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MIND & BRAIN, THE JOURNAL OF PSYCHIATRY


REVIEW ARTICLE


Affective Disorders, Mild Cognitive Impairment, and Risk for Dementia


Martine Simard Affiliation: School of Psychology, Laval Uniuersity, Quebec City, QC, Canada


ABSTRACT


The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals’ cognitive functions, but it has recently been suggested that neuropsychiatric symptoms (NPS), and especially affective symptoms, should also be considered important factors in age- related neurodegeneration. This article reviews and summarizes recent evidence, published over the last 3 years, regarding the presence of various affective disorders in healthy older adults and MCI patients, and its relationship to risk for developing dementia. The results presented in this review show that depressive, apathetic, and anxious symptoms can be present in cognitively intact healthy elderly and MCI, and may predict progression to dementia. This article also provides suggestions for future research.


Keywords: depression, apathy, anxiety, MCI, dementia Correspondence: Dr Martine Simard, Ecole de psychologie, Universite


INTRODUCTION Dementia and its most common form, Alzheimer’s disease


(AD), is a major public health issue.13 The experts meeting at the fifth annual Mild Cognitive Impairment (MCI) Sympo- sium agreed that AD should be diagnosed before the onset of dementia, particularly as new interventions are available.4 The concept of MCI is the result of the past 20 years of research efforts to diagnose the prodromes of AD and that of other neurodegenerative dementias. MCI is currently diagnosed using Petersen’s criteria: (1) memory complaint, preferably corroborated by an informant; (2) objective memory impair- ment relative to age- and education-matched healthy indivi- duals; (3) intact general cognitive functioning; (4) absence/ few problems with activities of daily living; and no dementia.5 Petersen6 later suggested the existence of four MCI subtypes: (1) single-domain amnestic MCI (A-MCI; ie, isolated memory impairment), (2) multiple-domain A-MCI (ie, memory im- pairment and a deficit in at least one other cognitive domain), (3) single-domain nonamnestic MCI (ie, an isolated non- memory impairment), and (4) multiple-domain nonamnestic MCI (ie, deficits in multiple nonmemory domains). An annual conversion rate to AD or other dementias of up to 20% has been reported,7 as well as a conversion rate of 48% after 30 months of follow-up in individuals with A-MCI.8


The MCI concept is essentially cognitive in nature. However,


the experts of the Second Canadian Conference on the Development of Anti-dementia Drug Guidelines9 and of the Third Canadian Consensus Conference on Diagnosis and Treatment of Dementia10 emphasized that neuropsychiatric


´ Laval, Pavilion F.-A. Savard, Que Tel: 1-(4i8)-656-2131, X12193; Fax: 1-(418}-656-3646; e-mail: martine.simard@psy.ulaval.ca


symptoms (NPS), and especially affective symptoms, should also be considered pertinent indicators of the installation of a neurodegenerative disease in old age.


Therefore the objectives of this article were to critically


review (1) the recent evidence and relevant issues regarding the presence, in older noncognitively impaired (NCI) adults and patients with MCI, of depressive, anxious, and/or apathetic symptoms in relation to progression toward dementia; (2) the literature regarding the differential cogni- tive profile of MCI patients with and without affective symptoms. The third objective was to provide suggestions for future research.


SEARCH METHOD


PubMed and Psychlnfo databases were searched using the keywords (apathy), (anxiety), (late-life anxiety), (mood dis- order), (depression), (depressive symptoms) AND (risk) AND (dementia); AND (MCI). To summarize results published before August 31, 2008, systematic literature reviews were searched (see Section ‘‘Systematic Reviews’’). However, only original prospective longitudinal and naturalistic cohort studies were retained among articles published from 2008 until April 30, 2010, for Section ‘‘Prospective Longitudinal Studies’’ (objective 1 of this review), because these robust research designs make it possible to identify predictors of cognitive decline. In Section ‘‘Affective Symptoms versus MCI and Dementia: Differential Cognitive Profiles?’’ (objective 2) all types of studies (except case reports) were considered for review.


´bec, G1V 0A6, QC, Canada.


M&B 2011; 2:(1). July 2011


22


www.slm-psychiatry.com


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