Evaluation of clinical comorbidities in cognitively impaired patients with depressive symptoms

Funari, Rossana Maria Russo; Mansur, Letícia Lessa; Varandas, Paulo Rogério Rosmaninho; Freitas, Maria Isabel D´Avila; Jacob Filho, Wilson

doi:10.1590/S1980-57642008DN10400013

Abstract

In demented patients, depressive symptoms as well as cognition and clinical comorbidities can interact and induce a complex condition of severity and handicap. Objective: The objective of this study was to evaluate the influence of depressive symptoms in cognitively impaired patients on associated clinical comorbidities in geriatric patients. Methods: One-hundred-thirty-eight (138) patients were divided into two groups: the first contained cognitively impaired patients with depressive symptoms while the second comprised cognitively impaired patients without depressive symptoms. To quantify comorbidities, the Modified CIRS Scale was used. Results: Out of the 138 patients, 52 were cognitively impaired with depressive symptoms and 86 were cognitively impaired without depressive symptoms, both having mean CDR of 1.74 (moderate dementia). The patients with depressive symptoms used more drugs (4.98 per patient vs. 3.45 per patient without depressive symptoms; p=0.001), presented more comorbidities (3.24 per patient vs. 2.46 per patient without depressive symptoms; p=0.009). However, these comorbidities were neither more severe nor more complex in the patients with depressive symptoms, with mean Comorbidity Severity Index of 1.45 in patients with and 1.37 in patients without depressive symptoms (p= 0.078) and mean Comorbidity Complexity Index of 2.41 in patients with depressive symptoms and 2.01 in those without depressive symptoms (p=0.103). Conclusion: Cognitively impaired patients with depressive symptoms had a greater absolute number of comorbidities and took more drugs although these comorbid diseases were less severe and complex than in non-depressive cognitively impaired patients.

Key words:
dementia; depressive symptoms; comorbidities; depression

Resumo

Em pacientes com demência, sintomas depressivos, cognição e comorbidades podem interagir resultando em uma condição de agravamento do quadro e desvantagem. Objetivo: O objetivo do estudo foi avaliar a influência de sintomas depressivos sobre as comorbidades em pacientes geriátricos com declínio cognitivo. Metodos: 138 pacientes foram divididos em dois grupos: o primeiro composto de pacientes com distúrbio cognitivo associado a sintomas depressivos e o segundo de pacientes com distúrbio cognitivo sem sintomas depressivos. Para quantificar as comorbidades a Escala CIRS modificada foi utilizada. Resultados: 52 pacientes apresentavam distúrbio cognitivo com sintomas depressivos e 86 apresentavam distúrbios cognitivos sem sintomas depressivos, ambos com média de 1.74 no CDR (demência moderada). Os pacientes com sintomas depressivos usaram maior número de fármacos (4.98 / paciente com sintomas depressivos versus 3.45 / pacientes sem sintomas depressivos; p=0.001), apresentaram maior número de comorbidades (3.24 / paciente com sintomas depressivos versus 2.46 / pacientes sem sintomas depressivos; p=0.009) mas essas comorbidades não foram mais graves nem mais complexas nos pacientes depressivos: média do Índice de Gravidade das Comorbidades=1.45 no grupo com sintomas depressivos e 1.37 no grupo sem sintomas depressivos (p=0.078) e média de do Índice de Complexidade da Comorbidade com sintomas depressivos = 2.41 no grupo com sintomas depressivos e 2.01 no grupo sem sintomas depressivos (p=0.103). Conclusão: Os pacientes com distúrbio cognitivo associado a sintomas depressivos apresentaram maior número absolute de comorbidades e ingeriam maior número de fármacos mas as doenças eram menos graves e complexas do que as do grupo de não depressivos.

Palavras-chave:
demência; sintomas depressivos; comorbidades; depression

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References

¹
Greenwald BS, Kramer-Ginsberg E, Marin DB, et al. Dementia with coexistent major depression. Am J Psychiatry 1989;146:1472-1478.
²
Reifler BV, Larson E, Hanley R. Coexistence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry 1982;139:623-626.
³
Lyketsos CG, Olin J. Depression in Alzheimer's disease: overview and treatment. Biol Psychiatry 2002;52:243-252.
⁴
Simpson S, Allen H, Tomenson B, et al. Neurological correlates of depressive symptoms in Alzheimer's disease and vascular dementia. J Affect Disord 1998;53:129-136.
⁵
Groves WC, Brandt J, Steinberg M et al. Vascular dementia and Alzheimer's disease: is there a difference? a comparison of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000;12:305-315.
⁶
Mehta KM. Cognitive impairment, depressive symptoms, and functional decline in older people. J Am Geriatr Soc 2002;50:1045-1050.
⁷
Starkstein SE, Mizrahi R, Garau L. Specificity of symptoms of depression in Alzheimer disease. Am J Geriatric Psychiatry 2005;13:802-807.
⁸
Snow AL, Dani R, Souchek J, Sullivan G, Ashton CM, Kunik ME. Comorbid psychosocial symptoms and quality of life in patients with dementia. Am J Geriatr Psychiatry 2005;13:393-401.
⁹
Kunik ME, Cully JA, Snow AL, Souchek J, Sullivan G, Ashton CM. Treatable comorbid conditions and use of VA health care services among patients with dementia. Psychiatr Serv 2005;56:70-75.
¹⁰
McKhann G, Drachman D, Folstein M, et al: Clinical Diagnosis of Alzheimer's Disease: Report of the NINCDS-ADRDAwork group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-44.
¹¹
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: Diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.
¹²
American Psychiatric Association (DSM-IV). Diagnostic and Statistical Manual of Mental Disorders, 4th; Washington, DC: American Psychiatric Association;1994.
¹³
Folstein MF, Folstein SE, Mc Hugh PR.? Mini-mental state. A practical method for grading the cognitive state of patients for clinician. J Psychiat Res 1975;12:189-198.
¹⁴
Morris JC. Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr 1997; 9(Suppl 1):173-176;discussion 177-8.
¹⁵
Burke WJ, Houston MJ, Boust SJ, Roccaforte WH. Use of the Geriatric Depression Scale in dementia of the Alzheimer type. J Am Geriatric Soc 1989;37: 856-860.
¹⁶
Pamelle PA, Thuras PD, Katz IR, Lawton MP. Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatric Soc 1995;43:130-137.
¹⁷
Bussab WO, Morettin PA. Estatística básica. 5o ed. São Paulo: Saraiva, 2006.
¹⁸
Schubert CC, Boustani M, Callahan CM, et al. Comordidity profile of dementia patients in primary care: are they sicker? J Am Geriatric Soc 2006;54:104-109.
¹⁹
Kaup BA, Loreck D, Gruber-Baldini AL, et al. Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry. 2007;15:438-42.
²⁰
Kales HC, Chen P, Blow FC, Welsh DE, Mellow AM. Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. Am J Geriatr Psychiatry 2005;13:441-449.
²¹
Artaz MA, Boddaert J, Hériche-Taillandier E, Dieudonné B, Verny M; le groupe REAL.FR. Medical comorbidity in Alzheimer's disease: baseline characteristics of the REAL.FR Cohort. Rev Med Interne. 27:91-97.
²²
Ganguli M, Du Y, Dodge HH, Ratcliff GG, Chang CC. Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. Arch Gen Psychiatry. 2006;63:153-160.
²³
Kales HC, Blow FC, Copeland LA, et al. Healthcare utilization by older patients with coexisting dementia and depression. Am J Psychiatry 1999;156:550-556.
²⁴
Lyketsos CG, Del Campo L, Steinberg M , Miles Q. Treating depression in Alzheimer disease 2003;60:737-746.

Publication Dates

Publication in this collection
Oct-Dec 2007

History

Received
02 Nov 2007
Reviewed
25 Nov 2007
Accepted
30 Nov 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Greenwald BS, Kramer-Ginsberg E, Marin DB, et al. Dementia with coexistent major depression. Am J Psychiatry 1989;146:1472-1478.

[2] ²
Reifler BV, Larson E, Hanley R. Coexistence of cognitive impairment and depression in geriatric outpatients. Am J Psychiatry 1982;139:623-626.

[3] ³
Lyketsos CG, Olin J. Depression in Alzheimer's disease: overview and treatment. Biol Psychiatry 2002;52:243-252.

[4] ⁴
Simpson S, Allen H, Tomenson B, et al. Neurological correlates of depressive symptoms in Alzheimer's disease and vascular dementia. J Affect Disord 1998;53:129-136.

[5] ⁵
Groves WC, Brandt J, Steinberg M et al. Vascular dementia and Alzheimer's disease: is there a difference? a comparison of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000;12:305-315.

[6] ⁶
Mehta KM. Cognitive impairment, depressive symptoms, and functional decline in older people. J Am Geriatr Soc 2002;50:1045-1050.

[7] ⁷
Starkstein SE, Mizrahi R, Garau L. Specificity of symptoms of depression in Alzheimer disease. Am J Geriatric Psychiatry 2005;13:802-807.

[8] ⁸
Snow AL, Dani R, Souchek J, Sullivan G, Ashton CM, Kunik ME. Comorbid psychosocial symptoms and quality of life in patients with dementia. Am J Geriatr Psychiatry 2005;13:393-401.

[9] ⁹
Kunik ME, Cully JA, Snow AL, Souchek J, Sullivan G, Ashton CM. Treatable comorbid conditions and use of VA health care services among patients with dementia. Psychiatr Serv 2005;56:70-75.

[10] ¹⁰
McKhann G, Drachman D, Folstein M, et al: Clinical Diagnosis of Alzheimer's Disease: Report of the NINCDS-ADRDAwork group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-44.

[11] ¹¹
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: Diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology 1993;43:250-260.

[12] ¹²
American Psychiatric Association (DSM-IV). Diagnostic and Statistical Manual of Mental Disorders, 4th; Washington, DC: American Psychiatric Association;1994.

[13] ¹³
Folstein MF, Folstein SE, Mc Hugh PR.? Mini-mental state. A practical method for grading the cognitive state of patients for clinician. J Psychiat Res 1975;12:189-198.

[14] ¹⁴
Morris JC. Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. Int Psychogeriatr 1997; 9(Suppl 1):173-176;discussion 177-8.

[15] ¹⁵
Burke WJ, Houston MJ, Boust SJ, Roccaforte WH. Use of the Geriatric Depression Scale in dementia of the Alzheimer type. J Am Geriatric Soc 1989;37: 856-860.

[16] ¹⁶
Pamelle PA, Thuras PD, Katz IR, Lawton MP. Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatric Soc 1995;43:130-137.

[17] ¹⁷
Bussab WO, Morettin PA. Estatística básica. 5o ed. São Paulo: Saraiva, 2006.

[18] ¹⁸
Schubert CC, Boustani M, Callahan CM, et al. Comordidity profile of dementia patients in primary care: are they sicker? J Am Geriatric Soc 2006;54:104-109.

[19] ¹⁹
Kaup BA, Loreck D, Gruber-Baldini AL, et al. Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry. 2007;15:438-42.

[20] ²⁰
Kales HC, Chen P, Blow FC, Welsh DE, Mellow AM. Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. Am J Geriatr Psychiatry 2005;13:441-449.

[21] ²¹
Artaz MA, Boddaert J, Hériche-Taillandier E, Dieudonné B, Verny M; le groupe REAL.FR. Medical comorbidity in Alzheimer's disease: baseline characteristics of the REAL.FR Cohort. Rev Med Interne. 27:91-97.

[22] ²²
Ganguli M, Du Y, Dodge HH, Ratcliff GG, Chang CC. Depressive symptoms and cognitive decline in late life: a prospective epidemiological study. Arch Gen Psychiatry. 2006;63:153-160.

[23] ²³
Kales HC, Blow FC, Copeland LA, et al. Healthcare utilization by older patients with coexisting dementia and depression. Am J Psychiatry 1999;156:550-556.

[24] ²⁴
Lyketsos CG, Del Campo L, Steinberg M , Miles Q. Treating depression in Alzheimer disease 2003;60:737-746.

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