Impact of depressive symptoms in outcome of Alzheimer's disease.

Anita De Paula Eduardo Garavello,Regina Miksian Magaldi,Wilson Jacob Filho,Sérgio Márcio Pacheco Paschoal

doi:10.1590/s1980-57642010dn40400015

Anita De Paula Eduardo Garavello, Regina Miksian Magaldi + Show 2 more

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https://doi.org/10.1590/s1980-57642010dn40400015

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Journal: Dementia & neuropsychologia	Publication Date: Dec 1, 2010
Citations: 3	License type: cc-by

Affiliation: Universidade de São Paulo

Abstract

There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimer’s disease (AD).ObjectiveTo compare the evolution of AD patients, with and without depressive symptoms, in terms of cognition, functionality and caregiver stress.MethodsThe study entailed 2 stages: an initial retrospective stage involving review of medical charts of patients with mild and moderate AD. Patients were divided according to the presence or absence of depressive symptoms, defined by medical interview and questions on depressed mood from the CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) and Neuropsychiatric Inventory (NPI). Twenty-nine patients were evaluated, 37.9% with depression (Group D+) and 62.1% without depression (Group D–). The groups were compared regarding demographic and medical characteristics, cognitive and functional performance, presence of apathy as a separate symptom, and caregiver stress, using standardized tests and questionnaires. In the second transversal step, the same tools were reapplied after 2 to 4 years of follow-up, and evolution for the two groups was compared.ResultsThe two groups were highly homogeneous in demographic and clinic characteristics, as well as in length of follow-up, and presented no significant difference in cognitive or functional evaluation at the time of diagnoses or after follow-up. Only caregiver stress was greater in Group D+ at the two time points (p<0.001).ConclusionsNo differences in the evolution of AD patients with or without depressive symptoms were evident. Nevertheless, these symptoms were associated to emotional burden of caregivers.

Highlights

There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimer’s disease (AD)
Patients were selected based on the following criteria: 60 years old and over; diagnosis of probable or possible Alzheimer’s disease according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA),[13] associated with dementia diagnosis according to the Diagnostic and Statistical Manual of Mental Disorder- Fourth Edition (DSM-IV);[14] mild or moderate AD, based on scores on the Mini Mental State Examination (MMSE), i.e. MMSE ≥9;15 patients that had 2 to 4 years of follow-up from diagnoses to end-point of this study (September 2008 to June 2009); use of proper treatment for AD, i.e. inhibitors of acetylcholinesterase at an adequate and stable dose for at least 3 months
Selected patients were subdivided based on the presence or otherwise of depressive symptoms at the first clinical assessment in the CEREDIC, defined by: [1] medical interview; [2] questions regarding depressed mood from the CAMDEX (Cambridge Examination for Mental Disorders of Elderly),[16,17] considering a positive response as the presence of 2 out of three items; [3] questions about depression from the Neuropsychiatric Inventory (NPI).[18]

Summary

Introduction

Abstract – There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimer’s disease (AD). Objective: To compare the evolution of AD patients, with and without depressive symptoms, in terms of cognition, functionality and caregiver stress. The groups were compared regarding demographic and medical characteristics, cognitive and functional performance, presence of apathy as a separate symptom, and caregiver stress, using standardized tests and questionnaires. Conclusions: No differences in the evolution of AD patients with or without depressive symptoms were evident These symptoms were associated to emotional burden of caregivers. Objetivo: Comparar a evolução de pacientes com DA, com e sem sintomas depressivos, quanto à cognição, à funcionalidade e estresse do cuidador. Os grupos foram comparados quanto a variáveis demográficas, clínicas e quanto ao desempenho cognitivo, funcionalidade, presença de apatia do paciente e estresse do cuidador, através de questionários e testes padronizados.

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