Longitudinal analysis of cognitive performances and structural brain changes in late-life bipolar disorder.

OBJECTIVES: Cross-sectional studies in bipolar disorder (BD) suggested the presence of cognitive deficits and subtle magnetic resonance imaging (MRI) changes in limbic areas that may persist at euthymic stages. Whether or not cognitive and MRI changes represent stable attributes of BD or evolve with time is still matter of debate. To address this issue, we performed a 2-year longitudinal study including detailed neuropsychological and magnetic resonance imaging (MRI) analyses of 15 euthymic older BD patients and 15 controls. METHODS: Neuropsychological evaluation concerned working memory, episodic memory, processing speed, and executive functions. MRI analyses included voxel-based morphometry (VBM) analysis of gray matter including region of interest (ROI) analysis and tract-based spatial statistics (TBSS) analysis of white matter of diffusion tensor imaging derived fractional anisotropy (FA). RESULTS: BD patients displayed significantly lower performances in processing speed and episodic memory but not in working memory and executive functions compared to controls. However, BD patients did not differ from controls in the mean trajectory of cognitive changes during the 2 years follow-up. In the same line, longitudinal gray matter (VBM, ROI) and white matter (TBSS FA) changes did not differ between BD patients and controls. CONCLUSION: The lack of distinction between BD patients and controls in respect to the 2-year changes in cognition and MRI findings supports the notion that this disorder does not have a significant adverse impact on cognitive and brain aging. From this point of view, the present results convey a message of hope for patients suffering from BD.

[Caregivers of elderly patients suffering from mental disorders]. / Entourage des patients âgés avec une pathologie mentale.

Mental disorders in the elderly lead their families to stand in and adopt a variety of roles before institutional care takes over. These pathologies carry a high risk of suffering for families and distress for professional caregivers. Thus, the psychological burden endured by the proxies of an elderly depressed patient, or of one who has committed suicide, or of patient suffering from dementia needs special attention and, in some cases, professional care. The discussion of these paradigmatic situations in this manuscript will be extended by a paragraph on specific stakes raised by alcoholic patients living in nursing homes. It will stress the complexity and requirements of professionalism when approaching the familial and professional circle of the elderly psychiatric patient.

Cognitive impairment in late-onset depression. Limited to a decrement in information processing resources?

BACKGROUND: While cognitive dysfunction in late-onset depression (LOD) is common, the nature and determinants of this impairment are heterogeneous. It has been suggested that neuropsychological decrements in LOD patients might result from a deficit in processing resources. In order to address this issue, we analyzed processing resources in LOD to see if their decrease explains higher-level cognition (episodic memory and naming capacity) deficits. METHODS: Measures of processing speed, working memory, inhibition, episodic memory and naming capacity were administered to 14 LOD inpatients and 14 controls. RESULTS: The LOD patients performed significantly worse than the controls in all domains except for inhibition. Hierarchical regression analyses showed that naming capacity impairment was totally mediated by processing speed and working memory, whereas episodic memory dysfunction was only partially mediated by working memory. CONCLUSION: The reduction in certain processing resources (working memory, processing speed) in late-onset depressed patients appears to mediate impairments in episodic memory and naming capacity. However, episodic memory impairment cannot only be explained by processing resource decrement in LOD patients, suggesting that a primary episodic memory dysfunction is present in this condition.