Comparison of the Mini Mental State Examination and depressive symptoms between high cardiovascular risk and healthy community elderly groups

Costa, Amanda Lucas da; Varela, Juliana Santos; Mazetti, Osmar; Restelatto, Luciane; Costa, Andry Fitterman; Godinho, Claudia; Camozzato, Ana Luiza; Picon, Paulo D.; Chaves, Márcia L.

doi:10.1590/S1980-57642009DN20400011

Abstract

The aging of the population is a universal phenomenon with direct consequences upon the public health system. One of the main repercussions of the growth in this sector of the population is the increased prevalence of disorders such as dementia and depression which are very frequent among the elderly. The relationship between cardiovascular risk factors, dementia and depression have been addressed in many recent investigations. Objectives: To evaluate the relationship of cognitive performance and depressive symptoms with cardiovascular risk in the elderly. Methods: 94 high cardiovascular risk elderly patients and 160 healthy community elderly were evaluated cross-sectionally. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main measures. The cutoff for presence of depression was 6 on the GDS. Results: The high cardiovascular risk elderly group showed significantly lower scores on the MMSE (p<0.001) and was significantly associated to depression (p<0.001), independently of education. The logistic regression analysis for depression as the dependent variable, age and group (healthy community or high cardiovascular risk elderly) were kept in the final equation. Higher age (Odds Ratio=0.92; 95% CI 0.86-0.98) and high cardiovascular risk elderly (OR=2.99; 95% CI 1.36-6.59) were associated to depression. Conclusions: The present findings corroborate the different cognitive performance of elderly with high cardiovascular risk factors and the association of depressive symptoms with this group.

Key words:
cognitive disorder; cardiovascular risk; Mini Mental State Examination; depressive disorders.

Resumo

O envelhecimento da população é um fenômeno mundial com conseqüências diretas no sistema de saúde pública. Uma das principais conseqüências do crescimento desta parcela da população é o aumento da prevalência de doenças como demência e depressão que são muito freqüentes entre os idosos. Recentemente, a relação entre fatores de risco cardiovasculares, depressão e demência foi abordada em várias investigações. Objetivos: Avaliar a relação de desempenho cognitivo e sintomas depressivos com risco cardiovascular em idosos. Métodos: 94 idosos de alto risco cardiovascular e 160 idosos saudáveis da comunidade foram avaliados num corte transversal. O Mini-Exame do Estado Mental (MEEM) e a escala de depressão geriátrica (GDS-15) foram usados para as medidas principais. O ponto de corte para presença de sintomas depressivos foi 6 na GDS. Resultados: O grupo de alto risco cardiovascular mostrou escores significativamente mais baixos no MEEM (p<0001) independente da educação, e foi significativamente associado a depressão (p<0,001). A análise de regressão logística para depressão como variável dependente, idade e grupo (idosos saudáveis da comunidade ou idosos de alto risco cardiovascular) foram mantidos na equação final. Maior idade (Razão de Chance=0,92, IC 95% 0,86-0,98) e idosos de alto risco cardiovascular (RC=2,99; IC 95% 1,36-6,59) estavam associados à presença de depressão. Conclusões: Os achados do presente estudo corroboram o desempenho cognitivo diferencial dos idosos de alto risco cardiovascular e a associação de sintomas depressivos a este grupo.

Palavras-chave:
transtorno cognitivo; risco cardiovascular; Mini-Exame do Estado Mental; transtorno depressivo.

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References

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Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117.
²
Alzheimer's Disease Statistics Fact Sheet, Alzheimer's Association, 2008.
³
Herrera E Jr, Caramelli P, Silveira AS, et al. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
⁴
Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.
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Ávila R, Bottino CMC. Cognitive changes update among elderly with depressive syndrome. Rev Bras Psiquiatr 2006;28: 316-320.
⁶
Sartorius N. The economic and social burden of depression. J Clin Psychiatry 2001;62 (suppl 15):8-11.
⁷
Berlim MT, McGirr A, Fleck MP. Can sociodemographic and clinical variables predict the quality of life of outpatients with major depression; Psychiatry Res 2008;160:364-371.
⁸
Almeida OP, Forlenza OV, Lima NK, et al. Psychiatric morbidity among the elderly in a primary care setting--report from a survey in São Paulo, Brazil. Int J Geriatr Psychiatry 1997;12: 728-736.
⁹
Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. "Vascular depression" hypothesis. Arch Gen Psychiatry 1997;54:915-922.
¹⁰
Sposito AC, Caramelli B, Fonseca F, Bertolami MC. IV Diretriz Brasileira Sobre Dislipidemias e Prevenção da Aterosclerose Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2007;88(Suppl 1):2-19.
¹¹
Mohs RC, Cohen L. Alzheimer's Disease Assessment Scale (ADAS). Psychopharmacol Bull 1988;24:627-628.
¹²
Duron E, Hanon O. Vascular risk factors, cognitive decline, and dementia. Vasc Health Risk Manag 2008;4:363-381.
¹³
Vinkers DJ, Stek ML, van der Mast RC, et al. Generalized atherosclerosis, cognitive decline, and depressives symptoms in old age. Neurology 2005;65:107-112.
¹⁴
Roher AE, Esh C, Kokjohn T, Sue L, Beach T. Atherosclerosis and AD, Analysis of data from US National Alzheimes's Coordinating Center. Neurology 2005;64:494-500.
¹⁵
Jick, H, Zornberg, GL, Jick, SS, et al. Statins and the risk of dementia. Lancet 2000; 356:1627.
¹⁶
Kivipelto, M, Helkala, EL, Laakso, MP, et al. Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study. BMJ 2001;322:1447.
¹⁷
Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care 2005;28:726-735.
¹⁸
Thomas AJ, Kalaria RN, O´Brien JT. Depression and vascular disease: what is the relationship? J Affect Disord 2004;79:81-95.
¹⁹
Picon PD, Polanczyk CA, Amaral KM. Protocolo Clínico e Diretrizes Terapêuticas para Dislipidemias do Ministério da Saúde. Access in www.saude.gov.br/sas/dsra/protocolos
» www.saude.gov.br/sas/dsra/protocolos
²⁰
Chaves ML, Camozzato AL, Godinho C, Kaye J. Incidence of Mild Cognitive Impairment and Alzheimer's Disease in South of Brazil. J Geriat Psychiatry Neurol (in press).
²¹
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
²²
Chaves ML, Camozzato A, Godinho C, et al. Validity of the Clinical Dementia Rating Scale for The Detection and Staging of Dementia in Brazilian Patients. Alzheimer Dis Assoc Disord 2007;21:210-217.
²³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
²⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.
²⁵
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.
²⁶
Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999;14:858-865.
²⁷
Launer LJ, Ross GW, Petrovitch H, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000;21:49-55.
²⁸
Knopman D, Boland LL, Mosley T, et al. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 2001;56:42-48.
²⁹
Bellew KM, Pigeon JG, Stang PE, et al. Hypertension and the rate of cognitive decline in patients with dementia of the Alzheimer type. Alzheimer Dis Assoc Disord 2004;18:208-213.
³⁰
Qiu C, Winblad B, Marengoni A, et al. Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study. Arch Intern Med 2006;166:1003-1008.
³¹
Zuccalà G, Onder G, Marzetti E, et al. Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. Eur Heart J 2005;26:226-233.
³²
Wolozin B, Kellman W, Ruosseau P, et al. Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol 2000;57:1439-1443.
³³
Bernick C, Katz R, Smith NL, et al. Cardiovascular Health Study Collaborative Research Group. Statins and cognitive function in the elderly: the Cardiovascular Health Study. Neurology 2005;65:1388-1394.
³⁴
O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.
³⁵
de la Torre JC. Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet Neurol 2004;3:184-190.
³⁶
Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 1997;277:813-817.
³⁷
Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study. Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet 2001;357:169-175.
³⁸
Steffens DC, Krishnan KRR, Crump C, Burke GL. Cerebrovascular disease and evolution of depressive symptoms in the Cardiovascular Health Study. Stroke 2002;33:1636-1644.
³⁹
de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MMB. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry 2000;57: 1071-1076.
⁴⁰
Steffens DC, Krishnan KRR. Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions. Soc Biol Psychiatry 1998;43:705-712.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
27 Oct 2008
Accepted
22 Nov 2008

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

[1] ¹
Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117.

[2] ²
Alzheimer's Disease Statistics Fact Sheet, Alzheimer's Association, 2008.

[3] ³
Herrera E Jr, Caramelli P, Silveira AS, et al. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[4] ⁴
Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.

[5] ⁵
Ávila R, Bottino CMC. Cognitive changes update among elderly with depressive syndrome. Rev Bras Psiquiatr 2006;28: 316-320.

[6] ⁶
Sartorius N. The economic and social burden of depression. J Clin Psychiatry 2001;62 (suppl 15):8-11.

[7] ⁷
Berlim MT, McGirr A, Fleck MP. Can sociodemographic and clinical variables predict the quality of life of outpatients with major depression; Psychiatry Res 2008;160:364-371.

[8] ⁸
Almeida OP, Forlenza OV, Lima NK, et al. Psychiatric morbidity among the elderly in a primary care setting--report from a survey in São Paulo, Brazil. Int J Geriatr Psychiatry 1997;12: 728-736.

[9] ⁹
Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. "Vascular depression" hypothesis. Arch Gen Psychiatry 1997;54:915-922.

[10] ¹⁰
Sposito AC, Caramelli B, Fonseca F, Bertolami MC. IV Diretriz Brasileira Sobre Dislipidemias e Prevenção da Aterosclerose Departamento de Aterosclerose da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2007;88(Suppl 1):2-19.

[11] ¹¹
Mohs RC, Cohen L. Alzheimer's Disease Assessment Scale (ADAS). Psychopharmacol Bull 1988;24:627-628.

[12] ¹²
Duron E, Hanon O. Vascular risk factors, cognitive decline, and dementia. Vasc Health Risk Manag 2008;4:363-381.

[13] ¹³
Vinkers DJ, Stek ML, van der Mast RC, et al. Generalized atherosclerosis, cognitive decline, and depressives symptoms in old age. Neurology 2005;65:107-112.

[14] ¹⁴
Roher AE, Esh C, Kokjohn T, Sue L, Beach T. Atherosclerosis and AD, Analysis of data from US National Alzheimes's Coordinating Center. Neurology 2005;64:494-500.

[15] ¹⁵
Jick, H, Zornberg, GL, Jick, SS, et al. Statins and the risk of dementia. Lancet 2000; 356:1627.

[16] ¹⁶
Kivipelto, M, Helkala, EL, Laakso, MP, et al. Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study. BMJ 2001;322:1447.

[17] ¹⁷
Brands AM, Biessels GJ, de Haan EH, et al. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care 2005;28:726-735.

[18] ¹⁸
Thomas AJ, Kalaria RN, O´Brien JT. Depression and vascular disease: what is the relationship? J Affect Disord 2004;79:81-95.

[19] ¹⁹
Picon PD, Polanczyk CA, Amaral KM. Protocolo Clínico e Diretrizes Terapêuticas para Dislipidemias do Ministério da Saúde. Access in www.saude.gov.br/sas/dsra/protocolos
» www.saude.gov.br/sas/dsra/protocolos

[20] ²⁰
Chaves ML, Camozzato AL, Godinho C, Kaye J. Incidence of Mild Cognitive Impairment and Alzheimer's Disease in South of Brazil. J Geriat Psychiatry Neurol (in press).

[21] ²¹
Hughes CP, Berg L, Danziger WL, et al. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[22] ²²
Chaves ML, Camozzato A, Godinho C, et al. Validity of the Clinical Dementia Rating Scale for The Detection and Staging of Dementia in Brazilian Patients. Alzheimer Dis Assoc Disord 2007;21:210-217.

[23] ²³
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[24] ²⁴
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.

[25] ²⁵
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61:777-781.

[26] ²⁶
Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999;14:858-865.

[27] ²⁷
Launer LJ, Ross GW, Petrovitch H, et al. Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging 2000;21:49-55.

[28] ²⁸
Knopman D, Boland LL, Mosley T, et al. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 2001;56:42-48.

[29] ²⁹
Bellew KM, Pigeon JG, Stang PE, et al. Hypertension and the rate of cognitive decline in patients with dementia of the Alzheimer type. Alzheimer Dis Assoc Disord 2004;18:208-213.

[30] ³⁰
Qiu C, Winblad B, Marengoni A, et al. Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study. Arch Intern Med 2006;166:1003-1008.

[31] ³¹
Zuccalà G, Onder G, Marzetti E, et al. Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure. Eur Heart J 2005;26:226-233.

[32] ³²
Wolozin B, Kellman W, Ruosseau P, et al. Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol 2000;57:1439-1443.

[33] ³³
Bernick C, Katz R, Smith NL, et al. Cardiovascular Health Study Collaborative Research Group. Statins and cognitive function in the elderly: the Cardiovascular Health Study. Neurology 2005;65:1388-1394.

[34] ³⁴
O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.

[35] ³⁵
de la Torre JC. Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet Neurol 2004;3:184-190.

[36] ³⁶
Snowdon DA, Greiner LH, Mortimer JA, Riley KP, Greiner PA, Markesbery WR. Brain infarction and the clinical expression of Alzheimer disease. The Nun Study. JAMA 1997;277:813-817.

[37] ³⁷
Neuropathology Group of the Medical Research Council Cognitive Function and Ageing Study. Pathological correlates of late-onset dementia in a multicentre, community-based population in England and Wales. Lancet 2001;357:169-175.

[38] ³⁸
Steffens DC, Krishnan KRR, Crump C, Burke GL. Cerebrovascular disease and evolution of depressive symptoms in the Cardiovascular Health Study. Stroke 2002;33:1636-1644.

[39] ³⁹
de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MMB. Cerebral white matter lesions and depressive symptoms in elderly adults. Arch Gen Psychiatry 2000;57: 1071-1076.

[40] ⁴⁰
Steffens DC, Krishnan KRR. Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions. Soc Biol Psychiatry 1998;43:705-712.

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