Impaired cognition in depression and Alzheimer (AD): a
                    gradient from depression to depression in AD

Araujo, Narahyana Bom de; Moraes, Helena Sales; Silveira, Heitor; Arcoverde, Cynthia; Vasques, Paulo Eduardo; Barca, Maria Lage; Knapskog, Anne-Brita; Engedal, Knut; Coutinho, Evandro Silva Freire; Deslandes, Andrea Camaz; Laks, Jerson

doi:10.1590/0004-282X20140108

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Articles • Arq. Neuro-Psiquiatr. 72 (9) • Sept 2014 • https://doi.org/10.1590/0004-282X20140108 copy

Impaired cognition in depression and Alzheimer (AD): a gradient from depression to depression in AD

Alterações cognitivas na depressão e na doença de Alzheimer: um gradiente da depressão até a doença de Alzheimer

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly.

Method

Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests.

Results

We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar.

Conclusion

A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Alzheimer’s disease; depression; neuropsychological tests and cognition

	Control N=62	MD N=61	AD N=46	Depression in AD N=43
Age (years)^a	68.55 (±5.97)	70.89 (±7.30)	76.09 (±6.34)	75.86 (±7.6)
Education (years)	10.32 (±4.14)	8.18 (±3.91)^b	7.37 (±4.45)^b	6.56 (±3.87)^b
Duration of disease (years)	_	7 (0-40)	4 (1-11)	4 (1-10)
Depressive symptoms x (sd)	2.17 (±2.32)	12.21 (±4.03)	3.46 (±2.08)	11.23 (±4.64)
Gender (%)
Female	82.69	81.97	80.43	70.45
Disease Severity (%)
Mild	-	62.29	67.39	37.21
Moderate	-	34.43	21.74	34.88
Severe	-	3.28	10.87	27.91

	Control	MD	AD	Depression in AD	X² (p) Post hoc
	N; Median (min-max)	N; Median (min-max)	N; Median (min-max)	N; Median (min-máx)	X² (p) Post hoc
MMSE (score)	62; 29 (24-30)	61; 28 (21-30)	46; 19 (2-28)	43; 13 (0-27)	152.589 (<0.001)
					^bp<0.001
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
					^gp=0.025
Verbal fluency^a	62; 17.85 (4.89)	61; 15.90 (3.85)	46; 9.98 (5.15)	43; 7.37 (5.56)	52.705 (<0.001)
					^cp<0.001
					^dp<0.001
					^ep< 0.001
					^fp<0.001
Digit span (score)	62; 10 (4-23)	61; 8 (4-15)	44; 7 (0-17)	43; 6 (0-14)	53.848 (<0.001)
					^bp<0.001
					^cp<0.001
					^dp<0.001
					^fp<0.001
Digit forward (score)	62; 5.5 (2-13)	61; 4 (1-9)	44; 4 (0-11)	43; 4 (0-8)	24.304 (<0.001)
					^bp=0.003
					^cp=0.006
					^dp<0.001
Digit backward (score)	62; 5 (1-10)	61; 4 (2-9)	44; 3 (0-6)	43; 2 (0-7)	65.059 (<0.001)
					^bp=0.002
					^cp<0.001
					^dp<0.001
					^ep=0.009
					^fp<0.001
Stroop points (sec)	59; 15 (10-32)	61; 23 (12-50)	37; 28 (13-71)	34; 38,5 (13-226)	66,756 (<0.001)
					^bp<0.001
					^cp<0.001
					^dp<0.001
					^fp=0.012
Errors-stroop points	59; 0 (0-2)	61; 0 (0-0)	37; 0 (0-7)	34; 0.5 (0-19)	33,769 (<0.001)
					^dp=0.008
					^fp=0.007
					^gp=0.021
Stroop words (sec)	59; 20 (12-32)	61; 25 (13-59)	37; 34 (15-108)	34; 49.5 (14-144)	75,628 (<0.001)
					^ap<0.001
					^cp<0.001
					^dp<0.001
					^ep=0.030
					^fp<0.001
Errors-stroop words	59; 0 (0-1)	61; 0 (0-2)	37; 0 (0-24)	34; 1.5 (0-23)	51.105 (<0.001)
					^dp<0.001
					^fp=0.002
Stroop colors (sec)	59; 31 (19-58)	61; 38 (18-126)	37; 48 (20-118)	35; 57 (21-249)	46.931(<0.001)
					^bp=0.001
					^cp<0.001
					^dp<0.001
					^fp=0.008
Errors-stroop colors	59; 0 (0-18)	61; 0 (0-13)	37; 4 (0-24)	35; 7.5 (0-24)	64,621(<0.001)
					^cp=0.004
					^dp<0.001
					^ep=0.001
					^fp<0.001
RAVLT^a(list A1-A5)	62; 43.82 (12.51)	61; 36.28 (11.03)	42; 19.24 (8.99)	40; 13.57 (10.52)	81.633(<0.001)
					^bp=0.003
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
RAVLT B	62; 5 (1-12)	61; 5 (0-10)	41; 2 (0-5)	40; 1 (0-5)	102.852 (<0.001)
					^bp=0.40
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
RAVLT A6	62; 8.5 (2-14)	61; 7 (0-13)	41; 1 (0-6)	40; 0 (0-6)	129.420 (<0.001)
					^bp=0.004
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
RAVLT A7	62; 9 (0-15)	61; 6 (0-14)	41; 0 (0-7)	40; 0 (0-4)	130.106(<0.001)
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
RAVLT LR	62; 14 (4-18)	60; 13 (5-15)	37; 11 (0-15)	26; 6.5 (0-15)	53.187 (<0.001)
					^cp<0.001
					^dp<0.001
					^ep=0.001
					^fp<0.001
Similarities^a	62; 16.16 (5.55)	61; 16.18 (5.85)	25; 8.24 (5.47)	12; 5.25 (3.49)	25.279 (<0.001)
					^cp<0.001
					^dp<0.001
					^ep<0.001
					^fp<0.001
Rey figure	61; 31 (8-36)	60; 26.5 (3-34)	22; 18 (0-34)	14; 6.5 (0-34)	29.344(<0.001)
					^bp=0.008
					^cp=0.004
					^dp=0.003
					^fp=0.025

	Control (reference)	MD RR (CI)	AD RR (CI)	Depression in AD RR (CI)
	Control (reference)	p-value	p-value	p-value
MMSE (score)	1	0.97 (0.91-1.04)	0.65 (0.60-0.72)	0.51 (0.46-0.56)
		0.451	<0.001	<0.001
Verbal fluency	1	0.94 (0.83-1.07)	0.61 (0.52-0.72)	0.46 (0.38-0.55)
		0.37	<0.001	<0.001
Digit span (score)	1	0.85 (0.76-0.96)	0.77 (0.66-0.89)	0.63 (0.53-0.74)
		0.008	<0.001	<0.001
Digit forward (score)	1	0.85 (0.72-1.00)	0.86 (0.70-1.04)	0.76 (0.62-0.94)
		0.054	0.13	0.01
Digit backward (score)	1	0.85 (0.72-1.01)	0.66 (0.53-0.82)	0.47 (0.37-0.62)
		0.06	<0.001	<0.001
Stroop points (sec)	1	1.44 (1.22-1.71)	1.65 (1.35-2.03)	2.64 (2.16-3.23)
		<0.001	<0.001	<0.001
Errors-stroop points	1	0.93 (0.26-3.37)	1.54 (0.38-6.15)	37.06 (10.41-131.92)
		0.91	0.54	<0.001
Stroop words (sec)	1	1.41 (1.19-1.66)	1.89 (1.55-2.29)	2.76 (2.26-3.36)
		<0.001	<0.001	<0.001
Errors-stroop words	1	5.38 (1.02-28.27)	63.62 (11.66-347.00)	118 (22.74-621.11)
		0.047	<0.001	<0.001
Stroop colors (sec)	1	1.34 (1.13-1.58)	1.47 (1.20-1.80)	2.07 (1.69-2.54)
		0.001	<0.001	<0.001
Errors-stroop colors	1	0.77 (0.46-1.31)	3.48 (1.94-6.25)	5.47 (3.04-9.85)
		0.340	<0.001	<0.001
RAVLT (list A1-A5)	1	0.91 (0.77-1.06)	0.50 (0.41-0.61)	0.36 (0.29-0.45)
		0.240	<0.001	<0.001
RAVLT B	1	0.91 (0.77-1.07)	0.45 (0.35-0.58)	0.34 (0.26-0.45)
		0.237	<0.001	<0.001
RAVLT A6	1	0.81 (0.69-0.95)	0.21 (0.16-0.28)	0.10 (0.07-0.15)
		0.011	<0.001	<0.001
RAVLT A7	1	0.84 (0.68-1.04)	0.12 (0.68-1.04)	0.02 (0.01-0.05)
		0.116	<0.001	<0.001
RAVLT LR	1	0.99 (0.89-1.10)	0.76 (0.66-0.87)	0.54 (0.46-0.65)
		0.917	<0.001	<0.001
Similarities	1	1.09 (0.96-1.27)	0.57 (0.46-0.70)	0.39 (0.28-0.54)
		0.187	<0.001	<0.001
Rey figure	1	0.93 (0.79-1.08)	0.73 (0.59-0.91)	0.49 (0.37-0.65)
		0.353	0.005	<0.001

	MD (reference)	AD RR (CI)	Depression in AD RR (CI)
		p-value	p-value
MMSE (score)	1	0.68 (0.60-0.76)	0.53 (0.47-0.59)
		<0.001	<0.001
Verbal fluency	1	0.63 (0.52-0.76)	0.46 (0.37-0.57)
		<0.001	<0.001
Digit total (score)	1	0.90 (0.77-1.05)	0.74 (0.62-0.87)
		0.175	<0.001
Digit forward (score)	1	1,00 (0.82-1.21)	0.89 (0.72-1.10)
		0.991	0.300
Digit backward (score)	1	0.78 (0.63-0.98)	0.57 (0.44-0.73)
		0.033	<0.001
Stroop points (sec)	1	1.15 (0.94-1.42)	1.84 (1.49-2.27)
		0.179	<0.001
Erros-stroop points	1	1.74 (0.46-6.51)	44.14 (12.29-158.56)
		0.411	<0.001
Stroop words (sec)	1	1.34 (1.09-1.65)	1.96 (1.59-2.41)
		0.005	<0.001
Errors-stroop words	1	12.34 (4.16-36.64)	22.41 (8.17-61.42)
		<0.001	<0.001
Stroop colors (sec)	1	1.09 (0.89-1.35)	1.55 (1.25-1.92)
		0.401	<0.001
Errors-stroop colors	1	4.66 (2.74-7.91)	7.96 (4.69-13.49)
		<0.001	<0.001
RAVLT (list A1-A5)	1	0.55 (0.44-0.69)	0.39 (0.31-0.50)
		<0.001	<0.001
RAVLT B	1	0.49 (0.38-0.62)	0.37 (0.28-0.49)
		<0.001	<0.001
RAVLT A6	1	0.25 (0.18-0.34)	0.12 (0.08-0.17)
		<0.001	<0.001
RAVLT A7	1	0.13 (0.087-0.20)	0.02 (0.01-0.06)
		<0.001	<0.001
RAVLT LR	1	0.77 (0.66-0.91)	0.55 (0.45-0.68)
		0.002	<0.001
Similarities	1	0.50 (0.39-0.64)	0.34 (0.24-0.49)
		<0.001	<0.001
Rey figure	1	0.78 (0.58-1.05)	0.53 (0.37-0.76)
		0.105	0.001

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[1] Correspondence: Narahyana Bom de Araujo; Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria; Avenida Venceslau Brás, 71; 22290-140 Rio de Janeiro RJ, Brasil; E-mail: narahyana@hotmail.com