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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous frequency estimates of cognitive dysfunction in multiple sclerosis have ranged from 54 to 65 percent. These studies may overestimate the frequency in the general MS population, since the patients in these studies were recruited from clinic populations. In the present study, we administered a comprehensive neuropsychological test battery to 100 community-based MS patients and 100 demographically matched healthy controls. Of 31 cognitive test indices examined, 48 MS patients and five controls were impaired on four or more test indices, yielding an overall frequency rate of 43% for the MS group. The pattern of cognitive decline was not uniform: MS patients were more frequently impaired on measures of recent memory, sustained attention, verbal fluency, conceptual reasoning, and visuospatial perception, and less frequently impaired on measures of language and immediate and remote memory. We developed a brief (20-minute) screening battery empirically by selecting the four most sensitive test indices from the comprehensive battery. The brief battery yielded a sensitivity value of 71% and a specificity value of 94% in discriminating cognitively intact from impaired MS patients, as defined by the comprehensive battery. Cognitive impairment was not significantly associated with illness duration, depression, disease course, or medication usage, but was significantly (albeit weakly) correlated with physical disability.
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PMID:Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. 182 86

Of 317 consecutive cases seen in a dementia clinic, 19 (6%) had little or no objective evidence of cognitive impairment on clinical examination and extensive neuropsychological testing. Of the remaining 298 cases, 192 (64%) were diagnosed as probable or possible Alzheimer's disease (AD). Of the 19 nondemented cases, 8 (42%) were thought to have cognitive difficulty due to depression. In the AD group, only 4 cases (2%) were thought to be depressed and only 2 of the 4 met DSM-III-R criteria for major depression. There was no relationship between Hamilton Rating Scale for Depression scores and either cognitive or behavioral measurements of dementia severity, suggesting that the difference between the two groups was not due to underreporting by AD patients. The authors concluded that a tertiary care setting, depression is a common cause of cognitive complaints in persons without organic disease and a rare cause of excess morbidity in AD.
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PMID:Experiences with depression in a dementia clinic. 203 31

Early studies suggested that cerebrovascular change may be an etiological factor in the development of late-life depression. With the advent of magnetic resonance imaging (MRI), it has become possible to examine this hypothesis. MRI studies have demonstrated that patients with late-onset depression have more severe and frequent patchy lesions in the frontal deep white matter and basal ganglia than do controls or patients with early-onset depression. Patients with basal ganglia lesions, primarily caudate, are more likely to develop delirium with antidepressants and electroshock treatment (EST). The prognostic significance and the relationship of these lesions to cognitive impairment is unclear.
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PMID:Organic bases of depression in the elderly. 203 71

A random sample of 241 patients from General Practice registers in London were interviewed to assess alcohol consumption, cognitive impairment, depression and other factors. Fifty-one per cent of men and 22% of women reported use of alcohol in the previous 3 months. No significant association was found between reported drinking status and age, score on a depression scale, falls in the previous 3 months, attendance at outpatient clinics or inpatient care in the previous year. In the men abstainers were significantly more likely to show cognitive impairment than were drinkers. Amongst those respondents who admitted to drinking within the previous 3 months, total stated weekly alcohol consumption was not associated with age, cognitive impairment and scores on the depression scale, and there was no association with falls, or with outpatient or inpatient care. Only three men (3.6%) and five women (3.2%) admitted consuming more than 21 and 14 units of alcohol per week, respectively.
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PMID:Alcohol consumption by elderly people: a general practice survey. 205

The clinical symptoms of Alzheimer's disease must be assessed and characterized comprehensively to confirm a diagnosis of dementia, to follow the course of the illness, and to evaluate the effects of treatment. Comprehensive assessment measures are multi-item scales that evaluate the various core cognitive symptoms of dementia and that provide a total score representing the overall magnitude of cognitive impairment. Neuropsychologic test batteries provide more detailed, objective evaluations of the various cognitive functions that are impaired. Global staging methods provide a single measure of the stage or severity of dementia, which is useful for tracking the clinical course and for comparisons among different studies. Scales to assess activities of daily living (basic physical functions and more complex instrumental activities) provide the most clinically relevant information regarding a patient's capacity to function in daily life. Finally, noncognitive behavioral symptom scales evaluate the secondary dementia symptoms (depression, agitation, hallucinations, delusions, etc.) that provide the greatest difficulty for patient management.
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PMID:Scales for the assessment of Alzheimer's disease. 206 23

Depressive illness with initial onset after age 60 has different clinical and prognostic features compared to depression beginning at a younger age. We evaluated waking electroencephalograms (EEGs) in 61 elderly depressed patients (32 early onset, 29 late onset) without cognitive impairment and not receiving psychotropic medications. The groups were comparable for age, severity of Hamilton depression score, education, and Folstein Mini-Mental State scores. Conventional visual EEG analysis revealed no significant differences in the mean alpha rhythm, incidence of abnormal records, or types of EEG abnormalities. Computerized spectral EEG analysis was also performed in 48 patients (23 early onset, 25 late onset). There were no significant differences in the pooled parasagittal mean frequency, theta--beta difference, combined delta and theta percentage, or relative power of the frequency bands. Thus, waking EEGs do not differentiate between elderly patients with the initial onset of the depression before or after age 60.
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PMID:Age at initial onset of depression and waking EEG variables in the elderly. 206 41

In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as having minor depression and 14 percent major depression. At follow-up, fifteen months later, the prevalence of depressive disorder had declined substantially, to 12 percent overall. Major depression was characterized by an average duration of thirty-nine weeks, a mortality rate of 23 percent and was associated with positive family history of affective or anxiety disorder. Among patients with left hemisphere lesions, major depression was associated with cognitive impairment. Minor depression had a shorter average duration (twelve weeks) and was more common in males. These two syndromes may define distinct types of post-stroke depression with implications for treatment interventions.
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PMID:Prevalence and course of depressive disorders in hospitalized stroke patients. 208 22

Two-hundred four patients between 70 and 85 years of age were included in a double-blind randomized controlled multicenter study (almitrine-raubasine/placebo). Inclusion criteria were a complaint of cognitive disorders and an objective cognitive impairment evaluated by Folstein et al. "Mini-Mental State" (MMS) and by Sandoz Clinical Assessment for Geriatrics (SCAG). Patients were treated for 6 months and evaluations were performed at the beginning of the trial (T0), then 3 (T3) and 6 (T6) months later. Evaluations included a visual analogic self-rating scale and the following psychometric tests: Trail Making A (TMA), Shopping List Task, Word Fluency, Crossing Out Letters, Logical Memory, Digit Span, and Visual Retention. Anxiety and Depression Scales were also used to assess the effects of almitrine-raubasine on affective status. Statistical analysis involving the whole sample did not show any significant difference between the almitrine-raubasine and placebo groups concerning changes in assessment criteria from T0 to T6. However, these results may have been due to the wide heterogeneity of baseline performances in psychometric tests. To prevent this possible bias, further statistical analysis was performed for each psychometric test after patients had been divided into three classes according to baseline score levels. Considering scores on TMA and Digit Span for patients with scores in the intermediate class on TMA, almitrine-raubasine induced a significantly higher improvement in performance from T0 to T6 than that induced by placebo. On the other hand, no side effects were noted with almitrine-raubasine when compared with placebo. These data suggest that almitrine-raubasine enhances concentrated attention in patients with mild to moderate impairment of this function.
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PMID:Almitrine-raubasine and cognitive impairment in the elderly: results of a 6-month controlled multicenter study. 209 14

Pain is an understudied problem in geriatric medicine and especially among nursing home residents. The focus of this study was to describe the scope of the problem of pain in a long-term care facility. Ninety-seven subjects from a 311-bed multilevel teaching nursing home were interviewed, and charts were reviewed for pain problems and management strategies. Functional status, depression, and cognitive impairment were also evaluated. Results indicate that 71% of residents had at least one pain complaint (range, 1-4). Of subjects with pain, 34% described constant (continuous) pain and 66% described intermittent pain. Of 43 subjects with intermittent pain, 51% described pain on a daily basis. Major sources of pain included low back pain (40%), arthritis of appendicular joints (24%), previous fracture sites (14%), and neuropathies (11%). Moderately strong correlations were found between pain and infrequent attendance at recreational and social activities (r = .50). However, little correlation was observed between pain and the Yesavage Depression Scale, the Folstein Mini-Mental State Scale, or basic ADLs measured by the Katz Scale. Pain-management strategies consisted of analgesic drugs, physical therapy, and heating pads. Only 15% of patients with pain had received medication within the previous 24 hours. The findings suggest that pain is a major problem in long-term care. Strategies for pain management appear to be limited in scope and application in this setting. Important barriers were identified that influence the reporting and management of pain in this setting.
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PMID:Pain in the nursing home. 210 65

Unlike patients with irreversible dementia, elderly depressed patients with cognitive impairment are thought to have relatively preserved recognition, memory, and language abilities. To test this hypothesis, the authors compared memory and naming performance in elderly hospitalized patients with major depression alone, reversible dementia of depression, or irreversible dementia. All patient groups performed worse than nondemented, nondepressed control subjects on memory tasks. Patients with dementia of depression performed worse than depressed patients with normal cognition on tests of free recall, delayed recall, and verbal delayed memory but not on tests of delayed visual memory. Patients with dementia of depression and patients with irreversible dementia were severely compromised in both speed and accuracy on the confrontation naming task.
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PMID:Confrontation naming deficit in dementia of depression. 213 62


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