Current Evidence for the Clinical Use of Long-Chain Polyunsaturated N-3 Fatty Acids to Prevent Age-Related Cognitive Decline and Alzheimer’s Disease.

Current evidence for the clinical use of long-chain polyunsaturated N-3 Fatty acids to prevent age-related cognitive decline and Alzheimer’s disease.

J Nutr Health Aging. 2013; 17(3): 240-51
Dacks PA, Shineman DW, Fillit HM

An NIH State of the Science Conference panel concluded in 2010 that insufficient evidence is available to recommend the use of any primary prevention therapy for Alzheimer’s disease or cognitive decline with age. Despite the insufficient evidence, candidate therapies with varying levels of evidence for safety and efficacy are taken by the public and discussed in the media. One example is the long-chain n-3 (omega-3) polyunsaturated fatty acids (n-3 LC-PUFA), DHA and EPA, found in some fish and dietary supplements. With this report, we seek to provide a practical overview and rating of the level and type of available evidence that n-3 LC-PUFA supplements are safe and protective against cognitive aging and Alzheimer’s disease, with additional discussion of the evidence for effects on quality of life, vascular aging, and the rate of aging. We discuss available sources, dose, bioavailability, and variables that may impact the response to n-3 LC-PUFA treatment such as baseline n-3 LC-PUFA status, APOE ?4 genotype, depression, and background diet. Lastly, we list ongoing clinical trials and propose next research steps to validate these fatty acids for primary prevention of cognitive aging and dementia. Of particular relevance, epidemiology indicates a higher risk of cognitive decline in people in the lower quartile of n-3 LC-PUFA intake or blood levels but these populations have not been specifically targeted by RCTs. HubMed – depression

Hypovitaminosis d in psychogeriatric inpatients.

J Nutr Health Aging. 2013; 17(3): 231-4
Lapid MI, Drake MT, Geske JR, Mundis CB, Hegard TL, Kung S, Frye MA

Objectives: This study investigated the rate of hypovitaminosis D in psychogeriatric inpatients and explored whether any associations exist between vitamin D levels, cognitive function, and psychiatric diagnoses. Design: Retrospective medical record review from November 2000 through November 2010. Setting: Geriatric psychiatric ward of an academic tertiary care hospital. Participants: Psychiatric inpatients aged 65 years or older. Measurements and analysis methods: Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at admission. Associations between 25(OH)D levels, Mini-Mental State Examination (MMSE) scores were analyzed using Spearman correlations, and psychiatric diagnoses were analyzed using logistic regression models and Fisher’s exact tests. Results: In 141 subjects (mean age, 77.8 years; 86 [61%] female; 135 [96%] white), the most frequent diagnoses were major depressive disorder in 81 patients (57%), dementia in 38 (27%), delirium in 13 (9%), anxiety in 12 (8.5%), and bipolar disorder in 11 (8%). Mean MMSE score was 24±6.4 (range, 3-30). Forty-three subjects (30.4%) had mild to moderate vitamin D deficiency [25(OH)D, 10-24 ng/mL], and 6 (4.2%) had severe deficiency [25(OH)D <10 ng/mL]. Conclusions: Hypovitaminosis D was common in elderly psychiatric inpatients. No associations were found between vitamin D levels and global cognitive function or psychiatric diagnoses. HubMed – depression

[Electroconvulsive Therapy as a “Last Resort” in the Treatment of Depression?]

Psychiatr Prax. 2013 Mar 4;
Pfaff M, Seidl A, Angst K, Ramseier F, Seifritz E, Quednow BB, Böker H

Objective: The use of electroconvulsive therapy (ECT) in treatment-resistant depressed patients is supported by numerous international guidelines. This study aims to describe what type of patients are actually referred to treatment with ECT.Methods: We included all patients referred to two main ECT-treatment centers in Switzerland during the period of August 2008 to February 2011. We collected data on the diagnosis, severity of illness, and the history of treatment.Results: Most of the patients (n = 104) were referred after an average of 124 weeks of an index episode of unipolar depression. The patients were severely and chronically ill and had been treated on average for more than a decade. Eighty-three percent of the patients were referred for ECT treatment for the first time.Conclusions: The surveyed practice of referral does not concur with evidence-based guidelines for the use of ECT in the treatment of depression. HubMed – depression