Predictivity of Early Depressive Symptoms for Post-Stroke Depression.

OBJECTIVES: Depression is a frequent complication after stroke. However, little is known about the predictive value of early self-reported depressive symptoms (DS) for later development of post-stroke depression (PSD) 6 months after discharge. DESIGN: Using a prospective longitudinal design, we investigated the prevalence of DS and examined their predictive value for depressive disorders 6 months after stroke while statistically controlling major established PSD risk factors. SETTING AND PARTICIPANTS: During inpatient rehabilitation, 96 stroke patients were screened for DS. After 6 months, 71 patients were attainable for a follow-up. MEASUREMENTS: DS was assessed using the 15-item Geriatric Depression Scale (GDS-15). At follow-up a telephone interview that included the Structured Clinical Interview for Psychiatric Disorders (SCID), which is based on DSM-IV criteria, and the GDS-15 was conducted. Patients with major depression (MD) at the follow-up were considered to have PSD. RESULTS: Regression analyses were conducted to examine the influence of early DS on PSD after 6 months while controlling for age, premorbid depression, and functional and cognitive impairments. The percentage of patients who scored above the GDS-15 cut-off for clinically relevant DS increased significantly, from 37% to 44%, after 6 months. According to the SCID, 27% of stroke patients fulfilled the criteria for MD, and another 16% fulfilled those for minor depression. Logistic regression showed that DS at baseline significantly predicted PSD at follow-up (odds ratio: 1.43; 95% CI: 1.15-1.8). CONCLUSION: Self-reported DS during inpatient rehabilitation are predictive for PSD 6 months after discharge. Assessment of early DS contributes to identifying stroke patients at risk for PSD, thereby facilitating prevention and treatment.

The influence of self-efficacy, pre-stroke depression and perceived social support on self-reported depressive symptoms during stroke rehabilitation.

Post-stroke depression (PSD) is the most common mental disorder following stroke; however, little is known about its pathogenesis. We investigated the predictive value and mutual relationship of psychological factors such as self-efficacy and social support and known risk factors such as pre-stroke depression, activities of daily living (ADL), cognitive functioning, and age for the emergence of depressive symptoms in the acute phase after stroke. Ninety-six ischaemic stroke inpatients residing at a rehabilitation centre completed an interview about 6.5 weeks post-stroke. The interview included demographic data, psychiatric anamnesis, the Barthel Index, Mini-Mental State Examination, Social Support Questionnaire, Generalized Self-Efficacy Scale, Stroke Self-Efficacy Questionnaire, and the Geriatric Depression Scale. A multiple regression analysis was performed to ascertain the predictive value of the factors on depressive symptoms. High self-efficacy, no history of pre-stroke depression, and high levels of perceived social support were the strongest protective factors for depressive symptoms. The influence of cognitive functioning on depressive symptoms was fully mediated by general self-efficacy, and general self-efficacy was a stronger predictor than stroke-specific self-efficacy. Neither ADL nor age significantly predicted depressive symptoms. Our findings suggest that consideration of self-efficacy and perceived social support in the inpatient rehabilitation setting may help prevent PSD.

[MCI-plus: mild cognitive impairment with rapid progression. Part II: Biomarkers and research methods]. / MCI-plus: leichte kognitive Beeinträchtigung mit rascher Progredienz. Teil II: Biomarker und Untersuchungsmethoden.

Long-term studies will be pivotal in order to examine the efficacy of preventive and early therapeutic interventions during the preclinical phase of dementia. Biomarkers will be of importance due to the large sample sizes and the necessary logistic efforts, high drop-out rates and slow clinical progression. The validity of functional and even structural imaging methods is currently investigated with early and promising results; it is presently unclear whether conventional csf-markers of Alzheimer's disease (beta-amyloid and tau-proteins) are sufficiently sensitive to monitor the effects of early interventions. It also remains doubtful whether modifications of these methods will ever be useful and available for practical purposes.

[MCI-plus: mild cognitive impairment with rapid progression. Part I: prevention and therapy]. / MCI-plus: leichte kognitive Beeinträchtigung mit rascher Progredienz. Teil I: Prävention und Therapie.

Mild Cognitive Impairment (MCI) is a prevalent problem in the elderly and many patients show predictors of rapid cognitive decline ("MCI-plus"). MCI-plus represents a syndrome with growing importance in an ageing society, which will increasingly affect primary medicine and most other clinical specialties. We will have to face the dilemma of fast progress in the field of neurodiagnostics with innovative therapeutic strategies lagging behind. Psychological and medical co-morbidity in MCI-plus will therefore offer important opportunities to delay and to avoid the manifestation of dementia. We will review and discuss current training and treatment options including symptomatic and causal interventions.

[Cognitive training in Alzheimer's dementia]. / Kognitives Training bei Alzheimer-Demenz. Aktuelle Entwicklungen, Chancen und Grenzen gerontologischer Gedächtnisrehabilitation.

Memory rehabilitation in dementia patients is gaining importance. Among the increasing number of people affected by Alzheimer's dementia (AD), the number detected in early stages of the disease is growing disproportionately quickly. The reasons are obvious: improved clinical assessment in the initial disease stage, increased sensitization of the elderly towards cognitive deficits, and the prescription of drugs retarding cognitive decline. Given the limited success of early training programs in the 1980s, skepticism towards cognitive training in dementia is still common among clinicians. However, recent international studies in the field give reason for cautious optimism. Memory therapy in the early-to-moderate stages of AD can be successful, if it is tailored to patients' individual daily problems and based on their residual cognitive capacities. The present paper gives an overview of recent findings in clinical and cognitive neuroscience which have led to a conceptual change in the memory rehabilitation of patients with dementia. Based on a review of general principles and rehabilitation techniques proven successful in recent research, recommendations are formulated for future studies evaluating cognitive therapy in dementia.

Prefrontal cognitive deficits in patients with schizophrenia treated with atypical or conventional antipsychotics.

Forty-three patients with schizophrenia were investigated with a short neurocognitive screening battery focussing on working memory and executive functions. As compared to healthy controls, patients showed impairments in the modified card sorting test, in verbal fluency and all span tasks with exception of digit span forward. Patients who were treated with atypicals showed better performance in the digit ordering test (manipulation task) when compared to a group of patients who received conventional antipsychotics; this difference was not due to disease severity, age or education. Manipulation tasks might be useful for neurocognitive follow-up and intervention studies.

In vivo evidence for differential association of striatal dopamine and midbrain serotonin systems with neuropsychiatric symptoms in Parkinson's disease.

Parkinson's disease affects various neurotransmitter systems. Using SPECT, the authors measured [(123)I]beta-CIT binding ratios of the caudate, putamen, medial thalamus, and dorsal midbrain over cerebellum in 16 patients with Parkinson's disease, and examined correlations with clinical ratings. Whereas striatal binding ratios (reflecting regional dopamine transporter densities) were associated with motor symptoms, dorsal midbrain binding ratios (reflecting regional serotonin transporter densities) were significantly correlated with the mentation, behavior, and mood subscale of the Unified Parkinson's Disease Rating Scale. These findings indicate that degeneration of the nigrostriatal dopaminergic neurons and a dysfunctional serotonergic raphe system contribute differentially to motor deficits and neuropsychiatric symptoms in Parkinson's disease.

Digit Ordering Test: clinical, psychometric, and experimental evaluation of a verbal working memory test.

Cooper, Sagar, Jordan, Harvey, and Sullivan (1991) proposed a Digit Ordering Test (DOT) for the assessment of verbal working memory: A series of seven digits has to be memorized and immediately recalled in ascending order. In several studies Cooper and co-workers showed selectively reduced DOT performance in patients with Parkinson's disease (PD). We present results from three studies on the properties of this test. In study 1 we replicated the original findings and evaluated a new scoring method. Study 2 addressed the psychometric features of the DOT and provides normative data based on a total of 134 test protocols (PD: 18, other neurological patients: 60, healthy controls: 56). In study 3 we used an experimental modification of the test (DOT-EXP) to evaluate the effects of the presentation rate on serial recall and digit ordering performance. The standard presentation rate of seven digits in 5 s was confirmed as most sensitive for detection of verbal working memory deficits. Findings confirmed that the DOT addresses the manipulatory component of verbal working memory and conveniently detects respective deficits in clinical testing.

[Recommendations for standarsized psychological diagnosis in Parkinson patients]. / Vorschläge für eine standardisierte psychologische Diagnostik bei Parkinsonpatienten.

In addition to the motor symptoms of Morbus Parkinson, a number of cognitive and emotional changes take place. The diagnosis of these concomitant symptoms has received increasing attention in research and clinical practice. Global rating scales offer economical advantages but generally do not satisfy the requirements of psychometric criteria, and they do not suffice in light of the multidimensional symptoms of the disease. Based on recent research results, recommendations from the CAPSIT protocol (Core Assessment Program for Surgical Interventional Therapies) for diagnosis of neurosurgically treated Parkinson's patients, and the restraints of everyday clinical work, we propose a standardized neuropsychological diagnostic routine. It includes diagnostic methods that are in use internationally and so timesaving and easily accessible that they can be considered suitable for routine diagnostics. Data comparison among various treatment centers can thus take place more easily. We have included only methods that differentiate well and whose test criteria offer a basis for thorough consultation as well as planning and evaluation of multidimensional therapy.