Prevalence Of Significant Depressive Symptoms Research Articles

Supplemental Nutrition Assistance Program and depressive symptoms among adults with low family income in the U.S.: The National Health and Nutrition Examination Survey 2011–2018

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) has been established to reduce food insecurity. Limited evidence is available on SNAP participation status over time and depressive symptoms. We aimed to examine the associations of SNAP status over time among low-income individuals, with depressive symptoms in the U.S. MethodsNHANES participants aged ≥20 years of low family income from 2011 to 2018 with information available on depressive symptoms and SNAP use were included in analysis. Depressive symptoms were assessed using 9-item Patient Health Questionnaire (PHQ-9), and PHQ-9 score ≥ 10 is indicative of significant depressive symptoms. Multivariable linear and logistic regressions models were conducted to examine the associations of SNAP participation status over time (never receiving SNAP, receiving SNAP prior to >12 months ago, current receiving SNAP, receiving SNAP in the last 12 months but not currently) with depressive symptoms and significant depressive symptoms. ResultsCurrently receiving SNAP (beta (β) = 0.17, 95 % CI: 0.10, 0.25; odds ratio (OR) = 1.52, 95 % confidence interval (CI): 1.16, 2.00) and receiving SNAP in the last 12 months but not currently (β = 0.24, 95 % CI: 0.04, 0.43; OR = 1.83, 95 % CI: 1.16, 2.89) were associated with higher depressive symptoms and higher prevalence of significant depressive symptoms. LimitationsThe cross-sectional design precludes causal interpretation, and key variables were measured with self-report. ConclusionReceiving SNAP in the last 12 months was associated with higher levels of depressive symptoms among individuals with low family income. Improvement on diet quality may be important for reducing depressive symptoms among SNAP users.

Depressive symptoms in younger adults before and during the COVID-19 pandemic: A nationally representative cross-sectional data analysis

ObjectiveSeveral studies have reported an increased prevalence of depressive symptoms during the coronavirus disease 2019 (COVID-19) pandemic. However, the prevalence of significant depressive symptoms and its associated factors in younger adults remain uncertain. We aimed to investigate this association during the COVID-19 pandemic and make a comparison with the pre-pandemic period. MethodsCross-sectional data from the 2018 and 2020 Korea National Health and Nutrition Examination Surveys were analyzed, and 3281 respondents aged 19–40 years were included. We defined a Patient Health Questionnaire-9 score ≥ 10 as significant depressive symptoms and the categories of depressive symptoms were also classified as none, mild, moderate, and severe. ResultsThe prevalence of significant depressive symptoms was higher in the pandemic group (7.4% vs. 4.7%). Furthermore, the prevalence in the pandemic group was higher for all degrees: mild, moderate, and severe depressive symptoms. A multivariable logistic regression indicated that significant depressive symptoms during the pandemic was significantly associated with female sex, low educational attainment, unemployment, chronic medical disease, and being overweight. ConclusionsOur findings suggest an increase in depressive symptoms in younger adults during the pandemic. It is necessary to develop policies to provide younger adults with resources to cope with depressive symptoms related to COVID-19 and potential global outbreak of infectious disease.

Profiles of Depressive Symptoms Among Men Who Have Sex With Men and Transgender Women During the COVID-19 Outbreak in Mexico: A Latent Class Analysis.

The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.

Profiles of Depressive Symptoms Among Men Who Have Sex With Men and Transgender Women During the COVID-19 Outbreak in Mexico: A Latent Class Analysis

[enter Abstract Body]The impact of the COVID-19 outbreak on mental health among HIV high-risk populations is not known. We assess the prevalence of depressive symptoms (DS) and explore the association with characteristics related to the COVID-19 pandemic. We conducted an online survey among 881 men who have sex with men (MSM) and transgender women (TGW) assessing the presence of DS using the Center for Epidemiological Studies Depression Scale (CESD-10); results were compared with previously self-reported DS and national data. We applied latent class analysis (LCA) to identify classes of participants with similar COVID-19 related characteristics. The overall prevalence of significant DS was 53.3%. By LCA posterior probabilities we identified three classes: (1) minimal impact of COVID-19 (54.1%), (2) objective risk for COVID-19 (41.5%), and (3) anxiety and economic stress caused by COVID-19 (4.4%). Multivariate logistic regression showed that compared with those in class one, the odds to have significant DS were almost five times higher for those in class three. Our findings suggest high levels of depression among MSM and TGW in Mexico during the COVID-19 pandemic and highlight the need for the provision of targeted psychological interventions to minimize the impacts of COVID-19 on the mental health.

Conception by means of in vitro fertilization is not associated with maternal depressive symptoms during pregnancy or postpartum

To study whether conception by means of invitro fertilization (IVF) is associated with maternal depressive symptoms during pregnancy or postpartum. Longitudinal observational study. University hospital. A total of 3,283 women with singleton pregnancies receiving antenatal care and delivering in Uppsala from 2010 to2015. A web-based self-administered structured questionnaire including sociodemographic, clinical and pregnancy-related items, and the Edinburgh Postnatal Depression Scale (EPDS) was delivered at 17 and 32 gestational weeks and at 6weeks and 6months postpartum. Prevalence of significant depressive symptoms (EPDS ≥12) and EPDS scores. A total of 167 women (5%) had conceived via IVF and 3,116 (95%) had a spontaneous pregnancy. IVF mothers were more frequently ≥35years of age (46.1% vs. 22.6%) and primiparous (71.7% vs. 49.9%) and had a higher cesarean delivery rate (22.4% vs. 14.2%). Demographic and clinical characteristics were otherwise similar between the two groups. Significant depressive symptoms were reported by 12.8%, 12.4%, 13.8%, and 11.9% of women at 17 and 32 gestational weeks and 6weeks and 6months postpartum, respectively. The prevalence of depressive symptoms and the EPDS scores during pregnancy and postpartum were similar between women conceiving spontaneously or through IVF. The mode of conception was not associated with significant depressive symptoms at any time point, even when adjusting for several possible confounders in multivariable logistic regression analysis. Despite the psychologic distress characterizing subfertility and its treatment, conception by means of IVF is not associated with maternal depressive symptoms during pregnancy or postpartum.

Mental health of Japanese psychiatrists: the relationship among level of occupational stress, satisfaction and depressive symptoms.

BackgroundPsychiatrists in clinical practice face a number of stressors related to patient care, such as overwork. On the other hand, they gain satisfaction from their work. We quantified and assessed the potential relationship between levels of occupational stress, satisfaction, and depressive symptoms among Japanese clinical psychiatrists. We surveyed 206 psychiatrists with up to 15 years of clinical experience who primarily worked in patient care. Levels of occupational stress and occupational satisfaction were measured using the Visual Analogue Scale and the level of depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Workplace stressors and satisfiers were also evaluated.ResultsOut of 206 psychiatrists, 154 (74.8%) responded to the survey. The respondents’ mean (SD) age was 34.3 (5.2) years. The estimated prevalence of significant depressive symptoms was 34.4% (n = 53), and the experienced frequent violence was 14.9% (n = 23). The level of depressive symptoms was inversely correlated with the level of occupational satisfaction. In respondents who reported a moderate level of occupational stress, having fewer depressive symptoms was associated with higher occupational satisfaction, but this association was not significant in those who reported a high level of stress. In addition, high occupational satisfaction was associated with interest towards work content, ability to work at one’s discretion, opportunities for growth and career development, and ease of communication with supervisors and colleagues.ConclusionsNearly one-third of the psychiatrists screened positive for significant depressive symptoms. Having fewer depressive symptoms was associated with higher occupational satisfaction in those who reported a moderate level of stress. Implications from the present findings may be to enhance occupational satisfaction by discussing work interests with a supervisor, as well as increased opportunities for career development, which may prevent depression among psychiatrists.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1054-7) contains supplementary material, which is available to authorized users.

Depression, social support and associated factors among women living in rural China: a cross-sectional study.

BackgroundFew studies have focused on depression and social support in Eastern populations, especially women in rural China. Our research investigated depression among women in rural China, and studied the relationships between social support and depression.MethodsWe recruited women ages 16 years and older from north Sichuan. Participants completed socio-demographic measures, the Center for Epidemiologic Studies Depression Scale, and the Duke Social Support Index. The analysis method included descriptive statistics and logistic regression.ResultsThe final sample included 1,898 participants with a mean age of 48.6 years, and the prevalence of significant depressive symptoms was 12.4%. Results suggest being unemployed, having poorer perceived health/economic status, and lower social support were positively associated with depression. Younger age and greater social support were negatively associated with depression.ConclusionsThis study provides insights on the psychological health of women in rural China and potential directions for future research. These issues are especially pertinent during this time of rapid economic transformation and outmigration in rural China.

Efficacy of an evidence-based ARV adherence intervention in China.

We designed a randomized controlled trial of a home based intervention to improve antiretroviral adherence and to assess the impact of depressive symptoms among people living with HIV in Hunan, China. At baseline, 110 subjects reported taking 90% or less of prescribed medication. At 6 months, when the intervention ended, 56% of subjects in the control and 87% of subjects in the experimental group were adherent. This difference was maintained at 12 months. In multivariate analyses, controlling for baseline visual analogue adherence scale, stigma, social support, and Center for Epidemiological Studies Depression scale, the experimental group had a significantly higher proportion of people who were adherent (p=0.009). The high prevalence of significant depressive symptoms (67%) at baseline is of concern. It is of particular importance that future studies look at the types of depression likely to be seen in these patients and differentiate early between those likely to benefit from HIV-related support and those who will require additional depression-targeted interventions.

Prevalence of depressive symptoms among elderly in the city of Tremembé, Brazil: preliminary findings of an epidemiological study.

Depression is a heterogeneous mental disease classified as a set of disorders, which manifest with a certain duration, frequency and intensity. The prevalence of depression in the elderly ranges from 0.5 to 16%.OBJECTIVETo establish, in an epidemiological study, the prevalence of significant depressive symptoms in the population aged 60 years or older.METHODSResults of a cross-sectional epidemiological study, involving home visits, being carried out in the city of Tremembé, Brazil, were reported. The sample was randomly selected by drawing 20% of the population over 60 years from each of the city's census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, the Cornell scale and the Patient Health Questionnaire for psychiatric symptoms. Scores greater than or equal to 8 on the Cornell scale were taken to indicate the presence of depressive symptoms.RESULTSA total of 455 elders were assessed, and of these 169 (37.1%) had clinically significant depressive symptoms (CSDS). Depression prevalence was higher among women (p<0.001) and individuals with lower education (p=0.033). The Chi-square test for trends showed a significant relationship where lower socioeconomic status was associated with greater likelihood of depressive symptoms (p=0.005).CONCLUSIONThe prevalence of depressive symptoms was high in this sample of the population-based study and was associated with female gender, low educational level and socioeconomic status. The assessment of the entire population sample must be completed.

Prevalence and associated behavioral symptoms of depression in mild cognitive impairment and dementia due to Alzheimer's disease

Mild cognitive impairment (MCI) is a clinical concept that categorizes subjects who are in an intermediate cognitive state between normal aging and dementia. The aims of this study are to determine the prevalence of significant depressive symptoms in MCI and Alzheimer's disease (AD) patients and to characterize the behavior associated with significant depressive symptoms in MCI and AD patients. A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms of dementia and MCI was performed. The study population consisted of 270 MCI and 402 AD patients. Behavioral assessment was performed by means of Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cohen-Mansfield Agitation Inventory. The presence of significant depressive symptoms was defined as a Cornell Scale for Depression in Dementia total score >7. The prevalence of significant depressive symptoms in AD patients (25%) was higher compared with MCI patients (16%) (p = 0.005). Patients with significant depressive symptoms showed an increased severity of frontal lobe symptoms, behavioral symptoms and agitation (Middelheim Frontality Score, Behave-AD and Cohen-Mansfield Agitation Inventory total scores; p < 0.001). Also, most of the individual frontal lobe and behavioral symptoms were more prevalent and severe, resulting in higher Behave-AD global scores. Mild cognitive impairment patients with depressive symptoms showed more severe behavioral symptoms and more severe verbally agitated behavior than AD patients without depressive symptoms (p < 0.001). Frontal lobe and behavioral symptoms are more prevalent and severe in MCI and AD patients with significant depressive symptoms as compared with patients without depressive symptoms.

Depressive Symptoms Among Older Adults in Mexico City

Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries. To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider. Cross-sectional, multistage community survey. A total of 7,449 persons aged 60 years and older. Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire. The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2). According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations

Objective This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations ( n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment. Method One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use. Results Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score ≥8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score ≥8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. Conclusions These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.

Depression in survivors of burn injury: a systematic review

Background The objective of this study was to systematically review the prevalence, persistence, and risk factors for depression postburn injury. Methods A search of the MEDLINE, CINAHL, and PsycINFO databases was conducted in June 2006 to identify studies that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals and references of identified articles and reviews. Results Major depression was identified in 4% to 10% of adult patients using structured interviews in hospital and in the year following discharge. The prevalence of significant depressive symptoms in studies that used the depression subscale of the Hospital Anxiety and Depression Scale post discharge was 4% to 13%, whereas studies that used the Beck Depression Inventory generally produced substantially higher rates: between 13% and 26% for “moderate to severe” symptoms and between 22% and 54% for at least “mild” symptoms. Conclusions The general low quality of studies reviewed suggests the need for future studies using larger sample sizes to adequately assess prevalence rates and risk factors. No existing studies have addressed the persistence of depression in burn survivors; there are no treatment studies; and there are no recent studies of children.

Course of Depressive Symptoms After Myocardial Infarction and Cardiac Prognosis: A Latent Class Analysis

The presence of depressive symptoms after myocardial infarction (MI) is a risk factor for new cardiovascular events. The importance of the course of post-MI depressive symptoms for cardiac prognosis is not clear. We therefore set out to investigate whether different courses of post-MI depressive symptoms can be identified and determine their associations with cardiac events. Data were derived from the Depression after Myocardial Infarction (DepreMI) study, a naturalistic follow-up study of patients admitted for an MI in four hospitals in The Netherlands (N = 475). Scores on the Beck Depression Inventory (BDI) during hospitalization and at 3, 6, and 12 months post-MI were analyzed. Using latent class analysis (LCA), we identified classes characterized by distinctive courses of depressive symptoms and then examined their link to cardiac prognosis. The prevalence of significant depressive symptoms ranged from 22.7% to 25.5% throughout the post-MI year. Five distinct courses were found: no depressive symptoms (56.4%), mild depressive symptoms (25.7%), moderate and increasing depressive symptoms (9.3%), significant but decreasing depressive symptoms (4.6%), and significant and increasing depressive symptoms (4.0%). Subjects in this last class had, statistically, a significantly higher risk for a new cardiovascular event compared with subjects without depressive symptoms (hazard ratio (HR) = 2.73; p = .01). Controlling for baseline cardiac status and sociodemographic data did not alter the association (HR = 2.46; p = .03). Post-MI depressed subjects with significant and increasing depressive symptoms are at particular risk of new cardiac events. This subgroup may be most suited for evaluation of the effects of antidepressant treatment on cardiac prognosis.

Affective Distress and Amputation-Related Pain Among Older Men with Long-Term, Traumatic Limb Amputations

Psychological distress and postamputation pain were investigated in a sample of 582 males with long-term limb amputations (mean time since amputation 639.3 months, standard deviation 166.1; range 240–784 months). Prevalence of significant depressive symptoms (Hospital Anxiety and Depression Scale [HADS]-D score ≥ 8) was 32.0%, and 34.0% of respondents met the screening criterion for clinical anxiety (HADS-A score ≥ 8). Nearly one quarter (24.6%) of respondents reported significant post-traumatic psychological stress symptoms (Impact of Event Scale scores ≥ 35). In total, 87.8% experienced either phantom or residual limb pain. Affective distress scores differed according to the respondents' type of pain experience. Respondents who experienced residual limb pain reported significantly higher affective distress scores than those with no phantom or residual limb pain. Many older individuals with long-term traumatic limb amputations could benefit from interventions to ameliorate affective distress and appropriate residual limb pain treatment.

Prevalence of depression in survivors of acute myocardial infarction

To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded if only an abstract was provided, if not in English, or if depression was not measured by a validated method. Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points. Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms.

The prevalence of depressive symptoms among elderly Chinese private nursing home residents in Hong Kong.

Privately-owned Nursing homes (PNH) in Hong Kong present a unique setting of institutional care where elderly with the whole spectrum of health status live together. This cross-sectional descriptive study aimed to determine the prevalence of significant depressive symptoms in a group of Cantonese-speaking Chinese private nursing home elderly living in Hong Kong, and to identify associated psychosocial and health factors. METHODOLOGICAL RESULTS: Two hundred and forty five residents fulfilled the inclusion criteria. Using the Chinese version of the Geriatric Depression Scale--Short Form (GDS-SF), we detected significant depressive symptoms in 29% of subjects. Univariate analysis revealed some associated socio-economic risk factors including current non-Comprehensive Social Security Assistance (CSSA) recipients, education levels and low abilities for social activities. Low vision, swallowing difficulties and low levels of basic activities of daily living (BADL) as reflected by the total Modified Barthel Index of less than 61 were important health predictors. Depression was also associated with features of self-perception of financial inadequacy, life dissatisfaction, poor self-perceived health, poor attitudes towards living arrangement and suicidal thoughts. Stepwise logistic regression identified swallowing problems, current non-CSSA recipient and low BADL ability as independent risk factors. The high prevalence of depressive symptoms in the nursing home elderly requires the attention of Government authorities, health care and social service providers.

Prevalence, incidence and correlates of depression in the oldest old: The OCTO study

While there has been extensive research on depression in later life, few studies have focused on the prevalence of symptoms and patterns of change over time among the oldest old. This paper reports on a longitudinal study of a population-based sample of older people initially aged 84 to 90. Participants were interviewed at two-year intervals over a six-year period of time. From an initial population base of 400, 324 people participated in the initial survey, 254 of whom provided information on depressive symptoms. Using a short form of the CES-D we found prevalence of significant depressive symptoms to range between 43 and 50% for the four times of measurement. Incidence of clinically significant symptoms ranged between 9 and 16% between measurement periods, while some people who were previously depressed showed improvement. A multivariate model indicated that depressive symptoms were related to functional impairments and disabilities but these effects were mediated by mastery beliefs. These findings indicate that depressive symptoms affect a somewhat higher proportion of the population in very late life than among the young old, but there is evidence of recovery and that psychological resources mediate the impact of impairment and disability on mood. Treatment strategies which enhance psychological resources such as mastery may reduce the impact of disability on mood, and may even have a preventive role.

Factors associated with depressive symptoms in non-demented community-dwelling elderly

We examined the risk for depressive symptoms associated with age, education, ethnicity, gender, marital status, apolipoprotein E genotype (APOE) and memory complaints among non-demented elderly (> or = 60 years). Cross-sectional study of geriatric patients recruited from a free memory screening offered to the community. This investigation included 506 community-residing elderly subjects who were screened for cognitive impairment and classified as non-demented based on age and education-adjusted Folstein Mini-Mental State Exam (MMSAdj) scores of 24 or greater. The prevalence of significant depressive symptoms (Hamilton Depression Rating Scale > or = 12) was 12.1% (N = 61). Increased risk for depression was associated with female gender (OR = 2.3; 95% CI = 1.1-4.8; p < 0.05), Cuban American ethnicity (OR = 4.9; 95% CI = 2.3-10.4; p < 0.0001) and memory complaints (OR = 1.3; 95% CI = 1.2-1.4; p < 0.0001). The APOE allele frequencies in the current sample were 0.07, 0.80 and 0.13 for the epsilon 2, epsilon 3 and epsilon 4 alleles, respectively. The results suggest that signs and symptoms of depression are common among non-demented elderly subjects in the community. In this study, mood disturbances were associated with Cuban American ethnicity, female gender and more memory complaints. Factors that were not confirmed by this study include age, education, marital status and APOE genotype. The observed APOE, epsilon 4 allele frequency of 0.13 supports the normal cognitive classification of the sample.