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BACKGROUND Our goal was to specify the relationship between the level of activity (intellectual, physical, and social) in persons diagnosed with mild cognitive impairment (MCI) and the further progression of cognitive dysfunction. MATERIAL AND METHODS We examined 193 patients diagnosed with MCI (according to the criteria of the Working Group on Mild Cognitive Impairment) and under treatment at our Mental Disorders Clinic. It was assumed that these persons would remain under systematic psychiatric observation until dementia was diagnosed. The present study results from a seven-year observation period. The mini-mental state examination (MMSE), the Activity Scale (with the intellectual, physical, and social subscales), and the Instrumental Activities of Daily Living (IADL) scale were used to evaluate the participants' status at baseline. The MMSE was re-administered after one year and again at the end of the observation (either upon diagnosis of dementia or after seven years). At each meeting with the participant, the clinical diagnosis was verified to determine if the patient had dementia or not. Of the 193 people initially qualified for the study, 75 were available for the final analysis. RESULTS It was found that there was no statistically significant difference in the baseline MMSE scores between the persons with stable MCI and the persons who had progressed to dementia. However, statistically significant differences in the level of activity at baseline on both the global IADL scale and the Activity Scale between those with stable MCI and those who had progressed to dementia were found. These differences were manifested in the IADL subscales for telephone use, shopping, transportation, and personal finances, and in the physical activity subscale. CONCLUSIONS An evaluation of intellectual, physical, and social activity can be useful in determining the prognosis for the future course of MCI.

Background: The aim of this study was to analyze the influence of the level of perinatal depression on the labor-associated fear and emotional attachment of children born to women during high-risk pregnancies and in the first days after delivery., Material/methods: 133 women aged between 16 and 45 years took part in the study. The first group included 63 pregnant women (mean age=28.59, SD=5.578) with a high-risk pregnancy (of maternal origin, for example, cardiologic disorders and diabetes). The second group included 70 women (mean age=27.94, SD=5.164) who were in the first days post-partum. Research methods included: Analysis of medical documentation; Clinical interview; the Edinburgh Postnatal Depression Scale (EPDS); the Questionnaire of Labor-Associated Anxiety (KLP), the Maternal-Fetal Attachment Scale (MFAS)., Results: Women after delivery displayed a higher level of concern for the child's health and life when compared to the high-risk pregnancy group. The results indicated the appearance of a postnatal fear, the level of which is connected with the perception of the role of the mother. This fear is lower in women prior to childbirth than it is after. There has also been noted a statistically significant relationship between the appearance of depression and attachment to the child. Those women with depression show less attachment to their child than is the case for those who do not suffer from depression., Conclusions: The appearance of a high level of depression amongst women from the high-risk pregnancy group during the first days post childbirth was accompanied by perinatal depression and a weaker attachment to the child.

Background: The purpose of the present study was to assess the influence of vascular factors on the degree of intensity and rate of progression of cognitive disorders in the course of Alzheimer Disease (AD)., Material and Methods: The research group consisted of 39 persons, all of whom were diagnosed with AD according to the NINCDS/ADRDA criteria. We divided these patients into 2 subgroups, based on the vascular factors measured by the modified Hachinski Ischemic Scale (Ha-mod): group A, without the vascular component (HA-mod score of 0-1 point), and group B, with the vascular component (a score over 1 point). Cognitive functions were evaluated at baseline and again 2 years later, using the Cognitive Part of the Alzheimer Disease Assessment Scale (ADAS-cog)., Results: We found that the patients from subgroup B, with the stronger vascular component, demonstrated the highest intensity of cognitive disorders at baseline, both in terms of the overall ADAS-cog score, and in the subscores for ideational praxis, orientation, spoken language ability, comprehension of spoken language, and word-finding difficulty in spontaneous speech. Another variable which was connected with the intensity of dementia was age. After 2 years, however, the rate of progression of cognitive disorders was not significantly different between the 2 groups., Conclusions: The severity of vascular factors correlates directly with the intensity of cognitive disturbances. At the 2-year follow-up examination, however, no correlation was observed in the research group between greater vascular involvement and more rapid progression of cognitive disorders, as measured by the ADAS-cog scale.

Background: The authors performed a long term outcome analysis of minimal brain damage in children delivered in breech presentation, and related the results to the mode of delivery (vaginal or by cesarean section)., Material/methods: In the Department of Obstetrics at the Medical University of Gdansk (Poland), 917 breech deliveries took place between 1981 and 1990. Excluding stillbirths and multiple pregnancies, 874 deliveries were analyzed. We received positive responses from 232 mothers, who provided us with considerable information about the children's further development and problems that had arisen during their school years. All the respondents were contacted by telephone, and 83 of them agreed to visit our Department with their children to undergo a psychological examination - the following tests were performed: 1) the Bender-Kopitz Test (BKT), and 2) the Benton Visual Retention Test (BVRT)., Results: The mode of delivery for all groups and subgroups had no influence on the incidence of organic brain disorders in later childhood, assessed by the Benton Visual Retention test and by the Bender-Kopitz test., Conclusions: Vaginal breech deliveries are safe in both primiparous and multiparous mothers.

Background: The symptoms of Alzheimer's disease (AD) are numerous, including worsening of mood, psychotic symptoms, aggressive and impulsive behaviours, and many others. It is generally assumed that there exists a relationship between the severity of dementia and aggressive symptoms. The aim of this study was to assess the relationship between aggressive and impulsive behaviours and cognitive function disorders in AD patients., Material/methods: Forty-eight AD patients living in a nursing home were included in the research group on the basis of NINCDS/ADRDA criteria. The subjects underwent two years of naturalistic observation. The intensity of agitation and aggressive behaviours was assessed on the basis of the Cohen-Mansfield Agitation Inventory (CMAI). The Alzheimer's Disease Assessment Scale Cog (ADAS-cog) was used to assess cognitive function. Pharmacotherapy administered during the observation period was also taken into account., Results: Thirty-one patients completed the two year long observation. Individuals with more severe cognitive deficiencies demonstrated a greater intensity of aggressive and impulsive behaviours, as assessed using the CMAI scale. Aggression escalated together with the development of dementia disorders. The intensity of dementia disorders was most significantly connected with physical agitation and verbal aggression. The use of neuroleptics and mood stabilisers decreased the progression of aggressive and impulsive behaviours., Conclusions: There is a relationship between cognitive functioning disorders and the intensification of aggressive and impulsive behaviours. More severe forms of dementia are connected with greater intensification of aggressive and impulsive behaviours as the disease progresses. Periodical administration of pharmacotherapy may reduce the development of aggressive behaviours.

Background: The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD)., Material/method: Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale-III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients--68 men and 46 women treated in the Reintegrative-Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdańsk, who were suffering from various types of dementia., Results: It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness., Conclusions: The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

Background: As pre- and postnatal depression is a multifactorial disorder, the screening programmes which are currently in use in obstetric clinics remain problematic due to their inadequate standardization and limited efficacy. The evaluation of core risk factors for perinatal depression in the screening process, in addition to routine questionnaire-based tools such as the Edinburgh Postnatal Depression Scale (EPDS), might improve the diagnosis and early treatment of women affected by depression. This study was undertaken to analyze the relationship between personality traits and the risk of perinatal depression in pregnant and postpartum women., Material/methods: For the study, 229 patients (pregnant and postpartum women) admitted to an obstetric hospital in Poland were recruited. Two self-report questionnaires were used: the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depressive symptoms and the NEO Five-Factor Inventory (NEO-FFI) for the evaluation of five personality traits in the studied patients., Results: Neuroticism significantly increased the risk of perinatal depressive symptoms in both pregnant and postpartum women (OR=1.23 and OR=1.11, respectively). Personality traits related to a lower risk of perinatal depression in the group of pregnant women included extraversion, openness to experience, high degree of agreeableness and conscientiousness (OR=0.90, OR=0.92, OR=0.90 and OR=0.91, respectively). However, among at-risk postpartum women no additional factors, except neuroticism, affected the prevalence of depressive symptoms., Conclusions: Personality trait like neuroticism as measured by the NEO-FFI is associated with a greater risk of perinatal depression. The NEO-FFI is a useful tool, potentially adding significant value to the program of perinatal depression screening.

Background: Stress urinary incontinence often leads to major physical, psychological and social problems, and many patients struggle to cope with this illness. The issue of urinary leakage during sex is particularly troublesome., Case Report: In order to show the relationship between psychosexual biography and the strategies applied to cope with urinary leakage during sexual intercourse, we analyzed the psychosexual biographies of 2 patients with stress urinary incontinence., Conclusions: Psychosexual biography influences the choice of strategies used by incontinent women to cope with urinary leakage during sexual intercourse. Normal psychosexual development in all developmental stages conditions proper sexual functioning in women with urinary leakage during sexual intercourse and the choice of less restrictive coping strategies.

Background: Differentiating FTD and AD is of great clinical significance, due to the very different efficacy of cholinesterase inhibitors in the two disorders. Previous studies have pointed to behavioral differences in FTD and AD, but less attention has been paid to comparing aggressive and impulsive behaviors in the AD and the FTD., Material/methods: Nursing home residents diagnosed with AD (NINCDS/ADRDA criteria) or the behavioral variant of FTD (Frontotemporal Dementia and Pick's Disease Working Group criteria) were included in the research group. Individuals diagnosed with AD who showed atrophy of the frontal lobes in neuroimaging were excluded from the study, as were patients matching the clinical criteria for bvFTD, but with lesions in the temporal lobes. Agitation and aggressive behaviors were assessed using the Cohen-Mansfield Agitation Inventory (CMAI), whereas behavioral and psychological symptoms were assessed with the Neuropsychiatric Inventory - Nursing Home Version (NPI-NH)., Results: The overall NPI-NH score, including with some partial scores (apathy/indifference and disinhibition), together with the intensity of aberrant motor behavior differentiated individuals with AD from those with bvFTD. On the CMAI scale, both the overall score and physical aggressive behaviors differentiated the two study groups., Conclusions: Our research confirms previous results indicating a greater intensity of behavioral pathology in FTD. A detailed assessment of aggressive behaviors revealed further differences between AD and FTD in this respect.

Background: Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients., Material/methods: Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline., Results: Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation., Conclusions: Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.

Background: AD is preceded by a lengthy preclinical period. Neural degeneration may lead to the appearance of behavioral and psychological symptoms, even before other clinical symptoms are manifest. We attempted to evaluate this symptomatology in preclinical AD., Material/methods: We recruited 291 care center residents who did not demonstrate dementia symptoms according to DSM-IV, whose MMSE score was at least 24, and who reached the first or second stage on the Global Deterioration Scale. Psychopathology was assessed using the AMDP, while the ADAS-cog was used to assess cognitive dysfunctions. Seven years later, 155 patients participated in the follow-up study (MMSE and ADAS-cog). If the MMSE was less than 24, a psychiatric workup was done to verify dementia. The AD group consisted of persons properly diagnosed with AD (n=25), while the control group consisted of persons in whom dementia had not developed., Results: The AD and control groups differed in the level of psychopathological symptoms at baseline. The disparities related both to the global AMDP score and to every particular symptom category. The analysis did not disclose a pathognomonic symptom for preclinical AD, but there were many symptoms whose intensity differentiated AD patients from the controls. The degree of cognitive dysfunction seems to correlate with the clinical manifestation of some psychopathological symptoms in preclinical AD., Conclusions: The degeneration process before the clinical manifestation of dementia leads not only to the impairment of several cognitive functions, but also the intensification of behavioral and psychological symptoms.

Background: It remains an open issue in old age psychiatry whether or not persons with mild cognitive impairment (MCI) are at increased risk for developing a dementia syndrome, and if so, to what extent and under what circumstances. The purpose of the present study was to examine a population of older patients 5 years after a diagnosis of MCI., Material/methods: From an initial group of 158 older patients from our clinic who had been tested neuropsychologically and diagnosed with MCI between 1994 and 1996, and who meet the inclusion and exclusion criteria, 52 were available for follow-up five years later., Results: Of the 52 subjects we successfully recruited, 12 had developed dementia within the five-year follow-up period, including 8 with DAT, 3 with mixed dementia, and 1 with vascular dementia. The rate of cognitive decline is a good predictor of later dementia., Conclusions: Patients with MCI are at some risk of developing a dementia syndrome, most commonly DAT. Evaluating both the cognitive and neuropsychological functioning of individuals affected with MCI, as well as their global functioning, can be useful in terms of predicting the clinical outcome in these patients.