Open-trial response to antidepressant treatment in elderly patients with mixed depression and cognitive impairment

We report open-trial antidepressant response in 16 inpatients with mixed symptoms of depression and cognitive impairment, compared to 16 elderly depressives without cognitive impairment. Criteria for adequate treatment specified a steady-state plasma nortriptyline level of 50-150 ng/ml for 4 consecutive weeks or a minimum of six treatments with electroconvulsive therapy. Ten of 16 mixed-symptom patients showed a drop in Hamilton depression ratings greater than or equal to 50% during treatment. Similarly, Blessed dementia ratings declined significantly; the % change in Blessed dementia ratings was significantly correlated with improvement in Hamilton depression ratings. By contrast, Folstein mini-mental state scores did not change significantly during treatment. Six of 16 (37.5%) patients showed resolution of cognitive impairment with adequate treatment of depression. Mixed-symptom patients diagnosed as suffering from major depression (with cognitive impairment) showed more robust pre-post treatment differences, particularly in Hamilton, Folstein, and Blessed dementia scores, than did mixed patients diagnosed as having primary degenerative dementia (with depression). In cognitively intact elderly depressives, the mean % change in Hamilton ratings was 72% (4.3), not significantly different from mean % change in mixed-symptom patients (57.4 +/- 29.9). The proportion of intact depressives showing a reduction greater than or equal to 50% in Hamilton depression ratings was significantly greater (93.8%) than in the mixed group (62.5%). In both groups, 81.3% of patients (13 of 16 in each cell) had a final Hamilton rating less than or equal to 10. These data suggest that elderly patients with mixed depression and cognitive impairment respond to treatment similar to that used in cognitively intact elderly depressives. A controlled study of antidepressant treatment in mixed-symptom patients is warranted.     

Depressive symptoms in Parkinson disease: degree of association and rate of agreement of clinician-based and self-report measures

Depression in Parkinson disease (PD) is associated with faster disease progression, lower activities of daily living, and more severe cognitive impairment. Even mild symptoms of depression may impact outcomes in patients with PD. Nevertheless, a low rate of agreement has been reported between patient and clinician ratings of depression, suggesting that clinicians may underestimate depression in patients with PD. However, to accurately compare the rates of agreement, comparable estimates are needed so that patient and clinician ratings have similar meaning (eg, mild, moderate, severe, etc). The purpose of this study was to examine this question by investigating the degree of association and rate of agreement of levels of symptom severity among self-report and clinician ratings using established cutoffs that correspond to more comparable estimates of these levels for both patient and clinician. Our findings suggest that patient's self-report of depressive symptoms was significantly correlated with clinician-based report irrespective of the stage of disease. Moreover, patients demonstrated a 72% rate of agreement with clinicians in classifying symptoms as asymptomatic, mildly symptomatic, or fully symptomatic, a rate significantly higher than the rate of 35% previously reported. This difference in rate of agreement may be accounted for using varying criteria for severity levels across the studies. Findings suggest that clinician and patient reports show a high rate of agreement across a range of depressive symptoms and that self-report measures may provide a relatively efficient means of detecting depressive symptoms especially if patients are disinclined to initiate their report.     

Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture

OBJECTIVES: This study examines the effects of depression and cognitive impairment in elderly hip fracture patients receiving inpatient rehabilitation. Our goal was to determine whether any association of depression and cognitive impairment with rehabilitation outcome is accounted for by more immediate effects of these variables on rehabilitation participation. METHODS: We measured depression using the Hamilton Rating Scale for Depression (Ham-D), cognition using the Mini Mental State Examination (MMSE), and rehabilitation outcomes using the motor scale of the Functional Independence Measure (motor FIM) in a prospective observational study of 57 elderly rehabilitation hospital patients admitted to a university-affiliated, freestanding rehabilitation hospital with primary diagnosis of hip fracture. We also assessed rehabilitation participation, to determine whether this accounted for (mediated) any relationship of depression and cognitive impairment with rehabilitation outcome. RESULTS: Baseline Ham-D and MMSE scores were correlated with motor FIM efficiency-those with higher depressive symptoms had lower efficiency (r = -0.44, p < 0.001); similarly, those with more cognitive impairment had lower motor FIM efficiency (r = 0.52, p < 0.001). Rehabilitation participation was a mediator of this association: greater depressive symptoms and cognitive impairment predicted poorer rehabilitation participation which, in turn, predicted lower motor FIM efficiency. Ham-D and MMSE scores were predictors of discharge location: subjects with high depressive symptoms and greater cognitive impairment were more likely to go to a nursing home or personal care home upon discharge. CONCLUSIONS: Depression and cognitive impairment are predictive of negative outcomes in elderly patients' rehabilitation from hip fracture. This effect is mediated by rehabilitation participation, and ratings in this area may serve as a potentially useful clinical and research tool for the rehabilitation environment.     

Association of anticholinergic load with impairment of complex attention and memory in schizophrenia

OBJECTIVE: The authors' goals were 1) to establish a clinically useful standard index of the relative anticholinergic potency of psychiatric medications; 2) to determine which cognitive functions are most affected by the administration of anticholinergic medications to patients with schizophrenia; and 3) to compare in vitro and clinically derived indexes of anticholinergic load in predicting these cognitive impairments. METHOD: One hundred six clinically stable patients with schizophrenia were given a brief neuropsychological battery and evaluated on a standard symptom rating scale. The anticholinergic load associated with their psychiatric medications was estimated by using 1) a pharmacological index, calculated from a compilation of published studies reporting in vitro brain muscarinic receptor antagonism, and 2) a clinical index, based on clinician ratings of the anticholinergic side effects of medications. The authors analyzed the correlations of both indexes with the neuropsychological measures and with summary neuropsychological factor scores. RESULTS: The clinical and pharmacological anticholinergic indexes were highly correlated with each other and showed virtually identical associations with neuropsychological measures. Anticholinergic load was associated with lower scores on measures of attention and declarative memory, including several measures of auditory and visual memory and two tests of complex attention, but was unrelated to intelligence, simple attention, working memory, executive functions, conceptual fluency, or motor speed. CONCLUSIONS: This pattern of cognitive impairment with central cholinergic antagonism is consistent with emerging models of the functional anatomy of ascending forebrain cholinergic subsystems. Both pharmacological and clinical indexes show utility in predicting the effects of anticholinergic load on cognition in schizophrenia. Doses of psychiatric medication within the range of routine pharmacotherapy practice may have clinically significant effects on memory and complex attention in patients with schizophrenia; these effects may contribute as much as one-third to two-thirds of the memory deficit typically seen in patients with schizophrenia.     

帕金森病患者外周血单核细胞趋化蛋白-1及巨噬细胞炎性蛋白-1α水平与非运动症状的相关性研究

目的检测帕金森病(PD)患者血清单核细胞趋化蛋白-1(MCP-1)、巨噬细胞炎性蛋白-1α(MIP-1α)水平,并探讨其与PD、尤其与非运动症状(non-motor symptoms,NMS)的相关性。方法采用ELISA法对67例PD组患者及年龄、性别匹配的34例正常对照组血清MCP-1、MIP-1α水平进行检测。采用UPDRSⅢ评分和Hoehn-Yahr分级对PD患者运动功能进行评估,将其分为早期、中晚期;用PD非运动症状评定量表(NMSQuest)对NMS损害程度进行总体评估;用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、简易精神状态评价量表(MMSE)对患者抑郁、焦虑、认知功能评估,并用Pearson直线相关分析检验MCP-1、MIP-1α浓度与各量表评分之间的相关性。结果 PD患者血清MCP-1、MIP-1α水平明显高于健康对照组(P0.01);血清MCP-1、MIP-1α水平与抑郁、焦虑、认知功能呈显著正相关,特别是发现PD早期患者血清MCP-1、MIP-1α水平与HAMD评分呈显著正相关,PD中晚期患者血清MCP-1、MIP-1α水平与MMSE评分呈负相关;中晚期PD患者血清MCP-1、MIP-1α水平显著高于PD早期,PD合并抑郁、认知功能障碍组血清MCP-1、MIP-1α水平显著高于PD未合并抑郁、认知功能正常组(P均0.01)。结论血清MCP-1、MIP-1α可能参与PD的发病过程,在PD早期与抑郁显著正相关,在PD晚期与认知功能障碍显著正相关。PD患者血清MCP-1、MIP-1α水平随着运动症状、非运动症状(如抑郁、认知功能)的加重而升高。     

Neuropsychological performance,disease severity,and depression in progressive supranuclear palsy

To investigate the relationship between disease severity, cognitive impairment and depression in progressive supranuclear palsy (PSP) we studied a group of 25 patients who fulfilled strict research criteria and 25 matched controls. Disease severity was judged from the duration of symptoms, level of physical disability using the Columbia Rating Scale (CRS), and the degree of eye movement abnormality. The neuropsychological battery was designed to assess attention and executive function, visual and auditory perception, semantic memory and language production. Although the PSP group were significantly impaired on almost all of these measures, the most profound deficits were on tests of sustained and divided attention. There was no correlation between cognitive impairment and either disease duration or scores on the CRS, but performance on tests of attention correlated significantly with the degree of ocular motor impairment. Depression was found to be common in PSP but did not correlate with any other parameters. It is concluded that the cognitive deficit in PSP is widespread and independent of depression. The association between the severity of eye movement disorder and deficits in sustained and divided attention leads us to postulate that pathology involving the midbrain periaqueductal region may be critical for breakdown in these fundamental processes.     

Major depressive disorder in the elderly: The relationship between age of onset and cognitive impairment

In order to determine if later age of onset of depression in the elderly is associated with increased cognitive impairment, the scores on the Mini-Mental State Examinations of 41 elderly depressed patients were correlated with the ages of onset of depression. All subjects, average age 74.7, were referred to a psychiatric day hospital for treatment of a major depressive disorder, and all scored at least 14 on the 17-item Hamilton Depression Rating Scale. The ages of first mental health contact and symptom onset were significantly negatively correlated with Mini-Mental State scores (p =0.021 and 0.035 respectively) after the confounding effect of age was adjusted for using partial correlations. The relation between late-onset depression and cognitive impairment lends support to the hypothesis that late-onset depressive disorders in the elderly may be associated with occult brain disease.     

Interpreting patient/informant discrepancies of reported cognitive symptoms in MS.

Although numerous studies have shown that brain-damaged patients tend to underestimate neuropsychological (NP) impairment when self-ratings are compared to informant ratings, the meaning of such discrepancies is not well studied in multiple sclerosis (MS). We compared patient self- and informant-report questionnaire ratings of NP functioning in 122 MS patients and 37 age- and education-matched normal controls. In addition to completing the Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), participants underwent NP testing and assessment of depression, personality, and neuropsychiatric symptoms. Based on the normal distribution of discrepancy scores, patients were classified according to whether they overestimated or underestimated their cognitive ability, relative to informant ratings. ANOVAs comparing test scores derived from overestimators, underestimators, and accurate estimators were significant for multiple measures of cognitive function, depression, personality, and neuropsychiatric symptoms. Overestimators were characterized by less depression and conscientiousness, and greater degrees of cognitive impairment, euphoric behavioral disinhibition, and unemployment as compared to underestimators. We conclude that patient/informant discrepancy scores on the MSNQ are associated with the aforementioned neuropsychiatric features, and that the MSNQ has potential utility for predicting euphoria and disinhibition syndromes in MS.     

Associations between psychotic symptoms and dependence in activities of daily living among older adults with Alzheimer's disease

BACKGROUND: Alzheimer's disease (AD) is associated with dependence in activities of daily living (ADL). In addition to the cognitive impairment resulting from AD, the presence of psychotic symptoms may further increase this dependence. The objective of this study was to quantify the additional contribution of psychotic symptoms to dependence in ADL. METHOD: We analyzed data from 558 individuals with AD referred to a memory clinic. Information on ADL, psychotic symptoms, depression symptoms, and cognition was collected with standardized instruments. RESULTS: The frequency of psychotic symptoms was correlated with dependence in ADL (r = -.44, p < .001). The independent contribution of psychotic symptoms to ADL (basic and instrumental) after consideration for cognitive impairment and depression symptoms was assessed with hierarchical regression models. Twenty-five percent of basic ADL variance was explained by cognition; psychotic symptoms accounted for an additional 7% of the variance (b = -0.12, p < .001). Cognitive impairment explained 31% of instrumental ADL variance; psychotic symptoms accounted for an additional 6% (b = -0.21, p < .001). DISCUSSION: Psychotic symptoms are associated with dependence in ADL after controlling for cognitive impairment and depression symptoms. Future research should investigate possible causal linkages between psychotic symptoms and dependence in ADL. This may have implications regarding interventions to maintain independent living in people with AD.     

Screening for frontal lobe and general cognitive impairment in patients with amyotrophic lateral sclerosis

ObjectivesCognitive impairment occurs in up to 50% of patients with amyotrophic lateral sclerosis (ALS). Simple tools are required to identify such individuals, as cognitive impairment adversely impacts quality of life and survival. Our objective was to determine the potential utility of the Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) in evaluating frontal lobe and general cognitive impairment, respectively. We also assessed the feasibility of screening for cognitive impairment in those patients with advanced physical disability by modifying selected FAB and MoCA subtasks.MethodsFifty-four consecutive ALS patients were screened; 44 completed the FAB and 39 completed the MoCA. We administered modified tasks to patients with severe hand weakness or dysarthria. The patients were classified as cognitively impaired on each measure based on published cut-off scores of 14.11 on the FAB and 26 on the MoCA.ResultsTwenty-one percent and 53% of patients were impaired on the FAB and the MoCA, respectively. Scores from patients receiving modified instructions did not differ from those completing standard versions. There were statistically significant correlations between the MoCA total scores and forced vital capacity (FVC) and ALSFRS-R scores. There was no correlation between these variables and the FAB.ConclusionsBoth the FAB and MoCA detected cognitive impairment in ALS patients. While the MoCA classified more patients as cognitively impaired than the FAB, the latter was more feasible for assessing patients with physical impairment. Simple task modifications proved effective in allowing patients with speech and motor impairments to undergo screening. Future studies are required to validate both measures, establish optimal cut-off scores, and validate modifications.     

Neuropsychological function in physically asymptomatic, HIV-seropositive men

Twenty asymptomatic, HIV-seropositive homosexual men and a control group of 20 seronegative homosexual men were evaluated for evidence of neuropsychological impairment. Two-tailed paired t-tests of group differences revealed that the seropositive patients had significantly lower scores on two of 20 neuropsychological measures. Ten seropositive patients had scores two standard deviations below the sample, compared with three seronegative patients, a significantly different distribution (p = .04). The HIV-infected group exhibited lower mean scores on 17 of 20 variables (binomial probability, p less than .005). The 10 seropositive patients with scores that fell below the cut-off had significantly lower mean T4/T8 ratios than the 10 seropositive patients with scores above the cut-off (p = .02). The data suggest that a subpopulation of HIV-infected adults may exhibit subtle neuropsychological impairment before they develop clinical signs of cognitive deficit or immunosuppression.     

Reliable screening for neuropsychological impairment in multiple sclerosis

In an earlier study, we developed the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) to assist in the screening for neuropsychological (NP) impairments. Self-report MSNQ scores correlated significantly with measures of depression, whereas informant-report MSNQ scores correlated with cognitive performance, but not depression. This study was criticized for use of a small sample and lack of data regarding normal performance and test-retest reliability. The present study was designed to replicate the earlier work with a larger sample of patients and normal controls obtained from multiple sites. We also evaluated the test-retest reliability and predictive validity of the MSNQ. The sample included 85 multiple sclerosis (MS) patients and 40 normal controls, matched on demographic variables. All participants completed the MSNQ and underwent NP testing. Thirty-four patients were re-examined at one week. Pearson and ANOVA techniques were utilized for univariate comparisons. Bayesian statistics were calculated to assess predictive validity. Patient self- and informant-report MSNQ scores differed from normal and test retest reliability indices were high. Both self- and informant-reports were correlated with cognitive dysfunction and depression scales. Self-report MSNQ scores correlated more strongly with depression than cognitive performance, whereas the opposite pattern was observed with informant-report scores. Bayesian statistics showed that informant-report MSNQ scores predict cognitive impairment and patient self-report scores identify patients with cognitive impairment or depression. It is concluded that the MSNQ is useful, although patient self-reports may be exaggerated in depressed patients or reduced in patients with severe cognitive impairment.     

Cerebrospinal fluid somatostatin, mood, and cognition in multiple sclerosis.

BACKGROUND: Cerebrospinal fluid (CSF) somatostatin (SS) levels have been shown to be decreased in multiple sclerosis (MS) during relapse as well as in disorders characterized by depression or cognitive impairment. Since MS is often associated with depression and cognitive impairment, we examined both the effect of course of illness on CSF SS as well as the variance in SS attributable to associated features (e.g., depression or cognitive impairment). METHODS: Fifteen patients with chronic progressive MS participating in a 2-year cyclosporine trial underwent lumbar punctures for CSF SS at baseline and at 12 and 24 months. Additionally, patients were evaluated by neuropsychological testing, and physical disability and mood ratings. Baseline CSF SS levels were also obtained in a group of control subjects (n = 10). RESULTS: At baseline, CSF SS levels were lower in MS patients than control subjects (p < .001). Decreased CSF SS at 24 months was correlated with decreased cognitive performance on several measures and was best and significantly predicted by cognitive deterioration at 24 months. CONCLUSIONS: Our data support those from previous studies that found lower levels of CSF SS in MS during relapse and suggest that changes in CSF SS are related to the process responsible for diminished cognitive function in MS.     

Associations among measures of awareness of cognitive deficits in dementia

BackgroundAwareness of deficits is a complex phenomenon. In this study, we examined the relationships among various measures of awareness of cognitive deficits in dementia, and investigated the unique association between clinician ratings and alternative approaches to assessing awareness.MethodsParticipants included 108 patients with very mild (n = 50) or mild (n = 58) dementia. Awareness of cognitive difficulties was assessed by clinician ratings, informant ratings, patients' reports of cognitive difficulties, discrepancies between patients' and informants' reports of cognitive difficulties, and patients' perceptions of performance on neuropsychological tests. Correlational analyses were used to assess associations among these measures of awareness, and ordinal logistic regression was used to examine the unique relationship between clinician ratings of awareness and the other approaches.ResultsAll measures of awareness were significantly correlated with one another. Coefficients ranged from 0.26 to ?0.64. Patients categorized as unaware by either clinicians or informants reported fewer cognitive difficulties. Of the awareness measures evaluated, clinician ratings had the strongest correlation with measures of global cognition. In the regression analysis, only informant global ratings and patients' reports of cognitive difficulties were significantly associated with clinician ratings. The model's classification accuracy was satisfactory for patients in the “intact awareness” and “severe unawareness” categories, but not for those in the “mild unawareness” category.ConclusionsAlthough measures of awareness likely share overlapping variance, they are not interchangeable. Each potentially elucidates unique aspects of the complex phenomenon of awareness, with clinician assessment being the most suited for ambiguous cases. When clinician assessment is not feasible, informant rating (but not patient-informant discrepancy) would be a valid substitute.     

抑郁症患者的认知功能、事件相关电位P300和MR扩散张量成像研究

目的 联合应用事件相关电位P300和MR扩散张量成像(DTI)研究抑郁症患者的认知功能损害,探讨抑郁症合并认知损害的机制. 方法 选取深圳市第二人民医院心理门诊自2008年5月至2009年9月接收的30例首发抑郁症患者作为抑郁症组,同期与抑郁症患者年龄、教育程度相匹配的健康志愿者30名做为对照组.应用威斯康星卡片分类测验(WCST)、P300检查和DTI扫描分别检测WCST各亚项得分、P3潜伏期和P3波幅、脑不同解剖部位的各向异性(FA)值.并对三者进行相关性分析. 结果 抑郁症组患者WCST各亚项得分、P3潜伏期和P3波幅与对照组相比较差异均有统计学意义(P<0.05);与对照组相比,抑郁症组患者双侧额叶、扣带回前部、扣带回压部、胼胝体膝部和压部FA值下降,差异有统计学意义(P<0.05);抑郁症组患者P3潜伏期与持续性错误数呈正相关关系(r=0.677,P=0.009),P3波幅与持续性错误数、不能维持完整分类数数均呈负相关关系(r=0.765,P=0.001;r=0.654,P=0.012),抑郁症组患者左、右侧额叶白质FA值分别与持续性错误数、不能维持完整分类数呈负相关关系(P<0.05). 结论 神经心理学和事件相关电位P300检查反映了抑郁症患者存在认知功能损害,P3潜伏期和P3波幅可作为认知功能的参考指标,DTI结果 揭示了抑郁症患者存在白质区域神经纤维的异常,这可能是抑郁症合并认知损害的神经病理学基础之一.     

Sertraline treatment of elderly patients with depression and cognitive impairment

BACKGROUND: There is little information on the efficacy and side effects of antidepressant treatment in elderly patients with combined depression and cognitive impairment without dementia (DEP-MCI), and it is unclear if cognitive performance improves with antidepressant response in these patients. METHODS: In 39 elderly DEP-MCI patients, changes in depression and cognitive impairment were evaluated with open sertraline treatment up to 200 mg/day for 12 weeks. RESULTS: Of the 26 completers, 17 were responders and nine were non-responders. Diagnostic subtype of depression was unrelated to response. ANCOVA on WAIS-R digit symbol percent change scores revealed a significant effect for responder status (F = 5.59, p < 0.03), and age (F = 0.24, p < 0.64) and education (F = 1.64, p < 0.22) were not significant covariates. From pre-trial to post-trial, responders improved in WAIS-R digit symbol percent change scores (Mean -10% SD 24) while non-responders declined (Mean 14% SD 18; t = 2.60, p < 0.02). Other neuropsychological measures were unrelated to response. Percent change in HRSD scores showed significant inverse correlations with percent change in several cognitive measures. CONCLUSIONS: DEP-MCI patients showed moderate clinical response to sertraline treatment. When responders were compared to non-responders, cognitive improvement was limited to one measure of attention and executive function. Overall, there was little cognitive improvement with antidepressant treatment. The findings indirectly suggest that lack of improvement in cognition following treatment of depression in DEP-MCI patients may be associated with increased risk of meeting diagnostic criteria for dementia during follow-up.     

Social competence and observer-rated social functioning in bipolar disorder

Depp CA, Mausbach BT, Harvey PD, Bowie CR, Wolyniec PS, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL. Social competence and observer‐rated social functioning in bipolar disorder.
Bipolar Disord 2010: 12: 843–850. © 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective: Impairment in social functioning appears to be common in bipolar disorder, although estimates have been derived largely from self‐report measures. We examined performance‐based and observer‐based ratings of social competence and functioning and assessed the contribution of symptoms and neurocognitive ability to social functioning in bipolar disorder. Methods: In this cross‐sectional study, 164 subjects with bipolar disorder were administered the performance‐based Social Skills Performance Assessment (SSPA), rated by an informant on the Specific Level of Functioning (SLOF)–Interpersonal subscale, received clinical ratings of depression and manic symptoms, and performed neurocognitive tests. We assessed the proportion of patients exhibiting social deficits and examined the associations between composite measures of neurocognitive ability, depression and manic symptoms, and SSPA scores with informant‐rated, real‐world social functioning. Results: Mean age of the sample was 47.6 years (SD = 14.1). Subjects were experiencing, on average, mild levels of depression and minimal manic symptoms. A total of 29% exhibited norm‐referenced impairment on the SSPA, and 64% registered at least one impairment on SLOF items; unemployed subjects had lower SSPA and SLOF ratings. Neurocognitive performance correlated with both performance‐based and observer‐rated social functioning, whereas depressive and manic symptoms correlated only with observer‐rated social impairments. In multivariate models, depression was the most potent association with social functioning, and impairment in social competence (i.e., capacity) increased the strength of the relationships between depression and neurocognitive impairment and social functioning (i.e., real‐world functioning). Conclusions: Our study confirmed the negative relationship of bipolar depression with social functioning. A subgroup of outpatients with bipolar disorder has impaired social competence, which, when present, worsened the impact of depression and cognitive impairment on social functioning.     

Cognitive insight and its relationship with symptoms in deficit and nondeficit schizophrenia

Patients with deficit schizophrenia have worse cognition and poorer social functioning compared with those with nondeficit schizophrenia. Insight is another domain in which these two groups might differ. However, there is no literature data specifically on cognitive insight impairment in deficit versus nondeficit schizophrenia. We compared 40 patients with deficit schizophrenia with 81 nondeficit patients and found that schizophrenic patients with deficit syndrome were more self-reflective and have higher self-reflectiveness-self-certainty index scores than did those without deficit syndrome. These differences remained significant when analysis was controlled for sex, age, education, and depression severity. On the other hand, there was no significant difference in self-certainty scores between two groups. In addition, we found significant relationships between cognitive insight and specific psychotic symptoms. A better understanding of the cognitive component of insight in schizophrenia with deficit syndrome may help us to understand the true relationship between insight and negative symptoms and contribute to the development of more efficient cognitive strategies, thus improving patients' outcome in a severely disabled psychiatric patient group.     

Correlates of informant-rated cognitive decline after stroke

Cognitive impairment is common after stroke, but measurement is problematic. Six tests of mental ability, unaffected by loss of limb function, were administered to 49 subjects of mean age 74.2 years at a median of 4.3 years (range 0.1-16.8) after stroke together with a depression score and the IQCODE, an informant-rated scale of estimated cognitive decline. Over 90% of stroke patients were able to complete most tests. IQCODE correlated significantly with the HADS depression score (r = 0.35, p = 0.040), the 2-year Barthel score (r = -0.60, p = 0.001) and with a general cognitive factor extracted from the mental ability test scores (r = -0.42, p = 0.016). We conclude that informant-rated methods offer a promising approach to measuring cognitive decline after stroke.     

首次确诊帕金森病患者情绪和认知功能障碍的关系

目的观察研究首次确诊帕金森痛患者情绪和认知功能障碍之间的关系。方法60例首次确诊帕金森病（PD）患者,采用简易智能状态检查量表（MMSE）和词ir-流畅性测验评定患者的认知功能;采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定患者的情绪障碍。采用统一帕金森病评分量表（UPDRS）和改良Hoehn—Yahr分级评定患者的帕金森病严重程度。结果（1）60例首次确诊PD患者改良H0ehn～Yahr分级显示：I级11例,Ⅱ级32例,Ⅲ级16例,Ⅳ级1例。其中具有抑郁障碍患者28例,占46．7％;具有焦虑障碍患者20例,占33．3％,20例焦虑障碍PD患者都具有抑郁障碍。（2）60例首次确诊PD患者中,具有认知功能障碍患者23例,占38．3％;MMSE评分和词汇流畅性测验评分均与病程呈负相关,差异具有统计学意义（r分别为-0．42,-0．46;P〈0．05）。（3）60例首次确诊PD患者HAMD评分和MMSE评分及词汇流畅性测验评分呈负相关,差异具有统计学意义（r分别为-0．69,-0．76;P〈0．01）。PD患者HAMA评分和MMSE评分及词汇流畅性测验评分亦呈负相关,差异具有统计学意义（r分别为～0．60,-0．68;P〈0．01）。结论首次确诊PD患者多为轻、中度患者,早期即表现情绪障碍和认知功能障碍,且两者具有高度相关性。