In this multicenter study, the clinical efficacy of citalopram was investigated in 98 patients with moderate AD/SDAT or VD using a combined double-blind and open technique with placebo and citalopram. Analyses were made for each diagnosis after four weeks of double-blind treatment. Patients with AD/SDAT treated with citalopram showed a significant improvement in emotional bluntness, confusion, irritability, anxiety, fear/panic, depressed mood and restlessness. Those improvements were not found after treatment with placebo. There were no significant improvements in patients with VD. No improvements were recorded in motor or cognitive impairment. Citalopram provoked few and comparatively mild side-effects. None of the changes observed during the double-blind withdrawal period were identified as withdrawal symptoms or rebound phenomena.

Brain monoamine concentrations were determined post mortem in 19 patients with dementia of Alzheimer type. Samples were taken from 10 parts of the brain and compared with an age-matched control group. There were lower mean concentrations of dopamine in the demented group of patients in seven regions of the brain, and two of these were at a significant level. There were also significantly lower concentrations of homovanillic acid in the nucleus caudatus and in the putamen. The means of the concentrations of noradrenaline were also lower, and in the putamen and the cortex gyrus frontalis significant differnces were observed. The 5-hydroxytryptamine concentrations were slightly lower in the demented group but the differences did not reach significance. The degree of intellectual deterioration was negatively correlated with the noradrenaline concentrations in the hypothalamus and the cortex gyrus cinguli.

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Vascular dementia (VAD) is cognitive impairment caused by changes in the blood circulation of the brain. It is not synonymous with multi-infarct dementia. The latter is a subgroup of VAD. Neurochemical investigations of noninfarcted brain tissue from patients with VAD show general changes in VAD brains. The serotonin metabolism is severely reduced and so is the activity of choline acetyltransferase. Monamine oxidase B is significantly increased in the white matter. A severe decrease in myelin components indicates white matter disturbances of such a degree that they must be considered to be of pathogenetic importance. The levels of some neuropeptides in the hypothalamus are increased. This is a finding which is in agreement with clinical findings of a high activity in the hypothalamic-pituitary-adrenal axis in patients with VAD. This high activity is possibly due to a loss of serotonergic inhibitory tone on the hypothalamus in VAD brains.

In the present study, we have applied a novel strategy involving the postmortem measurement of the mitochondrial respiratory chain enzyme cytochrome-c oxidase (COX; complex IV) to identify regional changes in energy metabolism in the basal ganglia of chronic, medicated schizophrenics. COX activity was decreased in the caudate nucleus but increased in the putamen and nucleus accumbens. An increase in succinate dehydrogenase (complex II) was evident in the putamen and nucleus accumbens, but changes were not seen with NADH dehydrogenase (complex I). An analysis of interregional correlations in energy metabolismThe main contributors to the search for functional brain changes in schizophrenia have employed imaging techniques such as positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) to identify potential candidate regions which may define disease symptomatology. To date, over 300 published articles exist (Medline database 1966(Medline database -1997 in which imaging techniques have been utilized in schizophrenics. While the power of PET as a tool for understanding 'statedependent' brain function and receptor characteristics, as well as offering excellent patient control, is generally undisputed, the sheer bulk of data created by researchers in the field has generated a disconcertingly diffuse base of evidence for which regions may be involved in the disease. Although a general trend implicating reduced metabolism in cortical and sub-cortical regions has formed the foundation for assumptions about a possible defect in schizophrenics (Buchsbaum et al. 1982(Buchsbaum et al. , 1992Tamminga et al. 1992;Siegel et al. 1993), opposite findings have been made (Early et al. 1987;Wiesel et al. 1987;Cleghorn et al. 1989).As a complement to imaging studies, our laboratory has applied a strategy involving the post-mortem measurement of the mitochondrial respiratory chain en- COX Activity and Schizophrenia 373 zyme cytochrome-c oxidase (COX) in an attempt to localize altered brain function in schizophrenia. This approach is based upon a strong body of evidence which indicates that neuronal COX is highly regulated by the energy demands of the cell and as such represents an endogenous marker of cellular energy metabolism over time (Wong-Riley 1989). Interest in COX as a marker of neuronal function rests upon many of the same assumptions implicit in the use of PET in the measurement of regional glucose metabolism and blood flow. Neurons are highly dependent upon oxidative phosphorylation as the primary pathway for the generation of ATP, of which 40-60 % is utilized in the maintenance of ion gradients by ATPases. In support of this, a strong correlation has been demonstrated between the regulation of COX and Na ϩ ,K ϩ ATPase in brain tissue (Hevner et al. 1992). Traditionally however, the strongest evidence that COX is coupled to neuronal energy demands comes from studies in which changes in COX activity can be induced by experimental interventions which alter n...

Eleven patients with severe Parkinson's disease and on-off-phenomena were included in a controlled double-blind study on the effect of electroconvulsive therapy (ECT). Pharmacological treatment was optimally adjusted before the trial. The severity of extrapyramidal symptoms was measured before, during and after the treatment. The patients were randomly allocated into one group, receiving active ECT and another, receiving sham treatment. The patients given active ECT showed significantly (P less than 0.05) prolonged duration of "on"-phases after ECT, in comparison to the sham-treated group. When collecting data from the controlled part of the study and the subsequent with open administration of ECT, the treatment was in addition found to significantly decrease the time and number of steps required to walk 10 meters. Moreover it reduced the severity of parkinsonian symptoms according to the Webster scale. The improvement induced by ECT was generally short-lasting. Lumbar punctures were performed before and after ECT. The concentrations of monoamine metabolites in cerebrospinal fluid were not affected by the treatment. The results indicate that ECT has an antiparkinsonian effect which probably is mediated via changed responsiveness of dopamine receptors and that further improvement is possible in patients, therapy resistant to the presently available medication.

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