Caregiver self-efficacy and associated factors among caregivers of patients with dementia with Lewy bodies and caregivers of patients with Alzheimer's disease.

BACKGROUND: Dementia with Lewy bodies (DLB) is characterized by neuropsychiatric symptoms, which can be distressing to caregivers. However, little is known about their subjective distress in terms of caregiver self-efficacy. Thus, we examined the differences in caregiver self-efficacy and their associated factors between DLB and Alzheimer's disease (AD) caregivers. METHODS: We conducted a comprehensive questionnaire for DLB and AD caregivers. Caregiver self-efficacy was evaluated using three domains (Self-Efficacy for Obtaining Respite: SE-OR, Self-Efficacy for Responding to Disruptive Patient Behaviours: SE-RDPB, Self-Efficacy for Controlling Upsetting Thoughts about Caregiving: SE-CUT) of the Revised Scale for Caregiving Self-Efficacy (RSCSE). In addition, data on the following features of caregivers were assessed: depression, sleep disturbance, caregiver burden, executive function, loneliness, social support, and distress associated with neuropsychiatric symptoms. The patients were assessed for general cognitive tasks, executive function, and neuropsychiatric symptoms. RESULTS: Compared with AD caregivers, DLB caregivers experienced a significantly higher burden in terms of not only various clinical factors, but also all three domains of caregiver self-efficacy. Among the caregiver-associated factors, different domains were predictors of self-efficacy in DLB and AD caregivers (distress due to sleep disturbances in DLB patients; distress due to delusions in AD patients). Among the patient-associated factors, different domains were also predictors of self-efficacy in DLB and AD caregivers (sleep disturbances in DLB patients; delusions in AD patients). Among both the caregivers and the patients, executive function was a significant predictor of one RSCSE domain (SE-CUT). CONCLUSIONS: A reduction in caregiver self-efficacy may contribute to a severe subjective burden among DLB caregivers. Furthermore, two neuropsychiatric symptoms (delusions and sleep disturbances) affected caregiver self-efficacy differently depending on whether care was being provided to a DLB or AD patient. Understanding the association between specific neuropsychiatric symptoms and caregiver self-efficacy may be useful for conducting interventions for DLB patients.

Factor structure of the Japanese version of the Quality of Life in Alzheimer's Disease Scale (QOL-AD).

BACKGROUND: The Quality of Life in Alzheimer's Disease Scale (QOL-AD) developed by Logsdon et al. in1999 is believed to be useful for evaluating responses from both patients and their caregivers. We previously confirmed both the reliability and the validity of the Japanese version of the QOL-AD. However, the factor structure of this scale should be confirmed because the QOL-AD covers multiple facets of dementia patients' lives. Thus, we performed a factor analysis of the Japanese QOL-AD. Then, we examined the correlations between each of the identified QOL factor scores and the results of other scales. METHODS: The Japanese version of the QOL-AD was given to 132 AD patients and 132 caregivers. Four other tests were also performed at the same time: the Mini-Mental State Examination, the Neuropsychiatric Inventory (NPI), the Hyogo Activities of Daily Living Scale (HADL), and the Short Memory Questionnaire. A factor analysis using Varimax rotation was used to examine the dimensions underlying the QOL-AD. In addition, we examined the Pearson correlations between each of the identified QOL factor scores and the results of the other four tests. RESULTS: Factor analyses of both versions of the Japanese QOL-AD (both the patients' and the caregivers' responses) revealed three factors that were named 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The 'psychological wellbeing' factor was significantly correlated with the Mood factor of the NPI. The 'human relationships' factor was significantly correlated with the Psychosis factor of the NPI. The 'physical and social environment' factor was significantly correlated with the HADL. CONCLUSIONS: Both the patients' and the caregivers' responses to the Japanese version of the QOL-AD were composed of three factors: 'psychological wellbeing', 'human relationships', and 'physical and social environment'. The present results support the multi-domain concept of QOL proposed by Lawton.

Relationships among Communication Self-Efficacy, Communication Burden, and the Mental Health of the Families of Persons with Aphasia.

BACKGROUND: The purpose of this study was to elucidate the relationships among communication self-efficacy (SE), communication burden, and the mental health of the families of persons with aphasia using structural equation modeling (SEM). METHODS: This study examined 110 pairs of persons with aphasia receiving home care and 1 family caregiver per person with aphasia. The survey items for this study consisted of the Communication Self-efficacy Scale, the Communication Burden Scale, the Geriatric Depression Scale-Short Form-Japanese, and the Health-Related Quality of Life: SF-8 Health Survey. The relationships between the constructive concept of "communication self-efficacy" and "communication burden," and "mental-health status" were analyzed using SEM. RESULTS: The results of the SEM analysis revealed that a high communication SE of the families was associated with low burden of communication and good mental-health status. CONCLUSIONS: Psychoeducational programs that address the communication SE of family caregivers may have the potential to reduce the burden of communication and to improve the mental health of caregivers. These programs could lead to an enhanced quality of life for both persons with aphasia and their families.

Predicting the neural effect of switching from donepezil to galantamine based on single-photon emission computed tomography findings in patients with Alzheimer's disease.

BACKGROUND: A number of neuroimaging studies have addressed the specific effect of treatment with cholinesterase inhibitors on the frontal lobe in patients with Alzheimer's disease (AD). However, the neural effects of cholinesterase inhibitors on both apathy and executive dysfunction remain unclear. We examined whether baseline regional cerebral blood flow, as determined by using single-photon emission computed tomography, is capable of predicting changes in apathy and executive dysfunction in response to AD patients switching from donepezil to galantamine therapy. METHODS: We conducted a 24-week, prospective, open-label study of AD patients treated with galantamine who did not respond to previous treatment with donepezil. Single-photon emission computed tomography was performed at baseline, and behaviour and cognitive assessments including the Mini-Mental State Examination, the Japanese version of the Alzheimer's Disease Assessment Scale-cognitive subscale, the Frontal Assessment Battery, the Neuropsychiatry Inventory Brief Questionnaire Form, and the Dysexecutive Questionnaire were conducted at three time points (baseline and after 12 and 24 weeks of galantamine therapy). RESULTS: After galantamine therapy, the Neuropsychiatry Inventory Brief Questionnaire Form scores (apathy, irritability, and aberrant motor symptoms) and the Dysexecutive Questionnaire score improved significantly. The single-photon emission computed tomography findings showed that lower baseline regional cerebral blood flow values in several frontal areas, including the dorsolateral and ventrolateral prefrontal cortex, the anterior cingulate, and the orbitofrontal cortex, predicted greater reductions in the score for apathy (distress) on the Neuropsychiatry Inventory Brief Questionnaire Form and the Dysexecutive Questionnaire score after patients switched from donepezil to galantamine therapy. CONCLUSIONS: Our study suggests that galantamine therapy, unlike donepezil, is characterized by a dual mechanism of action that may increase acetylcholine and the nicotinic receptor-modulation effect within the frontal lobe, both of which are associated with apathy and executive dysfunction in AD patients.

No association between the COMT Val158Met polymorphism and the long-term clinical response in obsessive-compulsive disorder in the Japanese population.

OBJECTIVE: Catechol-O-methyltransferase (COMT) is an enzyme that participates in the metabolic inactivation of dopamine and norepinephrine, and the Met allele of the COMT Val158Met polymorphism is associated with lower enzymatic activity. The purpose of the present study was to investigate whether this functional variant is associated with obsessive-compulsive disorder (OCD) and the clinical responses in OCD. METHODS: We first performed a case-control association study between the COMT Val158Met polymorphism and OCD (171 cases and 944 controls). Then, we examined the association between this polymorphism and the clinical responses in 91 of the OCD patients. RESULTS: Our study did not find a significant association between the Met allele and OCD risk or between the Met allele and clinical responses (p > 0.05). CONCLUSION: The present case-control/pharmacogenetic study did not provide clear evidence that the COMT Val158Met polymorphism is a predictor of OCD or of OCD patients' clinical responses.

Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people.

BACKGROUND: The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. METHODS: The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). RESULTS: Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. CONCLUSIONS: J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.

Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial.

OBJECTIVES: Cognitive stimulation therapy (CST) has shown to have significant benefits in improving the cognitive function and quality of life (QOL) in people with mild-to-moderate dementia in a UK randomized controlled trial (RCT). We developed and examined the Japanese version of group CST (CST-J) in a single-blind, controlled clinical trial. METHOD: CST-J consisting of 14 sessions was administered to a treatment group (n = 26) twice a week for 7 weeks. The treatment group was compared with a control group (n = 30). Based on single-blindness, cognition was evaluated by a researcher, and QOL and mood were rated by the participants themselves. Additionally, QOL and mood of participants were rated by care workers who were not blind but who observed them most directly in their daily life (important for social validity). RESULTS: A linear mixed model was used for analyses of cognition and QOL. There were significant improvements in cognition [COGNISTAT (Neurobehavioral Cognitive Status Examination) and MMSE (Mini-Mental State Examination)] for the treatment group compared with the control group (p < 0.01). Regarding QOL, the EQ-5D was significant (p = 0.019) and the QoL-AD (Quality of Life - Alzheimer's Disease) showed a positive trend (p = 0.06) when rated by care workers, although not when rated by the participants themselves. Using a nonparametrical analysis, there were significant improvements in the face scale for mood when rated by both the participants (p < 0.01) and the care workers (p = 0.017). CONCLUSION: The CST-J shows promising improvements in cognition, mood, and aspects of QOL for people with dementia in Japanese care settings. A large RCT is now needed.

Neuropsychological and functional correlates of clock-drawing test in elderly institutionalized patients with schizophrenia.

BACKGROUND: There has been a growing need for a cognitive assessment tool that can be used for older adults with schizophrenia in clinical settings. The clock-drawing test (CDT) is a brief cognitive test that covers a wide range of cognitive function. Although it is widely used to assess patients with dementia, limited data are available on its usefulness in older patients with schizophrenia. Thus, we investigated the psychometric properties of the CDT and their relationship with life functions to examine the test's usefulness for assessing cognitive function in older adults with schizophrenia. METHODS: Seventy-three older adults with chronic schizophrenia who had been hospitalized for over 1 year participated in the study. We adopted the executive clock-drawing task for administration and scoring of the CDT, which consists of free-drawn and copy conditions. The Mini-Mental State Examination and the Brief Assessment of Cognition in Schizophrenia were administered. Symptom severity and life functions were assessed with the Positive and Negative Syndrome Scale and the Life Skills Profile, respectively. RESULTS: Both free-drawn and copy scores significantly correlated with the Mini-Mental State Examination score and the Brief Assessment of Cognition in Schizophrenia composite score. These scores also significantly correlated with symptom severity and length of current hospitalization. Stepwise regression analysis showed that only the copy score, together with symptom severity, predicted the Life Skills Profile score. CONCLUSIONS: The CDT can assess cognitive function in older adults with schizophrenia. Moreover, CDT performance is associated with life functions independent from other clinical variables. These results suggest that the CDT is a useful cognitive assessment tool for this population.

Evaluating the quality of life of people with dementia in residential care facilities.

AIMS: Our purpose was to compare recipient and caregiver perception of the quality of life (QoL) of people with dementia in residential care facilities and to identify the factors associated with their perception of QoL. METHODS: Residents' QoL was evaluated by both the patient and the caregiver, using the Quality of Life in Alzheimer's Disease and several other indices. RESULTS: The correlation between the self-rated QoL score and the staff-rated QoL score was low. CONCLUSIONS: The staff tended to underestimate QoL. The main determinants of QoL were the functional status and depression. Improving physical function and mood may be beneficial in providing a better QoL.

Distinct neuropsychological profiles of three major symptom dimensions in obsessive-compulsive disorder.

Recent neuroimaging studies have suggested that different symptom dimensions are mediated by partially distinct neural systems in obsessive-compulsive disorder (OCD). However, the correlations between neuropsychological profiles and symptom dimensions in OCD are unknown. The aim of this study was to examine the extent to which OCD symptom dimensions were associated with episodic memory and attention and executive functions. The symptom dimensions of 63 patients with OCD were assessed using both the Padua Inventory and the Y-BOCS symptom checklist. Then, we administered the Logical Memory (LM) subset of the Wechsler Memory Scale-Revised (WMR-R) test and evaluated inhibition (Stroop test, Trail Making test) and cognitive flexibility (Digit Symbol test, Letter Fluency, and Category Fluency). While associations were observed between scores on the contamination/cleaning dimension and better performances on the LM and Trail Making tests, associations were also observed between scores on the aggressive/checking dimension and poorer performances on the Trail Making test. In addition, we found that scores on the symmetry/ordering dimension were associated with poorer performances on the LM and Trail Making tests. Our results support the hypothesis that different symptoms may represent distinct and partially overlapping neurocognitive networks in OCD patients.

Fear of negative evaluation is associated with delusional ideation in non-clinical population and patients with schizophrenia.

PURPOSE: A number of recent studies suggest that delusions may be explained as a continuum from normal beliefs. Fear of negative evaluation from others (FNE) is one of potential factors that might describe this psychological process of delusions. METHODS: In order to examine whether FNE is associated with delusional ideation in both non-clinical population and patients with schizophrenia, two sets of data [from a non-clinical student sample (n = 282) and from patients with schizophrenia (n = 117)] were collected to examine whether Brief Fear of Negative Evaluation Scale (BFNE) score and the 21-item Peters Delusions Inventory (PDI-21) score were associated with each other. Linear regression analyses were carried out to assess if the BFNE score still remained associated with the PDI-21 scores once the confounding effects of depression were controlled. RESULTS: BFNE scores were significantly related to PDI-21 scores in both non-clinical [Pearson product-moment correlation coefficient (r) = 0.37, 95% confidence Interval (CI) = 0.25-0.48] and patient (r = 0.33, 95% CI = 0.14-0.49) samples. These associations were still significant when confounding effects of depression were controlled. Standardised coefficients for the BFNE scores in the linear regression model were 0.21 in the student sample and 0.19 in the clinical sample. CONCLUSIONS: FNE was associated with delusional ideation both in non-clinical population and in patients with schizophrenia. FNE might be a potential target for both pharmacological and psychological interventions for patients with delusions.

Reliability and validity of the Japanese version of the Agitated Behaviour in Dementia Scale in Alzheimer's disease: three dimensions of agitated behaviour in dementia.

BACKGROUND: Agitation in dementia seriously affects not only patients' quality of life (QOL), but also caregivers' QOL. Thus, an appropriate assessment of agitated behaviour in dementia is needed for clinical management. We developed the Japanese version of the Agitated Behaviour in Dementia scale (ABID), examined its reliability and validity, and carried out its factor analysis to elucidate its factor structure. METHODS: The Japanese version of the ABID was given caregivers of 149 Japanese patients with Alzheimer's disease (AD). The internal-consistency, test-retest reliability and concurrent validity of the Japanese version of the ABID were then examined. A factor analysis was used to examine the agitated behavioural dimensions underlying ABID. RESULTS: The Japanese version of the ABID showed an excellent internal reliability for both frequency ratings (Cronbach's α= 0.89) and reaction ratings (Cronbach's α= 0.92), and an excellent test-retest reliability for both frequency ratings and reaction ratings. The total score for the frequency ratings of the ABID was significantly associated with the Cohen-Mansfield Agitation Inventory (CMAI), and the total score for the reaction ratings of the ABID was significantly associated with the Zarit Burden Interview. The factor analysis showed three subtypes: physically agitated behaviour, verbally agitated behaviour and psychosis symptoms. CONCLUSIONS: The Japanese version of the ABID promises to be useful for assessing agitated behaviour in patients with AD. Importantly, understanding these subtypes of agitated behaviour might have implications for individualized treatment plans.

Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease.

This study aimed to clarify how behavioral and psychological symptoms of dementia (BPSD) and cognitive function affect the decision-making capacity of persons with Alzheimer's disease (AD) in a real informed consent situation about anti-dementia drug prescriptions. The participants were 76 patients with AD. We used the MacArthur Competence Assessment Tool to assess the capacity for consent to treatment (MacCAT-T). We simultaneously used the Mini-Mental State Examination, Executive Interview, Executive Clock Drawing Task, Logical Memory I of the Wechsler Memory Scale-Revised (LM I), LM II, and Neuropsychiatric Inventory (NPI) to assess cognitive function and psychiatric symptoms. We calculated the correlations between the MacCAT-T scores and the demographic, neuropsychological, and psychiatric variables. Once the univariable correlations were determined, we performed simple linear regression analyses to examine if the regression equations were significant. In the final analyses, we incorporated significant variables into stepwise multiple linear regression analyses to determine the most significant predictors of mental capacity. Age (ß = -0.34), anxiety (ß = -0.27), and LM I (ß = 0.26) were significant predictors of "understanding" (adjusted R 2 = 0.29). LM II (ß = 0.39), anxiety (ß = -0.29), and education (ß = 0.21) were significant predictors of "understanding of alternative treatments" (adjusted R 2 = 0.30). Anxiety (ß = -0.36) and age (ß = -0.22) were significant predictors of "appreciation" (adjusted R 2 = 0.18). Age (ß = -0.31) and anxiety (ß = -0.28) were significant predictors of explained variance in "reasoning" (adjusted R 2 = 0.17). Patients with anxiety had lower scores on all five MacCAT-T subscales: "understanding," without 3.8 [SD = 1.2] vs. with 2.6 [SD = 1.1]; "understanding of alternative treatments," without 2.9 [SD = 2.2] vs. with 1.3 [SD = 1.8]; "appreciation," without 2.9 [SD = 1.1] vs. with 1.9 [SD = 1.2]; "reasoning," without 4.0 [SD = 2.0] vs. with 2.7 [SD = 1.7]; and "expressing a choice," without 1.9 [SD = 0.4] vs. with 1.5 [SD = 0.6]. Considering the effects of BPSD, cognitive function, and age/education when assessing consent capacity in persons with AD is important. Reducing anxiety may contribute to improved capacity in persons with AD.

Widespread White Matter Aberrations Are Associated with Phonemic Verbal Fluency Impairment in Chronic Traumatic Brain Injury.

Microstructural white matter (WM) disruption and resulting abnormal structural connectivity form a potential underlying pathology in traumatic brain injury (TBI). Herein, to determine the potential mechanism of cognitive deterioration in TBI, we examined the association of damage to specific WM tracts with cognitive function in TBI patients. We recruited 18 individuals with mild-to-moderate/severe TBI in the chronic phase and 17 age-matched controls. We determined the pattern of WM aberrations in TBI using tract-based spatial statistics (TBSS) and then examined the relationship between cognitive impairment and WM damage using the threshold-free cluster enhancement correction in TBSS. TBSS analysis showed that TBI patients exhibited WM aberrations in a wide range of brain regions. In the majority of these regions, lower fractional anisotropy (FA) largely overlapped with increased radial diffusivity, but not with axial diffusivity. Further, voxel-wise correction in TBSS demonstrated that higher FA values were associated with better performance in the phonemic verbal fluency task (VFT) in widespread WM regions, but not with the semantic VFT. Despite variation in the magnitude and location of brain injury between individual cases, chronic TBI patients exhibited widespread WM aberrations. We confirmed the findings of previous studies that WM integrity is lower across the spectrum of TBI severity in chronic subjects compared to controls. Further, phonemic VFT may be a more sensitive cognitive measure of executive dysfunction associated with WM aberrations in TBI compared with semantic VFT.

Changes after behavior therapy among responsive and nonresponsive patients with obsessive-compulsive disorder.

Neuroimaging studies have suggested that behavior therapy (BT) might change abnormal activity in the frontal-subcortical circuits of the brain in patients with obsessive-compulsive disorder (OCD). However, the results of these studies have been rather inconsistent. The aim of the present study was to use statistical parametric mapping (SPM) analysis to explore the effects of successful BT on regional cerebral blood flow (rCBF) in patients with OCD. Forty-five OCD patients who were treatment-resistant to a single serotonin reuptake inhibitor (SRI) trial were examined. Single photon emission computed tomography (SPECT) using 99mTc-ECD was performed before and after the completion of 12 weeks of BT. Although no significant differences in pre-treatment rCBF were observed between responders and nonresponders to BT, the post-treatment rCBF values in the left medial prefrontal cortex (Brodmann area 10) and bilateral middle frontal gyri (Brodmann area 10) were significantly lower in the responders than in the nonresponders. Furthermore, the baseline rCBF in the bilateral orbitofrontal cortex (OFC) was significantly correlated with the change in the Y-BOCS score among the responders. Our results support the hypothesis that while the OFC may be associated with the BT response, BT may result in changes in rCBF in the medial and middle frontal cortex.

Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: a two-year follow-up study.

AIM: To examine the effect of neuropsychiatric symptoms on longitudinal changes in the quality of life (QOL) of patients with Alzheimer disease (AD). METHODS: First, we investigated whether neuropsychiatric symptoms at baseline predict changes in the QOL of AD patients over time. Then we examined the associations between changes in neuropsychiatric symptoms and changes in QOL. QOL was assessed using the Japanese version of the Quality of Life-Alzheimer Disease (QOL-AD) scale and other clinical instruments [the Mini-Mental State Examination, The Neuropsychiatry Inventory (NPI)] at baseline and again two years later in 96 AD patients among 140 AD patients at baseline. We performed a multiple regression analysis of the baseline QOL-AD score, NPI score (mood, psychosis, and euphoria factor), Mini-Mental State Examination score, and other clinical instrument variables (e.g. Activities-of-Daily-Living scores) to determine their contribution to the change in QOL-AD score. RESULTS: While the total QOL-AD score based on the patients' responses did not change significantly, the total QOL-AD score derived from the caregivers' responses declined. Both the Activities-of-Daily-Living score and the mood factor of the NPI score predicted the change in the QOL-AD score as assessed by the caregivers' responses. In addition, there was a significant correlation between the changes in two factors of the NPI, i.e. the mood and psychosis factor, and the changes in the QOL-AD score based on the caregivers' responses. CONCLUSIONS: The presence of specific neuropsychiatric symptoms (mood and psychosis symptoms) was associated with changes in the QOL of AD patients during the follow-up period.

Neural correlates of memory in depression measured by brain perfusion SPECT at rest.

AIM: Brain metabolism activated studies have indicated associations between memory and the anterior cingulate cortex and hippocampus in patients with depression. The aim of the present study was therefore to investigate memory function, measured as performance on the Wechsler Memory Scale-Revised (WMS-R), and its relationship to brain perfusion using single-photon emission computed tomography (SPECT) at rest in patients with depression. METHODS: The Hamilton Rating Scale for Depression (HAMD) and WMS-R were measured for 17 patients with depression by an independent clinical evaluation team. Voxel-based correlation analyses were performed with statistical parametric mapping at an extent threshold of 200 voxels. Associations were controlled for state and trait factors. RESULTS: WMS-R measurements of verbal, visual, and general memory were inversely correlated with brain perfusion in the right anterior cingulate cortex, left premotor cortices, and both regions, respectively. The HAMD directly correlated with brain perfusion in the right anterior cingulate cortex. CONCLUSION: Brain perfusion SPECT measurements of the anterior cingulate cortex at rest were associated with the severity of depression and immediate memory scores measured with the WMS-R.