Journal of Geriatric Psychiatry and Neurology current issue

Depressive Symptoms and Metabolic Syndrome: Selective Association in Older Women

Laudisio, A., Marzetti, E., Pagano, F., Pozzi, G., Bernabei, R., Zuccala, G. — Tue, 17 Nov 2009 15:18:52 PST

The metabolic syndrome (MetS) is being increasingly found in older populations. Depressive symptoms are prevalent in elderly populations, and they are associated with adverse outcomes, chiefly cardiovascular. The aim of this study was to evaluate the association of the 30-item geriatric depression scale (GDS) score with MetS, as defined according to the National Cholesterol Education Program’s Adult Treatment Panel III (ATP-III) criteria, in all 353 participants aged 75+ years living in Tuscania (Italy). Metabolic syndrome was associated with the GDS score in a multivariable linear regression analysis in women (β s= 2.14, 95% CI = 0.14 to 4.14; P = .036), but not in men (β = —.84, 95% CI = —3.17 to 1.49; P = .476), after adjusting. Analysis of the interaction term confirmed (P = .022) that such an association differed according to sex. Metabolic syndrome is independently associated with depressive symptoms in community-dwelling older women. Older women with depression should be prompted to undergo screening for MetS. Conversely, elderly women with MetS should be assessed for affective disorders.

Depressive Symptoms in Parkinson Disease Correlate With Impaired Global and Specific Cognitive Performance

Tue, 17 Nov 2009 15:18:52 PST

Consecutive patients in a Movement Disorders Center with Parkinson disease (PD) were offered to undergo complete neuropsychological testing and to complete the Beck Depression Inventory (BDI), regardless of their cognitive and behavioral status. A total of 82 patients were included in this cross-sectional study and had a mean age of 67.7 years, formal education of 14.8 years, PD duration of 101 months, Unified Parkinson Disease Rating Scale—Motor ‘‘off’’ score of 36.96, Mini-Mental State Examination (MMSE) score of 27.8 (range 19-30), and BDI score of 10.23 (SD 8.65). Beck Depression Inventory scores did not correlate with disease duration or motor scores but inversely correlated with the MMSE scores (r = —0.40; P < .001) and total Dementia Rating Scale (DRS) scores (r = —0.33; P < .01). Using a univariate regression analysis controlling for age, gender, education, and total Unified Parkinson Disease Rating Scales (UPDRS) score, the BDI scores had a significant and unique relationship with MMSE scores. However, when the BDI scores were correlated with specific cognitive domains, only the Boston Naming Test and the Hopkins Verbal Learning Test (HVLT) delayed recall remained significant after Bonferroni correction. Similarly, when comparing the cognitive performance of patients with PD who scored >14 on the BDI versus those who scored <14, only the mean score of the Boston Naming Test was different between the 2 groups. Our study shows that while depressive symptoms correlated with global cognitive performance, naming, verbal memory, and language are the most susceptible cognitive domains affected with depressive symptoms.

Assessing Cognition in Parkinson Disease: Use of the Cognitive Linguistic Quick Test

Parashos, S. A., Johnson, M. L., Erickson-Davis, C., Wielinski, C. L. — Tue, 17 Nov 2009 15:18:52 PST

Objective: To evaluate the Cognitive Linguistic Quick Test (CLQT) as a cognitive screening tool in Parkinson disease (PD). Methods: A total of 93 patients with PD were evaluated with the Mini-Mental State Examination (MMSE) and the CLQT. The CLQT provides separate ratings for 5 cognitive domains. Descriptive statistics, correlations between the tests, and diagnostic value for dementia were analyzed. Results: Cognitive Linguistic Quick Test correlated well with MMSE. Diagnostic values for dementia were similar for the 2 instruments. Unlike the MMSE, the CLQT also provided domain-specific information on cognitive deficits. Cognitive domains were differentially affected between and within the demented and nondemented patient groups with PD: memory was the weakest domain in the demented group and attention in the nondemented. Conclusions: The CLQT is a valuable instrument in assessing cognitive dysfunction in PD. The CLQT is superior to the MMSE as it also provides cognitive domain-specific information.

Clock Test Deficits Are Associated With Semantic Memory Impairment in Alzheimer Disease

Leyhe, T., Saur, R., Eschweiler, Gerhard. W., Milian, M. — Tue, 17 Nov 2009 15:18:52 PST

Based on previous findings, we hypothesized that Clock Test deficits in patients with Alzheimer disease (AD) are associated primarily with the impairment of semantic memory regarding the appearance and functionality of a clock. To scrutinize this hypothesis, we developed a Clock Questionnaire that examined the semantic knowledge of the concept of a ‘‘Clock’’ and correlated scores from the questionnaire with performance in Clock Drawing, Clock Setting, and Clock Reading by healthy control participants and patients with mild cognitive impairment, early AD, and progressed AD. The Rey-Osterrieth-Complex-Figure is known to measure both visuospatial abilities and executive functions, and was chosen as a control variable. We found that deteriorated semantic memory best predicted Clock Test performance. In progressed AD, degraded knowledge regarding the appearance of a clock can explain the reduced ability to draw a clock face, while in early AD, impaired access to semantic knowledge about the minute hand might explain observed difficulties in drawing, setting, and reading the minute hand.

Consistency of Clinical Diagnosis of Dementia in NEDICES: A Population-Based Longitudinal Study in Spain

Tue, 17 Nov 2009 15:18:52 PST

Background: Few longitudinal studies have verified the clinical diagnosis of dementia based on clinical examinations. We evaluated the consistency of the clinical diagnosis of dementia over a period of 3 years of follow-up in a population-based, cohort study of older people in central Spain. Methods: Individuals (N = 5278) were evaluated at baseline (1994-1995) and at follow-up (1997-1998). The evaluation included a screening questionnaire for dementia and a neurological assessment. Results: Dementia screening consisted of a 37-item version of the Mini-Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (FAQ). Study neurologists investigated those participants who screened positively (N = 713) as well as 843 who had screened negatively to test the sensitivity of the screening instruments or because they had a positive screening for other chronic neurological diseases. We detected 295 patients among those who screened positive and 13 among those who screened negatively. Three years follow-up evaluation demonstrated 14 diagnostic errors at baseline (4.5%) leading to a final number of 306 patients with dementia. The corrected prevalence of dementia was 5.8% (95% confidence interval [CI] 5.2-6.5). Conclusions: The diagnosis of dementia was highly accurate in this population-based, Spanish cohort study, and our prevalence figures agree with other European surveys. Given the high cost and difficulties of population rescreening and its relatively low yield, we conclude that a single 2-phase investigation (screening followed by clinical examination) provides accurate information for most population-based prevalence studies of dementia.

Cognitive Impairment in Older Adults Without Dementia: Clinical and Pathologic Outcomes in a Community-Based Sample

Tue, 17 Nov 2009 15:18:52 PST

This study examines clinical and neuropathologic characteristics of 37 participants in a community-based dementia series who had cognitive complaints at enrollment but did not meet dementia criteria. Participants had neuropsychological testing, were followed until death, and underwent autopsy. Twenty-four participants progressed to dementia, and their baseline characteristics were analyzed. Of the 24, 13 met criteria for neuropathologic Alzheimer disease (AD). The 13 participants who progressed to neuropathologic AD (mean intake age 78.5 ± 7.7, mean enrollment 6.4 ± 2.1 years) performed worse than the 11 who progressed to neuropathologic non-AD dementias (mean intake age 79.0 ± 6.0, mean enrollment 6.0 ± 3.2 years) on baseline Wechsler Memory Scale (WMS) delayed logical memory (3.4 ± 2.9 vs 6.3 ± 3.9, P = .05) and delayed visual reproduction (1.4 ± 2.1 vs 3.1 ± 2.7, P = .02). These observations are consistent with the view that nondemented patients with underlying AD may be more likely to present with memory than nonmemory cognitive impairment.

Functional Consequences of Subcortical White Matter Lesions and MRI-Defined Brain Infarct in an Elderly General Population

Baune, B. T., Schmidt, W. P., Roesler, A., Berger, K. — Tue, 17 Nov 2009 15:18:52 PST

The impact of single and combined effects of subcortical white matter lesions (WMLs) and magnetic resonance imaging (MRI)—defined brain infarct on activities of daily living (ADL), depression, and health status perception was analyzed in community-dwelling elderly individuals. The study included 268 participants from the Memory and Morbidity in Augsburg Elderly (MEMO) project, a population-based study on individuals aged 65 to 83 years, conducted in Augsburg, Germany. Cerebral MRI was performed, and 2 geriatric performance tests, scales to assess ADL, depressive symptoms, and self-perceived health status were assessed. The prevalence of large (>10 mm) subcortical WML was 37.7% and of MRI-defined infarct-like lesions was 15.3%. Both vascular lesion types combined were found in 9% of the participants. Large WMLs were associated with significantly more impairments in basic ADL, inferior results in the performance tests, and a worse self-perceived health status compared to those without large WML. Magnetic resonance imaging—defined brain infarct was associated with impairments in performance tests. Participants with both lesion types were limited in all domains and were 2 to 3 times more likely to have impairments in all examined functions. Their risk of impairment in a specific function was considerably higher than the sum of the single risks associated with each lesion type alone. This study suggests that the single and especially the combined occurrence of common vascular brain lesions are associated with functional impairment. Identifying individuals with severe WML combined with MRI-defined brain infarct can help better understand the development of marked impairments in old age.

The Reasons for Nursing Home Entry in an Adult Day Care Population: Caregiver Reports Versus Regression Results

Cohen-Mansfield, J., Wirtz, P. W. — Tue, 17 Nov 2009 15:18:52 PST

This article aims to compare reasons for nursing home entry determined through a regression of baseline predictors to relatives’ perceptions of reasons for entry. Participants included 201 community-residing members of 5 senior day care centers in Maryland. Through a prospective design, statistical predictors using Cox regressions were compared to the relatives’ reports of reasons for nursing home entry. These reports identified the most common reasons for nursing home entry as deterioration of independence and confusion. Behavior problems were also reported for almost half of the participants. In contrast, strong baseline statistical predictors of institutionalization were depressed affect, number of psychiatric diagnoses, a diagnosis of dementia, and age. Because of its strong significance within the baseline predictors, the meaning of depressed affect and why it was such a potent predictor of nursing home entry, yet still not reported by caregivers, should be studied further.