Acessibilidade / Reportar erro

screening for cognitive impairment in late onset depression in a Brazilian sample using the BBRC-edu

RASTREIO DE COMPROMETIMENTO COGNITIVO NA DEPRESSÃO DE INÍCIO TARDIO EM UMA AMOSTRA BRASILEIRA USANDO O BBRC-EDU

ABSTRACT

Depression and dementia are the most prevalent neuropsychiatric disorders in the elderly population. Alzheimer's disease is the leading cause of dementia in most countries, being responsible for more than half of all dementia cases. Late-onset depression is a frequent cause of cognitive decline in the elderly. Differentiating between cognitive impairment secondary to depression and incipient dementia poses a challenge in the clinical setting.

Objective:

To evaluate the performance of elderly depressed patients using the BBRC-Edu.

Methods:

We studied 25 patients with late onset depression (mean age: 73.6 y (6.6); schooling: 9.1 y (5.7)) and 30 patients with mild AD (mean age 76.6 y (5.4); schooling: 7.5 y (7.1)), who were compared to a control group of 30 healthy elderly (mean age 73.8 y (5.8); schooling: 9.1 y (5.4)) using the CERAD and BBRC-Edu batteries.

Results:

For the CERAD battery, depressed patients performed better than AD patients on all tasks (p<0.0001) except for Constructional Praxis (p>0.05), and performed poorer than controls on verbal fluency (animals) and Word List Recall tasks (p<0.0001). For the BBRC-Edu, depressed patients performed better than AD patients on all tasks (p<0.0001) except for Digit Span (direct order) (p=0.076) and Incidental Memory (p>0.05), and performed worse than controls on Learning (second presentation) and verbal fluency (fruits) tasks (p<0.0001).

Conclusion:

Overall performance on the BBRC-Edu allowed differentiation of controls and depressed patients from AD patients.

Key words:
Alzheimer's disease; CERAD; BBRC-Edu; depression; screening test; cognition; elderly.

RESUMO

Depressão e demência são os transtornos neuropsiquiátricos de maior prevalência na população idosa. A doença de Alzheimer é a principal causa de demência na maioria os países, sendo a responsável por mais da metade dos casos de demência. Depressão de início tardio é uma causa frequente de declínio cognitivo no idoso. A diferenciação entre transtorno cognitivo secundário à depressão e demência em fase inicial é um desafio na prática clínica.

Objetivo:

Avaliar o desempenho de pacientes idosos deprimidos usando a Bateria Breve de Rastreio Cognitivo (BBRC-Edu).

Métodos:

Estudamos 25 pacientes com depressão de início tardio, (idade média 73,6 (6,6); escolaridade: 9,1 (5,7)) e 30 pacientes com DA leve (CDR=1), (idade média 76,6 (5,4); escolaridade: 7,5 (7,1)). O desempenho de ambos os grupos foi comparado a um grupo controle de 30 idosos sadios (idade média 73,8 (5,8); escolaridade: 9,1 (5,4)).

Resultados:

Na Bateria CERAD pacientes deprimidos tiveram desempenho melhor que pacientes com DA em todos os testes (p<0,0001) exceto para Praxia Construcional (p>0,05), e desempenho pior que os controles na fluência verbal (animais) e Recordação da Lista de Palavras (p<0,0001). Na BBRC-Edu, pacientes deprimidos tiveram melhor desempenho comparados aos pacientes com DA em todos os testes (p<0,0001) exceto para Spam de Dígitos (ordem direta) (p=0,076) e Memória Incidental (p>0,05), e tiveram desempenho pior que os controles na Aprendizagem (segunda apresentação) e na fluência verbal (frutas) (p<0,0001).

Conclusão:

A Bateria Breve de Rastreio Cognitivo permite a diferenciação de controles e pacientes com transtorno depressivo, de pacientes com doença de Alzheimer.

Palavras-chave:
doença de Alzheimer; CERAD; BBRC-Edu; depressão; testes de rastreio; cognição; idosos.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERENCES

  • APA. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC; 1994.
  • Steffens DC, Skoog I, Norton MC, et al. Prevalence of depression and its treatment in an elderly population: The Cache County study. Arch Gen Psychiatry 2000;57:601-607.
  • Copeland JR, Beekman AT, Braam AW, et al. Depression among older people in Europe: The EURODEP Studies. World Psychiatry 2004;3:45-49.
  • Lee Y, Shinkai S. Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan. Int J Geriatr Psychiatry 2005;20:576-586.
  • Rait G, Fletcher A, Smeeth L, et al. Prevalence of cognitive impairment: results from the MCR trial of assessment and management of older people in the community. Age Aging 2005;34:242-248.
  • Graciani A, Banegas JR, Guallar-Castillon P, Domínguez-Rojas V, Rodríguez-Artalejo F. Cognitive assessment of the non-demented elderly community dwellers in Spain. Dement Geriatr Cogn Disord 2006;21: 104-112.
  • Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: findings from the Cache Country Study on Memory in Aging. Am J Psychiatry 2000;157,708-714.
  • 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). Neurology 2001;56: 1133-1142.
  • Dixon RA, Wahlin A, Maitland SB, Hultsch DF, Hertzog C, Backman L. Episodic memory change in late adulthood: generalizability across samples and performances indices. Memory Cognit 2004;32:768-778.
  • Amieva H, Goff ML, Millet X, et al. Prodromal Alzheimer's disease: successive emergence of the clinical symptoms. Ann Neurol 2008;64:492-498.
  • Carlson MC, Xue QL, Zhou J, Fried LP. Executive decline and dysfunction precedes declines in memory: the women's health and aging study II. J Gerontol 2009;64A:110-117.
  • Rabinowitz JC, Craik FI. Prior retrieval effects in young and old adults. J Gerontol 1986;41:368-375.
  • Hultsch DF, Hertzog C, Small BJ, McDonald-Miszczak L, Dixon RA. Short-term longitudinal change in cognitive performance in later life. Psychol Aging 1992;7:571-584.
  • Ritchie K, Touchon J, Ledesert B, Leibovici D, Gorce AM. Establishing the limits and characteristics of normal age-related cognitive decline. Rev Epidemiol Sante Publique 1997;45:373-381.
  • Rubin EH, Storandt M, Miller JP, et al. A prospective study of cognitive function and onset of dementia in cognitively healthy elders. Arch Neurol 1998;55:395-401.
  • Salthouse T. Mechanisms of age-cognition relations in adulthood. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989.
  • Schaie KW. Perceptual speed in adulthood: Cross-sectional and longitudinal studies. Psychol Aging 1989;4:443-453.
  • Butters MA, Whyte EM, Nebes RD, et al. The nature and determinants of neuropsychological functioning in late-life depression. Arch Gen Psychiatry 2004;61:587-595.
  • Lockwood KA, Alexopoulos GS, Van Gorp WG. Executive dysfunction in geriatric depression. Am J Psychiatry 2002;159:1119-1126.
  • Rapp MA, Dahlman K, Sano M, Grossman HT, Haroutunian V, Gorman JM. Neuropsychological differences between late-onset and recurrent geriatric major depression. Am J Psychiatry 2005;162:691-698.
  • Nebes RD, Butters MA, Mulsant BH, et al. Decreased working memory and processing speed mediate cognitive impairment in geriatric depression. Psychol Med 2000; 30:679-691.
  • Stek ML, Van Exel E, Van Tilburg W, Westendorp RGJ, Beekman ATF. The prognosis of depression in old age: outcome six to eight years after clinical treatment. Aging Ment Health 2002;6:282-285.
  • Bhalla RK, Butters MA, Mulsant BH. Persistence of neuropsychological deficits in the remitted state of late-life depression. Am J Geriatr Psychiatry 2006;14:419-427.
  • Rose EJ, Ebmeier KP. Pattern of impaired working memory during major depression. J Affect Disord 2006;90:149-161.
  • Novaretti TMS, D'Avila Freitas MI, Mansur LL, Nitrini R, Radanovic M. Comparison of language impairment in late-onset depression and Alzheimer's disease. Acta Neuropsychiatr 2011;23:62-68.
  • Nitrini R, Caramelli P, Porto CS, Fichman HC, Formigoni AP. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1: 32-36.
  • Smith GE, Ivnik RJ. Normative neuropsychology. In: Petersen RC: Mild Cognitive Impairment, New York: Oxford; 2003:63-88.
  • Spitzer RL, Williams JB, Gibbon M, First MB. The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale and description. Arch Gen Psychiatry 1992;49:624-629.
  • McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadian EM. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984; 34:939-944.
  • Hodges JR, Salmon DP, Butters N. Semantic memory impairment in Alzheimer's disease: failure of access or degraded knowledge. Neuropsychologia 1992;30:301-14.
  • Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I: Clinical and neuropsychological assessment for Alzheimer's disease. Neurology 1989;39: 1159-1165.
  • Bertoluci PHF, Okamoto IH, Brucki SMD, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsychiatr 2001;59:532-536.
  • Yesavage JA, Brink TL, Rose TL, et al. Development and validation of geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.
  • Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
  • Montgomery AS, Asberg M. New depression scale designed to be sensitive to change. Br J Psychiatry 1979;134:382.
  • Moreno RA, Moreno DH. Escalas de depressão de Montgomery & Åsberg (MADRS) e de Hamilton (HAM-D). Rev Psiq Clin 1998;25:262-272.
  • Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
  • Foldi NS, Brickman AM, Schaefer LA, Knutelska ME. Distinct serial position profiles and neuropsychological measures differentiate late life depression from normal aging and Alzheimer's disease. Psychiatry Res 2003;120:71-84.
  • Swainson R, Hodges JR, Galton CJ, et al. Early detection and differential diagnosis of Alzheimer's disease and depression with neuropsychological tasks. Dement Geriatr Cogn Disord 2001;12:265-280.
  • Backman L, Small B, Fratiglioni L. Stability of the preclinical episodic memory deficit in Alzheimer's disease. Brain 2001;124: 96-102.
  • Chen P, Ratcliff G, Belle SH. Patterns of cognitive decline in presymptomatic Alzheimer disease: a prospective community study. Arch Gen Psychiatry 2001;58:853-858.
  • Perry RJ, Hodges JR. Relationship between functional and neuropsychological performance in early Alzheimer's disease. Alzheimer Dis Assoc Disord 2000;14:1-10.
  • Henry JD, Crawford JR. Verbal fluency performance in dementia of the Alzheimer type; a meta-analysis. Neuropsychologia 2005;42:1212-1222.
  • Henry JD, Crawford JR. A meta-analytic review of verbal fluency deficits in depression. J Clin Exp Neuropsychol 2005;27:78-101.
  • Herrmann LL, Goodwin GM, Ebmeier KP. The cognitive neuropsychology of depression in the elderly. Psychol Med 2007;37:1693-1702.
  • Norris MP, Blankenship-Reuter l, Snow-Turek AI, Finch J. Influence of depression on verbal fluency performance. Age Cog 1995;2:206 -215.
  • Portela MJ, Marcos T, Rami L, Navarro V, Gasto C, Salamero M. Residual cognitive impairment in late-life depression after a 12-month period follow-up. Int J Geriatr Psychiatry 2003;18:571-576.
  • King DA, Cox C, Lyness JM, Conwell Y, Caine ED. Quantitative and qualitative differences in the verbal learning performance of elderly depressives and healthy controls. J Int Neuropsychol Soc 2006;4:115-126.
  • Sheline YI, Barch DM, Garcia K, et al. Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biol Psychiatry 2006;60:58-65.
  • Delaloye C, Baudois S, Bilbao F, et al.Cognitive impairment in late-onset depression. Limited to a decrement in information processing resources? Eur Neurol 2008;60:149-154.

Publication Dates

  • Publication in this collection
    Apr-Jun 2012

History

  • Received
    02 Feb 2012
  • Accepted
    03 May 2012
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br