Psychometric instruments for the assessment of depressive symptoms in patients with delusional disorder: A systematic review.

Patients with delusional disorder (DD) are at an increased risk for the development of depressive symptoms. We aimed to examine the literature dealing with assessment tools to assess depressive symptoms in DD. A systematic review was performed by searching PubMed, Scopus and clinicaltrials.gov databases from inception until June 2021 (PRISMA guidelines). From 1863 initial retrieved records, 11 studies were included (N = 715 DD patients). Depressive comorbidity ranged from 20.9% to 53.5%. Seven studies used semistructured/structured interviews: OPCRIT 4.0 (n = 1), Manual for Assessment and Documentation of Psychopathology in Psychiatry (AMDP System) (n = 2), the MINI interview (n = 1), DSM-IV (n = 1), ICD-10 (n = 1); and the Diagnostic Interview Schedule (DIS-R) (n = 1). Seven studies used at least one observer-rated scale: Positive and Negative Syndrome Scale (PANSS)-depressive component (n = 2), Hamilton Rating Scale for Depression (HRSD, n = 3), Montgomery-Asberg Depression Rating Scale (MADRS, n = 1), Clinical Global Impression Scale (CGI, n = 1) and the Bipolar Affective Disorder Dimension Scale (BADDS, n = 1). Assessment scales administered in depressive disorders and schizophrenia are applied to DD. This is the first systematic review exploring the use of assessment tools for depressive symptoms in DD. The use of the MADRS to assess depressive symptoms can be recommended in combination with other clinical scales, for instance, the CGI.

Unexplained pain complaints and depression in older people in primary care.

OBJECTIVE: Chronic pain and depression are frequent conditions in primary care patients. Depression is frequently overlooked in the presence of pain of uncertain origin. The aim is to measure the prevalence and clinical correlates of unrecognized comorbid mood disorders and chronic pain of uncertain origin in older primary care patients, and to elucidate the differences with younger adults with the same conditions. DESIGN: Cross-sectional study. SETTING: Primary care centres in Spain. PARTICIPANTS: Patients (n= 2720) with persistent pain of uncertain origin. MEASUREMENTS: Pain characteristics, sites and intensity (Visual Analogical Scales), depression (PRIME-MD interview), clinical characteristics and health services use. RESULTS: We observed a similarly high (80.5%) prevalence of undiagnosed mood disorders (especially major depressive disorders) among older and younger adult patients with comorbid chronic pain complaints of uncertain origin. Older patients suffered pain that was more intense, longer lasting and located in a higher number of different areas, when compared to younger patients. Pain intensity was a factor associated with suffering from mood disorders among patients above 65 years, whilst the number of pain sites was a more important factor among younger patients. CONCLUSIONS: Depression is highly associated with pain of uncertain origin in older patients with differences in pain characteristics when compared to younger patients. The robust comorbid relationship between both conditions should alert clinicians to specifically look for depression in the presence of poorly explained painful symptoms.

Predicting the onset of major depression in primary care: international validation of a risk prediction algorithm from Spain.

BACKGROUND: The different incidence rates of, and risk factors for, depression in different countries argue for the need to have a specific risk algorithm for each country or a supranational risk algorithm. We aimed to develop and validate a predictD-Spain risk algorithm (PSRA) for the onset of major depression and to compare the performance of the PSRA with the predictD-Europe risk algorithm (PERA) in Spanish primary care. METHOD: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multi-level logistic regression and inverse probability weighting to build the PSRA. In Spain (4574), Chile (2133) and another five European countries (5184), 11 891 non-depressed adult primary care attendees formed our at-risk population. The main outcome was DSM-IV major depression (CIDI). RESULTS: Six variables were patient characteristics or past events (sex, age, sex×age interaction, education, physical child abuse, and lifetime depression) and six were current status [Short Form 12 (SF-12) physical score, SF-12 mental score, dissatisfaction with unpaid work, number of serious problems in very close persons, dissatisfaction with living together at home, and taking medication for stress, anxiety or depression]. The C-index of the PSRA was 0.82 [95% confidence interval (CI) 0.79-0.84]. The Integrated Discrimination Improvement (IDI) was 0.0558 [standard error (s.e.)=0.0071, Zexp=7.88, p<0.0001] mainly due to the increase in sensitivity. Both the IDI and calibration plots showed that the PSRA functioned better than the PERA in Spain. CONCLUSIONS: The PSRA included new variables and afforded an improved performance over the PERA for predicting the onset of major depression in Spain. However, the PERA is still the best option in other European countries.

Pain as a symptom of depression: prevalence and clinical correlates in patients attending psychiatric clinics.

BACKGROUND: The need to assess the prevalence and characteristics of painful symptoms among depressed patients attended by psychiatrists in their regular clinical practice. METHODS: A multi-centre, cross-sectional study was carried out in a large sample (n=3566) of patients attending out-patient psychiatric facilities in Spain. All types of DSM-IV-TR depressive disorders were included. Data on the diagnosis, specific symptoms, intensity of depression and antidepressant and analgesic drug treatments were collected. The presence and characteristics of significant pain (visual analogue scale score>40) at the time of the study were also recorded. RESULTS: The prevalence of pain in depressed patients was 59.1% (CI 95%: 57.7%; 60.7%). Factors associated independently with the existence of significant pain were: being female, presence of loss of energy and the diagnosis of dysthymia or depression induced by physical disorders. In addition, age and the intensity of depression were two risk factors, where each year of age and each point in the Hamilton scale increased the risk of having pain by 2% and 8% respectively. The presence of anhedonia and the diagnosis of depression induced by illegal drugs were factors inversely related to pain. LIMITATIONS: The cross-sectional naturalistic characteristics of the study. CONCLUSION: Our data show a high prevalence of pain among depressive patients attending psychiatric clinics. Painful symptoms are modulated differently depending on the type of depression and the presence of specific symptoms, such as loss of energy or anhedonia. Psychiatrists should ask their depressive patients for the presence of pain on a regular basis.

Pattern of care for schizophrenia patients in Granada (Spain): a case register study.

AIMS: This study sets out to explore the use flow of mental health services by a cohort of patients with schizophrenia located in Granada (Spain). METHODS: All cases (N = 844) included in the analysis were users of the community mental healthcare public service provided in the area. The Markov chain model was used to calculate the probability of transition from one type of contact with mental health services resources to another type of contact in the next month, over a three-year follow-up. RESULTS: For a given one-month period, for each level of service contact, most patients continued to use the same level of care. CONCLUSIONS: Our results can be interpreted as a reflection of adequate continuity of mental health care provided by the Andalusian community service.

The risk for depression conferred by stressful life events is modified by variation at the serotonin transporter 5HTTLPR genotype: evidence from the Spanish PREDICT-Gene cohort.

We report results from the PREDICT-Gene case-control study nested in a prospective cohort designed to identify predictors of the onset of depression among adult primary-care attendees. We tested the potential gene-by-environment interaction between 5HTTLPR genotype at the serotonin transporter gene and previous exposure to threatening life events (TLEs) in depression. A total of 737 consecutively recruited participants were genotyped. Additional information was gathered on exposure to TLEs over a 6-month period, socio-demographic data and family history of psychological problems among first-degree relatives. Diagnoses of depression were ascertained using the Composite International Diagnostic Interview (CIDI) by trained interviewers. Two different depressive outcomes were used (ICD-10 depressive episode and ICD-10 severe depressive episode). Both the s/s genotype and exposure to increasing number of TLEs were significantly associated with depression. Moreover, the 5HTTLPR s/s genotype significantly modified the risk conferred by TLEs for both depressive outcomes. Thus, s/s homozygous participants required minimal exposure to TLE (1 TLE) to acquire a level of risk for depression that was only found among l/s or l/l individuals after significantly higher exposure to TLEs (two or more TLEs). The interaction was more apparent when applied to the diagnosis of ICD-10 severe depressive episode and after adjusting for gender, age and family history of psychological problems. Likelihood ratios tests for the interaction were statistically significant for both depressive outcomes (ICD-10 depressive episode: LR X(2)=4.7, P=0.09 (crude), LR-X(2)=6.4, P=0.04 (adjusted); ICD-10 severe depressive episode: LR X(2)=6.9, P=0.032 (crude), LR-X(2)=8.1, P=0.017 (adjusted)).

Premorbid cognitive testing predicts the onset of dementia and Alzheimer's disease better than and independently of APOE genotype.

OBJECTIVE: To determine whether a cognitive test package can predict the onset of dementia up to 11 years later, and the extent to which this prediction is independent of that provided by APOE genotype. METHODS: Prospective cohort study based on 54 general practices in the UK; 657 survivors of the 1088 participants in the MRC treatment trial of hypertension in older adults were followed for up to 11 years; 370 participants (57% of survivors) were traced, screened for dementia, and genotyped for APOE in 1994. Baseline assessments included trail making test A, paired associated learning test, Raven's progressive matrices, and national adult reading test. At follow up, both mini-mental state examination and CAMCOG were used. Outcome measures were DSM-IIIR dementia and NINCDS-ADRDA possible and probable Alzheimer's disease. RESULTS: All the cognitive tests completed in 1983 predicted onset of dementia and Alzheimer's disease up to 11 years later, as did APOE genotype. Cognitive test performance was not associated with APOE genotype. Addition of cognitive tests increased the area under the ROC curve for the prediction of Alzheimer's disease provided by age, family history, and APOE genotype (0.81 v 0.69, p = 0.048); addition of APOE genotype did not increase the area under the ROC curve for the prediction provided by age, family history, and cognitive tests (0.81 v 0.77, p = 0.28). CONCLUSIONS: Simple tests of cognitive ability provide useful predictive information up to a decade before the onset of dementia. The predictive information provided is independent of, but not enhanced by, the addition of APOE genotype.

Vascular disease risk factors as determinants of incident depressive symptoms: a prospective community-based study.

BACKGROUND: The potential association between vascular disease and depression have been the focus for much clinical psychiatric research, although few epidemiological prospective studies have looked into this association. AIMS: This study explores the a priori hypothesis of a prospective association between cardiovascular disease or its risk factors and incident depressive symptoms. METHOD: A prospective primary care based study derived from a multi-centre randomized controlled trial of moderate hypertension. 2584 moderately-hypertensive volunteers were followed-up for 54 months when five assessments of depressive symptoms, vascular disease and its risk factors were made. RESULTS: We found an association between the dependent variable (incident depressive symptoms measured with the Self-CARE-D) and baseline smoker status, low serum cholesterol levels, poorer cognitive function (particularly executive dysfunction), female gender and increasing age. These associations were independent of all other cardiovascular risk factors (ECG evidence of ischaemia or arrhythmia, systolic or diastolic blood pressure, blood pressure decline along the trial and body mass index). CONCLUSIONS: Our results do not support the hypothesis of a specific association between vascular disease or its risk factors and incident depressive symptoms.

Infección del tracto urinario: estudio prospectivo clínico y analítico para el diagnóstico diferencial en niños con sospecha de enfermedad infecciosa / Urinary tract infection in children: clinical and analytical prospective study for differential diagnosis in children with suspicion of an infectious disease

Objetivo: examinar las diferencias, en la clínica y en la analítica de sangre y orina, en los pacientes que acuden a urgencias de pediatría de un hospital de III nivel que permitan distinguir a aquellos que tienen infección del tracto urinario (ITU) de los que presentan otros procesos infecciosos o febriles. Con este fin, se hace un examen comparativo de los datos clínicos, sanguíneos, y análisis de orina entre dos grupos de pacientes, con y sin ITU, atendidos consecutivamente en urgencias. Pacientes y Métodos: durante un periodo de 6 meses, fueron evaluados prospectivamente 349 niños con edades comprendidas entre menos de 1 mes y los 14 años (media: 4,1 años), de entre los 14.400 atendidos en urgencias y que presentaban fiebre > 38,1° C y/o otros signos o síntomas relacionados con una ITU. En 247 pacientes, la ITU fue descartada. A los restantes 102 se les practicó un urocultivo y fueron divididos en dos grupos según el resultado del mismo, con y sin ITU; analizándose las diferencias entre los datos clínicos, exámenes de orina y análisis de sangre. Resultados: la sospecha de ITU en los 14.400 pacientes atendidos en urgencias, se planteó en 349 casos (2,4 por ciento), con una prevalencia de ITU en el conjunto de pacientes con sospecha de tener infección del 12,3 por ciento. La incidencia global de ITU en la población pediátrica que acudió a urgencias fue del 0,3 por ciento. Los 59 pacientes del grupo con urocultivo negativo, mostraron un porcentaje más alto de signos clínicos inespecíficos y examen microscópico de orina normal (p < 0,05), que los 43 pacientes del grupo con urocultivo positivo (ITU confirmada). El multistix de orina anormal, se obtuvo en mayor porcentaje (p < 0,05), en los pacientes con ITU. No se hallaron diferencias relevantes en otros parámetros clínicos y análisis de sangre entre ambos grupos. Fue necesario hospitalizar, basándose en la gravedad de los signos clínicos, en una proporción más elevada a los pacientes con ITU (27,9 por ciento vs 1,7 por ciento) y a los menores de 6 meses con ITU (66,6 por ciento). Conclusiones: el multistix y el examen microscópico anormal de orina en los pacientes con ITU, y los signos clínicos inespecíficos en los que no la tienen, poseen valor discriminativo en el diagnóstico diferencial. Se observa un gran solapamiento entre los signos clínicos y los análisis de sangre entre los pacientes que acuden a urgencias con infecciones varias y los que padecen una ITU. Estos parámetros, no son de utilidad significativa en el diagnóstico diferencial. Los multistix son útiles para el cribado en los casos sospechosos de ITU, si se conocen bien sus limitaciones. Es imprescindible obtener una muestra limpia de orina con cultivo positivo, para el diagnóstico de infección urinaria verdadera (AU)

Long-term predictors of cognitive outcome in a cohort of older people with hypertension.

BACKGROUND: Deteriorating cognitive function in late life substantially increases the risk for dementia, for other non-cognitive morbidity, for dependency, and early death. AIMS: To identify early predictors of late-life cognitive outcome. METHOD: Cognitive function, premorbid IQ, and cardiovascular risk exposure were recorded on 1083 subjects on entry to a hypertension treatment trial in 1983-1984. We followed up this cohort 9-12 years later to assess cognitive function with the Mini-Mental State Examination (MMSE), to update exposure status, and to obtain genomic material. Multivariate analysis was used to identify independent baseline predictors of cognitive outcome 9-12 years later. RESULTS: We followed up 387 subjects (58.6% of survivors). After adjusting for baseline cognition, poorer cognitive outcome was found to be independently associated with a family history of dementia, increasing age, less decline in systolic blood-pressure, lower premorbid IQ (rather than limited education), and abstinence from alcohol. CONCLUSIONS: Reduction in systolic blood pressure (among hypertensives) and moderate alcohol intake could protect against cognitive deterioration in late life.

Smoking, drinking, and incident cognitive impairment: a cohort community based study included in the Gospel Oak project.

OBJECTIVES: Recent longitudinal studies have reported that smoking increases risk for cognitive impairment and that moderate alcohol intake could be preventive. The association between both cigarette smoking and alcohol drinking and incident cognitive impairment was studied in a representative population. METHODS: This is a 1 year prospective population based cohort study of all residents aged 65 or over in the electoral ward of Gospel Oak in London, UK (n=889). Cognitive impairment was assessed at baseline and 1 year later using the organic brain syndrome (OBS) cognitive impairment scale from the short CARE structured assessment. Subjects who were cognitively impaired at baseline were excluded from this analysis. RESULTS: The prevalence of OBS cognitive impairment was 10.4% at index assessment and the 1 year cumulative incidence of cognitive impairment was 5.7%. Cognitive impairment was not associated with use of alcohol, although there was a non-significant association in the direction of a protective effect against onset of cognitive impairment for moderate drinkers compared with non-drinkers and heavy drinkers. Current smoking status predicted cognitive impairment (risk ratio (RR) 3.7; (95% confidence interval (95% CI)=1.1-12.3) independently from sex, age, alcohol, occupational class, education, handicap, depression, and baseline cognitive function. CONCLUSIONS: Smoking seems to be a prospective risk factor for incident cognitive impairment; thus encouragement of older people to stop smoking could be considered as part of a strategy to reduce the incidence of cognitive impairment.

The association between APOE and dementia does not seem to be mediated by vascular factors.

OBJECTIVE: The effect of APOE on dementia may be mediated through dyslipidemia and atherogenesis through its effect on cholesterol metabolism. The authors investigated this possibility among aged survivors from the UK Medical Research Council Trial of the Treatment of Hypertension in Older Adults. DESIGN: A total of 370 of 657 survivors from an initial cohort of 1,088 recruited into the trial between 1983 and 1985 were traced in 1994 and agreed to be screened for dementia. Blood samples were analyzed for APOE genotype and serum fibrinogen. Cholesterol level, smoking behavior, blood pressure, body mass index, and EKG recordings had been measured at recruitment 10 to 12 years earlier. Odds ratios (ORs) for the association between APOE epsilon4/* and both AD and dementia were estimated and adjusted incrementally for the effect of age and premorbid intelligence, cholesterol, other risk factors for vascular disease, and EKG evidence of cardiovascular disease. RESULTS: The authors diagnosed 24 cases of National Institute of Neurological and Communicative Disorders and Stroke AD from 41 cases of dementia. The crude OR for the association between APOE epsilon4/* and AD was 3.40 (95% CI 1.30 to 8.91). APOE genotype was associated with serum cholesterol level, and there was a nonsignificant trend for an association with smoking behavior. After adjusting for these and all other vascular risk factors and vascular disease variables listed earlier, the OR for the association between APOE epsilon4/* and AD increased to 4.81 (1.60 to 14.4). CONCLUSION: Presence of APOE epsilon4/* seems to increase the risk for dementia and AD independently of its effect on dyslipidemia and atherogenesis.

Long-term effects of severe undernutrition during the first year of life on brain development and learning in Chilean high-school graduates.

The objective of this study was to assess the relative impact of undernutrition during the first year of life on brain development, intellectual quotient (IQ), and scholastic achievement (SA) of poor Chilean high-school graduates (mean age = 18.3 +/- 0.9 y). A comparative study of two groups of high-school graduates from a low socioeconomic stratum was carried out. The undernourished group (n = 16), who had suffered from severe undernutrition during the first year of life, was compared with the non-undernourished group (n = 16). The final sample consisted of 32 right-handed high-school graduate students born at term who had no history of alcoholism or symptoms of brain damage, epilepsy, or heart disease and whose mothers had no history of smoking, alcoholism, or drug intake before and during pregnancy. Socioeconomic status was measured by using Graffar's modified method. Birth weight was used as the prenatal nutritional status index, and postnatal nutritional status was assessed by the body mass index, Z score for head circumference, and brachial anthropometry. IQ was determined with the Wechsler Intelligence Scale for Adults, and SA was determined with test in language and mathematics with the academic aptitude test. Brain development was evaluated by magnetic resonance imaging. Statistical analysis included variance tests, Scheffe's test for comparison of means, correlation, and multiple regression. Maternal schooling, brain volume, and undernutrition were the independent variables, with the greatest explanatory power in IQ variance (r(2) = 0.714). Only IQ explained SA variance (r(2) = 0.860); IQ, corpus callosum length, anteroposterior diameter, and maternal schooling were the independent variables, with the greatest explanatory power in the academic aptitude test variance (r(2) = 0.949). Results show that the long-term effects of malnutrition at an early age may affect brain development, IQ, and SA in school-age children. These findings are useful for nutrition and educational planning.

Does depression predict cognitive outcome 9 to 12 years later? Evidence from a prospective study of elderly hypertensives.

BACKGROUND: Previous longitudinal studies of the association between depression and cognitive dysfunction have had relatively short follow-up periods. This report presents a long-term study of the association between baseline syndromal depression and cognitive outcome measured 9 to 12 years later. METHODS: Self-CARE (D) depression, cognitive function and pre-morbid intelligence were recorded on 1083 subjects on entry to the Medical Research Council trial of treatment of hypertension in older adults in 1983-5. In 1994-5, we aimed to re-interview all survivors to assess cognitive function using the MMSE. We used multivariate analysis to explore whether baseline depression predicted cognitive outcome after this long follow-up period. RESULTS: Baseline depression was crudely associated with poorer cognitive outcome at time 2. However, this long-term prospective association was no longer apparent after adjusting for baseline cognitive performance, which was associated with baseline depression and robustly predicted cognitive outcome at time 2. We found that gender modified the association between depression and poorer cognitive outcome, so that the association was statistically significant only among men. CONCLUSION: Propensity for depression and failing cognition may have common determinants that still need to be established by future neurobiological investigations in conjunction with further long-term prospective epidemiological research.

CYP2D6 polymorphisms in Alzheimer's disease, with and without extrapyramidal signs, showing no apolipoprotein E epsilon 4 effect modification.

BACKGROUND: Allelic variation at the CYP2D6 gene has been reported to be associated with Parkinsons' disease (PD) and Lewy body dementia (LBD), but not with Alzheimer's disease (AD). AD has been associated with apolipoprotein E (apoE) epsilon 4 allele loading. METHODS: We examined CYP2D6 and apoE polimorphisms in a sample of 259 patients with dementia, 210 of whom had a diagnosis of AD, and 107 healthy controls. RESULTS: We found that the allelic frequency in our AD sample did not vary from that in the controls. The debrisoquine hydroxylase poor metabolize phenotype was not more prevalent among AD cases than among controls in contrast to that reported for PD and LBD. We also found that CYP2D6 status does not modify the risk effect for AD conferred by apoE epsilon 4 alleles. CONCLUSIONS: These findings provide some support to the notion that, at a genetic level, at least at this locus, AD could be distinct from PD and LBD.

[Neonatal sepsis: epidemiologic indicators and relation to birth weight and length of hospitalization time]. / Sepsis neonatal: indicadores epidemiológicos en relación con el peso del recién nacido y el tiempo de hospitalización.

OBJECTIVE: All cases of neonatal septicemia among neonates admitted to the neonatal unit in the pediatric department (CHUS) in Santiago de Compostela between 1992 and 1995 were studied. Our aims were: 1) To assess the incidence and microbial epidemiology. 2) To study the incidence of coagulase-negative staphylococci (CONS) sepsis stratified according to birth weight and gestational age. 3) To assess the incidence density of sepsis (IDS) and 4) To analyze the associated mortality. PATIENTS AND METHODS: One hundred eighteen episodes of sepsis in 103 neonates which fulfilled clinical and laboratory criteria with positive blood cultures were included in this study. Between the years of 1992 and 1995 there were 318 neonates suspect of having sepsis among the 2,083 who were admitted to the unit during this period and which came from our own maternity department, as well as other centers. RESULTS: In this period there were 10,457 live births in our maternity department. The annual incidence of sepsis was 6/1000 live births. Early onset sepsis was observed in 2.5/1000 live births (26 cases) and the occurrence of late onset increased to 3.5/1000 live births (36 cases). Neonatal sepsis was confirmed in 103 neonates (4.9%) corresponding to 118 episodes of sepsis. S. epidermidis was the most frequent agent isolated in blood cultures (38.1%). The highest incidence of sepsis caused by S. epidermidis was observed in neonates below 1500 g (12.1%) and less than 32 weeks gestational age (13.4%). The incidence was lower in those whose birth weights were more than 2500 g (1.9%) and > 37 weeks of gestational age (1.6%), p < 0.001. Overall mortality due to sepsis was 0.7% and increased to 5.0% among hospitalized newborns with birth weights below 1500 g. The average IDS stratified in three groups of birth weight and gestational age was 18 sepsis work-ups per 1000 patient-days of hospitalization, the lowest IDS 12.9/1000 was found in neonates whose birth weights were between 1501 g and 2500 g in comparison with neonates who weighted more than 2500 g (21.5/1000), p < 0.05, and very similar to the IDS found in the intermediate group of gestational age (13.1/1000). CONCLUSIONS: S. epidermidis and other CONS are the main agents causing sepsis in hospitalized neonates, although there is a decreasing trend of incidence (-71.1%) between the years 1992 and 1995 (5.0% vs 1.5%). Gram-negative organisms and S. agalactiae played a minor role as agents causing sepsis even though S. agalactiae is the most important agent in early onset sepsis. Overall mortality associated with sepsis (7/1000 live births) is in or under the average range of international statistics. Indexes of IDS are more valuable as epidemiological tools in assessing septicemia than the simple attack rate because they have taken into consideration the length of stay, number of hospitalized newborns, as well as the number of positive sepsis work-ups in the calculating process.

Cognitive impairment and social distress as different pathways to depression in the elderly: a cross-sectional study.

BACKGROUND: This study investigates the recent suggestion that some putative aetiological factors for depression, such as cerebral deterioration and social distress, may act differentially in the aetiology of depression in old age. METHOD: In a cross-sectional study, a community sample of 654 elderly subjects were interviewed with Short-CARE to assess the prevalence of depression and cognitive impairment. Information was collected for a variety of potential risk factors for depression such as exposure to social support deficit, threatening life events, impairment, disability and handicap. RESULTS: The prevalence of depression was 17% and that of a broad concept of cognitive impairment 23.9%. This analysis found associations between depression and exposure to social support deficits and threatening life events in the year prior to interview. These associations were considerably stronger for those subjects with no cognitive impairment than for those with cognitive impairment. We also found a progressive lowering in the strength of these associations the higher the chance of cognitive impairment measured as a longitudinal variable using both the Dementia Diagnostic Scale (DDS) and the Organic Brain Syndrome Scale (OBS) included in Short-CARE. CONCLUSIONS: The results of this theory-driven analysis lend some support to the notion of at least two differential pathways to depression in the elderly, one via social distress factors and another mediated by cerebral deterioration clinically expressed as cognitive impairment.

[Depression and cognitive deterioration: a transversal study of comorbidity]. / Depresión y deterioro cognitivo: un estudio transversal de comorbilidad.

This cross-sectional study investigates the relation between a broad category of cognitive impairment and depression in a sample of 654 subjects aged 65 or over. This sample represents 74% of all subjects of that age living in a defined electoral district in North London, UK. The presence of depression and cognitive impairment was ascertained by interviewing all subjects with Short-CARE. Information was collected also for a variety of socto-demographic factors, level of social support and variables of functional limitation (i.e., impairment, disability and handicap). We found a cross-sectional association between depression and cognitive impairment (OR = 3.3; 95% CI: 2.1-3.1). However, when the analysis was adjusted for potential confounders using stratified analysis and logistic regression, we found that variables of functional limitation (especially disability and handicap) acted as confounders of the above association. This confounding effect did not differ significantly across sexes in our study.