In contrast to recurrent geriatric major depressive disorder, late-onset major depressive disorder is characterized by specific deficits in tasks of attention and executive function, consistent with increased anhedonia and cardiovascular comorbidity. These findings, if confirmed, suggest that recurrent and late-onset geriatric major depressive disorder may represent distinct phenomenological entities. Such phenomenological differences as a function of lifetime history of major depression can guide research in the neurophysiology, prevention, and treatment of geriatric major depressive disorder.
SUMMARY Background The mini-mental state exam (MMSE) has been used to address questions such as determination of appropriate cutoff scores for differentiation of individuals with intact cognitive function from patients with dementia and rate of cognitive decline. However, little is known about the relationship of performance in specific cognitive domains to subsequent overall decline. Objective To examine the specific and/or combined contribution of four MMSE domains (orientation for time, orientation for place, delayed recall, and attention) to prediction of overall cognitive decline on the MMSE. Methods Linear mixed models were applied to 505 elderly nursing home residents (mean age = 85, >12 years education = 27%; 79% F, mean follow-up = 3.20 years) to examine the relationship between baseline scores of these domains and total MMSE scores over time. Results Orientation for time was the only domain significantly associated with MMSE decline over time. Combination of poor delayed recall with either attention or orientation for place was associated with significantly increased decline on the MMSE. Conclusions The MMSE orientation for time predicts overall decline on MMSE scores over time. A good functioning domain added to good functioning delayed recall was associated with slower rate of decline.
The purpose of the current study was to examine neuropsychological functioning in a group of never-medicated first-break adolescents with psychosis. It is the first report of cognition in a sample of adolescents with psychosis in which all patients were drug-naive. Twenty-nine adolescent patients (mean age = 16.07; SD = 2.00; 15 male and 14 female patients) experiencing their first psychotic episode and 17 age-matched and sex-matched normal volunteers (mean age = 16.88; SD = 2.39; 9 male and 8 female subjects) were recruited and assessed with a neuropsychological battery. Measures of attention, memory, language, executive functioning, perceptual motor processing, and motor speed were obtained. Psychiatric symptomatology, estimated verbal IQ, and parental socioeconomic status were also determined. Patients with psychosis were significantly more impaired than normal volunteers; effect sizes were greatest in the areas of executive functioning, attention, and memory, and significantly smaller in areas of language, perceptual motor processing, and motor speed. The pattern was not altered when differences in verbal IQ and parental socioeconomic status were controlled. Sex and age interactions indicated that younger male patients were particularly impaired. The findings demonstrate neuropsychological deficits in adolescents with psychosis and suggest that cognitive deficits are core symptoms in psychotic disorders.
Background: This study examines whether the association of diabetes with the rate of cognitive decline varies according to dementia severity. Methods: Longitudinal study on subjects residing in nursing homes and assisted living (n = 342). The Mini Mental State Examination (MMSE) was used to measure the rate of cognitive decline in diabetic and nondiabetic subjects who were nondemented (Clinical Dementia Rating, CDR = 0; n = 125), questionably demented (CDR = 0.5; n = 58) or frankly demented (CDR ≧1; n = 89) at baseline. Diagnosis of diabetes was ascertained by review of medical records and history. Results: Diabetes was associated with an increased rate of decline in the MMSE score of questionably demented subjects (p < 0.0001). In frankly demented subjects, diabetes tended to be associated with less cognitive decline (p = 0.04). Diabetes was not associated with the rate of MMSE decline in nondemented subjects (p = 0.89). Conclusion: In individuals with questionable dementia (CDR = 0.5), diabetes is associated with a faster rate of cognitive decline as measured by the MMSE, but not in nondemented (CDR = 0) or frankly demented (CDR ≧1) individuals.
Cardiovascular risk factors including hypertension (HTN) have been shown to increase the risk of Alzheimer disease. The current study investigated whether individuals with HTN are more susceptible to increased cognitive decline and whether the influence of HTN on cognitive decline varied as a function of dementia severity. A total of 224 nursing home and assisted living residents, with a mean age of 84.9 (±7.6) years, were assessed longitudinally with Mini Mental State Exams (MMSE) and Clinical Dementia Ratings (CDR). Baseline dementia status was defined by the CDR score. As described in Table 2, MMSE scores in persons with HTN and questionable dementia (CDR = 0.5) declined significantly faster than nonhypertensive questionably demented persons. Hypertensive participants did not decline significantly faster than nonhypertensive participants in persons with intact cognition (CDR = 0) or frank dementia (CDR ≥ 1). These results suggest an increased risk of subsequent cognitive decline in hypertensive individuals who are especially vulnerable to developing dementia and raises the possibility that avoiding or controlling HTN might reduce the rate of cognitive decline in cognitively vulnerable individuals, potentially delaying their conversion to full-fledged dementia. KeywordsAlzheimer disease; cardiovascular risk factors; cognitive impairment; dementia; elderly people; hypertension; mild cognitive impairment OBJECTIVES Cardiovascular (CV) disease and dementia are disorders common in the geriatric population. 1 Although the link between CV risk factors and vascular dementia has been observed for some time, 2-4 links between CV risk factors and cognitive impairment due to nonvascular causes, including Alzheimer disease (AD) have also been noted. [5][6][7][8] Hypertension (HTN) is a CV disease risk factor that affects 65% of the population age 65 and older 9 and nonvascular dementia (e.g., AD) affects nearly 5 million people in the United States. 10 A possible relationship between HTN and cognitive impairment has been the focus of increased attention in recent years because lifestyle factors associated with HTN (such as alcohol, tobacco, and sodium consumption, as well as obesity and amount of exercise) are 12,14,15 has also been associated with dementia. Individuals with increased diastolic blood pressure (BP) at age 70 were significantly more likely to develop AD by age 75. Some findings suggest that associations between HTN and dementia are more subtle, possibly more complex or less direct than originally theorized. 16,17 These results may have been affected by factors such as small sample size, reliance on an inadequate number of concurrent BP measures, and relatively young age of the studied samples. The latter factor is especially germane in light of the possibility of an age-dependent association between BP and cognitive function; that is, these relationships are stronger in older samples. [18][19][20] The majority of these studies have examined the association of HTN with prevalent or incident dementia...
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