The prevalence of major depression or dysthymia among aged Medicare Fee-for-Service beneficiaries

RESEARCH OBJECTIVE: Estimates of the prevalence of major depression vary widely. Current estimates range from 2 to 14 % depending upon the definition and procedure for diagnosis. Further, most estimates are for special populations, either living in selected geographic areas or receiving specific types of medical care. A national survey of Medicare Fee-for-Service (FFS) beneficiaries provides an opportunity to assess the current level of major depression or dysthymia among a diverse population of older Americans. STUDY DESIGN: The Health Outcomes Survey (HOS) was administered to a national random sample of 1,000 Medicare FFS beneficiaries. We used the Mental Component Summary (MCS) measure of the SF-36 to estimate the prevalence of major depression or dysthymia. Logistic regression was used to examine associated factors. RESULTS: The response rate was 61.7%. Using an MCS score of 42 or lower, prevalence of major depression or dysthymia was estimated to be 25% for respondents age 65 years and older. Logistic regression analysis revealed that the likelihood of major depression or dysthymia was associated with years of education (Odds Ratio (OR) = 0.87), difficulties performing activities of daily living (OR = 1.72), and Medicaid enrollment (OR = 2.67). CONCLUSIONS: The results revealed that one-quarter of the respondents reported mental health problems consistent with major depression or dysthymia. This is higher than previously reported. Like previous studies, years of education, physical impairment, and poverty are strong predictors of major depression or dysthymia. The high rate of major depression or dysthymia implies there may be considerable unmet need among elderly Medicare FFS beneficiaries for diagnosing and treating mental illness.     

社区轻度认知功能损害老年人认知减退影响因素的研究

目的 探讨社区轻度认知功能损害老年人认知减退影响因素.方法 采用巢式病例-对照研究方法,由600名患轻度认知功能损害的社区老年居民组成随访队列,按年龄、性别、文化程度1:1匹配后形成认知减退组和对照组后进行影响因素分析.结果 发生认知减退的危险因素有:从事体力劳动(OR=1.949,95％ CI:1.041～ 3.637)、吸烟(OR=2.062,95％ CI:1.029～4.445)、喜欢呆在家里(OR=2.254,95％ CI:1.029～4.937)、血清中较高血糖(OR=3.584,95％ CI:1.891～6.791)、胆固醇(OR=2.204,95％CI:1.137～4.275)、低雌激素水平(OR=1.946,95％CI:1.087～3.411),高血压(OR=3.951,95％ CI:1.822 ～4.637),糖尿病(OR=3.016,95％CI:1.886～4.157),高血脂(OR=4.061,95％ CI:1.724 ～9.568),脑血栓(OR=2.347,95％CI:1.329～4.533),脑出血(OR =2.668,95％CI:1.579 ～4.802),较高收缩压(OR=2.208,95％CI:1.343～ 3.629),载脂蛋白E( ApoEε4)型等位基因(OR =2.717,95％CI:1.084 ～6.743)、ApoEε4型等位基因*胆固醇(OR=1.626,95％CI:1.011～2.618);保护因素有:常读书看报(OR=0.203,95％CI:0.112～0.411)、常做家务( OR =0.249,95％ CI:0.135 ～0.528)、性格外向(OR =0.544,95％ CI:0.327～0.938).结论 从事体力劳动,吸烟,喜欢呆在家里,较高收缩压,血清中较高血糖,胆固醇,低雌激素水平,ApoEε4型等位基因,高血压,糖尿病,高血脂,脑血管病变是认知减退发生的危险因素;常读书看报,常做家务,性格外向是保护因素.     

广州市60岁及以上老人轻度认知障碍的患病率调查

目的调查广州地区城乡年龄≥60岁老人中轻度认知障碍(MCI)的患病率。方法用分层随机整群抽样方法抽样,采用筛查和确诊两阶段法进行调查,实查年龄≥60岁老人4697人,失访率4.9%。MCI诊断需符合Petersen的诊断标准及临床痴呆程度评定量表(CDR)评分等于0.5。结果①检出MCI患者257例,粗患病率为5.47%,经广州市2000年人口年龄构成标化,MCI的患病率为4.94%;②其中男女MCI患者分别为67例和190例,女性粗患病率显著高于男性(6.87%vs 3.47%,P<0.001),年龄标化患病率分别为6.51%和2.90%;③MCI患病率随年龄的增加而增高(P<0.001);④城区MCI粗患病率略低于农村,但差异无统计学意义(5.22%vs 6.66%,P>0.05);⑤有脑血管病史患者MCI的患病率高于无脑血管病史的老人(10.93%vs 5.08%,P<0.001)。⑥血管性非痴呆认知障碍(VMCI)的患病率为0.72%,男女两性的患病率差异无统计学意义(P>0.05)。结论MCI患病率随年龄增长而增高,女性高于男性,有脑血管病史者患病率较高,提示高龄、女性、有脑血管病史是MCI的易感因素。     

Depression among older people with cognitive impairment: prevalence and detection

BACKGROUND: Past research has demonstrated that there is a high level of depression among older people, particularly for those with cognitive impairment and those in residential care. The current study was designed to determine the prevalence of depression among older people in hostels with cognitive impairment using a structured diagnostic interview. A further aim was to determine an appropriate screening instrument to detect depression within this population. It was also designed to evaluate the extent to which depression among these older people had previously been detected. METHOD: Five commonly used depression scales were administered and compared to the results of the diagnostic interview. RESULTS: The results demonstrated that 38.9% of older people were diagnosed with depression, but that only 50% of these people had been previously diagnosed with this disorder. All scales showed some level of validity to detect depression. CONCLUSIONS: The implications of these findings for our understanding of depression among older people with cognitive impairment are discussed.     

Association between depression and cognitive impairment in aged male war veterans

This study examined the association between both depressive symptoms and depressive disorder and subsequent cognitive performance and incident dementia. Participants were selected randomly from male veterans of World War II living in Sydney, Australia in 1982 (n=342). Those surviving were interviewed again in 1991 (n=209). Depressive disorder and dementia were diagnosed clinically. Depressive symptoms were assessed by a standard self-completed scale. Cognitive performance was assessed by 18 standard neuropsychological tests representing a range of mental functions. There was essentially no predictive and no concurrent association between depressive disorder and cognitive performance. There was a marginal correlation between depressive disorder in 1982 and dementia in 1991 but no concurrent association in 1991. Initially, depressive symptoms appeared to be associated with cognitive impairment, both predictively and concurrently. However when verbal intelligence was controlled, the predictive association disappeared for all but two cognitive performance tests and the concurrent association weakened distinctly across all tests. We concluded that cognitive performance and incident dementia were not predicted by depressive disorder nor by depressive symptoms after adjusting for the effect of intelligence.     

Treatment response and cognitive impairment in major depression: association with C-reactive protein

Levels of inflammatory markers have been found to be significantly associated with major depressive disorder (MDD) and cognitive impairment. The aim of this study was to investigate whether the level of C-reactive protein (CRP) is correlated with depressive mood and cognitive impairment in MDD patients. In 149 subjects with MDD, the 21-item Hamilton Rating Scale for Depression (HAM-D), Continuous Performance Test (CPT), Finger-Tapping Test (FTT), and Wisconsin Card-Sorting Test (WCST) were administered before and after antidepressant treatment. Besides, the level of CRP was measured. After 6 weeks of treatment, the total HAM-D scores decreased significantly. In addition, the subjects’ performance in the masked CPT and the WCST with completed categories significantly improved (p < 0.001 and p = 0.027, respectively) after the reliable change indices were corrected for practice effects. The CRP levels had increased significantly after six weeks of treatment after adjustment for age and gender (p < 0.001). In addition, the CRP levels remained significantly high after six weeks of treatment in patients with a higher baseline level (r = 0.657, p < 0.001). Although the association between baseline CRP level and HAM-D score was not significant, the baseline CRP level was significantly correlated with treatment response at week 2 (r = 0.327, p = 0.020). The baseline CRP level was also negatively correlated with performance in the FTT before treatment (r = −0.580, p = 0.006). Moreover, the baseline CRP level was significantly correlated with performance in the FTT (r = −0.501, p = 0.021) and WCST with completed categories (r = −0.521, p = 0.015) at week 6. The cognitive function of patients with high baseline CRP levels might remain impaired even if their mood symptoms improve after antidepressant treatment. Whether adjunctive anti-inflammatory medication may help to preserve cognitive function merits further investigation.     

Neuropsychological correlates of self-reported depression and self-reported cognition among patients with mild cognitive impairment

Patients with mild cognitive impairment (MCI) frequently experience significant depressive symptomatology and report cognitive disturbances. To date, no studies have examined the relationship between MCI patients' neuropsychologic functioning, self-reported depressive symptoms, and self-reported cognitive difficulties. In this study, 82 MCI patients completed a comprehensive neuropsychological evaluation that included the Beck Depression Inventory (BDI). A subset of 41 patients and informants also completed a measure of cognitive difficulties. Poorer memory functioning was associated with fewer self-reported depressive symptoms and fewer cognitive complaints.     

The screen for cognitive impairment in psychiatry (SCIP) is associated with disease severity and cognitive complaints in major depression

Objective: To assess the relationship between the Screen for Cognitive Impairment in Psychiatry (SCIP) score and illness severity, subjective cognition and functioning in a cohort of major depressive disorder (MDD) patients.

Methods: Patients (n?=?40) diagnosed with MDD (DSM-IV-TR) completed the SCIP, a brief neuropsychological test, and a battery of self-administered questionnaires evaluating functioning (GAF, SDS, WHODAS 2.0, EDEC, PDQ-D5). Disease severity was evaluated with the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI).

Results: Age and sex were associated with performance in the SCIP. The SCIP-Global index score was associated with disease severity (r?=??0.316, p?<?.05), the SDS, a patient self-assessment of daily functioning (r?=??0.368, p?<?.05), and the EDEC subscales of patient-reported cognitive deficits (r?=??0.388, p?<?.05) and their functional impacts (r?=??0.335, p?<?.05). Multivariate analysis adjusted for age and sex confirmed these tests are independent predictors of performance in the SCIP (CGI-S, F_[3,34]?=?4.478, p?=?.009; SDS, F_[3,34]?=?3.365, p?=?.030; EDEC-perceived cognitive deficits, F_[3,34]?=?5.216, p?=?.005; EDEC-perceived impacts of functional impairment, F_[3,34]?=?5.154, p?=?.005).

Conclusions: This study confirms that the SCIP can be used during routine clinical evaluation of MDD, and that cognitive deficits objectively assessed in the SCIP are associated with disease severity and self-reported cognitive dysfunction and impairment in daily life.     

Six-month cognitive improvement in nursing home residents with severe cognitive impairment

The number of patients in nursing homes with severe cognitive impairment (SCI) is growing. The authors compared the characteristics and 6-month outcomes of a sample of nursing home residents with SCI to those of other residents. This cross-sectional and 6-month follow-up study used data from pooled 1990 and 1993 cohorts in the Resident Assessment Instrument Evaluation Study. The authors compared baseline characteristics of residents with SCI (n = 1304) with all others and evaluated 6-month improvement and associated factors in the SCI group. SCI residents had poorer nutrition and lower frequencies of most symptoms and chronic diseases. Fourteen percent showed 6-month cognitive improvement, associated with higher baseline function, antidepressant medication, and recent falls. Nursing home residents with SCI had possible underrecognition of medical problems and poor nutritional status. Measured improvement may indicate possible misclassification for some residents and potential for improvement for others.     

Effect of major depression on cognitive performance among treatment-seeking adolescents

We investigated the association between cognitive performance and major depressive disorder (MDD) in adolescents seeking outpatient treatment. We used several tests comparing cognitive capacities between 16 adolescents with MDD and 25 adolescents not diagnosed as suffering from psychiatric illness according to the Structured Clinical Interview for DSM-III-R (SCID). No difference in neuropsychological test performance was found between adolescents with MDD and those without psychiatric diagnosis. Logistic regression analysis showed the only independent factor associated with MDD to be Emotional Tone (S2; odds ratio 1.13). The specific effects of MDD on the adolescents were restricted to the emotional area and were expressed as a broad deterioration in psychosocial functioning.     

Effect of major depression on cognitive performance among treatment-seeking adolescents

We investigated the association between cognitive performance and major depressive disorder (MDD) in adolescents seeking outpatient treatment. We used several tests comparing cognitive capacities between 16 adolescents with MDD and 25 adolescents not diagnosed as suffering from psychiatric illness according to the Structured Clinical Interview for DSM-III-R (SCID). No difference in neuropsychological test performance was found between adolescents with MDD and those without psychiatric diagnosis. Logistic regression analysis showed the only independent factor associated with MDD to be Emotional Tone (S2; odds ratio 1.13). The specific effects of MDD on the adolescents were restricted to the emotional area and were expressed as a broad deterioration in psychosocial functioning.     

老年高干人群轻度认知功能障碍调查及危险因素分析

目的 了解年龄≥65岁的高干人员轻度认知功能障碍的患病情况及其相关危险因素,为进行有效防治提供参考依据.方法 选取在广州市第一人民医院体检的老年高干454例为研究对象,分别给予简易精神状态量表(mini mental state examination,MMSE)的认知量表和蒙特利尔认知量表(Montreal cognitive assessment,MoCA)评估,进行两种量表得分相关性分析和MCI检出率比较.同时根据临床诊断标准将研究对象分为正常组(96名)和MCI组(337例),分析轻度认知功能障碍的相关危险因素.结果 MoCA和MMSE得分显著相关(r ＝ 0.563,P ＜ 0.01),MoCA检出率(78.98%)大于MMSE检出率(45.96%).年龄、抑郁得分、收缩压、高血压在两组之间的差异有显著统计学意义(P ＜ 0.01).MCI组中,年龄、高血压和抑郁得分均是MCI的独立危险因素(P ＜ 0.01).结论 老年高干人群中,年龄、高血压和抑郁均是MCI的独立危险因素,有针对性的对其干预可减少痴呆的发生.     

Relationship of depression and cognitive impairment to self-injury in borderline personality disorder, major depression, and schizophrenia

Self-injury was studied in 64 adults with borderline personality disorder, major depression, or chronic paranoid schizophrenia. Subjects were rated according to acute depression, chronic depression, self-injurious behaviors, and neurocognitive deficits, as measured by cognitive function examination. Borderline patients showed more self-injurious behaviors and more chronic depressive symptoms than the major depression or schizophrenia groups. Self-injury was not significantly correlated with acute or chronic depression in any group, but self-injury was correlated with neurocognitive deficits in borderline and schizophrenic groups. The results are explained in the context of a neurocognitive model of psychotic thought process in borderline disorder and schizophrenia.     

The relationship among depression, subjective cognitive impairment, and neuropsychological performance in multiple sclerosis

The aim of this study was to examine, within the context of a treatment study, the relative contributions of depression and neuropsychological performance on patient ratings of cognitive functioning in a cohort of 58 moderately-depressed multiple sclerosis (MS) patients. All participants were randomized to one of three 16-week conventional treatments for depression. Assessments were conducted pre- and post-treatment using: (1) Cognitive Function subscale of the Multiple Sclerosis Quality of Life-54 (MSQOL-54) to evaluate subjective cognitive impairment (SC), (2) Beck Depression Inventory (BDI), and (3) a neuropsychological index score (NP). Prior to treatment, 8% of the variance in SC was explained by NP, whereas 14% of the variance was explained by BDI, above and beyond NP. At post-treatment, patients were classified as 'responders' (BDI < 11) and 'non-responders' (BDI > or = 11). Among those participants classified as 'responders', NP accounted for 39% of the variance in SC, and BDI did not significantly predict SC. The results of this study suggest that depression may influence subjective reports of cognitive impairment, but these reports may not be reliably related to objective neuropsychological performance. Furthermore, patients may be more accurate reporters of their cognitive impairment after successful treatment for depression, suggesting that depression decreases the accuracy of patient reported cognitive impairment.     

Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia

BACKGROUND: The course of depression in residents of long-term care with dementia is not well studied. OBJECTIVES: To estimate the incidence, prevalence, and outcomes of depression in long-term care residents with dementia. METHOD: 201 residents of Copper Ridge, a long-term care facility for the memory impaired, were followed every six months during the first year after their admission. RESULTS: On admission 19.9% of the residents had depression, the majority (75%) occurring in persons with a prior history of depression. At six months, only 15% of the original 40 depressed patients were still depressed, while at twelve months only 7.5% were depressed. The incidence of depression at six and twelve months was 1.8% and 6.4% respectively. Most persons with new depression at six months were no longer depressed at one year. The annual attack rate (cumulative likelihood of depression over one year) for the total population was 26.4%. The rates for the subgroup of Alzheimer's were similar to the rates of the total population, except for an annual attack rate of 17.5%, reflecting a lower rate of depression on admission. The decline in depression over the year after admission is noteworthy and likely reflects appropriate diagnosis and treatment of depression. CONCLUSIONS: These results indicate that, over the course of one year, depression afflicts a considerable proportion of long-term care residents with dementia. Admission to a long-term care facility may actually result in a reduction of depression within the year after admission in part due to rapid recognition, appropriate diagnosis and treatment.