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Lithium and prevention of cognitive impairment

  • Zareena Abidin (a1), Colm Cooney (a2), Deirdre Jackson (a3) and Aideen Freyne (a4)
Abstract

Objective: To examine the rate of cognitive decline and occurrence of dementia among patients attending a lithium clinic for those aged 65 years and over.

Method: Retrospective chart review of the cognitive function of 29 patients receiving maintenance lithium treatment attending the Dublin South East Old Age Psychiatry service, over a nine-year time period.

Results: Twenty-nine patients were included in the study (20 female, nine males), with a mean age of 79 years. Two patients had concurrent dementia. Six patients fulfilled ICD10 criteria for mild cognitive disorder and all of these patients also fulfilled revised consensus criteria for mild cognitive impairment amnestic subtype. Sixteen patients were commenced on lithium as an augmentation treatment for recurrent depressive disorder, 12 patients were on treatment for bipolar affective disorder and one patient on treatment for schizoaffective disorder. Patients had been receiving lithium treatment for an average of 109 months with follow-up by the service for a mean duration of 38 months. The initial mean MMSE score of patients at first presentation to the service was 26.9 (SD = 5.6) compared to a mean MMSE score 25.8 (SD = 5.8) (CI of change in MMSE score at 95% level = −2.1 and 0) at follow-up. The mean MMSE of patients with mild cognitive impairment prior at first contact with the service was 26.8 (SD = 3.2) and at follow-up was 26 (SD = 3.2) which was not statistically significantly different (p=0.40) (CI for change in MMSE at 95% level = −3.2 to 1.5). No patient had developed incident dementia during the follow-up period of the study.

Conclusion: The results tentatively suggest that lithium may have a protective effect against cognitive decline and a neuroprotective role in patients with concurrent affective disorder and cognitive impairment. Multi-centre prospective studies of cognitive function in patients attending lithium clinics are needed to examine the neuroprotective properties of lithium.

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Corresponding author
*Correspondence Email: c.cooney@st-vincents.ie
References
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1.Cade, J. Lithium salts in the treatment of psychotic excitement. Med J Australia 1949; 2: 349352.
2.Geddes, JR., Burgess, S, Hawton, K, Jamison, K and Goodwin, GM. Long-term lithium therapy for bipolar disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Psychiatry 2007; 161:217222.
3.Ferrier, IN., Ferrie, LJ., Macritchie, KA. Old drug, new data. Revisiting Lithium therapy. Advances in Psychiatric Treatment 2006; 12: 256264.
4.Cipriani, A, Pretty, H, Hawton, K and Geddes, J R. Lithium in the Prevention of Suicidal Behavior and All-Cause Mortality in Patients with Mood Disorders: a Systematic Review of Randomized Trials. Am J Psychiatry 2005; 162: 18051819.
5.Fahy, S, Lawlor, B. Lithium use in octogenarians. Int J of Geriat Psych 2001; 16:10001003.
6.Young, AH., Hammond, JM. Lithium in mood disorders: increasing evidence base, declining use. Brit J Psychiatry 2007; 191: 474476.
7.Kozman, MN., Wattis, J and Curran, S. Pharmacological management of behavioural and psychological disturbance in dementia. Human Psychopharmacology Clinical Experience 2006; 21: 112.
8.Terao, T, Nakano, H, Inoue, Y, Okamoto, T, Nakamura, J and Iwata, N. Lithium and dementia: a preliminary study. Prog Neuropsychopharmacology Biol Psychiatry 2006; 30(6): 11251128.
9.Nunes, PV., Forlenza, OV., Gattaz, WF. Lithium and risk for Alzheimer's disease in elderly patients with bipolar disorder. Brit J Psychiatry 2007; 190:359360.
10.Kessing, LV., Sondergard, L, Forman, JL and Andersen, PK. Lithium Treatment and Risk of Dementia. Arch Gen Psychiatry 2008; 65(11): 13311335.
11.Folstein, ME., and Folstein, SE. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Research 1975; 12: 189195.
12.Winblad, B, Palmer, K, Kivipelto, M, Jelic, V, Fratiglioni, L, Wahlund, L.O. et al.Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Int Medicine 2004; 256: 240246.
13.Cleveland, W.S. Robust Locally Weighted Regression and Smoothing Scatterplots. J Am Statistical Association 1979; 74: 368, 829836.
14.Kessing, LV., Nilsson, FM. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses. Journal of Affective Disorders 2003; 73(3):261269.
15.Gauthier, Set al.Mild Cognitive Impairment. Lancet 2006; 367:12621270.
16.Morris, JCet al.Mild cognitive impairment represents early-stage Alzheimer's disease. Arch Neurology 2001; 58: 397405.
17.Petersen, RC., Steven, JC., Ganguli, M, Tangalos, EG., Cummings, JL. DeKosky, ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidenced-based review). Report of the Quality Standards Subcommittee of the American Academy of neurology. Neurology 2001a; 56: 11331142.
18.Phiel, CJ., Klein, PS. Molecular targets of lithium action. Ann Rev Pharm Toxicology 2001; 41: 789813.
19.Rockenstein, E, Torrance, M, Adame, A, Mante, Met al.Neuroprotective effects of regulators of the Glycogen Synthase Kinase-3β Signaling pathway in a transgenic model of Alzheimer's disease are Associated with Reduced Amyloid Precursor Protein Phosphorylation. J Neuroscience 2007; 27(8): 19811991.
20.Phiel, JC., Wilson, CA., Lee, VMY and Klein, PS. GSK-3α regulates production of Alzheimer's disease amyloid-β peptides. Nature 2003; 423: 435439.
21.Moore, GJ., Bebchuck, JM., Wilds, IB., Chen, G, and Manji, HK. Lithium-induced increase in human grey matter. Lancet 2000; 356(9237): 12411242.
22.Yucel, K, Taylor, VH., McKinnon, MC., MacDonald, K, Alda, M, Young, LT., et al.Bilateral hippocampal volume increase in patients with bipolar disorder and short term lithium treatment. Neuropsychopharmacology 2008; 33: 361367.
23.Yucel, K, McKinnon, C, Taylor, VH., MacDonald, K, Alda, A, Young, LT., et al.Bilateral hippocampal volume increases after long-term lithium treatment in patients with bipolar disorder: a longitudinal MRI study. Psychopharmacology 2007; 195: 357367.
24.Beyer, J, Kuchibhatla, M, Payne, M, Moo-Young, M, Cassidy, F, McFall, J, et al.Hippocampal Volume Measurement in Older Adults with Bipolar Disorder. Am J Geriatr Psychiatry 2004; 12(6): 613620.
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Irish Journal of Psychological Medicine
  • ISSN: 0790-9667
  • EISSN: 2051-6967
  • URL: /core/journals/irish-journal-of-psychological-medicine
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