ECT is a well-evidenced, cost-effective intervention for treatment-resistant depression. In Ireland acute (twice-weekly) outpatient ECT for depression has not been reported, though common elsewhere. Ireland has among the lowest number of inpatient psychiatry beds per person in Europe. We observed a clinical need for acute outpatient ECT for people who could not access elective inpatient care.

We describe the process, interventions, outcomes and stakeholder feedback for four cases of acute outpatient ECT.

All cases provided written informed consent. A multidisciplinary (psychiatry, anaesthesiology, nursing) protocol for assessment and delivery of acute outpatient ECT was developed and implemented, cases described and feedback from stakeholders sought in an acceptability forum.

Four medically stable patients (ASA Grades 2-3) completed acute outpatient ECT (Table 1), receiving between n=6 and n=12 ECT treatments, attending from home. N=140 inpatient psychiatry bed days were saved, and n=45 community psychiatry reviews were required. No adverse events or medical interventions occurres. Three people had CGI outcome of “very much improved” and one person halted their treatment course when “minimally improved”, citing lack of response. Stakeholder feedback in an acceptability forum highlighted the increased resource intensity of twice-weekly community review for outpatient ECT, and the positive outcomes for treatment-resistant depression.

Acute outpatient ECT was safe and effective in this case series and resulted in n=140 psychiatry inpatient bed days being saved. There was an increased need for reviews from the community team during the treatment protocol. Medically stable patients with substantial social support were eligible for this pilot phase, thus a priority for future development must be equity of access to this effective intervention.

None Declared

Frontotemporal dementia (FTD) is a heterogeneous group of brain disorders associated with progressive frontal and temporal lobe atrophy. The main syndrome, behavioral variant FTD, is characterized by personality and behavior changes such as apathy, disinhibition, loss of empathy, new compulsive behaviors and executive dysfunction (Pressman, 2021). Psychotic symptoms may occur years prior to diagnosis of FTD, which can lead to misdiagnosis of a psychiatric disorder.

To highlight late psychosis as an initial indicator of frontotemporal dementia and emphasize the relationship of somatic delusions with the c9orf72 mutation.

We reported the clinical case of a 64-year-old patient who was admitted in our acute psychiatric unit for late-onset psychosis with predominance of somatic delusions as the first indicator of c9orf72 frontotemporal dementia. Access to the medical history of the patient and non-systematic review of the literature on MEDLINE (Pubmed) was conducted.

A 64-year-old male initially consulted the mental health services for oral stereotyped movements and behavioral changes after dental surgery. After a few months, the patient was concerned because he reported that he had holes in his mouth from which liquid was leaking. He consults numerous dentists and undergoes several surgeries, without success. The belief becomes more intense and delirious, and he develops self-harming ideation that leads him to be urgently admitted to the acute psychiatric unit. During the admission, aggressive behavior of the patient towards the staff was observed. Treatment with antipsychotics, antidepressants and ECT was carried with little improvement. He was admitted to a Medium-Term Unit where the patient deteriorated rapidly becoming apathetic, uninhibited and mutistic. Finally, after several months, he was diagnosed with C9orf72 frontotemporal dementia. Psychotic symptoms may be the initial manifestation of frontotemporal dementia. There is a hypothesis that somatic delusions are caused by an altered body schema, correlated with a pattern of posterior, subcortical and cerebellar atrophy (Ducharme, 2011).

Late-life psychosis should be investigated as a possible prodrome of a frontotemporal dementia. Physicians should be aware given the psychiatric-like presentation, unaltered imaging exam and delayed appearance of typical symptoms of FTD. An increased prevalence of somatic delusions in FTD patient with C9orf72 expansion has been reported (Downey, 2014).

None Declared

A case report on the use of Brexpiprazole for the treatment of behavioral disturbance in dementia is presented.

A brief review of the benefit of Brexpiprazole treatment in the treatment of dementia is presented in a case report.

This is an 84-year-old female patient with newly diagnosed multifactorial cognitive impairment. The patient was brought to Mental Health because of the behavioral alteration presented. She reported delusions of harm, theft and a suspicious attitude in relation to moderate cognitive impairment, as well as the recent transfer to a nursing home. In addition, the nursing home had observed that he presented erratic wandering that affected the functioning of the residential environment. In response to this symptomatology, the patient was aggressive and physically heteroagressive towards the caregivers.

The patient, due to the clinical presentation, had been treated with benzodiazepines, which had worsened the episodes of agitation and confusion, interspersed with episodes of somnolence. Therefore, her treatment was modified by adding quetiapine and haloperidol, worsening her psychomotor restlessness and alertness.

When the patient was seen in the psychiatry department, she presented a high level of restlessness that corresponded to akathisia due to the haloperidol, as well as a fluctuating level of alertness that oscillated between wakefulness and somnolence. Despite the overmedication, according to the residency report, the patient maintained episodes of agitation and heteragresivity during wakefulness.

For this reason, it was decided to replace the antipsychotic treatment of quetiapine and haloperidol, progressively with brexpiprazole at 4mg DMD divided in two.

After two weeks of monotherapy with brexpiprazole, the side effects of the previous treatment disappeared, and the patient’s daily functioning improved. She remained alert, the suspicious attitude and the delusions of harm disappeared. The episodes of behavioral disturbances had also ceased.

For the treatment of behavioral symptoms in dementia, it is important to have an effective approach to the clinical management without causing adverse effects that can be severe in elderly people. Brexpiprazole is an atypical antipsychotic, being a 5HT1A and D2 partial agonist and a 5HT2A antagonist, and is an appropriate treatment in this age group.

None Declared

Aging leads to a progressive deterioration at the communicative level. The identification of language impairment in older adults could help to prevent or slow down the development of a possible neurocognitive disorder.

To evaluate psychopathological manifestations in language and communication by means of a psychopathological evaluation protocol in a control group of subjects matched by age and sex to a group of people with mild cognitive impairment.

The sample consists of twenty healthy older adults (75% female, 25% male) with mean age of 84.15 years (SD = 6.81). A descriptive and observational study was carried out. Subjects of both sexes between 70 and 95 years of age, with absence of possible cognitive impairment, were included. The Mini-Cognitive Examination was used to assess cognitive performance, the PRESEEA interview was used to obtain the speech sample and a psychopathological assessment protocol.

Increasing age is associated with greater intensity of language impairment (R2 = .02, p = .047). In the MEC-35 total score, the control group shows a significantly higher performance than the patient group (F = 49.11, p < .001). A negative correlation appears between the total score of psychopathological manifestations and the variables ‘educational level’ (R2 = .23, p = .029) and ‘socioeconomic level’ (R2 = .33, p = .007).

Anomia, perseverations, disintegrated language, concretism and paragrammatism are possible early indicators of cognitive impairment. The elaboration and application of both assessment protocols and speech therapy intervention programs in older adults may improve communication skills.

None Declared

Health literacy (HL) is characterised as the ability to understand health and involves people’s knowledge, motivation and skills to access, recognise, evaluate and apply health-related information. It is an important topic in the context of healthcare, with studies suggesting that low levels of HL are predictors of adverse health outcomes. Socioeconomic status, age, race, cognition and level of education are factors that contribute to HL levels, with older age being strongly associated with poor HL. However, the relationship between HL and the psychological well-being of older people has not been explored as much in the literature.

To describe HL and psychological well-being levels in community-dwelling older people and to analyse the association between these two constructs.

The data analysed in this study derives from a longitudinal research project called FelizIDADE, whose main objective was to empower older people to promote health and HL. A sample with older people aged 65 years and over, living in the municipality of Vila Nova de Famalicão, in Portugal was included. All participants were assessed with a comprehensive research protocol, which comprised, amongst others, the European Health Literacy Questionnaire (HLS-EU-Q16) and the Psychological Well-Being Scale (PWBS). For statistical analysis, non-parametric tests were used, since data did not follow a normal distribution.

A sample with 59 community-dwelling older people was considered, with a mean age of 72 years (SD=4.5). The majority was female (59%), married (83%) and 91.5% had the completed primary school. Around 83% lived with their spouse and 88% were retired due to age. Statistically positive correlations were identified between the HLS-EU-Q16, age (rs=0.0274; p<0.05) and PWBS (rs=0.336; p<0.01). The total of HLS-EU-Q16 also correlated positively with the total of four domains of the PWBS: Autonomy (rs=0.412;p<0.01); Personal Growth (rs=0.280; p<0.05); Positive relations with others (rs=0.275; p<0.05) and Purpose in life (rs= 0.379; p<0.01).

It is well known that HL plays a fundamental role in older people and lower levels are related to negative impacts on health. This reinforces the importance of understanding the factors that are associated with poor HL. The present findings provide empirical insights into the association between HL and psychological well-being among older people living in the community. Furthermore, these results emphasise HL as an individual resource in promoting well-being.

None Declared

Psychiatric symptoms in vascular dementia occur in up to 95 % of patients. These symptoms can be of a depressive or manic type, among others. For this reason, it is essential to carry out a proper differential diagnosis between vascular dementia and other types of pathology that include psychiatric symptoms.

1. 1) To describe the main psychiatric symptoms that could guide the diagnosis of vascular dementia.

2. 2) To make an appropriate differential diagnosis in order to carry out the most suitable therapeutic approach in each specific case.

A review of the most recent literature related to psychiatric symptomatology in patients with vascular dementia.

Vascular dementia can present with very diverse psychiatric pathology. Depending on the subcortical area affected, a particular symptomatology will predominate. For this reason, it is of vital importance to carry out a proper differential diagnosis. When the brain area affected is the ventromedial prefrontal cortex, the predominant symptomatology is depressive, with a higher percentage of patients with abulia. If the area most affected is the orbitofrontal cortex, disinhibition will predominate. However, if it is the dorsolateral prefrontal area, it will lead to executive dysfunctions.

On the other hand, it should be noted that psychiatric symptomatology due to vascular damage often has an atypical presentation in patients. For example, if what predominates is depressive symptomatology, what might appear relatively frequently would be late onset anxiety, irritability, or excessive somatic preoccupation. However, sadness or crying would not be as representative. If what predominates is the manifest symptomatology, in this case, with a high probability it would manifest itself in the form of behavioural disinhibition.

Because of these peculiarities, it is essential to make a proper screening between vascular dementia, late onset depression or Alzheimer’s disease, as the therapeutic approach to each pathology will be very different, as will be the prognosis.

• - Atypical psychiatric symptomatology may be the key to a diagnosis of vascular dementia.

• - A proper differential diagnosis between vascular dementia, late onset depression and Alzheimer’s disease is essential.

• - There is no clear benefit in the use of ACE inhibitors and NMDA receptor antagonists in cognitive impairment. However, there is evidence of improvement in cognitive function with SSRI antidepressants in patients with and without depression.

None Declared

Social isolation (SI) is defined as the lack of social contact or support. Older adults have a higher risk of social isolation because of the changes in health and social relationships that can occur during ageing. Several studies have shown that SI is independently associated with poorer physical and mental health and worsened quality of life. However, limited evidence is available on SI predictors in old public housing populations.

To assess the risk of SI and dependency in Basic and Instrumental Activities of Daily Living (BADL; IADL) in a sample of older people living alone in public housing. To identify predictors of SI, namely whether ADL dependency is one of them.

As part of the ongoing “Porto Importa-se” project, this study included a sub-sample of older persons aged 70 years and over living alone in public housing communities in Porto City, Portugal. All participants were assessed with a comprehensive multidimensional assessment protocol, which encompassed the Barthel and Lawton Indexes (BADLs and IADLs dependency) and the Lubben Social Network Scale-6 (SI risk). Loneliness was measured with a categorical question. A multiple logistic regression model was performed to identify predictive factors for SI. Odds Ratio (OR) and its 95% Confidence Interval (95%CI) were calculated. A p<0.05 was considered statistically significant.

The final sample (n=716) was namely female (84%), with an average age of 80.4 years (SD=6.2). Around 36% presented a risk of SI, and 24% reported feeling lonely almost always to always. About 53% had moderate dependency on IADLs, and 11% dependency on BADLs. The proportion of participants dependent on BADLs and at risk of SI is more than double the proportion of cases considered not to be at risk (17%v.s.8%; p<0.001). Similarly, the proportion of cases considered to be severely dependent on IADLs and at risk of SI is about four times higher than the proportion of cases considered not to be at risk (13%v.s.3%; p<0.001). Based on the logistic regression model, severe dependence on IADLs (OR=5.16, 95%CI[2.37;11.24], p<0.001) and loneliness (OR=2.87, 95%CI[2.02;4.09], p<0.001) were significant predictors of the risk of SI. The model has a modest explanatory power (Nagelkerke R2=0.126).

The rate of SI found in this study aligns with the results reported in other studies with similar objectives. The identification of loneliness and dependence in ADL as predictors of SI also complies with previous studies. These results reinforce the importance of monitoring elderly people who find themselves alone and dependent on the fulfilment of their ADLs more closely.

This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020)

None Declared

Careful qualitative analysis of medical comorbidities in psychogeriatric patients is frequently overlooked in clinical practice, although these individuals often present with complex clinical pictures where multiple age-related somatic conditions can influence or alter the psycopathological presentation of mental disorders. This interplay can significantly affect both diagnosis and management, complicating the therapeutic approach and influencing prognosis.

We present the case of an 81-year-old male with a history of schizoaffective disorder admitted to our Psychiatry Unit due to an episode of marked motor inhibition and delusions. This case is notable for its complex clinical presentation, requiring a broad differential diagnosis, and serves as a representative example of the challenges in managing psychogeriatric patients with overlapping psychiatric and neurological comorbidities.

1. 1) To describe the clinical particularities of this case, focusing on relevant psychogeriatric comorbidities and related changes in pathoplasticity.

2. 2) To review the available evidence regarding the characteristics and management of comorbid neurological disorders in psychogeriatric patients.

The patient’s clinical history was reviewed, including complementary tests such as brain MRI and PET-CT scans. Additionaly, a literature search was carried out, focusing on psychiatric and neurological comorbidities in elderly patients with a history of psychotic and affective disorders.

The patient’s clinical course reveals a significant change in the presentation of symptoms starting at the age of 70. Prior to this age, episodes were characterized mainly by inhibition, mutism, and delusional guilt. However, from the age of 70, there is a notable shift to more complex presentations with both manic and psychotic symptoms, including persecutory delusions, hyperactivity, and religious ideation, alongside periods of mixed affective states with significant affective lability. The development of probable drug-induced parkinsonism, confirmed by a negative DaTSCAN, and neuroimaging findings suggestive of a neurodegenerative process akin to Alzheimer’s disease further complicated the clinical picture. Therapeutic interventions included psychopharmacological adjustments and electroconvulsive therapy, resulting in partial stabilization.

1. 1. Managing psychogeriatric patients requires addressing comorbidities with a flexible, symptom-based approach.

2. 2. Neurodegenerative processes can alter prognosis by increasing relapse risk and changing symptom patterns.

3. 3. A multidisciplinary approach is crucial for optimizing care in complex psychogeriatric cases.

None Declared

Older patients in palliative care often experience considerable stress due to physical, emotional and existential factors. Previous research has identified cortisol, a glucocorticoid hormone, as a key biomarker for stress assessment. This pilot study aimed to investigate the potential of hair cortisol as a potentially objective stress biomarker in a specific population (aiming for a broader aplicability), as well as to explore cognitive changes in older palliative patients using the Mini-Mental State Examination (MMSE-2).

This study objectives were to (1) assess changes in hair cortisol levels and cognitive function in older palliative care patients over three weeks of hospitalization and (2) evaluate the suitability of hair cortisol as a short-term stress biomarker in this patient group.

This monocentric pilot study included 19 patients from different palliative care hospital services in Croatia, gathered via a convenience sampling approach with strict inclusion/exclusion criteria. Hair cortisol levels were measured at baseline and after three weeks using an enzyme-linked immunosorbent assay (ELISA). Cognitive function was assessed using the 16-point MMSE-2. Statistical analyses included paired t-tests and linear regression, and significance was set at p<0.05.

A statistically significant increase in mean hair cortisol levels was observed after three weeks of hospitalization (p=0.007), suggesting heightened stress over time. In contrast, MMSE-2 scores showed no statistically significant change (p=0.064), indicating no detectable cognitive decline within the study period. No significant correlations were found between cortisol levels and MMSE-2 scores at either time point, and differences between male and female patients were not statistically significant.

The findings support the potential use of hair cortisol as a biomarker for stress in palliative care settings, especially for tracking the transition from acute to chronic stress. However, MMSE-2 may not be sensitive enough to detect cognitive changes over short time spans in this patient group. Consequently, further research with larger samples is needed to validate hair cortisol as a practical tool for monitoring stress and to explore its clinical implications for improving palliative care outcomes.

None Declared

Hospitalization in psychiatry often marks a critical point in the management of mental health disorders. For elderly patients, this can be a first-time experience and is often associated with complex psychological, social, or medical factors. Due to the age, psychiatric symptoms may become more pronounced because of comorbidities, cognitive decline and social challenges. Understanding the profile, medical history, presenting complaints, and associated conditions of elderly patients admitted for the first time to psychiatric care is essential to improve the comprehensive care.

The objective of this study is to analyze the profile of elderly patients hospitalized for the first time in the psychiatric department, focusing on their medical history, presenting complaints, diagnoses, and comorbidities.

It’s a retrospective study. We reviewed the files of all patients aged over 65 years old who were hospitalized in the Avicenne Psychiatric Department at Razi Hospital between September 2022 and September 2024.

We identified 22 patients with 16 men and 6 women. The average age of our patients was 68 years (ranging from 64 to 80 years). The majority had a secondary school education (47%), came from an urban background (81%) , were retired (54%), with a high socioeconomic status (42%), married (61%), parent of an average of 2 children and with a family history of mental disease (52%). A history of somatic illness was found in 61% of the patients. The reason for hospitalization was behavioral disorder in 73%, suicidal thoughts in 18.2% and refusal to eat in 8.8%. A history of psychiatric consultation without the need for hospitalization was found in 59% of the cases around the age of 51 years. In 18% of the cases, the onset of the disorder was acute, while it was progressive in the rest. Concerning the diagnosis, we observed mental confusion caused by an organic pathology in 9%, a purely neurological cause of the disorder in 14% ( dementia in 10% and Parkinson’s disease in 4%), a depressive episode in 31%, a manic episode within the context of bipolar disorder in 37%, and schizophrenia in 9%. Comorbidity with paranoid personality disorder was observed in 4 patients, all of them were females. For patients with a psychiatric diagnosis, a neurological comorbidity was found in 31.25% (25% dementia, 6.25% Parkinson’s disease).

This study shows that elderly patients in their first psychiatric hospitalization have complex profiles affected by age-related factors and comorbidities. Diagnosis varied from mood to psychotic disorders, often with neurological issues. The frequent history of psychiatric consultations without hospitalization suggests that early intervention could help prevent more severe admissions. Understanding these profiles is crucial for improving care and treatment for elderly patients.

None Declared

According to the World Health Organization, the global population aged 60 and older is projected to nearly double between 2015 and 2050, increasing from 12% to 22%. This demographic shift presents unique challenges in the management of psychopharmacological treatment in the elderly. Factors such as multimorbidity, atypical presentations of psychiatric disorders, age-related alterations in pharmacokinetics and pharmacodynamics, and the high prevalence of polypharmacy— often defined as the concomitant use of five or more medications—complicate therapeutic approaches in this population.

This review synthesizes the current evidence on the prevalence, contributing factors, and consequences of polypharmacy in elderly psychiatric patients.

A narrative review was conducted using key terms and their combinations, including “polypharmacy”, “elderly”, “geriatric” and “psychiatry”. Relevant studies, case reports, and reviews published from 2000 to 2024 were included.

The prevalence of polypharmacy in the population varies across the literature; however, several well-established risk factors have been identified. These include age 65 years and older, living in a nursing home, comorbidities like diabetes mellitus, cardiovascular disease, metabolic syndrome, and COPD, as well as cognitive impairment. Additionally, prescription-related factors contribute to polypharmacy, such as poor quality of clinical records, automatic prescription renewals, and the involvement of multiple prescribers. The high rate of polypharmacy in older adults is associated with several challenges, including inappropriate medication use, difficulties in adhering to treatment regimens, increased risk of hospitalization, a higher likelihood of adverse effects, functional and cognitive decline, higher healthcare costs, and an increased risk of mortality. Additionally, a recent meta-analysis revealed for the first time that polypharmacy was significantly associated with the incidence of dementia and worsened its prognosis.

Advanced age is a significant risk factor for polypharmacy, often resulting in adverse outcomes such as reduced quality of life, increased morbidity, and higher mortality rates. Identifying and regularly assessing polypharmacy cases, alongside evaluating potentially inappropriate medications, are critical steps. Implementing safe prescribing practices and deprescribing strategies specifically adapted to the needs of elderly patients can effectively reduce risks and improve overall well-being in this vulnerable population.

None Declared

Loneliness, social isolation, and living alone are emerging as significant risk factors for mortality, especially in older adults.

Loneliness, social isolation, and living alone are recognized as significant risk factors for mortality in older adults. This study aimed to quantify their associations with all-cause and cause-specific mortality, extending the scope of previous research by considering a broader range of social factors.

A systematic search was conducted in PubMed, APA PsycINFO, and CINAHL databases up to December 31,2023, adhering to PRISMA 2020 and MOOSE guidelines. Inclusion criteria comprised prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analyses utilized random-effects models with the Restricted Maximum Likelihood method, while subgroup and meta-regression analyses explored further relationships.

Out of 11,964 studies screened, 86 met the inclusion criteria. Loneliness was associated with a 14% increase in all-cause mortality risk, social isolation with a 35% increase, and living alone with a 21% increase. However, substantial heterogeneity was observed across studies, influenced by various factors including gender, age, geographical region, chronic diseases, and study quality. Meta-regression analysis identified predictors such as longer follow-up periods, female sex, validated social network indices, cognitive function adjustments, and study quality.

Loneliness, social isolation, and living alone significantly increase mortality risk in older adults, emphasizing the urgency of public health interventions targeting these factors to enhance health outcomes among the aging population. However, due to study variations, further research is needed to understand their cumulative effect on mortality risks and inform tailored interventions.

None Declared

Very late-onset schizophrenia-like psychosis (VLOSLP) is one of the largest group of mental illnesses in late life after dementia and depression. The question of role of cognitive impairment and the risk of dementia development in this group is still open.

To determine the relationship between cognitive impairment and clinical features.

65 patients (62 woman, 3 man), medium age 72,5 [63,5; 78,5], medium age of onset 69 [62; 76] with schizophrenia (F20), n=23; chronic delusion disorder (F22.81), n=7, organic schizophrenia-like disorder (F06.2), n=7, schizoaffective disorder (F25), n=11, manifesting after 60 years, underwent clinical examination. The assessment was carried out using clinical-psychopathological, psychometric and statistical methods.

Based on clinical and psychopathological features, 3 clinical groups were formed. The group of patients with acute polymorphic symptoms with mental disorganization included 25 patients. The cognitive impairment was the most acute in this group and correlated with psychotic and affective symptoms. It reduced by the 28th day of investigation, but didn’t reach the normative ones, which may indicate the presence of persistent cognitive dysfunction associated with the present neurobiological changes and creates particular concern regarding the development of a neurodegenerative process in this group of patients.

The 2nd group included 30 patients with a predominance of paranoid symptoms with an “age” coloring, which, however, wasn’t the leading plot. Cognitive impairment was less pronounced compared to the first group and was stable in nature, was not associated with the degree of reduction of psychotic and affective symptoms. This allows us to consider it as a predictor of the development of psychosis.

The 3rd group included 10 patients and was characterized by the prevalence of affective and delusional symptoms with acute sensory delirium, pseudodementia at the height of the condition. The degree of cognitive decline at the beginning of the study was comparable with patients in the 2nd group. High correlations were established between the degree of reduction of productive and affective symptoms and the improvement of cognitive functions. A complete reduction of existing disorders was noted by the end of treatment, which may indicate a more congenial prognosis.

This study confirms the results of previous studies on presence cognitive impairment in patients with VLOSLP, and in addition demonstrates specific differences in cognitive profiles depending on the clinical variant of VLOSLP.

None Declared

Recent research highlights the importance of technological solutions in delaying cognitive decline and improving life quality for at-risk individuals, emphasizing the need for innovative, tech-based approaches in dementia prevention (Johnson et al.,2023; Smith et al.,2023). Exercogs® is an innovative tool designed to tackle the global challenge of dementia by addressing modifiable risk factors (Livingston et al.,2020). Developed through a clinic-academia partnership, it integrates physical exercise, cognitive skills, and social interaction into a single activity for dementia prevention programs.

This scientific study aims to: 1) Creating and validating 4 Exercogs® (using gamification) for an augmented reality platform; 2) Validating a dementia prevention program that generates health benefits using Exercogs®.

1. 1. Research and Planning: assessment of seniors’ needs; survey of market solutions;

2. 2. Ideation and Concept Development: definition of therapeutic objectives; selection of stimulus types; idealization of game scenarios, cognitive, and motor areas;

3. 3. Design and Prototyping: programming video games; implementation of gamification techniques;

4. 4. Testing and Evaluation: testing the prototypes and interaction mechanics with a group of users; usability testing.;

5. 5. Scientific Validation: experimental study with pre and post-test assessment, with a sample of 204 subjects aged ≥ 65 years old.

6. 6. Maintenance and Improvement: the solution is being used in pilot studies in different institutions in Portugal for evaluation and continuous improvement.

Exercogs® consists of 4 games that target key areas of healthy and pathological ageing, focusing on cognitive (attention, memory, executive functions), physical (mobility, coordination, balance) and social (general social skills) domains. Each game adapts to users’ abilities with different difficulty levels and is designed for group play to enhance social interaction, crucial for mental health. Utilizing gamification and augmented reality for engagement, scientific validation showed significant improvements in cognitive, affective, social, functional domains, and quality of life, with marked statistical significance in all areas assessed.

Image 1:

Image 2:

Notable health benefits were observed among users, particularly in cognitive function and quality of life. These findings indicate the potential effectiveness of Exercogs® in dementia prevention programs. The alliance between the clinic and academia is crucial for solving the challenges of longevity and creating technological solutions that respond to new health needs. The use of technologies in health intervention generates high levels of adherence and motivation among older adults, as well as among health professionals. Exercogs® are a promising technological solution that uses gamification with clinical support to prevent dementia!

None Declared

Even mild forms of dementia have a detrimental effect on memory and activities of daily living, and cause distress to patients and their families. As the disease progresses, the impairment of patients and the burden on their carers increases over time. Thus, there is a need for effective, safe and well-tolerated treatments that can be initiated at the earliest stages.

A meta-analysis of pooled patient subgroup data from randomised clinical trials was conducted to assess the treatment effects of Ginkgo biloba extract EGb 761 in patients with mild dementia.

The studies included in this meta-analysis were selected from a previous systematic review (von Gunten et al. World J Biol Psychiatry 2016, 17(8),622-633). They enrolled patients with mild dementia (total score 9-15 on the SKT Short Cognitive Performance Test, SKT) (Lehfeld and Erzigkeit, Int Psychogeriatr 1997, 9(Suppl 1), 115-21) with probable Alzheimer’s disease, probable vascular dementia, or possible Alzheimer’s disease with cerebrovascular disease, respectively. Outcome measures were cognition, activities of daily living, global clinical assessment and quality of life.

From four eligible trials data of 782 patients with mild dementia were included in the meta-analysis. The analysis demonstrated that treatment with 240 mg EGb 761 daily was significantly superior to placebo in cognition (p=0.04), global assessment (p=0.01), activities of daily living (p=0.01) and quality of life (p=0.02) with medium to large standardised effects. Adverse events were similarly frequent in patients treated with EGb 761 and placebo (p=0.66).

Image:

Image 2:

Image 3:

The meta-analysis shows that EGb 761 has beneficial effects on cognition, activities of daily living, global assessment and quality of life in patients with mild dementia.

M. Riepe Speakers bureau of: Dr. Willmar Schwabe GmbH & Co. KG, M. Burkart Employee of: Dr. Schwabe Holding SE & Co. KG

The concept “mild cognitive impairment” (MCI) means a decline in executive functions (such as memory, attention, language or thought) that does not correspond to what is expected for a person’s age group. It is estimated that this diagnosis may affect a fifth of the population over 65 years and 50-80% of them will develop dementia. This pathology is related to a loss of autonomy and an increase in dependence. In addition, there are therapeutic limitations, so it is a flagrant health and social problem. In this context of difficulties, various non-pharmacological therapies are emerging with the aim of improving various aspects of this disease, among which we can found music therapy (MT).

The aim of this study is to review the most recent findings of the scientific community regarding the validity of MT as an intervention in patients with MCI. Specifically, its efficacy on cognition and its power to stop the progression of dementia are evaluated, as well as its effects on other areas of the patient.

A systematic review was carried out in the “WOS-Web of Science”, “Scopus” and “Psycoinfo” databases following PRISMA guidelines. The keywords were “MT” and “MCI”. We included clinical trials, systematic reviews and meta-analyses in english or spanish whose study population had MCI, excluding those published before 2017.

15 studies were selected, all with high quality evidence designs measured by Scotish Intercollegiate Guidelines Network scale. Among all the types of MT evaluated, various studies agree that Active MT (which includes activities that involve active participation of the patient such as singing or dancing) stands out as one of the best options, showing post-intervention improvements in MMEE scores and, secondarily, in emotional well-being (specially depression and anxiety). Instrumental practice has an important protective effect on cognitive function. On the other hand, MT with movement, in addition to being effective on cognition (it increases activity in prefrontal cortex), also causes an improvement in physical conditions. However, musical reminiscence (which consists of listening to music with an emotional component for patients with simultaneus display of images to favor memories), although it shows postive effects in several articles, these are not statistically significant. Finally, multimodal therapy (which is a combination of training and cognitive stimulations based on reminiscence and MT) did not show statistically significant changes in either mood or executive functions.

MT is a valid intervention to improve cognitive function, some neuropsychiatric symptoms and the quality of life of patients with MCI. If we also take into account its economic accessibility, the organizational simplicity and null adverse effects, it is easily concluded to be one of the most attractive therapeutic options for treating MCI today.

None Declared

Delusions and hallucinations can appear in various psychiatric and neurological pathologies. When these psychotic symptoms are of late onset, in geriatric age, it may be necessary to make a differential diagnosis between dementia or other psychiatric disorders.

To describe the differential diagnosis between dementia and delusional disorder.

Review of the scientific literature based on a relevant clinical case.

70-year-old woman who lives with her husband. She has two independent daughters. History of a depressive episode in her youth related to her husband’s gambling addiction. She attended the emergency department due to behavioural alteration at home with verbal heteroaggressiveness towards her sister and several neighbours. At the hospital she was approachable, with some psychomotor restlessness, reporting that a neighbour wanted to harm her and spoke of her, making delirious interpretations of harm and referring to visual hallucinations in the form of animals in the courtyard of her house. A brain CAT scan was performed, with normal results.

Her family reports that for about a year she has been saying incoherent things on occasions and behaving strangely. It was decided to admit her to the acute care unit.

During hospitalisation she didn’t present behavioural alterations. Treatment with risperidone was introduced with adequate tolerance and response, with distancing of the delusional ideation of harm. MOCA test was performed: 23/30 (suggestive of cognitive impairment), so PET-CT was requested with results not suggestive of neurodegenerative disease and neurodiagnostic tests (SCIP-S and BCSE); the results indicate heterogeneous cognitive performance, and no global cognitive impairment could be observed at the present time and a repeat assessment was recommended in one year’s time. Due to the results of the tests and the decrease in positive symptomatology with antipsychotic treatment, a diagnosis of delusional disorder was made upon discharge.

None Declared

A 64-year-old male with diabetes-related blindness was admitted with anxiety, low mood, and passive suicidal ideation. Despite no psychiatric history, he experienced visual hallucinations, which he recognized as “optical illusions.” A CT scan ruled out organic causes, and retinal detachment with irreversible vision loss was confirmed. Diagnosed with Charles Bonnet Syndrome (CBS), he developed delusional interpretations and auditory hallucinations. Initially treated with Venlafaxine 150 mg/day, his psychotic symptoms persisted until Risperidone was increased to 6 mg/day, which resolved the hallucinations. Lithium was then added, allowing a reduction in Risperidone without relapse.

This review, based on a case study, focuses on the challenges of treating Charles Bonnet Syndrome (CBS), early diagnosis, and the lack of clear diagnostic criteria. It explores the connection between CBS and visual loss, the emergence of psychotic symptoms, and the role of antipsychotics in managing them.

Literature was reviewed using the following keywords: (Charles Bonnet syndrome) AND (visual hallucinations OR hallucinations) AND (treatment OR management OR therapy OR pharmacotherapy). Databases such as PubMed were used to gather relevant studies.

There are several challenges in diagnosing and treating CBS. Underdiagnosis is common, leading to misdiagnoses such psychosis (Voit et al., 2021; Stojanov, 2016). Non-pharmacological approaches, including improving vision aids, have shown effectiveness in reducing hallucinations (Yacoub & Ferrucci, 2011; Pang, 2016).However, pharmacological treatments, including antipsychotics and SSRIs, have shown inconsistent results (Voit et al., 2021; Rojas & Gurnani, 2023). Differentiating CBS from psychiatric disorders is crucial, as patients typically retain awareness of the unreal nature of their hallucinations (Stojanov, 2016). Emerging research on CBS neurobiology suggests potential for future targeted therapies (Weil & Lees, 2021; Collerton et al., 2023).

Charles Bonnet Syndrome (CBS) is frequently underdiagnosed due to limited awareness and patient underreporting. Non-pharmacological approaches, such as improving vision and social support, help alleviate symptoms, though no standardized pharmacological treatments exist. This case underscores the importance of distinguishing CBS from psychiatric disorders, especially when psychotic features are present. A multidisciplinary approach, involving ophthalmologists, psychiatrists, and neurologists, is essential for effective management, as seen in this case. Early diagnosis and ongoing research are crucial for developing more targeted treatments for CBS.

None Declared

This case of a 79-year-old patient with inferred past exposure to toluene and persistent paranoid delusions illustrates the potential neuropsychiatric consequences of solvent exposure. The patient’s work as a car painter (1990-1992) aligns with literature highlighting the neurotoxic effects of organic solvents. Despite no direct evidence of exposure, treatment with Zuclopentixol 200 mg Depot every two weeks led to symptom improvement, reflecting findings on toluene-related neuropsychiatric disorders such as psychosis.

• - Present a potential case of toluene-induced psychosis.

• - Review the etiopathogenesis and treatment.

• - Assess evidence linking chronic solvent exposure with neuropsychiatric disorders.

A literature search using PubMed databases was conducted with keywords: (toluene OR xylene OR volatile organic compounds OR organic solvents) AND (psychosis OR schizophrenia OR mental disorders). Case series and observational studies were reviewed. No randomized clinical trials on antipsychotic treatment for toluene-induced psychosis were found.

The patient’s exposure to toluene was inferred based on work history, without direct evidence such as biomarkers or occupational assessments. As most studies are case series, results must be interpreted with caution. There is a lack of randomized controlled trials exploring antipsychotic treatments in solvent-induced psychosis.

Chronic exposure to toluene is associated with cognitive impairment, memory deficits, personality changes, and psychosis. Neuroimaging often reveals white matter alterations and cerebral atrophy in chronic users. Rare cases of irreversible schizophreniform psychosis have been documented. Treatment with atypical antipsychotics like risperidone shows variable efficacy, but outcomes differ between patients. In this case, Zuclopentixol 200 mg Depot every two weeks led to significant symptom reduction.

Chronic toluene exposure can result in severe neuropsychiatric disorders, including psychosis, as demonstrated by this 79-year-old patient. Neuroimaging showed cerebral atrophy and white matter changes in long-term exposure cases. Treatment with Zuclopentixol effectively reduced symptoms, despite the limited literature, which is mostly based on case series. Randomized clinical trials are needed to develop standardized treatment protocols. Additionally, occupational safety measures are critical to preventing adverse effects from solvent exposure.

None Declared

We present the case of an 88-year-old woman with severe hearing loss and a history of hypertension, non-valvular atrial fibrillation (AF), hypothyroidism, and depressive episodes, admitted following a medication overdose in a context of depressive ideation. The patient reported auditory hallucinations, hearing the voice of her deceased mother; however, she did not exhibit delusional interpretations regarding these experiences, suggesting auditory Charles Bonnet syndrome. This rare phenomenon is primarily described in older patients without psychotic disorder and requires an interdisciplinary approach for appropriate management.

To describe the clinical progression of a probable case of auditory Charles Bonnet syndrome and analyze the importance of a multidisciplinary approach, particularly in coordination with neurology, to achieve optimal diagnosis and treatment in a geriatric context.

The case was addressed through a detailed psychiatric evaluation focused on psychopathological assessment and structured interviews to evaluate affective, cognitive, and behavioral symptoms. Neuropsychological assessment included the Phototest and Clock Drawing Test to rule out advanced cognitive impairment, as well as a cranial CT scan, which showed no significant abnormalities. The neurology consultation evaluated cognitive status, hearing loss, and its impact on the patient’s psychological state, while also ruling out other neurological disorders.

The patient showed favorable progress during admission, with mood stabilization and reduced anxiety. She exhibited long-standing depressive symptoms, including feelings of guilt and burden on her family. She acknowledged hearing her mother’s voice calling her and was able to critically assess the unreal nature of these hallucinations. The neurology consultation confirmed significant hearing loss, which contributed to her isolation and, possibly, to the development of auditory hallucinations (due to the lack of sensory input). No signs of advanced cognitive impairment were found.

This case highlights the importance of a multidisciplinary approach in managing elderly patients with unusual hallucinatory phenomena. Once psychotic symptoms were ruled out by psychiatry, the neurology consultation was essential to exclude cognitive impairment and contextualize the auditory hallucinations in relation to the patient’s hearing loss and emotional burden. The integrated intervention with her family facilitated a more comprehensive approach, including family support and psychoeducation, adjustments in psychopharmacological treatment, and recommendations to improve quality of life (including emphasizing the use of hearing aids) and social support; demonstrating the effectiveness of collaboration between psychiatry and neurology.

None Declared