Predictors of response in the treatment of moderate depression

Objective: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. Method: The present study derives from a research project in which depressed patients (n=272) received one of three treatments – long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) – over a 24-month period. Results: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. Conclusions: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

Predictors of response in the treatment of moderate depression.

OBJECTIVE:: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. METHOD:: The present study derives from a research project in which depressed patients (n=272) received one of three treatments - long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) - over a 24-month period. RESULTS:: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. CONCLUSIONS:: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.

NEUROPSYCHOLOGICAL PREDICTORS OF TREATMENT RESPONSE TO COGNITIVE BEHAVIORAL GROUP THERAPY IN OBSESSIVE-COMPULSIVE DISORDER.

BACKGROUND: The available research on the relationship between neuropsychological functioning and the therapeutic outcome of obsessive-compulsive disorder (OCD) has yielded inconsistent results. In this study, our aim was twofold. First, we sought to evaluate the effects of cognitive behavioral group therapy (CBGT) on neurocognitive functions in OCD patients. Second, we assessed the viability of neuropsychological test performance as a predictor of treatment response to CBGT. METHODS: One hundred fifty carefully screened OCD patients were randomized to receive either 12-week CBGT (n = 75) or to remain on a waiting list (WL; n = 75) for the corresponding time. Forty-seven participants dropped out of the study, leaving 103 participants that were included in the analysis (CBGT, n = 61; WL, n = 42). Participants had several neuropsychological domains evaluated both at baseline and at end-point. RESULTS: A significant difference in obsessive-compulsive, anxiety, and depression symptoms was observed between treated patients and controls favoring the CBGT group, but no significant differences were found on neuropsychological measures after 3 months of CBGT. In addition, there were no differences between treatment responders and nonresponders on all neuropsychological outcome measures. Employing a conservative alpha, neuropsychological test performance did not predict CBGT treatment response. CONCLUSIONS: Although the CBGT group demonstrated significant improvement in OCD symptoms, no significant difference was found on all neuropsychological domains, and test performance did not predict treatment response.

Relationship between inflammation and oxidative stress and cognitive decline in the institutionalized elderly.

OBJECTIVE: Cognitive impairment reduces quality of life and is related to vascular and neurodegenerative disorders. However, there is also a close relationship between these diseases and oxidative stress. Thus, the purpose of this study was to assess whether inflammation and oxidative damage are associated with low cognitive performance in the elderly with different housing conditions. METHODS: The study groups consisted of 32 institutionalized and 25 noninstitutionalized Brazilian elderly subjects. Oxidative damage, inflammation markers, and cognitive function were evaluated. RESULTS: The results demonstrated pronounced oxidative stress in the institutionalized elderly group, which also had a lower antioxidant status compared to noninstitutionalized subjects. High levels of proinflammatory cytokines were also observed in the institutionalized elderly. Furthermore, the raised levels of inflammatory markers were correlated with increased oxidative stress, and both were associated with low cognitive performance. However, based on multiple linear regression analysis, oxidative stress appears to be the main factor responsible for the cognitive decline. CONCLUSIONS: The findings suggest that individuals with lower antioxidant status are more vulnerable to oxidative stress, which is associated with cognitive function, leading to reduced life quality and expectancy.

Normas de associação semântica para 20 categorias em adultos e idosos / Semantic association norms for 20 categories in adults and elderly / Normas de asociación semántica para 20 categorías en adultos y ancianos

O desenvolvimento de normas para categorias semânticas é necessário para a compreensão do modo como os indivíduos organizam o conhecimento na memória e para a construção de instrumentos de avaliação cognitiva. O objetivo do presente estudo é fornecer normas associativas de 20 categorias semânticas para adultos e idosos brasileiros. Participaram do estudo 236 pessoas, entre 40 e 88 anos, das cinco regiões brasileiras. Os participantes responderam a um questionário de dados sociodemográficos e a um questionário de itens para categorias semânticas, e foram solicitados a produzir os cinco primeiros exemplares de cada categoria apresentada. Os resultados foram agrupados e são apresentadas as normas das categorias (exemplares, tamanho da categoria, respostas corretas, em branco e erros), bem como as respostas de cada categoria que foram comuns a todas as regiões brasileiras.(AU)

The development of semantic category norms is necessary to assist in the understanding of how individuals organize knowledge in memory, and to the creation of cognitive assessment instruments. The aim of this study is to provide associative norms of 20 semantic categories for Brazilian adults and elderly. The study included 236 participants from 40 to 88 years of age from the five Brazilian regions. They answered a socio-demographic questionnaire and a semantic category questionnaire, in which they were asked to produce the first five items of each category. Results are presented in category norms (items, category set size, correct responses, no responses and errors), as well as the responses that were common to all Brazilian regions belonging to each category.(AU)

Es necesario el desarrollo de normas para categorías semánticas para poder comprender cómo las personas organizan el conocimiento en la memoria y para la construcción de instrumentos de evaluación cognitiva. El objetivo de este estudio es proporcionar normas asociativas de 20 categorías semánticas para muestras de brasileños adultos y ancianos. Participaron 236 personas entre 40 y 88 años, de cinco regiones de Brasil. Los participantes completaron un cuestionario de datos sociodemográfico y un cuestionario de ítems para categorías semánticas y se les solicitó la producción de los cinco primeros ejemplares de cada categoría presentada. Los resultados fueron agrupados y son presentadas las normas de las categorías (ejemplares, tamaño de categoría, respuestas correctas, en blanco y errores), así como las respuestas de cada categoría, comunes a todas las regiones de Brasil.(AU)

Normas de associação semântica para 20 categorias em adultos e idosos / Semantic association norms for 20 categories in adults and elderly / Normas de asociación semántica para 20 categorías en adultos y ancianos

O desenvolvimento de normas para categorias semânticas é necessário para a compreensão do modo como os indivíduos organizam o conhecimento na memória e para a construção de instrumentos de avaliação cognitiva. O objetivo do presente estudo é fornecer normas associativas de 20 categorias semânticas para adultos e idosos brasileiros. Participaram do estudo 236 pessoas, entre 40 e 88 anos, das cinco regiões brasileiras. Os participantes responderam a um questionário de dados sociodemográficos e a um questionário de itens para categorias semânticas, e foram solicitados a produzir os cinco primeiros exemplares de cada categoria apresentada. Os resultados foram agrupados e são apresentadas as normas das categorias (exemplares, tamanho da categoria, respostas corretas, em branco e erros), bem como as respostas de cada categoria que foram comuns a todas as regiões brasileiras...

The development of semantic category norms is necessary to assist in the understanding of how individuals organize knowledge in memory, and to the creation of cognitive assessment instruments. The aim of this study is to provide associative norms of 20 semantic categories for Brazilian adults and elderly. The study included 236 participants from 40 to 88 years of age from the five Brazilian regions. They answered a socio-demographic questionnaire and a semantic category questionnaire, in which they were asked to produce the first five items of each category. Results are presented in category norms (items, category set size, correct responses, no responses and errors), as well as the responses that were common to all Brazilian regions belonging to each category...

Es necesario el desarrollo de normas para categorías semánticas para poder comprender cómo las personas organizan el conocimiento en la memoria y para la construcción de instrumentos de evaluación cognitiva. El objetivo de este estudio es proporcionar normas asociativas de 20 categorías semánticas para muestras de brasileños adultos y ancianos. Participaron 236 personas entre 40 y 88 años, de cinco regiones de Brasil. Los participantes completaron un cuestionario de datos sociodemográfico y un cuestionario de ítems para categorías semánticas y se les solicitó la producción de los cinco primeros ejemplares de cada categoría presentada. Los resultados fueron agrupados y son presentadas las normas de las categorías (ejemplares, tamaño de categoría, respuestas correctas, en blanco y errores), así como las respuestas de cada categoría, comunes a todas las regiones de Brasil...

Are delta-aminolevulinate dehydratase inhibition and metal concentrations additional factors for the age-related cognitive decline?

Aging is often accompanied by cognitive impairments and influenced by oxidative status and chemical imbalances. Thus, this study was conducted to examine whether age-related cognitive deficit is associated with oxidative damage, especially with inhibition of the enzyme delta-aminolevulinate dehydratase (ALA-D), as well as to verify the influence of some metals in the enzyme activity and cognitive performance. Blood ALA-D activity, essential (Fe, Zn, Cu, Se) and non-essential metals (Pb, Cd, Hg, As, Cr, Ni, V) were measured in 50 elderly and 20 healthy young subjects. Cognitive function was assessed by tests from Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery and other. The elderly group presented decreased ALA-D activity compared to the young group. The index of ALA-D reactivation was similar to both study groups, but negatively associated with metals. The mean levels of essential metals were within the reference values, while the most toxic metals were above them in both groups. Cognitive function impairments were observed in elderly group and were associated with decreased ALA-D activity, with lower levels of Se and higher levels of toxic metals (Hg and V). Results suggest that the reduced ALA-D activity in elderly can be an additional factor involved in cognitive decline, since its inhibition throughout life could lead to accumulation of the neurotoxic compound ALA. Toxic metals were found to contribute to cognitive decline and also to influence ALA-D reactivation.

Fatty acid status and its relationship to cognitive decline and homocysteine levels in the elderly.

Polyunsaturated fatty acids (PUFAs), especially the n-3 series, are known for their protective effects. Considering that cardiovascular diseases are risk factors for dementia, which is common at aging, the aim of this study was to evaluate whether fatty acid status in the elderly was associated with cognitive function and cardiovascular risk. Forty-five elderly persons (age ≥ 60 years) were included and divided into two groups based on their Mini-Mental Status Examination score adjusted for educational level: the case group (n = 12) and the control group (n = 33). Serum fatty acid composition, homocysteine (Hcy), hs-CRP, lipid profile and different cognitive domains were evaluated. The case group, characterized by reduced cognitive performance, showed higher levels of 14:0, 16:0, 16:1n-7 fatty acids and lower levels of 22:0, 24:1n-9, 22:6n-3 (DHA) and total PUFAs compared to the control group (p < 0.05). The n-6/n-3 ratio was elevated in both study groups, whereas alterations in Hcy, hs-CRP and lipid profile were observed in the case group. Cognitive function was positively associated with the 24:1n-9, DHA and total n-3 PUFAs, while 14:0, 16:0 and 16:1n-7 fatty acids, the n-6/n-3 ratio and Hcy were inversely associated. In addition, n-3 PUFAs, particularly DHA, were inversely associated with cardiovascular risk, assessed by Hcy levels in the elderly.

Evidence of criterion validity for the Benton Visual Retention Test: comparison between older adults with and without a possible diagnosis of Alzheimer's disease

The present study sought to provide evidence of criterion validity for the Benton Visual Retention Test by making comparisons between older adults with and without a possible diagnosis of Alzheimer's disease. The control group was composed of 50 older adults, and the clinical group was composed by 16 subjects. Descriptive and inferential statistics were performed, including χ² test, F and Wald statistics, t-test, analyses of covariance with α = .05, and effect size calculations. We used a sociodemographic data form, the Geriatric Depression Scale-15, and Mini Mental State Examination. Despite the small clinical sample size, the results pointed to evidence of validity for the Benton Visual Retention Test for Administration A (Memory) and Administration C (Copy). The clinical group had significantly poorer performance on most scores. These results also indicate important deficits in other neuropsychological functions in Alzheimer's disease.(AU)

Evidence of criterion validity for the Benton Visual Retention Test: comparison between older adults with and without a possible diagnosis of Alzheimer's disease

The present study sought to provide evidence of criterion validity for the Benton Visual Retention Test by making comparisons between older adults with and without a possible diagnosis of Alzheimer's disease. The control group was composed of 50 older adults, and the clinical group was composed by 16 subjects. Descriptive and inferential statistics were performed, including χ² test, F and Wald statistics, t-test, analyses of covariance with α = .05, and effect size calculations. We used a sociodemographic data form, the Geriatric Depression Scale-15, and Mini Mental State Examination. Despite the small clinical sample size, the results pointed to evidence of validity for the Benton Visual Retention Test for Administration A (Memory) and Administration C (Copy). The clinical group had significantly poorer performance on most scores. These results also indicate important deficits in other neuropsychological functions in Alzheimer's disease...

Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?

OBJECTIVE: To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. METHOD: Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. RESULTS: The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. CONCLUSIONS: Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD.

Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?

Objective: To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country. Method: Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II. Results: The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests. Conclusions: Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD. .

Cognitive estimation abilities in healthy and clinical populations: the use of the Cognitive Estimation Test.

Estimation abilities are a group of processes that involve functions such as planning, attention, abstract reasoning, and also mnemonic processes, like semantic and working memory. They are allocated in order to solve problems for which the answers are not readily available. Estimation abilities can be measured using the Cognitive Estimation Test (CET). The aim of this article was to review the use of the CET and other tests of cognitive estimation in healthy and pathological populations. We discussed studies examining correlations between the CET and other measures of executive functions and the importance of the standardization of measures that assess estimation abilities.

Development and validation of the Brazilian version of the Attitudes to Aging Questionnaire (AAQ): An example of merging classical psychometric theory and the Rasch measurement model.

BACKGROUND: Aging has determined a demographic shift in the world, which is considered a major societal achievement, and a challenge. Aging is primarily a subjective experience, shaped by factors such as gender and culture. There is a lack of instruments to assess attitudes to aging adequately. In addition, there is no instrument developed or validated in developing region contexts, so that the particularities of ageing in these areas are not included in the measures available. This paper aims to develop and validate a reliable attitude to aging instrument by combining classical psychometric approach and Rasch analysis. METHODS: Pilot study and field trial are described in details. Statistical analysis included classic psychometric theory (EFA and CFA) and Rasch measurement model. The latter was applied to examine unidimensionality, response scale and item fit. RESULTS: Sample was composed of 424 Brazilian old adults, which was compared to an international sample (n = 5238). The final instrument shows excellent psychometric performance (discriminant validity, confirmatory factor analysis and Rasch fit statistics). Rasch analysis indicated that modifications in the response scale and item deletions improved the initial solution derived from the classic approach. CONCLUSION: The combination of classic and modern psychometric theories in a complementary way is fruitful for development and validation of instruments. The construction of a reliable Brazilian Attitudes to Aging Questionnaire is important for assessing cultural specificities of aging in a transcultural perspective and can be applied in international cross-cultural investigations running less risk of cultural bias.

[WHOQOL-OLD Project: method and focus group results in Brazil]. / Projeto WHOQOL-OLD: método e resultados de grupos focais no Brasil.

OBJECTIVES: Exploring the conditions that allow satisfactory quality of life in old age is an issue of scientific and social relevance. Thus, the objective of the study was to describe a quality of life assessment method for the elderly and present the results from focus groups conducted among old people in good health and ill health, as well as their caregivers. METHODS: The methodology used in the WHOQOL-OLD project is the same as utilized in the development of other WHOQOL modules. Five focus groups were conducted in Brazil. The sampling procedure was done according to convenience. Eighteen old people and five caregivers took part in the focus groups. All the focus groups followed a pre-established methodology. RESULTS: A tendency towards making an association between quality of life and wellbeing and feeling well was observed. The responses spontaneously included the 6 domains proposed in WHOQOL-100, thus corroborating the multidimensional nature of this construction. Nineteen out of the 24 original facets of this instrument were cited as relevant, and the five facets not spontaneously remembered were not concentrated in a single domain. When questioned about the importance of each of the 24 facets of WHOQOL-100, the groups considered all of them to be relevant. However, suggestions for modifications to five facets were made. Additional items were also examined and considered relevant for assessing quality of life among the elderly, by both the old people and the caregivers. CONCLUSIONS: The results corroborate the hypothesis that old people constitute a particular group and, as such, they have relevant specific characteristics. Thus, an appropriate instrument for assessing quality of life among the elderly needs to consider such matters.

Projeto WHOQOL-OLD: método e resultados de grupos focais no Brasil / WHOQOL-OLD Project: method and focus group results in Brazil

OBJETIVO: A investigaçäo sobre as condições que permitem uma boa qualidade de vida na velhice é de interesse científico e social. Assim, o estudo objetivou apresentar a metodologia utilizada e os resultados dos grupos focais para avaliaçäo da qualidade de vida do idoso. MÉTODOS: A metodologia do projeto WHOQOL-OLD é a mesma utilizada no desenvolvimento de outros módulos do WHOQOL. Foram realizados cinco grupos focais no Brasil. O método amostral foi o de conveniência. Dezoito idosos e cinco cuidadores participaram dos grupos focais. Todos os grupos obedeceram a uma metodologia pré-estabelecida. RESULTADOS: Observou-se uma tendência de associaçäo entre qualidade de vida e bem-estar ou sentir-se bem. Espontaneamente, as respostas incluíram os seis domínios propostos no WHOQOL-100, reforçando a multidimensionalidade do construto. Das 24 facetas originais, 19 foram citadas como relevantes, sendo que as cinco facetas näo espontaneamente lembradas näo se centraram em um único domínio. Quando perguntados sobre a importância de cada uma das 24 facetas do WHOQOL-100, os grupos consideraram-nas todas relevantes. Foram sugeridas modificações para serem aplicadas a idosos para cinco facetas. Itens adicionais também foram examinados e considerados relevantes para a avaliaçäo de qualidade de vida em idosos, tanto pelos idosos entrevistados como pelos cuidadores. CONCLUSÕES: Os resultados corroboram com a hipótese de que os idosos constituem um grupo particular e, como tal, apresentam especificidades de importante relevância para a qualidade de vida. Assim, um instrumento adequado para a avaliaçäo da qualidade de vida de idosos tem que necessariamente contemplar esses aspectos.

Bereavement-related cognitive impairment in an oldest-old community-dwelling Brazilian sample.

As it is already known that depression can cause a demonstrable impact on cognition in elderly subjects, the objective of this study was to determine whether also the mourning process is associated with any cognitive impairment in this age range. A random and representative sample (a sample with 77 subjects/total county population of oldest-old with 219 subjects = 35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, the cognitive function of subjects without grief and of subjects with the presence of grief were compared. Five neuropsychological tests (the Buschke-Fuld Selective Reminding Test, the word-list from the CERAD battery, the Verbal Fluency Test, and two subtests of the Wechsler memory scale), the Mini-Mental State Examination (MMSE) and two self-perceived memory impairment questionnaires were used. Presence of depressive symptomatology was identified by the Yesavage Geriatric Depression Scale (GDS). The prevalence rates of some psychiatric diagnoses (syndromic general anxiety disorder, major and minor depression) were compared between the bereaved group and the control group. There was not a statistically significant difference between the scores of controls and subjects with grief in the GDS. The frequency of affective disorders in both groups did not differ. However, the recently bereaved elderly subjects presented a mild cognitive impairment when evaluated with the MMSE, with the digit span test and with Word-list neuropsychological memory test. Likewise these bereaved octogenarian subjects presented more frequently a diagnosis of 'aging-associated cognitive decline' when compared with non-bereaved oldest-old. These results suggest that the normal sadness and/or the chronic stress of the grieving process, even without the presence of an identifiable syndromal-level depression, are associated with memory and cognitive differences among the bereaved oldest-old. Cause-effect relationships, however, cannot be established from this cross-sectional correlational study: Grief may influence cognitive functioning in the elderly, but mildly cognitively compromised elderly persons may be more likely to experience strong grief reactions after loss.

The DSM-IV 'minor depression' disorder in the oldest-old: prevalence rate, sleep patterns, memory function and quality of life in elderly people of Italian descent in Southern Brazil.

OBJECTIVES: (1) To describe the prevalence of minor depression in a community-dwelling population aged 80 years and over. (2) To compare the sleep pattern, memory function and the prevalence rate of other psychiatric diagnoses between normal controls and subjects with minor depressive disorder. DESIGN: A random representative sample (sample=77 subjects/county population of oldest-old =219--35%) aged 80 years or more was selected from the county of Veranópolis in the Brazilian rural southern region. Of this group, eight subjects who met the DSM-IV criteria for minor depression, and 50 subjects without diagnosed delirium disorder, cognitive or affective problems were compared. RESULTS: The prevalence rate of minor depression was 12%. Subjects with this diagnosis were more likely to complain about sleep and memory problems than elderly people without any other affective disorder (major depression or dysthymic disorder). Otherwise, objective evaluation of these two areas, memory and sleep, did not show differences between the groups. Moreover, in terms of factors such as life satisfaction and some domains from the Short-form 36 Quality of Life Scale (SF-36), subjects with minor depression presented worse self-reported evaluations. Female gender was associated (p=0.01) with a more frequent presence of minor depression disorder, and those with this diagnosis were more likely to have co-morbidity with generalized anxiety disorder (p=0.007) when compared with elderly people without any depressive disorder. CONCLUSION: In this study, minor depression has been significantly associated with lower life satisfaction and worse indexes of life quality. The results supported the current concept that minor depression is prevalent in later life, especially among the oldest-old. Subjects with minor depression had worse self-reported opinions about memory and sleep patterns, but when these variables were objectively measured, no meaningful differences could be determined by the research team. Female gender and the concurring presence of generalized anxiety disorder were both significantly associated with the presence of minor depression diagnosis.