The novel antidepressant agent milnacipran is a dual and equipotent serotonin and noradrenaline reuptake inhibitor. The aim of this double-blind study was to compare the efficacy and safety of milnacipran (50 mg twice daily) with that of imipramine (50 mg twice daily) in elderly patients with major depressive episode. A total of 219 patients were randomly assigned to 8 weeks of double-blind treatment with either milnacipran or imipramine; 72 patients withdrew from the study. At the end of treatment no significant differences were found between milnacipran and imipramine in antidepressant efficacy. A significantly greater number of side-effects, particularly anticholinergic effects, was observed in the imipramine group. Milnacipran may be preferable to imipramine in elderly depressed patients, as it provides the same antidepressant activity as imipramine with a lower incidence of side-effects, and does not impair cognitive ability.

Psychosocial interventions, such as music therapy, can contribute to maintain or rehabilitate functional cognitive and sensory abilities, as well as emotional and social skills and to reduce the severity of some behavioural disorders.

We describe three cases of extracranial vertebral artery dissection that are unusual in both thenmodes of presentation and their associations with other pathologic conditions. The first patient had Marian's syndrome and migraine; his dissection was asymptomatic and was diagnosed by chance at the time of repeat angiography following a previous internal carotid artery dissection. The second patient had systemic lupus erythematosus and presented with a subarachnoid hemorrhage attributed to an intracranial vertebral artery dissection by the demonstration of an extracranial dissection. The third patient had a minor basilar artery stroke in which dissection had occurred beside a congenital hemivertebra deformity. {Stroke 1990-21:618-625) C ervical artery dissection accounts for approximately 4% of the cases of ischemic stroke in young adults, 1 with the internal carotid artery most commonly affected. Vertebral artery dissections are less frequent 2 ; they usually affect the extracranial portion of the artery, and persons with such dissections present with ischemic strokes in the vertebrobasilar territory, preceded by cervical pain.3 " 5 The cause of vertebral artery dissection is unknown, although neck trauma (often apparently trivial) is frequently implicated.6 Of the so-called "spontaneous" cases of vertebral artery dissection reported, there is often an associated underlying disorder such as fibromuscular dysplasia, elastic tissue disease, arterial hypertension, or migraine. We describe three cases of vertebral artery dissection that are unusual both in their modes of presentation and in their associations with other pathologic conditions. Case Reports Case 1A 31-year-old right-handed male smoker was admitted September 15, 1986. He gave a history of migraine without aura since the age of 18 years. He had once had difficulty in "finding his words" for 15 minutes in 1976; there had been no headache, and he had not sought medical care. The patient awoke at 2 AM the morning before admission with a severe right-sided headache typical of his usual migraine. Later that morning he felt nauseated and vomited. At 7 PM, he suddenly developed aphasia and right-sided hemiparesis; there was no cervical pain. On admission at midnight there was partial recovery of function, with mild mixed aphasia and right-sided hemiparesis. An intermittent midsystolic cardiac murmur was audible. The patient was tall and thin, and there was mild laxity of his articular ligaments.An early head computed tomogram (CT scan) was normal, but a second one a week later was suggestive of an infarct in the left middle cerebral artery territory. Contrast echocardiography showed a patent foramen ovale and prolapse of the mitral and tricuspid valves without regurgitation. There was proximal aortic dilatation, but aortic valve function was normal. Blood count and erythrocyte sedimentation rate (ESR) and the results of hemostatic studies and urinary amino acid analyses were normal.Four-vessel cerebral angiography on October 8, 1986, showed localized aneurysmal ...

Background The aim of this study is to look at the correlation between the presence of apathy measured by Marin's scale and family complaints related to withdrawal and the loss of motivation, or depression. The multicentre study was performed on 58 non‐demented elderly people, 132 outpatients with Alzheimer's‐type dementia, as well as their main caregiver. Methods After agreement of the patients and the family, the patients were assessed using different scales: Cornell's for depression, Marin's for apathy, MMS for cognitive disorders, and IRG for dependence. At the same time, two self‐administered questionnaires were given to the patients' families: one concerning a list of complaints scored from 1 to 4 relating to various disorders and the other addressing the boundary ambiguities translated from Boss' questionnaire. The 58 non‐demented people were 81.20 years old±13.75. One hundred and thirty‐two demented patients were included: 39 men and 93 women. The mean age was 79.47 years±9.03. Results The first family complaint relates to the loss of motivation (65%). Apathy and depression occur more frequently in dementia, in particular when the MMS is degraded. Depression and apathy attracted a high complaint score. In our study the score of boundary ambiguity is higher among patients with a weak cognitive status. A high level of ambiguity is accompanied by a high score of family complaints. When the family complaint concerning the loss of motivation is present, apathy is significantly more common. Family complaints about withdrawal and loss of motivation are frequently present, and are congruent with the actual presence of apathy in the patient. It bears witness to the distress felt by families faced with the loss of ability noted in the demented person. The family's difficulties are increased by the patient's depression. Copyright © 2001 John Wiley & Sons, Ltd.

The aim of this study was to describe the epidemiological features of agitation and aggressiveness in elderly individuals living in French nursing and retirement homes in the year 2000. Data were collected on the type, time of onset, and duration of symptoms, medical evaluation and treatment, and medical and psychiatric comorbidities of the elderly patients. The most frequently reported behavior was verbal aggressiveness and the least reported behavior was physical aggressiveness. A triggering factor initiating the symptoms of agitation or aggressiveness was reported in 61% of the cases. In 61% of the study population, there were several morbidities reported as caused by the agitated or aggressive behavior (anorexia, weight loss, dehydration). A specialist was consulted for nearly half of the agitated or aggressive patients. For 55% of the patients, a new medication regimen was started or the administration of previous medications was modified, the most frequently prescribed drugs being antipsychotics. The results of our study and others show that agitation and aggression have a substantial impact on the lives of the elderly population, as well as on the lives of their family members and caretakers.