Background
Agitation and psychosis are common among older adults with dementia and are challenging to manage. At the present time, little is known about the efficacy and safety of antidepressant ...medications when used to treat these symptoms.
Objectives
To assess the safety and efficacy of antidepressants in treating psychosis and agitation in older adults with Alzheimer's disease, vascular, or mixed dementia.
Search methods
We searched the Cochrane Dementia and Cognitive Improvement Group’s Specialized Register which included Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (January 1950 to October 2009), EMBASE (1980 ‐ October 2009), CINAHL (all dates ‐ October 2009) and PsycINFO (1806 to October 2009).
Selection criteria
Randomized, controlled trials of antidepressants (selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, trazodone, and other antidepressants), compared to either placebo or comparator medications (typical or atypical antipsychotics, anticonvulsants, benzodiazepines, cholinesterase inhibitors, memantine or other medications) for treatment of agitation or psychosis in older adults with dementia.
Data collection and analysis
Two authors independently assessed trial quality and extracted trial data. We collected information on efficacy as measured by dementia neuropsychiatric symptom rating scales and adverse effects. Study authors were contacted for additional information.
Main results
Nine trials including a total of 692 individuals were included in the review. Five studies compared SSRIs to placebo and two studies were combined in a meta‐analysis for the outcome of change in Cohen‐Mansfield Agitation Inventory (CMAI) scores. There was a significant difference between antidepressants and placebo on measures of agitation as reported on the change in CMAI total score (mean difference (MD), ‐0.89, 95% CI, ‐1.22 to ‐0.57) although the results were heavily weighted by one large study. There were no significant differences in change in behavioral symptoms of dementia for SSRIs compared to placebo in the one study that reported on changes in the Neuropsychiatric Inventory and Behavioral Pathology in Dementia scales. One study comparing citalopram to placebo found a significant difference in NPS as measured on the Neurobehavioral Rating Scale (NBRS) after controlling for baseline severity NBRS score although the unadjusted mean difference was not statistically significant (MD ‐ 7.70, 95% CI: ‐16.57 to 1.17). There was no difference in the rates of trial withdrawals due to adverse events for SSRIs compared to placebo for four studies reporting this outcome (relative risk (RR), 1.07, 95% CI: 0.55 to 2.11) or in the number of trial withdrawals due to any cause in the three studies reporting this outcome (RR, 0.91, 95% CI, 0.65 to 1.26). One study compared the SSRI citalopram to the atypical antipsychotic risperidone and found no difference in NBRS scores, trial withdrawals due to any cause or trial withdrawals due to adverse events although the rates of adverse events as measured on the UKU side effect scale total score were lower for citalopram (MD ‐2.82, 95% CI: ‐4.94 to ‐0.70). Three studies compared SSRIs to typical antipsychotics. In meta‐analysis of two studies there was no statistically significant differences in changes in CMAI total scores (MD, 4.66, 95% CI: ‐3.58 to 12.90). There was also no difference in trial withdrawals due to any cause or due to adverse events for SSRIs compared to typical antipsychotics. One study of trazodone compared to placebo did not find any significant difference in change in CMAI total scores (MD, 5.18, 95% CI, ‐2.86 to 13.22) or trial withdrawals due to any cause (RR, 1.06, 95% CI, 0.54 to 2.09). Two studies comparing trazodone to haloperidol also failed to detect any difference in change in CMAI total scores (MD, 3.28, 95% CI, ‐3.28 to 9.85) or trial withdrawals due to any cause (RR, 0.79, 95% CI, 0.43 to 1.46).
Authors' conclusions
Currently there are relatively few studies of antidepressants for the treatment of agitation and psychosis in dementia. The SSRIs sertraline and citalopram were associated with a reduction in symptoms of agitation when compared to placebo in two studies. Both SSRIs and trazodone appear to be tolerated reasonably well when compared to placebo, typical antipsychotics and atypical antipsychotics. Future studies involving more subjects are required to determine if SSRIs, trazodone, or other antidepressants are safe and effective treatments for agitation and psychosis in dementia.
We present density split statistics, a framework that studies lensing and counts-in-cells as a function of foreground galaxy density, thereby providing a large-scale measurement of both 2-point and ...3-point statistics. Our method extends our earlier work on trough lensing and is summarized as follows: given a foreground (low redshift) population of galaxies, we divide the sky into subareas of equal size but distinct galaxy density. We then measure lensing around uniformly spaced points separately in each of these subareas, as well as counts-in-cells statistics (CiC). The lensing signals trace the matter density contrast around regions of fixed galaxy density. Through the CiC measurements this can be related to the density profile around regions of fixed matter density. Together, these measurements constitute a powerful probe of cosmology, the skewness of the density field and the connection of galaxies and matter. In this paper we show how to model both the density split lensing signal and CiC from basic ingredients: a non-linear power spectrum, clustering hierarchy coefficients from perturbation theory and a parametric model for galaxy bias and shot-noise. Using N-body simulations, we demonstrate that this model is sufficiently accurate for a cosmological analysis on year 1 data from the Dark Energy Survey.
Scaling cryogenic Germanium-based dark matter detectors to probe smaller WIMP-nucleon cross-sections poses significant challenges in the forms of increased labor, cold hardware, warm electronics and ...heat load. The development of larger crystals alleviates these issues. The results of ionization tests with two 100 mm diameter, 33 mm thick cylindrical detector-grade Germanium crystals are presented here. Through these results the potential of using such crystals in the Super Cryogenic Dark Matter Search (SuperCDMS) SNOLAB experiment is demonstrated.
The OLYMPUS Collaboration reports on a precision measurement of the positron-proton to electron-proton elastic cross section ratio, R_{2γ}, a direct measure of the contribution of hard two-photon ...exchange to the elastic cross section. In the OLYMPUS measurement, 2.01 GeV electron and positron beams were directed through a hydrogen gas target internal to the DORIS storage ring at DESY. A toroidal magnetic spectrometer instrumented with drift chambers and time-of-flight scintillators detected elastically scattered leptons in coincidence with recoiling protons over a scattering angle range of ≈20° to 80°. The relative luminosity between the two beam species was monitored using tracking telescopes of interleaved gas electron multiplier and multiwire proportional chamber detectors at 12°, as well as symmetric Møller or Bhabha calorimeters at 1.29°. A total integrated luminosity of 4.5 fb^{-1} was collected. In the extraction of R_{2γ}, radiative effects were taken into account using a Monte Carlo generator to simulate the convolutions of internal bremsstrahlung with experiment-specific conditions such as detector acceptance and reconstruction efficiency. The resulting values of R_{2γ}, presented here for a wide range of virtual photon polarization 0.456<ε<0.978, are smaller than some hadronic two-photon exchange calculations predict, but are in reasonable agreement with a subtracted dispersion model and a phenomenological fit to the form factor data.
Within the coastal zone, waterfront development has caused severe loss of shallow-water habitats, such as salt marshes and seagrass beds. Although the effects of habitat degradation on community ...structure within intertidal marshes have been well studied, little is known about the impact of habitat degradation on, and the ecological value of, subtidal shallow-water habitats, despite the prevalence of these habitats in coastal ecosystems. In coastal habitats, bivalves are dominant benthic organisms that can comprise over 50% of benthic prey biomass and are indicative of benthic production. We quantified bivalve diversity, density, and biomass in deep and shallow (<1.5 m MLW) unstructured subtidal habitats in 2 tributaries of lower Chesapeake Bay (Elizabeth-Lafayette River system and York River). We also examined the effects of shoreline alteration in shallow habitats by contrasting the benthos of the subtidal areas adjacent to natural marsh, bulkhead, and rip-rap shorelines. Bivalve diversity, density, and biomass were significantly higher in shallow than in deep benthic habitats in both systems. Benthic abundance and diversity were higher in subtidal habitats adjacent to natural marsh than those adjacent to bulkhead shorelines; abundance and diversity were intermediate in rip-rap shorelines, and appeared to depend on landscape features. Predator density and diversity tended to be highest adjacent to natural marsh shorelines, and density of crabs was significantly higher in natural marsh than in bulkhead habitats. There is thus a crucial link between natural marshes, infaunal prey in subtidal habitats, and predator abundance. Consequently, the indirect effects of coastal habitat degradation upon secondary production in the shallow, subtidal habitats adjacent to salt marshes may be as great as or greater than direct habitat effects.
Piwi-interacting RNAs (piRNAs) silence transposons and maintain genome integrity during germline development. In Drosophila, transposon-rich heterochromatic clusters encode piRNAs either on both ...genomic strands (dual-strand clusters) or predominantly one genomic strand (uni-strand clusters). Primary piRNAs derived from these clusters are proposed to drive a ping-pong amplification cycle catalyzed by proteins that localize to the perinuclear nuage. We show that the HP1 homolog Rhino is required for nuage organization, transposon silencing, and ping-pong amplification of piRNAs. rhi mutations virtually eliminate piRNAs from the dual-strand clusters and block production of putative precursor RNAs from both strands of the major 42AB dual-strand cluster, but not of transcripts or piRNAs from the uni-strand clusters. Furthermore, Rhino protein associates with the 42AB dual-strand cluster,but does not bind to uni-strand cluster 2 or flamenco. Rhino thus appears to promote transcription of dual-strand clusters, leading to production of piRNAs that drive the ping-pong amplification cycle.
We present an analysis of the MUSIC-2 /V-body/hydrodynamical simulations aimed at estimating the expected concentration-mass relation for the CLASH (Cluster Lensing and Supernova Survey with Hubble) ...cluster sample. We study nearly 1,400 halos simulated at high spatial and mass resolution. We study the shape of both their density and surface-density profiles and fit them with a variety of radial functions, including the Navarro-Frenk-White (NEW), the generalized NEW, and the Einasto density profiles. We derive concentrations and masses from these fits. We produce simulated Chandra observations of the halos, and we use them to identify objects resembling the X-ray morphologies and masses of the clusters in the CLASH X-ray-selected sample. We also derive a concentration-mass relation for strong-lensing clusters. We find that the sample of simulated halos that resembles the X-ray morphology of the CLASH clusters is composed mainly of relaxed halos, but it also contains a significant fraction of unrelaxed systems. For such a heterogeneous sample we measure an average two-dimensional concentration that is ~11% higher than is found for the full sample of simulated halos. After accounting for projection and selection effects, the average NEW concentrations of CLASH clusters are expected to be intermediate between those predicted in three dimensions for relaxed and super-relaxed halos. Matching the simulations to the individual CLASH clusters on the basis of the X-ray morphology, we expect that the NEW concentrations recovered from the lensing analysis of the CLASH clusters are in the range 3-6, with an average value of 3.87 and a standard deviation of 0.61.
Weakly Interacting Massive Particles (WIMPs) are a strong candidate for the Cold Dark Matter of the Universe. CDMS-II is a direct-search WIMP search experiment, operating at 50 mK and housed at the ...Soudan mine, Minnesota. The 250 gram Ge detectors utilize athermal phonon sensors where tungsten transition edge sensors are operated in negative electrothermal feedback. The search at Soudan is ongoing with an expected final reach of CDMS-II by the end of 2008 of a WIMP-nucleon cross-section sensitivity of 2.1 x10-44 cm2, at a WIMP mass of 60 GeV/c2. To proceed further, we have proposed the SuperCDMS program.
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