Michael Van Buggenhout

Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment

To determine the reliability of the 30‐item Geriatric Depression Scale (GDS‐30) for the screening of depressive symptoms in dementia and mild cognitive impairment (MCI) using the Cornell Scale for Depression in Dementia (CSDD) as the ‘gold standard’.

Relation between frontal lobe symptoms and dementia severity within and across diagnostic dementia categories

To study frontal lobe symptoms in relation to dementia severity within and across diagnostic dementia categories, a cross‐sectional analysis of behavioural data was performed.

Differentiation Between Dementia and Depression Among Older Persons: Can the Difference Between Actual and Premorbid Intelligence Be Useful?

We wanted to investigate whether the difference between actual and premorbid intelligence can be useful to make an early differentiation between Alzheimers disease (AD) and depression among elderly. A Dutch version of the National Adult Reading Test (NLV), a measure of premorbid IQ and the Raven Coloured Progressive Matrices (RCPM), a measure of actual intelligence were administered to patients with mild (34) and moderate (27) AD, depressed elderly (36) and healthy control subjects (51). Logistic regression analyses revealed that intellectual decline (i.e. subtracting NLV percentile score from RCPM percentile score) was only able to predict group membership when moderate AD patients were compared to depressed and healthy individuals. Our results indicate that intellectual decline may not be a concomitant of elderly depression. However, the differentiation between mild AD and elderly depression can not be made by means of the difference between premorbid (NLV) and actual (RCPM) intelligence scores.

P3-392: The dopaminergic neurotransmitter system is associated with aggression and agitation in frontotemporal dementia

To identify neurochemical correlates of behavioral and psychological signs and symptoms of dementia (BPSD), we set up a prospective study. Patients with probable Alzheimers disease (AD) (n=181), mixed dementia (MXD) (n=28), frontotemporal dementia (FTD) (n=25) and dementia with Lewy bodies (DLB) (n=24) were included. At inclusion, all patients underwent lumbar puncture, neuropsychological examination and behavioral assessment (battery of behavioral assessment scales). Cerebrospinal fluid (CSF) levels of norepinephrine and of (nor)epinephrine (MHPG), serotonin (5HIAA) and dopamine (DOPAC, HVA) metabolites were determined by HPLC and electrochemical detection. Spearman Rank-Order followed by Bonferroni correction was used for calculating correlations. In FTD patients, CSF norepinephrine levels were positively correlated with dementia severity (r=0.539; p=0.021). CSF DOPAC levels were correlated with BPSD in general (r=0.537; p=0.007), associated caregiver burden (r=0.567; p=0.004) and agitated and aggressive behavior (r=0.568; p=0.004). In a subgroup of FTD patients who did not receive psychotropic pharmacological treatment, a strong correlation between CSF HVA/5HIAA ratios (reflecting serotonergic modulation of dopaminergic neurotransmission) and aggressive behavior (r=0.758; p=0.009) was found. In MXD patients, (verbally) agitated behavior was positively associated with the turnover of norepinephrine (r=0.633; p=0.002). No significant correlations were found in AD and DLB groups. In FTD, increased activity of dopaminergic neurotransmission and altered serotonergic modulation of dopaminergic neurotransmission is associated with agitated and aggressive behavior respectively. This study demonstrated that neurochemical mechanisms underlying the pathophysiology of BPSD are both BPSD-specific and disease-specific which might have implications for future development of new and more selective pharmacological treatments of BPSD.

Characterisation of Depression in Dementia and Mild Cognitive Impairment

Background: Baseline data-analysis of a prospective Belgian study was performed to characterise significant depressive symptoms and its behavioural correlates in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) patients. Methods: 200 AD (189 probable and 11 definite AD patients) and 200 MCI patients were included and behavioural and neuropsychological data were obtained using a standard battery of assessment scales and tests. Statistical analysis consisted of Mann Whitney U test for comparison of data between groups and univariate analysis. Multivariate analysis was used to develop models that accounted for the variation of depressive symptoms. Results: MCI patients showed less behavioural symptoms and were less cognitively impaired than AD patients. MCI/AD patients with significant depressive symptoms showed significantly more behavioural symptoms than patients without significant depressive symptoms. Depressive symptoms were correlated with almost all BPSD tested in AD and MCI patients. For MCI patients, a model with three behavioural symptoms (verbally agitated behaviour, physically non-aggressive behaviour, diurnal rhythm disturbances) was developed that accounted for 53,7% of variation of depressive symptoms. For AD patients a model with three behavioural symptoms (frontal lobe symptoms, delusions and diurnal rhythm disturbances) was developed that accounted for 40,7% of variation of depressive symptoms. Conclusions: Several behavioural symptoms were correlated with depressive symptoms in MCI and AD. A model was developed that accounted for 52,1% and 46,1% of variation in depressive symptoms in MCI and in AD, respectively. The occurrence of diurnal rhythm disturbances urge to screen for depression in bothMCI and AD patients.

O2-07-02: Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment?

SUMMARY Objective To determine the reliability of the 30-item Geriatric Depression Scale (GDS-30) for the screening of depressive symptoms in dementia and mild cognitive impairment (MCI) using the Cornell Scale for Depression in Dementia (CSDD) as the ‘gold standard’. Methods Diagnosed according to strictly applied clinical diagnostic criteria, patients with MCI (n ¼ 156) and probable Alzheimer’s disease (AD) (n ¼ 247) were included. GDS-30, CSDD, Mini Mental State Examination (MMSE) and Global Deterioration Scale were assessed in all patients at inclusion. The AD group was divided in three subgroups: mild AD (MMSE� 18) (n ¼ 117), moderate AD (MMSE< 18 and � 10) (n ¼ 89) and severe AD (MMSE<10) (n ¼ 38). Results In MCI patients, moderate but highly significant correlations were found between GDS-30 and CSDD scores (Pearson: r ¼ 0.565; p < 0.001). In mildly (r ¼ 0.294; p ¼ 0.001), moderately (r ¼ 0.273; p ¼ 0.010) and severely (r ¼ 0.348; p ¼ 0.032) affected AD patients, only weak correlations between GDS-30 and CSDD scores were calculated. ROC curve analysis showed that sensitivity and specificity values of respectively 95% and 67% were achieved when a GDS-30 cut-off score of 8 was applied in MCI patients. In AD patients, too low sensitivity and specificity values did not allow selecting an optimal cut-off score by means of ROC curve analysis. Conclusion Using the CSDD as ‘gold standard’, we demonstrated that the GDS-30 is a reliable screening tool for depressive symptoms in MCI but not in AD patients. Copyright # 2009 John Wiley & Sons, Ltd.