Sébastien Grenier

Sleep quality and 1-year incident cognitive impairment in community-dwelling older adults.

STUDY OBJECTIVES To examine in cognitively intact older men and women the associations between subjective sleep quality and 1-yr incident cognitive impairment. DESIGN Prospective cohort study. SETTING General community. PARTICIPANTS 1,664 cognitively intact individuals age 65 to 96 years. MEASUREMENTS AND RESULTS Sleep quality at baseline was measured using the Pittsburgh Sleep Quality Index (PSQI). Cognitive functioning was assessed at baseline and 12 months later using the Mini-Mental State Examination (MMSE). Incident general cognitive impairment was defined according to a follow-up MMSE score below the 15(th) percentile according to normative data and of at least 2 points below baseline. General cognitive impairments were also separated into amnestic and nonamnestic subtypes according to MMSE delayed recall performance. Associations between sleep quality indicators at baseline and incident cognitive impairment were assessed by odds ratio (OR) adjusted for age, education, baseline MMSE score, psychotropic drug use, anxiety, depressive episodes, cardiovascular conditions, and chronic diseases. Results revealed that global PSQI score was significantly linked with incident cognitive impairment (OR 1.17, 95% confidence interval (CI) 1.05-1.30) in men, but not in women. In women, sleep disturbance score (OR 2.62, 95% CI 1.41-4.86) and long sleep duration (≥ 9 hr; OR 3.70, 95% CI 1.49-9.17) were associated with nonamnestic and amnestic incident cognitive impairment, respectively. In men, short sleep duration (≤ 5 hr; OR 4.95, 95% CI 1.72-14.27) and habitual sleep efficiency score (OR 1.94, 95% CI 1.42-2.66) were associated with amnestic and general incident cognitive impairment, respectively. CONCLUSIONS Sleep quality in older adults should receive particular attention by clinicians because poor sleep quality can be an early sign of cognitive decline.

The Epidemiology of Psychiatric Disorders in Quebec's Older Adult Population

Objective: To document the prevalence of psychiatric disorders in Quebecs older adult population. Method: Data came from the Enquête sur la santé des aînés study conducted in 2005–2006 using a representative sample (n = 2798) of community-dwelling older adults. Results: Our results indicate that 12.7% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine dependency. The 12-month prevalence rate of major depression was 1.1% and the prevalence of minor depression 5.7%. A total of 5.6% of the respondents reported an anxiety disorder. The most prevalent anxiety disorders were specific phobia (2.0%), obsessive–compulsive disorder (OCD) (1.5%), and generalized anxiety disorder (GAD) (1.2%). Agoraphobia without panic disorder and panic disorder were reported by 0.3% and 0.6% of the respondents, respectively. The prevalence rate of benzodiazepine dependency was 2.3%. The 12-month comorbidity prevalence rate between any psychiatric disorders was 2.2%. Among those with depressive disorder, the most frequent comorbidity was observed between minor depression and specific phobia (4.3%), GAD (4.3%), OCD (3.7%), and mania (1.3%). Further, only 39% of those having at least one active DSM-IV diagnosis reported having used health services for their psychological distress symptoms during the previous 12 months. Among those who consulted health services, 85% visited a general practitioner. Conclusions: Our results indicate that a large proportion of the elderly population in Quebec presents mental health needs. Longitudinal research focusing on the individual and social consequences of mental health problems reported by older adults is needed to avoid misinterpretation of this finding.

The Impact of DSM-IV Symptom and Clinical Significance Criteria on the Prevalence Estimates of Subthreshold and Threshold Anxiety in the Older Adult Population

OBJECTIVES Subthreshold anxiety refers to a condition where individuals do not meet the full symptom criteria (i.e., the number of symptoms required for a formal diagnosis is not reached) and/or do not report significant impairment or distress in functioning (i.e., the clinical significance criterion is not met). The purpose of this study was to examine how the symptom and the clinical significance criteria may affect the prevalence estimates of anxiety problems in the older adult population and whether applying these criteria results in an identifiable older group showing more severe anxiety. SETTING AND PARTICIPANTS Data came from a large representative sample of community-dwelling older adults age 65 years and older (N = 2,784). RESULTS Results showed that the 12-month prevalence rate of any anxiety problem varied from 5.6% when DSM-IV criteria for anxiety disorders were used to 26.2% when all subthreshold manifestations of anxiety were considered. Findings also indicated that when compared with respondents without anxiety, older adults presenting different manifestations of subthreshold or threshold anxiety appear to be more similar than different in their health and health behavior characteristics. CONCLUSIONS Subthreshold anxiety has a high prevalence and may cause significant impairment. Both symptom and clinical significance criteria do not perfectly discriminate between older adults with or without a severe anxiety problem presenting comorbid disorders and needing psychiatric help.

Cognitive behaviour therapy and medication in the treatment of obsessive–compulsive disorder

Objective:  To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive–compulsive disorder (OCD).

Anxiety, Depression, and 1-Year Incident Cognitive Impairment in Community-Dwelling Older Adults

OBJECTIVES: To examine in men and women the independent associations between anxiety and depression and 1‐year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1‐year incident anxiety or depression.

Correlates of Potentially Inappropriate Prescriptions of Benzodiazepines among Older Adults: Results from the ESA Study

Les données de l’étude ESA ont été appariées aux données d’utilisation des services médicaux et pharmaceutiques de la Régie d’assurance maladie du Québec pour documenter la prescription potentiellement non appropriée de benzodiazépines chez les personnes âgées. Nos résultats indiquent que 32% des répondants ont pris une dose journalière moyenne de 6.1 mg de l’équivalent diazépam pour une durée moyenne de 205 jours par année. Nos résultats indiquent aussi que presque la moitié, 48% des utilisateurs de benzodiazépines, ont reçu au moins une prescription de benzodiazépine potentiellement non appropriée pendant les 12 mois qui précédaient l’étude. Près de 23% des consommateurs ont reçu au moins une prescription concomitante de Bzs et d’un autre médicament pouvant résulter en une interaction sérieuse. De plus, les personnes âgées de 75 ans et plus avaient plus de chances de recevoir une Bz pour une longue période de temps que les personnes âgées de 65–74 ans. Cette étude a montré que la durée d’utilisation des benzodiazépines augmentait avec le nombre de prescripteurs et avec le nombre de pharmacies consultées pendant l’année. Le nombre de pharmacies utilisées a aussi été associé avec la présence d’une ordonnance non appropriée de benzodiazépines pendant la même année. Nos résultats plaident en faveur d’un système de santé plus intégré, incluant une révision régulière des médicaments pris par les personnes âgées. ESA study data were paired with Quebec medical and pharmaceutical services records to document potentially inappropriate benzodiazepines (Bzs) prescriptions among community-dwelling adults aged 65 and older. Results indicate that 32 per cent of respondents took a mean daily dose of 6.1 mg of equivalent diazepam for, on average, 205 days per year. Almost half (48%) of Bzs users received a potentially inappropriate benzodiazepine prescription at least once during the year preceding the survey. About 23 per cent received at least one concomitant prescription of a Bz and another drug that could result in serious interaction. In addition, individuals aged 75 and older were more likely to receive Bzs for a longer period of time than those aged 65–74. Number of pharmacies used was associated with inappropriate Bzs prescriptions. Our results argue in favour of a more integrated health services system, including a regular review of older adults’ drug regimens.

Treating Delusional Disorder: A Comparison of Cognitive-Behavioural Therapy and Attention Placebo Control

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group. Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS). Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief. Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.

Subjective sleep characteristics associated with anxiety and depression in older adults: a population-based study

Sleep complaints are often associated with anxiety and depression, but the specific complaints related to each syndrome are poorly characterized, especially in older adults. The objective was to identify subjective sleep characteristics specific to anxiety and depression in this population.

Benzodiazepine use and quality of sleep in the community-dwelling elderly population.

Background: About 50% of the elderly population report being dissatisfied with their sleep. Although benzodiazepines are the most prescribed drugs to treat sleep complaints, the effectiveness of their use on the quality of sleep is not well documented. Objectives: This study aimed to assess the association between benzodiazepine use and global sleep quality, as well as six components of sleep quality. Methods: Data from the cross-sectional Quebec Survey on Seniors’ Health (n = 2798) conducted in 2005–2006 were used. Quality of sleep was self-reported and use of benzodiazepines was assessed during the previous year. Results: Benzodiazepine users reported poorer quality of sleep than non-users. The association between benzodiazepine use and each of the six quality of sleep components studied were similar except for the daytime dysfunction component. Conclusion: The results suggest that there is no evidence that using benzodiazepines is associated with better quality of sleep than non-users in the elderly population. Future longitudinal population-based studies are needed to assess improvements in quality of sleep in the elderly associated with the use of benzodiazepines.

Anxiety disorders, depressive episodes and cognitive impairment no dementia in community-dwelling older men and women.

Anxiety symptoms are highly prevalent in elders with mild cognitive disorders, but little is known about the associations of specific anxiety disorders to mild cognitive disorders.