Maria Lage Barca

A Reliability and Validity Study of the Cornell Scale among Elderly Inpatients, Using Various Clinical Criteria

Background: The validity of the Cornell Scale for Depression in Dementia is seldom studied in institutions. Method: Two reliability studies, with 103 and 32 patients, and a validity study with 231 patients in nursing homes and in hospital were performed. They were assessed by the Cornell Scale, Clinical Dementia Rating scale and Self-Maintenance scale. A psychiatrist ‘blind’ to the Cornell assessment diagnosed depression according to the ICD-10, DSM-IV-TR and the Provisional Criteria for Depression in Alzheimer’s Disease (PCD-dAD). Results: Cronbach’s α values were 0.81 and 0.95, and the mean ĸ for the Cornell items were 0.91 and 0.57, respectively. In the validity study, 164 subjects had dementia; 105 (45.5%) had depression according to the ICD-10, 68 (29.9%) according to the DSM-IV-TR and 88 (53.3%) of the demented patients had depression according to the PCD-dAD. In the receiver operating characteristic analysis, the DSM-IV-TR criteria produced the highest area under the curve, i.e. 0.81 (95% CI: 0.75–0.87). A range of cutoff points for a depressive disorder was found for the various clinical criteria. Conclusion: The Cornell Scale is reliable and a range of cutoff points should be used for various clinical criteria of depression.

Quality of Life among Elderly Patients with Dementia in Institutions

Aim: To study quality of life among the elderly with dementia in institutions. Methods: Patients above 60 years with dementia, 82 in nursing home and 74 in departments of geriatric psychiatry, were included. They were assessed with the Quality of Life in Late-Stage Dementia (QUALID); the Self-Maintenance scale, Mini Mental State Examination (MMSE) and Clinical Dementia Rating scale. Patient’s age, gender, previous medical and psychiatric history were recorded. Dementia was diagnosed according to ICD-10 criteria for research. Based on information in an interview with the patient and a carer and information in the patient’s record, a geriatric psychiatrist made a diagnosis of major depression according to DSM-IV, if present. Results: The patients’ mean (± SD) age was 82.9 ± 7.7 years, 103 (66%) were women. A factor analysis of the QUALID scale resulted in two factors: ‘discomfort’ and ‘comfort’. Three linear regression analyses were performed. Variables associated with lower quality of life (total QUALID score) were: a diagnosis of major depression (p < 0.001), lower score on MMSE (p = 0.032), impaired function in activities of daily living (p = 0.007) and female gender (p = 0.046). Variables associated with the ‘discomfort’ subscale score were: major depression (p < 0.001), lower score on MMSE (p = 0.006) and living in a department of geriatric psychiatry (p = 0.041). The ‘comfort’ subscale score was associated with impaired function in activities of daily living (p < 0.001). Explained variance for the three models was 34, 33 and 23%, respectively. Conclusion: Quality of life is diminished among elderly patients in institutions and the most marked correlates were a diagnosis of major depression, worse performance in activities of daily living and worse cognitive function.

Prevalence of depression among memory clinic patients as measured by the Cornell Scale of Depression in Dementia.

Objectives: Depression in dementia is common, but the prevalence rates differ according to the populations studied and which diagnostic tools are being used. The aim of this study is to explore the prevalence of depression among patients referred to a memory clinic or an outpatient clinic as measured by the Cornell Scale of Depression in dementia (CSDD) and to investigate which factors are associated with depression. Method: The CSDD was completed for 1470 patients on their first visit to a memory clinic or an outpatient clinic. The prevalence of depression using three different cut-off points was calculated. Logistic regression and correlation analyses were performed. Results: Half of the patients had dementia. The mean CSDD was 6.7 (SD: 5.3) for the whole group, and 50.2% had a score above 5, whereas 37.5% had depression defined as a CSDD score above 7, and 14.1% had a score above 12. The mean scores were higher among those with dementia other than Alzheimers disease, those with previous depression, and those with greater impairment in the activities of daily living (ADL). In the logistic regression analyses, younger age, ADL dysfunction, and previous depression were significantly associated with higher CSDD scores. Conclusion: We found that depressive symptoms are common among patients referred for a dementia assessment in specialist health care. The strongest factors associated with depressive symptoms were younger age, ADL impairment, and previous depression.

A Comparison of the Validity of the Cornell Scale and the MADRS in Detecting Depression among Memory Clinic Patients

Background: The aim of the study was to compare the validity of the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. Methods: The scales were independently completed for 125 patients. The diagnosis of depression was made by psychiatrists blinded to the depression scores. Results: The mean score of the Mini-Mental State Examination was 25.5 (SD: 4.6), of the CSDD 6.8 (SD: 4.9), and of the MADRS 8.5 (SD: 6.8). In receiver operation characteristics (ROC) analyses, the AUC for the CSDD was 0.73 (95% CI: 0.63–0.82) using the International Classification of Diseases-10 (ICD-10) criteria for depression, and 0.68 (95% CI: 0.57–0.79) using the DSM-IV criteria. The AUC was 0.88 (95% CI: 0.81–0.95) for the MADRS using the ICD-10 criteria, and 0.84 (95% CI: 0.76–0.92) using the DSM-IV criteria. Conclusion: Both scales are suitable as screening tools. According to the ROC analyses, the MADRS seems better at distinguishing depressed from nondepressed patients.

The validity of the Montgomery-Aasberg depression rating scale as a screening tool for depression in later life.

BACKGROUND The aims of the study were to examine the validity of the MADRS and to compare it with the validity of the Cornell Scale for Depression in Dementia (CSDD). METHODS We included 140 patients without dementia, with mean age 81.5 (sd 7.7) years. Trained psychiatric nurses interviewed all of them using the MADRS. In addition, for 70 patients caregivers were interviewed using the CSDD. A psychiatrist who had no access to the MADRS or the CSDD results made a diagnosis of depression according to the DSM-IV criteria for major depression, and the ICD-10 criteria was also applied for the 70 patients assessed with the CSDD. RESULTS Twenty-two out of the 140 had depression according to the DSM IV criteria, whereas 25 out of 70 had depression according to the ICD-10 criteria. The area under the curve (auc) in a receiver operating characteristic analysis was 0.86 (95% CI 0.79-0.93) for the MADRS using the DSM-IV criteria. The best cut-off point was 16/17 with sensitivity of 0.80 and specificity of 0.82. The AUC for the CSDD was 0.83 (95% CI 0.71-0.95). The recommended cut-off score on the CSDD of 7/8 was valid but not the best in this study. LIMITATIONS The patients were diagnosed with a diagnosis of depression by only one psychiatrist, and the procedures in the two centres were not exactly the same. CONCLUSIONS The MADRS has good discriminating power to detect depression in elderly persons and should be preferred to the CSDD for use with persons without dementia.

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression

OBJECTIVE: To compare verbal fluency among Alzheimers disease, Parkinsons disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS: Patients from an outpatient university center with a clinical diagnosis of Alzheimers disease, Parkinsons disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinsons disease, major depression, and Alzheimers disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS: The mean digit span and verbal fluency scores were lower in patients with Alzheimers disease (n = 34) than in patients with major depression (n = 52) or Parkinsons disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimers disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinsons disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinsons disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimers disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS: Verbal fluency provides a better characterization of Alzheimers disease, major depression, and Parkinsons disease, even at later stages.

Disrupted global metastability and static and dynamic brain connectivity across individuals in the Alzheimer’s disease continuum

As findings on the neuropathological and behavioral components of Alzheimer’s disease (AD) continue to accrue, converging evidence suggests that macroscale brain functional disruptions may mediate their association. Recent developments on theoretical neuroscience indicate that instantaneous patterns of brain connectivity and metastability may be a key mechanism in neural communication underlying cognitive performance. However, the potential significance of these patterns across the AD spectrum remains virtually unexplored. We assessed the clinical sensitivity of static and dynamic functional brain disruptions across the AD spectrum using resting-state fMRI in a sample consisting of AD patients (n = 80) and subjects with either mild (n = 44) or subjective (n = 26) cognitive impairment (MCI, SCI). Spatial maps constituting the nodes in the functional brain network and their associated time-series were estimated using spatial group independent component analysis and dual regression, and whole-brain oscillatory activity was analyzed both globally (metastability) and locally (static and dynamic connectivity). Instantaneous phase metrics showed functional coupling alterations in AD compared to MCI and SCI, both static (putamen, dorsal and default-mode) and dynamic (temporal, frontal-superior and default-mode), along with decreased global metastability. The results suggest that brains of AD patients display altered oscillatory patterns, in agreement with theoretical premises on cognitive dynamics.

Quality of life in young onset dementia: an updated systematic review

INTRODUCTION Young onset dementia (YOD) develops before 65 years of age and has specific age-related adverse consequences for quality of life (QoL). We systematically examined factors related to the QoL of people with YOD and their caregivers. METHOD This systematic review used the PRISMA methodology. The literature search was undertaken on July 5, 2015, using Cochrane, PubMed, SciELO, PsycINFO, Scopus and Thomson Reuters Web of Science electronic databases. The search keywords included early onset and young onset combined with, dementia, Alzheimer, vascular dementia, mixed dementia, frontotemporal dementia, quality of life, well-being and unmet needs. Nine studies were included. We revised objectives, study design, sample, instruments and results related to QoL. RESULTS People with YOD rated their own QoL significantly higher than their caregivers. Greater awareness of disease among people with YOD is associated with better QoL in caregivers. A relationship was found between unmet needs and daytime activities, lack of companionship and difficulties with memory. Issues associated with unmet needs were prolonged time to diagnosis, available health services and lack of caregivers own future perspective. CONCLUSION Consideration should be given to conducting investigations with more homogeneous samples and use of a clear concept of QoL. The present study highlights the need for future research in a wider range of countries, using instruments specifically for YOD. It would be interesting if studies could trace parallels with late onset dementia groups.

Impaired cognition in depression and Alzheimer (AD): a gradient from depression to depression in AD

OBJECTIVE To assess cognition in major depressed (MD), Alzheimers disease (AD), and depression in AD elderly. METHOD Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. RESULTS We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. CONCLUSION A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Dissociable diffusion MRI patterns of white matter microstructure and connectivity in Alzheimer’s disease spectrum

Recent efforts using diffusion tensor imaging (DTI) have documented white matter (WM) alterations in Alzheimer’s disease (AD). The full potential of whole-brain DTI, however, has not been fully exploited as studies have focused on individual microstructural indices independently. In patients with AD (n = 79), mild (MCI, n = 55) and subjective (SCI, n = 30) cognitive impairment, we applied linked independent component analysis (LICA) to model inter-subject variability across five complementary DTI measures (fractional anisotropy (FA), axial/radial/mean diffusivity, diffusion tensor mode), two crossing fiber measures estimated using a multi-compartment crossing-fiber model reflecting the volume fraction of the dominant (f1) and non-dominant (f2) diffusion orientation, and finally, connectivity density obtained from full-brain probabilistic tractography. The LICA component explaining the largest data variance was highly sensitive to disease severity (AD < MCI < SCI) and revealed widespread coordinated decreases in FA and f1 with increases in all diffusivity measures in AD. Additionally, it reflected regional coordinated decreases and increases in f2, mode and connectivity density, implicating bidirectional alterations of crossing fibers in the fornix, uncinate fasciculi, corpus callosum and major sensorimotor pathways. LICA yielded improved diagnostic classification performance compared to univariate region-of-interest features. Our results document coordinated WM microstructural and connectivity alterations in line with disease severity across the AD continuum.