The stages of advanced dementia are often plagued with intense and distressing symptoms as well as a variety of critical care interventions. Perhaps this information is not too awful surprising to clinicians and healthcare professionals; however, for families, understanding the end-stage realities of dementia can be the difference between a distressing and burdensome happening and a loving calm goodbye. Findings from a study reported in the October 14th issue of the New England Journal of Medicine found that often times end-stage dementia is associated with eating disorders and various infections. Out of the 323 patients with advance dementia in the study, 40% developed pneumonia, nearly half had a febrile episode, and nearly 85% suffered from eating problems during the 18 month period of observation. According to Susan L. Mitchel, MD, MPH, of the Hebrew Senior Life Institute for Aging Research in Boston, and colleagues, “…patients, families and healthcare providers must understand and be prepared to confront the end-stage of this disease, which is estimated to afflict more than 5 million Americans currently and is expected to afflict more than 13 million by 2050.” Click here to read an article from TIME that discusses this study more.

According to a study published online in BMC Medicine, tricyclic antidepressants are more likely to cause suicidal thoughts as compared to SSRI. According to the study, men taking nortriptyline were 2.4 times more likely to have suicidal thoughts than those taking Lexapro (SSRI compared). Nortiptyline was also associated with a 9.8 fold higher risk of suicidal ideation than the SSRI. According to Nader Perroud, MD, of Kings College London, and colleagues, the difference between the two drugs and prevalence of suicidal ideation is that nortiptyline acts primarily in the noradrenergic system; this system, when it is over active, is often associated with agitation and anxiety. The researchers put it this way, “suicidal idiation is more common in agitated and irritable types of depression… it is possible that nortiptyline may induce or worsen suicidal thoughts in some male subjects, possibly through an induction of this more agitated type of depression.” Click here to read an article from Pharma Times that discusses the findings more.

What will they come up with next? According to an article published in the October issue of the Archives of General Psychiatry a vaccine against cocaine was effective in nearly 40% of the drugs users. According to Thomas Kosten, MD, of Baylor College of Medicine in Houston and colleagues, in the randomized placebo-controlled study volunteers, who after receiving the vaccination reached a high level of antibodies, ended up using less cocaine than those whose response was lower. According to the researchers, “We didn’t expect to cure them in six months… in clinical practice, you’d probably give people a booster shot every two months.” This appears to be some very exciting news with a great deal of potential. I could see where this would be particularly beneficial to those that were trying to decrease their dependance on the illegal substance. Click here to read an article from TIME that discusses the study more.

According to a study published in the October Archives of General Psychiatry, a Mediterranean diet may actually protect against factors causing depression. Countries that consume a majorly Mediterranean diet, which is largely composed of fruit, legumes, vegetables, and olive oil, have shown on average a lower lifetime prevalence of psychiatric disorders according to a Spanish study. Almudena Sanchez-Villegas, PhD, of the University of Las Palmas de Gran Canaria in Spain, and colleagues, relayed that after the participants were scored for their dietary practices, those that were found to fit into the constraints of what is considered to be a “Mediterranean diet” were found to be less likely to develop depression (HR 0.58, 95% CI 0.44 to 0.77); this was compared to those in the lowest quintile. Click here to read an article from the New York Times that discusses this study more.