The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) stated that CPR status must be considered and recorded for all acute hospital admissions. Compliance with this recommendation and with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) form documentation in an inpatient psychiatric hospital was assessed. Multidisciplinary team (MDT) opinions surrounding DNACPR were also explored with an aim to educate staff, improving frequency and quality of future discussions.

Ensure patient suitability for CPR is discussed at admission, that discussions are documented and forms completed in line with Trust policy and national guidelines.

Resuscitation Council UK guidelines were used as a standard, namely recommendations for clear and full documentation of CPR decisions triggered by a new admission to hospital. A retrospective study of admissions to the older adult psychiatric ward over a four-month period was carried out, identifying 25 patients fulfilling the inclusion criteria. Demographics and CPR consideration at the initial consultant ward round were documented. Completed DNACPR forms were audited for compliance with Trust guidance. Following data collection, 14 staff interviews using standardised questions were completed to gauge understanding of DNACPR. Answers were analysed and education was identified as key. Bite-sized teaching for MDT staff on DNACPR was carried out and response to the intervention assessed using these same standardised questions.

1 patient out of 25 had a CPR discussion documented from their initial consultant review. 12% had documentation of DNACPR consideration throughout the entirety of admission. The 1 DNACPR form subsequently completed had 91% compliance with Trust policy. Qualitative results from staff interviews were insightful with 50% knowing where DNACPR forms werekept, 29% feeling confident discussing DNACPR and 93% feeling able to contribute to team decisions.Following a bite-sized education session these figures increased to 100% having awareness and confidence discussing CPR suitability.

DNACPR considerations are infrequent and staff interviews suggest this may be due to lack of confidence and knowledge surrounding CPR. Bite-sized education may play a significant role in informing the MDT and ensuring vital DNACPR considerations are not forgotten about in the psychiatric setting.

Hallucinations are common in elderly. Understanding the diverse aetiologies and behavioural reactions to hallucinations is vital to provide the best level of care.

An 85-year-old man, with several cerebrovascular risk factors (dyslipidaemia, atrial fibrillation, previous ischemic-stroke), developed cognitive impairment after an acute confusional state (two years before), characterized mainly by short-term memory deficit and executive dysfunction. In the meantime, he started recurrent periods of multimodal hallucinations, with predominant sundowning pattern, along several months, comprising complex visual hallucinations, with which he interacted, sometimes combined with haptic hallucinations, describing a plastic sensation in his hands, and manifesting carphologia and psychomotor agitation. Insight into the hallucinatory nature of the phenomenon recovered after a few hours. The neurologic examination revealed partial left oculomotor nerve palsy (left exotropia and diplopia on the right conjugate eye movement), postural instability, slight truncal bradykinesia, and symmetrical rigidity. The neuroimaging studies confirmed small vessel disease with leukoaraiosis and lacunar infarcts in the lentiform nuclei. No lesions were observed within the visual pathway nor the midbrain.

This case leads to an interesting discussion regarding the differential diagnosis of combined hallucinations in elderly.

The presence of the oculomotor nerve palsy selectively affecting somatic fibers, raised the suspicious of peduncular hallucinosis, in the framework of vascular disorder. Combination of visual and tactile may occur in peduncular hallucinosis. However, the neuroimaging studies did not reveal ischemic lesions in the midbrain. Therefore, the most plausible aetiology for hallucinations is a demential syndrome, namely a vascular dementia, considering the findings on neuroimaging. Additionally, a Lewy-body disease (LBD) cannot be ruled out by virtue of the clinical picture of recurrent well-formed visual hallucinations, symptom fluctuation and slight parkinsonism, or even a Lewy-body variant of Alzheimer disease, considering the presence of amnestic symptoms. Tactile hallucinations have been described in alfa-synucleinopathies. Contrarily to Parkinson disease, when the LBD patients touch their visual hallucinations, the perceived objects often do not disappear and may experience specific texture and thermic sensations.

Future research would benefit from a more detailed investigation of the profile of similarities and differences in hallucinations across clinical disorders to facilitate differential diagnosis.

Since the disease caused by the SARS-Cov-2 virus was declared a pandemic by the World Health Organization, countries around the globe adopted measures of social distancing to limit the spread of the virus. Although social distancingmeasures are essential preventive mechanisms, they can promote feelings of loneliness and influence the onset or exacerbation of psychiatric disorders. Current knowledge about the impact of COVID-19 on mental health - and in particular on mental health of the geriatric population - is still scarce.

The present review aimed to analyze the COVID-19 pandemic impact on the elderly´s mental health and to suggest measures that can mitigate this impact.

A non-systematic review of the literature, through bibliographic research in Pubmed and Embase databases - using the keywords “COVID-19", “SARS-CoV-2", “Coronavirus”, “Aging”, “Older adults”, “Elderly”, “Quarantine” and “Mental health” -was performed.

The available literature points towards a likely increase in mental disorders as a result of the COVID-19 pandemic. This phenomena may be particularly relevant in the elderly population. Several measures – pharmacological and non-pharmacological – can help to maintain the physical and mental health of the elderly.

The COVID-19 pandemic had an important impact in elderly’s mental health. This subject should be addressed by profissionals/caregivers and measures tominimize negative consequences are in order.

Differentiating mild cognitive impairment with Lewy bodies (MCI-LB) from mild cognitive impairment due to Alzheimer’s disease (MCI-AD) is challenging due to an overlap of symptoms. Quantitative EEG analyses have shown varying levels of diagnostic accuracy, while visual assessment of EEG may be a promising diagnostic method. Additionally, a multimodal EEG-MRI approach may have greater diagnostic utility than individual modalities alone.

To evaluate the utility of (1) a structured visual EEG assessment and (2) a machine learning multimodal EEG-MRI approach to differentiate MCI-LB from MCI-AD.

300 seconds of eyes-closed, resting-state EEG from 37 MCI-LB and 36 MCI-AD patients were analysed. EEGs were visually assessed for the presence of diffuse, focal, and epileptiform abnormalities, overall grade of abnormalities and focal rhythmic delta activity (FIRDA). Random forest classifiers to discriminate MCI-LB from MCI-AD were trained on combinations of visual EEG, quantitative EEG and structural MRI features. Quantitative EEG features (dominant frequency, dominant frequency variability, theta/alpha ratio and measures of spectral power in the delta, theta, prealpha, alpha and beta bands) and structural MRI features (hippocampal and insular volumes) were obtained from previous analyses of our dataset.

Most patients had abnormal EEGs on visual assessment (MCI-LB = 91.9%, MCI-AD = 77.8%). Overall grade (Χ2 (73, 2) = 4.416, p = 0.110), diffuse abnormalities Χ2(73,1) = 3.790, p = 0.052, focal abnormalities Χ2 (73,1) = 3.113, p = 0.077 and FIRDA Χ2(73,1) = 0.862, p = 0.353 did not differ between groups. All multimodal classifiers had similar diagnostic accuracy (area underthe curve, AUC = 0.681 - 0.686) to a classifier that used quantitative EEG features only (AUC =0.668). The feature ‘beta power’ had the highest predictive power in all classifiers.

Visual EEG assessment was unable to discriminate between MCI-LB and MCI-AD. However, future work with a more sensitive visual assessment score may yield more promising results.A multimodal EEG-MRI approach does not enhance the diagnostic value of quantitative EEG alone in diagnosing MCI-LB.

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The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients’ neuropsychiatric morbidity. Currently, there is still few data regarding mental health after hospital discharge of severe COVID-19 elderly patients. Considering this, the present study aims to characterize the neuropsychiatric morbidity in old severe COVID-19 patients.

In the context of an ongoing multidisciplinary research project, this study analyzed a subsample of patients aged ≥60 years, admitted due to COVID-19, during the first wave, in the Intensive Care Medicine Department (ICMD) of a University Hospital in Porto, Portugal. ICMD length of stay (LoS) ≤24h, terminal illness, major auditory loss or inability to communicate at the time of follow- up were used as exclusion criteria. Participants were evaluated by telephone in average 99 (±32) days after being discharged from the hospital, with Six-item Cognitive Impairment Test, PatientHealth Questionnaire and Generalized Anxiety Disorder Scale. Sociodemographic and relevant clinicaldata were obtained from hospital electronic records and clinical interview.

A sample of 39 survivors with a mean age of 70 (±6.3) years old were assessed. The majority were male (62%), married (64%), retired (77%), with low educational level (59%), and 15% lived alone. The average number of comorbidities and the daily medications per patient were 4.7 (±1.7) and 5.5 (±3.5), respectively.

During ICMD stay, 69% had nosocomial infections and 56% delirium. Deep sedation was used in 74% of the patients (mean=30 days) and 74% needed Invasive Mechanical Ventilation. ICMD mean LoS was33 (±28.3) days. Based on follow-up assessment, 18% of survivors had cognitive impairment, whereas23% and 15% had depressive and anxiety symptoms, respectively. A positive and high correlation between depression and anxiety was found (rs=0.792; p<0.001). No significant associations were observed with cognitive impairment.

The presence of this symptomatology may hinder a successful recovery once the patient is discharged back home. This is particularly relevant accruing the strong relationship between depressive and anxious symptoms found in this sample. Therefore, early screening and timely multidisciplinary support interventions to minimize these neuropsychiatric symptoms after discharge should be considered in order to achieve positive health outcomes.