Guillermo Marcos

Depressive disorder and incident diabetes mellitus: the effect of characteristics of depression.

OBJECTIVE The purpose of this study was to test the hypothesis that clinically significant depression detected in a population sample increases the risk of diabetes mellitus. The authors examined the effect of characteristics of depression frequently found in the community on the risk of incident diabetes mellitus. METHOD A large community sample of adults aged > or = 55 years (N=4,803) was assessed at baseline in a longitudinal three-wave epidemiological enquiry using a psychiatric interview and the Geriatric Mental State Schedule. Cases of depression were diagnosed according to standardized criteria, and diabetes was assessed using a risk factors questionnaire. Follow-up evaluations, conducted 2.5 and 5 years later, were completed to determine the incidence of diabetes. RESULTS At baseline, 379 case subjects with depression were identified. The risk of incident diabetes mellitus was higher among subjects with depression when compared with nondepressed subjects, and the association remained significant after controlling for potential confounders, including diabetes risk factors. The estimated rate of diabetes mellitus attributable to depression was 6.87%. An increased risk of diabetes mellitus was also associated with the following characteristics of depression: nonsevere depression, persistent depression, and untreated depression. Treatment with antidepressants was not associated with an increased risk of diabetes mellitus. CONCLUSIONS Clinically significant depression is associated with a 65% increased risk of diabetes mellitus. Characteristics of depression frequently found in the community, namely nonsevere depression, persistent depression, and untreated depression, may play a role in the development of diabetes in a predominantly elderly adult population.

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.

Consumption of alcohol, coffee, and tobacco, and gastric cancer in Spain

A case-control study on gastric cancer was carried out between 1987 and 1989 in four regions of Spain. Three hundred and fifty-four cases of histologically confirmed adenocarcinoma were included (235 men and 119 women). For each case, a control was selected, matched by sex, age, and area of residence, from the same hospital as the case. No association was observed with smoking, nor with the consumption of coffee or tea. The usual consumption of alcohol was associated with gastric cancer in men (odds ratio = 1.54, 95 percent confidence interval = 1.03–2.31), but there was no dose-response relationship. No association was observed in women. All estimations were carried out taking into account the effect of the dietary factors associated with gastric cancer. In accordance with previous evidence, the association observed between gastric cancer and alcohol appears not to be causal.

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).

Is There an Association Between Low-to-Moderate Alcohol Consumption and Risk of Cognitive Decline?

The authors evaluated the association of low-to-moderate alcohol consumption with risk of cognitive decline in a census-based cohort study of men and women aged ≥55 years conducted in Zaragoza, Spain (1994-1999). Participants free of dementia at baseline (N = 3,888) were examined after 2.5 and 4.5 years of follow-up. Information on alcohol intake was collected with the EURODEM Risk Factors Questionnaire and the History and Aetiology Schedule. The study endpoint was severe cognitive decline, defined as loss of ≥1 point/year on the Mini-Mental State Examination or a diagnosis of incident dementia (Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, Text Revision criteria). Compared with those for abstainers, the multivariate-adjusted odds ratios for severe cognitive decline for male drinkers of <12 g alcohol/day, drinkers of 12-24 g alcohol/day, and former drinkers were 0.61 (95% confidence interval (CI): 0.31, 1.20), 1.19 (95% CI: 0.61, 2.32), and 1.03 (95% CI: 0.59, 1.82), respectively. The corresponding odds ratios for women were 0.88 (95% CI: 0.45, 1.72), 2.38 (95% CI: 0.98, 5.77), and 1.03 (95% CI: 0.48, 2.23). This study did not support the hypothesis that low-to-moderate alcohol consumption prevents cognitive decline. The inverse association between low-to-moderate alcohol intake and cognitive decline observed in other studies may have been due to inclusion of former drinkers in the abstainers reference category.

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.

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.

Prevalence and implications of psychopathological non-cognitive symptoms in dementia

Objective:  Clinical experience and recent population studies suggest that psychopathological, non‐cognitive symptoms are both frequent and relevant in dementia.

Somatic and psychiatric comorbidity in the general elderly population: Results from the ZARADEMP Project

OBJECTIVE In a representative sample of the elderly population in a southern European city, we tested the hypothesis that there is an association between general somatic and general psychiatric morbidity. METHODS A stratified random sample of 4803 individuals aged > or =55 years was selected for the baseline study in the ZARADEMP Project. The elderly were assessed with standardized Spanish versions of instruments, including the Geriatric Mental State (GMS)-AGECAT. Psychiatric cases were diagnosed according to GMS-AGECAT criteria, and somatic morbidity was documented with the EURODEM Risk Factors Questionnaire. RESULTS General comorbidity clustered in 19.9% of the elderly when hypertension was removed from the somatic conditions category, with 33.5% of the sample remaining free from both somatic and psychiatric illnesses. General comorbidity was associated with age, female gender, and limited education, but did not increase systematically with age. The frequency of psychiatric illness was higher among the somatic cases than among noncases, and the frequency of somatic morbidity among the psychiatric cases was higher than among noncases. This association between somatic and psychiatric morbidity remained statistically significant after controlling for age, gender, and education [odds ratio (OR)=1.61; confidence interval (CI)=1.38-1.88]. Most somatic categories were associated with psychiatric illness, but after adjusting for demographic variables and individual somatic illnesses, the association remained statistically significant only for cerebrovascular accidents (CVAs) (OR=1.47; CI=1.09-1.98) and thyroid disease (OR=1.67; CI=1.10-2.54). CONCLUSION This is the first study to document that there is a positive and statistically significant association between general somatic morbidity and general psychiatric morbidity in the (predominantly) elderly population. CVAs and thyroid disease may have more weight in this association.

RELIABILITY AND VALIDITY OF THE SPANISH VERSION OF THEGMS–AGECAT PACKAGE FOR THE ASSESSMENT OF DEMENTIA AND COGNITIVE DISTURBANCES

This report confirms the reliability and validity of the Geriatric Mental State–Automated Geriatric Examination for Computer Assisted Taxonomy (GMS–AGECAT) package in a Spanish elderly population. No changes in the original English version are considered necessary. A representative sample (N=1080) of the elderly (65+ years) community in Zaragoza, Spain, stratified by age and sex was assessed. A two‐phase screening was designed: phase I (lay interviewers): Spanish versions of GMS–AGECAT and Mini‐Mental (MMSE); phase II (psychiatrists,N=324): the same instruments and History and Aetiology Schedule (HAS). Diagnosis: DSM‐III‐R criteria. Stringent test–retest reliability coefficients were calculated by comparing lay interviewers’ (phase I) vs psychiatrists’ (phase II) ratings. DSM‐III‐R psychiatric diagnoses in phase II were the gold standards for the validity study. Test–retest reliability coefficients of the cognitive sections of GMS were: case/no case distinction, mean kappa=0.71; dementia/no dementia distinction, mean kappa=0.80. GMS validity coefficients: detection of cases, sensitivity=98.4%; specificity=76.5%. Test–retest reliability coefficients of AGECAT: case/no case distinction, mean kappa=0.59; organic syndrome, dementia, mean kappa=0.68. Validity coefficients of AGECAT (psychiatrists’ outputs): case/no case distinction, sensitivity=90.6%; specificity=89.3%; dementia/no dementia distinction, sensitivity=86.4%; specificity=94.3%.