American Association for Geriatric Psychiatry (AAGP)

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Hard evidence supporting the use of either atypical antipsychotics or antidepressants in Alzheimer’s disease patients remains scant, Dr. Daniel Weintraub reported at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Weintraub of the departments of psychiatry and neurology at the University of Pennsylvania, Philadelphia, said that although older adults with Alzheimer’s disease (AD) frequently are prescribed atypical antipsychotics to control psychosis, aggression, or agitation, the drugs also are associated with significant adverse events and a long-term increase in mortality risk in this population.

He noted that investigators in a 42-site, placebo-controlled trial of 421 patients with Alzheimer’s and psychosis found that the adverse effects of the agents offset possible advantages (N. Engl. J. Med. 2006;355:1525-38).

Adverse events included an increase in parkinsonism and/or extrapyramidal symptoms with olanzapine and risperidone, which occurred in 12% of patients on each drug, compared with 2% for quetiapine. All three of these agents were associated with increased sedation, compared with placebo, and olanzapine and risperidone both were associated with more confusion and changes in mental status than was placebo, said Dr. Weintraub, who is also a psychiatrist at the Philadelphia VA Medical Center.

Long-term follow-up from the DART-AD (Dementia Antipsychotic Withdrawal trial) also showed that antipsychotics were associated with an increased long-term risk of mortality in patients with AD (Lancet Neurol. 2009;8:151-7).

The picture is no rosier when it comes to the use of selective serotonin reuptake inhibitors for depression in AD, Dr. Weintraub said.

In the DIADS-2 (Depression in Alzheimer’s Disease–2) trial, no evidence of efficacy was found for the use of sertraline for the treatment of depressive symptoms in patients with AD, and an increase in adverse events was found, including a doubling of dry mouth and diarrhea vs. placebo, as well as a near trebling of dizziness. Sertraline also was associated with a significant increase in pulmonary adverse events at 24 weeks, compared with placebo (P = .006).

The cholinesterase inhibitor rivastigmine fared no better as an adjunct to usual care with haloperidol for treating delirium in a study from the Netherlands. In addition, rivastigmine did not decrease the duration of delirium, compared with placebo (median 5 vs. 3 days, respectively), and a trend was found toward higher mortality with the drug, at 22%, compared with 8% among patients treated with placebo. The actual number of patients was small, however, and the trend did not reach statistical significance. The trial was halted early (Lancet 2010;376:1829-37).

One agent that had some efficacy in AD is the N-methyl-D-aspartate (NMDA) receptor antagonist memantine, Dr. Weintraub said. He pointed to a 2008 pooled analysis of data from three large, randomized studies. The authors of the analysis found a significant benefit for memantine over placebo for the proportion of patients who showed improvement in neuropsychiatric symptom clusters at weeks 12 (P = .008) and 24 (P = .002). Memantine also proved superior to placebo for the treatment of agitation/aggression at both time points (P = .011 and .001, respectively), and the drug was well tolerated (J. Clin. Psychiatry 2008;69:341-8).

Only clozapine (Clozaril) has been shown to have efficacy at treating psychosis associated with Parkinson’s disease, but high potency antipsychotics are poorly tolerated in this population. Also, evidence suggests increased mortality risk (Am. J. Geriatr. Psych. 2010 [doi:10.1097/JGP.0b013e3182051bd6]).

For treatment of depression with Parkinson’s disease (PD), however, the news is a little better, Dr. Weintraub said. In a small trial, the tricyclic antidepressant nortriptyline was superior to placebo at change from baseline in the HAM-D (Hamilton Rating Scale for Depression; P = .002) and in the percentage of responders at 8 weeks (P = .024). In contrast, no significant difference was found in the depression scale between controlled-release paroxetine (Paxil CR) and placebo (Neurology 2009;72:886-92).

Pramipexole (Mirapex), a dopamine agonist, appears to positively affect depression in PD patients, producing significantly better mean reductions in Beck Depression Inventory scores (P = .001). About 80% of the total treatment effect was a direct effect of the drug on depression, the authors found (Lancet Neurol. 2010;9:573-80).

Finally, Dr. Weintraub said, neither antipsychotics nor antidepressants have not been formally tested in dementia with Lewy bodies. However, two studies suggest possible benefits of memantine (Lancet Neurol. 2010;9;969-77) and rivastigmine (Lancet 2000;356:2031-6) in this second most-common form of dementia.

Dr. Weintraub has received honoraria from several companies, including Novartis Pharmaceuticals, Boehringer Ingelheim, Merck Serono, and Labopharm Pharmaceuticals.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Older adults with schizophrenia are more likely to be depressed if they have a lower quality of life index, are less religious, and take more medications or receive more psychotherapy than do other adults with schizophrenia, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

But evidence also suggests that the outlook for older people with schizophrenia is not as bleak as was once thought, said Dr. Carl I. Cohen, professor and director of the division of geriatric psychiatry at State University of New York, Brooklyn, and SUNY Downstate Medical Center.

"We now recognize that outcome in schizophrenia is much more heterogeneous than we originally conceived," Dr. Cohen said.

Among older adults with schizophrenia, the prevalence of depression (including mild or subsyndromal depression) ranges from about 44% to 75%, but little is known about the prognosis of depression in this group, he said.

Dr. Cohen reported data from a longitudinal follow-up study of 101 people aged 55 and older with schizophrenia. The mixed-race sample consists of men and women with schizophrenia who were living in New York City and available for structured interviews at baseline (median age, 59) and at a median follow-up of 52 months. In all, 65% of those in the sample were living in supported residences, and 35% were living independently.

The investigators defined depression as a CES-D (Center for Epidemiologic Studies–Depression) scale score of 16 or greater, subsyndromal or mild depression as a score of 8-15, and no depression as a score lower than 8.

Of the 29 people in the sample with syndromal depression at baseline, the researchers found that 12 (41%) remained depressed at follow-up, 10 (35%) had subsyndromal depression, and 7 (24%) had remission of depression.

Of the 31 people with subsyndromal depression at baseline, 9 (29%) went on to more serious depression, 10 (39%) still had mild depression, and 12 (32%) were no longer depressed at follow-up. Of the remaining 41 patients with no depression baseline, 3 (7%) went on to develop syndromal depression, and 7 (17%) developed the subsyndromal form; 31 (76%) remained free of depression.

The investigators also found that suicidality seemed to moderate over time, with 80% (12 of 15) patients who tested positive for suicidality at baseline no longer wishing to die or having suicidal thoughts or actions at follow-up. In contrast, of those with no evidence of suicidality at the outset, only 7 of 86 (8%) went on to develop suicidality.

When the investigators looked for predictors of depression at the second interview in a bivariate analysis, they found "surprisingly few" predictors, Dr. Cohen said. Depression at follow-up was not predicted by demographics, physical health, instrumental activities of daily living, cognitive functioning, social network variables, lifetime traumatic events, coping styles, or PANSS (Positive and Negative Syndrome Scale) scores.

Only a lower quality of life index, less religiosity, receipt of more medication and/or psychotherapy, and baseline depression were predictive of depression at follow-up.

In logistic regression analysis that was controlled for age, sex, number of confidants, physical disorders, and other factors, the only significant predictors for depression at follow-up were religiosity (odds ratio, 0.84; P = .03), CES-D score greater than 7 (OR, 7.27; P = .002), and receipt of mental health services at follow-up (OR, 1.40; P = .04).

The findings suggest that clinicians need to develop strategies for diminishing depression among older adults with schizophrenia, possibly through pharmacotherapy, cognitive-behavioral therapy that focuses on depressive and psychotic symptoms, and – for some patients – the encouragement of religiosity, Dr. Cohen said.

The study was funded by grants from the National Institute of General Medical Sciences. Dr. Cohen had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Longer follow-up supports earlier findings that subsyndromal symptoms of depression and suicidal ideation in middle-aged and older adults with schizophrenia or schizoaffective disorder might respond to treatment with a selective serotonin reuptake inhibitor, reported investigators at the annual meeting of the American Association for Geriatric Psychiatry.

In 24-week follow-up of a previously reported 12-week study, patients aged 40 years and older with schizophrenia or schizoaffective disorder whose regular antipsychotic therapy was augmented with the SSRI citalopram (Celexa) maintained a significant decrease in suicidal ideation scale scores, compared with similar patients on an antipsychotic and placebo, reported Dr. Ipsit V. Vahia from the Stein Institute for Research on Aging and Department of Psychiatry at the University of California, San Diego.

Patients with schizophrenia are 8-20 times more likely than is the general public to attempt suicide, and more than half of all people with schizophrenia have either suicidal ideation or attempt suicide. Suicide accounts from 5-13% of all deaths among people with schizophrenia, and is the leading cause of premature death in this population Dr. Vahia said.

Initial results of the trial were published last year (J. Clin. Psychiatry 2010;71:915-22). After 12 weeks of therapy with either citalopram at a flexible dose of 10-60 mg daily or placebo plus the patients’ standard antipsychotic agent, citalopram was associated with lower Beck Hopelessness Scale (BHS) scores (P less than .05), and lower likelihood of having suicidal ideation on both the InterSePT Scale for Suicidal Thinking (ISTT; P less than .005) and Hamilton Depression Rating Scale item 3 (P less than .05).

Citalopram was not associated with emergent (that is, treatment-related) suicidal ideation in 114 of the 198 participants with no suicidal ideation at baseline. Among 55 patients with suicidal thoughts or actions at baseline, 28.6% of those on the antidepressant still had such ideation at the study endpoint, compared with 66.7% of those on placebo (P less than .05). The effect of the drug on reduction in suicidal ideation was significantly greater among depression responders than non-responders (P less than .05).

Looking at secondary outcomes on the Positive and Negative Syndrome Scale, the investigators found that the antidepressant was significantly better at reducing negative symptoms of schizophrenia than placebo (P = .049). No significant effect of the drug was found on the other scale items of positive symptoms, depression, cognition, or excitement, however.

Dr. Vahia noted that 64% of patients in the placebo group and 65% in the citalopram group have completed 24 weeks of follow-up after the study taper. There were no changes in depression scores from scores from weeks 12 to 24, and the improvements seen with the citalopram group were maintained, he said.

The findings suggest that subsyndromal depression in older adults with schizophrenia is responsive to treatment with SSRIs, as demonstrated by reductions in depressive symptoms, suicidal ideation, and negative symptoms of schizophrenia, Dr. Vahia concluded.

The study was supported by grants from the National Institute of Mental Health and Department of Veterans Affairs. Medications were supplied by Forest Pharmaceuticals. Dr. Vahia had no conflict of interest disclosures.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.

SAN ANTONIO – Older adults with diabetes who frequently have hypoglycemia may be especially vulnerable to the development of cognitive impairment or dementia, suggest data from a study of nearly half a million veterans.

The findings also suggest that patients aged 65 years and older with diabetes should have cognitive screening, and that there should be increased overall surveillance in this population, according to Dr. Denise G. Feil, a geriatric psychiatrist at the VA Greater Los Angeles Healthcare System, and colleagues.

An examination of the association of antidiabetic treatment with rates of ICD-9-CM–coded hypoglycemia in 497,900 veterans aged 65 years and older with diabetes showed that veterans who had cognitive impairment (CI) or dementia had significantly higher rates of hypoglycemia than did their cognitively intact peers in both adjusted and unadjusted analyses, the researchers reported.

"The risk of hypoglycemia is higher even when their medication regimen is the same and their [hemoglobin A_1c] levels are the same as those of patients without dementia, which suggest that there are social factors that might be different in this patient population. There may be other issues that are neurological, such as whether neuroglycopenia from repeat hypoglycemia is having some kind of effect," said Dr. Feil in an interview at the annual meeting of the American Association for Geriatric Psychiatry.

Dietary changes that occur as cognitive impairment progresses into dementia may also make cognitively impaired diabetics more susceptible to hypoglycemia, and memory problems may make compliance difficult, especially when patients have complicated or intensive antidiabetic regimens, she added.

Diabetes is associated with a doubling of the risk of cognitive impairment and dementia, and intensive glycemic control has been shown to significantly decrease the risk of diabetes-associated complications. But the risk/benefit trade-off of intensive glycemic control in cognitively impaired patients has not been studied, the authors stated.

"Recent trials of intensive glycemic control in older patients with diabetes of longer duration showed a lack of benefit and higher rates of hypoglycemia, macrovascular events, and death," they wrote.

They hypothesized that they would find that diabetics with dementia or CI would be managed less aggressively than would cognitively normal diabetics of the same age, but would still have similar rates of hypoglycemia after adjustments.

The investigators tested this idea by conducting a cross-sectional analysis of data on veterans who were treated at Department of Veterans Affairs facilities in fiscal years 2002 and 2003, stratified by coded dementia and cognitive impairment, age, antiglycemic medications, and HbA_1c values.

They found that 18% of the population had a diagnosis of either dementia or cognitive impairment, and that the proportion and distribution of antidiabetic prescriptions were similar among patients with dementia, CI, or neither condition.

They also found that hypoglycemia rates rose with both increasing cognitive impairment and the complexity of the diabetes regimen, yet the mean HbA_1c levels were nearly identical among all three cognitive groups: 7.0% for those with dementia, 6.9% for patients with CI, and 7.0% for those with neither dementia nor CI.

But when the authors looked at the unadjusted odds of hypoglycemia, they found that patients with dementia were more than twice as likely as cognitively normal patients to have hypoglycemia (odds ratio, 2.4), and those with cognitive impairment were likely to have a nearly twofold greater risk of hypoglycemia (OR, 1.7).

Adjustment for potential confounders slightly lowered – but did not eliminate – the excess hypoglycemia in patients with dementia and cognitive impairment (OR, 1.8 and 1.2, respectively).

The study was funded by the VA’s Health Services Research and Development Service. Dr. Feil received a VA Career Development Award.