Depressive symptoms among cognitively normal versus cognitively impaired elderly subjects

OBJECTIVES: The present cross-sectional study analyzed the prevalence and severity of depressive symptoms among patients with Alzheimer's disease (DAT), vascular dementia (VAD), and among the cognitively normal elderly. Putative risk factors contributing to depression were likewise evaluated. METHODS: Seventy-six DAT patients, 51 VAD patients, and 121 cognitively normal subjects were admitted to the study. Questionnaires concerning demography and their vascular and familial risk factors together with results of neuropsychological testing by combined Mini-Mental Status Examinations (MMSE), Cognitive Capacity Screening Examinations (CCSE), and Hamilton Depression Rating Scales (HDRS) were obtained so that resulting data would be statistically analyzed. RESULTS: Prevalence of depressive symptoms among VAD, DAT, and cognitively normal elderly were 31.4%, 19.9%, and 13.2%, respectively. 25.5% of VAD and 13.2% of DAT patients had depression of mild to moderate degrees. Regression analysis revealed that diagnosis of VAD and DAT, heart disease, and past history of depression was significantly associated with high HDRS scores. There was no correlation between degree of depression and severity of cognitive impairments. CONCLUSION: Mild to moderate depression is a common comorbidity with organic dementia, especially VAD, but associated depression is independent of severity of cognitive impairments.     

Impact of depressive symptoms on the rate of progression to dementia in patients affected by mild cognitive impairment. The Italian Longitudinal Study on Aging

BACKGROUND: Mild cognitive impairment (MCI) is often a prodromal of dementia and depressive symptoms have been suggested as risk factor for dementing disorders. We evaluated the possible impact of depressive symptoms on the rate of progression to dementia in MCI patients after a 3.5-year follow-up; and the interaction between depressive symptoms and vascular risk factors for conversion to dementia. METHODS: A total of 2,963 individuals from a sample of 5,632 65-84 year old subjects were evaluated at the first (1992-1993), and second survey (1995-1996) of the Italian Longitudinal Study on Aging (ILSA), a prospective cohort study. MCI and dementia were classified using current clinical criteria. Depressive symptoms were measured with the Geriatric Depression Scale. RESULTS: Among the 2,963 participants, 139 prevalent MCI patients were diagnosed at the first survey. During the 3.5-year follow-up, 14 MCI patients progressed to dementia, and we did not find any significant relationship between depressive symptoms and rate of progression to dementia (RR 1.42, 95% CI, 0.48-4.23, chi2 0.40, p < 0.53). No socio-demographic variables or vascular risk factors modified the association between depressive symptoms and conversion to dementia. CONCLUSIONS: In our population, depressive symptoms were not associated with the rate of progression to dementia in MCI patients. Our findings did not support a role of socio-demographic variables or vascular risk factors in the association of depressive symptoms and conversion to dementia.     

Depressive symptoms, vascular risk factors, and Alzheimer's disease

BACKGROUND: Depressive symptoms in the elderly are associated with an increased Alzheimer's disease (AD) risk. We sought to determine whether the association between depressive symptoms and AD is explained by a history of vascular risk factors and stroke. METHODS: Five hundred and twenty-six elderly persons from New York City without dementia at baseline were followed for a mean of 5 years. Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAM). Incident AD was ascertained using standard criteria. Diabetes, hypertension, heart disease, current smoking and stroke were ascertained by self-report. Proportional hazards regression was used to relate HAM scores to incident AD. RESULTS: HAM scores were higher in persons with hypertension, heart disease, and stroke, which in turn were related to higher AD risk. AD risk increased with increasing HAM scores as a continuous logarithmically transformed variable (HR for one point increase = 1.4; 95% CI = 1.1,1.8) and as a categorical variable (HR for HAM >/= 10 = 3.4; 95% CI = 1.5,8.1; p for trend = 0.004 with HAM = 0 as the reference). These results were virtually unchanged after adjustment for vascular risk factors and stroke, individually (HR for HAM >/= 10 = 3.4; 95% CI = 1.5,8.1; p for trend = 0.004), and in a composite measure (HR for HAM >/= 10 = 3.0; 95% CI = 1.2,7.8; p for trend = 0.02). CONCLUSION: The prospective relation between depressive symptoms and AD is not explained by a history of vascular risk factors and stroke, suggesting that other mechanisms may account for this association. Copyright (c) 2008 John Wiley & Sons, Ltd.     

Neuropsychiatric symptoms in South‐East Asian patients with mild cognitive impairment and dementia: prevalence,subtypes, and risk factors

Background

The subtypes and risk factors of neuropsychiatric symptoms remain largely unexplored in South‐East Asian populations.

Objective

We investigated the prevalence, subtypes, and risk factors, namely, demographic, medical morbidity, and cognitive impairment associated with neuropsychiatric symptoms in a South‐East Asian cohort of patients with mild cognitive impairment (MCI) and dementia.

Methods

A clinical cohort of 38 MCI and 198 mild–moderate dementia patients were assessed using the Neuropsychiatric Inventory‐Questionnaire.

Results

Neuropsychiatric symptoms were equally prevalent among patients with MCI (74%) and mild–moderate dementia (85%). Three subtypes of symptoms were identified for each diagnostic group; for MCI, they included mood disturbances, anxiety/sleep problems, and psychosis, while for dementia, the subtypes included behavioral disturbances, psychosis/mood, and hyperactive behaviors. The largest risk for neuropsychiatric symptoms for both MCI and dementia patients was male gender. Among patients with MCI, burden of cerebrovascular disease and global cognitive impairment were small risks for neuropsychiatric symptoms, while for patients with dementia, an older age (>65 years) was a small risk and lower educational attainment was a moderate risk.

Discussion

These findings contribute to the worldwide epidemiology of neuropsychiatric symptoms in MCI and dementia and highlight that the profile of symptoms, subtypes, and risks is fairly homogenous across Western and Asian cultures. Copyright © 2017 John Wiley & Sons, Ltd.     

Alcohol consumption in mild cognitive impairment and dementia: harmful or neuroprotective?

Objective: In several longitudinal studies, light‐to‐moderate drinking of alcoholic beverages has been proposed as being protective against the development of age‐related changes in cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer's disease, AD) or vascular origin (vascular dementia). However, contrasting findings also exist. Method: The English literature published in this area before September 2011 was evaluated, and information relating to the various factors that may impact upon the relationship between alcohol consumption and dementia or predementia syndromes is presented in the succeeding texts. Results: Light‐to‐moderate alcohol consumption may be associated with a reduced risk of incident overall dementia and AD; however, protective benefits afforded to vascular dementia, cognitive decline, and predementia syndromes are less clear. The equivocal findings may relate to many of the studies being limited to cross‐sectional designs, restrictions by age or gender, or incomplete ascertainment. Different outcomes, beverages, drinking patterns, and study follow‐up periods or possible interactions with other lifestyle‐related (e.g., smoking) or genetic factors (e.g., apolipoprotein E gene variation) may all contribute to the variability of findings. Conclusion: Protective effects of moderate alcohol consumption against cognitive decline are suggested to be more likely in the absence of the AD‐associated apolipoprotein E ε4 allele and where wine is the beverage. At present, there is no indication that light‐to‐moderate alcohol drinking would be harmful to cognition and dementia, and attempts to define what might be deemed beneficial levels of alcohol intake in terms of cognitive performance would be highly problematic and contentious. Copyright © 2012 John Wiley & Sons, Ltd.     

The effects of a computer-based cognitive and physical training program in a healthy and mildly cognitive impaired aging sample

Objectives: The Long Lasting Memories (LLM) program concerns a newly integrated platform which combines cognitive exercises with physical activity within the context of advanced technologies. The main objective of this study was to present the preliminary results that determine the possible effectiveness of the LLM program in the improvement of cognitive functions and symptoms of depression in healthy elderly and subjects with mild cognitive impairment (MCI). Method: Fifty healthy and MCI subjects participated in the study. All of them received one hour's physical training and 35 minutes’ cognitive training, 3 times a week, during the 12 weeks of the program. Before and after the intervention all participants were assessed using a battery of neuropsychological tests.Results: The results showed a significant improvement after the LLM training in global cognitive function, in verbal memory, in attention, in episodic memory and symptoms of depression. Conclusion: This study indicates that LLM is a promising solution for older adults with and without cognitive impairment, maintaining their wellbeing with few professional and technical requirements.     

Plasma biomarkers of depressive symptoms in older adults

The pathophysiology of negative affect states in older adults is complex, and a host of central nervous system and peripheral systemic mechanisms may play primary or contributing roles. We conducted an unbiased analysis of 146 plasma analytes in a multiplex biochemical biomarker study in relation to number of depressive symptoms endorsed by 566 participants in the Alzheimer''s Disease Neuroimaging Initiative (ADNI) at their baseline and 1-year assessments. Analytes that were most highly associated with depressive symptoms included hepatocyte growth factor, insulin polypeptides, pregnancy-associated plasma protein-A and vascular endothelial growth factor. Separate regression models assessed contributions of past history of psychiatric illness, antidepressant or other psychotropic medicine, apolipoprotein E genotype, body mass index, serum glucose and cerebrospinal fluid (CSF) τ and amyloid levels, and none of these values significantly attenuated the main effects of the candidate analyte levels for depressive symptoms score. Ensemble machine learning with Random Forests found good accuracy (∼80%) in classifying groups with and without depressive symptoms. These data begin to identify biochemical biomarkers of depressive symptoms in older adults that may be useful in investigations of pathophysiological mechanisms of depression in aging and neurodegenerative dementias and as targets of novel treatment approaches.     

The relationship between severity of Alzheimer's disease and prevalence of comorbid depressive symptoms and depression: a systematic review

OBJECTIVES: To gain more insight into the association between severity of Alzheimer's Disease (AD) and prevalence of comborbid depression. METHODS: A systematic literature review based on the Cochrane methodology was performed. PubMed, PsychINFO and EMBASE databases were searched for existing studies that fulfilled predefined inclusion criteria. The studies were divided into: (1) those that analysed the association between severity of AD and prevalence of depressive symptoms ('continuous' approach) and (2) those that investigated the association between severity of AD and diagnosed depression ('categorical' approach). The quality of existing studies was rated and the results were synthesized with a best evidence synthesis. RESULTS: Twenty-four studies fulfilled the inclusion criteria. Nineteen reported results for a continuous approach and seven for a categorical approach. Three of the four high quality studies within the continuous approach did not find a significant association between severity of AD and prevalence of depressive symptoms. None of the three high quality studies using the categorical approach found a significant association between the severity of AD and the prevalence of diagnosed depression. CONCLUSIONS: There is evidence for a lack of association between the severity of AD and the prevalence of comorbid depressive symptoms or diagnosed depression. Until new studies contradict this conclusion, prevention and intervention strategies for comorbid depression in AD should be aimed at all patients irrespective their disease severity.     

Personality changes in normal and cognitively impaired elderly: Informant reports in a community sample

Personality changes are included in the DSM-III-R and ICD-10 criteria for diagnosis of dementia. However, until quite recently, dementia research has emphasized cognitive decline, with little interest being shown in personality change. Recent studies looking at personality changes in dementia have usually used small clinical samples. In the study reported here, such changes have been assessed in a community sample of persons over 70 years. Information was obtained from a close relative or friend. A single dimension of personality change was found. There was a moderate but significant correlation between personality change and cognitive change. Reports of personality change were also correlated to neurotic symptoms in the informant. Personality change was unrelated to the gender of the informant, the relationship of the informant to their relative or whether they lived with their relative. Also, there was no association between personality change and the elderly subject's age, gender or level of education. Through logistic regression, the neurotic symptom score of the informant was found to be the best predictor of reported personality change. This suggests that caution may be needed in interpreting information about personality change obtained from informants.