Affiliation: Current Psychopharmacology CEMIC University Hospital Buenos Aires, Argentina.
In the past four decades there have been numerous advances in various branches of science in general and medicine in particular that had led to increasing elderly population. Depression, cognitive impairment and dementia are among the most important mental health problems in elderly people. Both conditions have severe consequences for the patients, including diminished quality of life, functional decline, increased use of services, and high mortality. Furthermore, these diseases impact health of caregivers. The World Health Organization considers the care of these pathologies a risk factor for the development of mental disorders and burden. The aim of this thematic issue is to describe different pathologies present in elderly patients and develop these topics with an interdisciplinary approach. This thematic issue focuses on different aspects of psychogeriatrics such as onset age and clinical heterogeneity of dementias. Frontotemporal dementia (FTD) is the main differential diagnosis with early stages of Alzheimer’s disease (AD). Usually, differential diagnosis between a first depressive episode and the beginning of an early degenerative dementia with mood disorders, either AD or FTD, can be difficult. This topic is addressed in the research article of Serrano and colleagues , were they conclude that onset age of cognitive and/or behavioral impairment may be one of the variables influencing the clinical heterogeneity of dementias. Many of the young-onset dementias may be potentially reversible so its early identification and pathophysiology understand increase pharmacological intervention opportunities of halting the cascade of events that lead inexorably to dementia. Moreover, cognitive impairment underpins some of the clinical spectrum of the cerebrovascular disease (CVD), as well as contributes to the patient´s impaired social and behavioral functioning, and the higher mortality. Despite a general emphasis in the international literature on the primary and secondary prevention of CVD to avoid vascular dementia or their combination with Alzheimer’s disease, the controversy concerning their diagnostic criteria and optimal treatment is still open. Given its growing burden, the prevention and treatment of CVD and the spectrum of VCI are critical priorities for clinical care and research. Russo and Allegri  performed a selective review about the current status of vascular dementia, mild cognitive impairment due to CVD, and mixed dementia, with special emphasis on available evidence of pharmacological strategies for treatment and prevention from controlled clinical trials. Late life depression is a prevalent disorder that affects elderly population and it is frequently associated to cognitive impairment. This disease is sub diagnosed due to great variability in the sample involved, the definition of depression, the methodology used, and the experience of the evaluator. Dillon, Rodriguez and Taragano, in their review , analyze the different subtypes of late life depression, the diagnostic methods that can be performed and the pharmacological treatment of this disease. Elderly patients who suffer degenerative diseases generally need caregiving. Considering that the task of caregiving, this is generally carried out by a family member who becomes an easy target for diseases, especially for being subjected to a stressing process. Tartaglini and colleagues  studied whether the older caregivers’ health suffers affections if compared with the health conditions of those who do not take care of family members. Environmental complexity states that those individuals involved in activities that require greater cognitive demands keep their cognitive abilities undamaged despite the passing of time. Feldberg, Stefani and Allegri  will demonstrate how environmental complexity and the importance of engaging in recreational activities influence individuals’ lives and their cognitive healthy aging. Finally, in relation to pharmacological treatment in dementia, in the last decade, various medications have been used for the treatment of cognitive symptoms in Dementia. Many of them have few scientific evidence of their effectiveness. Pérez Leguizamón and colleagues  review and update the current status of the pharmacological treatment of cognitive symptoms in Alzheimer´s Disease, one of the most prevalent and disabling diseases in the elderly.