BackgroundDepressive symptoms are associated with cognitive decline in elderly people, but the nature of their temporal relationship remains equivocal.AimsTo test whether depressive symptoms predict cognitive decline in elderly people with normal cognition.MethodThe Center for Epidemiologic Study depression scale (CES – D) and the Mini-Mental State Examination (MMSE) were used to evaluate depressive symptomatology and cognitive functioning, respectively. A sample of 1003 persons aged 59–71 years and with a MMSE score of 26 or over was selected. Cognitive decline was defined as a drop of at least 3 points on the MMSE at 4-year follow-up.ResultsBaseline high levels of depressive symptoms predicted a higher risk of cognitive decline at 4-year follow-up. The MMSE score of participants with depression was more likely to fall below 26 at 2-year follow-up and to remain below at 4-year follow-up than the MMSE score of those without depressive symptoms. Persistent but not episodic depressive episodes were associated with cognitive decline.ConclusionsHigh levels of depressive symptoms, when persistent, are associated with cognitive decline in a sample of elderly people.

In our study, low blood pressure was a risk factor for, but not a consequence of, high depressive symptomatology.

The relationship between pregnancy and multiple sclerosis (MS) was assessed in a clinic-based, prospectively followed, population of 125 patients with a remittent onset of MS who had been followed for a mean (SD) of 10-3 (0-1) years. Thirty three women had a total of 49 pregnancies of which 32 had been full term and 17 terminated. There was a three-fold increase in the relapse rate per year during the first three months following delivery, compared with the baseline period of the same patients [1t62(0*38) vs 0*51(0O08) p = 0.05]. During pregnancy itself, the relapse-rate was not different from baseline. The overall relapse rate of the pregnancy group was lower than that of a control group without pregnancies after MS onset, but similar to that of patients who had children after MS onset, but no pregnancy during follow up. Pregnancy did not lead to increased disability. These results confirm that post partum increase in relapse rate is the main event related to pregnancy in MS and underline the difficulties of undertaking prospective studies in this field. A number of retrospective studies have evaluated the impact of pregnancy on the course of multiple sclerosis (MS).'-"3 Overall they report an increase of the relapse-rate during the post-partum period compared to pregnancy itself or to non-pregnancy periods in the same patients, and a lower relapse-rate during pregnancy itself.81 0 Three studies7 9 12 evaluated disability in relation to pregnancy, but only one of them considered prognostic factors such as duration of MS and age at onset.'2 Prematurely-terminated pregnancies have not been assessed in these studies. The retrospective design of these studies implies obvious limitations as to their conclusions, because recollection biases can alter the number and the temporal location of events, and may lead to false associations. The only prospective study published to date'4 concerns only a small number of patients. We evaluated the effects of all pregnancies on different parameters of the long-term evolution of MS in our clinic-based, prospectively-followed MS population and now report our results in the group of patients with the remittent form of MS. Our objectives were: 1) to describe the course of MS during pregnancies and the post-partum period; and 2) to determine if pregnancies could alter the long-term prognosis of disease in these patients. We compared two groups of patients, with and without pregnancy during follow up, and analysed the relationship between the course of MS and the occurrence of pregnancies in these patients.

The factorial structure of the Center for Epidemiologic Studies-Depression (CES-D) scale has been examined on a large sample of multiple sclerosis (MS) subjects (n = 696), general practice patients (n = 1,308) and healthy workers (n = 342). The aim of this study was to verify if the CES-D is a valid and reliable scale to assess depressive symptomatology in MS. As previously reported in the literature, we found four factors that measure depressed affect, positive affect, somatic complaints or retarded activity and interpersonal relationships. The percent of total variance explained by the four factors was greater than 50% in each group. Cronbach’s α coefficients were 0.90 in the MS sample and 0.93 in the general practice sample, indicative of high reliability in both samples. From these results, we conclude that the CES-D can be used to screen for depression in epidemiological studies of this psychiatric disorder among MS patients.

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