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OBJECTIVES: To assess the strength of association between cognitive tests and on-road driving ability in people with dementia by conducting a systematic review and meta-analysis. METHODS: A literature search strategy was developed using terms related to dementia and driving. Fifteen databases were searched. Studies were selected if they investigated the predictive ability of cognitive tests and on-road fitness to drive in people with dementia. The primary author performed the initial screening of title and abstract of each paper. Two reviewers then independently checked whether the abstracts met the inclusion and exclusion criteria. The primary author also hand searched included studies, reference lists and conducted citation searches. Studies were quality assessed using Newcastle-Ottawa Quality Assessment Scale for Cohort and Case-Control Studies. A random effect model was employed to analyse effect size. RESULTS: The initial search identified 6734 articles, of which 47 full-text articles were screened for inclusion. Thirty articles were included in the review and sixteen articles were included in the meta-analysis. Analysis showed statistically significant weak to moderate (0.3-0.4) relationships between cognitive measures and on-road driving for all cognitive domains except language. CONCLUSION: All cognitive domains apart from language showed a statistically significant moderate association with on-road driving outcome in patients with mild dementia. A composite cognitive battery is likely to be better than testing single cognitive domains in assessing fitness to drive in patients with dementia.

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Bipolar affective disorder (BPAD) is a chronic debilitating psychiatric illness seriously affecting the quality of patients' life. The available treatment is effective in about half of those suffering from the illness. The neurobiological basis of the disorder is not fully unraveled. With such lacunae, attempts have been made to decipher the underlying neuroimmunological process of the illness as is the case with other mental disorders. As a result, some inflammatory processes have been implicated in the etiology of BPAD, as described in this communication. Subsequently, the role of anti-inflammatory agents such as celecoxib was investigated by treating different phases of BPAD. Given the promising outcomes of several trials and reviews, celecoxib has gained momentum and has been recommended as an adjunctive treatment by some guidelines for treating resistant BPAD cases. This brief communication highlights some of the caveats in the randomized trials using celecoxib as an add-on treatment in bipolar mania specifically, which need to be addressed in future work.

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OBJECTIVES: This study exclusively aimed to clinically assess which symptom pattern discriminates primary depression from depression-secondary to-schizophrenia. METHODS: A total of 98 patients with primary depression and 71 patients with secondary-to-schizophrenia depression were assessed for identifying the clinical phenomena of depression. Diagnosis of schizophrenia was confirmed by Mini International Neuropsychiatric Interview. Each participant was, however, assessed by Patient Health Questionnaire-9 as well as Calgary Depression Scale for Schizophrenia (CDSS) for possible concurrent depressive symptoms. RESULTS: Depressed mood, loss of interest, reduced energy and pathological guilt were more common in primary depression, whereas sleep disturbance and guilty ideas of reference were more amounting towards the diagnosis of depression secondary-to-schizophrenia. CONCLUSIONS: It is clinically hard to differentiate primary from secondary-to-schizophrenia depression, especially in the absence of obvious psychotic symptoms. However, the classical symptoms of depression like subjective depressed mood, anhedonia, reduced energy and pathological guilt are more prominent in the primary depression.

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