As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke-Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of 'aging-associated cognitive decline' when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause-effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.

Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.

No abstract

Aggressive behaviour is commonly observed in patients with dementia, and current pharmacological treatments are still deficient in terms of efficacy and tolerability. Allopurinol is an inhibitor of the enzyme xanthine oxidase, with previously suggested anti-aggressive effects. After successful treatment of aggression in two patients, we performed a case-series study with allopurinol 300 mg a day orally for 6 weeks (increasing 300 mg every 2 weeks if the response was less than 50%) in six patients with dementia associated with prominent aggressive behaviour who failed to respond to two previous treatment strategies. Five patients were considerably responsive to allopurinol (four with 300 mg within 2 weeks and one with 600 mg), apparently without side-effects, which is in accordance with its well-established safety and tolerability profile. The observed therapeutic effect of allopurinol might be due to the inhibition of the enzyme xanthine oxidase, possibly decreasing production of oxygen-free radicals or promoting the accumulation of purines. Controlled studies are warranted to confirm these preliminary observations.

ResumoO objetivo do estudo foi avaliar as habilidades cognitivas de idosos viúvos. O grupo total de 34 viúvos (com perda do companheiro nos últimos 12 meses) foi identificado entre os idosos de Veranópolis (RS), sendo que 30 aceitaram participar do estudo. Outros 30 participantes casados, pareados conforme sexo, idade e escolaridade, compuseram o grupo controle. Os instrumentos utilizados foram: Questionário de Medida de Queixas Subjetivas de Memória (Mac-Q); Fluência verbal, categoria animal; Mini-exame do estado mental (MEEM); Teste de evocação seletiva livre e com pistas de Buschke; subteste de Dígitos da escala WAIS; Escala de depressão geriátrica (GDS) e Questionário fenomenológico do luto (BPQ). Verificou-se que os viúvos tinham significativamente mais sintomas depressivos e mais pontos na escala de luto. Entretanto, não foi evidenciada diferença significativa entre as médias no desempenho cognitivo de idosos viúvos ou idosos casados. Discute-se que a escolha da viuvez censitária (ter o estado civil viúvo) e não do luto emocional (autoreferido) como critério de seleção pode ter influído na ausência de associação entre viuvez e disfunção cognitiva, entre outros. Palavras-chave: Idosos; Viúvos; Habilidades cognitivas; Avaliação neuropsicológica; Viuvez. AbstractTo assess the cognitive abilities of widowed elders, a total sample of 34 elders (who have lost their spouses in the last 12 months) was identified among elders in Veranópolis-RS and 30 of them accepted to participate in the study. The control group was composed by 30 married subjects paired according to gender, age and level of education. The instruments used were: Measure Questionnaire of Memory Loss Complaints; Verbal Fluency -animal category; Mini-Mental State Examination (MMSE); Free and Cued Selective Reminding Test; Digit subtest; Geriatric Depression Scales and Bereavement Phenomenology Questionnaire. Widowed elders had significantly more depressive symptoms and more points on the bereavement scale. However, there was no significant difference between the means of cognitive performance of widowed or married elders. In the census, the choice of widowhood as a selection criterion instead of bereavement (self reported) might have influenced the lack of association between widowhood and cognitive dysfunction, among other aspects.