Functional and cognitive criteria produce different rates of mild cognitive impairment and conversion to dementia.

OBJECTIVE: To compare rates of mild cognitive impairment (MCI) and rates of progression to dementia using different MCI diagnostic systems. METHODS: MCI was investigated at baseline in 3063 community dwelling non-demented elderly in the Ginkgo Evaluation of Memory (GEM) study who were evaluated every 6 months to identify the presence of dementia. Overall MCI frequency was determined using (1) a Clinical Dementia Rating (CDR) score of 0.5 and (2) neuropsychological (NP) criteria, defined by impairment on standard cognitive tests. RESULTS: 40.2% of participants met CDR MCI criteria and 28.2% met NP MCI criteria (amnestic MCI = 16.6%). 15.7% were classified as MCI by both criteria and 47.4% as normal by both. Discordant diagnoses were observed in 24.5% who met NP normal/CDR MCI and in 12.4% who met NP MCI/CDR normal. Factors associated with CDR MCI among NP normal included lower education, lower NP scores, more instrumental activities of daily living impairment, greater symptoms of depression and subjective health problems. Individuals meeting NP MCI/CDR normal were significantly more likely to develop dementia over the median follow-up of 6.1 years than those meeting NP normal/CDR MCI. CONCLUSIONS: Different criteria produce different MCI rates and different conversion rates to dementia. Although a higher percentage of MCI was identified by CDR than NP, a higher percentage of NP MCI progressed to dementia. These findings suggest that the CDR is sensitive to subtle changes in cognition not identified by the NP algorithm but is also sensitive to demographic and clinical factors probably leading to a greater number of false positives. These results suggest that identifying all individuals with CDR scores of 0.5 as Alzheimer's disease is not advisable.

Long-term reliability of diagnosing lifetime major depression in a community sample.

Limited information is available on the reliability of diagnostic assessments in community populations. This study analyzed the 18-month test-retest stability of lifetime major depression determined from the Schedule for Affective Disorders and Schizophrenia-Lifetime Version using the Research Diagnostic Criteria. Overall, the reliability among the 391 female subjects was poor. Clinical status during the 18-month interval influenced reliability, while demographic, psychosocial, and interviewer characteristics were unrelated. The women who reliably reported lifetime episodes of depression were consistent about details such as medication use, but were inconsistent about other features, eg, number of episodes, length of longest episode, and age at first episode. The results suggest the need for caution in analyzing data on the lifetime prevalence of depression in community samples.

Mental health effects of the Three Mile Island nuclear reactor restart.

Controversy over potential mental health effects of the Three Mile Island Unit-1 restart led the authors to examine prospectively the pattern of psychiatric symptoms in a sample of Three Mile Island area mothers of young children. Symptom levels after restart were elevated over previous levels; a sizable subcohort of the sample reported relatively serious degrees of postrestart distress. History of diagnosable major depression and generalized anxiety following the Three Mile Island accident, plus symptoms and beliefs about personal risk prior to the restart, best predicted postrestart symptoms.

Factors affecting help-seeking during depression in a community sample.

Little is known about factors that influence community residents to seek professional help while experiencing diagnosable episodes of depression. The present study utilized longitudinal data from 96 female subjects to examine whether clinical and psychosocial features of a recent depressive episode, as well as preexisting psychiatric and psychosocial characteristics, could distinguish between individuals who (a) did and did not seek help during their episode and (b) chose to consult one professional source rather than another. Results showed that less than half of the sample sought professional help. Few variables could distinguish subjects who sought help from those who did not. Instead, subjects consulting mental health specialists were more clinically impaired and had fewer psychosocial assets than both those consulting nonpsychiatric physicians and those seeking no help. Subjects in the latter two groups were indistinguishable from one another on the assessed variables. Results were cross-validated with a smaller sample of male community residents.

Community adjustment of chronic schizophrenic patients in urban and rural settings.

The influence of environmental conditions on the community adjustment of chronic schizophrenic patients who live in boarding homes and other residential facilities was studied using data from medical records and interviews with patients. Seventy-eight patients living in an urban area and 46 patients living in a rural area were included in the study. Compared with rural patients, urban patients were more likely to live in substandard dwellings, to receive less practical support from the home operator, and to report more incongruence with household members and aversive neighborhood conditions. Urban patients showed significantly more psychopathology, functioned more poorly in relationships with others, and had poorer global functioning than rural patients. Except for the physical condition of patients' dwellings, all the environmental conditions measured in the study were significantly associated with some measures of community adjustment regardless of geographic setting.

Affective disorder in mothers of young children.

This research assessed the rate of affective disorder in 124 mothers of preschool children, which was found to be lower than in earlier studies, i.e. twelve per cent during the child-rearing years, and eight per cent in the year before interview. In half of those mothers who had an affective episode during the child-rearing years, its onset had predated the birth of the first child. We investigated sociodemographic and social support variables in relation to clinical and subclinical disturbance and found only modest associations. The apparent discrepancy between the present findings and those of previous research is discussed in relation to environmental and methodological factors.

Effectiveness of the United Steel Workers of America Coke Oven Intervention Program.

This paper describes the implementation and evaluation of the Coke Oven Intervention Program developed jointly by the United Steel Workers of America and the University of Pittsburgh. The program was offered on four occasions at each of seven coke oven plants over a 2-year period. Participants were compared with nonparticipating co-workers and controls from matched plants on knowledge of the Coke Oven Standard and workplace behaviors. Few baseline differences were found among participants, nonparticipants, and controls. Participants improved significantly as a result of the program, with those attending multiple programs accruing the greatest benefits. Panel controls interviewed on six occasions throughout the 2-year period showed little improvement. Reasons for and implications of the effectiveness of the program are discussed.

Epidemiology of depression and alcohol abuse/dependence in a managerial and professional work force.

Detailed clinical interviews focusing on depression and alcohol abuse/dependence were conducted with 1870 managers and professionals drawn from a major US corporation. Among men, the lifetime and 1-year prevalence rates of DSM-III-R major depression were 23% and 9%, respectively. Among women, the rates were 36% and 17%, respectively. Lifetime and 1-year prevalence rates of DSM-III-R alcohol abuse/dependence were 16% and 4% for men, and 9% and 4% for women. Imposing a requirement that alcohol-related symptoms cluster together in time reduced the lifetime and 1-year prevalence rates to 11% and 3% for men and 5% and 2% for women. The odds ratio for the lifetime occurrence of depression and alcohol abuse/dependence with such clustering was 2.28. The three most important risk factors for depression were being female, separated or divorced, and having a family history of depression. For alcohol abuse/dependence, the most important risk factors were being male, unmarried, and having a family history of alcoholism. Manager/professional status, length of employment, hours worked per day, and supervisory responsibility were not statistically associated with either DSM-III-R major depression or alcohol abuse/dependence.

Health effects of long-term solvent exposure among women in blue-collar occupations.

The relationship of solvent exposure to self-reported neurologic and somatic symptoms as well as neuropsychological performance was examined in a sample of 567 female blue collar workers who were members of the International Brotherhood of Electrical Workers (IBEW). Structured interviews were conducted at IBEW offices. Five solvent exposure categories were derived--never exposed, exposed prior to but not during the past year, exposed during the past year but not currently, currently exposed less than 50% of the time, and currently exposed more than 50% of the time. No differences among the groups on neuropsychological performance were found. On the other hand, heightened exposure was significantly related to depression, severe headaches, light-headedness, room spinning, appetite difficulties, funny taste in mouth, weakness/fatigue, rashes, and abdominal pain after controlling for the effects of seven risk factors (age, smoking, moderate-heavy alcohol consumption, severe obesity, history of physician-diagnosed chronic illness, working in a clean room, and exposure to other chemicals). These findings are consistent with Scandinavian studies of solvent-exposed male workers and point to the need for careful prospective research.

Work stress, family stress and depression in professional and managerial employees.

Detailed interviews were conducted with 1523 married professional and managerial employees of a major US corporation to test associations of acute and chronic occupational and domestic stress with DSM-III-R major depression and current depressive symptoms. After controlling for demographic and clinical risk factors, both sources of stress were significantly associated with the two measures of depression. On the other hand, neither the demographic and clinical risk factors, nor several psychosocial characteristics (social support, sense of mastery and organizational commitment) moderated the relationship between stress and depression.