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Affective disorders, mild cognitive impairment, and risk for dementia Table 1 (Continued)


Follow-up dura-


Authors Wilson et al.21 Study design Prospective longitudinal tion(years) Sample type 13


Community- basedjj


Test; FCSRTFree and Cued Recall Selective Reminding Test; GDS-30GeriatricDepression Scale HDRSHamilton depression rating scale; MADRSMontgomery


Perseveration subscale;MCImild cognitive impairment; NCInoncognitively impaired individuals; NPINeuropsychiatric Inventory; RAVLTRey Auditory Verbal Learning Test; ROCFRey


TMT-A & BTrial Making Test A and B; WAISWechsler Adult Intelligence Scale. 


identifed). jjCatholic nuns, priests, and monks.


Even among studies reporting an association between the presence of affective symptoms and risk for dementia, some contradictory results were reported. For instance, a study associated the risk of developing cognitive disorders with either minor or major depression,17 whereas other studies clearly associated the risk of developing cognitive disorders and/or dementia to the elevated number of NPS present in MCI25 and to depressive symptoms severe enough to require antidepressant drugs in elderly participants NCI.15,26


Boyle and colleagues17 investigated whether depression is independendy associated with increased risk of incident dementia or cognitive disorder not otherwise specified (NOS) in an older NCI primary care population. The results showed that over the course of 3 years, 12 participants met the criteria for dementia, and 24 met the criteria for cognitive disorder NOS representing a cumulative incidence of 13%. One patient with incident cognitive disorder NOS subse- quently converted to dementia. Using Cox proportional hazard survival models to calculate the risk ratio of depres- sion for development of cognitive disorders, major depres- sion disorder (HR3.68; 95% CI, 2.16.42), minor depression (HR1.84; 95% CI, 1.053.21) and the HDRS24 scores (HR1.07; 95% CI, 1.021.12) all predicted new onset dementia or cognitive disorder NOS, when covarying age, gender, and education. Thus even minor depression would predict the development of cognitive decline.


In the study of Edwards and colleagues [25J, the distribu-


tion of NPS across the MCI subtypes6 and whether NPS increase risk of progression to dementia were investigated. The results showed that patients with]4 NPS had more medical comorbidities and greater functional impairment, and were also more likely than patients with 03 NPS to have A-MCI (81% vs 71%, respectively, p0.03). Patients with A- MCI were more likely than those with other MCI subtypes to manifest depressive symptoms. Patients with]4 NPS had nearly 2.5 times the odds of developing dementia at follow-up than patients with 03 NPS. The authors therefore concluded


www.slm-psychiatry.com 25


that MCI patients with an elevated number of NPS may be more likely to have A-MCI, and depression may be more common in A-MCI than in other MCI subtypes. However, this study had a major limitation: there was no validated scale to assess the presence of NPS (see Table 1). This study emphasized another controversial issue regarding the asso- ciation between affective symptoms and the risk for demen- tia: the subtypes of MCI and their association with affective disorders.


On the contrary to the previous results,25 Ravaglia and colleagues26 reported that the association between depressive symptoms and MCI was independent of the MCI subtype, antidepressant use, and sociodemographic and vascular risk factors. They also found that depressive symptoms were more frequent in patients with prevalent MCI (44.4%) than in NCI participants (18.3%) at baseline. In NCI individuals, baseline depressive symptoms were associated with increased risk of MCI at follow-up, but only for participants on antidepressant drugs at baseline, compared with those without depressive symptoms and not on antidepressant therapy. This finding suggests that the presence of depressive symptoms alone in NCI cannot predict the conversion to MCI; depressive symptoms severe enough to require an antidepressant treat- ment may be more indicative of future cognitive decline. This study had nevertheless some important limitations, one of them being the very small number of the A-MCI cases (less than 1%). This could have influenced the conclusions regarding the subtypes of MCI. Another limitation was the use of less restrictive criteria than those of Petersen to include MCI patients. The authors might have therefore focused on patients with a lower global cognitive function.


Another large community-based study15 conducted in NCI


found that current anxiety, medications for anxiety and depression, as well as past harmful alcohol intake, increased systolic blood pressure, and past smoking, were main predictors of conversion to MCI and to other mild cognitive disorders. However, major limitations of this study included


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


 


Osterrieth Complex Figure; SCIDStructured Clinical Interview for DSM-IV; SF-12Short Form health survey


Asberg depression rating scale; Mattis-IPMattis dementia rating scale Initiation/ 12 items;


 


*From Alzheimer’s research centers of California. $Induces the RAVLT, tests of visual memory, language (sentence construction), phonological verbal fluency, Raven’s 47 progressive matrices, and tests of


visuospatial abilities (freehand copy of drawings and copying of drawings with landmarks); %From memory clinic. §Tests for measuring learing and memory, fluency, intelligence, speed of information procesing, and executive functions (these tests were not otherwise


N and Dx at baseline


917 without dementia


Age at baseline (years)


56 102 


Measures of affective symptoms


CES-D-10


Measures of congnition


Battery of 19 cognitive all cognitive domains


A-MCIamnestic mild cognitive impairment; AMNARTAmerican version of the National Reading Test; DxDiagnosis; BDSBlessed Dementia Rating scale; BNTBoston Naming Test; BVRTBenton Visual Test; CDRClinical Dementia Rating scale; CES-DCenter for Epidemiologic Studies-Depression scale; CES-D-10Center for Epidemilogic Studies-Depression scale


10 items (short) version; CFTClock Figure Test; CVLTCalifornia Verbal Learning 30 items; GDS-15Geriatric Depression Scale 15 items;


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