Modified Mini Mental State Examination Research Articles

Effects of acute tryptophan depletion on neuropsychological and motor function in Parkinson’s disease

Interactions between the 5-HT system and the dopaminergic system and cholinergic system may be important in determining cognitive function and motor function in Parkinson's disease (PD). Previous studies have shown effects of reducing serotonin function, by acute tryptophan depletion (ATD), on neuropsychological function. In particular, an adverse effect on verbal memory has been demonstrated. This study compared with the effects of ATD on cognitive and motor function in PD and healthy control subjects. The effects of ATD were investigated in a double-blind, placebo-controlled, counterbalanced, cross-over, randomised design in 20 patients with PD and 35 healthy controls matched for age, gender and premorbid IQ. There was a differential group effect of ATD on global cognitive function whereby the mean score on the modified mini mental state examination during ATD was lower than placebo in PD but higher in controls. There was a similar pattern of effects on verbal recognition. In a visual recognition task, ATD improved performance in the PD but not in the control group. In terms of psychomotor speed, there was also a group-specific effect with reduced latency of response during ATD in the PD group but increased latency in the control group. ATD has subtle neuropsychological effects, which differ significantly between PD and healthy control subjects. This suggests that the dopaminergic and cholinergic deficit of PD significantly modulates the effects of serotonin depletion, resulting in positive effects in some domains. Further investigation on the effects of specific serotonin antagonists may be merited in PD.

The Effect of an Educational Program for Persons with Macular Degeneration: A Pilot Study

One in eight Americans aged 65 and older has an eye disease resulting in low vision (National Eye Institute, NEI, 2006). Macular degeneration is the leading cause of vision loss in the United States for persons aged 60 and older (NEI, 2007). Compared to individuals without disabilities, individuals with low vision demonstrate a 15% to 30% higher dependence on others to perform activities of daily living (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002). In addition, low vision can adversely affect a person's quality of life (Brown, 1999; Lamoureux et al., 2007; Scott, Smiddy, Schiffman, Feuer, & Pappas, 1999; Stelmack, 2001; Wolffsohn & Cochrane, 2000). Vision rehabilitation has been shown to improve the performance of everyday activities and to increase the quality of life of people with low vision (Lamoureux, Hassell, & Keeffe, 2004; Lamoureux et al., 2007; Teitelman & Copolillo, 2005). However, a standard of care has not been established for low vision rehabilitation, and most outcome studies have focused on individual, rather than on group, rehabilitation (LaGrow, 2004; Lamoureux et al., 2007; McCabe, Nason, Turco, Friedman, & Seddon, 2000; Pankow, Luchins, Studebaker, & Chettleburgh, 2004; Scanlan & Cuddeford, 2004). The purpose of the pilot study reported here was threefold. First, we sought to pilot-test a new instrument that measures independence in activities of daily living, the Smith's Activity of Daily Living Independence Survey (hereafter Smith's), which is in the early stages of development and is being designed specifically for use with people with low vision. Second, we sought to pilot-test an educational program that has been developed specifically for a low vision population to determine if it needs to be altered to be more effective when used with people with low vision. Third, we wanted to determine if the methodology that we used in the study needed to be revised so that the effects of an educational program on the independence of persons with macular degeneration in everyday activities can be more effectively determined by identifying factors that may affect the strength of any treatment effect. The research hypothesis was this: Individuals with low vision who receive the educational program will demonstrate higher change scores in independence in their activities of daily living than will individuals with low vision who do not receive the educational program. To obtain additional information about the educational program if the research hypothesis was confirmed, the following research question was posed: Which of the six sections of the Smith's was responsible for the overall score of the Smith's being statistically significant? METHOD Design and participants The pilot study used a quasi-experimental pretest-posttest research design with a nonequivalent comparison group. Participants, both men and women aged 55 and older, were recruited from the Lighthouse of Houston. All had been diagnosed with macular degeneration and had a moderate to severe level of visual impairment and a score of at least 23 on a modified Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975). The institutional review board of the university with which we are affiliated approved the study. All the participants were read the consent form and then gave written informed consent before taking part in the study. Although 20 persons were recruited from the Lighthouse of Houston, because of attrition there were 16 participants, 8 in the treatment group and 8 in the comparison group. Members of the comparison group chose to be in that group because although they indicated they were interested in attending the educational program, they would not commit six weeks to the study. Procedures After the participants gave informed consent, they completed a modified Mini Mental State Examination (MMSE, Folstein et al. …

Depressive symptoms and associated factors following cerebrovascular accident among Nigerians

Background: Much has been written on post stroke depression in the last 10 years in developed countries. However little is known about this important condition in this environment, thus the need for this study.Aims: This study intends to estimate the prevalence of post stroke depression (PSD) and identify other associated factors.Methods: One hundred and eighteen stroke survivors, managed at a Nigerian Teaching Hospital (mean post stroke survival duration = 11 months) were compared with 118 hypertensive controls using Beck Depression Inventory (BDI) and the modified Mini Mental State Examination (mMMSE). Sociodemographic variables were controlled for.Results: Sixteen (13.6%) control subjects compared with 47 representing 38.8% had significant depressive symptoms. Cognitive deficit, paresis and low education were identified as predictors of depressive symptoms (PSD) among survivors.Conclusion: Physicians need to be alert to this condition, especially since it can be treated and this will improve the quality of life among this group of patients.

Relationship between depression, cognitive function and quality of life of Nigerians with diabetic foot ulcers. A preliminary controlled study

Background. Severe negative effects of diabetic foot ulcers on health related quality of life have been documented in western studies using quantitative and qualitative methods. Aim. The aim of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. Methods. Thirty nine Nigerian adults with diabetes completed the WHO Quality of LifeBrief version (WHOQoL-Bref), modified mini mental state examination (mMMSE) and a rating scale for depression (Beck’s Depression Inventory). There were two matched groups composed of 21 subjects undergoing treatment for diabetic foot ulcers (index) and 18 subjects without foot related morbidity but with evidence of peripheral neuropathy as measured by Semmes-Weinstein 5.07(10 gm) monofilament (control). Results. Patients with diabetic foot ulcers had significantly poorer scores on domains of WHOQoL particularly in physical, psychological, overall quality of life and overall health score. There was evidence of depression in both groups with the index group more significantly depressed. There was no evidence of clinically significant cognitive impairment in either group. There was a relationship between clinical depression and negative effects of diabetic foot ulcer on health related quality of life. Conclusions. The results of this study suggest that the negative impact on healthrelated quality of life in diabetic patients with foot ulcers may be more severe than in diabetics without foot related morbidity. The negative effect did not seem to cause cognitive impairment in either group.

Investigation on the relationship between diabetes mellitus type 2 and cognitive impairment

Objective The incidence of cognitive impairment is increasing with age; however, little is known about the role of hyperglycemia in cognitive impairment. This study focuses on investigating the relationship between diabetes mellitus type 2 and cognitive impairment. Methods 60 diabetic patients, amongst whom, 30 had a well-controlled diabetes status and the other 30 had not. These patients were compared to 60 non-diabetic controls whose age, sex and educational class matched with the individuals of the first group. Patients with important risk factors for cognitive disorders (renal failure, major depressive disorders and psychoactive drug users, cerebrovascular accident history, etc.) were not included in the study. Modified Mini Mental Status examination (mMMSE) was done for all patients by a blinded expert examiner. Results Subjects with diabetes ( n = 60) had lower MMSE score than those without diabetes ( P < .01). Diabetes was also associated with increased odds of cognitive decline as determined by MMSE scores (odds ratio = 1.9; CI = 95%, 1.01–3.6). A significant correlation between duration of disease and cognitive dysfunction was observed, P = 0.001. Also, the same correlation was found for quality of diabetes control, P = 0.002. Conclusion Diabetes mellitus is associated with lower levels of cognitive function.

The Derivation and Validation of the Ottawa 3D and Ottawa 3DY Three- and Four-Question Screens for Cognitive Impairment

Objective: To derive and validate simple screens of 2 to 4 questions to identify cognitive impairment. Design: Cross-sectional database analysis. Setting and Participants: Community-dwelling participants in the Canadian Study of Health and Aging with mild to moderate cognitive impairment (N = 958), or normal cognition (N = 602). Measurements: Cognitive questions not requiring paper, pen, cue cards, props or more than 30 seconds to answer were selected from the Modifi ed Mini-Mental State Examination (3MS). A sequential weighting approach was applied to logistic regression analyses to create scales of equally-weighted questions using the fi rst 2, 3 or 4 questions from the regression equations. Sensitivities and specifi cities were calculated for all cutoffs. Two sets of questions, which approximated the psychometric properties of the 3MS, were validated in a second database. Results: The two tests whose properties approached those of the 3MS (sensitivity 84%, specifi city 62%) were the Ottawa 3D test: Day, Date, DLROW (sensitivity 76%, specifi city 62%) and the Ottawa 3DY test: Day, Date, DLROW, Year (sensitivity 80%, specifi city 61%). Conclusions: The Ottawa 3D and 3DY tests show promising psychometric properties and are easy enough to employ to promote widespread use but must be revalidated in the target groups for which they are intended. The full potential value of the Ottawa 3D and 3DY tests can best be understood in the context of ‘serial trichotomization’ cognitive screening or case-finding algorithms. Dementia researchers focusing on biomarkers and neuroimaging should consider similar trichotomization approaches as these may improve the sensitivities and specificities of their tests.

Cognitive Function, Gait Speed Decline, and Comorbidities: The Health, Aging and Body Composition Study

Emerging evidence indicates an association between cognitive function and physical performance in late life. This study examines the relationship between cognitive function and subsequent gait speed decline among high-functioning older adults. Measures of global cognitive function (Modified Mini Mental State Examination [3MS]) and executive control function (ECF) (a clock drawing task [CLOX 1] and the 15-item Executive Interview [EXIT 15]) were obtained in the Health, Aging, and Body Composition Study in 1999-2000. Gait-speed (meters/second) was assessed over 20 meters at usual pace. Using a mixed model, we assessed the relationship between baseline cognitive function and gait-speed change over 3 years. Two thousand, three hundred forty-nine older adults (mean age 75.6 +/- 2.9 years) completed the assessments. After adjustment for baseline gait speed, a 1-standard-deviation (SD) lower performance on each cognitive test was associated with greater gait-speed decline over 3 years: 0.016 m/s for the 3MS (SD = 8.1), 0.009 m/s for CLOX 1 (SD = 2.4), and 0.012 m/s for EXIT 15 (SD = 4.1) (p <.0005 for all). After adjustment for comorbidities, the effect size was attenuated for 3MS and CLOX 1, and the association for EXIT 15 was no longer significant. Depression score was most strongly associated with the EXIT 15 effect reduction. Global and executive cognitive functions predict declines in gait speed. The association of ECF with gait speed decline is attenuated by comorbid conditions, particularly depression. Elucidation of the mechanisms underlying these associations may point to new pathways for the treatment of physical decline associated with diminished cognitive function.

The effect of androgen deprivation on mini-mental status examination in patients with biochemical recurrence of prostate cancer

15592 Background: Androgen deprivation (AD) is a common treatment option for asymptomatic patients with biochemical recurrence of prostate cancer. Side effects such as sexual dysfunction, hot flashes, fatigue and gynecosmastia have been well documented. However, some of the side effects such as osteoporosis, insulin resistance, hyperglycemia, and anemia have only been recently recognized. The effects of AD on memory are not known. Aim: To determine if there is a decline in cognitive function(CF) in patients on AD using the modified MiniMental Status examination (MMSE). This test was chosen because it was simple, easy to administer and reproducible. Methods: We prospectively enrolled men with biochemical recurrence of prostate cancer prior to initiation of AD and monitored their MMSE at baseline, 2 ,and 4 months and while on AD (Mayo Clinic Jacksonville 8/2004- 9/2006). Results: 38 men were enrolled,however, only 20 men had at least 3 MMSE testing done. (5 withdrew consent, 13 had missing MMSE or lost to followup). The mean age was 68 years, mean baseline MMSE score was 27 and none had a clinical diagnosis of dementia or depression. Comparing the first MMSE and the 2nd MMSE score 19/20 patients had no decline of CF except for one patient who had a transient decline of 5 points in his MMSE score during a period of depression ,however, he had subsequent recovery of his score back to his normal baseline 27. Comparing the first and third MMSE score 20/20 patients had no decline of CF. The mean score change in MMSE score was -1 in 3 patients, 0 in 9 patients, +1 in 4 patients, +2 in 2 patients and +3 in 2 patients. There was no decline of 3 or more points in the mean score in any patient. Interestingly, 2 patients had an 3 point improvement of their MMSE score. We felt that it was secondary to being more familiar to the test process and not due to AD. Conclusions: There is no significant decline in MMSE score in men on AD at 2 and 4 months. MMSE might not be able to detect subtle changes in memory therefore, further study with more sensitive test to discriminate CF decline would be warranted and with longer followup cognitive impairement may be more evident. No significant financial relationships to disclose.

Cognitive Impairment and Quality of Life among Stroke Survivors in Nigeria

The study investigated cognitive impairment and quality of life (QOL) among 109 consecutive stroke survivors and 109 normal controls. Each group comprised 64 (58.7%) men and 45 (41.3%) women. The modified Mini Mental State Examination (mMMSE) and the WHO Quality of Life Questionnaire (WHOQOL-Bréf) indicated that 19 (17.4%) stroke survivors had cognitive deficits (mMMSE score <16) compared with 5 (4.6%) control participants (chi1(2)=4.27, p<.05). Control participants performed significantly better on orientation, language comprehension, laterality, and the WHOQOL-Bréf. Being GHQ-30 positive predicted poor performance on the mMMSE among the stroke survivors and reduced QOL on three of the four domains of the WHOQOL-Bréf. In addition, previous psychiatric illness, paresis, low education, and shorter time elapsed after a stroke predicted reduced QOL on one or more domains of the WHOQOL-Bréf but age and sex of the stroke survivors were not associated with quality of life, and not with cognitive function.

Cognitive Ability and Timed “8-Foot Up-and-Go Test” Performance in the Older Adult

INTRODUCTION: Previous research has demonstrated that exercise improves memory and other cognitive abilities in older adults. Cognitive abilities decline with age, even in the absence of neurological illness or injury. Furthermore, aging may be accompanied with disturbances in gait and postural instability that may be in part the result of a reduction in motor function, thereby reducing physical activity and activities of daily living (ADL's). PURPOSE: To examine the relationship between cognition and the time to complete functional mobility tasks in the older adult. METHODS: Thirty-five community-dwelling older adults, (sixteen males, nineteen females aged 73.7 ± 6.6 years), were measured for performance on the 8-Foot Up-and-Go Test and Modified Mini Mental State Examination (3MS). The 8-Foot Up-and-Go Test assesses the agility/dynamic balance required in many ADL's. The Modified Mini Mental State Exam (3MS) is a brief screening measure of global cognitive function that is sensitive to Alzheimer's disease and assesses memory, attention, and language functioning. RESULTS: A Pearson product moment correlation revealed a significant negative correlation (r = −0.425, p = 0.011) between the 3MS and the 8-Foot Up-and-Go Tests. CONCLUSION: Based on these data, global cognitive function was associated with physical functioning in the older adult. Subsequent research in this area may focus on blood markers and their alteration with improved physical fitness, in an effort to elucidate the mechanism that is intrinsic to the development, connection and repair of neurons in the brain, and thereby ADL's.

Cognitive function and its effects on the quality of life status in the patients with chronic obstructive pulmonary disease (COPD)

The objective of the present study was to determine the relationships between the cognitive function and quality of life in the patients with chronic obstructive pulmonary disease (COPD). Thirty-two patients with stable COPD (mean age 66.7 ± 2.5 years) and 26 healthy community residents (mean age 65.7 ± 7.3 years) were included in the present study. Cognitive status was measured using a modified mini mental state examination (MMSE) and quality of life status using the health survey questionnaire short form-36 (SF-36). The patients with COPD were mildly hypoxemic and their lung function was significantly poorer than in the healthy group ( p = 0.001). The quality of life scores were lower in the patients with COPD than in the healthy subjects ( p = 0.01). Impaired cognitive function in the patients with COPD and healthy subjects was not found (the mean MMSE scores 24.8 ± 2.0 versus 25.4 ± 3.2 for COPD and healthy groups, respectively, p = 0.49). No correlation was found between the SF-36 and MMSE and spirometric values in either of groups ( p > 0.05). In conclusion, the cognitive function of COPD patients with mild hypoxemia may not be impaired in spite of their poor quality of life status.

The trail making test in India

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. Like most neuropsychological tests, it is derived from and primarily applicable to English-speaking individuals. Norms for other ethnic minorities may differ significantly. The application of majority or mixed norms to specific ethnic subcultures may introduce systematic bias. To examine the impact of an English test on primarily nonEnglish-speaking individuals, outpatients attending the dermatology department of a large Indian hospital (n = 120) were asked to complete the English version of the TMT. The time taken to complete the TRAILS was unexpectedly long, although all the subjects scored within normal limits on the modified mini mental status examination and a test for general knowledge. Possible reasons for the delayed completion times are discussed below.

Clinical efficacy and cognitive side effects of bifrontal versus right unilateral electroconvulsive therapy (ECT): A short-term randomised controlled trial in pharmaco-resistant major depression

Background In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less antidepressant efficacy compared with bi(fronto)temporal ECT at certain intensities. Aims To compare the short-term efficacy and side effects of right unilateral ECT and bifrontal ECT. Methods In a double-blind randomised controlled clinical trial, 92 patients diagnosed with pharmaco-resistant major depression received either six right unilateral ECT treatments (250% stimulus intensity of titrated threshold) or six bifrontal ECT (150% of threshold) treatments over a 3-week period. Concomitant psychotropic medications were continued during ECT treatments. The severity of depression and cognitive status was assessed prior to the first ECT and one day after the sixth ECT using the 21-item Hamilton Depression Rating Scale and the modified Mini Mental State Examination. Results Eight patients did not complete the course of the study due to minor side effects or withdrawal of consent. The mean Hamilton Depression score decreased from 27 to 17 points in both groups of 46 patients, resulting in 12 responders (primary endpoint defined as a decrease > 50%) in each patient group (95% confidence interval for the odds ratio from 0.35 to 2.8). There was no reduction in the modified Mini Mental State score (mean score 86 of 100 points). Conclusions Both bifrontal and right unilateral electrode placements in ECT were reasonably safe and moderately efficacious in reducing symptoms of pharmaco-resistant major depression.

Quality of Life and Associated Factors among Adults with Epilepsy in Nigeria

Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE),and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. The mean age of the 51 respondents was 27.7 years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.

Cardiovascular disease and Alzheimer's disease: common links

Growing evidence supports a strong and likely causal association between cardiovascular disease (CVD), and its risk factors, with incidence of cognitive decline and Alzheimer's disease. Individuals with subclinical CVD are at higher risk for dementia and Alzheimer's. Several cardiovascular risk factors are also risk factors for dementia, including hypertension, high LDL cholesterol, low HDL cholesterol and especially diabetes. Moderate alcohol appears to be protective for both CVD and dementia. In contrast, inflammatory markers predict cardiovascular risk, but not dementia, despite biological plausibility for such a link. The substantial overlap in risk factors points to new avenues for research and prevention.

P2-188: Prediction of cognitive impairment among elderly persons using a brief cognitive screening battery

Early detection of cognitive impairment among the elderly is becoming increasingly important. There is a need for brief measures that can reliably predict the presence of clinically significant cognitive impairment. To decipher which brief cognitive tests most reliably predict cognitive impairment, particularly amnestic Mild Cognitive Impairment (aMCI), among elderly persons. Participants aged 70+ with normal baseline cognitive functioning were subsequently administered yearly 30–35 minute cognitive screening batteries, including the Modified Mini Mental State Examination (3MSE), generative verbal fluency (supermarket items), Narratives from the Rivermead Behavioral Memory Test (RBMT), Brief Visuospatial Memory Test, Revised (BVMT–R), Hopkins Verbal Learning Test, Revised (HVLT–R), digit span (DS), and the Geriatric Depression Scale (GDS). When participants' scores on these measures fell below pre–specified cut points, a more expansive dementia evaluation was triggered to assist in diagnosing the presence and extent of cognitive impairment. Scores on the cognitive screening measures were entered into a stepwise logistic regression analysis to predict outcome of the dementia evaluation. The 3MSE, RBMT delay, HVLT–R delay, DS backward, and GDS were identified as significant predictors of normal versus impaired cognitive functioning. However, when participants with normal cognitive functioning were compared only to those with aMCI, the 3MSE and RBMT delay were the only significant predictors. Furthermore, only the 3MSE was identified as a significant predictor of aMCI versus Alzheimer's disease (AD). Brief cognitive screening measures are capable of differentiating between normal and impaired cognitive functioning upon more in–depth cognitive evaluation. The fact that fewer and less diverse measures reliably predicted cognitive impairment when the outcome was narrowed to normal versus aMCI supports the notion that diverse cognitive impairment can result from a variety of factors among the elderly. This finding also highlights the benefit of using certain screening measures to assist in differentiating aMCI from other forms of cognitive impairment. Results of this study further suggest that some measures are not helpful in predicting dementia evaluation outcome. Thus, their utility in triggering a dementia evaluation should be further examined. Overall results of this study have implications for the effective early evaluation and diagnosis of aMCI.

DO ALL PATIENTS WITH MILD COGNITIVE IMPAIRMENT PROGRESS TO DEMENTIA?

DO ALL PATIENTS WITH MILD COGNITIVE IMPAIRMENT PROGRESS TO DEMENTIA?

Validierung eines kurzen telefonischen Tests (T3MS) für die Erkennung kognitiver Störungen

The identification of cognitive impairment in general practice requires short but accurate tests. For epidemiologic surveys and genetic family studies cognitive tests are desirable which can be administered over the telephone. We assessed the ability of a telephone version of the Modified Mini Mental State Examination (T3MS) to identify mild cognitive impairment (MCI) and mild dementia in Alzheimer's disease (AD) and compared it with the diagnostic accuracy of the conventional Mini Mental State Examination (MMSE). The study refers to 34 patients of the outpatient clinic for cognitive disorders of the technical university of Munich of whom 18 had MCI and 16 had mild dementia in AD, respectively. The study also included 14 cognitively unimpaired age-matched probands. The T3MS and MMST were validated against an expert diagnosis base on a comprehensive diagnostic workup. Statistical analysis was performed using the receiver-operator-characteristics (ROC) method. The T3MS outperformed the MMST in the distinction between MCI patients and cognitively unimpaired individuals. In the separation between cognitively unimpaired probands and patients with mild AD the T3MS achieved a sensitivity and specificity of 100 %. The T3MS is a short and practical but accurate telephone test for the identification of mild dementia in AD for use in epidemiological surveys and genetic family studies. The interview achieves higher diagnostic precision than the MMSE and contributes to a valid assessment of cognitive performance. For the identification of mild cognitive impairment, however, the T3MS was less appropriate.

Effects of Acute Tryptophan Depletion on Mood and Cognitive Functioning in Older Recovered Depressed Subjects

<h3>Objective</h3> Previous studies show that acute tryptophan depletion (ATD), by administration of an amino acid drink lacking tryptophan, can produce clinically significant depressive symptoms in subjects who have recovered from major depression. This is more likely in female patients who have had suicidal ideation, recurrent depression, and treatment with specific serotonin reuptake inhibitors. These risk factors are frequent in older recovered depressed people. The authors investigated the effects of ATD on mood and cognitive functioning in this group. <h3>Methods</h3> Sixteen recovered depressed (RD) subjects and 17 healthy-comparison subjects, over 60 years old, participated in a double-blind, placebo-controlled, crossover study involving administration of a tryptophan-depleting and a placebo drink. Mood ratings scales were administered at baseline and at 4 and 7 hours post-drink on each test day. A battery of neuropsychological tests, including the modified Mini-Mental State Examination (MMSE) was administered between 4 and 6 hours post-drink. <h3>Results</h3> Depletion of plasma free tryptophan was 71% at 4 and 7 hours after the active drink. There was no evidence of mood change at any time in either group. On the MMSE, however, the ATD/RD group showed a significant decrease compared with placebo. <h3>Conclusions</h3> There was no evidence of mood disturbance during ATD in any subject. This may imply less sensitivity to acute disturbance of the 5HT system than in younger recovered patients.

Effects of Acute Tryptophan Depletion on Mood and Cognitive Functioning in Older Recovered Depressed Subjects

Previous studies show that acute tryptophan depletion (ATD), by administration of an amino acid drink lacking tryptophan, can produce clinically significant depressive symptoms in subjects who have recovered from major depression. This is more likely in female patients who have had suicidal ideation, recurrent depression, and treatment with specific serotonin reuptake inhibitors. These risk factors are frequent in older recovered depressed people. The authors investigated the effects of ATD on mood and cognitive functioning in this group. Sixteen recovered depressed (RD) subjects and 17 healthy-comparison subjects, over 60 years old, participated in a double-blind, placebo-controlled, crossover study involving administration of a tryptophan-depleting and a placebo drink. Mood ratings scales were administered at baseline and at 4 and 7 hours post-drink on each test day. A battery of neuropsychological tests, including the modified Mini-Mental State Examination (MMSE) was administered between 4 and 6 hours post-drink. Depletion of plasma free tryptophan was 71% at 4 and 7 hours after the active drink. There was no evidence of mood change at any time in either group. On the MMSE, however, the ATD/RD group showed a significant decrease compared with placebo. There was no evidence of mood disturbance during ATD in any subject. This may imply less sensitivity to acute disturbance of the 5HT system than in younger recovered patients.