Cerebral white matter lesions and depressive symptoms in elderly adults

BACKGROUND: There is evidence for a vascular cause of late-life depression. Cerebral white matter lesions are thought to represent vascular abnormalities. White matter lesions have been related to affective disorders and a history of late-onset depression in psychiatric patients. Their relation with mood disturbances in the general population is not known. We investigated the relation between white matter lesions and the presence of depressive symptoms or a history of depression in a population-based study. METHODS: In a sample of 1077 nondemented elderly adults, we assessed the presence and severity of subcortical and periventricular white matter lesions using magnetic resonance imaging, presence of depressive symptoms, and history of depression. Using multiple regression analysis, we examined the relation among white matter lesions, depressive symptoms, and history of depression. RESULTS: Most of the subjects had white matter lesions. Persons with severe white matter lesions (upper quintile) were 3 to 5 times more likely to have depressive symptoms as compared with persons with only mild or no white matter lesions (lowest quintile) (periventricular odds ratio [OR] = 3.3; 95% confidence interval [CI], 1.2-9.5; subcortical OR = 5.4; 95% CI, 1.8-16.5). In addition, persons with severe subcortical but not periventricular white matter lesions were more likely to have had a history of depression with an onset after age 60 years (OR = 3.4; 95% CI, 1.1-10.7) compared with persons with only mild or no white matter lesions. CONCLUSION: The severity of subcortical white matter lesions is related to the presence of depressive symptoms and to a history of late-onset depression.     

Combined effect of vision and hearing impairment on depression in elderly Chinese

BACKGROUND: Sensory impairment and depression are common in old age and the relation between depression and vision as well as hearing impairment have been established. However, few studies have directly compared their effects and examined the impact of dual sensory loss. The purpose of this study is to compare impacts of self-reported hearing and vision loss as well as the effect of double sensory impairment on depression. METHOD: This article analyzes cross-sectional data collected from a representative community sample of 2,003 Chinese elderly people aged 60 or above in Hong Kong. Respondents were interviewed in a face-to-face format and data including vision and hearing impairment, socio-demographic variables, health indicators, family support, and depression were obtained. RESULTS: Logistic regression analyses revealed that visual impairment was significantly related to depression even after age, gender, marital status, education, self-reported health status, the presence of 11 diseases, functional limitation and family support were controlled but hearing loss was not. Hearing impairment did not add to the likelihood of depression where visual impairment was already present. CONCLUSION: The impact of visual impairment on psychological well-being among elderly Chinese is more robust than hearing loss. Therefore, aged care service practitioners must take this risk factor into consideration in their preventive intervention and treatment for psychological well-being.     

Influence of patient preference and primary care clinician proclivity for watchful waiting on receipt of depression treatment

OBJECTIVE: We examined whether patients' preference for watchful waiting and their primary care clinician's proclivity for watchful waiting were associated with decreased likelihood of receiving depression treatment. METHODS: In a quality improvement intervention for depression in primary care, patients with depressive symptoms were identified through screening in 46 clinics from June 1996 to March 1997. We analyzed baseline survey data completed by clinicians and patients using logistic regression models. RESULTS: Of 1140 patients, 179 (16%) preferred watchful waiting over active treatment. After controlling for covariates, patients with depressive disorders who preferred watchful waiting were less likely to report use of antidepressants (OR=0.86, 95% CI=0.77-0.95). Among patients with depressive symptoms only, those who preferred watchful waiting were less likely to report antidepressant use (OR=0.84, 95% CI=0.76-0.93) or counseling (OR=0.84, 95% CI=0.77-0.95). Patients with less knowledge about depression were less likely to receive depression treatment. Clinician proclivity for watchful waiting was not associated with the likelihood that patients received depression treatment. CONCLUSIONS: Patient preference for watchful waiting is associated with lower rates of some depression treatments, especially among patients with subsyndromal depression. Addressing patient preference for watchful waiting in primary care may include active symptom monitoring and patient education.     

Prevalence of depression and correlates of depressive symptoms for residents in the urban part of Jeju Island, Korea

AIMS: This study examined the prevalence of depression and depressive symptoms, and the correlates of depressive symptoms, and proposes some methods for reducing risk of depression in residents of the urban part of Jeju Island in Korea. METHODS: In all, 1050 residents were selected using multiphasic cluster sampling to represent each district. Of the 981 respondents, 413 were men and 568 were women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to evaluate depression (CES-D score over 25) and depressive symptoms (CES-D score over 21). Multiple logistic regression analysis was performed for comparisons. RESULTS: The prevalence of depression in males and females was comparable, at 9.47 and 11.36%, respectively. The prevalence of depressive symptoms in men was 15.01%, while in women the level rose to 18.37%. Those with high self-assessed level of stress scores were significantly more likely to have depressive symptoms than those with low self-assessed level of stress scores (odds ratio (OR) = 5.73 (95% confidence interval (95% CI), 1.29-25.36)). Residents at high risk of problem drinking (CAGE score over 3) were significantly more likely to have depressive symptoms than those with a CAGE score under 1 (OR = 3.43 95% CI, 1.77-6.66). Respondents who slept poorly had more depressive symptoms than respondents who slept well (OR = 2.11 95% CI, 1.37-3.23). Females were significantly more likely to have more depressive symptoms than males (OR = 1.70 95% CI, 1.08-2.68). CONCLUSIONS: The prevalence of depression and depressive symptoms in urban Jeju Island is similar to that in a nation-wide sample. By providing intensive mental health services to those who have high stress levels, problem drinking, and poor health behavior, early detection of depressive symptoms in the community will be important for improving general health status.     

Combined hearing and visual impairment and depression in a population aged 75 years and older

BACKGROUND: Depression is associated with both visual and hearing impairment. Little is known about the relationship between combined hearing and visual impairment and mood in this age group. The aim of this population-based study was to investigate the association between functional sensory impairment, especially combined sensory impairment and depressive symptoms and depression diagnosed according to the DSM-IV criteria. METHOD: The study group consisted of 470 adults, population-based sample, aged 75 years or older. We used the Snellen eye charts with E-letters and reading charts to evaluate the functional visual acuity. The ability to conduct a face-to-face conversation, the hearing aid use and the self-reported hearing problems were used to assess the functional hearing acuity. Depression was identified with two different methods. A geriatrician interviewed the subjects and the DSM-IV checklist was used to determine whether they met the criteria for major depression. The Zung Depression Status Inventory (DSI) was used to identify depressive symptoms. The cut off points of 40/80 and 48/80 in the DSI-score was used. RESULTS: Seventy-two persons (15%) of the study population had depression diagnosed according to the DSM-IV criteria. Twelve per cent of subjects in the Functional Hearing Impairment (FHI) group, twenty per cent in the Functional Visual Impairment (FVI) group, eighteen per cent in the Combined Sensory Impairment (CSI) group and fifteen per cent in the Adequate Sensory Function (ASF) group suffered major depression. The differences between these groups were insignificant. The occurrence rates of the DSI score equal or over 40 points was 50% in the FHI group, 53% in the FVI group, 70% in the CSI group and 45% in the ASF group. The difference between the ASF group and sensory impairment group including FHI, FVI and CSI groups was statistically significant (p = 0.03). CONCLUSIONS: Depressive symptoms, but not major depression, were common if elderly persons had combined sensory impairment.     

Is it contagious? Affect similarity among spouses

Theories of emotional contagion suggest that spouses mutually experience affective or emotional states. However, empirical support for this theory is limited. Using a dyadic approach, this study examines affect similarity of depressive symptoms between elders with vision impairment and their spouses. As part of an investigation on older couples dealing with disability, 123 elders dealing with a recent vision loss and their spouses were interviewed. Guided by a stress process model, predictors of spouse depressive symptoms were examined. Hierarchical regression analyses revealed that the spouse's race, health, care-giving appraisal, self-efficacy, conflict with other family members regarding their partner, and their partner's depressive symptoms significantly predicted spouse depression. Specifically, spouses who were white, in poorer health, experienced more care-giving burden, had more family conflict, and poorer self-efficacy, were more likely to be depressed. Entered in the final step, elder depression uniquely contributed to the prediction of spouse depression. This points to affect similarity among spouses, which suggests that when one spouse is depressed, the other spouse is likely to experience a similar depressive symptomatology.     

Depressive symptoms as relative and attributable risk factors for first-onset major depression.

Using longitudinal data from a community study of 9900 adults drawn from four sites in the United States and interviewed twice, 1 year apart, we investigated the predictors of first-onset major depression. Using odds ratios to estimate relative risk, we found that persons with depressive symptoms, compared with those without such symptoms, were 4.4 times more likely and persons with dysthymia were 5.5 times more likely to develop a first-onset major depression during a 1-year period. The lifetime prevalence rate for depressive symptoms was 24%. The attributable risk is a compound epidemiologic measure that reflects both the relative risk associated with depressive symptoms (4.4) and the prevalence of exposure to that risk (24%). It is a useful measure to document the burden of a risk to the community, and it was determined to be greater than 50%. Thus, more than 50% of cases of first-onset major depression are associated with prior depressive symptoms. The high prevalence of depressive symptoms in the community and their strong association with first-onset major depression make them important from a public health perspective. Because depressive symptoms are often unrecognized and untreated in clinical practice, we conclude that their identification and the development of effective treatments could have implications for the prevention of major depression.     

Risk factors for depression among older adults with dual sensory loss

Objectives: The purpose of this study was to identify risk factors that are associated with depression among older adults with dual sensory loss, evaluating variables typically associated with depression in an elderly population and variables related to sensory loss.

Method: Survey data was collected from a sample of 203 adults aged 55 years and older with significant hearing and vision loss. Independent variables included demographics (as control variables), sensory loss-related factors, activity factors, and social factors. Correlation and hierarchical linear regression were used to analyze the data.

Results: A large proportion of participants experienced depression. Risk factors typically associated with depression in the elderly were also significant for this group, with the exception of functional disability, but only one variable directly related to sensory loss was significant in the final model. The block of variables with the greatest relationship to depression was the social factor.

Discussion: Receipt of rehabilitation services and use of assistive devices are two strategies that could be used to address the issue of depression with this population. Interventions could target some of the variables found to be associated with depression in this study: communication problems, loss of activity, and physical activity.     

The influence of socio-economic conditions on the prevalence of depressive symptoms and its covariates in an elderly population with slight income differences: the Bambuí Health and Aging Study (BHAS)

BACKGROUND: The influence of socio-economic conditions on covariates of depression has received little attention. AIMS: Examine whether prevalence and covariates of depressive symptoms are affected by socio-economic circumstances. METHODS: Participants were 1,499 (86%) residents in Bambuí city, Brazil, aged ->- 60 years. Depressive symptoms were assessed by the GHQ-12 questionnaire and exploratory variables included demographic characteristics, life events, social support, health conditions and health service use. The analysis was stratified by family income (< US$240.00 [lowest tertile] vs. ->- US$240.00). RESULTS: The prevalence of depressive symptoms was higher in those with lower income (43.9%) in comparison with the better off (27.7%). Dissatisfaction with relationships, worse self-rated health and insomnia were independently associated with depressive symptoms in both income groups (OR from 2.00 to 4.74; p < 0.05). Depressive symptoms were associated with number of chronic diseases, functional disability and hospitalizations among the poorer (OR from 1.73 to 2.37; p < 0.05), while old age (OR 2.08) and female gender (OR 2.03) were associated with depressive symptoms among the better off. CONCLUSION: This study provides evidence that the prevalence of depressive symptoms and their covariates are influenced by socio-economic conditions in a population with slight income differences.     

Comparison of users and non-users of mental health services among depressed, older, urban African Americans.

OBJECTIVE: The authors sought to determine differences between depressed older black residents in an urban community who do and do not use formal mental health services. METHODS: The Treatment Group (TG) consisted of 106 black patients age >or=55 with a diagnosis of depression who were recruited from outpatient psychiatric programs in Brooklyn, NY. The Untreated Community Group (UCG) consisted of 101 cognitively intact black subjects age >or=55 from randomly selected block groups in Brooklyn who met symptom criteria for major or minor depression and had no previous history of psychiatric treatment. RESULTS: In logistic regression analysis, TG persons were significantly more likely than the UCG persons to be female, younger, born in the United States, to have impaired daily functioning, have a family history of mental illness, and believe that environmental factors and religious activities could influence mental illness. TG persons were significantly less likely to have social network members who provided advice, to use spiritualists or their products, to have vision or hearing impairments, and to have depressive symptoms. Although most UCG persons visited their doctor at least three times annually, only 11% reported using these physicians for help with mental health problems. CONCLUSIONS: A combination of demographic and attitudinal factors, family psychiatric history, social supports, and functional impairments were associated with the use of mental health services. Despite reluctance of persons in the UCG to use primary-care physicians for mental health reasons, the latter remain the most feasible intervention point within the existing service system.     

Fatigue and psychiatric illness in a large community sample of persons with multiple sclerosis

BACKGROUND: Fatigue and depression are among the most common and disabling symptoms in multiple sclerosis (MS), but the nature and extent of the relationships between fatigue and psychiatric disorders in MS patients remain poorly understood. METHODS: A mail survey was completed by 739 members of the King County (WA) MS Association. Fatigue was evaluated by questions from the Modified Fatigue Impact Scale (MFIS), depressive symptoms by the Center for Epidemiologic Studies Depression Scale (CES-D), substance-use disorders from the PRIME-MD. Information on demographics, employment and characteristics of MS was also collected. Logistic regression was used to identify covariates significantly associated with disabling fatigue. Receiver operating characteristic (ROC) curve analysis evaluated the sensitivity and specificity of fatigue for depression. RESULTS: Twenty-five percent of this community-dwelling sample reported that their activities were often or almost always limited by fatigue. Seventy-six percent of subjects with disabling fatigue had significant depressive symptoms (CES-D >16), compared with 31% of those without disabling fatigue. Depression was strongly associated with fatigue, after controlling for age, gender, marital status, and severity, course and duration of illness. In logistic regression analysis, subjects with clinically significant depressive symptoms (CES-D >16) were much more likely to report disabling fatigue: OR = 6.24 (4.16, 9.35). Anxiety and substance-use disorders did not have the same strong associations with fatigue. Fatigue was highly sensitive and specific for clinically significant depressive symptoms. CONCLUSIONS: Disabling fatigue is strongly associated with clinically significant depressive symptoms. Patients who report disabling fatigue should be screened for depression.     

The role of patient personality in the identification of depression in older primary care patients

BACKGROUND: Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. METHODS: We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. RESULTS: High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). CONCLUSION: Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care.     

Cannabis abuse as a risk factor for depressive symptoms

OBJECTIVE: This study sought to estimate the degree to which cannabis abuse is a risk factor for depressive symptoms rather than an effort to self-medicate depression. METHOD: Participants (N=1,920) in the 1980 Baltimore Epidemiologic Catchment Area (ECA) study who were reassessed between 1994 and 1996 as part of a follow-up study provided the data. The analysis focused on two cohorts: those who reported no depressive symptoms at baseline (N=849) and those with no diagnosis of cannabis abuse at baseline (N=1,837). Symptoms of depression, cannabis abuse, and other psychiatric disorders were assessed with the Diagnostic Interview Schedule. RESULTS: In participants with no baseline depressive symptoms, those with a diagnosis of cannabis abuse at baseline were four times more likely than those with no cannabis abuse diagnosis to have depressive symptoms at the follow-up assessment, after adjusting for age, gender, antisocial symptoms, and other baseline covariates. In particular, these participants were more likely to have experienced suicidal ideation and anhedonia during the follow-up period. Among the participants who had no diagnosis of cannabis abuse at baseline, depressive symptoms at baseline failed to significantly predict cannabis abuse at the follow-up assessment. CONCLUSIONS: Further research is needed to identify characteristics of individuals who abuse cannabis that account for their higher risk of depression to estimate the degree of impairment resulting from their depression.     

Dissatisfaction with performance of valued activities predicts depression in age-related macular degeneration

OBJECTIVE: To determine whether dissatisfaction with performance of valued activities predicts depression in patients with age-related macular degeneration (AMD). PATIENTS: Two hundred and six patients with newly diagnosed neovascular AMD in one eye and pre-existing AMD in the fellow eye who were participating in a clinical trial of a psychosocial intervention to prevent depression. MEASURES: Structured clinical evaluations of vision function, depression, visual acuity, contrast sensitivity and medical morbidity. Subjects were classified as dissatisfied if they indicated that they were dissatisfied with their performance of a valued activity. RESULTS: Subjects who were dissatisfied with performance of valued activities (n = 71) had similar demographic characteristics to satisfied subjects (n = 135) but had worse visual acuity (p < 0.054), greater medical comorbidity (p < 0.006), and lower vision function (p < 0.001). Dissatisfied subjects were almost 2.5 times more likely (OR = 2.41; [95% CI 1.02, 5.65]; p = 0.044) to become depressed within 2 months than satisfied subjects independent of baseline visual acuity, vision function, and medical comorbidity. CONCLUSION: Dissatisfaction with performance of valued activities in older persons with AMD predicts depression over a 2-month period. Assessing the ability to pursue valued activities may identify patients at risk for depression and prompt clinicians to initiate rehabilitative interventions and careful surveillance for depression.     

Religious attendance and depressive symptoms among community dwelling elderly in Taiwan

BACKGROUND: The purpose of this study was to investigate the unique association between religious attendance and the prevalence of depressive symptoms among community dwelling elderly persons. METHODS: Employing a multilevel stratified sampling strategy, a total of 1000 subjects, aged 65-74 and living in Taiwan, were recruited for this interview survey during the year 2001. Aside from background information, the Taiwanese Depression Questionnaire (TDQ) and the Neighborhood Quality Index were used to assess degree of depression and its correlates. RESULTS: Altogether, 863 subjects (age, M = 69.4, SD = 2.7) had complete data for analysis; 215 (24.8%) had had depressive symptoms in the past week. Among them, those who were female, (OR = 2.17, 95% CI = 1.59-2.97), illiterate(OR = 2.42, 95% CI = 1.76-3.33), unemployed (OR = 1.80, 95% CI = 1.24-2.61), or not married (OR = 1.71, 95% CI = 1.22-2.38), or those who had less family income (OR = 1.84, 95% CI = 1.24-2.73), physical illness (OR = 2.68, 95% CI = 1.86-3.86), or less social capital (OR = 0.91, 95% CI = 0.88-0.94), were at higher risk of being depressed. Moreover, those (95.2% with religious belief ) who had not attended religious activities during the past 6 months were at higher risk of being depressed than those (100% with religious belief ) who had (OR = 2.63, 95% CI = 1.41-4.91). Multivariate logistic regression disclosed that those never attending religious activities were 2.70 times more likely to be depressed when compared to those who had, after taking into consideration sociodemographics and social capital. CONCLUSION: The attending of religious activities is a protective factor for geriatric depression.     

Extending the bereavement exclusion for major depression to other losses: evidence from the National Comorbidity Survey

CONTEXT: Symptoms of intense bereavement-related sadness may resemble those of major depressive disorder (MDD) but may not indicate a mental disorder. To avert false-positive diagnoses, DSM criteria for MDD exclude uncomplicated bereavement of brief duration and modest severity. However, the DSM does not similarly exempt depressive reactions to other losses, even when they are uncomplicated in duration and severity. OBJECTIVE: To test the validity of the DSM exclusion of uncomplicated depressive symptoms only in response to bereavement but not in response to other losses. DESIGN: Community-based epidemiological study. PARTICIPANTS: From the National Comorbidity Survey (NCS) of 8098 persons aged 15 to 54 years representative of the US population, we identified individuals who met MDD symptom criteria and whose MDD episodes were triggered by either bereavement (n = 157) or other loss (n = 710). Intervention We divided the bereavement and other loss trigger groups into uncomplicated and complicated cases by applying the NCS algorithm for uncomplicated bereavement to the reactions to other losses. We then compared uncomplicated bereavement and uncomplicated reactions to other losses on a variety of disorder indicators and symptoms. MAIN OUTCOME MEASURES: Nine disorder indicators, as follows: number of symptoms, melancholic depression, suicide attempt, duration of symptoms, interference with life, recurrence, and 3 service use variables. RESULTS: Episodes of uncomplicated depression triggered by bereavement and by other loss have similar symptom profiles and are not significantly different for 8 of 9 disorder indicators. Moreover, uncomplicated reactions, whether triggered by bereavement or other loss, are significantly lower than complicated reactions on almost all disorder indicators. CONCLUSION: The NCS data do not support the validity of uniquely excluding uncomplicated bereavement but not uncomplicated reactions to other losses from MDD diagnosis.     

Does depression prior to caregiving increase vulnerability to depressive symptoms among caregivers of persons with Alzheimer's disease?

Based on the vulnerability model of depression, this study tested the hypothesis that caregivers with prior depression are more likely to be depressed during caregiving than caregivers without prior depression. We further hypothesized an interaction effect in which caregivers with prior depression would be affected more by care-recipient dependency in activities of daily living and care-recipient depressive symptoms than those without prior depression. In a sample of 111 caregivers of persons with Alzheimer's disease, in an additive regression model, neither 'prior depressive symptoms' nor the clinically more serious 'prior depressive syndrome' was related to depressive symptoms during caregiving. In an interaction model, for caregivers with either 'no prior depression' or 'prior depressive symptoms,' the greater the care-recipient dependencies in instrumental activities of daily living (IADL), the greater were the depressive symptoms during caregiving. For caregivers with a 'prior depressive syndrome', however, the greater the IADL dependency, the fewer were the depressive symptoms during caregiving. This unexpected finding suggests that caregivers with a history of clinically significant depression are not necessarily more prone to depressive symptoms when caregiving responsibilities, at least for instrumental activities, are high. This result questions the vulnerability model of depression when applied to older caregivers.     

Ethnicity and preferences for depression treatment

OBJECTIVE: The objective of this work was to describe ethnic differences in attitudes toward depression, depression treatment, stigma and preferences for depression treatment (counseling vs. medication). METHOD: This study used a cross-sectional Internet survey measuring treatment preference, stigma and attitudes toward depression. Depressive symptoms were measured with the Center for Epidemiological Studies Depression (CES-D) scale. Multivariable regression models adjusting for treatment attitudes and demographics estimated the independent effect of ethnicity on treatment preference. RESULTS: A total of 78,753 persons with significant depressive symptoms (CES-D>22), including 3596 African Americans, 2794 Asians/Pacific Islanders and 3203 Hispanics, participated. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications [odds ratio (OR)=2.6, 95% confidence interval (95% CI)=2.4-2.8; OR=2.5, 95% CI=2.2-2.7; and OR=1.8, 95% CI=1.7-2.0, respectively]. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression. Attitudes and beliefs somewhat attenuated the association between ethnicity and treatment preference in adjusted analyses. CONCLUSION: Racial and ethnic minorities prefer counseling for depression treatment more than whites. Beliefs about the effects of antidepressants, prayer and counseling partially mediate preferences for depression treatment.     

Are cognitively intact seniors with subjective memory loss more likely to develop dementia?

BACKGROUND: Subjective memory loss (SML) is common in elderly persons. It is not clear if SML predicts the development of dementia. OBJECTIVES: (1) to determine if SML in those with normal cognition predicts dementia or cognitive impairment without dementia (CIND); (2) to determine if an association is independent of the effect of age, gender and depressive symptoms. METHODS: Secondary analysis of the Manitoba Study of Health and Aging (MSHA), a population-based prospective study. Data were collected in 1991, and follow-up was done 5 years later. Community-dwelling seniors sampled randomly from a population-based registry in the Canadian province of Manitoba, stratified on age and region. Only those scoring in the normal range of the Modified mini-mental state examination (3MS) were included. Predictor variables were self-reported memory loss, 3MS, Center for epidemiological studies-depression scale (CES-D), age, gender, and education. Outcomes were mortality and cognitive impairment five years later. RESULTS: In bivariate analyses, SML was associated with both death and dementia. In multivariate models, SML did not predict mortality. After adjusting for age, gender, and depressive symptoms, SML predicted dementia. However, after adjusting for baseline 3MS score, SML did not predict dementia. CONCLUSIONS: Memory complaints predict the development of dementia over five years, and clinicians should monitor these persons closely. However, the proportion of persons developing dementia was small, and SML alone is unlikely to be a useful clinical predictor of dementia.     

Musical hallucinations associated with abruptly developed bilateral loss of hearing

OBJECTIVE: To present a depressive patient who developed abrupt hearing loss with musical hallucinations. METHOD: This study is a case report. The patient was evaluated by cranial CT, EEG. audiometry, brain SPECT. MMPI and the Hamilton Depression Scale. RESULTS: A patient with depression developed abrupt hearing loss with musical hallucinations following an intramuscular injection of gentamycin. Audiometry showed mild sensorineural hearing loss in both ears. The Hamilton Depression Scale disclosed moderate depression. Her symptoms disappeared with the initiation of antidepressive medication. CONCLUSION: Musical hallucinations are the hearing of tunes, melodies, harmonics, rhythms and timbres. They have been reported to be in association with healing loss in several published cases. The uniqueness of our patient was that she was younger than previously reported cases of musical hallucinations, who were elderly people, and her symptoms of depression disappeared gradually after the initiation of moclobemide.