Geriatric Mental State Research Articles

Clinically relevant late-life depression as risk factor of dementia: a systematic review and meta-analysis of prospective cohort studies

To carry out a meta-analysis of population-based prospective cohort studies to investigate the risk of dementia and Alzheimer's disease (AD) according to clinically relevant depression, assessed with Geriatric Mental State (GMS) criteria. A systematic literature search of the studies published in PubMed and Web of Science up to January 2018 was performed to identify all longitudinal studies on the association between clinically relevant depression (diagnosed with GMS criteria) and risk of dementia in the elderly. We calculated pooled relative risks to examine depression as a possible risk factor for dementia in community studies, as well as to compute population attributable fraction (PAF). Six studies met inclusion criteria for the systematic review. All of them provided enough information to perform a meta-analysis. Participants with clinically relevant depression had a 54% higher risk of dementia (p = 0.026) with a PAF attributable to clinically relevant depression of 8.6%. The numbers for AD were 50% higher risk (p = 0.038) and a PAF of 10.8%. Clinically relevant depression is associated with an increased risk for dementia and AD in the community, with a potential impact higher than other known/recognized risk factors. Future studies should explore the mechanisms linking depression and dementia and AD as well as whether an effective treatment of clinically significant depression could prevent dementia and AD development.

The prevalence of late-life depression in a Portuguese community sample: A 10/66 Dementia Research Group study

Late life depression is associated with a significant burden of disease. Estimating depression in older adults can be difficult and requires different methodological approaches from those fitting younger adults. As community prevalence data is scarce in Portugal, we estimated the prevalence of depression in a sample of older Portuguese adults. Moreover, we investigated the association between depression and disability. A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of one urban and one rural catchment area in Southern Portugal. Standardized 10/66 assessments include a comprehensive cognitive module and the Geriatric Mental State (GMS)-AGECAT. Information on demographics, non-communicable disease risk factors and disability/functioning (WHODAS 2.0) was also recorded. Depression was assessed using both ICD-10 and EURO-D criteria. We interviewed 1405 older people (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for ICD-10 depression was 4.4 (95% CI 3.5-5.6) and 18.0 (95% CI 16.0-20.1) using the EURO-D case definition. As compared with having no depression, ICD-10 depression was associated with a higher level of disability, even after adjusting for confounders (4.8, 95% CI 2.8-8.1). The same happened with subsyndromal depression ('EURO-D only') cases (2.2, 95% CI 1.4-3.5). Non-generalisability of findings outside of catchment areas. In this sample of older Portuguese people, the prevalence of depression was high and so were the associated levels of disability. EURO-D diagnoses may provide a better picture of clinically significant old age depression as a basis for health and social service planning.

Prevalence of Psychiatric Disorders among Elderly In-Patients in Non-Psychiatric Wards of a Teaching Hospital in Northern Nigeria

The population of the elderly is increasing globally with enormous challenges particularly in developing countries. Aging increases the risk for both physical and psychiatric disorders with psychiatric disorders often unrecognized in non-psychiatric settings. This presents huge costs to both patient and society. The study aimed at estimating the rate of psychiatric morbidity in non-psychiatric wards of a tertiary hospital in Northern Nigeria. One hundred and forty (140) subjects were recruited into this cross-sectional descriptive study. Participants were initially screened using the Self Reporting Questionnaire (SRQ) and the Modified Mini-Mental State Examination (MMSE) after administering the Socio-demographic questionnaire. Subjects scoring >5 in the SRQ and or ≤13 in the Modified MMSE were then further interviewed using the Geriatric Mental State Schedule (GMS). Clinical Psychiatric diagnosis was also made based on ICD-10 diagnostic criteria from all information available and later compared with GMS diagnoses. Mean age of participants was 67.5, SD ±6.4. The rate of psychiatric morbidity using ICD-10 diagnosis was 47.9% with depression being the commonest disorder (18.6%) followed by delirium (17.1%) and dementia (10.7%). Depression and anxiety disorders were particularly under-recognized by non-psychiatric doctors. Identified risk factors for psychiatric morbidity included female gender, low socioeconomic status, low educational level and presence of multiple medical diagnoses. The rate of psychiatric morbidity among elderly in-patients in non-psychiatric settings has remained high in comparison to previous studies with huge gaps in recognition and treatment reflecting the need for more collaboration between medical teams.

Changes in pro-inflammatory cytokine levels and late-life depression: A two year population based longitudinal study

Longitudinal associations of cytokine levels with depression are unclear. This study aimed to investigate cross-sectional and prospective associations between five serum pro-inflammatory cytokine levels and late-life depression. 732 Korean people aged 65+ were evaluated at baseline. Of 631 without depression (Geriatric Mental State schedule) at baseline, 521 (83%) were followed over a 2 year period and incident depression was ascertained. Serum tumor necrosis factor-α, interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels were assayed at both baseline and follow-up. Associations between cytokine levels and depressive status were evaluated using linear regression models, considering potential covariates (demographics, cognitive function, disability, lifestyle factors, and vascular risk factors) and applying Bonferroni corrections. Prevalent depression at baseline was significantly associated with higher contemporaneous levels of IL-1β and IL-8, independent of relevant covariates and after applying Bonferroni corrections. In the analyses of the five cytokine levels in combination, independent associations were found between prevalent depression and increased numbers of cytokines at higher levels at baseline. Incident depression was significantly associated with increases in IL-1β, IL-6, and IL-8 levels during the follow-up independent of relevant covariates and after applying Bonferroni corrections. In combination analyses, incident depression was independently associated with higher numbers of cytokines showing increasing levels over the same follow-up period. However, incident depression was not predicted by higher baseline pro-inflammatory cytokine levels in any analysis. Our findings suggest that depression might affect serum cytokines alterations and lead to inflammatory processes in late-life.

Longitudinal associations between glucocorticoid receptor methylation and late-life depression

It has been suggested that hypothalamus–pituitary–adrenal (HPA) axis dysregulation plays a role in the etiology of depression. HPA axis function is mediated by glucocorticoid receptors (GRs), which are influenced by epigenetic mechanisms (DNA methylation). The association between the DNA methylation of the GR gene (nuclear receptor subfamily 3, group C, member 1; NR3C1) and late-life depression as well as the role of NR3C1 methylation in the prediction of the incidence of depression have not yet been investigated. Therefore, we examined the independent and longitudinal effects of the methylation of three CpG sites in exon 1F of NR3C1 on late-life depression using peripheral blood. In total, 732 Korean community residents aged ≥65 years were assessed; 521 individuals in this group without depression at baseline were followed 2 years later. The Geriatric Mental State Schedule was used to identify depression, and demographic and clinical covariates were evaluated. The effects of NR3C1 methylation (the individual methylation status of three CpG sites and their average values) on current and follow-up depression were calculated using a multivariate logistic regression model. Higher NR3C1 methylation levels at CpG 2 and 3 and the average methylation value were independently associated with the prevalence of depression at baseline. Additionally, a higher NR3C1 methylation level at CpG 2 was associated with depression incidence 2 years later in this population. These findings suggest an association between the methylation of NR3C1 exon 1F, especially at CpG 2, and depression later in life.

Gender differences in the association of cognitive impairment with the risk of hip fracture in the older population

ObjectivesTo test the hypothesis that differences by gender will be observed in the association of hip fracture risk with stages of cognitive impairment; and to explore the association between Petersen’s “mild cognitive impairment” (MCI) and DSM-5 “mild neurocognitive disorder” (MND). Study designA community sample of 4803 individuals aged 55+ years was assessed in a two-phase case-finding enquiry in Zaragoza, Spain, and was followed up for 16 years. Medical and psychiatric history was collected with standardized instruments, including the Mini-Mental Status Examination (MMSE), Geriatric Mental State (GMS), History and Aetiology Schedule, and a Risk Factors Questionnaire.The statistical analysis included calculations of Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. Main outcome measuresIdentified cases of hip fracture, validated by blind researchers. ResultsIn men, hip fracture risk was increased at the “mild” (HR=4.99 (1.39–17.91)) and at the “severe” (HR=9.31 (1.35–64.06)) stages of cognitive impairment, indicated by MMSE performance. In contrast, in women no association could be documented at the “mild stage” (power=89%), and the association disappeared altogether at the “severe stage” in the final multivariate statistical model (power 100%). No association observed between hip fracture and mild cognitive impairment in both men (power=28% for P-MCI) and women (power=44% and 19% for Petersen’s MCI and DSM-5 MND, respectively). ConclusionsIncreased hip fracture risk was associated with “mild” stages of cognitive impairment in men, but not in women. To explore the potential association with the construct MCI or MND, studies with greater statistical power would be required.

Association of Self-Reported Discrimination and Suicide Ideation in Older Chinese Americans

This study examines racial discrimination as a potential novel risk factor for suicide ideation among older Chinese Americans. In a cross-sectional analysis, this study drew on data collected in the Population-based Study of Chinese Elderly in Chicago on Chinese older adults age 60 + in the Greater Chicago area (N = 3,157). Thirty-day suicide ideation was a dichotomous variable, derived from items of the Physical Health Questionnaire and the Geriatric Mental State Examination-Version A. Self-reported discrimination was dichotomously coded, based on the Experiences of Discrimination instrument, which asks respondents whether they have ever experienced discrimination in nine situations because of their race/ethnicity/color. About 4.1% of the sample reported 30-day suicide ideation and 21.5% reported discrimination. Self-reported discrimination was significantly associated with suicide ideation before and after adjusting for covariates including sociodemographic characteristics; neuroticism; social relationships; and physical, cognitive and mental health. In the fully adjusted model, those who reported discrimination had 1.9 times higher odds (OR: 1.9; 95% CI: 1.18-3.08; Wald χ2 = 6.9, df = 1, p = 0.01) of suicide ideation than those who did not. Chinese American seniors who reported discrimination had an almost twofold greater odds of 30-day suicide ideation compared with those who did not. Clinicians need to recognize the impact of discrimination on ethnic minority elders. For those who report experiencing discrimination, assessment of suicide risk may be necessary. Efforts to promote civil rights and reduce discrimination may also be a form of primary prevention of suicide.

Elder Self-neglect and Suicidal Ideation in an U.S. Chinese Aging Population: Findings From the PINE Study.

Self-neglect and suicidal ideations are important public health issues among the aging population. This study aims to examine the association between self-neglect, its phenotypes, and suicidal ideation among U.S. Chinese older adults. Guided by a community-based participatory research approach, the Population Study of Chinese Elderly in Chicago (PINE) study is a population-based epidemiological study conducted from 2011 to 2013 among 3,159 Chinese older adults aged 60 years and older in the Greater Chicago area. Self-neglect was assessed by a 27-item instrument, describing five phenotypes with hoarding, poor personal hygiene, unsanitary condition, lack of utilities, and need of home repair. Suicidal ideation was assessed by the ninth item of the Patient Health Questionnaire-9 (PHQ-9) and the Geriatric Mental State Examination-Version A (GMS-A). Logistic regression is utilized to analyze the association. Higher level of self-neglect was found significantly associated with increased risk of self-reported suicidal ideation within 2 weeks (odds ratio 2.97 [1.54-5.72]); 12 months (odds ratio 2.82 [1.77-4.51]); and lifetime (odds ratio 2.74 [1.89-3.95]). For phenotypes, the study found that poorer personal hygiene and severer level of unsanitary conditions were associated with increased risk of suicidal ideation at all three time periods. This study suggests that self-neglect and its phenotypes are significantly associated with suicidal ideation among Chinese older adults. Longitudinal studies are needed to explore the mechanisms through which self-neglect links with suicidal ideation.

Potential Value of Impaired Cognition in Stroke Prediction: A U.K. Population-Based Study.

ObjectivesTo determine whether the association between impaired cognition and greater risk of incident stroke is also observed when cognitive impairment is defined using different criteria for mild cognitive impairment (MCI).DesignProspective cohort study with 10 years of follow‐up.SettingLarge multicentre study in the United Kingdom.ParticipantsIndividuals (aged 64–105) from the Medical Research Council Cognitive Function and Ageing Study (N = 13,004). From this, a subsample of 2,640 individuals was selected based on age, center, and cognitive ability to undergo a detailed cognitive assessment.MeasurementsInformation on sociodemographic characteristics, health, cognition, and functional ability was collected in an interview. The Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy and the Cambridge Cognitive Examination were used to determine cognitive status. Stroke incidence was derived from self‐report, informant report, and death certificates. Participants were divided into no, mild, moderate, and severe cognitive impairment according to their baseline Mini‐Mental State Examination (MMSE) score. MCI criteria were used to classify persons into four groups: no cognitive impairment, MCI, severe impairment (i.e. other cognitive impairment no dementia: OCIND) and dementia.ResultsOver 10 years, 703 incident strokes occurred. Lower MMSE score at baseline was associated with greater risk of incident stroke. When cognitive status was determined according to MCI criteria, those with severe impairment (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0–2.2) and dementia (OR = 2.6, 95% CI = 1.6–3.4) had a significantly greater risk of stroke than those with no cognitive impairment.ConclusionCriteria for MCI, defined using MMSE scores or clinical criteria, can capture individuals at greater stroke risk. The results highlight the need to focus on stroke risk in individuals even with MCI.

The association between subjective memory complaint and objective cognitive function in older people with previous major depression.

The goal of this study is to investigate associations between subjective memory complaint and objective cognitive performance in older people with previous major depression–a high-risk sample for cognitive impairment and later dementia. A cross-sectional study was carried out in people aged 60 or over with previous major depression but not fulfilling current major depression criteria according to DSM-IV-TR. People with dementia or Mini-Mental State Examination score less than 17 were excluded. Subjective memory complaint was defined on the basis of a score ≧4 on the subscale of Geriatric Mental State schedule, a maximum score of 8. Older people aged equal or over 60 without any psychiatric diagnosis were enrolled as healthy controls. Cognitive function was evaluated using a series of cognitive tests assessing verbal memory, attention/speed, visuospatial function, verbal fluency, and cognitive flexibility in all participants. One hundred and thirteen older people with previous major depression and forty-six healthy controls were enrolled. Subjective memory complaint was present in more than half of the participants with depression history (55.8%). Among those with major depression history, subjective memory complaint was associated with lower total immediate recall and delayed verbal recall scores after adjustment. The associations between subjective memory complaint and worse memory performance were stronger in participants with lower depressive symptoms (Hamilton Depression Rating Scale score<7). The results suggest subjective memory complaint may be a valid appraisal of memory performance in older people with previous major depression and consideration should be given to more proactive assessment and follow-up in these clinical samples.

Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population.

ObjectiveThis study aimed to investigate the longitudinal effects of anxiety, depression, and their comorbidity on physical disorders and disability in an elderly Korean population.MethodsIn total, 1,204 community-dwelling elders were evaluated at baseline, and of these 909 (75%) were re-assessed two years later. Anxiety and depression were identified at baseline using questions from the community version of the Geriatric Mental State diagnostic schedule (GMS-B3). Participants were assessed for functional disability and for 11 physical disorders both at baseline and at follow-up.ResultsAnxiety alone was associated with the incidence of heart disease, depression alone with the incidence of asthma, and comorbid anxiety and depression with incidence of eyesight problem, persistent cough, asthma, hypertension, heart disease, and gastrointestinal problems. Comorbid anxiety and depression were associated with an increase in the number of physical disorders and the degree of disability during the two-year follow-up, compared to anxiety or depression alone or the absence of anxiety or depression.ConclusionAnxiety, depression, and particularly their comorbidity should be assessed in the elderly population considering their longitudinal effects on physical disorders and disability. Future study is required to determine whether interventions aimed at these disorders can mitigate their impacts.

Associations of Upper Arm and Thigh Circumferences with Dementia and Depression in Korean Elders.

ObjectivePrevious studies have reported an association between weight loss and cognitive impairment. Changes in anthropometric measurements, such as arm and thigh circumferences, are associated with body mass changes and physical activity. Our aim was to investigate the association of upper arm and thigh circumferences with dementia and depression in the community-dwelling elderly population.MethodsIn total, 2,498 community residents aged 65 years or over were clinically assessed for dementia using the Korean version of the Community Screening Interview for Dementia. Depression was also assessed using the Korean version of the Geriatric Mental State Schedule B3. Arm and thigh circumferences were measured. Complex sample logistic regression was performed to evaluate associations of changes in anthropometric measurements with dementia/depression after controlling for other covariates.ResultsIn the adjusted analyses, there was an independent association between dementia and arm circumference (OR=1.12; 95% CI=1.06–1.19). This association was significant in the females (OR=1.12; 95% CI=1.05–1.19) but not in males (OR=1.07; 95% CI=0.93–1.28). The association between dementia and thigh circumference was not significant in the adjusted analysis (OR=1.03; 95% CI=0.99–1.07). No significant association was found between either upper arm or thigh circumference and depression.ConclusionIn the older female Korean population, decreased upper arm circumference was associated with dementia and may represent a biological marker for this condition. This association may be explained by nutritional deficits or decreased physical activity.

Gender differences in the incidence of and risk factors for hip fracture: A 16-year longitudinal study in a southern European population

ObjectivesTo analyze independently in men and women the incidence rate of and risk factors for hip fracture in a southern European population. Illiteracy, dementia, clinically significant depression and disability were factors to receive special emphasis. Study designA community sample of 4803 individuals aged over 55 years was assessed in a two-phase case-finding study in Zaragoza, Spain, and was followed up for 16 years. Medical history and psychiatric history were collected with standardized instruments, including the History and Aetiology Schedule, the Geriatric Mental State (GMS) scale, and a Risk Factors Questionnaire. Operational criteria were used to define covariates, including diagnostic criteria for both dementia and depression.The statistical analysis included calculations of incidence rate, IR; women/men incidence rate ratio (IRR); and Hazard Ratios (HR) in multivariate Cox proportional hazards regression models. Main outcome measuresCases of hip fracture (International Classification of Diseases, WHO) identified in the treating hospitals, validated by blinded researchers. ResultsHip fractures were more frequent among women than men (IRR=3.1). Illiteracy (HR=1.55) and depression (HR=1.44) increased the risk in women, and smoking (HR=2.13) and disability in basic activities of daily living (HR=3.14) increased the risk in men. Dementia was associated with an increased risk in an univariate analysis, but the association disappeared (power=85% in men, 95% in women) when disability was included in the multivariate models. ConclusionsThe IR of hip fractures was three times higher among women. Illiteracy and clinically significant depression among women and active smoking and disability (HR=3.14) among men independently increased the risk, but dementia did not.

Mortality rates in major and subthreshold depression: 10-year follow-up of a Singaporean population cohort of older adults

ABSTRACTObjectives: To investigate the associations of major and subthreshold depression with all-cause, cardiovascular disease and stroke mortality, and the extent to which health behaviour, medical comorbidity and functional disability explained the associations.Methods: A cohort of 1070 persons aged ≥60 with Geriatric Mental State (GMS) diagnoses of major and subthreshold depression, and data on health behaviour (smoking, alcohol, physical activity) and physical comorbidity (hypertension, diabetes, cardiovascular disease, stroke, chronic pulmonary disease, multi-comorbidity and activity of daily living disability) at baseline (15 Feb 2003 - 30 Mar 2004) were followed up on mortality from 1 Jan 2005 to 31 Dec 2012.Results: Major and subthreshold depression was present in 5.1% and 9.9% of the participants at baseline. The all-cause mortality HR adjusted for age, sex, ethnicity and marital status was 1.73 (95% CI, 1.11-2.67) for major depression and 1.38 (95% CI, 0.96-1.97) for subthreshold depression. In hierarchical models, the addition of health behaviour and especially physical comorbidity substantially reduced the HR estimates for all-cause mortality associated with major depression (HR=1.39, 95% CI, 0.89-2.18) and subthreshold depression (HR=0.94, 95% CI, 0.64-1.37). Controlling for the effects of all variables, only major depression was significantly associated with increased cardiovascular disease and stroke mortality (HR=2.10, 95% CI, 1.07-4.11).Conclusions: Both major and subthreshold depression were associated with increased mortality, largely due to hazardous behaviours and physical comorbidity. Only major depression per se was independently associated with excess cardiovascular disease and stroke mortality.

Development of a brief assessment and algorithm for ascertaining dementia in low-income and middle-income countries: the 10/66 short dementia diagnostic schedule

ObjectivesTo develop and evaluate a short version of the 10/66 dementia diagnostic schedule for use in low-income and middle-income countries.DesignSplit-half analysis for algorithm development and testing; cross-evaluation of short-schedule and...

Prevalence of psychotic symptoms among older adults in an Asian population.

Psychotic symptoms are common among older adults and are seen in a wide range of conditions. Most studies examining the prevalence and correlates of psychotic symptoms among older adults have been conducted in Western populations. To address this gap the current study was undertaken to establish the prevalence and correlates of psychotic symptoms and paranoid ideation within a community sample of older adults without dementia in an Asian population. The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. All respondents were assessed using the Geriatric Mental State examination (GMS). Specific questions of the GMS were then used to establish the prevalence of hallucinations and persecutory delusions. A total of 2,565 respondents completed the study giving a response rate of 65.6%. The prevalence of any psychotic symptoms in this population of older adults was 5.2%. The odds of hallucinations and any psychotic symptoms were significantly higher among those of Malay ethnicity, and those who had no formal education. Older adults aged 75-84 years were significantly associated with lower odds of having hallucinations (vs. older adult aged 60-74 years), while homemaker status was significantly associated with lower odds of having any psychotic symptoms. The prevalence of psychotic symptoms among older Asian adults without dementia was higher than that reported from Western countries. Psychotic symptoms were associated with Malay ethnicity, poor cognitive performance and fewer years of schooling, visual and hearing impairment as well as depression and irritability.

Differential mortality rates in late-life depression and subthreshold depression: 10-year follow-up in the community

Background Although the association between depression and excess mortality is well-established, effects of subthreshold depression on mortality are unclear. We compared excess mortality between threshold and subthreshold depression, and investigated risks factors and disease-specific mortality rates according to the depression threshold levels. Methods Cross-sectional and longitudinal analyses of data from 1070 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS). Baseline depression levels (Geriatric Mental State Examination, GMS), chronic medical comorbidity, instrumental activities of daily living (IADL) were related to baseline and 10-year follow-up of differential mortality rates according to depression threshold level. Results The prevalence of late-life subthreshold and threshold depression was 9.9% and 5.1%, respectively; 26.3% of respondents died by the 10-year follow-up, with a mortality rate of 28.2 per 1000 person-years. The risk of mortality increased with age, male gender, lower physical activity, multiple medical comorbidities and IADL-disability, but when stratified according to depression status, none of the variables was statistically significant for the subthreshold depression group. Depression, regardless of threshold levels, increased mortality risk by at least 1.6 folds, with small difference between the two. Cardiovascular mortality risk was significantly increased by 2.17 fold ( P =0.024) in threshold but not subthreshold depression. Conclusion Both subthreshold and threshold depression increase the risk of excess mortality, though it is slightly higher when reaches threshold levels. Subthreshold depression should be regarded as part of the depressive illness spectrum and more emphasis on recognition and timely treatment of this disorder should be considered in clinical practice.

Prevalence and correlates of sleep problems among elderly Singaporeans.

The current study examined the prevalence and correlates of sleep problems among elderly Singaporeans. Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore residents aged 60 years and above (n = 2565). Respondents were screened for sleep problems through a series of questions in the Geriatric Mental State examination. Details on sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression were also collected. Logistic regression analysis was used to explore significant associations between sleep problems, sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression. Overall, 13.7% (n = 341) of older adults reported at least one sleep problem. Of those who reported sleep problems, 69.4% experienced sleep interruption at night, 48.9% reported having difficulty falling asleep, 22.3% reported early morning awakening, and 11.4% had all three problems. Elderly with sleep problems were significantly more likely to have a range of chronic physical conditions and depression and were also significantly less likely to be physically active. Older adults with at least one sleep problem reported significantly greater disability compared to those with no sleep problems. The high probability of comorbid chronic conditions as well as higher disability among those with sleep problems makes this an important area of research.

Prevalence and Correlates of Pain in People Aged 60 Years and above in Singapore: Results from the WiSE Study

Background. Although pain is experienced among people of all ages, there is a need to study its risk factors and impact among older adults. Aims. The study sought to determine the prevalence, sociodemographics, and clinical correlates of pain along with association of pain with disability among older adults in Singapore. Methods. The WiSE study was a comprehensive cross-sectional, single phase, epidemiological survey conducted among the elderly aged 60 years and above and used a nationally representative sample of three main ethnic groups in Singapore: Chinese, Malays, and Indians. The survey administered 10/66 protocol pain questionnaire, sociodemographic questionnaire, health status questionnaire, World Health Organization Disability Assessment Scale (WHODAS 2.0), and Geriatric Mental State (GMS) examination. Results. A total of 2565 respondents completed the study giving a response rate of 65.5%. The prevalence of pain among the elderly aged 60 years and above is 19.5 %. Females, incomplete primary education Indians, and those diagnosed with any chronic health condition were associated with risk of pain and disability. Conclusion. Study findings showed that disability related to pain among the elderly is considerable making it a priority to reduce the morbidity and disability among the elderly with pain.

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 Alzheimer's disease (AD) of mild cognitive impairment (MCI) as diagnosed using DSM-5 (DSM-5-MCI) and Petersen's (P-MCI) criteria. A population representative cohort of 4057 dementia-free individuals 55+ years of age was followed up at 2.5 and 4.5 years in Zaragoza, Spain (ZARADEMP). Using the Geriatric Mental State- AGECAT for assessment, research psychiatrists diagnosed DSM-5-MCI and P-MCI following operationalized criteria. 'Conversion rate' (CR), 'annual conversion rate' (ACR), and incidence rate (IR) were calculated along with incidence rate ratio (IRR) to compare the performance of the intermediate cognitive definitions. At 4.5-year follow-up, in individuals aged 65+ years, ACRs for non-cases, P-MCI, and DSM-5-MCI were 0.8, 1.9 and 3.4, respectively, for global dementia. The IRRs were 2.9 and 5.3 for P-MCI and DSM5-MCI, respectively, being the non-cases the reference category. The corresponding values were slightly lower for AD. Conversion rate to dementia and AD was higher using DSM-5-MCI criteria than using Petersen's criteria. However, prediction of the construct still has some way to go, as most MCI individuals did not convert at 4.5-year follow-up.