Carla Moleiro

White matter changes and diabetes predict cognitive decline in the elderly The LADIS Study

Objective: We aimed to study if age-related white matter changes (WMC) and vascular risk factors were predictors of cognitive decline in elderly subjects with WMC living independently. Methods: The Leukoaraiosis and Disability prospective multinational European study (LADIS) evaluates the impact of WMC on the transition of independent elderly subjects into disability. Independent elderly were enrolled due to the presence of WMC. Subjects were evaluated yearly during 3 years with a comprehensive clinical protocol and a neuropsychological battery. Additionally, dementia, subtypes of dementia, and cognitive decline without dementia were classified according to usual clinical criteria. MRI was performed at entry and at the end of the study. Results: A total of 639 subjects were included (74.1 ± 5 years, 55% women, 9.6 ± 3.8 years of schooling). At end of follow-up, 90 patients had dementia and 147 had cognitive impairment no dementia. Using Cox regression analysis, WMC severity independently predicted cognitive decline (dementia and not dementia), independently of age, education, and medial temporal atrophy (MTA). Diabetes at baseline was the only vascular risk factor that independently predicted cognitive decline during follow-up, controlling for age, education, WMC severity, and temporal atrophy. Considering subtypes of dementia, Alzheimer disease (AD) was predicted only by MTA, while vascular dementia was predicted by previous stroke, WMC severity, and MTA. Conclusion: WMC severity and diabetes are independent predictors of cognitive decline in an initially nondisabled elderly population. Vascular dementia is predicted by previous stroke and WMC, while AD is predicted only by MTA.

Perceived social support as an offshoot of attachment style

Abstract Questionnaires were completed by college students (N=182), with the purpose of examining the role of adult attachment and social support as predictors of psychological distress. Factor analyses of the attachment and social support measures yielded three factors for attachment (Preoccupation, Avoidance, Dismissiveness), and two for social support (Intimate, Casual). Both types of support were significant zero-order predictors of distress, but intimate support effects were rendered non-significant when attachment style was controlled for. In contrast, attachment style (Preoccupation) exerted a significant additional effect after social support was controlled for. Analyses of interactions suggested that Preoccupation reduces the effect of Intimate Support, while Avoidance enhances the effect of Casual Support. These results support the hypothesis that perceived social support, and particularly Intimate Support is, to a large extent, a by-product of attachment style, but also point towards possible moderator effects of attachment style upon the impact of support.

Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study

Objective Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC). Methods The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3. Results 639 subjects were included (74.1±5 years old, 55% women, 9.6±3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline. Conclusions DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction

Versão Portuguesa do CORE-OM: tradução, adaptação e estudo preliminar das suas propriedades psicométricas

BACKGROUND: The Clinical Outcome Routine Evaluation - Outcome Measure (CORE-OM) is a European self-report measure of psychological well-being in adults, which is already adapted for more than 20 countries. The CORE-OM is applicable in primary care settings, in occupational health and educational contexts, as well as for evaluations of mental health services quality. OBJECTIVES: To translate the CORE-OM into and adapt it to the Portuguese language. METHODS: The translation of CORE-OM to Portuguese was conducted in accordance with the CORE System Trust international guidelines, in collaboration with the authors of the original CORE-OM. This guidelines involved seven independent translations by individuals familiar/non-familiar with the field of mental health and by licensed translators. After the discussion of these translations in a focus group, a final version of the Portuguese CORE-OM was established. Individuals from different age groups, socio-cultural backgrounds and educational levels participated in this translation process. RESULTS: Preliminary results in a sample of 111 individuals (general population) show that the translated measure is confidential and has a good internal reliability. DISCUSSION: The Portuguese version of the CORE-OM is a valid and adequate instrument to evaluate psychological changes, both in research and clinical practice contexts.

Self-perceived memory complaints predict progression to Alzheimer disease: The LADIS study.

Memory complaints are frequent in the elderly but its implications in cognition over time remain a controversial issue. Our objective was to evaluate the risk of self perceived memory complaints in the evolution for future dementia. The LADIS (Leukoaraiosis and Disability) prospective multinational European study evaluates the impact of white matter changes (WMC) on the transition of independent elderly subjects into disability. Independent elderly were enrolled due to the presence of WMC. Subjects were evaluated yearly during 3 years with a comprehensive clinical protocol and a neuropsychological battery. Dementia and subtypes of dementia were classified. Self perceived memory complaints in independent elderly were collected during the interview. MRI was performed at entry and at the end of the study. 639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). At end of follow-up, 90 patients were demented (vascular dementia, 54; Alzheimers disease (AD) and AD with vascular component, 34; frontotemporal dementia, 2). Using Cox regression analysis, we found that self perceived memory complaints were a strong predictor of AD and AD with vascular component during the follow-up (β = 2.7, p = 0.008; HR = 15.5, CI 95% [2.04, 117.6]), independently of other confounders, namely depressive symptoms, WMC severity, medial temporal lobe atrophy, and global cognition status at baseline. Self perceived memory complaints did not predict vascular dementia. In the LADIS study, self perceived memory complaints predicted AD but not vascular dementia in elderly subjects with WMC living independently.

Clinically significant change in psychotherapy for depressive disorders

BACKGROUND The assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices. METHODS In the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336-352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285-299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. RESULTS Findings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance. LIMITATIONS Small sample sizes and representativeness of each treatment warrant further replication of these results. CONCLUSIONS Implications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.

Health and Mental Health Needs and Experiences of Minority Clients in Portugal

The paper addresses diversity, multi‐culturalism and mental health. It reports qualitative data from a larger project on multi‐cultural counselling competencies in Portugal which sought to meet the needs identified by specific minority groups by developing integrative, responsive and culturally sensitive treatments. A qualitative study is presented, with the aim of exploring the representations of mental health and illness held by ethnic minority groups in Portugal, as well as their specific needs and obstacles encountered in their interactions with health professionals. Semi‐structured interviews were conducted, and the results indicate that the meanings of health and mental health varied. Meanings of psychological health were related to general well‐being. Help‐seeking behaviours were associated with providing and receiving family and social support, mainly among participants of African descent. Although the great majority of participants had had no experience of counselling or psychotherapy, they expec...

Social competence, personality and adult attachment style in a Portuguese sample

Abstract The aim of the present study was to examine the correlates of adult attachment style, measured using a Portuguese translation of the paragraphs proposed by Hazan and Shaver (1987). University students ( N = 138) responded to this measure, to the Social Competence Questionnaire (ComQ) and to the Eysenck Personality Inventory (EPI). Percentages found for each attachment style were similar to those found by other authors. Secure participants scored higher in social competence. In the EPI, the anxious/ambivalent group was higher in neuroticism, whereas the avoidants leaned toward introversion. Differences in correlations among social competence and personality scales were also found in different attachment styles.

Effects of Age on Spiritual Well-being and Homonegativity: Religious Identity and Practices Among LGB Persons in Portugal

The present study explored the effects of age on spiritual well-being and internalized homonegativity among Portuguese lesbian, gay, and bisexual (LGB) persons. A set of questionnaires were filled out by 471 LGB participants using the Lesbian, Gay, and Bisexual Identity Scale; the Spiritual Well-being Scale; and the Multidimensional Measurement of Religiousness and Spirituality. While most participants had been raised Catholic, only 17% currently belonged to a religious denomination. Participants higher in religious well-being were more likely to have concerns in concealing their sexual identity. Existential well-being was related to higher identity affirmation. Older participants reported better spiritual well-being and lower homonegativity.

Sexual orientation and gender identity: review of concepts, controversies and their relation to psychopathology classification systems

Numerous controversies and debates have taken place throughout the history of psychopathology (and its main classification systems) with regards to sexual orientation and gender identity. These are still reflected on present reformulations of gender dysphoria in both the Diagnostic and Statistical Manual and the International Classification of Diseases, and in more or less subtle micro-aggressions experienced by lesbian, gay, bisexual and trans patients in mental health care. The present paper critically reviews this history and current controversies. It reveals that this deeply complex field contributes (i) to the reflection on the very concept of mental illness; (ii) to the focus on subjective distress and person-centered experience of psychopathology; and (iii) to the recognition of stigma and discrimination as significant intervening variables. Finally, it argues that sexual orientation and gender identity have been viewed, in the history of the field of psychopathology, between two poles: gender transgression and gender variance/fluidity.