Depression in older patients admitted for postacute nursing home rehabilitation

OBJECTIVES: To describe the prevalence, recognition, and persistence of depression in older adults undergoing postacute rehabilitation in a nursing home (NH) setting and to explore the effect of depression on rehabilitation outcomes. DESIGN: Prospective cohort study. SETTING: One rehabilitative NH in the Los Angeles area. PARTICIPANTS: One hundred fifty-eight patients (aged >/=65) admitted for postacute rehabilitation over a 9-month recruitment period. MEASUREMENTS: Depression was assessed using the 15-item Geriatric Depression Scale (GDS-15) or the Cornell Scale for Depression (in participants with dementia). Medical records were reviewed for documentation of depression and antidepressant use before and during the rehabilitative NH stay. Rehabilitation process was assessed using total amount of successfully completed therapy (minutes). Rehabilitation outcome was assessed using the motor component of the Functional Independence Measure (mFIM). Measures were performed at admission and 2 months later. RESULTS: Of the 646 potentially eligible patients admitted during the study, 158 consented, and 151 were screened for depression. Forty-two (27.8%) had depressive symptoms (GDS=6 or Cornell=5). Of these, only 15 had a documented diagnosis of depression, and 12 were receiving antidepressants. Depression was associated with longer NH stay but not with discharge mFIM score. Two months later, depression persisted in 24 participants and was associated with worse mFIM (55.5+/-22.7 vs 67.0+/-23.7, depressed vs nondepressed; P=.03). CONCLUSION: Depression was common, underrecognized, and undertreated in these postacute rehabilitation patients. Depression generally persisted and was associated with worse functional status at 2-month follow-up.     

老年冠心病患者与抑郁障碍的相关性研究

目的 探讨抑郁障碍是否为老年冠心病的危险因素并观察冠心病伴抑郁障碍患者炎性标记物水平变化.方法 对188例入选者进行临床情况调查、汉密顿抑郁量表评分和血清炎性标记物水平测定,分析冠心病伴抑郁障碍患病率及影响冠心病发病的危险因素.结果 冠心病患者87例,其抑郁障碍患病率为29.9%(26例),非冠心病入选者101例,患病率为11.9%(12例),抑郁障碍在两组间差异有统计学意义(P＜0.01).年龄、高血压、糖尿病、脂代谢异常和抑郁障碍是冠心病的危险因素之一.冠心病伴抑郁障碍组和冠心病不伴抑郁障碍组入选者在突发生活事件、心功能分级差异有统计学意义(均P＜0.05).两组入选者在冠状动脉病变、冠状动脉病变治疗差异无统计学意义(P＞0.05).冠心病伴抑郁障碍组和冠心病不伴抑郁组外周血炎性标记物水平比较显示,伴抑郁障碍组血清单核细胞趋化因子-1水平增高,高敏C反应蛋白和肿瘤坏死因子α差异无统计学意义.结论 老年冠心病患者伴抑郁障碍患病率高于老年非冠心患者群.抑郁障碍是影响冠心病发病的危险因素之一.老年冠心病患者抑郁障碍与炎性标记物之间可能存在一定关系.

Abstract：

Objective To explore whether depressive disorder is one of risk factors for coronary artery disease (CAD) in enrolled patients and observe the level of inflammation markers in coronary artery disease patients with depression. Methods In all patients, we recoded clinical information and data from Hamilton Depression Rating Scale for Depression( HRSD)and measured concentration of monocyte chemoattractant protein-1 (MCP-1), tumour necrosis factor α (TNFα) and hypersensitive C-reaction protein (hsCRP). Results Among 87 patients with coronary artery disease, depressive disorder was diagnosed in 26 patients, the prevalence of depressive disorder was 29. 9%. Among 101 patients without coronary artery disease, 12 patients were suffering from depressive disorder, the prevalence of depressive disorder was 11.90%. The prevalence of depressive disorder in coronary artery disease group was statistically higher than that in non-coronary heart disease group (29.8% vs.11.9%, P<0. 01). The incidence of coronary artery disease was associated with age, hypertension,diabetes mellitus, hypercholesterolemia and depression. Life events and stage of heart function occurred differently between CAD patients with and without depression (P<0. 05). There were no differences in the degree of coronary artery stenosis and the type of treatment (P>0. 05) between the two groups. There were higher concentration of MCP-1 in coronary artery disease patients with depression, but no remarkable difference in hsCRP and TNFa. Conclusions There is high prevalence of depressive disorder, which is one of risk factor for coronary artery disease. The depressive disorder may be associated with inflammation biomarker in patients with coronary artery disease.     

Odor identification in Alzheimer's disease and depression

BACKGROUND AND AIMS: In Alzheimer's disease (AD) olfactory deficits are common and depression is a difficult differential diagnosis. We therefore investigated the usefulness of an odor identification test to differentiate both conditions. METHODS: Twenty patients with probable Alzheimer's disease (AD), twenty elderly patients with a depressive disorder, and thirty healthy elderly subjects performed a German odor identification test. RESULTS: AD patients had significantly lower odor identification scores, compared with both depressive patients and control subjects (F=121.96, df=2, 67, p<0.001). With a cut-off score of 10/11, the sensitivity of the identification test to differentiate AD patients from depressive patients was 100%, and specificity was 95%. CONCLUSIONS: The odor identification test used in this study is able to reveal olfactory deficits in AD. It also seems to be a useful instrument to differentiate AD from depression.     

Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure

BACKGROUND: Depression is 4 to 5 times as common in heart failure (HF) patients as in the general population, might confer a higher risk of developing HF, and negatively affects prognosis in established HF. METHODS AND RESULTS: A review was undertaken via Medline (1966-2003) and PsycINFO (1872-2003) searches using the subject headings "depressive disorder" and "heart failure, congestive." Our findings suggest that the link between depression and HF may be due to shared pathophysiology. Depression may augment catecholamine release, arrhythmias, elaboration of proinflammatory cytokines, and platelet activation--processes that may influence prognosis in HF. Depression is also associated with a higher risk of noncompliance and lower levels of social support, which have been shown to worsen prognosis in HF. The impact of pharmacologic or behavioral treatment for depression on physiologic parameters or clinical outcomes in HF remains unclear. Inherent difficulties in recognition of depression in the setting of HF may decrease the likelihood that depressed patients receive the treatment they need. CONCLUSIONS: Depression is common in HF, may contribute to the development of HF in susceptible populations, and is independently predictive of poor clinical outcomes. Pathophysiologic pathways and psychosocial issues that are shared between the 2 conditions might explain these observations and represent potential therapeutic targets. Vigilant attention to the recognition and treatment of depression in HF patients is warranted.     

Do depressive symptoms predict Alzheimer's disease and dementia?

BACKGROUND: Depressive symptoms are common in seniors and may predict dementia. The objective of this study was to evaluate multiple measures of depressive symptoms to determine whether they predict subsequent Alzheimer's disease (AD) or dementia. METHODS: This population-based cohort study with 5-year follow-up included 766 community-dwelling seniors (ages 65+ years) in Manitoba, Canada. Measurements considered were the Center for Epidemiologic Studies Depression (CES-D) scale, participant-reported medical history, and duration of depression. RESULTS: Total CES-D score was a significant predictor of AD and dementia when categorized as a dichotomous variable according to the cutoff scores of 16 and 17; a CES-D cutoff of 21 was a significant predictor of AD and a marginally significant predictor of dementia. When analyzed as a continuous variable, CES-D score was marginally predictive of AD and dementia. Neither participant-reported history of depression nor participant-reported duration of depression was significant in predicting AD or dementia. CONCLUSION: Because depressive symptoms as measured by the CES-D predict the development of AD and dementia over 5 years, clinicians should monitor their older patients with these symptoms for signs of cognitive impairment.     

Development of a minimum data set-based depression rating scale for use in nursing homes

BACKGROUND: depression is common but under-diagnosed in nursing-home residents. There is a need for a standardized screening instrument which incorporates daily observations of nursing-home staff. AIM: to develop and validate a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument. METHODS: we conducted semi-structured interviews with 108 residents from two nursing homes to obtain depression ratings using the 17-item Hamilton Depression Rating Scale and the Cornell Scale for Depression in Dementia. Nursing staff completed Minimum Data Set assessments. In a randomly assigned derivation sample (n = 81), we identified Minimum Data Set mood items that were correlated (P < 0.05) with Hamilton and Cornell ratings. These items were factored using an oblique rotation to yield five conceptually distinct factors. Using linear regression, each set of factored items was regressed against Hamilton and Cornell ratings to identify a core set of seven Minimum Data Set mood items which comprise the Minimum Data Set Depression Rating Scale. We then tested the performance of the Minimum Data Set Depression Rating Scale against accepted cut-offs and psychiatric diagnoses. RESULTS: a cutpoint score of 3 on the Minimum Data Set Depression Rating Scale maximized sensitivity (94% for Hamilton, 78% for Cornell) with minimal loss of specificity (72% for Hamilton, 77% for Cornell) when tested against cut-offs for mild to moderate depression in the derivation sample. Results were similar in the validation sample. When tested against diagnoses of major or non-major depression in a subset of 82 subjects, sensitivity was 91% and specificity was 69%. Performance compared favourably with the 15-item Geriatric Depression Scale. CONCLUSION: items from the Minimum Data Set can be organized to screen for depression in nursing-home residents. Further testing of the instrument is now needed.     

Anosognosia and depression in patients with Alzheimer's dementia

Anosognosia refers to impaired awareness of patients to realize deficits related to a disorder and is a common symptom of dementia. Anosognosia has far-reaching consequences for diagnosis and treatment and is probably associated with unfavorable prognosis. This study examined the relationship between anosognosia and depression in patients with Alzheimer's dementia (AD). Assessment included interviews of patients and their caregivers. Depressive symptoms were evaluated with observer and self-rating instruments: the Geriatric Depression Scale (GDS), and the “mood” subscale of the Nurses Observation Scale for geriatric patients (NOSGER). Anosognosia was evaluated with the Anosognosia Questionnaire for Dementia (AQ-D). For the evaluation of behavioral and neuropsychological symptoms in dementia and the caregiver burden, the neuropsychiatric inventory (NPI) and the Cares of older People in Europe (COPE) Index were administered. A total of 47 patients were enrolled in the study at the department's geriatric psychiatry outpatient clinic. A considerable discrepancy was found between observer- and self-ratings of depressive symptoms. In 74.5% of the participants, caregiver ratings indicated secondary symptoms of depression as opposed to patient ratings. Thus, in AD, anosognosia may affect not only deficits in cognition and everyday functioning but also affective symptoms (“affective anosognosia”). Caregiver rating therefore is particularly important when assessing mood changes in AD patients.     

Depressive symptoms and level of physical activity in patients with Alzheimer's disease

Aim: The purpose of this study was to determine the presence of depressive symptoms in patients with Alzheimer's disease, to assess whether there was an association between physical activity level and depressive symptoms in this population, and to assess whether more active patients had lower rates of depressive symptoms when compared with less active patients. Methods: The study included 37 patients with Alzheimer's disease and used the following instruments: the Geriatric Depression Scale, the Cornell Scale for Depression in Dementia and the Baecke Questionnaire Modified for the Elderly. The Shapiro–Wilk test was used to determine whether the data were normally distributed. The Spearman correlation test and the Mann–Whitney U‐test was used. P‐values less than 5% were considered statistically significant. Results and discussion: The prevalence of depressive symptoms in the sample was 35.13%. The Spearman correlation test verified the relationship between level of physical activity and depressive symptoms (rho = ?0,4), and between the sports activities domain and depressive symptoms (rho = ?0,4). Patients who were more active had lower depressive symptoms. Conclusions: The prevalence of depressive symptoms in the sample was 35.13%. Patients who were more active had lower rates of depressive symptoms. Geriatr Gerontol Int 2012; ??: ??–??.     

Anomalous functional connectivity within the default-mode network in treatment-naive patients possessing first-episode major depressive disorder

Background and Objective:Previous studies have shown that the default-mode network (DMN) has a substantial role in patients with major depressive disorder (MDD). However, there is a shortage of information regarding variations in the functional connectivity (FC) of the DMN of treatment-naive patients with first-episode MDD. The present study aims to explore the FC of the DMN in such patients.Methods:The study population consisted of 33 patients and 35 controls, paired regarding age, gender, education level, and health condition. Depression severity was assessed through the Hamilton Depression Scale (HAM-D), and subjects underwent evaluation during the resting-state through functional magnetic resonance imaging (rs-fMRI). To assess the result, we used FC and ICA. We used Spearman''s correlation test to detect potential correlations between anomalous FC and severity of HAM-D scores.Results:We have found a decreased FC in the left medial orbitofrontal gyrus (MOFG) and right marginal gyrus (SMG) in depressive patients compared to controls. There was a negative correlation between abnormal FC in the right SMG and HAM-D scores. We have not found any increase in FC of the DMN in treatment-naive, first-episode of MDD patients.Conclusions:Our study provided evidence of a negative correlation between abnormal FC in the DMN and severity of depression symptoms measured by HAM-D in treatment-naive MDD patients. This finding could shed some light on the relevance of DMN for understanding the pathophysiology of cognitive impairment in MDD.     

Behavioral Activation as a Treatment for Geriatric Depression

By encouraging older adults to become more active, behavioral activation (BA) may help reduce depressive symptoms brought on by activity restriction. The purpose of this study was to determine, through a multiple-baseline design, whether BA could be successfully applied to older adults with depression. Nine depressed older adults (M = 75 years of age) underwent a course of in-home BA therapy (mean number of sessions = 14.7). Overall, participants' Geriatric Depression Scale and Hamilton Rating Scale for Depression scores decreased from pre- to post-treatment, and 71% of participants no longer met criteria for a depressive disorder. Behavioral activation shows promise as a treatment for geriatric depression.     

Anosognosia and depression in patients with Alzheimer's dementia

Anosognosia refers to impaired awareness of patients to realize deficits related to a disorder and is a common symptom of dementia. Anosognosia has far-reaching consequences for diagnosis and treatment and is probably associated with unfavorable prognosis. This study examined the relationship between anosognosia and depression in patients with Alzheimer's dementia (AD). Assessment included interviews of patients and their caregivers. Depressive symptoms were evaluated with observer and self-rating instruments: the Geriatric Depression Scale (GDS), and the “mood” subscale of the Nurses Observation Scale for geriatric patients (NOSGER). Anosognosia was evaluated with the Anosognosia Questionnaire for Dementia (AQ-D). For the evaluation of behavioral and neuropsychological symptoms in dementia and the caregiver burden, the neuropsychiatric inventory (NPI) and the Cares of older People in Europe (COPE) Index were administered. A total of 47 patients were enrolled in the study at the department's geriatric psychiatry outpatient clinic. A considerable discrepancy was found between observer- and self-ratings of depressive symptoms. In 74.5% of the participants, caregiver ratings indicated secondary symptoms of depression as opposed to patient ratings. Thus, in AD, anosognosia may affect not only deficits in cognition and everyday functioning but also affective symptoms (“affective anosognosia”). Caregiver rating therefore is particularly important when assessing mood changes in AD patients.     

Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT.

AIMS: Depression in patients following myocardial infarction (MI) is associated with an increased risk of mortality, but this association may be confounded by cardiac disease severity. We explored the relationship between left ventricular ejection fraction (LVEF) and depression in MI patients. METHODS AND RESULTS: In the Myocardial Infarction and Depression-Intervention Trial (MIND-IT), 1989 MI patients were assessed for depressive symptoms [Beck Depression Inventory (BDI) t = 0, 3, 6, 9, and 12 months post-MI]. Patients with BDI score > or =10 were assessed for the presence of International Classification of Diseases, 10th revision (ICD-10) depressive disorder (t = 3, 6, 9, and 12 months post-MI). Patients were divided into categories according to their LVEF during hospitalization, i.e. LVEF <30%, LVEF 30-45%, LVEF 45-60%, and LVEF > or = 60%. During hospitalization, presence of depressive symptoms was higher in patients with LV dysfunction. A relationship was found between LVEF and ICD-10 depressive disorder, i.e. a lower LVEF was associated with a higher rate of depression from 3-12 months post-MI (P < 0.01). Levels of LVEF inversely correlated with the BDI score at 3 months post-MI. Associations persisted after adjustment for demographics, risk factors for coronary artery disease, co-morbidity, Killip class, and baseline BDI score. CONCLUSION: In MI patients, the rate of depression and the severity of depressive symptoms are significantly related to the severity of LV dysfunction. The association between depression and LV dysfunction must be acknowledged when evaluating the prognostic effects of depression in cardiac patients.     

Depression and severe heart failure: benefits of cardiac resynchronization therapy

Depression and Cardiac Resynchronization Therapy . Background: The relationship between depression and heart failure is neither coincidental nor trivial, since depression is a powerful predictor of re‐hospitalization and mortality. We prospectively studied the prevalence and impact of depression on the clinical outcomes of patients attending for cardiac resynchronization therapy (CRT). We specifically examined whether patients with depression have a different rate of response to CRT and whether CRT has an effect on depressive symptoms. Methods: Sixty‐eight recipients of CRT systems were included. The depressive status was evaluated before implant and after 6 months by a structured diagnostic interview measuring Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria of major depression and by a self‐report questionnaire (Center for Epidemiological Studies Depression Scale, CES‐D). The CRT response was assessed at 6 months by a clinical composite score. Results: At inclusion, DSM‐IV criteria of major depression were identified in 41% of the population, while using the self‐report questionnaire 65% were observed to have mild to major depressive symptoms (CES‐D ≥ 16). Only 4 patients were taking antidepressants. At 6 months, 75% were considered responders to CRT. Response to CRT did not differ between those with and without depression at baseline. The rate of patients with depression at 6 months was significantly lower in responders to CRT compared with nonresponders. Conclusions: We found a high prevalence of depressive symptoms in patients receiving CRT systems. Patients with depression should not be excluded from CRT, because they demonstrate a similar rate of response than the persons without depression and the responders are less likely to be depressed at 6 months. (J Cardiovasc Electrophysiol, Vol. 23, pp. 631–636, June 2012)     

Association of depressive symptoms with reduced baroreflex cardiac control in coronary artery disease

BACKGROUND: Although depression has been associated with cardiac death in coronary artery disease (CAD), little is known about the effects of depression on autonomic nervous system control of heart rate. This study evaluated whether depressive symptomatology is associated with impaired baroreflex sensitivity (BRS) in patients with CAD. METHODS AND RESULTS: BRS was assessed in 66 patients with stable CAD by using cross-spectral analysis to measure baroreceptor-mediated R-R interval oscillations. Depressive symptomatology was determined with the Beck Depression Inventory, with lower (scores <3, n = 14) and upper (scores >9, n = 16) quartiles of scores used to define groups with low and high depressive symptomatology, respectively. Comparison of the two groups showed that age-adjusted BRS was reduced in the patients with high depressive symptomatology when compared with patients with low depressive symptomatology (4.5 +/- 2.7 vs 6.5 +/- 2.8 ms/mm Hg; P <. 05). CONCLUSIONS: The current findings show that patients with CAD and depressive symptomatology have reduced BRS. Future studies are needed to examine whether reduced baroreflex cardiac control predicts cardiac risk in patients with CAD and depressive symptomatology.     

Screening Clinical Depression in HIV-Seropositive Patients Using the Hospital Anxiety and Depression Scale

The aim of this study was to verify the capacity of the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), a self-report scale, to screen clinical depression in HIV-seropositive patients. Sixty-nine HIV-infected patients participated in this study, of whom 22 met diagnostic criteria for a depressive disorder or an adjustment disorder with depressed mood, while the remaining 47 did not. Results of the Receiver Operating Characteristic (ROC) analyses suggest that the HADS-D is a highly effective screening tool for clinical depression in this population. The Beck Depression Inventory (BDI) was also found to be effective, but it takes much longer to complete than the HADS-D (21 vs. 7 items) and is therefore less likely to be routinely implemented in HIV care settings. Moreover, the BDI contains somatic items that can be confused with HIV manifestations. For these reasons, health care providers are encouraged to use the HADS to screen depression in their HIV-infected patients.     

Depression in patients with primary biliary cirrhosis and primary sclerosing cholangitis

BACKGROUND/AIMS: Former studies reported a high prevalence of depression in patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). These studies hypothesized that the presence of depression could explain the fatigue experienced by these patients. METHODS: Our aim was to study the prevalence of depression in a Dutch population with PBC and PSC. In addition, to investigating the effects of using an additional diagnostic structured psychiatric interview, after screening with the Beck Depression Inventory (BDI), a self-report severity scale instrument used in former studies. Patients with PBC and PSC (n=92) completed the BDI. Patients with scores of 10 or higher (n=39) were interviewed using a structured psychiatric interview. Patients with scores lower than 10 were at random (30/53, 57%) also interviewed using a structured psychiatric interview. RESULTS: Of the 92 patients that were included 42% had depressive symptoms according to the BDI. However, of these patients only 3.7% had a depressive syndrome according to the DSM-IV criteria as assessed with the structured psychiatric interview. CONCLUSIONS: The prevalence of a depressive disorder in patients with PBC and PSC is not higher than in the general population. Fatigue in patients with PBC and PSC cannot be explained by depression.     

Prevalence of depressive disorders in men and women enrolled in cardiac rehabilitation

PURPOSE: Epidemiological studies have demonstrated that depression is an independent risk factor for the development and recurrence of coronary heart disease (CHD). The prevalence of depressive disorders, however, is not well documented in CHD patients enrolled in cardiac rehabilitation (CR). The purpose of this study was to estimate the prevalence of current and lifetime depressive disorders in the CR setting. METHODS: One hundred ten men and women diagnosed with CHD and enrolled in a phase II CR program were screened via a psychiatric, structured interview to assess current and lifetime history of major depressive disorder, minor depression, and dysthymic disorder. RESULTS: A total of 17 (15.5%) individuals screened positive for a current depressive disorder at entry into the CR program, with 10 (9.1%) individuals screening positive for major depressive disorder, 7 (6.4%) for minor depression, and 6 (5.5%) for dysthymic disorder. With respect to lifetime prevalence of mood disorders, 29 (26.4%) individuals met the diagnostic criteria for at least one depressive disorder during their lifetime. The lifetime prevalence of major depressive disorder, minor depression, and dysthymic disorder was 11.8%, 14.5%, and 10.9%, respectively. Female CR participants evidence significantly higher current and lifetime prevalence rates for depressive disorders compared to their male counterparts. CONCLUSIONS: The results of this study suggest that a substantial number of CHD patients enrolled in CR report a clinically significant history of depression. Efforts to assess and treat depression are needed in the CR setting and may be associated with better adherence to lifestyle modification programs.     

Even minimal symptoms of depression increase mortality risk after acute myocardial infarction.

Mild to moderate levels of depressive symptoms as characterized by Beck Depression Inventory (BDI) scores of > or =10 are associated with decreased survival after acute myocardial infarction (AMI). We investigated whether lower levels of depressive symptoms are also associated with increased mortality risk after AMI. We prospectively studied 285 patients with AMI who survived to discharge for evidence, at the time of hospitalization, of a DSM-IIIR mood disorder (using a structured clinical interview) and for symptoms of depression (using the BDI). The overall mortality rate at 4 months was 6.7%. Multiple logistic regression (chi-square 35.79, p < or =0.001) revealed that the independent predictors of mortality were: age > or =65 years, left ventricular ejection fraction <35%, diabetes mellitus, and any depression (DSM-IIIR mood disorder or BDI > or =10) present at the time of AMI. Among patients > or =65 years old with left ventricular ejection fraction <35%, the 4-month mortality was 12%. However, in this same group, those with any depression at the time of AMI had a 4-month mortality of 50% (relative risk 4.1, p = 0.01). Among patients aged > or =65 years, the mortality according to BDI scale grouping 0 to 3, 4 to 9, and 10+ was 2.6%, 17.1%, and 23.3%, respectively (p <0.002). Highest mortality rates were observed in patients with most severe depressive symptoms. However, compared with those without depression, higher mortality was also observed at very low levels of depressive symptoms (BDI 4 to 9) not generally considered clinically significant and below the level usually considered predictive of increased post-AMI mortality.     

Relationships between mood and estradiol (E2) levels in Alzheimer's disease (AD) patients

This study investigates the relationship between mood and estradiol (E2) levels and assesses the prevalence of mood symptoms in Alzheimer's disease (AD) patients compared to healthy elderly controls. Fifty-two AD patients (26 men, 23 estrogen non-using women and three estrogen-using women), mean age 76.2 years, were recruited and assessed with the Geriatric Depression Scale (GDS), a test of mood, and a radioimmunoassay measure of E2 levels at the time of testing. The AD patients were compared to a control group of age and gender-matched healthy elderly men and women estrogen-users and non-users. No differences were found between the AD patients and the controls in overall E2 levels, but, as expected, the women estrogen-users in both the AD and control groups had higher E2 levels than the men and the female estrogen non-users. Both groups of men had higher E2 levels than the estrogen non-using women. There was a significant negative correlation between E2 levels and GDS scores in the full sample, which was particularly strong in the estrogen-using women. This indicates that those subjects with higher E2 levels had less mood symptomatology. Overall, mood scores in the AD patients were higher than in the healthy controls, indicating higher levels of depressive symptomatology; the highest depression scores occurred in the AD women who were estrogen non-users. This suggests that depressive symptoms are common in AD patients, and that women with AD who are not taking estrogen replacement may be especially vulnerable to depression.