Selective reminding procedure in depression and dementia

Neuropsychological Performance in Alzheimer's Disease versus Late-Life Depression: A Systematic Review and Meta-Analysis

OBJECTIVE

Despite decades of research, neuropsychological tests (NPTs) that clearly differentiate between Alzheimer's disease (AD) and late-life depression (LLD) have yet to be agreed upon. Given this gap in knowledge and the rapid deployment of disease-modifying drugs for the two disorders, accurate clinical diagnosis using evidence-based assessment is essential. This study aims to systematically examine the literature to identify NPTs that would be able to differentiate AD and LLD.

METHOD

Databases and bibliographies were searched to identify articles for analysis. Two major inclusion criteria were that the studies compared neuropsychological functioning of AD versus LLD using normed NPTs and provided data for effect size calculation. Risk of bias was minimized by having independent coders for all steps in the review.

RESULTS

Forty-one studies met inclusion criteria (N = 2,797) and provided effect sizes for tests that were classified as belonging to 15 domains of functioning. The two groups were well differentiated by tasks of delayed contextual verbal memory as compared to immediate or non-contextual memory, recognition cueing, confrontation naming, visuospatial construction, and conceptualization. Specific NPTs that appear to be useful for differential diagnosis include the Rey Auditory Verbal Learning Test-Delayed Recognition; Boston Naming Test; the Dementia Rating Scale's memory, conceptualization, and construction subscales; and the CERAD Constructional Praxis.

CONCLUSIONS

The NPTs highlighted in this systematic review could be used as a relatively simple and cost-effective method to differentiate between patients with cognitive dysfunction due to AD versus LLD.

Examining the association between late-life depressive symptoms, cognitive function, and brain volumes in the context of cognitive reserve

OBJECTIVE

The present study aimed to investigate whether cognitive reserve moderated the association between depressive symptoms and cognition, as well as brain volumes in a sample of older adults.

METHODS

Non-demented participants (n = 3484) were selected from the Washington Heights/Hamilton Heights Inwood Columbia Aging Project (Northern Manhattan). A subsample of these participants without dementia (n = 703), who had brain imaging data, was also selected for a separate analysis. Depressive symptomatology was assessed with the 10-item Center for Epidemiologic Studies Depression Scale. Reading level and years of education were used as measures of cognitive reserve. Four distinct cognitive composite scores were calculated: executive function, memory, visual-spatial, and language.

RESULTS

Multiple regression analysis revealed interaction effects between both measures of cognitive reserve and depressive symptoms on all the cognitive outcome measures except for visual-spatial ability. Those with greater reserve showed greater cognitive decrements than those with lower levels of reserve as depressive symptoms increased. A borderline interaction effect was revealed between reading level and depressive symptoms on total brain volumes. Those with lower reading scores showed greater volume loss as depressive symptoms increased than those with higher reading scores.

CONCLUSIONS

Our findings indicate that the association between late-life depressive symptoms and core aspects of cognition varies depending on one's level of cognitive reserve. Those that had greater levels of education and/or reading ability showed a greater decrease in memory, executive, and language performances as depressive symptoms increased than those with lower years of education and reading ability.

Neurocognitive Problems in Children and Adolescents With Depression Using the CHC Theory and the WJ-III

Depression has been commonly associated with both subjective complaints and objectively measured problems in cognition. Most commonly discussed in relation to the adult population, growing evidence has supported the idea that children and adolescents experience cognitive problems in relation to depression. The purpose of this study was to further examine the negative influence of depression on the cognitive functioning of children and adolescents. Additionally, the present study evaluated the sensitivity of the Woodcock-Johnson III Test of Cognitive Abilities (WJ-III-COG) and, in turn, the Cattell-Horn-Carroll (CHC) theory in measuring cognitive problems related to depression in children and adolescents. Participants included 420 children and adolescents aged 8 to 18 years old (M = 13.09, SD = 2.95) with a clinical diagnosis of depression. Comparisons were made against the normative mean. All participants completed 11 subtests of the WJ-III-COG including Visual-Auditory Learning, Spatial Relations, Sound Blending, Concept Formations, Visual Matching, Numbers Reversed, Auditory-Working Memory, Picture Recognition, Analysis Synthesis, Decision Speed, and Memory for Words. Children and adolescents with depression demonstrated significantly lower performance on subtests related to learning and memory (long-term retrieval), attentional capacity, working memory, reasoning, and processing speed. No problems were noted on subtests related to visual-spatial thinking and auditory processing. Findings suggested sensitivity of the WJ-III-COG and CHC theory in identifying cognitive problems associated with depression in children and adolescents.

Word reading threshold and mild cognitive impairment: a validation study

Background

It was previously found, in a pilot study, that Word Reading Threshold (WRT) test is abnormally prolonged in individuals with Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI), with high sensitivity and specificity. This validation study examines the WRT test as a prognostic tool in MCI individuals. We wish to confirm in a larger group the sensitivity and specificity of the WRT test and determine whether it is influenced by deterioration on other cognitive domains.

Methods

We measured WRT in 60 MCI individuals, 29 AD patients, and 33 normal elderly control (NE). We followed the MCI individuals over 8 years to monitor who progressed to dementia.

Results

We found a statistically significant difference in WRT scores between the three groups. However, using the same cutoff of 85 milliseconds suggested by Massoud and his colleagues, we found lower diagnostic sensitivity (72%) and specificity (76%) when comparing NC and AD. Furthermore, the test did not clearly differentiate MCI individuals who progressed to dementia from those who did not. WRT was found to correlate to some degree with other cognitive domains, especially attention.

Conclusions

We conclude that the WRT is insufficient alone as a diagnostic tool for prodromal AD.

Reduced hippocampal CA2, CA3, and dentate gyrus activity in asymptomatic people at genetic risk for Alzheimer's disease

Previous functional magnetic resonance imaging (MRI) studies in healthy subjects with the apolipoprotein Eepsilon4 (APOE-4) genetic risk for Alzheimer's disease have shown increased activation during memory task performance in broadly distributed cortical regions. These findings have been hypothesized to reflect compensatory recruitment of intact brain regions that presumably result from subtle neural dysfunction reflecting incipient disease. In this study, we used high-resolution functional MRI in APOE-4 carriers and non-carriers to measure activity in hippocampal subregions (CA fields 1, 2, 3; dentate gyrus [DG], and subiculum) and adjacent medial temporal lobe (parahippocampal and entorhinal) subregions. We found reduced left CA2, CA3, and dentate gyrus (CA23DG) activity in cognitively intact APOE-4 carriers. These results suggest that reduced neural activity in hippocampal subregions may underlie the compensatory increase in extrahippocampal activity in people with a genetic risk for Alzheimer's disease prior to the onset of cognitive deficits.

Distinguishing between depression and dementia in older persons: neuropsychological and neuropathological correlates

Dementia and depression are frequently comorbid among older adult patients. Depression is related to cognitive decrement and can even represent the first signs of a neurodegenerative process. It can be difficult to distinguish depressed patients exhibiting the first signs of dementia from those whose cognition will improve with treatment. In this article, studies from the neuropsychological literature are reviewed that aid in accurate diagnosis and prognosis. Furthermore, the relationship between depression and dementia is explored by examining potential neurobiological mechanisms that may potentiate both syndromes in the context of the ongoing debate on depression as a prodrome and/or a risk factor for dementia. This article is concluded with suggestions for clinicians when deciding who to refer for neuropsychological assessment and with ideas for further research that might promote a better understanding of the complex association between depression and dementia during old age.

Impact of depressed mood on neuropsychological status in temporal lobe epilepsy

OBJECTIVES

Depression is a common psychiatric complication of temporal lobe epilepsy. This study examined the effect of depressed mood on neuropsychological performance among patients with chronic temporal lobe epilepsy.

METHODS

Seventy consecutive surgery candidates for medication resistant complex partial seizures of unilateral temporal lobe origin were assessed for psychiatric symptoms and underwent comprehensive neuropsychological assessment.

RESULTS

Standardised psychiatric interview disclosed that 34% of the patient sample exhibited significant depression. Controlling for seizure frequency, patients with comorbid depression at the time of neuropsychological assessment exhibited significantly poorer performance on measures of intelligence, language, visuoperceptual ability, memory, and executive function. Within lateralised temporal lobe epilepsy groups, the adverse effects of depression on cognitive function were greater in patients with left temporal lobe compared with those with right temporal lobe epilepsy. In addition, depression seemed to be underrecognised and undertreated as none of the patients with epilepsy and comorbid depression were treated for their psychiatric condition at the time of admission for monitoring.

CONCLUSIONS

Depression, a common psychiatric comorbidity among patients with chronic temporal lobe epilepsy, seems to be undertreated and to have adverse effects on cognitive functioning.

Psychometric analysis of the selective reminding procedure in a sample from the general elderly population

The selective reminding procedure (SRP) has been proposed for the assessment of distinct aspects of episodic memory, i.e. storage to and retrieval from short-term and long-term memory, item learning and list learning, and as dementia screening tool. In the present study SRP results were analysed in 256 probands from the general elderly population. SRP scores were highly intercorrelated, and principal component analysis yielded only one single factor. The SRP scores were moderately and not differentially correlated with immediate and delayed free recall and recognition and with verbal fluency. All SRP scores discriminated nondemented probands with episodic long-term memory impairment from those without. The MMSE performed significantly better than any SRP score in detecting dementia. The theory-based assumption that the SRP allows assessment of different, independent aspects of memory could not be validated. It is suggested that the SRP is a mixed measure of semantic memory, episodic long-term and short-term memory, and working memory, and that the different SRP scores do not allow to assess different memory functions. Thus, the SRP may neither be recommended for assessment of different subfunctions of memory nor for dementia screening.

Source memory in major depression

BACKGROUND

Research demonstrating episodic memory deficits in clinical depression has dealt with item memory exclusively. The present research sought to determine whether memory for source is differentially affected by depression.

METHODS

Patients with major depression and normal control subjects were examined in item memory and two types of source memory, requiring discriminations between (e.g. something that the subject said and something another person said) and within (e.g. something that one person said and something another person said) classes.

RESULTS

Depression-related deficits in item memory were exacerbated in source memory. However, deficits in source memory in depressed patients were restricted to those conditions requiring within-class discriminations.

CONCLUSION

The overall pattern of results may reflect that those symptoms of major depression that affect the individuals basic processing resources (e.g. concentration difficulties, lack of effort, loss of energy) results in an impairment of episodic memory, particularly when the demands of differentiating perceptual and cognitive information are high.

Cognitive impairment in the euthymic phase of chronic unipolar depression

Cognitive functioning in the nonsymptomatic phase and the long-term cognitive outcome of patients with mood disorders are both heuristic and important clinical issues in the study of mood disorders. Literature findings are inconsistent because of design confounds. We tried to address these issues while controlling for several confounds including age, education, gender differences in neurobehavioral functioning, and diagnosis. Nonsymptomatic patients with a history of chronic unipolar depression and bipolar affective disorder and healthy male individuals were administered neuropsychological tests to assess attention, visual-motor tracking, executive abilities, and immediate verbal memory. Subjects had comparable depression scores at the time of testing. Disease duration was 7.5 years (SD 5.1) for unipolar and 11 years (SD 7.3) for bipolar patients. Unipolar patients were more impaired than healthy normal comparison subjects on measures of visual-motor sequencing (Trail Making Test A, p < .05), executive function (Trail Making Test B, Stroop Test Color/Word Trial, p < .05), and immediate memory and attention (CERAD 1st trial, WAIS Digit Symbol subtest, p < .05). Differences between bipolar patients and normal comparison subjects did not reach significance in any of the selected measures. Male patients with a history of chronic unipolar disorder are at risk for cognitive impairment in the nonsymptomatic phase of their disease. Cognitive disturbance is the type seen with prefrontal dysfunction and may be assessed with standard neuropsychological assessments.

Depression and memory in the elderly: a meta-analysis

A meta-analysis (N = 40) of the effects of depression on memory in the elderly (sample mean age > or = 55 years) examined variables potentially accounting for divergent findings in the literature. The distribution of effects was bimodal and the effect sizes were heterogeneous. Compared to controls, groups containing unipolar subjects only were significantly less impaired than were mixed unipolar-bipolar; five of six studies mixing depression subtype were associated with the more negative mode. Samples containing younger depressed subjects (< 45 years) were significantly more impaired and were associated with the more negative mode. Significant group differences were found between studies matching their comparison groups reasonably well on years of education and those that did not. Thoroughness of dementia screening yielded no group differences. Although correlated observations precluded significance tests, larger effects were found for (1) figural (vs. verbal) memory; (2) delayed (vs. immediate) memory; and (3) recognition (vs. free recall and incidental or cued recall; incidental and cued recall effects were nearly identical). Similar effects were found for composite memory scores versus constituent and for various presentation paradigms (e.g., single presentation, selective reminding). Effect sizes for these categories were in the moderate range. Difficulties synthesizing this literature are discussed as are suggested remedies and directions for future research.

Normal ageing in adults with Down's syndrome: a longitudinal study

The ubiquitous presence of the neuropathology of Alzheimer disease (AD) in individuals with Down's syndrome (DS) over 40 years of age suggests that this group of people will exhibit a high prevalence of dementia of the Alzheimer type (DAT) as they age. The present study indicates that there is a clear discrepancy between the presumed presence of AD neuropathology and the clinical expression of DAT among older people with DS. In the first 6 years of a longitudinal study, the present authors compared 91 adults (31-63 years of age) with DS and mild or moderate mental retardation to 64 adults (31-76 years of age) with other forms of mental retardation (MR) on yearly measures of mental status, short- and long-term memory, speeded psychomotor function, and visuospatial organization. The results indicated that, over repeated testing on the verbal long-term memory test, younger participants with DS showed small increases in their scores, while older participants with DS showed very slight decreases. Overall performance scores on this test and a speeded psychomotor task were poorer for both diagnostic groups in individuals aged 50 years and older. The magnitude and type of these selective changes in performance were consistent with performance profiles observed in older healthy adults without mental retardation on tests measuring similar cognitive functions. Only four out of the 91 people with DS in the present sample showed changes in functioning that have led to a diagnosis of possible DAT, and in these individuals, alternative causes of performance declines were concurrently present (e.g. thyroid dysfunction). These findings indicate that some age-associated changes in functioning are related to "normal' but probably precocious ageing among adults with DS. Furthermore, these findings suggest that adults with DS and mild or moderate mental retardation may be at lower risk for dementia during their fourth and fifth decades of life than previous studies have suggested.

Memory Self-Appraisal and Cerebral Glucose Metabolism in Age-Associated Memory Impairment

The authors used positron emission tomography to measure cerebral glucose metabolism in 43 people with age-associated memory impairment to determine relationships between memory self-appraisal and brain function. People with lower frontal metabolism during a resting state reported more frequent prior mnemonics usage, a measure of memory self-appraisal. A multiple regression analysis indicated that reported mnemonics usage was the most significant predictor of left (P = 0.0004) and right (P = 0.0014) frontal metabolism. These models indicated that mnemonics usage, along with depression ratings, accounted for 39% of left frontal lobe function and, along with visual spatial memory, accounted for 40% of right frontal metabolism. These results suggest that mnemonics usage may compensate for subtle frontal dysfunction or reflect greater efficiency of memory processing.

Long-term memory deficits in patients with malignant gliomas

Knowledge about the neuropsychological performance of adult patients with brain tumors, and especially with malignant gliomas, is limited. In this study 30 patients were consecutively included at time of diagnosis. Five months after completion of radiotherapy eleven of the patients showed no signs of focal neurology or tumor recurrence. These eleven patients, and their partners, were interviewed independently. Using each partner as control the patients were assessed neuropsychologically with special emphasis on memory abilities. The selective reminding technique was used with nouns of different visual imagery. A consistent pattern was found: there was no clear impairment in global intellectual abilities, but there was a pronounced deficit in long-term memory. However, the patients had a preserved capacity to use visual imagery to boost performance. It is important that medical staff acknowledge or confirm this problem. The sparing of imaginal coding makes it possible for the staff to assist with advice facilitating memory. Memory is a vital cognitive ability and the selective reminding technique was a sensitive method capable of detecting subtle impairments. The technique is recommended in future examinations of conditions and evaluations of treatments affecting the CNS.

WAIS-R performance in dementia with and without depression

A lower mean WAIS-R Performance IQ and lower mean scores on the Arithmetic and Picture Arrangement subtests for dementia patients with affective disorder (n = 22) versus dementia patients without affective disorder (n = 10) are presented. Implications of these findings and suggestions for further research are tendered.

Predicting development of dementia in the elderly with the Selective Reminding Test

The ability to predict the development of dementia through the detection of memory impairment in nondemented individuals was assessed with the Selective Reminding Test (SR), a popular test of verbal memory functioning in the elderly. The SR was administered to 385 nondemented volunteer subjects (mean age = 80.4 years) enrolled in a longitudinal study of risk factors in the development of dementia. Of these, 36 subjects ultimately became demented. SR scores obtained from 1 to 2 years prior to the diagnosis of dementia were compared with a set of previously established cutoff scores derived from a cognitively normal elderly sample. The results demonstrated that sum of recall and delayed recall were the SR measures best able to predict dementia with sensitivities of 47% and 44%, respectively. The predictive values were 37% and 40%, respectively, or better than two-and-one-half times the base rate. The contributions of both the SR Test and the Fuld Object-Memory Test (OM) were discussed in terms of the further understanding of the characteristics of the preclinical phase of dementia.

Patterns of performance on the Fuld Object Memory Evaluation in elderly inpatients with depression or dementia

The Fuld Object Memory Evaluation (Fuld, 1981) was administered to 80 elderly adults (aged 60 to 90 years) who were hospitalized for evaluation and treatment of primary degenerative dementia (PDD), other organic disorders (e.g., Parkinson's disease or multi-infarct dementia), or major depression. Although mean performance in each of the diagnostic groups was below normative levels reported by Fuld (1981), PDD patients performed significantly more poorly than those with depression or other organic disorders. Analysis of subscore patterns failed to support the hypothesis of a selective memory deficit in depression, and substantial overlap in scores was observed between the depressed group and patients with organic disorders other than PDD. Object Memory Evaluation performance was influenced by global mental status and secondary psychiatric diagnoses, but not by education, age, or physical health.

The problem of naming in SDAT: a relative deficit

Research relating to language disorder in senile dementia of the Alzheimer type (SDAT) has focused primarily on naming impairment, formally termed anomia or nominal aphasia/dysphasia. Data resulting from this research have been insufficiently informed by a comparative linguistic framework in which performance on naming tasks is contrasted with performance on other forms of language tasks. The present study involves the comparison of 21 adults with SDAT and 18 demographically controlled normal elderly adults on the Test for Syntactic Complexity and fifteen subtests of the Western Aphasia Battery. Performance on naming is compared with performance on oral language variables of repetition, yes/no response, auditory word recognition, sequential commands, syntactic processing, as well as with performance on reading tasks and non-verbal tasks. Findings relating to oral language tasks show that structured syntactic processing requiring explicit interpretation and sequential commands are significantly more difficult for the SDAT sample than are three of four naming tasks. Further, significant SDAT performance variability is found across naming tasks. The generative categorical naming task is found to be significantly more difficult for the SDAT patient than are the other three naming tasks. It is concluded that the generative categorical naming task should be regarded as a meta-naming task. In sum, it is found that although language dysfunction in SDAT has anomic components, the essential character of the language disorder is not best conceptualized as a problem of naming.