Concepción De-la-Cámara

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

Objective:  To compare the prevalence of dementia in two different time periods and two different studies.

Mild cognitive impairment diagnosed with the new DSM-5 criteria: prevalence and associations with non-cognitive psychopathology.

To contrast the prevalence of mild cognitive impairment (MCI) as diagnosed using DSM‐5 criteria (DSM5‐MCI) with MCI as diagnosed using Petersens criteria (P‐MCI) and to explore the association of both with non‐cognitive psychopathological symptoms (NCPS).

Non-cognitive psychopathological symptoms associated with incident mild cognitive impairment and dementia, alzheimer’s type

Objective: To test the hypothesis that specific psychopathological non-cognitive symptoms are associated with incident mild cognitive impairment (MCI), while different symptoms are associated with incident dementia of Alzheimer’s type (DAT).Methods: A representative community sample of 4,803 individuals aged 55+ years was interviewed in a two-phase screening, in Wave I or ZARADEMP I. This is the baseline, cross-sectional study of the ZARADEMP Project, a longitudinal study to document incidence and risk factors of dementia. The main instrument for assessment of participants was the ZARADEMP Interview, which includes standardized Spanish versions of instruments such as the Mini-Mental Status Examination and the Geriatric Mental State GMS-AGECAT. Two years later, in Wave II or ZARADEMP II, the cognitively non-deteriorated elderly were reassessed in a similar, two-phase procedure. “Incident cases” of both dementia and DAT (DSM-IV-TR criteria), as well as MCI (operationally defined Petersen’s criteria) were diagnosed by a panel of psychiatrists. Statistical, logistic regression models, adjusted by age, sex and education were used to test the hypothesized association.Results: “Irritability”, “neurovegetative symptoms”, “sleep problems”, “concentration ifficulties”, “loneliness” and “subjective slowing” documented at baseline were associated with incident MCI (odds ratio, OR range 1.71-2.67). A different profile of non-cognitive symptoms was associated with incident DAT, specifically “tension” (OR= 2.45), “sleep problems” (OR= 2.81), and “observed slowing” (OR= 4.35). On the contrary, “subjective restriction of activities” seemed to be negatively associated with DAT (OR= 0.12).Conclusions: To our knowledge, this is the first report about some specific psychopathological, non-cognitive symptoms associated with incident MCI and/ or incident DAT, when controlling by each other. The psychopathological profile associated with MCI is different from the profile preceding DAT.

Mortality and mental disorders in a Spanish elderly population

To analyse the relationship between mental disorders and mortality rates in the elderly community of Zaragoza, Spain.

Depression and Incident Alzheimer Disease: The Impact of Disease Severity

OBJECTIVES To test the hypothesis that clinically significant depression (particularly severe depression) increases the risk of Alzheimers disease (AD). METHODS A longitudinal, three-wave epidemiologic study was implemented in a sample of individuals aged 55 years and older (n = 4,803) followed up at 2.5 years and 4.5 years. This was a population-based cohort drawn from the Zaragoza Dementia and Depression (ZARADEMP) Project, in Zaragoza, Spain. Participants included individuals cognitively intact at baseline (n = 3,864). The main outcome measures were depression as assessed by using the diagnostic interview Geriatric Mental State- Automated Geriatric Examination for Computer Assisted Taxonomy package; and AD diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Fine and Gray multivariate regression model was used in the analysis, accounting for mortality. RESULTS At baseline, clinically significant depression was diagnosed in 452 participants (11.7%); of these, 16.4% had severe depression. Seventy incident cases of AD were found at follow-up. Compared with nondepressed individuals, the incidence rate of AD was significantly higher in the severely depressed subjects (incidence rate ratio: 3.59 [95% confidence interval: 1.30-9.94]). A consistent, significant association was observed between severe depression at baseline and incident AD in the multivariate model (hazard ratio: 4.30 [95% CI: 1.39-13.33]). Untreated depression was associated with incident AD in the unadjusted model; however, in the final model, this association was attenuated and nonsignificant. CONCLUSIONS Severe depression increases the risk of AD, even after controlling for the competing risk of death.

Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population

Lobo A, Lopez‐Anton R, Santabárbara J, de‐la‐Cámara C, Ventura T, Quintanilla MA, Roy JF, Campayo AJ, Lobo E, Palomo T, Rodriguez‐Jimenez R, Saz P, Marcos G. Incidence and lifetime risk of dementia and Alzheimer’s disease in a Southern European population.

Association of Hypertension with Depression in Community-Dwelling Elderly Persons: Results from the ZARADEMP Project

National Committee Seventh Report criteria [11] were used for the diagnosis of hypertension. Research psychiatrists individually supervised the standardized interviews of lay interviewers doing the field study, and reassessed the cases considered to be ‘doubtful’ in the elderly homes (n = 159) [12] . A systematic control of the reliability of lay interviewers and psychiatrists was implemented to prevent reliability decay. Psychiatric cases were diagnosed according to GMS-AGECAT criteria. The specific hypothesis of the association of hypertension with depression was tested by means of logistic regression (LR) analysis. Potentially confounding factors ( table 1 ) were selected for the analysis because of their association with depression in previous research and in preliminary, bivariate models calculated here. Standard ethical principles have been maintained, according to Spanish law (article 5, 1992). The analysis of data has been completed in the subjects with full information (n = 4,136), the 667 losses being due to missing data in blood pressure measurements or other variables. Hypertension was documented in 2,523 individuals (61.0%; 41.7% were stage 1 and 19.3% were stage 2 hypertensives), and 314 of them (12.4%) were depressed. Results of LR analysis show, in the unadjusted model, that OR for depression was significantly higher in stage 2 hypertension (OR = 1.46, 95% CI = 1.12–1.90). Potential modifiers/confounders were then included in the model ( table 1 ; models 1–5), the results being similar. Finally, table 1 also shows the results of LR analysis when controlling for all variables (model 5), showing that the estimated risk for depression remains statistically significant for grade 2 hypertension (OR = 1.37, 95% CI = 1.03–1.81). The results support the hypothesized association of hypertension with depression. It might be argued that not all GMS-AGECAT cases of depression fulfill DSM-IV-TR or ICD-10 psychiatric criteria. However, this computerized diagnostic system has been shown to correspond with what psychiatrists recognize as a case for intervention [7] . Subsyndromal depression, which has also been suggested in some reports to be associated with hypertension [1] , was not approached in this study because we were more interested in potential clinical implications. Our findings are rather consistent with the report by Copeland et al. [1] . The British authors used the same GMS-AGECAT standardized diagnostic method and controlled for a number of potential risk factors. However, hypertension was self-reported and cognitive performance was not controlled. Barrett-Connor and Palinkas [4] also found an association with depression scores, but it was limited to DBP, both high and low DBP. However, their paper is not totally comparable to ours, since their sample was limited to men, depression was only assessed by a questionnaire and they only controlled for age and weight loss. The studies by Friedman et al. [2] The empirical literature in population studies does not unequivocally support clinical observations suggesting the association of hypertension with depression. A positive association has been reported in some inquiries [1] but not in others [2, 3] , and the relationship was limited to individuals with diastolic blood pressure (DBP) in some studies [4] . Differences in design make between-study comparisons difficult. Methodological difficulties are observed in previous research: some studies are based on self-reported hypertension, adjustment for potential confounders is not systematic and no studies with the exception of the investigation by Copeland et al. [1] have used a standardized psychiatric diagnosis. This study tests the hypothesis of a positive association between hypertension and depression, and tries to circumvent the described methodological difficulties. It is the baseline, crosssectional study of the ZARADEMP Project, a longitudinal, threewave epidemiological inquiry, the methodology of which has been previously described [5] . A large, stratified random sample of individuals from the census list aged 55 and over was selected. Refusal rate was 20.5%, and 4,803 people were interviewed. Residents of old age homes and other institutions were included in the community sample. An epidemiological screening design was implemented, and standardized Spanish versions of assessment instruments were used, including the Geriatric Mental State (GMS) [6] , its computerized diagnostic program, AGECAT, and the History and Aetiology Schedule [7, 8] . The history of medical diseases was documented by means of the Risk Factor Questionnaire designed by the EURODEM Workgroup [9] . The assessment of blood pressure followed World Health Organization standards, modified by the European Society of Hypertension [10], and Joint Published online: July 25, 2008

Conversion to dementia in mild cognitive impairment diagnosed with DSM‐5 criteria and with Petersen's criteria

In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimers disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM‐5 (DSM‐5‐MCI) and Petersens (P‐MCI) criteria.

The ZARADEMP Project on the incidence, prevalence and risk factors of dementia (and depression) in the elderly community: I. The context and the objectives

Background and Objectives: The public health dimension of the problem of dementia and depression in the elderly population is well documented, but epidemiological data are generally considered to be insufficient and, at times, contradictory. This paper identifies relevant research areas for the 7ARADEMP Project, which follows the Zaragoza Study (or ZARADEMP 0) and is part of both EURODEM and EURODEP Studies. Methods: Review of the literature. Hypotheses emerging in previous studies of this research group. Results: The following relevant objectives to study in relation to dementia (and depression) have been identified: a) potential variations over time in the prevalence rate; b) provision of reliable estimations of incidence rates, specific for age and gender; c) data about the course and natural history of so called mild cognitive deficit; d) association between hypothesized risk factors and cases of dementia (and depression) and its most frequent subtypes; and e) testing of hypotheses related to the overlap between dementia and depression and, specifically, to what extent depression has an increased risk for DAT. Other objectives of the study are also reviewed, in particular the cross-cultural comparison of findings in Zaragoza and in other European cities incorporated in both EURODEM and EURODEP Studies. The importance of maintaining good, contemporary methodological standards is emphasized. Conclusions: A number of relevant research areas in the epidemiology of both dementia and depression in the elderly have been identified. Case-control studies based on incident cases of dementia of the Alzheimers type (DAT) to adequately assess risk factors seem particularly timely.

Prevalence of "organic brain syndrome" in a Southern European population in two different time periods: The ZARADEMP Project

Background: Comparative studies of dementia in different time periods are quite limited in the international literature, but might be useful to test environmental hypotheses. The aim of this study is to compare the prevalence of organic brain syndrome, as a measure of dementia, in the elderly living in the same community in two different time periods and using the same methods. Methods: Representative samples of the elderly in the Zaragoza Study or ZARADEMP 0 (n= 1,080), completed the past decade, and now in Wave I of the ZARADEMP Project or ZARADEMP I (n= 4,803) were interviewed. The Geriatric Mental State (GMS) was the main case-finding instrument and the results were analysed using the AGECAT diagnostic package to generate diagnoses. Results: Adjusted, total prevalence of organic brain syndrome in individuals aged 65 years and older has not varied from the previous decade. It was 8.4% in ZARADEMP I, and 7.4% in ZARADEMP 0 (prevalence ratio, PR = 0.83; CI 0.65-1.07). Adjusted prevalence among men was lower in ZARADEMP 1(3.6%) when compared to ZARADEMP 0 (5.5%), although the differences do not reach statistically significance (PR= 0.65; CI 0.41-1.05). However, in support of the working hypothesis, the differences were more marked, and we consider they reach statistically significant proportions in the age group 80-84 years. Conclusions: The prevalence of organic brain syndrome has not increased from the previous decade. On the contrary, the prevalence tends to be lower in men, and the differences reach stastistical significance in the age group 80-84 years. New analysis using diagnostic criteria of dementia in the same sample are required to confirm these findings.