April 2009

Medication Treatment for BPD: The Limited Evidence Base
Antipsychotics, especially olanzapine (Zyprexa), may be beneficial in treating borderline personality disorder, but the data are limited and mixed.

Chelation Therapy for Autism?
A study of chelation therapy for autism was stopped due to potential adverse effects.

Varenicline for Smoking Cessation
Varenicline (Chantix) should be used with caution in psychiatric patients attempting to quit smoking.

In Brief
Modifying risk factors can help prevent dementia; Increased lighting improves cognition in elderly

Minocycline for Schizophrenia: Preliminary Results
The results from an open-label study of minocycline (Solodyn and others) suggest benefit in the treatment of schizophrenia.

In Brief

April 2009

Although no treatments are yet available that completely ameliorate the degenerative effects of dementia, the risk of cognitive decline may be reduced by modifying vascular, dietary, and lifestyle factors. Reviewing the literature on this topic, Ruth Peters notes that the association of high blood pressure in midlife with an increased risk of developing dementia has been demonstrated by many longitudinal population studies (Int J Geriatr Psychiatry. Article published online at DOI: 10.1002/gps.2153). Results from studies on lowering blood pressure to prevent dementia onset, however, have been mixed. High cholesterol, diabetes, and very high or very low body mass index may also increase the risk of dementia, but the evidence is not as clear-cut. Maintaining a healthy diet and moderate alcohol use have been linked to a lower incidence of dementia, and a "Mediterranean diet," with regular fish, vegetable and fruit consumption, seems to be the best. Exercise and education have positive effects on cognitive functioning and may reduce the incidence of dementia, while smoking has clear negative effects. Risk factors may vary with age, and there are some that cannot be amended, such as genetic risk factors. In the absence of a prophylactic treatment, maintaining a healthy lifestyle may be the best way to reduce the chances of developing dementia.

A separate study published last year suggests a simple measure to improve functioning in people who have dementia—increasing daytime light levels. In a double-blind, random-assignment study of elderly residents in group care facilities, 87% of whom had dementia, bright light boosted cognitive function and reduced depressive symptoms (Riemersma-van de Lek et al. JAMA 2008;299:2642-2655). About half of the 189 subjects had normal office-level lighting in their rooms, while the other half had much brighter lighting for about 9 hours per day for a mean of 15 months. Within each group, half the subjects took melatonin, 2.5 mg/day. Subjects who were given melatonin had slight improvements in sleep and aggressive behavior. Those in the darker rooms who took melatonin, however, became more withdrawn. The authors conclude that increased illumination levels could be considered by care facilities for elderly individuals with dementia, because the long-term application appears to cause no harm, but melatonin should only be used to improve sleep in combination with light because of its possible adverse effects on mood.

Heather S. Hopkins