at Razi Hospital between September 2022 and September 2024.

We identified 22 patients with 16 men and 6 women. The average age of our patients was 68 years (ranging from 64 to 80 years). The majority had a secondary school education (47%), came from an urban background (81%) , were retired (54%), with a high socioeconomic status (42%), married (61%), parent of an average of 2 children and with a family history of mental disease (52%). A history of somatic illness was found in 61% of the patients. The reason for hospitalization was behavioral disorder in 73%, suicidal thoughts in 18.2% and refusal to eat in 8.8%. A history of psychiatric consultation without the need for hospitalization was found in 59% of the cases around the age of 51 years. In 18% of the cases, the onset of the disorder was acute, while it was progressive in the rest. Concerning the diagnosis, we observed mental confusion caused by an organic pathology in 9%, a purely neurological cause of the disorder in 14% ( dementia in 10% and Parkinson’s disease in 4%), a depressive episode in 31%, a manic episode within the context of bipolar disorder in 37%, and schizophrenia in 9%. Comorbidity with paranoid personality disorder was observed in 4 patients, all of them were females. For patients with a psychiatric diagnosis, a neurological comorbidity was found in 31.25% (25% dementia, 6.25% Parkinson’s disease).

This study shows that elderly patients in their first psychiatric hospitalization have complex profiles affected by age-related factors and comorbidities. Diagnosis varied from mood to psychotic disorders, often with neurological issues. The frequent history of psychiatric consultations without hospitalization suggests that early intervention could help prevent more severe admissions. Understanding these profiles is crucial for improving care and treatment for elderly patients.

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Older patients in palliative care often experience considerable stress due to physical, emotional and existential factors. Previous research has identified cortisol, a glucocorticoid hormone, as a key biomarker for stress assessment. This pilot study aimed to investigate the potential of hair cortisol as a potentially objective stress biomarker in a specific population (aiming for a broader aplicability), as well as to explore cognitive changes in older palliative patients using the Mini-Mental State Examination (MMSE-2).

This study objectives were to (1) assess changes in hair cortisol levels and cognitive function in older palliative care patients over three weeks of hospitalization and (2) evaluate the suitability of hair cortisol as a short-term stress biomarker in this patient group.

This monocentric pilot study included 19 patients from different palliative care hospital services in Croatia, gathered via a convenience sampling approach with strict inclusion/exclusion criteria. Hair cortisol levels were measured at baseline and after three weeks using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed using the 16-point MMSE-2. Statistical analyses included paired t-tests and linear regression, and significance was set at p<0.05.

A statistically significant increase in mean hair cortisol levels was observed after three weeks of hospitalization (p=0.007), suggesting heightened stress over time. In contrast, MMSE-2 scores showed no statistically significant change (p=0.064), indicating no detectable cognitive decline within the study period. No significant correlations were found between cortisol levels and MMSE-2 scores at either time point, and differences between male and female patients were not statistically significant.

The findings support the potential use of hair cortisol as a biomarker for stress in palliative care settings, especially for tracking the transition from acute to chronic stress. However, MMSE-2 may not be sensitive enough to detect cognitive changes over short time spans in this patient group. Consequently, further research with larger samples is needed to validate hair cortisol as a practical tool for monitoring stress and to explore its clinical implications for improving palliative care outcomes.

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Careful qualitative analysis of medical comorbidities in psychogeriatric patients is frequently overlooked in clinical practice, although these individuals often present with complex clinical pictures where multiple age-related somatic conditions can influence or alter the psycopathological presentation of mental disorders. This interplay can significantly affect both diagnosis and management, complicating the therapeutic approach and influencing prognosis.

We present the case of an 81-year-old male with a history of schizoaffective disorder admitted to our Psychiatry Unit due to an episode of marked motor inhibition and delusions. This case is notable for its complex clinical presentation, requiring a broad differential diagnosis, and serves as a representative example of the challenges in managing psychogeriatric patients with overlapping psychiatric and neurological comorbidities.

1. 1) To describe the clinical particularities of this case, focusing on relevant psychogeriatric comorbidities and related changes in pathoplasticity.

2. 2) To review the available evidence regarding the characteristics and management of comorbid neurological disorders in psychogeriatric patients.

The patient’s clinical history was reviewed, including complementary tests such as brain MRI and PET-CT scans. Additionaly, a literature search was carried out, focusing on psychiatric and neurological comorbidities in elderly patients with a history of psychotic and affective disorders.

The patient’s clinical course reveals a significant change in the presentation of symptoms starting at the age of 70. Prior to this age, episodes were characterized mainly by inhibition, mutism, and delusional guilt. However, from the age of 70, there is a notable shift to more complex presentations with both manic and psychotic symptoms, including persecutory delusions, hyperactivity, and religious ideation, alongside periods of mixed affective states with significant affective lability. The development of probable drug-induced parkinsonism, confirmed by a negative DaTSCAN, and neuroimaging findings suggestive of a neurodegenerative process akin to Alzheimer’s disease further complicated the clinical picture. Therapeutic interventions included psychopharmacological adjustments and electroconvulsive therapy, resulting in partial stabilization.

1. 1. Managing psychogeriatric patients requires addressing comorbidities with a flexible, symptom-based approach.

2. 2. Neurodegenerative processes can alter prognosis by increasing relapse risk and changing symptom patterns.

3. 3. A multidisciplinary approach is crucial for optimizing care in complex psychogeriatric cases.

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Social isolation (SI) is defined as the lack of social contact or support. Older adults have a higher risk of social isolation because of the changes in health and social relationships that can occur during ageing. Several studies have shown that SI is independently associated with poorer physical and mental health and worsened quality of life. However, limited evidence is available on SI predictors in old public housing populations.

To assess the risk of SI and dependency in Basic and Instrumental Activities of Daily Living (BADL; IADL) in a sample of older people living alone in public housing. To identify predictors of SI, namely whether ADL dependency is one of them.

As part of the ongoing “Porto Importa-se” project, this study included a sub-sample of older persons aged 70 years and over living alone in public housing communities in Porto City, Portugal. All participants were assessed with a comprehensive multidimensional assessment protocol, which encompassed the Barthel and Lawton Indexes (BADLs and IADLs dependency) and the Lubben Social Network Scale-6 (SI risk). Loneliness was measured with a categorical question. A multiple logistic regression model was performed to identify predictive factors for SI. Odds Ratio (OR) and its 95% Confidence Interval (95%CI) were calculated. A p<0.05 was considered statistically significant.

The final sample (n=716) was namely female (84%), with an average age of 80.4 years (SD=6.2). Around 36% presented a risk of SI, and 24% reported feeling lonely almost always to always. About 53% had moderate dependency on IADLs, and 11% dependency on BADLs. The proportion of participants dependent on BADLs and at risk of SI is more than double the proportion of cases considered not to be at risk (17%v.s.8%; p<0.001). Similarly, the proportion of cases considered to be severely dependent on IADLs and at risk of SI is about four times higher than the proportion of cases considered not to be at risk (13%v.s.3%; p<0.001). Based on the logistic regression model, severe dependence on IADLs (OR=5.16, 95%CI[2.37;11.24], p<0.001) and loneliness (OR=2.87, 95%CI[2.02;4.09], p<0.001) were significant predictors of the risk of SI. The model has a modest explanatory power (Nagelkerke R2=0.126).

The rate of SI found in this study aligns with the results reported in other studies with similar objectives. The identification of loneliness and dependence in ADL as predictors of SI also complies with previous studies. These results reinforce the importance of monitoring elderly people who find themselves alone and dependent on the fulfilment of their ADLs more closely.

This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

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Psychiatric symptoms in vascular dementia occur in up to 95 % of patients. These symptoms can be of a depressive or manic type, among others. For this reason, it is essential to carry out a proper differential diagnosis between vascular dementia and other types of pathology that include psychiatric symptoms.

1. 1) To describe the main psychiatric symptoms that could guide the diagnosis of vascular dementia.

2. 2) To make an appropriate differential diagnosis in order to carry out the most suitable therapeutic approach in each specific case.

A review of the most recent literature related to psychiatric symptomatology in patients with vascular dementia.

Vascular dementia can present with very diverse psychiatric pathology. Depending on the subcortical area affected, a particular symptomatology will predominate. For this reason, it is of vital importance to carry out a proper differential diagnosis. When the brain area affected is the ventromedial prefrontal cortex, the predominant symptomatology is depressive, with a higher percentage of patients with abulia. If the area most affected is the orbitofrontal cortex, disinhibition will predominate. However, if it is the dorsolateral prefrontal area, it will lead to executive dysfunctions.

On the other hand, it should be noted that psychiatric symptomatology due to vascular damage often has an atypical presentation in patients. For example, if what predominates is depressive symptomatology, what might appear relatively frequently would be late onset anxiety, irritability, or excessive somatic preoccupation. However, sadness or crying would not be as representative. If what predominates is the manifest symptomatology, in this case, with a high probability it would manifest itself in the form of behavioural disinhibition.

Because of these peculiarities, it is essential to make a proper screening between vascular dementia, late onset depression or Alzheimer’s disease, as the therapeutic approach to each pathology will be very different, as will be the prognosis.

• - Atypical psychiatric symptomatology may be the key to a diagnosis of vascular dementia.

• - A proper differential diagnosis between vascular dementia, late onset depression and Alzheimer’s disease is essential.

• - There is no clear benefit in the use of ACE inhibitors and NMDA receptor antagonists in cognitive impairment. However, there is evidence of improvement in cognitive function with SSRI antidepressants in patients with and without depression.

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Health literacy (HL) is characterised as the ability to understand health and involves people’s knowledge, motivation and skills to access, recognise, evaluate and apply health-related information. It is an important topic in the context of healthcare, with studies suggesting that low levels of HL are predictors of adverse health outcomes. Socioeconomic status, age, race, cognition and level of education are factors that contribute to HL levels, with older age being strongly associated with poor HL. However, the relationship between HL and the psychological well-being of older people has not been explored as much in the literature.

To describe HL and psychological well-being levels in community-dwelling older people and to analyse the association between these two constructs.

The data analysed in this study derives from a longitudinal research project called FelizIDADE, whose main objective was to empower older people to promote health and HL. A sample with older people aged 65 years and over, living in the municipality of Vila Nova de Famalicão, in Portugal was included. All participants were assessed with a comprehensive research protocol, which comprised, amongst others, the European Health Literacy Questionnaire (HLS-EU-Q16) and the Psychological Well-Being Scale (PWBS). For statistical analysis, non-parametric tests were used, since data did not follow a normal distribution.

A sample with 59 community-dwelling older people was considered, with a mean age of 72 years (SD=4.5). The majority was female (59%), married (83%) and 91.5% had the completed primary school. Around 83% lived with their spouse and 88% were retired due to age. Statistically positive correlations were identified between the HLS-EU-Q16, age (rs=0.0274; p<0.05) and PWBS (rs=0.336; p<0.01). The total of HLS-EU-Q16 also correlated positively with the total of four domains of the PWBS: Autonomy (rs=0.412;p<0.01); Personal Growth (rs=0.280; p<0.05); Positive relations with others (rs=0.275; p<0.05) and Purpose in life (rs= 0.379; p<0.01).

It is well known that HL plays a fundamental role in older people and lower levels are related to negative impacts on health. This reinforces the importance of understanding the factors that are associated with poor HL. The present findings provide empirical insights into the association between HL and psychological well-being among older people living in the community. Furthermore, these results emphasise HL as an individual resource in promoting well-being.

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Aging leads to a progressive deterioration at the communicative level. The identification of language impairment in older adults could help to prevent or slow down the development of a possible neurocognitive disorder.

To evaluate psychopathological manifestations in language and communication by means of a psychopathological evaluation protocol in a control group of subjects matched by age and sex to a group of people with mild cognitive impairment.

The sample consists of twenty healthy older adults (75% female, 25% male) with mean age of 84.15 years (SD = 6.81). A descriptive and observational study was carried out. Subjects of both sexes between 70 and 95 years of age, with absence of possible cognitive impairment, were included. The Mini-Cognitive Examination was used to assess cognitive performance, the PRESEEA interview was used to obtain the speech sample and a psychopathological assessment protocol.

Increasing age is associated with greater intensity of language impairment (R2 = .02, p = .047). In the MEC-35 total score, the control group shows a significantly higher performance than the patient group (F = 49.11, p < .001). A negative correlation appears between the total score of psychopathological manifestations and the variables ‘educational level’ (R2 = .23, p = .029) and ‘socioeconomic level’ (R2 = .33, p = .007).

Anomia, perseverations, disintegrated language, concretism and paragrammatism are possible early indicators of cognitive impairment. The elaboration and application of both assessment protocols and speech therapy intervention programs in older adults may improve communication skills.

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A case report on the use of Brexpiprazole for the treatment of behavioral disturbance in dementia is presented.

A brief review of the benefit of Brexpiprazole treatment in the treatment of dementia is presented in a case report.

This is an 84-year-old female patient with newly diagnosed multifactorial cognitive impairment. The patient was brought to Mental Health because of the behavioral alteration presented. She reported delusions of harm, theft and a suspicious attitude in relation to moderate cognitive impairment, as well as the recent transfer to a nursing home. In addition, the nursing home had observed that he presented erratic wandering that affected the functioning of the residential environment. In response to this symptomatology, the patient was aggressive and physically heteroagressive towards the caregivers.

The patient, due to the clinical presentation, had been treated with benzodiazepines, which had worsened the episodes of agitation and confusion, interspersed with episodes of somnolence. Therefore, her treatment was modified by adding quetiapine and haloperidol, worsening her psychomotor restlessness and alertness.

When the patient was seen in the psychiatry department, she presented a high level of restlessness that corresponded to akathisia due to the haloperidol, as well as a fluctuating level of alertness that oscillated between wakefulness and somnolence. Despite the overmedication, according to the residency report, the patient maintained episodes of agitation and heteragresivity during wakefulness.

For this reason, it was decided to replace the antipsychotic treatment of quetiapine and haloperidol, progressively with brexpiprazole at 4mg DMD divided in two.

After two weeks of monotherapy with brexpiprazole, the side effects of the previous treatment disappeared, and the patient’s daily functioning improved. She remained alert, the suspicious attitude and the delusions of harm disappeared. The episodes of behavioral disturbances had also ceased.

For the treatment of behavioral symptoms in dementia, it is important to have an effective approach to the clinical management without causing adverse effects that can be severe in elderly people. Brexpiprazole is an atypical antipsychotic, being a 5HT1A and D2 partial agonist and a 5HT2A antagonist, and is an appropriate treatment in this age group.

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Frontotemporal dementia (FTD) is a heterogeneous group of brain disorders associated with progressive frontal and temporal lobe atrophy. The main syndrome, behavioral variant FTD, is characterized by personality and behavior changes such as apathy, disinhibition, loss of empathy, new compulsive behaviors and executive dysfunction (Pressman, 2021). Psychotic symptoms may occur years prior to diagnosis of FTD, which can lead to misdiagnosis of a psychiatric disorder.

To highlight late psychosis as an initial indicator of frontotemporal dementia and emphasize the relationship of somatic delusions with the c9orf72 mutation.

We reported the clinical case of a 64-year-old patient who was admitted in our acute psychiatric unit for late-onset psychosis with predominance of somatic delusions as the first indicator of c9orf72 frontotemporal dementia. Access to the medical history of the patient and non-systematic review of the literature on MEDLINE (Pubmed) was conducted.

A 64-year-old male initially consulted the mental health services for oral stereotyped movements and behavioral changes after dental surgery. After a few months, the patient was concerned because he reported that he had holes in his mouth from which liquid was leaking. He consults numerous dentists and undergoes several surgeries, without success. The belief becomes more intense and delirious, and he develops self-harming ideation that leads him to be urgently admitted to the acute psychiatric unit. During the admission, aggressive behavior of the patient towards the staff was observed. Treatment with antipsychotics, antidepressants and ECT was carried with little improvement. He was admitted to a Medium-Term Unit where the patient deteriorated rapidly becoming apathetic, uninhibited and mutistic. Finally, after several months, he was diagnosed with C9orf72 frontotemporal dementia. Psychotic symptoms may be the initial manifestation of frontotemporal dementia. There is a hypothesis that somatic delusions are caused by an altered body schema, correlated with a pattern of posterior, subcortical and cerebellar atrophy (Ducharme, 2011).

Late-life psychosis should be investigated as a possible prodrome of a frontotemporal dementia. Physicians should be aware given the psychiatric-like presentation, unaltered imaging exam and delayed appearance of typical symptoms of FTD. An increased prevalence of somatic delusions in FTD patient with C9orf72 expansion has been reported (Downey, 2014).

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ECT is a well-evidenced, cost-effective intervention for treatment-resistant depression. In Ireland acute (twice-weekly) outpatient ECT for depression has not been reported, though common elsewhere. Ireland has among the lowest number of inpatient psychiatry beds per person in Europe. We observed a clinical need for acute outpatient ECT for people who could not access elective inpatient care.

We describe the process, interventions, outcomes and stakeholder feedback for four cases of acute outpatient ECT.

All cases provided written informed consent. A multidisciplinary (psychiatry, anaesthesiology, nursing) protocol for assessment and delivery of acute outpatient ECT was developed and implemented, cases described and feedback from stakeholders sought in an acceptability forum.

Four medically stable patients (ASA Grades 2-3) completed acute outpatient ECT (Table 1), receiving between n=6 and n=12 ECT treatments, attending from home. N=140 inpatient psychiatry bed days were saved, and n=45 community psychiatry reviews were required. No adverse events or medical interventions occurres. Three people had CGI outcome of “very much improved” and one person halted their treatment course when “minimally improved”, citing lack of response. Stakeholder feedback in an acceptability forum highlighted the increased resource intensity of twice-weekly community review for outpatient ECT, and the positive outcomes for treatment-resistant depression.

Acute outpatient ECT was safe and effective in this case series and resulted in n=140 psychiatry inpatient bed days being saved. There was an increased need for reviews from the community team during the treatment protocol. Medically stable patients with substantial social support were eligible for this pilot phase, thus a priority for future development must be equity of access to this effective intervention.

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Alzheimer’s disease (AD) is a progressive neurodegenerative disease and the most common form of dementia; currently there is no effective causal treatment for AD. The main targets of new drugs for AD are processes related to amyloid beta and tau neurotoxicity, neurotransmission, inflammation, metabolism and bioenergetics, synaptic plasticity, and oxidative stress.

The effects of methylene blue, curcumin, ginkgolide B, and melatonin are being tested as antioxidants, tau-aggregation inhibitors, and mitochondrial-targeted therapies. These antioxidants will also be tested as protective agents against tau-induced mitochondrial dysfunction caused by oligomers of phosphorylated tau (P-tau). The aim of our study is to systematically investigate tau-induced mitochondrial dysfunction in isolated brain mitochondria and the protective effects of AD drugs, adjuvants, against mitochondrial dysfunction.

Isolated pig brain mitochondria were used as an in vitro biological model to evaluate the effects of antioxidants. Hydrogen peroxide formation was determined by fluorescence measurements (starting with Amplex Red, horseradish peroxidase). Mitochondrial respiration was measured using high-resolution respirometry. The effects of tested drugs were measured at concentrations in the range 0.1 to 500 μmol/l; the effect of P-tau was measured in the range 3-120 nmol/l.

Methylene blue and curcumin significantly reduced hydrogen peroxide production at high concentrations. The antioxidants were further tested in combination with effect of P-tau oligomers in various states of mitochondrial respiration.

The results of this study will contribute to the connection of today’s most accepted hypotheses of AD (amyloid, tau and mitochondrial), to the understanding of intracellular processes associated with the formation and progression of AD. The applied impact of the study will be the introduction of an in vitro mitochondrial assay to evaluate the anti-tau effects of new AD drugs, which will allow the selection of agents with high potential for causal treatment of AD.

J. Hroudová Grant / Research support from: Supported by Ministry of Health of the Czech Republic, NU23-04-00032, Z. Fišar Grant / Research support from: Supported by Ministry of Health of the Czech Republic, NU23-04-00032.

Last scene of all That ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything. Shakespeare, As you like it, II, vii, 163-166

The paper will make reference to the debate generated by the implementation of the Law 8/ 2021 approved three years ago in Spain. The objective was to provide support measures to persons with dementia according to their wishes, beliefs, values and preferences without resorting to legal incapacity. Respect to the person´s wishes is pivotal to the Law and is creating many problems due to the fact that some patients with severe cognitive impairment cannot make a judgement and is not clear what the judge can decide.

From the start, forensic psychiatrists received an increasing number of requests to produce medico-legal reports due to the omission to refer to the protective, medical and personal aspects that such measures involve. Some decisions totally ignore these aspects referring only to the patrimonial ones with no mention of the person`s life trajectory nor to the personal and medical care provided and the medication prescribed.

In the second section, a case where the medical aspects where not contemplated in the sentence will illustrate the consequences for a patient who was misdiagnosed and mistreated.

An extensive observation following the Tavistock Method will describe the process, including the organizational dynamics.

As Kitwood suggested, working with people suffering from dementia includes confronting organic impairment and the great difficulties there may be in consciously articulating any psychological conflicts, there may also be a breaking down of the individual’s lifelong defences that leaves the person exposed and vulnerable to episodes of catastrophic anxiety and rage. Fear of abandonment and inability to bear separateness are characteristic of dementia sufferers, and these persecutory states of mind increase with organic impairment. Caregivers, whether family or staff in residential or nursing homes, have a crucial function in containing those deteriorated aspects of the person they are with.

“Dementia will always have a deeply tragic aspect, both for those who are affected and for those who are close to them. There is, however, a vast difference between a tragedy in which persons are actively involved and morally committed, and blind and hopeless submission to fate” (Kitwood, 1997).

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Delirium is a severe neurocognitive condition marked by acute, fluctuating disruptions in attention, awareness, and cognition, leading to significant morbidity and mortality. Despite its impact, there is currently no definitive pharmacological or non-pharmacological treatment for delirium (cf. American Psychiatric Association, 2013). Recognizing and managing delirium early is crucial to prevent long-term consequences. However, there is an international lack of consensus regarding the division of responsibilities in delirium care among physicians and advanced practice nurses (APNs).

Distribution of tasks between physicians and nurses in delirium management: „where everyone is responsible, no one is responsible

An international systematic literature review investigated the task distribution between advanced practice nurses (APNs) and physicians. The review focused on publications retrieved from PubMed and CINAHL databases.

From the initial systematic literature search, 395 articles were identified. Following the PRISMA statement (cf. Page et al., 2021) criteria, 30 articles were selected for analysis. Utilizing MAXQDA® (Release 2022.6) and qualitative content analysis, the literature was examined across categories such as physical examination, delirium screening, ordering pharmacological tests, treatment, psychoeducation on delirium. or procedures, diagnosis, non pharmacological treatment, and

Our systematic review revealed the absence of international guidelines for defining task distribution between physicians and nurses, particularly advanced practice nurses (APNs), in delirium care. We propose that research defining the roles among these experts will create synergies in delirium management which result in better recognition and management of delirium. Future research will test this hypothesis

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A 71-year-old female patient with schizoaffective disorder, under psychiatric follow-up and treated with lithium for over 20 years (with successive stable therapeutic blood levels), presented to the emergency department with symptoms of temporospatial disorientation, aphasia, gait disturbances, tremor, and fluctuating encephalopathy. Symptoms have progressively worsened since she was found on the floor of her home one month ago. Subsequent complementary examinations (clinical evaluation, cranial CT scan, and laboratory tests) returned normal results.

Given the clinical picture presented, a differential diagnosis was made including neurocognitive, toxic-metabolic, psychiatric, and pharmacological causes (lithium neurotoxicity). Initially, the treatment was adjusted by reducing the lithium dose (from 600mg to 400 mg/day) and the associated medication was modified (mirtazapine and lormetazepam). Additional investigations or hospital admission were recommended to rule out an underlying pathology.

The aim of this study is to explore and discuss the differential diagnosis and symptoms associated with lithium neurotoxicity.

We conducted a literature review through the PubMed database.

The patient’s symptoms worsened, and she was admitted to a long-term care facility. Active psychiatric pathology and cognitive decline were ruled out; renal function, thyroid function, and cranial MRI were normal. However, neurological symptoms and disorientation persisted.

The lithium dose was reduced to 200 mg/day, which led to the onset of manic symptoms. Upon increasing the dose back to 400 mg/day, the patient exhibited decreased consciousness, and serum lithium levels increased to 1.24 mEq/L, despite previously stable levels at this dose. Lithium was discontinued and replaced with valproic acid.

After the medication change, the manic state resolved, and consciousness and disorientation improved. A few months later, the patient remained stable with no other symptoms except gait instability.

Lithium neurotoxicity is a rare but severe complication of chronic lithium treatment, which can occur even at therapeutic levels (Konieczny K et al. Alpha Psychiatry 2024; 25:190-205). It should be suspected in cases of cerebellar ataxia, parkinsonism, disorientation, or cognitive impairment and requires early intervention to prevent irreversible neurological dysfunction (Schneider MA et al. J Neurosci Nurs. 2019; 51:283-286). In this case, symptoms improved following lithium discontinuation, although sequelae persisted months later, suggesting a potential diagnosis of SILENT syndrome.

We encourage clinicians to consider these symptoms and approach lithium dosing more cautiously in patients undergoing long-term treatment who have maintained psychopathological stability over time (Marmol S et al. Cerebellum 2024; 23:1733-1735).

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The number of elderly people requiring social and health care support in the last years of life is constantly increasing. The consequence is a significant increase in the number of guests in assisted nursing homes. The elderly patient, collaborating with healthcare professionals, becomes the protagonist of the entire care process. The places and times of care, together with the lived experience and the emotions felt, are just some dimensions of humanization, dignity of care and dignified care. This recognition of the patient experience within the definition of quality of care is associated with better clinical outcomes and patient safety. Patient Reported Experience Measures (PREM) are psychometrically validated questionnaires returned directly by patients and aim to provide a standardized assessment of individual care experiences.

Assess the emotionality, dignity, depressive symptoms of the elderly patient without significant psychiatric disorders at the time of admission to a place of care.

Sixty-seven elderly subjects (28 F, 38 M) were recruited in some elderly residential facilities (total mean age (yrs)(±SD): 75.64 ±5.96)

age ≥ 65 years; MMSE ≥20; absence of overt diagnosis of psychiatric or neurodegenerative disorders (evaluation with SCID-5-CV). All patients were given a PREM questionnaire at the beginning and during the care pathway. All patients were administered at baseline (T0), after 6 months (T1) and after 1 year (T2) the following evaluation rating scales:

• - Mini-Mental State Examination (MMSE) (only T0); Patient Dignity Inventory (PDI); Geriatric Depression Scale (GDS); Global Assessment of Functioning (GAF); Quality Life Index (QLi)

The data were statistically analyzed with the EZAnalyze 3.0 software for the Excel platform.

Tables 1 and 2 show the results obtained with each scale analyzed. On the PDI scale, the ANOVA results indicate that at least two of the repeated measures differed significantly [Mean scores ± Std. Dev: (T0) 63.388 ± 22.042; (T1): 57.313 ±21.159; (T2): 49.985 ±17.418]. The data obtained with the GDS scale showed no variation during the observational period. Although the differences were not statistically significant, the data indicate that no increases in depressive symptoms were observed. I results obtained with the QLi showed that the ANOVA results indicate that at least two of the repeated measures differed significantly [Mean scores ± SD: (T0) 3.358 ± 1.164; (T1): 6.075 ±1.222; (T2): 6.657 ±1.213]. Similar results were observed with the GAF scale.

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Intervention programs that allow older residents to express their emotions and observations are not only beneficial for corporate welfare, but also promote a sense of empowerment and involvement. Our small observational study has shown that these programs can significantly improve residents’ quality of life and protect against the onset of depressive symptoms.

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Dementia is a syndrome usually chronic and progressive, in which cognitive deterioration occurs at a rate greater than what is expected due to natural aging. (WHO). Because it has a major impact on functional levels, dementia is a major cause of dependence and loss of autonomy in the elderly population.

As the population ages, the prevalence of dementia disorders is expected to increase over the years. This will lead to serious problems in the healthcare sector and social welfare. As populations age, the prevalence of dementia will increase, with the number of people with dementia worldwide expected to rise to 150 million by 2050.

This group of neurocognitive disorders has multiple possible aetiologies, constituting a highly heterogeneous group. However, several studies within this area have been searching for and studying modifiable risk factors, to predict and reduce its incidence.

The authors propose a review of the various modifiable risk factors involved in developing dementia syndromes.

Review of the existing literature about modifiable risk factors for dementia, using the keywords: dementia, modifiable risk factors, prevention. The results were selected taking into account the degree of relevance.

Several studies argue that several modifiable risk factors may be involved in the development of dementia, from early to late life, such as less education, mental illnesses such as depression, hearing, and vision loss, high LDL cholesterol, and social isolation, among others.

Dementia has a significant mortality rate and is responsible for great disability and dependence in older populations. The implementation of global health measures, focusing on prevention and reducing risk factors, could be an important link in reducing the prevalence of dementia in the future.

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Humor is widely recognized for its potential to improve psychosomatic health, enhancing both physical and mental well-being.

To investigate the correlation between humor styles and psychosomatic health in older adults.

A cross-sectional study was conducted with 83 older adults (41 females, 42 males), aged 65 to 94 years (mean age: 74.1, SD = 8.1). Participants completed a sociodemographic questionnaire, the 32-item Humor Styles Questionnaire, and the 36-Item Short Form Survey (SF-36). Linear regression analysis was used to examine the relationship between humor styles and psychosomatic health outcomes.

Self-Enhancing Humor. For Aggressive Humor, the mean was 22.7 (SD = 7.95), and for Self-Defeating Humor, 26.3 (SD = 8.70). The mean scores for Physical Health and Mental Health were 277 (SD = 84.5) and 272 (SD = 70.6), respectively. Self-Enhancing Humor had a significant positive effect on Mental Health (B = 3.458, SE = 0.893, p < 0.001), RF (B = 0.7659, SE = 0.375, p = 0.044), GH (B = 0.7113, SE = 0.234, p = 0.003), MH (B = 0.9711, SE = 0.228, p < 0.001), and SF (B = 0.7165, SE = 0.329, p = 0.033). Additionally, Self-Defeating Humor showed a significant negative effect on RE (B = -1.093, SE = 0.474, p = 0.024).

The findings suggest that positive humor styles, particularly Self-Enhancing Humor, are strongly associated with better psychosomatic health in older adults. Incorporating humor-based interventions could be a valuable approach to enhancing psychosomatic health in this population.

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