Flávio Xavier

Bereavement-related cognitive impairment in an oldest-old community-dwelling Brazilian sample.

As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke–Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of ‘aging-associated cognitive decline’ when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause–effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.

The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI)

BACKGROUND The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> or = 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.

A relação entre variáveis de saúde mental e cognição em idosos viúvos

To assess the cognitive abilities of widowed elders, a total sample of 34 elders (who have lost their spouses in the last 12 months) was identified among elders in Veranopolis-RS and 30 of them accepted to participate in the study. The control group was composed by 30 married subjects paired according to gender, age and level of education. The instruments used were: Measure Questionnaire of Memory Loss Complaints; Verbal Fluency - animal category; Mini-Mental State Examination (MMSE); Free and Cued Selective Reminding Test; Digit subtest; Geriatric Depression Scales and Bereavement Phenomenology Questionnaire. Widowed elders had significantly more depressive symptoms and more points on the bereavement scale. However, there was no significant difference between the means of cognitive performance of widowed or married elders. In the census, the choice of widowhood as a selection criterion instead of bereavement (self reported) might have influenced the lack of association between widowhood and cognitive dysfunction, among other aspects.

Bereavement and cognition in older adults.

those who had been widowed in recent months. In our study, the criterion for grieving was emotional: the subject must, in their own and their carer’s opinion, feel the emotional impact of the loss. As is the case in the recently defined criteria for prolonged grief disorder [3] , the inclusion criteria for our study also take into account the impact of this condition on functionality, which is not the case in the study of Ward et al. (b) On this basis, and because we did not limit the period of grief to 12 months, there is a far greater probability of our having included subjects suffering from prolonged grief disorder and/or complicated grief than in the Australian study. There is a theoretical possibility (supported by the data of Ward et al.) that only complicated grief is associated with cognitive dysfunction. (c) Our definition of major and minor depressive disorders is that of the DSM-IV. (d) Our sample is community-based, while that of Ward et al. is derived from a healthcare service. Our sample of grieving and non-grieving subjects included the entire population of a municipality, and was thus epidemiologically more representative. In Gerontology , Vol. 53, No. 6, 2007, Dr. Lynn Ward et al. from the University of Adelaide published the paper ‘Relationships between bereavement and cognitive functioning in older adults’ [1] . The study aimed to ‘replicate and expand’ a previous study carried out by our group in Brazil [2] . Both studies sought to investigate a possible presence of cognitive decline among bereaved older adults, as with the pseudodementia observed in depressed older adults. In contrast to our results, Ward et al. found no association between loss of cognitive function and the grieving process. It is our opinion that Dr. Ward has produced a methodologically sophisticated study with more elaborate controls than our own, such as the evaluation of premorbid IQ. They were also careful to control for variables such as stress and anxiety. In our reading, however, there are important methodological differences between the two studies, which we believe explain the divergent results. We are therefore not in agreement with the affirmation that the work of Ward et al. is a ‘replication’ or an expansion of our own, but rather a different study. (a) Ward’s only criterion for ‘grieving’ is marital status information, including Received: December 12, 2007 Accepted: February 4, 2008 Published online: March 27, 2008