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Alzheimer's disease (AD) is the most common cause of dementia and is characterized by an insidious onset and slow deterioration in cognition, activities of daily living (ADL), mood stability and social functioning. The cholinesterase inhibitors (ChEIs), developed based on the cholinergic hypothesis, are currently considered to be the best established treatment for AD, although the significant advances in the symptomatic pharmacotherapy of AD may be followed by disease-modification treatments. Donepezil is a mixed competitive and noncompetitive acetylcholinesterase inhibitor that shows a relative selectivity for acetylcholinesterase inhibitor compared with butyrylcholinesterase. In many clinical trials of donepezil, beneficial effects on standard measures of cognitive function, ADL and behavior have been shown in patients with mild, moderate or severe AD. Although the pharmacological and phamacokinetic profiles of the currently available ChEIs have notable differences that may affect efficacy, the clinical significance of these differences remains hypothetical in the absence of large, randomized trials that compare the ChEIs with each other.

Depression and dementia, in particular Alzheimer's disease (AD), are critically important issues in the mental health of old age. Both conditions apparently reduce quality of life and increase the impairment of activities of daily living for elderly persons. AD usually shows poor prognosis owing to progressive neuronal degeneration, while depression is basically reversible. However, depressive symptoms are common in AD and occur in approximately 20-30% of patients with AD. Epidemiological studies have shown a possible pathological association between depression and AD. Some longitudinal studies have reported that depression is a prodromal sign or might be both a prodromal symptom of AD and a risk factor. Other studies have suggested that depressive symptoms appear to coincide with or follow the onset of AD rather than precede it. However, it still remains controversial whether depressive symptoms represent a risk factor for AD, whether they are an early symptom of neurodegeneration, or whether they are a reaction to early cognitive deficits. A better understanding of the link between AD and depression might have important clinical and research implications. This review provides an overview of current knowledge regarding a relation between depression and AD and also proposes a research and clinical perspective on depression in AD.

SUMMARY Epidemiological studies have suggested that excessive daytime sleepiness (EDS) is associated with depression, but the association between EDS and other psychiatric disorders has not been investigated. The aim of this study was to investigate the association of EDS with a wide range of psychiatric disorders and health-related conditions in the elderly population. Two thousand two hundred and fifty-nine noninstitutionalised persons aged 65-years and over randomly recruited from the Montpellier district, France, completed the Epworth Sleepiness Scale (ESS). Psychiatric status was assessed by the Mini International Neuropsychiatric Interview and demographic and other health information was obtained. This cross-sectional study was conducted from March 1999 to February 2001. Men were significantly more likely to report EDS (ESS score>10) compared with women (12.0% versus 6.0% respectively). EDS was significantly associated in univariate analyses with chronic diseases, early awakening, snoring, severity of depression and lifetime prevalence of manic and hypomanic episodes. A multivariate analysis revealed that the lifetime prevalence of manic and hypomanic episodes, snoring and gender (male) were independently associated with EDS. No independent association with other psychiatric disorders was found.k e y w o r d s daytime sleepiness, elderly, epidemiology, Epworth Sleepiness Scale, psychiatric disorders

In order to elucidate brain mechanisms that contribute to the increased tendency for vigilance dysregulation in the elderly, we examined the spatial organization of brain electric activity [electroencephalogram (EEG)] during decreasing vigilance from alertness to onset of sleep stage 2, comparing 7 old and 10 younger, healthy subjects (60–79 and 18–41 years old, respectively). Two features were analyzed: (1) change of location of the brain electric source gravity centers of the EEG frequency bands, and (2) magnitude of fluctuation of these locations over time. Multichannel EEG was analyzed into source gravity center localizations for seven EEG frequency bands, using fast Fourier transform (FFT) Dipole Approximation (first principal component‐single source modeling in the frequency domain). Multivariate analysis of covariance (MANCOVA) showed: source localizations were more anterior in old than younger subjects for beta‐1 and more superior for all three beta bands; from alertness to sleep, delta and theta EEG sources (inhibitory activity) changed to more posterior and superior areas, and alpha‐1 and ‐2 (routine activity) and beta‐1 and ‐2 sources (excitatory activity) towards anterior and superior areas. Fluctuations of the source locations of delta and beta‐2 were larger on the superior–inferior axis, and of beta‐2 smaller on the left–right axis in the old than younger subjects. The results suggest functional specifications (inhibitory, routine, excitatory) of cortical positron emission tomography (PET) changes reported in sleep. In sum, aging exhibits changes in spatial organization of EEG‐generating neuronal assemblies; during the transition wakefulness‐to‐sleep, aging affects the spatial‐temporal dynamics of this organization. The latter is suggested to contribute to the increased risk for consciousness disturbances in the elderly.

Background: In this study, we examined the construct validity, concurrent validity concerning other standard scales, intrarater reliability, and changes in scores at 12 weeks of the previously developed ABC Dementia Scale (ABC-DS), a novel assessment tool for Alzheimer’s disease (AD). Methods: Data were obtained from 312 patients diagnosed with either AD or mild cognitive impairment. The scores on the ABC-DS and standard scales were compared. Results: The 13 items of the ABC-DS are grouped into three domains, and the domain-level scores were highly correlated with the corresponding conventional scales. Statistically significant changes in assessment scores after 12 weeks were observed for the total ABC-DS scores. Conclusion: Our results demonstrate the ABC-DS to have good validity and reliability, and its usefulness in busy clinical settings.

Introduction: Although anxiety symptoms are often observed in Alzheimer's disease (AD), little attention has been paid to this symptom compared with other neuropsychiatric symptoms. Methods: Twenty-six patients with mild AD underwent both magnetic resonance imaging and single photon emission tomography with technetium-99m ethyl cysteinate dimer. Neuropsychiatric symptoms were evaluated using the Behavioral Pathology in Alzheimer's Disease Scale (Behave-AD). We investigated the relationship between anxiety and neuroimaging using Statistical Parametric Mapping 8 software. Results: The Behave-AD anxiety score was correlated with hyperperfusion in the bilateral anterior cingulate cortices and a reduction in the gray matter volume in the right precuneus and inferior parietal lobule. Conclusion: Our results suggest that anxiety in AD could overlap with the neural correlates of anxiety disorders, and that the specific degeneration associated with AD might be associated with anxiety.

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