Comparison of medical image interpretation time between conventional and automated methods of breast ultrasound.

Objective: To compare the medical image interpretation's time between the conventional and automated methods of breast ultrasound in patients with breast lesions. Secondarily, to evaluate the agreement between the two methods and interobservers. Methods: This is a cross-sectional study with prospective data collection. The agreement's degrees were established in relation to the breast lesions's ultrasound descriptors. To determine the accuracy of each method, a biopsy of suspicious lesions was performed, considering the histopathological result as the diagnostic gold standard. Results: We evaluated 27 women. Conventional ultrasound used an average medical time of 10.77 minutes (± 2.55) greater than the average of 7.38 minutes (± 2.06) for automated ultrasound (p<0.001). The degrees of agreement between the methods ranged from 0.75 to 0.95 for researcher 1 and from 0.71 to 0.98 for researcher 2. Among the researchers, the degrees of agreement were between 0.63 and 1 for automated ultrasound and between 0.68 and 1 for conventional ultrasound. The area of the ROC curve for the conventional method was 0.67 (p=0.003) for researcher 1 and 0.72 (p<0.001) for researcher 2. The area of the ROC curve for the automated method was 0. 69 (p=0.001) for researcher 1 and 0.78 (p<0.001) for researcher 2. Conclusion: We observed less time devoted by the physician to automated ultrasound compared to conventional ultrasound, maintaining accuracy. There was substantial or strong to perfect interobserver agreement and substantial or strong to almost perfect agreement between the methods.

The Automation of Breast Ultrasonography and the Medical Time Dedicated to the Method.

In this integrative review, we aimed to describe the records of time devoted by physicians to breast ultrasound in a review of articles in the literature, in order to observe whether the automation of the method enabled a reduction in these values. We selected articles from the Latin American and Caribbean Literature in Health Sciences (LILACS) and MEDLINE databases, through Virtual Health Library (BVS), SciELO (Scientific Electronic Library Online), PubMed, and Scopus. We obtained 561 articles, and, after excluding duplicates and screening procedures, 9 were selected, whose main information related to the guiding question of the research was synthesized and analyzed. It was concluded that the automation of breast ultrasound represents a possible strategy for optimization of the medical time dedicated to the method, but this needs to be better evaluated in comparative studies between both methods (traditional and automated), with methodology directed to the specific investigation of this potentiality.

Na presente revisão integrativa, objetivamos descrever os registros de tempo dedicado pelos médicos à ultrassonografia mamária em revisão de artigos da literatura, visando observar se a automação do método possibilitou redução destes valores. Selecionamos artigos nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE, através da Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), PubMed e Scopus. Obtivemos 561 artigos e, após a exclusão de artigos duplicados e procedimentos de triagem, foram selecionados 9 artigos, cujas informações principais relativas à pergunta norteadora da pesquisa foram sintetizadas e analisadas. Foi concluído que a automação da ultrassonografia mamária representa uma possível estratégia de otimização do tempo médico dedicado ao método; porém, essa conclusão necessita ser melhor avaliada em estudos comparativos entre ambos os métodos (tradicional e automatizado), com metodologia direcionada à investigação específica desta potencialidade.

Association of frailty with cognitive impairment and functional disability in older adults with affective disorders: a brief research report.

Introduction: The Clinical-Functional Vulnerability Index (IVCF-20) is a validated multidimensional instrument that has been used in Brazil to evaluate functional disability in frail older adults. The main aim of this study was to assess frailty using this novel screening tool. In addition, to investigate whether frailty was associated with cognitive impairment and functional disability in older adults with affective disorders. Methods: Participants included were over 60 years old, with affective disorders (depressive or anxiety disorders), from two specialized outpatient clinics. The sample was comprised of 46 patients (30% of a total from 153). The following instruments were applied: Clock Drawing Test (CDT), Mini Mental State Examination (MMSE); Verbal Fluency Test (VFT); Pfeffer Questionnaire or Functional Assessment Questionnaire (FAQ); Katz Index; Geriatric Depression Scale (GDS-15); Geriatric Anxiety Inventory (GAI), and IVCF-20 as well as sociodemographic and clinical questionnaires. The association between the variables of interest was estimated using Spearman correlation. Results: This study found a negative correlation between frailty and cognitive decline (MMSE; rs = -0.58; p < 0.001); (VFT; rs = -0.60; p < 0.001); (CDT; rs = -0.47; p = 0.001) and a positive correlation between frailty and depressive symptoms (GDS-15; rs = 0.34; p = 0.019) as well as disability for IADLs (FAQ; rs = 0.69; p < 0.001). However, there was no statistical difference in the association between frailty and anxiety symptoms (GAI; rs = 0.24; p = 0.103) or disability for BADLs (Katz; rs = -0.02; p = 0.895). Discussion: Our data support that the associations between frailty, cognitive and functional disability are prevalent issues in Psychogeriatrics. Assessing frailty in a multidimensional context is essential using a rapid assessment frailty tool in clinical practice.

The Automation of Breast Ultrasonography and the Medical Time Dedicated to the Method / A automatização da ultrassonografia mamária e o tempo médico dedicado ao método

Abstract In this integrative review, we aimed to describe the records of time devoted by physicians to breast ultrasound in a review of articles in the literature, in order to observe whether the automation of the method enabled a reduction in these values. We selected articles from the Latin American and Caribbean Literature in Health Sciences (LILACS) and MEDLINE databases, through Virtual Health Library (BVS), SciELO (Scientific Electronic Library Online), PubMed, and Scopus. We obtained 561 articles, and, after excluding duplicates and screening procedures, 9 were selected, whose main information related to the guiding question of the research was synthesized and analyzed. It was concluded that the automation of breast ultrasound represents a possible strategy for optimization of the medical time dedicated to the method, but this needs to be better evaluated in comparative studies between both methods (traditional and automated), with methodology directed to the specific investigation of this potentiality.

Resumo Na presente revisão integrativa, objetivamos descrever os registros de tempo dedicado pelos médicos à ultrassonografia mamária em revisão de artigos da literatura, visando observar se a automação do método possibilitou redução destes valores. Selecionamos artigos nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE, através da Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), PubMed e Scopus. Obtivemos 561 artigos e, após a exclusão de artigos duplicados e procedimentos de triagem, foram selecionados 9 artigos, cujas informações principais relativas à pergunta norteadora da pesquisa foram sintetizadas e analisadas. Foi concluído que a automação da ultrassonografia mamária representa uma possível estratégia de otimização do tempo médico dedicado ao método; porém, essa conclusão necessita ser melhor avaliada em estudos comparativos entre ambos os métodos (tradicional e automatizado), com metodologia direcionada à investigação específica desta potencialidade.

Frailty and affective disorders throughout adult life: A 5-year follow-up of the Lifelines Cohort Study.

BACKGROUND: Frailty is an important concept for risk stratification in clinical practice, but it is hardly acknowledged at all in mental healthcare settings. This paper aims to assess the impact of frailty on the course of depression and anxiety, and the impact of these affective disorders on the course of frailty. METHODS: Lifelines, a prospective population-based cohort study, evaluated 167,729 people living in the northern Netherlands. Frailty was based on the deficit accumulation model, which resulted in a 60-item frailty index (FI) at baseline and a 35-item FI at baseline and 5-year follow-up. Current depressive and anxiety disorders were assessed with the Mini International Neuropsychiatric Interview according to DSM-IV criteria. Bidirectional associations between frailty and affective disorders were investigated using separate multivariable regression analyses in younger (<60 years) and older adults (≥60 years). RESULTS: The FI was associated with the onset of a depressive disorder (younger adults: odds ratio [OR] = 1.12; 95% confidence interval [CI] 1.11-1.13; older adults: OR = 1.13; 95% CI 1.09-1.16) as well as any anxiety disorder (younger adults: OR = 1.10; 95% CI 1.09-1.10; older adults: OR = 1.07; 95% CI 1.04-1.09). The other way around, depressive disorder and anxiety disorders were associated with an accelerated increase of frailty over time (depressive disorder: younger adults: beta [ß] = 0.03, p < 0.001; older adults: ß = 0.04, p < 0.001; and any anxiety disorder: younger adults: ß = 0.02, p < 0.001; older adults: ß = 0.01, p < 0.142), although the effect of anxiety disorders was less equivocal among older adults. CONCLUSIONS: Affective disorders are reciprocally related to frailty. Results with respect to the impact of anxiety disorders on frailty suggest most impact at lower levels of frailty. Our results might imply that interventions to slow biological aging should be broadened towards younger and middle-aged people as well as non-frail older patients. To develop targeted treatment, future clinical and epidemiologic studies on the underlying pathways of this bidirectional association are needed.

The Frail Depressed Patient: A Narrative Review on Treatment Challenges.

Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit-harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered.

Decision-making executive function profile and performance in older adults with major depression: a case-control study.

OBJECTIVES: Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD: The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS: In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION: Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.

Frailty in geriatric psychiatry inpatients: a retrospective cohort study.

OBJECTIVE: We aimed to evaluate the prevalence, clinical determinants, and consequences (falls and hospitalization) of frailty in older adults with mental illness. DESIGN: Retrospective clinical cohort study. SETTING: We collected the data in a specialized psychogeriatric ward, in Boston, USA, between July 2018 and June 2019. PARTICIPANTS: Two hundred and fourty-four inpatients aged 65 years old and over. MEASUREMENTS: Psychiatric diagnosis was based on a multi-professional consensus meeting according to DSM-5 criteria. Frailty was assessed according to two common instruments, that is, the FRAIL questionnaire and the deficit accumulation model (aka Frailty Index [FI]). Multiple linear regression analyses were conducted to evaluate the association between frailty and sample demographics (age, female sex, and non-Caucasian ethnicity) and clinical characteristics (dementia, number of clinical diseases, current infection, number of psychotropic, and non-psychotropic medications in use). Multiple regression between frailty assessments and either falls or number of hospital admissions in the last 6 and 12 months, respectively, were analyzed and adjusted for covariates. RESULTS: Prevalence of frailty was high, that is, 83.6% according to the FI and 55.3% according to the FRAIL questionnaire. Age, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty identified by the FRAIL. Dementia, current infection, the number of clinical (somatic) diseases, and the number of non-psychotropic medications were independently associated with frailty according to the FI. Falls were significantly associated with both frailty instruments. However, we found only a significant association for the number of hospital admissions with the FI. CONCLUSION: Frailty is highly prevalent among geriatric psychiatry inpatients. The FRAIL questionnaire and the FI may capture different forms of frailty dimensions, being the former probably more associated with the phenotype model and the latter more associated with multimorbidity.

A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder.

INTRODUCTION: Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder. METHODS: A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HRFI  = 1.04 [95% CI: 1.02-1.06]). RESULTS: Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HRFI  = 0.98 [95% CI: 0.97-0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time. CONCLUSIONS: The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late-life depression.

The concept of anorexia of aging in late life depression: A cross-sectional analysis of a cohort study.

INTRODUCTION: Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. METHODS: We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. RESULTS: Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). CONCLUSIONS: Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings.

Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?

OBJECTIVES: This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. METHODS: Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a self-report questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30-item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. RESULTS: Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. CONCLUSIONS: Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. CLINICAL IMPLICATIONS: Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.

Serotonin receptor inhibitor is associated with falls independent of frailty in older adults.

OBJECTIVES: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. METHODS: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. RESULTS: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. CONCLUSION: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.

Depression as a determinant of frailty in late life.

OBJECTIVES: Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. METHOD: Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. RESULTS: Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. CONCLUSION: Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.

Design and protocol of the multimorbidity and mental health cohort study in frailty and aging (MiMiCS-FRAIL): unraveling the clinical and molecular associations between frailty, somatic disease burden and late life depression.

BACKGROUND: To explore the mutual relationship between multimorbidity, mental illness and frailty, we have set-up the Multimorbidity and Mental health Cohort Study in FRAILty and Aging (MiMiCS-FRAIL) cohort. At the population level, multimorbidity, frailty and late-life depression are associated with similar adverse outcomes (i.e. falls, disability, hospitalization, death), share the same risk factors, and partly overlap in their clinical presentation. Moreover, these three variables may share a common underlying pathophysiological mechanism like immune-metabolic dysregulation. The overall objectives of MiMiCS-FRAIL are 1) to explore (determinants of) the cross-sectional and longitudinal relationship between multimorbidity, depression, and frailty among non-demented geriatric outpatients; 2) to evaluate molecular levels of senoinflammation as a broad pathophysiological process underlying these conditions; and 3) to examine adverse outcomes of multimorbidity, frailty and depression and their interconnectedness. METHODS: MiMiCS-FRAIL is an ongoing observational cohort study of geriatric outpatients in Brazil, with an extensive baseline assessment and yearly follow-up assessments. Each assessment includes a comprehensive geriatric assessment to identify multimorbidity and geriatric syndromes, a structured psychiatric diagnostic interview and administration of the PHQ-9 to measure depression, and several frailty measures (FRAIL, Physical Phenotype criteria, 36-item Frailty Index). Fasten blood samples are collected at baseline to assess circulating inflammatory and anti-inflammatory cytokines, leukocytes' subpopulations, and to perform immune-metabolic-paired miRome analyses. The primary outcome is death and secondary outcomes are the number of falls, hospital admissions, functional ability, well-being, and dementia. Assuming a 5-year mortality rate between 25 and 40% and a hazard rate varying between 1.6 and 2.3 for the primary determinants require a sample size between 136 and 711 patients to detect a statistically significant effect with a power of 80% (beta = 0.2), an alpha of 5% (0.05), and an R2 between the predictor (death) and all covariates of 0.20. Local ethical board approved this study. DISCUSSION: Frailty might be hypothesized as a final common pathway by which many clinical conditions like depression and chronic diseases (multimorbidity) culminate in many adverse effects. The MiMiCS-FRAIL cohort will help us to understand the interrelationship between these variables, from a clinical perspective as well as their underlying molecular signature.

Relationship between affective temperament and major depressive disorder in older adults: A case-control study.

BACKGROUND: In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. METHODS: A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. RESULTS: In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1-7.2). LIMITATIONS: The sample was relatively small, and their educational level was very low. CONCLUSION: A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.

Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms.

OBJECTIVE: Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment. DESIGN: Cross-sectional analysis of a cohort study on cognitive aging. PARTICIPANTS: 143 older adults. SETTING: University-based memory clinic. METHODS: Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles. RESULTS: The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007). CONCLUSION: Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence.

This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.

Human placental GLUT1 glucose transporter expression and the fetal insulin-like growth factor axis in pregnancies complicated by diabetes.

We have previously described regulation of syncytial GLUT1 glucose transporters by IGF-I. Despite this, it is not clear what signal regulates transplacental glucose transport. In this report we asked whether changes in GLUT1 expression and glucose transport activity in diabetic pregnancies were associated with alterations in the fetal IGF axis. Cord blood samples and paired syncytial microvillous and basal membranes were isolated from normal term pregnancies and pregnancies characterized by gestational diabetes type A2 (GDM A2) and pre-existing insulin-dependent diabetes mellitus (IDDM). Circulating IGF-I, basal membrane GLUT1 expression and glucose transporter activity were correlated with birth weight, but only in control, not diabetic groups. Basal membrane GLUT1 and transporter activity were correlated with IGF-I concentrations in control, but not diabetic groups. IGF binding protein (IGFBP) binding capacity showed a ≥50% reduction in the diabetic groups compared to control; both showed a higher level of free IGF-I. The absence of a correlation between birth weight and factors such as fetal IGF-I or GLUT1 expression in the diabetic groups suggests that IGF-I-stimulated effects may have reached a limiting threshold, such that further increases in IGF-I (or GLUT1) are without effect. These data support that fetal IGF-I acts as a fetal nutritional signal, modulating placental GLUT1 expression and birth weight via altered levels of fetal circulating IGFBPs. Diabetes appears to exert its effects on fetal and placental factors prior to the third trimester and, despite good glycemic control immediately prior to, and in the third trimester, these effects persist to term.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review.

INTRODUCTION: Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review / Rastreio para doença de Alzheimer em idosos brasileiros de baixa escolaridade ou analfabetos: revisão sistemática

ABSTRACT Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

RESUMO Os instrumentos de rastreio cognitivo sofrem influência educacional e/ou cultural. No Brasil, como as taxas de analfabetismo e baixa escolaridade são altas, é necessário identificar os instrumentos com maior acurácia diagnóstica para a doença de Alzheimer (DA). Objetivo: identificar os instrumentos de rastreio cognitivo aplicados na população brasileira com maior acurácia para detectar DA em indivíduos com baixo nível de escolaridade ou que são analfabetos. Métodos: Busca sistemática de estudos que utilizaram testes de rastreio cognitivo para detectar DA em idosos brasileiros de baixa escolaridade ou analfabetos, nas bases de dados: SCIELO, PUBMED E LILACS. Resultados: Foram encontrados 328 artigos e 9 preencheram os critérios de inclusão. Os instrumentos identificados apresentaram acurácia diagnóstica adequada ou elevada. Conclusão: Para um rastreio cognitivo válido é importante considerar os fatores socioculturais e educacionais na interpretação dos resultados. A construção de instrumentos epecíficos para idosos de baixa escolaridade ou analfabetos deve ser incentivada para melhor refletir as dificuldades dos idosos brasileiros de diferentes regiões.