RESUMEN
OBJECTIVES: To estimate the incidence of dementia in a community-dwelling older population from São Paulo city, Brazil. METHODS/DESIGN: This two-phase prospective cohort study evaluated a representative cluster sample of 1370 individuals aged 60 years old and over from three different socioeconomic levels. The community screening phase consisted of a tested combination of cognitive and functional tests administered among the subjects and informants. In the hospital diagnosis phase, the Cambridge Examination was performed; the diagnosis of dementia and dementia subtypes was made according to DSM IV criteria. Incidence rates were expressed in person-years, multiplied by 1000. The risk of developing dementia was calculated using Cox regression. RESULTS: Among 1370 eligible subjects, 678 were accessed, and 489 completed the evaluation. Forty-two subjects were diagnosed with dementia. The incidence rate of dementia and Alzheimer's disease (AD) were 11.2 (95% CI: 8.0-15.1) and 8.9 (95% CI: 6.1-12.5) per 1000 person-years, respectively; there were high age-specific rates of dementia among younger individuals. There was a trend of a higher risk of developing AD for women than for men. Multivariate analysis showed that older age, the presence of diabetes and the presence of amnestic MCI increased the risk of developing dementia. CONCLUSIONS: The age-specific rates in younger individuals were expressively higher than in worldwide studies and supposedly affected by cardiovascular morbidity. The higher risk in women in a younger sample corroborated the interaction between sex and AD. The increased risk of amnestic MCI reinforced its contribution to the progression to dementia and AD.
Asunto(s)
Enfermedad de Alzheimer , Demencia , Anciano , Enfermedad de Alzheimer/epidemiología , Brasil/epidemiología , Estudios de Cohortes , Demencia/diagnóstico , Demencia/epidemiología , Femenino , Humanos , Incidencia , Masculino , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. METHODS: Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: "mild cognitive impairment," "dementia," "prodromal dementia," "preclinical dementia," "Alzheimer's," "depression," "dysphoria," "mania," "euphoria," "bipolar disorder," and "irritability." RESULTS: Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. CONCLUSION: Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.
Asunto(s)
Ansiedad/psicología , Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Depresión/psicología , Euforia , Genio Irritable , Síntomas Afectivos , Anciano , Disfunción Cognitiva/psicología , Demencia/complicaciones , Emociones , Humanos , Pruebas Neuropsicológicas , Evaluación de SíntomasRESUMEN
Depression is the most frequent mental disorder in older people, often causing emotional distress and reduced quality of life. Despite its clinical significance, depression remains underdiagnosed and inadequately treated in older patients. Regarding prognosis, data suggest that almost 70% of patients, treated long enough and with appropriate doses, recover from an index episode of depression. Antidepressants are efficient for treating depressed outpatients with several comorbid physical diseases as well as hospitalized patients, with selective serotonin reuptake inhibitors being the antidepressants of choice for older patients. Available data can guide pharmacological treatment in both the acute and maintenance stages, but further research is required to guide clinical strategies when remission is not achieved. Approaches for the management of resistance to treatment are summarized, including optimization strategies, drug changes, algorithms, and combined and augmentation pharmacological treatments. Finally, additional therapeutic choices such as electroconvulsive therapy, transcranial magnetic stimulation, and integrated psychotherapy are presented.
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Antidepresivos/uso terapéutico , Trastorno Depresivo/terapia , Terapia Electroconvulsiva , Psicoterapia/métodos , Edad de Inicio , Anciano , Anciano de 80 o más Años , Antidepresivos/efectos adversos , Quimioterapia Combinada , Terapia Electroconvulsiva/métodos , HumanosRESUMEN
OBJECTIVES: This study aims to determine the frequency of clinically significant depressive symptoms (CSDS) in a community sample of older Brazilians and to examine their relationship with sociodemographic factors, cognitive and functional impairment (CFI), and medical illness. METHODS: A total of 1145 subjects aged 60 years or older living in the City of Ribeirao Preto, State of Sao Paulo, Brazil, were interviewed. The following instruments were used: a 10-item scale for screening of depressive symptoms in older people, the mini mental state examination, the Fuld object memory evaluation, the informant questionnaire on cognitive decline in the elderly, the Bayer activities of daily living scale, and a sociodemographic and clinical questionnaire. RESULTS: The frequency of CSDS was 15.7%. Logistic regression analysis indicated that being previously depressed, having CFI, having lower level of education, using psychotropics, and not engaging in physical exercise were related to CSDS. On the other hand, being a woman, older, medically ill, employed, or married was not associated with CSDS. CONCLUSIONS: Consistent with previous reports, lower education, lack of physical activity, and CFI were significantly associated with higher frequencies of CSDS. Further investigations are necessary to clarify the occurrence of depression and possible modifiable factors in developing countries such as Brazil.
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Trastorno Depresivo/epidemiología , Actividades Cotidianas , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Trastornos del Conocimiento/psicología , Trastorno Depresivo/etiología , Escolaridad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Distribución por Sexo , Factores SocioeconómicosRESUMEN
BACKGROUND: Although studies indicate that community-dwelling elderly have a lower prevalence of major depression compared with younger age groups, prevalence estimates in Brazil show that clinically significant depressive symptoms (CSDS) and depression are frequent in the older population. However, a systematic review and meta-analysis of prevalence of and factors associated with depressive disorders and symptoms in elderly Brazilians has not previously been reported. The aims were (i) to perform a survey of studies dating from 1991 to 2009 on the prevalence of depressive disorders and CSDS in elderly Brazilians residing in the community; (ii) to determine depression prevalence and identify associated factors; and (iii) develop a meta-analysis to indicate the combined prevalence and the influence of gender on depressive morbidity in this population. METHODS: Studies were selected from articles dated between January 1991 and May 2009, extracted from Medline, LILACS and SciELO databases. RESULTS: A total of 17 studies were found, 13 with CSDS, 1 with major depression alone and 3 with major depression and dysthymia, involving the evaluation of 15,491 elderly people. The average age of participants varied between 66.5 and 84.0 years. Prevalence rates of 7.0% for major depression, 26.0% for CSDS, and 3.3% for dysthymia were found. The odds ratios for major depression and CSDS were greater among women. There was a significant association between major depression or CSDS and cardiovascular diseases. CONCLUSION: The review indicates greater prevalence of both major depression and CSDS compared to rates reported in the international literature, while the prevalence of dysthymia was found to be similar. The high prevalence of CSDS and its significant association with cardiovascular diseases reinforces the importance of evaluating subthreshold depressive symptoms in the elderly in the community.
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Trastorno Depresivo/epidemiología , Anciano/psicología , Anciano de 80 o más Años , Brasil/epidemiología , Enfermedades Cardiovasculares/psicología , Trastorno Depresivo/psicología , Trastorno Depresivo Mayor/epidemiología , Trastorno Depresivo Mayor/psicología , Trastorno Distímico/epidemiología , Trastorno Distímico/psicología , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Factores SexualesRESUMEN
OBJECTIVES: To determine the frequency of clinically significant depressive symptoms (CSDS) in a community sample of Brazilian elderly and to assess their relationship with sociodemographic factors, cognitive and functional impairment (CFI), and clinical diseases. DESIGN: Cross-sectional study of a community-based sample of elderly subjects. SETTING: City of Sao Paulo, State of Sao Paulo, Brazil. PARTICIPANTS: A total of 1,563 elderly subjects aged 60 years or older. MEASUREMENTS: A 10-item scale for screening of depressive symptoms in elderly people (D-10), the Mini Mental State Examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, and a sociodemographic and clinical questionnaire. RESULTS: The frequency of CSDS was 13.0%. Univariate analysis identified independent factors associated with these symptoms in our sample. Logistic regression analysis indicated that being female, brown skinned, previously depressed, having CFI, using psychotropics, and not practicing physical exercise were related to CSDS. On the other hand, being older, clinically sick, employed, or married were not associated with CSDS. CONCLUSIONS: : Consistent with previous reports, female gender, lack of physical activity, and CFI were significantly associated with higher frequencies of CSDS. Further investigations are necessary to clarify the occurrence of depression and possible modifiable factors in developing countries such as Brazil.
Asunto(s)
Actividades Cotidianas/psicología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Países en Desarrollo , Población Urbana , Anciano , Anciano de 80 o más Años , Brasil , Trastornos del Conocimiento/psicología , Comorbilidad , Estudios Transversales , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Escala del Estado Mental/estadística & datos numéricos , Persona de Mediana Edad , Actividad Motora , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Estadística como Asunto , Población Urbana/estadística & datos numéricosRESUMEN
PURPOSE OF REVIEW: Academic recognition of the implications of religion/spirituality (R/S) for mental health is increasing, with a growing number of studies involving older adults. The present review provides an overview of these studies, highlighting the influence of R/S on older adults' mental health and the clinical implications of addressing R/S in the geriatrics and gerontology context. RECENT FINDINGS: The available evidence suggests that R/S involvement is usually associated with lower levels of depression, substance use/abuse, and cognitive declining and better quality of life, well being, and functional status in older persons. Despite the number of studies showing this relationship, few have yet investigated the effects of addressing spiritual needs or carrying out R/S interventions in this age group. SUMMARY: Evidence is mounting that R/S is most important in geriatric psychiatry. In general, studies have shown a positive relationship between R/S and mental health in the older population. Health professionals should be attentive to these spiritual needs. Nevertheless, more studies are needed to investigate the mechanisms of the R/S-mental health association and how to integrate R/S in clinical practice.
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Envejecimiento/psicología , Psiquiatría Geriátrica/métodos , Calidad de Vida/psicología , Espiritualidad , Anciano , Humanos , Salud MentalRESUMEN
BACKGROUND: Studies investigating major depression and associated factors in older people from developing countries are scarce. METHODS: Cross-sectional study of a community-based sample of 1563 elderly subjects aged 60 years or older from Sao Paulo, Brazil. The frequency of major depression (MD) and the relationship with sociodemographic factors, cognitive and functional impairment (CFI), clinically significant depressive symptoms (CSDS) and clinical diseases were analyzed. A brief instrument for screening of depressive symptoms in elderly people, the Mini Mental State Examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, the Cambridge Mental Disorders of the Elderly Examination, and a sociodemographic and clinical questionnaire were applied to the subjects. RESULTS: Major depression was diagnosed in 60 patients (3.8%). A higher odds ratio of MD was associated with female gender, being widowed, previous depressive episode, hypertension, use of psychotropic medication, (CFI), and alcohol use. A lower odds ratio of depression diagnosis was associated with physical activity and going to cinema. LIMITATIONS: The cross-sectional design of the study; our sample was restricted only to community residents, excluding persons in hospitals or nursing homes. CONCLUSION: Our study shows significant association between depression and potentially modifiable factors, reinforcing the benefit of probable preventive measures, to incentive healthy lifestyle, leisure activities and the practice of physical exercise, as well as the diagnosis and treatment of CSDS, especially in primary care.
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Actividades Cotidianas , Trastorno Depresivo Mayor/epidemiología , Ejercicio Físico , Calidad de Vida , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Estudios Transversales , Trastorno Depresivo Mayor/etnología , Trastorno Depresivo Mayor/psicología , Países en Desarrollo , Femenino , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
OBJECTIVES: i) To investigate studies published between 1991 and 2010 on the prevalence of depressive morbidity (major depressive disorder [MDD], dysthymia and clinically significant depressive symptoms [CSDS]) among elderly Brazilians assisted at healthcare facilities; ii) to establish the prevalence of depression and identify its related factors; and iii) to conduct a meta-analysis to assess the prevalence of depressive syndrome among elderly individuals assisted or hospitalized at healthcare facilities. METHODS: Studies were selected from articles dated between January 1991 and June 2010 and extracted from the MEDLINE, LILACS, and SciELO databases. RESULTS: The final analysis consisted of 15 studies, distributed as follows: i) four sampled hospitalized patients, totaling 299 individuals, and found a prevalence of CSDS varying between 20 and 57% [corrected]; ii) four sampled outpatients, totaling 1,454 individuals; the prevalence of CSDS varied between 28 and 45% [corrected], and the prevalence of MDD varied between 23 and 42%; and iii) seven sampled elderly individuals residing in long-term care facilities (LTCF), totaling 839 individuals, and the prevalence of CSDS varied between 11 and 65%. CONCLUSION: The present review indicated a higher prevalence of both MDD and CSDS among elderly Brazilians assisted at healthcare facilities.
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Anciano/psicología , Atención Ambulatoria/estadística & datos numéricos , Trastorno Depresivo/epidemiología , Hospitalización/estadística & datos numéricos , Factores de Edad , Anciano de 80 o más Años , Brasil/epidemiología , Femenino , Humanos , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SexualesRESUMEN
Objectives: i) To investigate studies published between 1991 and 2010 on the prevalence of depressive morbidity (major depressive disorder [MDD], dysthymia and clinically significant depressive symptoms [CSDS]) among elderly Brazilians assisted at healthcare facilities; ii) to establish the prevalence of depression and identify its related factors; and iii) to conduct a meta-analysis to assess the prevalence of depressive syndrome among elderly individuals assisted or hospitalized at healthcare facilities. Methods: Studies were selected from articles dated between January 1991 and June 2010 and extracted from the MEDLINE, LILACS, and SciELO databases. Results: The final analysis consisted of 15 studies, distributed as follows: i) four sampled hospitalized patients, totaling 299 individuals, and found a prevalence of CSDS varying between 20 and 56%; ii) four sampled outpatients, totaling 1,454 individuals; the prevalence of CSDS varied between 11 and 65%, and the prevalence of MDD varied between 23 and 42%; and iii) seven sampled elderly individuals residing in long-term care facilities (LTCF), totaling 839 individuals, and the prevalence of CSDS varied between 11 and 65%. Conclusion: The present review indicated a higher prevalence of both MDD and CSDS among elderly Brazilians assisted at healthcare facilities. .