Healthcare services are increasingly confronted with challenges related to old age mental disorders. The survey aimed to provide an overview of existing psychogeriatric services in Albania, Bulgaria, Greece, and North Macedonia.

After identification of psychogeriatric units across the four countries, their head physicians were asked to provide data on their clinical, teaching, and research activity, as well as staff composition. Moreover, the attitudes of head physicians to current needs and future service development were explored.

A total of 15 psychogeriatric units were identified (3 in Bulgaria, 8 in Greece, and 4 in North Macedonia). Results show wide variation regarding the location, team size and composition, service availability, numbers of patients attending, and inpatient treatment length. Most head physicians underscored the urgent need for breakthroughs in the graduate and postgraduate education in psychogeriatrics of medical and nonmedical professionals, as well as in the interconnection of their units with community primary healthcare services and long-term care facilities for seniors via telemedicine. They would welcome the development of national standards for psychogeriatric units, potentially embodying clear pointers for action. A number of head physicians advocated the development of nationwide old age mental health registries.

Regional disparities in resources and services for seniors’ mental health services were unveiled. These data may enrich the dialogue on optimizing psychogeriatric services through planning future cross-border collaborations mainly based on telemedicine services, especially in the era of the novel coronavirus pandemic, and training/education in psychogeriatrics of mental health professionals.

Depression and apathy are common behavioral symptom of Alzheimer's disease (AD) and antidepressants, despite their role in improving depression have a minimum impact in improving apathy. Agomelatine has been shown to be effective in alleviating depression and reversing treatment emergent apathy.

The purpose of the current pilot study is to determine the efficacy of agomelatine in depressed patients with AD and comorbid apathy.

In this prospective 4 month study, twenty depressed elderly AD patients (age 65-85) who had been treated with SSRI and/or SNRI and shown a partial response to the antidepressant prescribed, in terms of apathy, were switched to agomelatine. Subjects were monitored for depression (Hamilton Rating Scale for Depression, HDRS), cognitive functions (Mini–Mental State Examination, MMSE) and apathy (Neuropsychiatric Inventory –apathy item, NPI-a).

Within groups, differences of HDRS, CSDD, MMSE and NPI-a scores at baseline, 2nd and 4th month of agomelatine treatment were estimated with repeated measure analysis of variance.

Following agomelatine, a numeric but not statistically significant improvement was observed in depression scores (8.2±3.5 vs 7.8±3.1, p=0.234, 7.8±3.1 vs5.8±2.3, p=0.421). A marked improvement in MMSE score was observed at both 2nd (22.2±4.9 vs 20.9± 5.4, p=0.05) and 3rd assessment(22.2±4.9 vs 23.9±4.9, p<0.05). Apathy score was also improved over the consecutive assessments (25.3±5.9 vs 18.6±3.9, p<0.05 and 18.6±3.9 15.5±4.3, p<0.05).

The present study demonstrated a good therapeutic response to agomelatine in elderly AD patients with depression and apathy symptoms in terms of alleviating apathy.