Micro-RNAs are short non-coding sequences playing a major role in regulating gene expression. Peripheral levels of the micro-RNA miR-1202 have been shown to predict antidepressant response and to change during treatment. However, it is not clear to what extent these peripheral measures reflect central neural changes in vivo.

We aimed at investigating a potential link between peripheral micro-RNA and neuroimaging measures.

At baseline and after 8 weeks of desvenlafaxine (50–100 mg die), twenty depressed patients were scanned with 3 T magnetic resonance imaging, first at rest then during the Go/NoGo task, a classical test of response inhibition. Blood samples were taken for RNA extraction.

During resting state, baseline miR-1202 levels were predictive of decreased connectivity between the posterior cingulate and the prefrontal, occipital and parietal cortices. Changes in miR-1202 levels were correlated with changes in activity in right precuneus within the default-mode network, and with decreased connectivity between the posterior cingulate and the temporal and prefrontal cortices, and the precuneus. During the Go/NoGo task, baseline levels and changes in these levels were correlated with activity changes in different regions, including bilateral prefrontal, insular, cingulate, and temporal cortices. Finally, secondary analyses suggest an association between miR-1202 levels and glutamate levels measured by spectroscopy in dorsomedial prefrontal cortex.

This is the first study showing that baseline and changes in peripheral levels of one micro-RNA were associated with changes in brain activity and connectivity during an antidepressant treatment. MiR-1202 may act through the modulation of the glutamatergic system.

Over 20% of patients with developmental delay (DD) has copy number variations (CNV) of unknown significance. Some CNV may be associated with disease in a patient and also present in their apparently healthy parents. According to the two-hit model another CNV may contribute to phenotypic variation of such genomic disorders.

DD diagnostics improvement.

Understanding the pathogenic significance of concomitant 3q13.31 and 22q13.32-q13.33 microdeletions.

Ring chromosome 22 was first detected by conventional cytogenetics. Microdeletions at 3q13.31 and 22q13.32–q13.33 were revealed by agilent technologies 60 K microarray and confirmed by qPCR. Ring chromosome was confirmed by FISH.

We present a four-year-old girl with del22q13.32-q13.33 resulted in a ring chromosome 22 and a single TUSC7 gene microdeletion at 3q13.31. The del22q13.32-q13.33 originated de novo, whereas del3q13.31 was inherited from healthy mother. The 22q13.32-q13.33 locus is associated with Phelan-McDermid syndrome (PHMDS, OMIM 606232). The patient demonstrated features both typical for the syndrome (psychomotor and speech development delay, autistic signs, aggression, sleep alteration, seizures) and atypical – attention deficit-hyperactivity disorder (ADHD), ventriculomegaly, and reduced size of cerebella hemispheres (Dandy-Walker variant). ADHD and ventriculomegaly were previously described in patients with del3q13.31 (OMIM 615433) but Dandy-Walker variant was observed in our patient for the first time. Possibly, atypical for PHMDS features, may result from trans-epistasis of microdeletions.

Multiple CNVs in one patient complicate genotype-phenotype correlations due to possible overlapping phenotypes and/or modifying effect of variants. This study was supported by Russian Science Foundation, grant no. 16-15-10231.

Individualized treatment decisions in psychiatry may be important, since substantial part of first choice drugs are ineffective or cause side effects. Polymorphic variants of genes that code CYP450 enzymes cause differences in their activity and therefore in efficacy and safety of drugs that are metabolized by them.

Determine whether pharmacogenetic testing of CYP2D6, CYP2C19 and CYP2C9 polymorphism would have had influence on selected patients’ treatment courses.

Five patients that were diagnosed for treament-resistant mood disorders in Vilnius university hospital Santariskiu clinics centre of neurology, department of psychiatry were invited to give blood samples for genetic testing retrospectively. Patients’ CYP2C19, CYP2D6 and CYP2C9 enzymes genetic polymorphism results were compared with previous empirical pharmacological treatment courses of these patients.

In four out of five cases significant polymorphism of CYP2C19 enzyme allele was detected. In all of these cases 1*/2* variant, that conditions intermediate metabolizer phenotype, was identified. Alterations in CYP2D6 and CYP2C19 regions were not found. In three cases the presence of varied genetic variant could have been clinically relevant. In two of these cases Sertraline and valproates, that are both metabolized by CYP2C19 enzyme, were taken by patients and side effects were observed. Unsuccessful treatment was repeated without effect, both in clinical and outpatient environment. Continuous rehospitalization took place until appropriate empirical treatments were established.

Pharmacogenetic testing could have had influence on treatment choices for three out of five selected patients leading to less side effects and rehospitalizations.

The authors have not supplied their declaration of competing interest.

Currently available data on the aetiology of schizophrenia suggests a major involvement of epigenetic mechanisms. One such mechanism could be the alteration of activation and silencing of genes, which involves DNA methylation and de-methylation. The main limiting enzyme involved in the methyl-donor cycle is methylene-tetra-hydro-folate-reductase (MTHFR), and the most frequently observed mutation in the MTHFR gene, altering its activity, is the C677 T mutation.

In the present study, we investigated the frequency of MTHFR C677 T mutation and total plasma homocysteine (tHcy) concentrations in a sample of Romanian schizophrenia patients as compared to healthy controls.

Seventy schizophrenia patients (35% females) with a mean age of 38.8 ± 20.5 years and 50 healthy controls (50% females) with a mean age of 36.3 ± 11.6 years were included. MTHFR genotype was determined through polymerase chain reaction and tHcy levels were determined through reversed phase high-pressure liquid chromatography.

Schizophrenia patients, registered higher frequency of the T allele, with the CC genotype observed in 39.4% of them, as compared to a frequency of 60.6% in the control group (P = 0.002–Fisher's exact test). tHcy concentrations did not differ between the two groups (10.7 ± 4.2 vs. 11.2 ± 4.1, P > 0.005–Mann–Whitney U test).

Romanian schizophrenia patients have a significantly higher frequency of the MTHFR C677 T mutation, but without significant effect on tHcy concentrations.

The authors have not supplied their declaration of competing interest.

Metabolic syndrome is a significant problem in the schizophrenia patients. Previous research demonstrated that single nucleotide polymorphisms in the serotonin 2C receptor (5HTR2C) genes are associated with metabolic syndrome related to schizophrenia patients taking atypical anti-psychotic drugs. This study aimed to investigate whether the effect of 3 SNPs in 5HTR2C gene on the presence of the metabolic syndrome in Thai schizophrenia patients.

We conducted a cross-sectional study and 154 patients were recruited. The schizophrenia patients were identified from a diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV) and criterion and determined the metabolic syndrome according to the 2005 international diabetes federation (IDF) Asia criteria. Patients were genotyped for the 5HTR2C rs51,8147, rs126,881,02, rs128,367,71 polymorphisms.

The preliminary analysis from 154 patients showed the metabolic syndrome prevalence was 38.73%, with 46.50% in male and 53.48% in female patients. The results showed that the patients who have heterozygous and homozygous variant on 5HTR2C gene (rs518,147 and rs126,881,02) showed a significant difference in the presence of metabolic syndrome when compare with patients who carry homozygous wild type (P = 0.007), especially in male patients (P = 0.002). The association between 5HTR2C polymorphisms and metabolic syndrome was found in male patients but not found in female patients.

These findings suggest that 5HTR2C genotypes are associated with the metabolic syndrome in patients taking atypical anti-psychotics. However, the metabolic syndrome results from the multigenetic effects. The further studies should focus on the other genes, which were involved in metabolic syndrome.

The authors have not supplied their declaration of competing interest.

The gene CYP2D6 is of great interest also due to its highly polymorphic nature, and involvement in a high number of medication metabolisms. The presence of polymorphisms in the CYP2D6 gene may modulate enzyme level and activity, thereby affecting individual responses to pharmacological treatment.

Allele and genotype frequency distributions of CYP2D6*10 variants and predicted phenotypes were analyzed in blood samples of 123 patients (53 patients from north-western region and 69 patients from Siberian region) using polymerase chain reaction (PCR)-restriction fragment length polymorphism, PCR-single-strand conformation polymorphism.

The T/T, C/T, and C/C genotype frequencies of the CYP2D6*10 allele were significantly different (P < 0.01) in regional groups. The frequency of the wild homozygous variant C/C of the CYP2D6*10 allele (extensive metabolizers) in the Siberian region was the highest, while the north-western region of Russia had the lowest frequency (P < 0.001), which are 82.6% and 64.2%, respectively. The frequency of the heterozygous variant C/T of the CYP2D6*10 allele (intermediate metabolizers) was significantly a bit high in the north-western region, while the Siberian region of Russia had the lowest frequency (P < 0.001), which are 35.8% and 17.4%, respectively. The homozygous variant T/T of theCYP2D6*10 allele (poor metabolizers) was not identified.

The C100T polymorphism of the CYP2D6 gene may be associated with several drug-induced reactions in patients with depression, schizophrenia, epilepsy etc. The differences in the prevalence of intermediate metabolizers in north-western and Siberian regions of Russia may be due to genetic drift and accumulation of alleles typical of European and Asian populations.

The authors have not supplied their declaration of competing interest.

Anxiety symptoms are frequent during pregnancy, and they adversely affect pregnancy outcomes and offspring development. The underlying biological mechanisms are not known, but may in part be explained by alterations in certain maternal metabolic pathways. No metabolomic studies have investigated possible metabolic alterations in anxious pregnant women.

This pilot study compared the metabolic profiles of anxious and non-anxious pregnant women using a mass spectrometry-based quantitative metabolomics system.

Cases were 20 participants of the Kuopio birth cohort study (www.kubico.fi) with first and third trimester symptoms of anxiety (Edinburgh postnatal depression scale, anxiety subscale – EPDS-3A ≥ 4), but no depression (EPDS ≤ 12). Controls were 20 participants with low anxiety (EPDS–3A ≤ 3) and depression (total EPDS ≤ 9) in both the first and third trimester. Maternal metabolic profiles were analyzed from serum samples drawn when the mothers arrived at the delivery hospital.

Metabolic pathway analyses revealed significant enrichment in the glycine, serine and threonine metabolism (P = 0.046), as well as in the betaine (P = 0.048) metabolism pathways. Homocysteine was the only metabolite to significantly differentiate between cases and controls (VIP score 3.3), with lower concentrations in cases (P = 0.003) even when excluding non-users of folic acid supplementation (n = 5; P = 0.002), C-sections (n = 5; P = 0.013), or samples taken immediately postpartum (n = 2; P = 0.004). No other metabolites significantly differed between the groups.

Physiological adaptation induced by pregnancy, which may have homogenized the study populations, could explain the only minor metabolic differences between the two groups. Further research in larger samples, comparing metabolic alterations in umbilical cord blood and maternal blood is warranted.

The authors have not supplied their declaration of competing interest.

Structural neuroimaging studies have revealed a consistent pattern of volumetric reductions in both the hippocampus and the anterior cingulate cortex (ACC) of individuals with a major depressive episode (MDE). This study investigated hippocampal and ACC volume differences in the elderly comparing currently depressed individuals and individuals with a past lifetime history of MDE versus healthy controls.

We studied non-demented individuals from a cohort of community-dwelling people aged 65 and over (ESPRIT study). T1-weighted magnetic resonance images were used to acquire anatomical scans from 150 currently depressed individuals, 79 individuals with at least one past MDE, and 310 healthy controls. We derived quantitative regional estimates of subcortical volume of hippocampus and ACC using FreeSurfer Software (automated method). Concerning hippocampus, we also used a manual method of measurement. General Linear Model was used to study brain volumes in current and past depression adjusting for gender, age, education level, total brain volume, and anxiety disorder comorbidity.

After adjustment, current depression was associated with a lower left posterior hippocampal volume (F = 10.38, P = 0.001) using manual estimation of volume. No other significant differences were observed. A positive correlation was found between time since the last MDE and left posterior hippocampal volume.

The finding of left posterior hippocampal volume reduction in currently depressed individuals but not in those with a past MDE compared to healthy controls could be related to brain neuroplasticity. Additionally, our results suggest manual measures to be more sensitive than automated methods.

The authors have not supplied their declaration of competing interest.

Evidence from the literature suggests that group mindfulness interventions result in improved quality of life, less depressive symptoms and improved subjective sleep quality among patients with memory problems [1].

To design and pilot a brief mindfulness intervention for Memory Clinic attendees.

To develop a non-pharmacological low-resource intervention for Memory Clinic attendees.

An introduction to mindfulness pack, designed by author CD, includes a booklet introducing the concept of mindfulness, instructions for meditation exercises with an accompanying CD. Memory clinic attendees diagnosed with subjective memory complaints or mild cognitive impairment were invited to take part. Participants completed standardised questionnaires pre- and post-intervention, which examined subjective memory, depression and anxiety symptoms, subjective sleep quality, worry and mindfulness levels. Qualitative information was also gathered.

Of twenty-four participants (66.6% female, mean age 60.8 years), 14 (58.3%) completed the 6-week study. There was no statistical difference in anxiety and depressive symptoms, quality of life, sleep quality and worry levels pre- and post-intervention among participants. However, 100% of participants found the mindfulness intervention beneficial, with 64.3% (n = 9) reporting a subjective improvement in both memory and concentration.

In this small pilot study, a brief self-guided mindfulness intervention was found to be acceptable to a heterogenous group of Memory Clinic attendees.

The authors have not supplied their declaration of competing interest.

The association between economic crises and mental health problems can be attributed to a number of factors. Among these, age seems to be an important determinant.

The aim of this study was to assess whether mental health of the Portuguese population following the onset of the 2008 recession, differs by age groups.

A follow-up study (2015) on the population aged 18 to > 65 years old, using the National Mental Health Survey (n = 911). The age-group prevalence of mental health distress assessed by the ten-item Kessler's Psychological Distress Scale (K10) was calculated using Chi2 statistics and mental distress as a categorical variable (P < 0.05).

Mean mental distress score differed significantly according to age group, χ2(3) = 10.684, P < = 0.05. The results showed that the older groups (50–64 and 65 = years old) were more frequently under mental distress (17–19%) compared to younger people (18–49 = years old), which were less likely to report being distressed (8–12%).

Age seems to be an important determinant of distress levels during the economic crisis in Portugal. Older adults reported to be more distressed compared to younger individuals. There are several hypotheses for a differential expression of psychological distress between age groups such as working status and retirement, which can express differential access to coping resources under such contextual negative pressure of economic recession. Further research on age groups is thus needed to better understand how recession generates adverse effects on mental well-being.

The authors have not supplied their declaration of competing interest.

Previous studies provided inconsistent evidences for the effect of apolipoprotein E ɛ4 (APOE ɛ4) status on the visuospatial working memory (VSWM). Our study was the first investigation with event-related potential (ERP) to explore the effect of APOE ɛ4 on VSWM in healthy elders and aMCI patients.

The aim was to investigate the effect of APOE ɛ4 on VSWM with event-related potential (ERP) study in healthy elders and aMCI patients.

Thirty-nine aMCI patients (27 APOE ɛ4 non-carriers and 12 APOE ɛ4 carriers) and 43 their matched control (25 APOE ɛ4 non-carriers and 18 APOE ɛ4 carriers) performed an N-back task, a VSWM paradigm that manipulated the number of items to be stored in memory.

Our study detected reduced accuracy and delayed mean correct response time in aMCI patients than healthy elders. P300 was elicited by VSWM and its amplitude was lower in aMCI patients at the central-parietal and parietal electrodes than healthy controls. In healthy elders, P300 amplitude declined prior to task performance change in APOE ɛ4 carriers than non-carriers. Regarding aMCI patients, P300 amplitude result revealed exacerbated VSWM deficits in APOE ɛ4 carriers than APOE ɛ4 non-carriers. Additionally, standardized low-resolution brain electromagnetic tomography analysis (s-LORETA) result showed enhanced brain activation in right parahippocampal gyrus during P300 time range in APOE ɛ4 carriers than non-carriers in aMCI patients (Fig. 1, Tables 1 and 2).

It demonstrated that P300 amplitude might serve as a biomarker for recognizing aMCI patients and contribute to early detection of worse VSWM in APOE ɛ4 carriers than non-carriers.

The author has not supplied his/her declaration of competing interest.

CBS becomes more prevalent as the population ages. CBS is characterized by the triad of impairment of vision, complex visual hallucinations with insight, mentally normal people. Although visual hallucinations in the elderly are often associated with dementia with Lewy body, Alzheimer's disease and delirium, they are excluded from the diagnosis of typical CBS. Here, we describe three typical CBS patients whose visual hallucinations developed after bilateral severe visual impairment due to diabetic retinopathy. The effectiveness of agomelatine adds to evidence implicating serotonergic and melatoninergic pathways in the pathogenesis of visual hallucinations.

The average age of these three patients (2 males and 1 female) is 71. Except for the visual hallucinations, all patients showed no psychiatric symptoms or cognitive decline or neurological focal signs. They were frequently upset by the fact of hallucinating, fearing that they are losing their minds. They lived in fear of impending insanity, guilty feeling, unhappy mood, insomnia. The frequency of visual hallucinations stopped with agomelatine 25 mg/day for 3 weeks in these cases.

To our knowledge, this is the first report describing the effectiveness of agomelatine in treating typical CBS patients and indicates that agomelatine is an safer option for the treatment of CBS, especially in the elderly, diabetic population. Therapeutic options for CBS still remain poor and of uncertain benefit for the individual patient. CBS has a high prevalence rate (0.4%–30%) among the visually impaired. Clinicians must ask elderly people with visual impairment whether they have hallucinations. Firm reassurance that the syndrome is not related to mental illness is a major relief to an elderly person burdened already with failing vision.

The authors have not supplied their declaration of competing interest.

Motor, perceptual, and cognitive functions affect driving competence. White matter hyperintensities (WMH) changes on brain MRI are associated structural brain changes along with cognitive and motor performance. The aim of this study was to investigate the association between WMH and driving ability in the elderly.

Participants (n = 540) were drawn from a nationwide, multicenter, hospital-based, longitudinal cohort study. Each participant underwent clinical evaluations, neuropsychological tests, and interview for caregiver including driving capacity, which was categorized as ‘now driving’, and ‘driving cessation (driving before, not now)’. A total 540 participants were divided into three groups (389 mild, 116 moderate, and 35 severe) depending on the degree of WMH. The same evaluations of them were followed after each year. The statistical analyses were performed using χ2 test, an analysis of variance (ANOVA), structured equation model (SEM), and generalized estimating equation (GEE).

In a SEM, greater baseline degree of WMH was directly associated with driving cessation regardless of cognitive and motor dysfunction (β = –0.110, P < 0.001). In GEE models controlling for age, sex, education, cognitive, and motor dysfunction, the more severe changes of the degree of WMH was associated with the faster change from ‘now driving’ state to ‘driving cessation’ state over time in the elderly (β = –0.508, P < 0.001).

In both cross-sectional and longitudinal aspects, the degree of WMH might be one of the predictive factors for driving cessation in the elderly, reflecting both motor and cognitive functions or independently.

The authors have not supplied their declaration of competing interest.

Several studies have reported controversial links between swallowing disturbances (SD) and psychiatric disorders in older age. The available data on the epidemiology of SD in the general population are scarce and often conflicting, because of numerous methodological factors source of possible counfounders.

We aimed to screen the presence of psychiatric and cognitive disorders associated with SD in a random sampling of the general population ≥ 65.

A sample of 1127 elderly individuals collected in a population-based study (GreatAGE) in Castellana Grotte (53,50% males, mean age 74.1 ± 6.3 years), South-East Italy, were mailed a validated self-report questionnaire to assess SD (Eating Assessment Tool-EAT10). Psychiatric disorders and symptoms [assessed with Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, Geriatric Depression Scale-30 (GDS-30) and Symptom Checklist Revised-90 (SCL-90R)], cognitive functions were assessed with a comprehensive neuropsychological battery, neurological exam, and demographics were compared in participants with and without SD using t-tests and Mann–Whitney U-test.

The prevalence rates of SD amounted at 5.97%. Psychiatric diagnosis (24.22% of the sample) was statistically significant associated with SD (EAT ≥ 3, P = 0.038), and a trend was found for major depressive disorder and generalized anxiety disorder. Among SCL-90R domains, only anxiety showed a significant association with EAT ≥ 3 (P = 0.006). GDS-30 score was found to be higher in subjects with SD (P = 0.008). Cognitive functions did not differ between the two groups except for an increasing trend for Clinical Dementia Rating Scale in EAT ≥ 3 (P = 0.058).

These preliminary results showed an association between SD in older age and late-life major depression and anxiety disorders.

The authors have not supplied their declaration of competing interest.

The validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.

To compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.

The sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.

According to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).

At the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.

The authors have not supplied their declaration of competing interest.

Elderly patients in nursing homes (NH) are often prescribed medications for many physical and mental health problems, with polypharmacy. There is a considerable number of studies documenting this extensive prescription of psychotropic medication, despite the raised concerns about their overuse/misuse, due to serious adverse effects, including increased rate of cognitive decline associated with antipsychotics.

To characterize the prescription of psychotropics in elderly sample with cognitive impairment living in NH.

Elderly living in three Portuguese NH were included in this cross-sectional study. All residents were eligible, unless they were unwilling or unresponsive. Participants’ medication was obtained from medical records. Guidelines of ATC were used to categorize the drugs. Participants were assessed with MMSE and GDS.

The sample included 172 elderly, mostly women (90%), with average of 81(sd = 10) years and median lengths of stay of 3 years. Overall, 79.1% used ≥ 1 nervous system-acting drugs. Anxiolytics (54.7%), antidepressants (29.1%) and antipsychotics (23.3%) were the most frequent. The majority (58%) presented cognitive impairment (MMSE). Among those, 46.2% presented depression (GDS) and 79.6% took at least one drug for the CNS and 41.9% ≥ 3. Antipsychotics were received by 26.5%, while 57.1% used anxiolytics, 31.6% antidepressants and 16.3% anti-dementia drugs. No significant relation between GDS and antidepressants was found.

This study confirms the high usage of CNS drugs in patients with cognitive impairment in NH. These rates were comparable with previous studies. Antidepressants appear to be under-used, which can be related to the under-recognition of depression. Also, potential harmful psychotropic drugs such as anxiolytics and antipsychotics are overused.

The authors have not supplied their declaration of competing interest.

Suicide rates worldwide are highest in elderly people compared to younger ages. The recognition of risk factors for late life suicide may be crucial, since one in four attempts is consummated. In this context, pain has been identified as a major event raising the probability for suicide in elders although very little research has examined this association.

To conduct a systematic review to examine whether pain is a risk factor for suicidal behaviour (suicide ideation/attempt/suicide) in elderly people.

The Cochrane Collaboration's guidelines and PRISMA statement were used. The electronic databases considered were MEDLINE, ISI Web of Knowledge, Scopus and PsycARTICLES. Search terms were “pain”, “suicide*” and “elderly”. Studies that assessed the relation between pain and suicidal behavior among people aged ≥ 60 years were included.

Of the 2655 references founded, only 41 articles met the inclusion criteria. Most of the quantitative studies concluded that there is a relationship between pain and late life suicidal ideation, in particular severe and chronic pain. Physical or psychological pain was also reported as the cause of attempting suicide in two studies and was considered an important risk factor for committed suicide in eight of them.

The results suggest that pain is a risk factor for suicidal behaviour in elderly people, especially suffering from severe and chronic pain, which are in accordance with previous reviews in this field. Future studies are needed to clarify this association and highlight about the importance of pain in suicide prevention initiatives for elders.

The authors have not supplied their declaration of competing interest.

Long-term care for the elderly by their family members represents a serious burden in Italy. The physical and psychological health of informal caregivers is a growing public health issue. Old patients often seek urgent medical attention in the Emergency Department (ED) and hospitalisation is frequent event among the elderly.

Aim of the study was (1) to investigate the burden of care among the caregivers of old patients; (2) to examine the influence of the burden experienced by the caregivers on ED and hospital admissions of the elderly.

We conducted a descriptive study of patients aged 75 years or older and their caregiver admitted to the ED from 10/1/15 to 6/10/15 (77 patient-caregiver pairs). The caregivers were evaluated using the Caregiver Burden Inventory (CBI). A case manager collected the patient's data.

CBI score is the highest among patients seeking ED evaluation due to caregiver's concern. The majority of the elderly admitted to the ED whose caregiver shows elevated emotional burden at the CBI do not present with serious or urgent medical condition and are not hospitalised. Emotional burden is the highest among the caregivers of demented subjects who share the same house.

Our findings indicate that the burden experienced by caregiving family members plays a role in elderly people avoidable ED visits.

The authors have not supplied their declaration of competing interest.

The study aims to examine whether cognitive deficits are different between patients with early stage Alzheimer's disease (AD) and patients with early stage vascular dementia (VaD) using the Korean version of the CERAD neuropsychological battery (CERAD-K-N).

Patients with early stage dementia, global Clinical Dementia Rating (CDR) 0.5 or 1 were consecutively recruited among first visitors to a dementia clinic, 257 AD patients and 90 VaD patients completed the protocol of the Korean version of the CERAD clinical assessment battery. CERAD-K-N was administered for the comprehensive evaluation of the neuropsychological function.

Of the total 347 participants, 257 (69.1%) were AD group (CDR 0.5 = 66.9%) and 90 (21.9%) were VaD group (CDR 0.5 = 40.0%). Patients with very mild AD showed poorer performances in Boston naming test (BNT) (P = 0.028), word list memory test (P < 0.001), word list recall test (P < 0.001) and word list recognition test (WLRcT) (P = 0.006) than very mild VaD after adjustment of T score of MMSE-KC. However, the performance of trail making A (TMA) was more impaired in VaD group than in AD group. The performance of WLRcT (P < 0.001) was the worst among neuropsychological tests within AD group, whereas TMA was performed worst within VaD group.

Patients with early-stage AD have more cognitive deficits on memory and language while patients with early-stage VaD show worse cognitive function on attention/processing speed. In addition, as the first cognitive deficit, memory dysfunction comes in AD and deficit in attention/processing speed in VaD.

The authors have not supplied their declaration of competing interest.

The author has not supplied his/her declaration of competing interest.