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[beta]-Amyloid precursor protein (APP) mutations cause familial Alzheimer's disease with nearly complete penetrance. We found an APP mutation [alanine-673 [right arrow] valine-673 (A673V)] that causes disease only in the homozygous state, whereas heterozygous carriers were unaffected, consistent with a recessive Mendelian trait of inheritance. The A673V mutation affected APP processing, resulting in enhanced [beta]-amyloid (A[beta]) production and formation of amyloid fibrils in vitro. Coincubation of mutated and wild-type peptides conferred instability on A[beta] aggregates and inhibited amyloidogenesis and neurotoxicity. The highly amyloidogenic effect of the A673V mutation in the homozygous state and its anti-amyloidogenic effect in the heterozygous state account for the autosomal recessive pattern of inheritance and have implications for genetic screening and the potential treatment of Alzheimer's disease.

A random sample of 368 elderly residents in nine geriatric institutions in Milan was selected, and interviewed using the Intervista Psicogeriatrica, the modified Italian version of the OBS scale (82.1% successfully completed) and the Depression scale (75.5% successfully completed) of the comprehensive Assessment and Referral Evaluation (CARE). The estimated prevalence rates of dementia and depression were 36% and 30% respectively and 50% for either or both diagnoses. Correlates of dementia were characteristics of the institutions (size, ownership, and admission criteria), age (for women), age at admission, female sex, and poor education. Correlates of depression were disability, length of stay in men (negative association), and marital status. Correlates of dementia and depression were also examined using multivariate analysis. The only significant independent effects on dementia were admission criteria of the institutions and age, while on depression were sex and marital status. [ABSTRACT FROM AUTHOR]

A drug utilization study was carried out in 11 geriatric institutions for independent or dependent people in Padua. Clinical records and treatment charts of the 1533 residents were reviewed and details on sociodemographic characteristics of the population and prescription of psychotropic drugs were recorded. Mean age of the residents was 79 years and mean length of stay five years; women were 78% of residents. Psychotropic drug prescriptions were recorded in 26% of the residents; frequency of prescriptions of benzodiazepines, neuroleptics and antidepressants was respectively 21%, 8% and 4% most of the residents (74%) receiving psychotropic agents were being prescribed only one category of psychotropic drug. Duration of treatment could not be reliably assessed. Psychotropic drug use in geriatric institutions is discussed and studies from different countries are briefly reviewed. Evidence from the literature and the present study suggests that, at least in some institutions, psychotropic drug use is inappropriate. [ABSTRACT FROM AUTHOR]