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Affective disorders, mild cognitive impairment, and risk for dementia


Table 3. Studies on the Cognitive Profile of MCI with and without Affective Symptoms and Dementia Authors


Study design


Depressive symptoms and cognition Federico et al.48


CS-between group


comparisions Hudon et al.49


CS-between group


comparisions


Clinical (MCI) and community (NCI)


Sample type Clinical N and Dx


76 AD 46 A-MCI 36


anxious/depressed


18 A-MCI/D 46 A-MCI 33 NCI


65.1911.1 65.298.0 66.299.9


Age (years)


73.496 73.194.5 66.494.7


Measures of af- fective symptoms


Measures of cognition


Clinical Interview MMSE3 words (recall) FCSRT16 items 10-Picture Reminding test BNT-10 items


GDS-5 items


Mattis DRS FCRST-16 items Strrop ROCF BNT BJLO


WAIS-Digit Symbol


Anxiety symptoms and cognition Rozzini et al.50


CS-Between group


comparisions Clinical


44 MCIanxiety 13 MCI


69.096.4 71.897.4


GDS-15 items GAI


MMSE


ADAS-Cog CDR


Novelli’s short story Raven’s Colored Matrices TMT- A & B Verbal fluency tasks (letter & category)


ROCF


ADAS-CogAlzheimer’s Disease Assessment Scale Cognition; A-MCIamnestic mild cognitive impairment; BNTBoston Naming Test; BJLOBenton Judgement Line Orientation test; CDRClinical Dimentia Rating Scale; CScross-sectional; FCSRTFree and Cued Recall Selective Reminding Test; GAI Geriatric Anxiety Inventory; GDS-15Geriatric Depression Scale15 items; GDS-5Geriatric Depression Scale5 items; Mattis-DRSMattis Dementia Rating Scale; MCImild cognitive impairment; NCInoncognitively impaired individuals; ROCFReyOsterrieth Complex Figure; TMT-A & BTrail Making Test A and B; WAISWechsler Adult Intelligence Scale.


tions of this study were (1) the fact that the anxious/ depressive group was significantly younger than the AD and A-MCI groups and no statistical correction was applied in the analyses; (2) the fact that anxiety and depressive symptoms were not quantified using a validated and standardized instrument that make them difficult to compare with other data.


The second study49 examined executive functions and memory in NCI older adults, A-MCI with subclinical depres- sive symptoms (A-MCI/Dgroup), and A-MCI with no depressive symptoms (A-MCI group). Patients with A-MCI/ Dshowed a poorer controlled inhibition capacity than A- MCI and controls on the Stroop task,51 whereas the A-MCI exhibited a normal performance on the executive task. The A-MCI/Dand A-MCI recalled fewer words than NCI on immediate and delayed free recall, and total recall paradigms of episodic memory, suggesting the existence of encoding and self-retrieval disturbances in memory. Therefore, A-MCI/ Dhad poorer executive functioning than A-MCI patients, but the two groups demonstrated memory impairments. A major problem with this study was the utilization of the GDS-5 items, which hardly covers all possible depressive symptoms and thus cannot differentiate very well the two clinical groups.


The third study50 assessed whether MCI patients with anxiety symptoms showed different neuropsychological pro- files compared with MCI patients without anxiety symptoms. Patients with GAI52]10 showed more agitation, anxiety, depression, and sleep disorders than patients with GAIB1o.


www.slm-psychiatry.com 29


Moreover, patients with GAI]10 were more impaired on instrumental activities of daily living and the TMT-B measur- ing executive functions. The authors50 hypothesized that the interaction between anxiety symptoms and executive functions could depend on specific pathologic features at the level of caudate nucleus characterizing early phases of dementia.


DISCUSSION MCI, dementia, and affective disorders/symptoms are


currently viewed as distinct syndromes that are diagnosed using different sets of clinical criteria.5,6,53,54 However, the present literature review has shown that depressive, apathetic, and anxious symptoms can all be present in healthy elderly and MCI, and may predict progression to dementia. The results showed that depressive symptoms requiring antide- pressants (and thus potentially more severe depressive symptoms) may be more indicative of future dementia than mild depressive symptoms in A-MCI. The relationship between depression, apathy, different subtypes of MCI, and dementia especially needs to be further investigated. In addition, prospective longitudinal studies assessing chronic psychological distress and late-onset anxiety symptoms as potential risk factors for dementia are clearly lacking.


The results of the cognitive studies demonstrated that in A-MCI patients with mood symptoms, executive functions seem especially vulnerable. Future research should address the issue of the differential cognitive profiles between MCI with and without NPS and between MCI with NPS and late-


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


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