P. Gracia-García

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).

Depression and Incident Alzheimer Disease: The Impact of Disease Severity

OBJECTIVES To test the hypothesis that clinically significant depression (particularly severe depression) increases the risk of Alzheimers disease (AD). METHODS A longitudinal, three-wave epidemiologic study was implemented in a sample of individuals aged 55 years and older (n = 4,803) followed up at 2.5 years and 4.5 years. This was a population-based cohort drawn from the Zaragoza Dementia and Depression (ZARADEMP) Project, in Zaragoza, Spain. Participants included individuals cognitively intact at baseline (n = 3,864). The main outcome measures were depression as assessed by using the diagnostic interview Geriatric Mental State- Automated Geriatric Examination for Computer Assisted Taxonomy package; and AD diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Fine and Gray multivariate regression model was used in the analysis, accounting for mortality. RESULTS At baseline, clinically significant depression was diagnosed in 452 participants (11.7%); of these, 16.4% had severe depression. Seventy incident cases of AD were found at follow-up. Compared with nondepressed individuals, the incidence rate of AD was significantly higher in the severely depressed subjects (incidence rate ratio: 3.59 [95% confidence interval: 1.30-9.94]). A consistent, significant association was observed between severe depression at baseline and incident AD in the multivariate model (hazard ratio: 4.30 [95% CI: 1.39-13.33]). Untreated depression was associated with incident AD in the unadjusted model; however, in the final model, this association was attenuated and nonsignificant. CONCLUSIONS Severe depression increases the risk of AD, even after controlling for the competing risk of death.

Conversion to dementia in mild cognitive impairment diagnosed with DSM‐5 criteria and with Petersen's criteria

In a background of revision of criteria for states of increased risk for progression to dementia, we compare the conversion rate to dementia and Alzheimers disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM‐5 (DSM‐5‐MCI) and Petersens (P‐MCI) criteria.

Mortality in Mild Cognitive Impairment Diagnosed with DSM-5 Criteria and with Petersen's Criteria: A 17-Year Follow-Up in a Community Study

OBJECTIVE To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5-MCI) will be higher than using Petersens criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI. METHODS A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5-MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups. RESULTS Compared with noncases, the mortality rate ratio was approximately double in DSM-5-MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5-MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories. CONCLUSION The mortality risk in comparison with noncases was higher in DSM-5-MCI than in P-MCI. The PAF of mortality in DSM-5-MCI individuals was ~ 1% over a 17-year period.

Clinically significant anxiety as a risk factor for dementia in the elderly community

To evaluate whether clinically significant anxiety is an independent risk factor for dementia, taking into account both depression among potentially confounding factors and the competing risk of death.

The state of the art in European liaison psychiatry and psychosomatics

The 11th meeting of the European Association for authorized guideline for liaison psychiatry of the Dutch Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) was held in Zaragoza, Spain, from June 25 to June 28, 2008. This was the second time that Spain had played host to the EACLPP meeting which was held in collaboration with the meeting of the Spanish Psychosomatic Medicine Association (SEMP) and the European Conference on Psychosomatic Research (ECPR). The conference was very well attended by delegates from Europe, the USA, and other countries. The meeting also coincided with the EXPO International Exhibition, and it was a great opportunity to visit Zaragoza and combine research with culture. Unfortunately, because of the success of EXPO 2008, there were some initial problems with hotel accommodation but these were resolved quickly. We are convinced that most people agreed it was worth the effort and the meeting was probably one of the best attended of all the European psychosomatic and liaison psychiatry meetings. A central issue of the conference was holistic medicine, both from the clinical and the research perspectives. The “psychosomatic” humanistic views were obvious in the presentations, as was the empirical philosophy, which was used in an attempt to find “evidence-based” foundations for our practice. Interactivity was promoted through “meet the expert” discussions, round tables, debates, workshops and symposia, following the tradition of recent years in our meetings. Recent advances were presented, and the range of topics covered gave an idea of the contemporary scope in the field. One of the most important topics covered was delirium. This included issues of clinical guidelines, new neuroleptics, the importance of cytokines in the pathogenesis or collaborative treatment issues. One of the highlights of the meeting was the intervention by Prof. Robinson, from Iowa, USA, who gave a presentation of new data related to the prevention of post-stroke depression and the reduction of mortality by means of antidepressant treatment. The current state of liaison psychiatry in Europe was discussed once again in Zaragoza, but the president of the American Academy of Psychosomatic Medicine, Dr. C. Alter, also informed the conference about new developments in the US. Dr. A. Leentjens, President of the EACLPP, presented the recently