Differential Diagnosis Findings Between Alzheimer's Disease and Major Depressive Disorder: A Review

Background

Differentiating diagnosis between Alzheimer's disease and major depressive disorder in the elderly is a great clinical challenge. This study aimed to identify the establishment of differential diagnosis protocols between Alzheimer's disease and major depressive disorder.

Methods

We searched studies in the Ovid MEDLINE, EMBASE, PsycINFO, and Web of Science databases between 2009 and 2019. A total of 155 references were found for searching relevant articles using Boolean search. After exclusion of redundancies and assessing of title, abstract, and full text for eligibility, 11 articles were selected. The total sample size was 1077 distributed in 8 different countries.

Results

Significant results were found for differential diagnosis between Alzheimer's disease and major depressive disorder, such as overall mental status, episodic memory, visuospatial construction, delayed recognition task, semantic verbal fluency, visual task in short-term memory, atrophy of the hippocampus, cortical activation in specific tasks, and cerebrospinal fluid biomarkers.

Conclusion

These findings are good pathways for discriminating Alzheimer's disease from major depression in the elderly.

Cognitive screening test in primary care: cut points for low education

OBJECTIVE

To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level.

METHODS

Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted.

RESULTS

Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance.

CONCLUSIONS

The GPCOG-Br is clinically well-suited for use in primary care.

Review of Decision-Making in Game Tasks in Elderly Participants with Alzheimer Disease and Mild Cognitive Impairment

BACKGROUND

Changes in decision-making (DM) have recently been investigated in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI). DM is highly relevant to everyday functioning and autonomy. It relies on several cognitive abilities, such as semantic and episodic memory, as well as aspects of executive functioning. We conducted a systematic review of DM in older adults with MCI and AD.

SUMMARY

Only 5 studies whose main objective was to evaluate the DM performance were selected. The results extracted indicated that DM in ambiguity and in at-risk situations are both impaired in probable AD patients. MCI patients have difficulty making advantageous decisions under ambiguity and at risk, similar to patients with probable AD but they are less impaired. Key Messages: DM deficits may be a predictor of cognitive impairment and conversion to dementia and its potential clinical value should be further explored in longitudinal studies involving direct comparison between MCI and AD patients.

Frontal Lobe Degeneration in Adults with Down Syndrome and Alzheimer's Disease: A Review

BACKGROUND

There is a proven link between Down syndrome and the early development of the neuropathological features of Alzheimer's disease (AD). Changes in the personality and behavior of adults with Down syndrome might indicate the early stages of dementia or of frontotemporal lobar degeneration. The objective of this study was to investigate the executive functions and changes in behavior associated with frontal lobe degeneration in individuals with Down syndrome who develop AD. We conducted a systematic review selecting studies employing cognitive assessments.

SUMMARY

We identified few studies using objective measurements to determine whether cognitive aspects associated with the frontal lobe correlate with dementia in this population. We observed a tendency toward such correlations.

KEY MESSAGES

There is a need for further studies in which objective measures of cognitive and behavioral factors are evaluated together with data related to brain function and morphology.

Cognitive intervention in amnestic Mild Cognitive Impairment: a systematic review

Mild Cognitive Impairment (MCI) represents a transitional state between normal aging and early dementia and is commonly associated with memory impairment (amnestic or A-MCI). Several studies have investigated therapeutic approaches to A-MCI, including cholinestherase inhibitors (I-ChEs), although this practice is still controversial. Thus, there is a current need to determine the effects of cognitive interventions either in combination with I-ChEs or alone. To assess the efficacy of such treatments, neuropsychological instruments and self-evaluated scoring of memory, mood, daily life activities and quality of life are employed. Recently, some studies have used functional magnetic resonance imaging (fMRI) in order to understand the neurobiological effects of these interventions. The aim of this systematic review is to investigate the effectiveness of cognitive interventions on the enhancement of learning abilities as well as their impacts on cognitive measurements of mood, everyday functioning and functional neuroimaging. This review also focused on the methodological aspects of such studies and attempted to introduce new perspectives on cognitive interventions in this population. The authors concluded that a-MCI patients are capable to learn new information and memory strategies. Although findings in standardized neuropsychological tests are limited, non-standardized cognitive measures and subjective measures show significant changes. Furthermore, fMRI reveals changes in the patterns of brain activation and increase of connectivity.

Processos perceptuais e cognitivos na leitura de palavras: propriedades dos movimentos oculares

A análise do padrão do movimento ocular auxilia discriminar leitores competentes daqueles com dificuldades de leitura. O padrão de leitura dos movimentos oculares é afetado por propriedades psicolingüísticas da palavra, tais como: comprimento, regularidade, freqüência e lexicalidade O objetivo do presente estudo foi analisar o padrão de movimentos oculares durante a leitura em português do Brasil e compará-lo com resultados de estudos de outras línguas. Os movimentos oculares durante a leitura de palavras e pseudopalavras foram analisados em 20 universitários com idade média de 20,5 anos (DP=2,9). Os resultados indicam que o número de fixações, tempo da primeira fixação e tempo total das fixações foram influenciados pelas variáveis, comprimento, lexicalidade e freqüência dos itens. Foi observado efeito de regularidade para todas as variáveis, exceto naquela do número de fixações. Os resultados obtidos foram semelhantes àqueles encontrados em outras línguas com predomínio de palavras regulares, mas não de palavras irregulares, como o inglês.