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

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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Sumário

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo

Avaliar a cognição em idosos com depressão Maior (DM), doença de Alzheimer (DA) e Depressão na DA.

Método

Utilizou-se o Mini Mental, Rey Auditory Verbal Learning Test, Figura de Rey, Dígitos, Semelhanças, Trail Making A/B, Fluência Verbal e Stroop. ANOVA one-way e modelos multivariados foram utilizados para comparar o desempenho dos grupos.

Resultados

Foram avaliados 212 sujeitos. Comparado com DM, controles apresentaram desempenho significativamente melhor na atenção, memória de trabalho, velocidade de processamento e evocação. Os controles apresentaram desempenho significativamente superior em todas as avaliações, exceto na atenção comparado com DA. Fluência verbal, memória, velocidade de processamento e raciocínio abstrato na DM foi significativamente maior comparado com DA. DA foi significativamente melhor no estado cognitivo geral comparado a depressão na DA, os outros domínios foram semelhantes.

Conclusão

Observou-se um gradiente decrescente na cognição dos controles até a Depressão na DA, com os grupos DM e DA com desempenhos intermediários.

doença de Alzheimer; depressão; testes neuropsicológicos e cognição

	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