OBSERVATIONAL SCALE AND GERIATRIC DEPRESSION SCALE OF YESAVAGE TO IDENTIFY DEPRESSIVE SYMPTOMS IN OLDER PATIENTS

Executive dysfunction assessed by Clock-Drawing Test in older non-demented subjects with metabolic syndrome is not mediated by white matter lesions

AIMS

Metabolic syndrome (MetS) has been associated with greater occurrence of white matter hyperintensities (WMH). It remains uncertain whether MetS as a construct is associated with poorer cognitive performances. This study explores whether MetS is associated with poorer performances in global and domain-specific cognitive tests in older non-demented subjects independently of its individual components, WMH severity and other variables.

METHODS

MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III definition. Brain magnetic resonance studies (1.5T) were performed. Deep and periventricular WMH were graded using the Fazekas scale. Subjects underwent the Mini-Mental State Examination, the Babcock Short Story Recall test and the Clock-Drawing Test (CDT).

RESULTS

Eighty community-dwellers aged 67-91 years were studied. Subjects with MetS (n = 35) had more severe WMH, and poorer performances on the CDT (P = 0.003) and the Babcock Short Story Recall test (P = 0.027). After multiple adjustment, MetS was inversely associated with CDT scores (B = -1.285; 95% confidence interval = -1.996--0.575; P = 0.001) but not with episodic memory. Results were not affected by WMH severity. Interestingly, none of the individual components of MetS predicted poorer cognitive performances.

CONCLUSIONS

Impairment in executive functions assessed by CDT may represent an early and specific sign of cognitive decline in older individuals with MetS. Future longitudinal studies are needed to better establish the predictive role of MetS on dementia and to demonstrate the possibility of dementia prevention by targeting MetS.

Processing of the platelet amyloid precursor protein in the mild cognitive impairment (MCI)

It has been suggested that mild cognitive impairment (MCI) patients deteriorate faster than the healthy elderly population and have an increased risk of developing dementia. Certain blood molecular biomarkers have been identified as prognostic markers in Alzheimer's disease (AD). The present study was aimed to assess the status of the platelet amyloid precursor protein (APP) metabolism in MCI and AD subjects and establish to what extent any variation could have a prognostic value suggestive of predictive AD in MCI patients. Thirty-four subjects diagnosed with MCI and 45 subjects with AD were compared to 28 healthy elderly individuals for assessing for protein levels of APP, β-APP cleaving enzyme 1 (BACE1), presenilin 1 (PS1) and a disintegrin and metalloproteinase-10 (ADAM-10) by western blot, and for the enzyme activities of BACE1 and γ-secretase by using specific fluorogenic substrates, in samples of platelets. A similar pattern in the healthy elderly and MCI patients was found for BACE1 and PS1 levels. A reduction of APP levels in MCI and AD patients compared with healthy elderly individuals was found. Augmented levels of ADAM-10 in both MCI and AD were displayed in comparison with age-matched control subjects. The ratio ADAM-10/BACE1 was higher for the MCI group versus AD group. Whereas BACE1 and PS1 levels were only increased in AD regarding to controls, BACE1 and γ-secretase activities augmented significantly in both MCI and AD groups. Finally, differences and similarities between MCI and AD patients were observed in several markers of platelet APP processing. Larger sample sets from diverse populations need to be analyzed to define a signature for the presence of MCI or AD pathology and to early detect AD at the MCI stage.

Dependence of the geriatric depression scores on age, nutritional status, and haematologic variables in elderly institutionalized patients

OBJECTIVE

To evaluate the relationships between depression and ageing, nutrition, and selected haematologic variables.

MEASUREMENTS

A cross-sectional study was performed in elderly institutionalized patients (n=100) of all nursing homes in the Brazilian city of Uberlandia, with determination of the Geriatric Depression Scale (GDS) and the Mini-Nutritional Assessment (MNA) scores, and selected haematologic variables.

RESULTS

GDS had a significant negative dependence with the MNA for the entire institutionalized population. The prevalence of depression was higher among females, but significant correlations existed between GDS scores and erythrocytes counts, haemoglobin levels, or haematocrit values for the males only. However, a borderline correlation existed between GDS and the mean corpuscular volume (MCV) values in the females.

CONCLUSIONS

Depression was associated with worsening of nutritional status and the degree of anemia of the entire elderly population and the male, but not the female subjects. The borderline correlation observed between the GDS and MCV for the female subjects suggests that the nutritional deficiencies responsible for the MCV increase are a cause, and not an effect, of depression.

Late life psychosis: assessment and general treatment strategies

With the increased number of elderly patients suffering from mental illness, an increased incidence of psychiatric conditions including psychotic disorders is also expected. When psychosis occurs in the elderly, its assessment and treatment may pose a challenge for primary care clinicians and caregivers. This article will review the assessment and treatment of late life psychosis.

Differences of peripheral inflammatory markers between mild cognitive impairment and Alzheimer's disease

Multiple pathogenic factors may contribute to the pathophysiology of Alzheimer's disease (AD). Peripheral markers have been used to assess biochemical alterations associated with AD and mild cognitive impairment (MCI) involved in its pathophysiology. The present study was conducted to evaluate inflammatory peripheral markers in elderly patients with MCI, patients with AD and normal elderly subjects. We measured plasma levels of different cytokines (IL-6, TNF-alpha and IFN-alpha) and platelet levels of cyclooxigenase-2 (COX-2) from 34 patients with MCI, 45 patients with AD and 28 age-matched control subjects. MCI and AD patients showed similarities in TNF-alpha and COX-2 levels, and differences in IL-6 and INF-alpha. Whereas augmented IL-6 levels have been found in AD patients, a significant increase in INF-alpha has been detected only in patients with MCI possibly associated with the depression stage frequently found in cognitive impairment. In conclusion, inflammatory response may be an early factor in AD development and these changes in circulating markers are possibly related to the progression of MCI to AD.