‘Journal of Neurology, Neurosurgery & Psychiatry” (July 10, 2020):
We tested the hypothesis that apathy, but not depression, is associated with dementia in patients with SVD. We found that higher baseline apathy, as well as increasing apathy over time, were associated with an increased dementia risk. In contrast, neither baseline depression or change in depression was associated with dementia. The relationship between apathy and dementia remained after controlling for other well-established risk factors including age, education and cognition. Finally, adding apathy to models predicting dementia improved model fit. These results suggest that apathy may be a prodromal symptom of dementia in patients with SVD.
Cerebral small vessel disease (SVD) is the leading vascular cause of dementia and plays a major role in cognitive decline and mortality.1 2 SVD affects the small vessels of the brain, leading to damage in the subcortical grey and white matter.1 The resulting clinical presentation includes cognitive and neuropsychiatric symptoms.1
Apathy is a reduction in goal-directed behaviour, which is a common neuropsychiatric symptom in SVD.3 Importantly, apathy is dissociable from depression,3 4 another symptom in SVD for which low mood is a predominant manifestation.5 Although there is some symptomatic overlap between the two,6 research using diffusion imaging reported that apathy, but not depression, was associated with white matter network damage in SVD.3 Many of the white matter pathways underlying apathy overlap with those related to cognitive impairment, and accordingly apathy, rather than depression, has been associated with cognitive deficits in SVD.7 These results suggest that apathy and cognitive impairment are symptomatic of prodromal dementia in SVD.
As societal stresses have increased, loneliness and social isolation have become silent killers. Dilip Jeste, MD, a geriatric neuropsychiatrist who specializes in successful aging, explains how loneliness has become an epidemic, the risk factors, helpful interventions, and how we can harness wisdom for compassion, self regulation, and more.
Psychiatry, as a distinct branch of medicine, has come far in its short life span. (The term psychiatrist is less than 150 years old.) The field has rejected the famously horrific practices of the recent past—the lobotomies, forced sterilizations, human warehousing. Today’s psychiatric practitioners boast a varied arsenal of effective drugs and have largely dropped the unscientific trappings of psychoanalytic psychobabble, the “schizophrenogenic mothers” of yesteryear who had been thought to have somehow triggered insanity in their unwitting offspring. Two decades into the 21st century, psychiatry now views severe mental illnesses as legitimate brain diseases. Despite all these advancements, however, the field still relies solely on self-reported symptoms and observable signs for diagnosis. Though the American Psychiatry Association reassures us that psychiatrists are uniquely qualified to “assess both the mental and physical aspects of psychological problems,” they are, like all of medicine, limited by the tools at hand. There are not, as of this writing, any consistent objective measures that can render a definitive psychiatric diagnosis.
From a Nature Magazine review:
He wondered whether lithium could have the same tranquillizing effect on his patients. After trying it out on himself to establish a safe dose, Cade began treating ten people with mania. In September 1949, he reported fast and dramatic improvements in all of them in the Medical Journal of Australia (J. F. J. Cade Med. J. Aus. 2, 349–351; 1949). The majority of these patients had been in and out of Bundoora for years; now, five had improved enough to return to their homes and families.
Lithium: A Doctor, a Drug, and a Breakthrough Walter A. BrownLiveright (2019)
Some 70 years ago, John Cade, an Australian psychiatrist, discovered a medication for bipolar disorder that helped many patients to regain stability swiftly. Lithium is now the standard treatment for the condition, and one of the most consistently effective medicines in psychiatry. But its rise was riddled with obstacles. The intertwined story of Cade and his momentous finding is told in Lithium, a compelling book by US psychiatrist Walter Brown.
Read first part of Chapter 1:
To read more click on following link: https://www.nature.com/articles/d41586-019-02480-0?WT.ec_id=NATURE-20190829&utm_source=nature_etoc&utm_medium=email&utm_campaign=20190829&sap-outbound-id=BBBDB22DFC5EF7E2826B76187F671FEEEA0EA3C0&utm_source=hybris-campaign&utm_medium=email&utm_campaign=000_SKN6563_0000014441_41586-Nature-20190829-EAlert&utm_content=EN_internal_32046_20190829&mkt-key=005056B0331B1EE88A92FE6D6D25F179