Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool

Comparison of Dutch healthy eating and healthy eating indexes and anthropometry in patients with major depression with health subjects: a case-control study

Background

Diseases and disorders related to mental health are spreading like other chronic diseases all around the world. Considering the role of food in the prevention and treatment of these disorders, including major depression, investigating the relationship between different food patterns and this disorder is of particular importance. The aim of this study was to compare Dutch healthy eating and healthy eating indexes and anthropometry in patients with major depression with healthy individuals.

Methods

In this case-control study, the final analysis was performed on 67 men and 111 women with an age range of 20-30 years. Height (cm), weight (kg), food frequency questionnaire (FFQ), physical activity (MET-min/week), demographic and PHQ-9 questionnaires were taken from all participants. In the following, all the food ingredients and their components were extracted and used to calculate HEI-2015 and DHD. Statistical analysis was performed using SPSS software with independent t-test, logistic regression and chi-square.

Results

It was found that people with major depression in this study were mostly women and occupied. The average HEI-2015 in healthy people and those with major depression was 58 and 54.3, respectively. Also, the average DHD in these people was 60.5 and 55, respectively. HEI-2015 and DHD had a significant negative correlation with depression score (r = -0.16, p-value = 0.03) (r = -0.19, p-value = 0.01). Also, in the logistic regression model, before and even after adjusting confounders, HEI-2015 and DHD had a reduced odds ratio in people suffering from major depression. The two groups did not differ significantly in terms of the average factors of height, weight and body mass index (BMI).

Conclusion

It seems that HEI2015 and DHD have a significant relationship in reducing major depression. However, due to the small number of studies in this regard, especially in the field of DHD, the need for more studies seems necessary.

Screening and Assessment for Alzheimer's Disease in the Days of Biological Biomarkers

The 1980s saw an upsurge of research in Alzheimer's disease (AD). The necessity of standardized assessment batteries became apparent, leading to the development of standardized instruments, such as the CERAD, the CAMDEX, the CSI 'D', and later the TOOLBOX. The advent of new biological markers has led to speculation in the research community about the necessity for these instruments. As the association of biomarkers with subsequent clinical dementia remains unclear, assessment batteries are still necessary, especially with growing evidence that prodromal symptoms of AD may not be cognitive decline but emotional or behavioral symptoms. Inclusion of ethnic minority groups is also essential.

Depression and Dementia in Older Adults: A Neuropsychological Review

Depression and dementia are the most common neuropsychiatric disorders in the older adult population. There are a certain number of depressed patients who visit outpatient clinics because they suspect dementia due to similarities in the clinical symptoms in both disorders. Depressive symptoms associated with dementia may be diagnosed with depression, and treatment with antidepressants is continued for a long time. Depression and dementia differ in their treatment approaches and subsequent courses, and it is necessary to carefully differentiate between the two in the clinical practice of dementia treatment. In this review, I describe the similarities between depression and dementia and how to differentiate depression in dementia treatment based on the differences and emphasize that there is a significant potential to cure depression, in contrast to dementia, for which there is currently no fundamental therapy. Therefore, it is important to recognize that depression and dementia may present with common symptoms and to appropriately differentiate depressed patients who are suspected of having dementia. Dementia is a disorder in which cognitive dysfunction is caused by a variety of causative diseases and conditions, resulting in impairment of activities of daily living. However, current medical science has had difficulty finding a cure for the causative disease. Based on clinical findings, it has also been shown that the degree of symptoms for preexisting psychiatric disorders is alleviated as the brain ages. In the presence of dementia, the speed of the alleviation will increase. The importance of focusing on the positive aspects of aging is also discussed.

Pseudodementia, pseudo-pseudodementia, and pseudodepression

Dementia has a wide range of reversible causes. Well known among these is depression, though other psychiatric disorders can also impair cognition and give the appearance of neurodegenerative disease. This phenomenon has been known historically as "pseudodementia." Although this topic attracted significant interest in the 1980s and 1990s, research on the topic has waned. In this paper, we consider reasons for this decline, including objections to the term itself and controversy about its distinctness from organic dementia. We discuss limitations in the arguments put forward and existing research, which, crucially, does not support inevitable progression. We also discuss other neglected masquerades, such as of pseudodementia itself ("pseudo-pseudodementia") and depression ("pseudodepression"). Based on this reappraisal, we argue that these terms, while not replacing modern diagnostic criteria, remain relevant as they highlight unique groups of patients, potential misdiagnosis, and important, but neglected, areas of research.

Incidence of dementia in the elderly: review of age and sex effects

A review of epidemiological studies about incidence of dementia among the aged is presented. Empirical studies on incidence of dementia have shown considerably differing estimations. Nevertheless, in all studies, an age-related increase in incidence becomes clearly apparent. Epidemiological field-studies could not yield consistent findings concerning the association of incidence and gender. However, most studies found an increased incidence for men until the age of 70–80 years. In older age most studies reported the same incidence for men and women or found an increased incidence of dementia in women. The findings are reviewed and discussed in the context of methodological issues.

The clinical and cost-effectiveness of a Victim Improvement Package (VIP) for the reduction of chronic symptoms of depression or anxiety in older victims of common crime (the VIP trial): study protocol for a randomised controlled trial

BACKGROUND

Older people are vulnerable to sustained high levels of psychosocial distress following a crime. A cognitive behavioural therapy (CBT)-informed psychological therapy, the Victim Improvement Package (VIP) may aid recovery. The VIP trial aims to test the clinical and cost-effectiveness of the VIP for alleviating depressive and anxiety symptoms in older victims of crime.

METHODS/DESIGN

People aged 65 years or more who report being a victim of crime will be screened by Metropolitan Police Service Safer Neighbourhood Teams within a month of the crime for distress using the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2. Those who screen positive will be signposted to their GP for assistance, and re-screened at 3 months. Participants who screen positive for depression and/or anxiety at re-screening are randomised to a CBT informed VIP added to treatment as usual (TAU) compared to TAU alone. The intervention consists of 10 individual 1-h sessions, delivered weekly by therapists from the mental health charity Mind. The primary outcome measure is the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI), used as a composite measure, assessed at 6 months after the crime (post therapy) with a 9-month post-crime follow-up. Secondary outcome measures include the EQ-5D, and a modified Client Service Receipt Inventory. A total of 226 participants will be randomised VIP:TAU with a ratio 1:1, in order to detect a standardised difference of at least 0.5 between groups, using a mixed-effects linear-regression model with 90% power and a 5% significance level (adjusting for therapist clustering and potential drop-out). A cost-effectiveness analysis will incorporate intervention costs to compare overall health care costs and quality of life years between treatment arms. An embedded study will examine the impact of past trauma and engagement in safety behaviours and distress on the main outcomes.

DISCUSSION

This trial should provide data on the clinical and cost-effectiveness of a CBT-informed psychological therapy for older victims of crime with anxiety and/or depressive symptoms and should demonstrate a model of integrated cross-agency working. Our findings should provide evidence for policy-makers, commissioners and clinicians responding to the needs of older victims of crime.

TRIAL REGISTRATION

International Standard Randomised Controlled Trials Number, ID: ISRCTN16929670. Registered on 3 August 2016.

Risk factors of major depression in the elderly

Background

Several risk factors of depression have been identified in retrospective as well as some prospective studies in the elderly. Confirmation in independent samples is needed. The present follow-up study prospectively investigated risk factors of depression in an elderly German sample.

Methods

One thousand four hundred and thirty-one subjects from a family study were re-investigated after 4.7 ± 2.5 years. Bivariate and multivariate forward logistic regression analyses were used to identify risk factors of the development of new depression in the elderly.

Results

Risk factors of a new depressive episode in 1408 elderly without current depression were age, female gender, a previous depression, subjective memory impairment, previous anxiety and somatoform disorders. The presence of dementia or mild cognitive impairment were significant risk factors in bivariate, but not multivariate analysis controlling for possible confounding. Risk factors of a first geriatric depressive episode were age, gender and subjective memory impairment; age remained the only significant risk factor in multivariate analysis.

Conclusions

This investigation confirms previous studies from other countries concerning the relevance of risk factors for depression in the elderly. The knowledge of risk factors might help identify subjects at increased risk of depression for early intervention approaches. Elderly with a history of previous depression carry the highest risk.

Cognition and daily activities in a general population sample aged +55

Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability. Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT). Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.

Mild cognitive impairment: narrative review of taxonomies and systematic review of their prediction of incident Alzheimer's disease dementia

Early detection of Alzheimer's disease is vital for developing novel treatments. Attempts to identify the intermediate state between normal cognition and dementia have evolved over the past 50 years. Current taxonomies of mild cognitive impairment (MCI) may be criticised for their imprecise operationalisation. With the advent of biomarkers such as amyloid-beta positron emission tomography imaging in established Alzheimer's disease, much research has focused on establishing which factors predict progression from MCI to Alzheimer's disease dementia. In this review, we discuss the historical context of MCI before reviewing the literature of MCI subtypes and their risk of progression to Alzheimer's disease dementia. Finally, we summarise the literature and discuss limitations and weaknesses of how the construct is operationalised and implemented, before offering suggestions for development of the concept of MCI. We conclude that MCI must be empirically defined for the sake of its predictive validity to identify Alzheimer's disease before dementia develops.

Longitudinal outcomes of patients with pseudodementia: a systematic review

Depression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as 'pseudodementia' and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

Managing depression in older people

Although common and disabling, depression in old age remains both underdetected and under-treated. This is particularly regrettable in view of its high risk of chronicity, recurrence and suicide, as well as the considerable burden of associated health care costs. Despite the availability of a variety of physical and psychological treatment options of well-established efficacy, there is little recent evidence of improvement in either clinical practice or patient outcome. An understanding of the principles of management of depression in elderly patients requires some knowledge of the differences between such patients and their younger counterparts. The clinical presentation and diagnosis of depression in old age, its epidemiology and prognosis are reviewed briefly below, before focusing on the practicalities of treatment.

Clinical characteristics of patients with non-affective, non-organic, late onset psychosis

OBJECTIVE

Schizophrenia and related psychotic disorders are predominantly studied in young population. However some individuals do develop psychotic disorder for the first time during their old age. The aim of this study is to look at the clinical characteristics of non-affective, non-organic, late onset psychosis.

PARTICIPANTS AND METHODS

Retrospective chart review study, medical records of all patients registered between 1st of January 2006 and 31st May 2011 at geriatric clinic in NIMHANS, Bangalore was screened, 83 files with a diagnosis of late onset psychosis and meeting the study criteria were systematically analyzed.

RESULTS

The mean age at onset of illness was 67±10years; 98.8% were married, females formed 67.5% of the sample, commonest phenomenon was delusions followed by hallucinations, 80.5% of the subjects had delusion of persecution, 38.5% had referential delusion, 51.8% had accusative and derogatory auditory hallucinations, negative symptoms was seen only in 2.4% of subjects, none had formal thought disorder. 3.6% had co-morbid Axis II diagnosis.

CONCLUSION

Despite its rarity non affective, non organic, late onset psychosis forms a distinct group with unique manifestation. Further systematic research is needed for better understanding of this condition.

Prevalence and incidence of Alzheimers disease and other dementing disorders in Pylea, Greece

We investigated the prevalence and incidence of dementing disorders in the city of Pylea, Greece, using a door-to-door three-phase approach, and explored the relationship between age and gender. From the initial cohort of 704-subjects, 112-subjects (15.9 percent) were excluded because they had moved out of town or could not be traced, 102-subjects (14.4 percent) died before the time of actual contact, and 110-subjects (15.6 percent) refused to be contacted. We were able to visit and examine 380-subjects (54 percent); each of them were administered the MMSE by one of three nurses and the CAMCOG by one of three physicians. We selected January 1, 1993, as the study prevalence day. Using specified diagnostic criteria, NINCDS-ADRDA and DSMIIIR, the study neurologists extensively investigated 118 from 380-subjects, who screened positive on MMSE (MMSE < 23) and CAMCOG (< 65). We found 35-subjects affected by dementia, 20 had Alzheimer's disease (AD), 11 had vascular or mixed dementia and four had secondary dementia (one Parkinson's disease, one Vitamin B12 deficiency, and two had Tumors). The estimated annual incidence rate for all forms of dementia, after correction for ageing of the samples was 57/1,000 persons aged > 70, made up of dementia of Alzheimer type (39.9/1,000), vascular dementia (13.9/1,000) and other forms (3.5/1,000). The prevalence of both dementia and AD increased steeply with advancing age and was consistently higher in women. The incidence of dementia increases with age, even in the oldest age groups and women have a higher risk of developing dementia than men. AD was the most common type of dementia. Our prevalence and incidence figures for dementia and AD are almost similar to those previously reported in Europe, the United States and Canada.

Association between apolipoprotein E gene polymorphism and depression

We performed an updated meta-analysis to obtain a more precise estimation of the relationship between apolipoprotein E (ApoE) gene polymorphism and susceptibility to depression, as previous reports have been inconsistent. Twenty studies with 2286 depression patients and 3845 controls were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to assess the association between ApoE gene polymorphism and depression using a random effects model. Results showed a significant association between ApoE gene polymorphism and susceptibility to depression in the overall population (ε2/ε3 genotype versus ε3/ε3: OR 0.76, 95% CI 0.59-0.99). Subgroup analyses indicated an association in the Caucasian population (ε2 allele versus ε3: OR 0.75, 95% CI 0.58-0.97) as well as in late-life depression (LLD) patients (ε3/ε4 genotype versus ε3/ε3: OR 1.34, 95% CI 1.07-1.68, and ε4 allele versus ε3: OR 1.30, 95% CI 1.06-1.59). We concluded that the ε2/ε3 genotype likely provided a protective effect against depression in the overall population and the ε2 allele acted as a protective factor for depression in the Caucasian population while the ε4 allele and ε3/ε4 genotype were associated with an increased risk of depression in the LLD subjects.

Late-life psychosis: diagnosis and treatment

Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the "six d's" of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.

Prevalence of mental illness in an elderly community dwelling population using AGECAT

Objective: The purpose of this study was to determine the prevalence of a range of mental disorders in an elderly community dwelling population in Dublin using AGECAT, a reliable and standardised computerised diagnostic system that has been previously validated in community epidemiological surveys.

Methods: A total of 451 individuals over the age of 65 in a GP group practice were interviewed using AGECAT.

Results: Approximately one in five subjects had a mental illness according to AGECAT criteria. The prevalence of depression was 13.1% and did not change appreciably with age. 5.5% of subjects met organic ‘case’ criteria, and the frequency of organic cases increased with age, approximating 15% in the over 80 year age group. Neurotic disorders occurred with very low frequency, representing 1.1% of the subjects tested.

Conclusions: These findings have implications for mentalhealth services planning at a local level, and underscore the utility of AGECAT as a tool for comparative crosscultural epidemiological surveys.

Barriers to the diagnosis and treatment of depression in the community dwelling elderly

There is broad agreement in the literature that depression in the community dwelling elderly is under-diagnosed and under-treated by general practitioners. Somatisation, overlap with medical illness, bereavement and atypical presentations of depression in this age-group may contribute to the difficulties in diagnosis in primary car settings. Furthermore, the apparent reluctance of primary care physicians to treat depression in the elderly may reflect the mistaken notion that depression in this population is a benign condition, an understandable reaction to physical illness and as such untreatable. Fundamental changes in the patterns of collaboration between psychiatry and general practice will be necessary to overcome these barriers to the detection and treatment of depression in the community dwelling elderly.

Prognosis of depression in the elderly

Objective: To ascertain the outcome of depression and factors associated with outcome over a minimum followup period of 12 months in patients referred to an Old Age Psychiatry Service.

Method: A retrospective study was performed. All depressed patients assessed by the service between January 1989 and December 1990 were followed up. This included patients seen on domiciliary and consultationliaison visits. Follow up data included information on physical, psychological, cognitive and social parameters using standardised scales where appropriate. Outcome of depression was assessed using a six point scale to enable comparison with other studies.

Results: 86 patients with a primary diagnosis of depression were seen in 1989 and 1990. At follow up, 37% were dead. 50% of patients alive at follow up were well and 7% were demented. Patients seen on domiciliary visits had the best outcome, and those with physical illness or cognitive impairment at presentation the worst outcome.

Conclusion: The association between physical status and outcome highlights the need for close monitoring of both physical and mental status of depressed elderly patients.

Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

BACKGROUND

Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce.

METHODS

We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status.

RESULTS

After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis.

CONCLUSIONS

Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.

Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment

The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression and describe their clinical significance. The complex relationship between geriatric depression and dementia is summarized and possible shared mechanisms discussed. Evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation is presented.

Neuropsychiatric disorders secondary to neurosyphilis in elderly people: one theme not to be ignored

BACKGROUND

Neurosyphilis (NS) may present with neuropsychiatric disorders characterized by cognitive impairment, personality disorders, and confusion, among others. Very few studies have focused on neuropsychiatric disorders secondary to NS in elderly people.

METHOD

A retrospective chart review was performed to characterize the psychiatric findings, clinical signs and symptoms, laboratory findings, and brain magnetic resonance imaging results of ten elderly inpatients with NS.

RESULTS

In these ten patients, the most common presenting symptoms included a wide variety of psychiatric manifestations. The serum rapid plasma regain (RPR) and Treponema pallidum particle agglutination assay (TPPA) of the ten patients were positive, with positive CSF TPPA and RPR rates of 100% and 60%, respectively. In addition, 90% of the patients demonstrated abnormal imaging, including cerebral atrophy, infarct ischemic stroke, and hydrocephalus.

CONCLUSIONS

Our findings support the importance of serological tests for syphilis as a routine component of the evaluation of patients with clinically evident neurological or psychiatric symptoms. If the serology is positive, all of the patients should be examined with a lumbar puncture. Moreover, psychiatric illnesses secondary to NS in the elderly also deserve medical attention.

Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study

OBJECTIVE

to determine incidence and predictors of late-life depression.

METHODS

this is a 3-year observational cohort study of 3,214 non-demented patients aged 75 and over completing three waves of assessment. The patients were recruited in 138 primary care practices in six urban areas in Germany. Depressive symptoms were measured at baseline, and 18 months and 36 months later using the GDS-15 Geriatric Depression Scale with a cut-off 0-5/6-15. Cox proportional hazard regression models were applied to examine predictors of incident depression, adjusting for sex, age, education, living situation, activities of daily living - and instrumental activities of daily living impairment, somatic comorbidity, alcohol consumption, smoking, mild cognitive impairment and apoE4 status.

RESULTS

the incidence of depression was 36.8 (95% CI: 29.6-45.3) per 1,000 person-years in men and 46.0 (95% CI: 39.9-52.8) in women (sex difference P = 0.069). The incidence increased from 35.4 (95% CI: 29.7-41.9) per 1000 person-years between the ages of 75 and 79 to 75.2 (95% CI: 53.2-103.2) for subjects 85 years and older. After full adjustment for confounding variables, hazard ratios (HR) for incident depression were significantly higher for subjects 85 years and older (HR: 1.83, 95% CI: 1.24-2.70) and those with mobility impairment (HR: 2.53, 95% CI: 1.97-3.25), vision impairment (HR: 1.41, 95% CI: 1.04-1.91), mild cognitive impairment (HR: 1.52, 95% CI: 1.10-2.10), subjective memory impairment (HR: 1.33, 95% CI: 1.01-1.74) and current smoking (HR: 1.69, 95% CI: 1.13-2.53).

CONCLUSIONS

the incidence of depression increased significantly with age. In designing prevention programmes, it is important to call more attention on functional impairment, cognitive impairment and smoking.

Gender differences in the relation between depression and social support in later life

BACKGROUND

Prevalence of depression is twice as high in women as in men, also in older adults. Lack of social support is a risk factor for late-life depression. The relation between depression and social support may be different for men and women.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used to investigate gender differences in the relation between social support and depression in a population-based sample aged 55-85 years, with n = 2,823 at baseline and using the 13-year follow-up data on onset of depression.

RESULTS

Respondents without a partner in the household, with a small network, and with low emotional support were more often depressed, with men showing higher rates of depression than women. A high need for affiliation was associated with depression in women but not in men. Lack of a partner in the household and having a small network predicted onset of depression in men but not in women. In respondents with high affiliation need and low social support, depression rates were higher, with men being more often depressed than women.

CONCLUSIONS

Low social support and a high need for affiliation were related to depression in later life, with men being more vulnerable for depression than women. Considering the serious consequences of depression, especially in older people, it is important to identify the persons with low social support and a high need for affiliation, and to help them to increase their social support or to adjust their needs.

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

BACKGROUND

Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors.

METHOD

In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors.

RESULTS

At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation.

CONCLUSIONS

Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

Antipsychotic drug treatment for elderly people with late-onset schizophrenia

BACKGROUND

Schizophrenia is usually considered an illness of young adulthood. However, onset after the age of 40 years is reported in 23% of patients hospitalised with schizophrenia. At least 0.1% of the world's elderly population have a diagnosis of late-onset schizophrenia which seems to differ from earlier onset schizophrenia on a variety of counts including response to antipsychotic drugs.

OBJECTIVES

To assess the effects of antipsychotic drugs for elderly people with late-onset schizophrenia.

SEARCH METHODS

We searched the Cochrane Schizophrenia Group Trials Register (January 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant authors of trials for additional information.

SELECTION CRITERIA

All relevant randomised controlled trials that compared antipsychotic drugs with other treatments for elderly people (at least 80% older than 65 years) with a recent (within five years) diagnosis of schizophrenia or schizophrenia like illnesses.

DATA COLLECTION AND ANALYSIS

For the 2010 search, two new review authors (AE, AG) inspected all citations to ensure reliable selection. We assessed methodological quality of trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. AE and AG also independently extracted data. For homogenous dichotomous data, we planned to calculate the relative risk (RR) and 95% confidence interval (CI).

MAIN RESULTS

There were no included studies in the original version of this review (2002 search). The 2010 search for the current update produced 211 references, among which we identified 88 studies. Only one study met the inclusion criteria and was of acceptable quality. This was an eight-week randomised trial of risperidone and olanzapine in 44 inpatients with late-onset schizophrenia. All participants completed the eight-week trial, indicating that both drugs were well tolerated. Unfortunately, this study provided little usable data. We excluded a total of 81 studies, 77 studies because they either studied interventions other than antipsychotic medication or because they involved elderly people with chronic - not late-onset - schizophrenia. We excluded a further four trials of antipsychotics in late-onset schizophrenia because of flawed design. Five studies are still awaiting classification, and one is on-going.

AUTHORS' CONCLUSIONS

There is no trial-based evidence upon which to base guidelines for the treatment of late-onset schizophrenia. There is a need for good quality-controlled clinical trials into the effects of antipsychotics for this group. Such trials are possible. Until they are undertaken, people with late-onset schizophrenia will be treated by doctors using clinical judgement and habit to guide prescribing.

Psychiatric disorders in the elderly

Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.

Trajectories of depression and their relationship with health status and social service use

This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression.

Psychiatric disorders and cognitive dysfunction among older, postmenopausal women: results from the Women's Health Initiative Memory Study

OBJECTIVE

To estimate the frequency of depressive symptoms and selected psychiatric disorders in the Women's Health Initiative Memory Study (WHIMS) cohort and related them to cognitive syndromes.

DESIGN

WHIMS was a randomized, double-blinded, placebo-controlled prevention clinical trial examining whether opposed and unopposed hormone therapy reduced the risk of dementia in healthy postmenopausal women. Participants scoring below a designated cutpoint on a cognitive screener received a comprehensive neuropsychiatric workup and adjudicated outcome of no cognitive impairment, mild cognitive impairment, or probable dementia.

PARTICIPANTS

Seven thousand four hundred seventy-nine WHIMS participants between age 65 and 79 years and free of dementia at the time of enrollment in WHIMS. Five hundred twenty-one unique participants contributed complete data required for these analyses.

MEASURES

Depressive symptoms were measured with the 15-item Geriatric Depression Scale and the presence of selected psychiatric disorders (major depression, generalized anxiety, and panic and alcohol abuse) was made using the PRIME-MD.

RESULTS

The 18% of women had at least one psychiatric disorder with depression being the most common (16%) followed by general anxiety or panic (6%) and alcohol abuse (1%). Depression and the presence of a psychiatric disorder were associated with impaired cognitive status. Participants having a psychiatric disorder were more than twice as likely to be diagnosed with cognitive impairment as those with no psychiatric disorder (odds ratio = 2.06, 95% confidence interval = 1.17-3.60). Older age, white race, and diabetes were also associated with cognitive impairment.

CONCLUSION

The frequency of a psychiatric disorder is associated with poorer cognitive functioning among older women enrolled in WHIMS. That approximately one in five women had a probable psychiatric disorder, most typically depression, highlights the need for greater detection and treatment efforts in this population.

[Association between anxiolytic and antidepressant consumption and psychiatric symptoms in the elderly]

INTRODUCTION

Many studies have reported excessive consumption of psychotropic drugs in the elderly but none have related psychotropic drug use to psychiatric symptoms and sleep disorders in community-dwelling patients aged more than 65 years old in Spain.

MATERIAL AND METHODS

We performed a cross sectional study in a representative sample (9,739 persons) from the population aged more than 55 years old in the city of Zaragoza in 2001. A total of 3,714 persons aged more than 65 years old were interviewed. The data belonged to the ZARADEMP project.

RESULTS

The mean age of the sample was 76.9 years (59.2% women and 40.8% men). Anxiolytics or antidepressants were consumed by 22.6% of the sample. A diagnosis of depression was made in 12.9%, anxiety in 1.6% and insomnia in 36%. We found high consumption of anxiolytics, especially in persons with depression (42.2%) and low consumption of antidepressants, especially in persons with a diagnosis of depression (15.4%) and in those with depressive symptoms (8.2%).

CONCLUSIONS

A correct psychiatric diagnosis is essential before psychotropic drugs are used to ensure appropriate treatment of the elderly with psychiatric symptoms.

Consistency of clinical diagnosis of dementia in NEDICES: A population-based longitudinal study in Spain

BACKGROUND

Few longitudinal studies have verified the clinical diagnosis of dementia based on clinical examinations. We evaluated the consistency of the clinical diagnosis of dementia over a period of 3 years of follow-up in a population-based, cohort study of older people in central Spain.

METHODS

Individuals (N = 5278) were evaluated at baseline (1994-1995) and at follow-up (1997-1998). The evaluation included a screening questionnaire for dementia and a neurological assessment.

RESULTS

Dementia screening consisted of a 37-item version of the Mini-Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (FAQ). Study neurologists investigated those participants who screened positively (N = 713) as well as 843 who had screened negatively to test the sensitivity of the screening instruments or because they had a positive screening for other chronic neurological diseases. We detected 295 patients among those who screened positive and 13 among those who screened negatively. Three years follow-up evaluation demonstrated 14 diagnostic errors at baseline (4.5%) leading to a final number of 306 patients with dementia. The corrected prevalence of dementia was 5.8% (95% confidence interval [CI] 5.2-6.5).

CONCLUSIONS

The diagnosis of dementia was highly accurate in this population-based, Spanish cohort study, and our prevalence figures agree with other European surveys. Given the high cost and difficulties of population rescreening and its relatively low yield, we conclude that a single 2-phase investigation (screening followed by clinical examination) provides accurate information for most population-based prevalence studies of dementia.

Non-cognitive psychopathological symptoms associated with incident mild cognitive impairment and dementia, Alzheimer's type

OBJECTIVE

To test the hypothesis that specific psychopathological non-cognitive symptoms are associated with incident mild cognitive impairment (MCI), while different symptoms are associated with incident dementia of Alzheimer's type (DAT).

METHODS

A representative community sample of 4,803 individuals aged 55+ years was interviewed in a two-phase screening, in Wave I or ZARADEMP I. This is the baseline, cross-sectional study of the ZARADEMP Project, a longitudinal study to document incidence and risk factors of dementia. The main instrument for assessment of participants was the ZARADEMP Interview, which includes standardized Spanish versions of instruments such as the Mini-Mental Status Examination and the Geriatric Mental State GMS-AGECAT. Two years later, in Wave II or ZARADEMP II, the cognitively non-deteriorated elderly were reassessed in a similar, two-phase procedure. "Incident cases" of both dementia and DAT (DSM-IV-TR criteria), as well as MCI (operationally defined Petersen's criteria) were diagnosed by a panel of psychiatrists. Statistical, logistic regression models, adjusted by age, sex and education were used to test the hypothesized association.

RESULTS

"Irritability", "neurovegetative symptoms", "sleep problems", "concentration difficulties", "loneliness" and "subjective slowing" documented at baseline were associated with incident MCI (odds ratio, OR range 1.71-2.67). A different profile of non-cognitive symptoms was associated with incident DAT, specifically "tension" (OR= 2.45), "sleep problems" (OR= 2.81), and "observed slowing" (OR= 4.35). On the contrary, "subjective restriction of activities" seemed to be negatively associated with DAT (OR= 0.12).

CONCLUSIONS

To our knowledge, this is the first report about some specific psychopathological, non-cognitive symptoms associated with incident MCI and/ or incident DAT, when controlling by each other. The psychopathological profile associated with MCI is different from the profile preceding DAT.

Prevalence and implications of psychopathological non-cognitive symptoms in dementia

OBJECTIVE

Clinical experience and recent population studies suggest that psychopathological, non-cognitive symptoms are both frequent and relevant in dementia.

METHOD

A representative community sample (n = 4,803 individuals, 55 + years) was interviewed in a two-phase design. The Geriatric Mental Sate (GMS) was used for assessment and cases were diagnosed according to DSM-IV-TR criteria.

RESULTS

The prevalence of non-cognitive symptoms (1 + symptoms) in cases of dementia (n = 223) was 90.1%, and negative-type symptoms were most frequently found. A GMS 'apathy-related symptom cluster' (anergia, restriction of activities and anhedonia) was significantly more frequent in the demented (55.6%) than in non-cases (0.7%; specificity = 99.2%). In both dementia of Alzheimer's type and vascular dementia, number of symptoms tended to be inversely related to severity of dementia, but psychopathological profiles differed.

CONCLUSION

Non-cognitive, negative-type symptoms are very frequent in cases of dementia living in the community. They have powerful specificity in the distinction with non-cases, and might change current concepts of dementia.

Depression and excess mortality: evidence for a dose response relation in community living elderly

CONTEXT

Depression is associated with an increased mortality risk. It is not known to what extent depression characteristics such as severity and length of exposure to depression contribute to the association with excess mortality.

OBJECTIVES

To investigate the association between depression severity and duration with mortality in community-living elderly.

DESIGN

Two-wave prospective cohort study with 10-year follow-up of vital status. Assessment of depression at baseline and at three year follow-up (GMS-AGECAT). Cox proportional hazards analyses of mortality with depression according to severity and length of exposure, adjusted for demographic variables, physical illnesses, cognitive decline and functional disabilities.

SETTING AND PARTICIPANTS

Randomly selected cohort of 3 746 non-demented older community-living persons in the city of Amsterdam.

MAIN OUTCOME MEASURES

Excess mortality of both the baseline cohort, and of non-demented subjects participating in both assessments (n = 1989).

RESULTS

Both moderate (MHR 1.29, 95% CI 1.03-1.61) and severe depression (MHR 1.34, 95% CI 1.07-1.68) predicted 10-year mortality after multivariate adjustment. Chronic depression was associated with a 41% higher mortality risk in 6-year follow-up compared to subjects without depression.

CONCLUSIONS

Severity and chronicity of depression are associated with a higher mortality risk. In combination with other findings this is suggestive of a causal relationship and may have implications for both preventive and treatment strategies of late-life depression.

Trends in antidepressant use in the older population: results from the LASA-study over a period of 10 years

BACKGROUND

In the past 15 years, antidepressant use in adults has increased, mainly due to a rise in SSRI-use. The question is if this is true for older adults as well.

METHODS

Data from the Longitudinal Aging Study Amsterdam were used to investigate trends in antidepressant use from 1992 through 2002 in a population-based sample aged 65-85 years.

RESULTS

Antidepressant use increased from 2% to 6%. In the group with major depressive disorder, treatment with antidepressants showed an increase from 15% to 30%. This increase was larger in the older-old than in the younger old. Also, the increase was mainly due to a rise in SSRI-use. Daily TCA-dosages often were too low; dosages of the other antidepressants seemed to be sufficient. However, rates of depression remained stable, in the treated as well as in the untreated group.

LIMITATIONS

Non-response was associated with depression, the indication for prescription of antidepressants was not known, and serum concentrations of antidepressants were not available.

CONCLUSIONS

Antidepressant use in older people increased over the past 15 years, mainly due to a rise in SSRI-use. Daily dosages of antidepressants had become more adequate. Still only a minority of the more severely depressed used antidepressants.

The Differentiation Between Depression and Dementia in the Very Old

Key questions in the psychiatric understanding of elderly people are the development of psychiatric morbidity, its phenomenology in old age, the differentiation between ‘normal’ and ‘pathological’ ageing, the interrelatedness of different types of mental disorders, their relation to somatic morbidity, and their consequences in daily life. Under the hypothesis of the de-differentiation of psychopathological features in old age, the relation between depression and dementia is studied. Contrary to most gerontopsychiatric research, the Berlin Aging Study (BASE) permits an analysis of these questions in a heterogeneous and primarily non-clinical community population. Initial data from the first 360 intake assessments and the first 156 intensively studied participants of BASE are presented. Results show that, even in very old individuals, depression and dementia still exhibit clearly distinctive psychopathological features. Prevalence rates in consecutive age groups show an age-related increase for dementia but not for depression. Nevertheless dementia and depression do not seem to be fully independent, because our data indicate a masking or extinction of depressive symptoms by dementia. Finally, both disorders have a similarly significant negative impact on independence, comparable to that of somatic morbidity.

Treated prevalence and incidence of dementia among National Health Insurance enrollees in Taiwan, 1996-2003

The National Health Insurance database to determine the treated prevalence and incidence of dementia in Taiwan was used in this study. A population-based random sample of 22 118 subjects aged 65 or older was obtained as a dynamic cohort. Those study subjects who had filed at least one service claim from 1996 to 2003 for either outpatient care or inpatient care with a principal diagnosis of dementia were identified. The annual treated prevalence increased from 0.71% to 1.92% from 1996 to 2003. The annual treated incidence rates were around 0.76% to 1.04% per year from 1997 to 2003. The annual treated incidence rates for the 5-year age groups, from 65 to 90 years and older, were 0.44%, 0.65%, 0.98%, 1.46%, 1.81%, and 1.80%, respectively. Both the treated prevalence and incidence rates of dementia in National Health Insurance were lower than those of community studies.

Age-related cognitive decline in patients with mood disorders

BACKGROUND

The relationship between depression and dementia is complex and appreciation of its true nature is evolving. Depression is an early symptom of dementia. Recent research suggests that mood disorders, in general, may be risk factors for the development of dementia.

METHOD

This was a cross-sectional study of the effect of aging on cognition in patients with mood disorders compared to normal controls. Patients and controls were tested with a comprehensive neurocognitive test battery, CNS Vital Signs. The question at issue was the rate of aging-related cognitive decline the same or different in mood disorder patients compared to normal controls.

SUBJECTS

455 patients with mood disorders, 336 with major depression and 119 with bipolar affective disorder, age 18-86, and 1003 normal controls, age 35-90. Normal controls were age 18 or older in the CNS Vital Signs normative database. The normal subjects were healthy, on no centrally-active medication, and free of psychiatric and neurological disorders.

RESULTS

Cognitive performance in the two groups run in parallel from age 18 to 45; they begin to diverge during the next decade; after age 65, mood disorder patients, as a group, decline more sharply than normal controls. The differential rate of decline was seen in the domains of memory, attention, processing speed and executive function.

CONCLUSIONS

There seems to be an acceleration in age-related cognitive decline in patients with depression in particular, and mood disorders in general, compared to age-matched normal controls. It is likely, then, that as people age, the ones who develop depression, or who fail to recover from early episodes of depression, include a substantial number of patients at risk for developing dementia. This is consistent with the fact that late-life depression may be an early manifestation of dementia. The data are also consistent with the idea that mood disorders are a risk factor, albeit a weak one, for the development of dementia. From a slightly different perspective, one might imagine that some pathophysiological event is shared by the mood disorders and dementing conditions.

Prevalence of dementia in a southern European population in two different time periods: the ZARADEMP Project

OBJECTIVE

To compare the prevalence of dementia in two different time periods and two different studies.

METHOD

Representative, random samples of the elderly (>65 years) in the Zaragoza Study or ZARADEMP-0 (n = 1080) completed the previous decade, and now in Wave I of the ZARADEMP Project or ZARADEMP-I (n = 3715) were interviewed. Standardized measures included the Geriatric Mental State and the History and Aetiology schedule. Cases of dementia were diagnosed according to DSM-IV criteria.

RESULTS

Adjusted, global prevalence of dementia has not varied significantly: it was 5.2% (95% CI = 3.9-6.6) in ZARADEMP-0 and 3.9% (95% CI = 3.3-4.5) in ZARADEMP-I (prevalence ratio = 0.75; 95% CI = 0.56-1.02). However, the prevalence in ZARADEMP-I was significantly lower among men, particularly in all age groups between 70 and 84 years.

CONCLUSION

Stability of the global prevalence of dementia in the elderly population has been documented. However, the decreased prevalence found in elderly men stimulated environmental hypotheses.

Long-term outcome of depressive pseudodementia in the elderly

BACKGROUND

The term depressive pseudodementia has proved to be a popular clinical concept. Little is known about the long-term outcome of this syndrome.

AIMS

To compare depressed elderly patients with reversible cognitive impairment and cognitively intact depressed elderly patients.

METHODS

All patients suffering from moderate or severe depression admitted to St Margaret's Hospital, UK as inpatients or day hospital outpatients between January 1 1997 and December 31 1999 (n=182) were screened for entry into the study. Eligible patients were divided into those presenting with pseudodementia and those who were cognitively intact and followed up for 5 to 7 years.

RESULTS

Seventy-one point four percent of those suffering from pseudodementia had converted into dementia at follow-up compared to only 18.2% in the cognitively intact group. The relative risk was 3.929 (95% CI: 1.985 to 7.775) and the 'number needed to harm' 1.88.

CONCLUSIONS

Reversible cognitive impairment in late-life moderate to severe depression appears to be a strong predictor of dementia. Inpatients and day hospital outpatients with depressive pseudodementia should probably have a full dementia screening, comprehensive cognitive testing and ongoing monitoring of their cognitive function.

The relationship between generalized anxiety disorder, depression and mortality in old age

BACKGROUND

The association between depression and an increased risk of death in elderly persons has been established in both clinical and community studies. Co-occurrence of depression and generalized anxiety has been shown to represent more severe and more chronic psychopathology. However, little is known about the relation between generalized anxiety disorder, mixed anxiety-depression (generalized anxiety disorder and depression) and excess mortality in the elderly.

OBJECTIVE

To investigate whether generalized anxiety and mixed anxiety-depression are associated with mortality.

METHOD

Generalized anxiety disorder, mixed anxiety-depression and depression were assessed in 4051 older persons with a ten-year follow-up of community death registers. The mortality risk of generalized anxiety, depression and mixed anxiety-depression was calculated after adjustment for demographic variables, physical illness, functional disabilities and social vulnerability.

RESULTS

In generalized anxiety disorder and mixed anxiety-depression no significant excess mortality was found. In depression a significant excess mortality was found in men [HR 1.44 (1.09-1.89)] but not in women [HR 1.04 (0.87-1.24)] after adjustment for the different variables.

CONCLUSIONS

In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored.

The Utility of PET Brain Imaging in the Initial Evaluation of Dementia

Given the challenges and benefits of timely and accurate diagnosis of neurodegenerative disorders and the importance of appropriate subsequent treatments, physicians and patients alike desire tools that aid in diagnosing dementia as early and as precisely as possible. One of these tools may be functional brain imaging, specifically positron emission tomography (PET). Recent technological advancements, ongoing research studies, and approval for reimbursement by various insurance companies and Medicare, under certain circumstances, have led to an increased interest in the use of this tool in the evaluation of dementia. This article will review PET brain imaging in the initial assessment and diagnosis of dementia, including its place in current guidelines and role in diagnostic algorithms, its applicability in differentiating among various dementia syndromes and major psychiatric disorders, and some of the controversies surrounding its utility in general clinical practice.

Prevalent and incident depression in community-dwelling elderly persons with diabetes mellitus: results from the ZARADEMP project

AIMS/HYPOTHESIS

Although several studies have reported on the association between diabetes and depression, none have used both formal psychiatric criteria and a prospective, population-based design. Therefore, it remains unclear whether diabetes is a risk factor for the development of depression. Moreover, it is not clear if this effect is influenced by other chronic diseases and functional disabilities.

METHODS

A large (n=4,803) representative community-based study in Spanish elderly subjects (at least 55 years of age) was conducted. The presence of major depression was assessed by means of a standardised psychiatric diagnostic interview (Automated Geriatric Examination for Computer Assisted Taxonomy). Subjects underwent a baseline assessment and a follow-up assessment after 2 and 5 years to determine the incidence of depression.

RESULTS

At baseline 597 subjects (12.5%) were identified as having diabetes. Prevalence and incidence of depression in cases of diabetes were 15.4% and 16.5% respectively. Diabetes was associated with an increased risk of prevalent (odds ratio [OR]=1.47; 95% CI: 1.16-1.83) and incident (OR=1.40; 95% CI: 1.03-1.90) depression. Controlling for potential confounders did not essentially change these findings (prevalent depression: OR 1.41, 95% CI: 1.08-1.83; incident depression: OR 1.26, 95% CI: 0.90-1.77).

CONCLUSIONS/INTERPRETATION

In a large, representative prospective population-based sample using strict psychiatric criteria, we confirmed previous findings that diabetes is associated with an increased risk of depression. The effect on the incidence of depression suggests that diabetes may play a role in the development of depression in the elderly. The presence of comorbid medical diseases seems to decrease the effects of diabetes on the risk of prevalent depression, but to increase the risk of incident depression.