Mirjam I. Geerlings

Are memory complaints predictive for dementia A review of clinical and population-based studies.

Objectives. To review studies that have reported on the prevalence of memory complaints and the relationship between memory complaints and impairment or decline (dementia) in elderly individuals

Risk factors for depression in later life; results of a prospective community based study (AMSTEL).

BACKGROUNDnDepression in the elderly was found to be associated with a variety of risk-factors in cross sectional designs. Based on the vulnerability-stress model, etiologic pathways for depression have been suggested, with vulnerability modifying the effect of stress factors. The current prospective study tests an etiologic model for depression incidence, by assessing modifying effects of three types of vulnerability: genetic/familial vulnerability, organic vulnerability, and environmental vulnerability.nnnMETHODSn1940 non-depressed community-living elderly were interviewed at baseline, and at follow-up three years later. Bivariate and multivariate relationships between risk factors and incident depression (GMS-AGECAT) were studied.nnnRESULTSnHigher age, personal history of depression, death of spouse, health related factors and comorbid organic or anxiety syndrome showed significant bivariate associations with depression incidence. In multivariate analysis, the effect of stress factors on incident depression was not modified by a genetic/familial vulnerability, nor by an organic vulnerability. Effect modification by environmental factors was however evident; having a marital partner, and if unmarried having social support, significantly reduced the impact of functional disabilities on the incidence of depression.nnnLIMITATIONSnThe study consisted of two measurements with a three years interval, depressive episodes with a short duration may be under-represented.nnnCONCLUSIONSnIn the elderly, the effect of stress on incident depression is modified by environmental vulnerability. No evidence was found of effect modification by either genetic/familial or organic vulnerability. The results have implications for both recognition and treatment of late-life depression.

Depressive symptoms and risk of Alzheimer's disease in more highly educated older people

BACKGROUND AND OBJECTIVE: In an earlier study we observed that a depressive syndrome was highly predictive of developing Alzheimers disease (AD) in older persons with normal baseline cognition and higher levels of education. We interpreted these findings as the depression being an early noncognitive manifestation of AD in persons with more cognitive reserve. The present study examines whether specific symptoms of depression can be identified that predict AD among older subjects with higher levels of education.

Increased risk of mortality in Alzheimer's disease patients with higher education? A replication study

The objective of this study was to replicate findings from an earlier study by Stern et al. of an increased risk of mortality in Alzheimers disease (AD) patients with higher levels of education and to compare this risk with the risk of death in the elderly population. As part of a community-based follow-up study on dementia (Amsterdam Study of the Elderly[AMSTEL]) a cohort of 4,051 noninstitutionalized elderly age 65 to 84 years stratified in four 5-year strata of equal size was screened for dementia using the MMSE (Mini-Mental State Examination). Those suspected of dementia received diagnostic evaluation using the CAMDEX (Cambridge examination for mental disorders in the elderly). Clinical diagnoses of probable AD were made according to NINCDS-ADRDA criteria. Thirty-six prevalent patients were diagnosed as having AD. The suspected subcohort was followed up yearly over a period of 4 years. During the three yearly follow-ups, 30 incident patients received a diagnosis as well. After 6 years mortality data were obtained from municipality records. Cox proportional hazards models adjusted for age and sex were used to estimate the relative risk of death associated with the level of education. Relative risk of death decreased (although not statistically significant) in AD patients as level of education increased (RR= 0.86; 95% CI, 0.63 to 1.19). In the full baseline sample, relative risk of death decreased as level of education increased (RR = 0.86; 95% CI, 0.89 to 0.97). In this study we could not replicate the findings of Stern et al. of an increased risk of death in more highly educated AD patients. Several major differences between the two studies, among which difference in populations used is considered to be most important, are discussed that might explain the conflicting results. We conclude that higher education is not associated with increased risk of mortality in AD patients.

Cognitive reserve and mortality in dementia: the role of cognition, functional ability and depression

OBJECTIVEnThis study examined whether dementia patients with greater cognitive reserve had increased mortality rates, and whether this association was different across strata of cognition, functional ability and depression.nnnMETHODSnIn the community-based Amsterdam Study of the Elderly, 261 non-institutionalized dementia patients, identified using the Geriatric Mental State Schedule (GMS), were followed for an average of 55.5 months after which mortality data were obtained. Cognitive reserve was indicated by years of education and pre-morbid intelligence (measured using the Dutch Adult Reading Test). Cognition, functional ability and depression were indicated by Mini-Mental State scores, ADL and IADL measurements and GMS depressive syndrome, respectively.nnnRESULTSnDuring the follow-up 146 persons (55.9%) died. Cox regression analyses showed that more highly educated dementia patients had higher mortality rates, only if they had low MMSE scores or if they had a concurrent depression. Pre-morbid intelligence was associated with a higher mortality rate, independent of cognition, but this association was much stronger among patients with depression. The positive association between education or intelligence and mortality was not modified by functional disabilities.nnnCONCLUSIONSnThe results suggest that dementia patients with greater cognitive reserve have increased mortality rates, only if the disease has progressed to such an extent that clinical symptoms are more severe. In this respect, the reserve hypothesis needs a modification. Depression in dementia patients with greater cognitive reserve may reflect a subgroup of patients with poor prognosis.

Psychotropic drug use in patients with various chronic somatic diseases

Background and Objectives: To reveal insight into prevalence and incidencenof psychotropic drug use in patients with various chronic somatic diseases and into time differencesnbetween incidence of the somatic disease and start of psychotropic drug use.nMethods: A cohort study was performed using the Agis Health Database from 2002 ton2005. Patients with one or more of nine frequently occurring chronic somatic diseasesnwere selected (N = 140,983). The non-exposed group (N = 417,486) was composed of patientsnwithout any of these nine diseases. For the somatic disease prescribed drugs werenused as a proxy-indicator. Prevalences and incidences of psychotropic drug use were calculatednas well as mean time between the incidence of the somatic disease and release datenof the psychotropic drug.nResults: Prevalence of antidepressant drugs and benzodiazepines was increased amongnpatients with somatic diseases, with odds ratios of respectively 1.83 (95%CI 1.80-1.87)nand 2.31 (95%CI 2.27-2.35). In the first year after incidence of the somatic disease, meannduration in time to start of psychotropic drug use was significantly shorter compared tonpatients without somatic disease.nConclusions: Physicians should be aware of the high prevalence and earlier onset ofnpsychotropic drug use in all patients with chronic somatic diseases.