Piet Eikelenboom

Melancholia is a historical concept according to which the clinical condition is characterised by gloom, apprehension and psychomotor disturbance, vital symptoms and psychotic phenomena. The condition needs to be accurately diagnosed if treatment is to be appropriate. If a patient shows no clear signs of depression, psychomotor disturbance is often not recognised as a feature of severe depression and as a result treatment is delayed. On the basis of two case studies we show that psychomotor symptoms can be extremely important for an accurate clinical evaluation.

Variation in APOE genotype is a determinant of Alzheimer disease (AD), but the risk associated with variation in plasma apoE levels has yet to be determined. Here, we studied offspring with and without a parental history of AD to identify the effect of plasma apoE levels at middle age on the risk of late-onset AD. Some 203 offspring from 92 families with a parental history of AD were compared with 197 offspring from 97 families without a parental history of AD. APOE genotypes and plasma apoE levels were assessed in all offspring. Difference in plasma apoE level between subjects with and without a parental history of AD was calculated using robust linear regression, both stratified and adjusted for APOE genotype. Offspring with a parental history of AD were more likely to be an APOE epsilon4 allele carrier (46% vs 21%, p < 0.001) than offspring without such a parental history. Mean plasma apoE levels strongly decreased from epsilon2 to epsilon3epsilon3 to epsilon4 carriers (p < 0.001). Offspring with a parental history of AD had lower plasma apoE levels than subjects without such a history, both in analyses adjusted for APOE genotype (difference: -0.21 mg/dL, p = 0.02) and when using standardized Z scores, when stratified for APOE genotype (difference: -0.22, p = 0.009). Our findings suggest that lower plasma apoE levels in middle age could be a risk factor for Alzheimer disease in old age, independent of APOE genotype.

In recent years there have been significant developments in psychiatry for the elderly in the Netherlands. Epidemiological research has widened its scope, collaborating with other disciplines and thereby creating a range of new perspectives. Patient care is shifting gradually to the general hospital and psychiatry for the elderly has a definite place in the curriculum for trainee psychiatrists. Increasingly, integrated care arrangements are becoming available for elderly psychiatric patients with handicaps. Psychiatry for the elderly has obtained a firm foothold in the Netherlands and should be able to participate in and benefit from the developments that are expected in the years to come.