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Objective: the aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: we recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries. The WHO "Encounter Form", a standardized schedule that enables data concerning basic socio-demographic, clinical and pathways data to be gathered, was completed for each participant. Results: the median time from the appearance of the first symptoms to the first contact with specialist dementia care was 56 weeks. The primary point of access to care was the general practitioners (55.8%). Psychiatrists, geriatricians and neurologists represented the most important second point of access. In about a third of cases, PwD were prescribed psychotropic drugs (mostly antidepressants and tranquillizers). Psychosocial interventions (such as psychological counselling, psychotherapy and practical advice) were delivered in less than 3% of situations. The analyses of the 'pathways diagram' revealed that the path of PwD to receiving care is complex, diverse across countries, and that there are important barriers to clinical care. Conclusions: the study of pathways followed by PwD to reach specialized care has implications for the subsequent course and the outcome of dementia. Insights into local differences in the clinical presentations and the implementation of currently available dementia care are essential to develop more tailored strategies for these patients, locally, nationally and internationally.

Insomnia means difficulty in falling asleep and/or stays asleep. Insomnia commonly leads to daytime sleepiness, lethargy, and a general feeling of being unwell. The most common treatment of insomnia includes GABAA receptor positive allosteric modulators or Melatonin agonists. Our study aimed to evaluate the efficacy of Magnesium- melatonin-vitamin B complex supplement in the treatment of insomnia. The study included 60 patients diagnosed with insomnia. The patients were randomly divided into study group (N = 30), and control group (N = 30), and study group was treated with Magnesium-melatonin-vitamin B complex (one dose contains 175 mg liposomal magnesium oxide, 10 mg Vit B6, 16 μg vit B12, melatonin 1 mg, Extrafolate-S 600 μg) once a day 1 hour before sleep, during the 3 months. The severity of insomnia symptoms was measured by self-reported Athens insomnia scale (AIS), with a cut-off score by Soldatos (AIS score ≥ 6). Mean AIS score at zero points was 14.93 ± 3.778 in the study group and 14.37 ± 4.081 in the control group (p = 0.476), indicating the compatibility of the groups, and both scores correspond to mild to moderate insomnia. Mean AIS score after 3 months of the Magnesium- melatonin- vitamin B complex supplementation was 10.50 ± 4.21 corresponding to mild insomnia, while median AIS score in the control group was 15.13 ± 3.76 which is referred to moderate insomnia, and difference among groups was significant (p = 0.000). Our founding’s indicating that 3 months of the Magnesium- melatonin-vitamin B complex supplementation has a beneficial effect in the treatment of insomnia regardless of cause.

Depression occures in 28-60% of patients with PD. There is little evidence of the efficacy and safety of antidepressant therapies in Parkinson´s disease. This interventive, paralel, RTC, safety/efficiency study included 339 patients aged 36-90, with ICD10/DSMIV criteria for PD and depression. Purpose of the study was to estimate depression, quality of life, and severity od PD symtoms after 3 months of antidepressant therapy. Methods: We have randomly divide patients into control group(N=45) without antidepressants, and experimental groups in accordance with applied antidepressants: clomipramine(N=48), fluoxetine (N=49), sertraline (N=51), escitalopram (N=49), mirtazepine (N=45), and tianeptine (N=52). We have used HAMD for estimation of depression, QOL scale for quality of life, and UPDRS subscales I(behaviour and mood) and II(daily activities) for PD symptoms at pretrial, and after 3 months scores in all groups. Data were processed with SPSS for Windows. Results: There is no statistical significance in pretrial scores between groups. After 3 months there is: significant increase in control and significant discrease(p=0.000) of HAMD scores in all experimental groups, in favour of antidepressant with higher mediana(escitalopram 9; sertralin 8; tianeptin 6;clompramin 3; mirtazapin 3;fluoxetine 1; control-2); significant increase of QOL scores in favour of antidepressant with higher mediana(escitalopram 1.24; sertraline 1.12; tianeptine 0.65; clomipramine 0.40; mirtazapine 0.27; fluoxetine 0.27), and significant difference in UPDRS II pretrial and after 3 months subscores(p=0.016), in favour of escitalopram. Conclusion: All tested antidepressant are efficient in reducing HAMD score, but only escitalopram,sertraline,and tianeptine improved HAMD, QOL, UPDRS I, and II scores without side effects.

Alcohol- Induced Persisting Dementia (AIPD) can occur because of both the direct effects of alcohol and specific vitamin deficiencies, and the indirect influence of genetic or neurochemical predisposition.Aim of this study was to ascertain the efficiency of the rivastigmine therapy in the treatment of AIPD.Methods:The prospective clinical study included 101 patients diagnosed in accordance with DSM IV criteria for AIPD. Patients were monitored for 3 months in hospital and outpatient conditions, according to specially designed protocol, which included MMSE, BPRS, CGI1-4 scales, and clock drawing test (CDT). Both the control and the experimental groups were treated with conventional therapy and in addition the experimental group treatment was supplemented with rivastigmine (3-12 mg/24 h).Results:The participants were in the same age range, predominantly male, with an similar average illness duration. Average daily rivastigmine dose was 9.76±2.014 mg. An average pretrial MMSE score was around 19, BPRS score was around 50, CGI1 score was around 4.6, and CDT score around 5. Statistically significant differences among the C and E group begin to show after 14th (in BPRS scores)and 28th day of therapy(in MMSE,CDT,and CGI1 scores) (p>0.1) and to become more apparently significant after two and three months of treatment (p>0.5).Conclusion:MMSE and CDT scores are significantly higher, and BPRS, CGI1-3 scores significantly lower in rivastigmine group from 14th and 28thday of treatment. Rivastigmine has statistically significant effect in treatment of AIPD.

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LTG is significantly efficient in the treatment of delirium tremens, but it does not decrease mortality rate.