Diana M. Bezerra

Effect of temporal lobe structure volume on memory in elderly depressed patients.

OBJECTIVE To compare the volume of the hippocampus and parahippocampal gyrus in elderly individuals with and without depressive disorders, and to determine whether the volumes of these regions correlate with scores on memory tests. METHOD Clinical and demographic differences, as well as differences in regional gray matter volumes, were assessed in 48 elderly patients with depressive disorders and 31 control subjects. Brain (structural MRI) scans were processed using statistical parametric mapping and voxel-based morphometry. Cognitive tests were administered to subjects in both groups. RESULTS There were no between-group gray matter volume differences in the hippocampus or parahippocampal gyrus. In the elderly depressed group only, the volume of the left parahippocampal gyrus correlated with scores on the delayed naming portion of the visual-verbal learning test. There were also significant direct correlations in depressed subjects between the volumes of the left hippocampus, right and left parahippocampal gyrus and immediate recall scores on verbal episodic memory tests and visual learning tests. In the control group, there were direct correlations only between overall cognitive performance (as assessed with the MMSE) and the volume of right hippocampus, and between the total score on the visual-verbal learning test and the volume of the right and left parahippocampal gyrus. CONCLUSIONS These findings highlight different patterns of relationship between cognitive performance and volumes of medial temporal structures in depressed individuals and healthy elderly subjects. The direct correlation between delayed visual-verbal memory recall scores with left parahippocampal volumes specifically in elderly depressed individuals provides support to the view that depression in elderly populations may be a risk factor for dementia.

Structural brain changes as biomarkers and outcome predictors in patients with late-life depression: a cross-sectional and prospective study.

The relationship between structural changes in grey matter and treatment response in patients with late-life depression remains an intriguing area of research. This magnetic resonance imaging (MRI) study compares the baseline grey matter volume of elderly people with and without major depression (according to the DSM-IV-TR criteria) and assesses its association with antidepressant treatment response. Brain MRI scans were processed using statistical parametric mapping and voxel-based morphometry. The sample consisted of 30 patients with depression and 22 healthy controls. We found a significant volumetric reduction in the orbitofrontal cortex bilaterally in patients in comparison with controls. According to their remission status after antidepressant treatment, patients were classified as remitted or not remitted. Compared with controls, remitted patients showed a volumetric reduction in the orbitofrontal cortex bilaterally and in another cluster in the right middle temporal pole. Non-remitted patients showed an even greater volumetric reduction in the orbitofrontal cortex bilaterally compared with controls. To investigate predictive factors of remission after antidepressant treatment, we used a logistic regression. Both baseline Mini Mental State Examination score and baseline left superior lateral orbitofrontal cortex volume (standardized to the total grey matter volume) were associated with remission status. Our findings support the use of regional brain atrophy as a potential biomarker for depression. In addition, baseline cognitive impairment and regional grey matter abnormalities predict antidepressant response in patients with late-life depression.

DTI voxelwise analysis did not differentiate older depressed patients from older subjects without depression.

INTRODUCTION Neuroimaging has been widely used in studies to investigate depression in the elderly because it is a noninvasive technique, and it allows the detection of structural and functional brain alterations. Fractional anisotropy (FA) and mean diffusivity (MD) are neuroimaging indexes of the microstructural integrity of white matter, which are measured using diffusion tensor imaging (DTI). The aim of this study was to investigate differences in FA or MD in the entire brain without a previously determined region of interest (ROI) between depressed and non-depressed elderly patients. METHOD Brain magnetic resonance imaging scans were obtained from 47 depressed elderly patients, diagnosed according to DSM-IV criteria, and 36 healthy elderly patients as controls. Voxelwise statistical analysis of FA data was performed using tract-based spatial statistics (TBSS). RESULTS After controlling for age, no significant differences among FA and MD parameters were observed in the depressed elderly patients. No significant correlations were found between cognitive performance and FA or MD parameters. CONCLUSION There were no significant differences among FA or MD values between mildly or moderately depressed and non-depressed elderly patients when the brain was analyzed without a previously determined ROI.

Profile of caregivers of Alzheimer’s disease patients attended at a reference center for cognitive disorders

This is a study on burden of caregivers of patients with Alzheimer’s disease attended at a Reference Center for Cognitive Disorders. Objective To evaluate the profile and burden on caregivers of patients with Alzheimer’s disease attended at a Reference Center for Cognitive Disorders. Methods We collected demographic information and data on the relationship with the patient from caregivers, and measured burden with the Zarit scale. The patients were evaluated with the following scales: the Cambridge Cognitive Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ for functional impairment. Results Of the 31 caregivers, 77.4% were female, predominantly, and daughters, having a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers co-resided with the patient and 71% did not work. The mean time as a caregiver was 3 years. Twenty-seven percent of the caregivers presented mild to severe burden. The variables presenting significant association with caregiver burden were scores on the NPI and CAMCOG. Conclusion The social demographic characteristics of the sample were similar to those of studies performed in other countries. The average time as a caregiver and the frequency of caregivers with mild to intense burden were lower than those reported in international studies. Neuropsychiatric symptoms and severity of cognitive decline were the main factors associated to burden in this sample of mostly mild to moderate demented AD patients. Further studies are necessary to verify whether the burden is indeed less intense in our milieu.

Association between cognitive impairment and presence of the apolipoprotein E epsilon4 allele in elderly patients with major depressive disorder

This knowledge has generated interest in the in fl uence of ApoE variants on cognition in different psychiatric conditions. Thus, we have performed a study in order to investigate the role of the ApoE4 allele in the cognition of patients with major depressive disorder according to the criteria established by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).Thirteen elderly patients older than 60 years [nine women (69.2%) and four men (30.8%)], all of them with a diagnosis of major depressive disorder according to DSM-IV criteria, were included in the study. Blood samples of all subjects were collected for genetic investigation. Patients were divided into two groups, according to the presence or absence of the ApoE4 allele (ApoE4 and non-ApoE4 groups). Genotyping was performed by two investigators according to Hixson & Vernier,

Impact of ApoE4 on cognition and functional performance of community-based older adults

Study for whom archived autobiographies written at an average age of 22 were available. Sisters were assessed for dementia at baseline and annually (mean follow-up 1⁄4 8.3 years), and for neuropathological outcomes at autopsy for those who died. Autobiographies were evaluated for ID; ROC analysis was conducted with ID scores for four outcomes: [1] prevalent dementia at baseline, [2] cumulative dementia prevalence during follow-up, [3] met neuropathologic criteria for Alzheimer’s disease (NPAD) at autopsy, and [4] neurofibrillary pathology in Braak Stage III or higher at autopsy. Area under the curve (AUC) was calculated for each outcome and compared; a jackknife procedure was used to generate mean AUC difference scores and variance. Results: The AUC (95%CI) for prevalent dementia at first examination was [0.887 (0.827-0.948); mean age 1⁄4 81yrs] and cumulative prevalence after follow-up was [0.753 (0.687-0.820); mean age at final assessment 1⁄4 88yrs]; AUC for NPAD was [0.688 (0.6060.769)] and for ‘‘Braak Stage III+’’ was [0.690 (0.607-0.773)]. Comparisons showed that ID predicted prevalent dementia significantly better than either neuropathological outcome (p < 0.0001), and predicted meeting or exceeding Braak Stage III slightly but significantly better than meeting NPAD upon autopsy (p < 0.0001). Predicting prevalent dementia at first exam, a threshold defined at 85% accuracy (25th percentile of ID score) corresponded with Sensitivity (95%CI) 1⁄4 0.87(0.70-0.96), Specificity 1⁄4 0.85(0.79-0.89), PPV 1⁄4 0.47(0.34-0.61), and NPV 1⁄4 0.98(0.94-0.99). Conclusions: Early life ID predicts expression of dementia by an average age of 81 years remarkably well and less well for dementia expressed at more advanced ages. Results suggest that ID represents expression of both incipient neurofibrillary changes and reserve factors, predicting probability of late life dementia expression better than neurofibrillary pathology alone.

Alzheimer's disease is inversely correlated with Cancer? Findings from a community-based sample from São Paulo, Brazil

P2-101 ALZHEIMER’S DISEASE IS INVERSELY CORRELATED WITH CANCER? FINDINGS FROM A COMMUNITY-BASED SAMPLE FROM SÃO PAULO, BRAZIL Sara M. B. Bottino, Diana M. Bezerra, Quirino Cordeiro, Júlio Litvoc, Cássio M. C. Bottino, Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, SÃO Paulo, Brazil; Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, SÃO Paulo, Brazil. Contact e-mail: sarabottino@uol.com.br

IC-P1-004: A voxel-based morphometry study of correlations between regional cerebral blood flow and cognitive alterations in patients with Alzheimer's disease after 4, 5 years of follow up

Diana M. Bezerra, Fabio L. S. Duran, Carlos A. Buchpiguel, Geraldo F. Busatto, Cassio M. C. Bottino, Old Age Research Group (PROTER), Department and Institute of Psychiatry Faculty of Medicine, University of Sa o Paulo, Sa o Paulo, Brazil; Neuroimaging Laboratory, Department and Institute of Psychiatry Faculty of Medicine, University of Sa o Paulo, Sa o Paulo, Brazil; Department of Radiology, Faculty of Medicine, University of Sa o Paulo, Sa o Paulo, Brazil. Contact e-mail: di_piparoti@yahoo.com.br

P1-385: Correlation between memory and volume of brain structures in depressed elderly: A study using voxel-based morphometry

Background: Cognitive deficits and structural brain alterations are usually found in depressed elderly. The objective of this study was to compare the volume of the hippocampus and parahippocampal gyrus of elderly with and without depressive disorders, investigating whether there is a correlation between the volume of these regions and the scores on these cognitive tests. Methods: In this study, the clinical and demographic differences, as well as the difference in the volume of the total brain matter were assessed using structural magnetic resonance imaging in 48 elderly people with depressive disorders and 31 controls. The comparison of the scores on the cognitive tests of both groups was carried out using the Analysis of Covariance, since the groups were different in terms of level of education. The correlation between the volume of each structure and the scores on the cognitive tests for each group studied was made using the Statistical Parametric Mapping program and Pearson’s Correlation Coefficient. Results: Patients and controls were similar regarding the total brain volume and also with respect to the regions of interest; however, the patients presented lower performance on the tests that assessed memory, executive functions and processing speed. In the group of elderly subjects with depressive disorder, there was a correlation between the verbal episodic memory test and the volume of the left hippocampus (p 0.023); right (p 0.044) and left (p 0.007) parahippocampal gyrus. In this group, there was also a correlation between the left parahippocampal gyrus, the visual episodic memory (p 0.039) and the delayed naming in the visual-verbal learning test (p 0.040). In the control group, there was a correlation between the performance on the Mini Mental State Examination and the right hippocampus (p 0.010), and the total naming on the visual-verbal learning test and the right (p 0.10) and left (p 0.015) parahippocampal gyrus. Conclusions: The results demonstrate that the elderly with depressive disorders have memory deficits and that these deficits are correlated to structural brain alterations. Such finding might help to understand the pathophysiology of depression in the elderly.