RESUMO
The authors aim to determine if a history of traumatic brain injury (TBI) assessed before dementia onset is associated with a higher risk of neuropsychiatric symptoms after dementia onset. A population-based incident series of people with dementia were assessed for TBI prior to onset of dementia and for neuropsychiatric symptoms after the onset, using the Neuropsychiatric Inventory. Participants with predementia TBI were more likely to exhibit disinhibition (12.7% versus 5.4%, OR=2.8, p=0.02), but not other neuropsychiatric symptoms. Traumatic brain injury may increase the risk of disinhibition in patients with dementia.
Assuntos
Lesões Encefálicas/epidemiologia , Demência/epidemiologia , Transtornos Mentais/epidemiologia , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/genética , Apolipoproteína E4/genética , Lesões Encefálicas/genética , Demência/genética , Feminino , Humanos , Comportamento Impulsivo/epidemiologia , Comportamento Impulsivo/genética , Modelos Logísticos , Masculino , Transtornos Mentais/genética , Testes Neuropsicológicos , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.
Assuntos
Agressão/psicologia , Lesões Encefálicas/complicações , Transtorno Depressivo Maior/complicações , Comportamento Social , Atividades Cotidianas , Adulto , Lesões Encefálicas/psicologia , Estudos de Casos e Controles , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Seleção de Pacientes , Estudos Prospectivos , Análise de Regressão , Ajustamento Social , Apoio SocialRESUMO
CONTEXT: Major depression affects about 25% of the patients who have Alzheimer disease and has serious adverse consequences for patients and caregivers. Results of prior antidepressant treatment studies have produced contradictory findings and have not fully assessed the benefits of depression reduction. OBJECTIVES: To assess the efficacy and safety of sertraline hydrochloride for the treatment of major depression in Alzheimer disease, and to evaluate the effect of depression reduction on activities of daily living, cognition, and nonmood behavioral disturbance. DESIGN: Randomized, placebo-controlled, parallel, 12-week, flexible-dose clinical trial with a 1-week, single-blind placebo phase. The study was conducted between January 1, 1998, and July 19, 2001. SETTING: University outpatient clinic. PARTICIPANTS: Forty-four outpatients who have probable Alzheimer disease and major depressive episodes. INTERVENTION: Sertraline hydrochloride, mean dosage of 95 mg/d, or identical placebo, randomly assigned. MAIN OUTCOME MEASURES: Response rate, Cornell Scale for Depression in Dementia, Hamilton Depression Rating Scale, Mini-Mental State Examination, Psychogeriatric Depression Rating Scale-activities of daily living subscale, and Neuropsychiatric Inventory to quantify patient behavior disturbance and caregiver distress. RESULTS: In the sertraline-treated group 9 patients (38%) were full responders and 11 (46%) were partial responders compared with 3 (20%) and 4 (15%), respectively, in the placebo-treated group (P =.007). The sertraline-treated group had greater improvements in the scores for the Cornell Scale for Depression in Dementia (P =.002) and Hamilton Depression Rating Scale (P =.01), and a statistical trend toward less decline in activities of daily living on the Psychogeriatric Depression Rating Scale-activities of daily living subscale (P =.07). There was no difference between the treatment groups in Mini-Mental State Examination (P =.22) or Neuropsychiatric Inventory (P =.32) ratings over time. When full responders, partial responders, and nonresponders were compared, full responders only, or full and partial responders had significantly better ratings on activities of daily living (P =.04), behavioral disturbance (P =.01), and caregiver distress (P =.006), but not on the Mini-Mental State Examination (P =.76). Safety monitoring indicated few differences in adverse effects between the 2 treatment groups. CONCLUSIONS: Sertraline is superior to placebo for the treatment of major depression in Alzheimer disease. Depression reduction is accompanied by lessened behavior disturbance and improved activities of daily living, but not improved cognition.