Moderate alcohol consumption and depression - a longitudinal population-based study in Sweden

BACKGROUND AND AIMS

The interrelationship between alcohol consumption and depression is complex, and the direction of the association is unclear. We investigated whether alcohol consumption influences the risk of depression while accounting for this potential bidirectionality.

METHODS

A total of 10 441 individuals participated in the PART study in 1998-2000, 8622 in 2001-2003, and 5228 in 2010. Participants answered questions on their alcohol consumption, symptoms of depression, childhood adversity, and sociodemographic, socioeconomic, psychosocial, and lifestyle factors. A total of 5087 participants provided repeated information on alcohol consumption. We used marginal structural models to analyze the association between alcohol consumption and depression while controlling for previous alcohol consumption and depressive symptoms and other time-varying confounders.

RESULTS

Non-drinkers had a higher depression risk than light drinkers (≤7 drinks/week) (risk ratio: 1.7; 95% confidence interval 1.3-2.1). Consumers of seven-fourteen drinks/week had a depression risk similar to that of light drinkers. Hazardous drinking was associated with a higher risk of depression than non-hazardous alcohol consumption (risk ratio: 1.8, 95% confidence interval: 1.4-2.4).

CONCLUSION

Light and moderate alcohol consumption and non-hazardous drinking were associated with the lowest risk of subsequent depression after accounting for potential bidirectional effects. Hazardous drinking increased the risk of depression.

Effectiveness of interventions on physical activity in overweight or obese children: a systematic review and meta-analysis including studies with objectively measured outcomes

There is no consensus on interventions to be recommended in order to promote physical activity among overweight or obese children. The objective of this review was to assess the effects on objectively measured physical activity, of interventions promoting physical activity among overweight or obese children or adolescents, compared to no intervention or to interventions without a physical activity component. Publications up to December 2015 were located through electronic searches for randomized controlled trials resulting in inclusion of 33 studies. Standardized mean differences from baseline to post-intervention and to long-term follow-up were determined for intervention and control groups and meta-analysed using random effects models. The meta-analysis showed that interventions had no effect on total physical activity of overweight and obese children, neither directly post-intervention (-0.02 [-0.15, 0.11]) nor at long-term follow-up (0.07 [-0.27, 0.40]). Separate analyses by typology of intervention (with or without physical fitness, behavioural or environmental components) showed similar results (no effect). In conclusion, there is no evidence that currently available interventions are able to increase physical activity among overweight or obese children. This questions the contribution of physical activity to the treatment of overweight and obesity in children in the studied interventions and calls for other treatment strategies.

Mental health literacy about depression and schizophrenia among adolescents in Sweden

BACKGROUND

Mental health literacy (MHL) refers to an individual's knowledge of mental disorders, including the ability to recognize psychopathology and being aware of help options. Most studies of MHL have focused on adults.

OBJECTIVE

The purpose of this study was to examine levels of MHL among adolescents.

METHODS

MHL was examined using two pre-established vignettes that presented an adolescent with symptoms of either depression or schizophrenia. The respondents were 426 adolescents (age mean=16). Vignette data were analyzed both qualitatively and quantitatively.

RESULTS

The data showed that 42.7% and 34.7% of the respondents identified depression and schizophrenia, respectively. Depression was recognized more often by females than males. Professional help was suggested by a minority of the respondents for managing symptoms of depression (22.5%) or schizophrenia (32.6%). Altruistic behaviors, examined through the willingness to help an acquaintance with mental illness symptoms, were apparent among 58.2% of the respondents and to a greater extent in females than males. Answers following the schizophrenia vignette also revealed stigmatizing attitudes in 11.5% of the participants.

CONCLUSIONS

There are relatively low levels of MHL among teenagers in Sweden. Awareness campaigns and the implementation of psychoeducation in the school curriculum could increase MHL in this group.

Impact of changes in life circumstances on subjective well-being in an adult population over a 3-year period

OBJECTIVES

Mental health problems are a major issue worldwide, and there is a need to further explore factors that may increase or decrease people's subjective well-being (SWB). The main aim of the present study was to extend knowledge concerning changes in cohabitation, social support or financial situation and their influence on SWB, after controlling for personality (i.e. neuroticism), in a 3-year follow-up of an adult population-based sample. The change in overall well-being was also studied during the 3- year interval.

STUDY DESIGN

Longitudinal design.

METHODS

A random sample of Swedish citizens, aged 20-64 years, residing in Stockholm County received a questionnaire by post, comprising items pertaining to demographics, personality, social support and SWB. All the respondents received a second questionnaire 3 years later. In total, 8324 subjects were included in the present study.

RESULTS

The overall well-being of the study sample was relatively stable. Separate analyses of the three life circumstances indicated that, after controlling for personality, positive and negative changes in each sphere of life still affected SWB.

CONCLUSIONS

Despite personality and the stability of SWB, these results indicate that changes in financial situation, social support and cohabitation influence SWB. It is important for society and the healthcare services to be aware that a negative change in any of these life circumstances may lead to decreased well-being for a period of at least 3 years.

Low episodic memory performance as a premorbid marker of depression: evidence from a 3-year follow-up

OBJECTIVE

To examine low episodic memory scores as a potential risk factor for depression.

METHOD

A population-based sample of non-depressed individuals (20-64 years) were re-examined 3 years after an initial screening (n = 708). At baseline, information on episodic memory scores, demographic and socioeconomic factors, alcohol use and anxiety diagnoses was collected. The data for depression diagnoses were collected at both baseline and follow-up.

RESULTS

Logistic regressions, conducted on three separate study groups that were defined according to three assessments of episodic memory (i.e. free + cued recall, free recall, cued recall) among individuals who scored in the 25 lowest or highest percentiles in the memory tests, revealed that low episodic memory performance defined as the sum of free and cued recalls of organizable words constitutes a risk of depression diagnosis 3 years later.

CONCLUSION

Low episodic memory performance predated depressive diagnosis and might be considered as a premorbid marker of depression.

Musculoskeletal pain and analgesic therapy in a very old population

The aim of this study was to examine the prevalence of musculoskeletal pain and use of analgesic drugs in a population of very old people. The investigation is based on data from the Kungsholmen project. Of the 2638 inhabitants aged 75 or more in a parish of central Stockholm 1800 were examined. Of the subjects. 60% reported trouble with pain at musculoskeletal locations, while only 40% of the pain reporting subjects used analgesics, one third of which were non-prescription minor analgesics. Prescription analgesics (non-steroidal antiinflammatory drugs or centrally acting drugs) were used by one fourth of the pain reporting subjects, and taken on a regular basis in only half of the cases. Potent opioids were used by less than 1% of the population. There was no increase in pain with increasing age, but an increase in use of minor analgesics with age >85. Women more often reported pain and had a higher consumption of analgesics. Light opioids were more often used by subjects with multifocal pain. Subjects living in sheltered accommodation used more analgesics, particularly light opioids, than did those living in their own homes or in institutions. Subjects with low or intermediate educational status more often reported pain and used light opioids to a larger extent than did the highly educated. These results indicate that musculoskeletal pain is relatively common among the very old, but does not seem to be a severe problem for the majority, considering the low proportion of subjects using prescription analgesics regularly. However, the very low use of potent opioids indicates that some of the elderly suffering from cancer and other severe pain causing diseases might be undertreated.

Cognitive functions in depressive disorders: evidence from a population-based study

BACKGROUND

Most of the available evidence on the effects of depression is based on in- and out-patient samples focusing on individuals suffering from major depression. The aims of this study were to examine cognitive functioning in population-based samples and to determine whether cognitive performance varies as a function of depression subgroup.

METHOD

Population-based samples (aged 20-64 years) with major depression (N = 68), dysthymia (N = 28), mixed anxiety-depressive disorder (N = 25) and minor depression (N = 66) were examined on a variety of cognitive tasks (i.e. episodic memory, verbal fluency, perceptual-motor speed and mental flexibility). One hundred and seventy-five non-depressed individuals served as controls.

RESULTS

The total group of depressed individuals showed impairments in tasks tapping episodic memory and mental flexibility. Of more interest, however, was the observation that the pattern of impairments varied as a function of depression subgroup: the major depression and mixed anxiety-depressive disorder groups exhibited significant memory dysfunction, whereas individuals with dysthymia showed pronounced difficulties in mental flexibility. Minor depression did not affect cognitive performance. Verbal fluency and perceptual-motor speed were not affected by depression.

CONCLUSIONS

These results indicate that persons with depressive disorders in the population exhibit cognitive impairments in tasks tapping episodic memory and mental flexibility and that cognitive impairment varies as a function of depressive disorder.

Psychotropic drug use in elderly people with and without dementia

OBJECTIVE

To determine the prevalence of psychotropic drug use in very old persons with and without dementia in two time periods, and describe the patterns of psychotropic drug use between institutions and non-institutions.

METHODS

Descriptive analysis on a sample of subjects aged 81+ from a population-based study in Stockholm, Sweden. Psychotropic drug use data were collected from the 1987-1989 and 1994-1996 periods of the study. The diagnosis of dementia was based on the DSM III-R.

RESULTS

About 41% of the subjects used at least one psychotropic drug in both periods. Women and subjects in institutions more commonly used psychotropic drugs. The most commonly reported were, in rank order, hypnotics-sedatives, anxiolytics, antipsychotics and antidepressants. Hypnotics-sedatives and anxiolytics were the most commonly used in both institutions and non-institutions. More persons with dementia used psychotropic drugs in both periods. The use of newer drugs, for example, SSRI, was evident. Multivariate analyses showed increased risk for psychotropic drug use among subjects in institutions.

CONCLUSIONS

This study confirms the high rate of psychotropic drug use in the very old, particularly in persons with dementia. Psychotropic drug use was high among subjects living in institutions.

Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years)

OBJECTIVES

To describe health and functional status in the oldest old; to explore the relationships of morbidity and functional status; and to verify whether this relationship was modified by gender.

DESIGN AND SETTING

A community-based survey including all inhabitants aged > or = 90 living in central Stockholm, Sweden. All participants were clinically examined by physicians, cognitively assessed by psychologists, and interviewed by nurses. Diagnoses were made according to the International Classification of Diseases-Ninth Revision (ICD-9), the DSM-III-R criteria for dementia, and Katz index of activities of daily living.

PARTICIPANTS

Of the 698 subjects in the study population, 99 (14%) had died and 29 (4%) moved before examination. Of the remaining subjects, 502 (88.1%) were examined, and the refusal rate was 11.9%.

MEASUREMENTS

Age- and gender-specific prevalence figures, and age-, gender- and education-adjusted odds ratios (OR) were used.

RESULTS

Of 502 examined subjects, 19% had no disease and 73% were functionally independent. Dementia was the most prevalent disease among women (42.2%), and cardio- and cerebrovascular diseases were the most frequent among men (42.4%). Women had higher prevalences of dementia (adjusted OR = 2.1, 95% confidence interval (CI) 1.2-3.7) and fractures and musculoskeletal diseases (adjusted OR = 2.8, 95% CI 1.1-7.3), whereas men had a higher prevalence of malignancy (OR = 0.2, 95% CI 0.1-0.7). Women were more disabled than men independent of age, education, and number of diseases (adjusted OR = 2.2, 95% CI 1.1-4.3).

CONCLUSIONS

A great proportion of nonagenarians were functionally independent despite their advanced age. Further studies are needed to clarify the excess of disability among very old women.

The relationship between signs of cardiovascular deficiency and cognitive performance in old age: a population-based study

The influence of cardiovascular signs (CVS) on cognitive performance was examined in 227 older adults not suffering from dementia between 75 and 96 years of age who were sampled from the community. Participants received a comprehensive physical examination that included specific evaluation of current CVS, including dyspnea, cardiac murmur, and edema in lower limbs. They were administered tests of digit span, episodic recall and recognition, verbal fluency, and visuospatial skill. CVS were found to predict performance on tests of episodic memory and visuospatial skill, after the effects of age, education, gender, relevant drug use, and mood symptoms were controlled for. Although CVS accounted for relatively little general performance variation, the findings are relevant to the understanding of normal variation in late-life cognitive performance. Finally, CVS increased with age and accounted for a sizable proportion of the age-related cognitive variation.

Death wishes in the very elderly: data from a 3-year follow-up study

OBJECTIVE

The aim of this study was to study the 3-year outcome of death wishes in an elderly population.

METHOD

1099 very elderly people were examined extensively by physicians, including a structured psychiatric interview. Three years later those who had survived were re-examined (n = 683) using a similar procedure.

RESULTS

Of the sample, 11.6% (n = 128) had death wishes at the first examination and 8.9% (n = 54) at the follow-up. Of the 54, 17 have had death wishes persistently during the 3-year period; all of them had psychiatric diagnoses. Of those having death wishes at one of the examinations 70% had psychiatric diagnoses. Attrition was more common in the group with death wishes than in the group without when age, gender, somatic disorders including dementia and disability in daily living were taken into account.

CONCLUSION

This study shows that there is a need for a psychiatric examination when elderly people express death wishes.

Predictors for Depression, Anxiety and psychotic symptoms in a very elderly population: data from a 3-year follow-up study

BACKGROUND

This study examined the predictors for Depression, Anxiety and psychotic symptoms in a population of very elderly persons.

METHODS

A total of 894 persons with a mean age of 84.5 years were examined twice using a 3-year interval. Physicians performed a structured psychiatric interview and persons with a current disorder or symptom were excluded.

RESULTS

Persons who had a history of psychosis, were affected with Dementia and had an insufficient social network had an increased frequency of psychotic symptoms. A history of Depression/Anxiety increased the frequency of having Anxiety and Depression. An insufficient social network was associated with Anxiety.

CONCLUSIONS

In this study Anxiety, Depression and psychotic symptoms in the very elderly seem to be linked to a lifetime psychological vulnerability, since all were related to a previous psychiatric history. Additionally, psychotic symptoms seemed to emerge due to structural brain damage, as seen in Dementia.

The occurrence of depressive symptoms in the preclinical phase of AD: a population-based study

OBJECTIVE

To examine preclinical depressive symptoms 3 years before the diagnosis of AD.

METHODS

The authors compared incident AD patients and nondemented individuals in terms of baseline mood- and motivation-related symptoms of depression, and assessed whether depressive symptoms in preclinical AD are related to self-perceived memory problems. Participants came from a population-based longitudinal study on aging and dementia in Stockholm, Sweden. The sample consisted of 222 persons older than 74 years who were followed for a 3-year interval. Thirty-four individuals had developed AD at follow-up, whereas 188 remained nondemented. Dementia diagnosis was made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised. Depressive symptoms were assessed by the Comprehensive Psychopathological Rating Scale.

RESULTS

The incident AD patients had more depressive symptoms than the nondemented persons at baseline. There was a dominance of motivation-related symptoms of depression (e.g., lack of interest, loss of energy, concentration difficulties) in preclinical AD. This association remained when adjusting for subjective memory complaints.

CONCLUSIONS

Depressive symptoms are elevated preclinically in AD, and this elevation is not merely a by-product of self-perceived cognitive difficulties. Thus, depressive symptoms may be part of the preclinical phase in AD.

Incidence of major depression in a very elderly population

BACKGROUND

Depression is considered to be a major health problem in the elderly. Due to methodological problems, there are few studies on the incidence of depression in old age. The present study examines the prevalence of depression in a 3-year follow-up study of a non-depressed very elderly population, thus estimating the incidence.

METHODS

875 non-depressed persons with a mean age of 85 years were extensively examined by physicians twice with a 3-year interval. Depression diagnosis was made according to DSM-IV. All persons with a history of depression or a current depression were excluded in order to estimate the first incidence.

RESULTS

4.1% of the population was diagnosed as having a depression at the follow-up examination. The estimated first incidence was 1.4% per person year (0.8% in males and 1.5% in females). Characteristics at baseline correlated with the onset of depression were: having a dementia, insufficient social network and having more than two depressive symptoms.

CONCLUSIONS

The incidence of depression was slightly lower in this very elderly population than for younger age groups, but followed the same female to male ratio.

Preclinical symptoms of major depression in very old age: a prospective longitudinal study

OBJECTIVE

The authors' goal was to examine whether individuals diagnosed as having major depression experienced greater levels of depressive symptoms and cognitive dysfunction up to 3 years before the clinical diagnosis was rendered.

METHOD

The study included 185 subjects 75 years old or older who participated in a population-based longitudinal survey in Stockholm. Ten of the subjects were diagnosed as depressed up to 3 years after initial screening, and these individuals were compared with the 175 subjects who were not depressed at 3-year follow-up. Depression was diagnosed according to DSM-III-R and DSM-IV criteria. Psychiatric signs and symptoms were assessed by physicians using a structured interview. Cognitive functioning was assessed with the Mini-Mental State.

RESULTS

At the initial screening, the patients later diagnosed as depressed had a greater number of depressive symptoms, such as dysphoria and appetite disturbance, and their symptoms were also more severe than those of the nondepressed subjects. Moreover, the depressed subjects suffered from a more severe lack of interest and psychomotor disturbance and had lower Mini-Mental State scores.

CONCLUSIONS

There are preclinical markers for individuals who will become depressed after a 3-year interval. Major depression may have a more chronic nature in very old age, in contrast to the relatively short clinical onset of depression seen in younger adults. The authors conclude that standard diagnostic instruments such as DSM-IV may have to take this lengthy course of impairment into consideration when dealing with very old adults.

Psychotic symptoms and apolipoprotein E genotypes in an elderly population

BACKGROUND

Psychotic symptoms have been found to be more common in demented elderly persons. Genetic variation in the apolipoprotein E (APOE) gene is reported to be associated with variation in the risk of Alzheimer's dementia. This study reports on variables associated with psychotic symptoms including APOE, in demented and nondemented elderly persons.

METHODS

A population of 668 elderly persons was examined. APOE genotype was available in 309 individuals.

RESULTS

Psychotic symptoms were found to be associated with dementia, a previous psychiatric history, female gender, being less educated, disability in daily living and institutionalisation. In the nondemented group, psychotic symptoms were equally common in subjects with or without the epsilon 4 present. In the demented subjects, psychotic symptoms were slightly more common, although not significant, in subjects without the epsilon 4 genotype.

CONCLUSIONS

There was no statistical significant difference in APOE genotype between subjects with and without psychotic symptoms, stratified by dementic diagnosis.

Feelings of anxiety and associated variables in a very elderly population

OBJECTIVE

Anxiety disorders have been reported to decrease with age, while anxiety feelings have been reported to be as common as in younger age groups. In order to further explore this relationship and variables associated with anxiety, a population of very elderly persons was examined.

METHODS

966 persons, aged 78 years and over, underwent an examination by a physician including a structured psychiatric interview.

RESULTS

Anxiety feelings are strongly associated with psychiatric disturbances (anxiety disorders and depressive disorders). Moreover, the feelings were associated with dementia, a history of psychiatric disorders (most often depression), being female and being dissatisfied with social network. Few of those with a psychiatric disorder were adequately treated, in spite of the fact that most of them had seen a physician during the past month.

CONCLUSIONS

After excluding an anxiety disorder, one of the most important things to consider in a very old person with anxiety is whether depression is present or not. Generally, there is a need for more education of physicians concerning the common mental disorders in the elderly in order to improve their management.

Epidemiology of paranoid symptoms in an elderly population

BACKGROUND

Elderly people with paranoid symptoms are a taxing group for medical and social services, but studies of the prevalence of these symptoms in the general elderly population are rare. This study aimed to estimate the community prevalence and to identify some associated variables.

METHOD

A community samples of 1420 elderly people, was extensively examined by nurses and physicians.

RESULTS

Paranoid ideation was found in 6.3% of the sample. The prevalence in people with cognitive dysfunction (n = 381, 12.1%) was higher than in those without (n = 1039, 2.6%). Once cognitive impairment had been controlled the associated variables were: being divorced, being female, having depressive symptoms, using psychotropic drugs, having no friends or visitors, using community care and being an immigrant.

CONCLUSION

Paranoid symptoms in this elderly population were associated most strongly with cognitive impairment. Other associated variables pointed to a higher level of social isolation than others in the community.

Benzodiazepines may have protective effects against Alzheimer disease

In this study, we examined the association between benzodiazepine use and the occurrence of Alzheimer disease and vascular dementia. The study was based on longitudinal data from a case-control study of 668 individuals aged 75 and older. The elderly were examined extensively by physicians, and family interviews were assessed. Dementia diagnosis was made by using DSM-III-R criteria. Individuals with a history of continuous use of benzodiazepines (BDZ+) were compared with nonusers (BDZ-), with respect to the incidence of Alzheimer disease or vascular dementia at follow-up 3 years later. It was found that there was a significantly lower incidence of Alzheimer disease in the BDZ+ group than in the BDZ- group. This negative association remained significant when controlling for age, gender, level of education, use of nonsteriodal antiinflammatory drugs, and estrogens. These results suggest that benzodiazepines may have protective effects against the disease.

Major depression in a population of demented and nondemented older people: prevalence and correlates

OBJECTIVE

To analyze the differences between variables associated with depression and symptoms of depression in demented and nondemented persons.

DESIGN

A survey design was used.

SETTING/PARTICIPANTS

A total of 1101 older persons registered in a district of Stockholm, Sweden, participated in the study.

MEASUREMENTS

Subjects were given physical and psychiatric examinations by physicians, and informants interviews and medical records were assessed. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria and major depression according to DSM-IV. The variables studied were age, gender, martial status, institutionalization, Mini-Mental State Exam score, disability in daily life, physical disorders with symptoms affecting daily life, and a previous history of depression (early and late).

RESULTS

27.8% of the patients in the study sample were demented according to DSM-III-R. Major depression was diagnosed in 3.9% of the nondemented and in 11.8% of the demented subjects. Some of the depressive symptoms, such as lack of energy, thinking/concentration difficulties, loss of interest, and psychomotor disturbance, were found more commonly in demented than in nondemented persons. Increased disability was associated with major depression both in demented and nondemented persons.

CONCLUSION

In this study, the prevalence of depression was higher in demented than in nondemented persons. Among the factors that were studied, increased disability was associated with depression both in demented and nondemented persons. No differences were found regarding the other studied variables.

Depression and dementia in relation to apolipoprotein E polymorphism in a population sample age 75+

The aim of this study was to define the co-occurrence of depression and dementia in relation to apolipoprotein E (APOE) polymorphism. Physicians extensively examined 806 persons aged 78 years and over. DNA was extracted from peripheral white blood cells, and APOE genotype was determined using a microsequencing method on microtiter plates. The prevalence of dementia was 22.8% and was found to increase with the number of epsilon 4 alleles present. Depression was found in 11.4% of the demented subjects compared to 3.5% of the nondemented subjects. The overrepresentation of depression in demented subjects was found for each of the common genotypes. Depression was not strongly associated with APOE polymorphism. In spite of the association between dementia and APOE polymorphism, as well as dementia and depression, there was no association between APOE polymorphism and depression.

Psychiatric disturbances and the use of psychotropic drugs in a population of nonagenarians

The present study examined the prevalence of dementia, anxiety syndromes, depression, psychotic symptoms, sleep disturbance and the use of psychotropic drugs in a population of 330 nonagenarians. Subjects underwent an extensive medical examination, and information on sociodemographic characteristics, mental health, physical health and psychotropic drug use was collected. The prevalence of dementia in the study sample was 46.7% according to DSM-III-R criteria. Demented persons had more often psychotic symptoms (11.7% versus 3.4%) and anxiety syndromes (5.2% versus 1.1%) than non-demented. Depression was equally prevalent in both the demented and non-demented (8.4% versus 7.4%), whereas sleep disturbance was a more common complaint in non-demented persons. Half of the study sample (49.7%) used some sort of psychotropic drug, with the most common being hypnotics and the least common being antidepressants. However, the rate of specific treatment was low, especially for depression, indicating the need for more knowledge concerning the recognition of depression in the very elderly.

Episodic remembering in a population-based sample of nonagenarians: does major depression exacerbate the memory deficits seen in Alzheimer's disease?

Population-based samples of normal old adults and people with major depression (MD), Alzheimer's disease (AD), and coexisting MD and AD (MD + AD) between 90 and 100 years of age were assessed in face recognition, word recall, and object recall. Results indicated a consistent pattern across tasks: no differences between the normal old and the MD participants or between the AD and MD + AD participants in any task, a clear performance decrement in the AD and MD + AD participants in all task variables reflecting long-term episodic memory, and no group differences in those variables reflecting short-term memory. These data suggest that depression in very old age may not exacerbate the episodic memory deficit that accompanies AD. Further, differences between normal old and MD participants in episodic memory tasks appear to be negligible among the oldest old. The general lack of effects of MD may be due to the fact that those symptoms of this disease that are most likely to affect memory functioning (e.g., loss of energy, concentration difficulties) are common in AD as well as in nondepressed people in the 10th decade of life.

Suicidal thoughts and associated factors in an elderly population

This study examined the prevalence of suicidal thoughts and associated factors in an elderly population. Data for 969 elderly subjects from a population-based study were used, and examinations by physicians, including psychiatric examination and informants' interview, were assessed. In total, 13.3% of the subjects had had suicidal thoughts during the last 2 weeks (10.8% fleetingly and 2.5% frequently). Of those who had had fleeting suicidal thoughts, 26.7% also had major depression, while 50% of those who had frequent suicidal thoughts were depressed. In addition, suicidal thoughts were associated with increased disability in daily living, institutionalization, visual problems and the use of psychotropic drugs. It is concluded that a careful psychiatric assessment is necessary when suicidal thoughts are expressed by an elderly person.

Episodic remembering in a population-based sample of nonagenarians: does major depression exacerbate the memory deficits seen in Alzheimer's disease?

Population-based samples of normal old adults and people with major depression (MD), Alzheimer's disease (AD), and coexisting MD and AD (MD + AD) between 90 and 100 years of age were assessed in face recognition, word recall, and object recall. Results indicated a consistent pattern across tasks: no differences between the normal old and the MD participants or between the AD and MD + AD participants in any task, a clear performance decrement in the AD and MD + AD participants in all task variables reflecting long-term episodic memory, and no group differences in those variables reflecting short-term memory. These data suggest that depression in very old age may not exacerbate the episodic memory deficit that accompanies AD. Further, differences between normal old and MD participants in episodic memory tasks appear to be negligible among the oldest old. The general lack of effects of MD may be due to the fact that those symptoms of this disease that are most likely to affect memory functioning (e.g., loss of energy, concentration difficulties) are common in AD as well as in nondepressed people in the 10th decade of life.

Episodic memory deficit in elderly adults with suspected delusional disorder

This study examined memory functions in two groups of elderly adults with and without suspected delusional disorder (SDD). The samples consisted of 66 normal elderly subjects and 33 elderly subjects with symptoms, as reported by close informants, of delusional disorder. Subjects were matched with regard to age, gender and education, and there were no differences between the two groups with regard to performance of visuo-spatial and primary memory tasks. Subjects were examined concerning a variety of episodic recall and recognition tasks. The results demonstrated that subjects with SDD performed at a lower level than controls for some episodic memory tasks (i.e. recall tasks). There were no group differences in measures of episodic recognition or in the primary memory tasks. In addition, the group of subjects with SDD was, to the same extent as the control group, able to utilize cognitive support in the form of organization, cues and previous knowledge in order to enhance episodic memory. In summary, it appears that elderly adults with SDD have a mild episodic memory deficit in the absence of other cognitive deficits.

The influence of depressive symptomatology on episodic memory functioning among clinically nondepressed older adults

The authors examined a community-based sample of 303 clinically nondepressed individuals aged 75 through 96 years on 4 recall tasks: free recall of rapidly presented random words, free recall of slowly presented random words, free recall of organizable words, and cued recall of organizable words. Using a classification taxonomy that identified mood- and motivation-related symptoms of depression, it was found that motivation-related symptoms had a negative effect on performance across all tasks, whereas mood-related symptoms had no effects. In addition, motivation-related symptoms negatively influenced the ability to benefit from more study time but had no effect on the ability to make use of item organization or category cues. An analysis of the specific motivation-related symptoms suggested that symptoms that may affect the ability to focus and sustain attention (e.g., concentration difficulties, lack of interest) were most strongly associated with performance deficits.

Prevalence and correlates of depression in a population of nonagenarians

BACKGROUND

Clinicians see many more nonagenarian patients now and there is a need for epidemiological data relating to this group. The aim of the present study was to investigate the prevalence of depressive symptoms and syndromes in this age group.

METHOD

The DSM-IV and the ICD-10 criteria for depression were used and correlated with physical health, disability in daily life, gender, use of drugs, social circumstances and cognitive dysfunction. Data were derived from 329 persons aged 90 and over, registered in a parish of Stockholm, who had been extensively examined by physicians and nurses.

RESULTS/CONCLUSIONS

The prevalence of Major Depressive Episode as defined in DSM-IV was 7.9%; and of mild, moderate and severe Depressive Episode (combined); as defined in ICD-10 9.1%. No gender difference was found. Disability in daily life and the use of psychotropic drugs were found to correlate with depressive symptoms and syndromes.

Association of age, sex, cognitive dysfunction, and disability with major depressive symptoms in an elderly sample

OBJECTIVE

Previous studies have yielded conflicting results regarding the association of age, sex, and cognitive deficit with depression in the elderly. However, there is agreement about a relationship between depressive symptoms and disability. The authors previously conducted a factor analysis of the symptoms of major depression in elderly subjects and found that the symptoms clustered into factors of mood disturbance and motivation disturbance. The aim of the present study was to replicate these findings in a larger population sample and relate some of the variables possibly associated with depression to these two factors.

METHOD

A population sample of 1,304 persons aged 75 years or older registered in a parish of Stockholm were examined by physicians to determine DSM-III-R depressive symptoms and disability in activities of daily living. The Mini-Mental State examination was also performed.

RESULTS

Factor analysis showed factors of mood and motivation symptoms, and these were related differently to the associated variables. When the other associated variables were controlled for, age was unrelated to both types of symptoms. Women had more mood disturbance, but men had slightly more motivation disturbance. As cognitive function declined, mood disturbance first increased, then decreased. Motivation symptoms increased sharply with decreasing cognitive function. A relationship was found between increasing disability and both the mood and motivation symptoms.

CONCLUSIONS

In the elderly, symptoms of depression involve either mood or motivation disturbance and the two types of symptoms are associated with different variables.

Episodic memory functioning in a community-based sample of old adults with major depression: utilization of cognitive support

Community-based samples of old adults with current major depression (n = 17; mean age = 83.29 years) and healthy old adults (n = 51; mean age = 83.29 years) were examined on a variety of episodic recall and recognition tasks. Results indicate depression-related deficits in recall that were reduced, but not eliminated, in recognition. Control Ss were able to utilize cognitive support in the form of more study time and item organizability in free recall, whereas depressed Ss were not. However, both groups showed equal gains from the provision of category cues and beneficial effects of prior knowledge and more study time in recognition. Results suggest that depression results in deficits in effortful, elaborate processes at encoding and retrieval and that old age depression is associated with a reduced ability to utilize cognitive support to improve episodic memory. Depressed older adults appear to require cognitive support at both encoding and retrieval to demonstrate memory facilitation.

Episodic memory functioning in a community-based sample of old adults with major depression: utilization of cognitive support

Community-based samples of old adults with current major depression (n = 17; mean age = 83.29 years) and healthy old adults (n = 51; mean age = 83.29 years) were examined on a variety of episodic recall and recognition tasks. Results indicate depression-related deficits in recall that were reduced, but not eliminated, in recognition. Control Ss were able to utilize cognitive support in the form of more study time and item organizability in free recall, whereas depressed Ss were not. However, both groups showed equal gains from the provision of category cues and beneficial effects of prior knowledge and more study time in recognition. Results suggest that depression results in deficits in effortful, elaborate processes at encoding and retrieval and that old age depression is associated with a reduced ability to utilize cognitive support to improve episodic memory. Depressed older adults appear to require cognitive support at both encoding and retrieval to demonstrate memory facilitation.

Severity of dementia and institutionalization in the elderly: prevalence data from an urban area in Sweden

This study investigated the severity of dementia in relation to disease type and sociodemographic variables. The dementia cases were detected with a two-phase study design in a population aged over 74 years in Stockholm. The prevalence of questionable, mild, moderate, and severe dementia was 1.0, 3.1, 5.5, and 2.3 per 100, respectively. Women aged over 84 had the highest prevalence of severe dementia. More severe cases and a higher institutionalization rate were present for vascular dementia than for Alzheimer's disease. Fifty-five percent of the demented subjects but only 3% of the nondemented were institutionalized. The institutionalized demented subjects were affected mostly by moderate-severe dementia (88.6%), while the noninstitutionalized were affected more often by a questionable-mild form (68.3%).

Memory complaints of elderly people in a population survey: variation according to dementia stage and depression

OBJECTIVE

To study the relationship between subjective memory complaints, cognitive functioning, and clinical diagnosis of dementia.

DESIGN

Cross-sectional, total-population survey.

MEASUREMENTS

A two-phase study was done. All 2368 were screened by Mini-Mental State Examination (MMSE). Then the 314 who screened positive and a sample of 354 who screened negative were examined clinically (by examining the subject and interviewing an informant) for DMS-III-R criteria for dementia, Clinical Dementia Rating (CDR) scale for severity of dementia and the presence of memory complaints or depressed mood.

SETTING

An area in Stockholm, Sweden.

PARTICIPANTS

All inhabitants of the area (2368) born in 1912 or before, living at home or in institutions.

RESULTS

A greater percentage of informants reported marked memory impairment than did the subjects themselves. Neither the informants' nor the subject' reports differed according to the type of dementia, but they differed clearly according to the stage of dementia. Informants reported memory impairment more frequently as dementia severity increased, while the subjects' complaints of marked memory impairment were most common in mild-moderate dementia. Furthermore, non-demented subjects with marked complaints performed more poorly on the MMSE. Subjects with depressed mood were also more likely to complain about their memory, both in the demented and non-demented groups.

CONCLUSION

Our data show the validity of the informants' reports about the subjects' memory deficits. Moreover, the study confirmed the clinical impression that the patient's own complaints should not be ignored, as subjects in the mild stage of dementia often have some insight into their own memory deficit. However, depressed individuals may underestimate their own memory, and individuals with moderate-severe dementia may overestimate theirs.

Variation in psychiatric and behavioural symptoms at different stages of dementia: data from physicians' examinations and informants' reports

An investigation was carried out of psychiatric and behavioural symptoms in non-demented and demented subjects derived from a population study of the very elderly. Information on psychiatric and behavioural symptoms came from two independent sources: a physician's examination and an interview with an informant. The symptoms were grouped into clusters using principal-components analysis. Little agreement was found between the two sources of information on symptoms of anxiety, depression and psychosis. However, there was agreement about an increase in inactivity symptoms as the severity of dementia increased.

Application of DSM-III-R criteria for major depressive episode to elderly subjects with and without dementia

OBJECTIVE

The aim of the present study was to see how DSM-III-R criteria for a major depressive episode functioned in a representative sample of elderly subjects with and without dementia.

METHOD

Data were used from a population-based study of individuals 75 years old or older living in Stockholm. Subjects were screened for dementia by using the Mini-Mental State. Subjects with scores of 23 or lower as well as age- and sex-matched subjects with scores of 24 or higher were given a medical examination. Dementia was diagnosed according to DSM-III-R and staged for severity by using the Washington University Clinical Dementia Rating Scale. The Comprehensive Psychopathological Rating Scale was used to record symptoms of depression, which were then classified according to DSM-III-R criteria for a major depressive episode. Data on depressive symptoms were available for 643 individuals: 213 with and 430 without dementia. A principal component analysis was carried out on the nine symptoms from criterion. A for a major depressive episode.

RESULTS

The depressive symptoms clustered into two groups: mood disturbance and motivation disturbance. The mood disturbance symptoms were most frequent in subjects with mild dementia and less frequent in those with more severe dementia; the subjects with the most severe dementia had the highest rates of motivation disturbance symptoms.

CONCLUSIONS

The different manifestations of depression in elderly patients with and without dementia should be taken into account when making the diagnosis of major depression. Further research is needed on the manifestations of depressive symptoms in the elderly in order to validate the diagnostic criteria.

Clinical diagnosis of Alzheimer's disease and other dementias in a population survey. Agreement and causes of disagreement in applying Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Criteria

In a population survey aimed to detect cases of Alzheimer's disease and other dementias, two preliminary diagnoses were made independently with the purpose of using the concordant diagnoses as final diagnoses. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, diagnostic criteria were followed. The 668 subjects examined were selected from the population of an area in Stockholm, Sweden, aged 75 years or more, with the Mini-Mental State Examination used as a screening test. The agreement on dementia diagnosis was moderate (kappa = .54) and could be clearly improved (kappa = .70) with modifications to the diagnostic criteria, such as adding a category of questionable dementia and giving more guidelines in the definition of impairment of a function. The agreement on the diagnosis of Alzheimer's disease vs vascular dementia vs secondary dementia was substantial (kappa = .67) when the cases with concordant dementia diagnoses were examined.

Clinical staging of dementia in a population survey: comparison of DSM-III-R and the Washington University Clinical Dementia Rating Scale

In a population survey in Stockholm, 224 dementia cases were staged using two scales: the Washington University Clinical Dementia Rating Scale and DSM III-R. Both scales had to be modified by adding additional specifications and, in the case of DSM III-R, a new category of questionable dementia. After modification, the comparison of the two scales showed good agreement when all stages were analyzed (kappa = 0.60), but moderate agreement on the questionable and mild stages (kappa = 0.47). These results confirm the staging of mild dementia as the most problematic issue. Finally, the scales both showed moderate agreement with the categorized Mini-Mental State Examination (MMSE) (0-17 for severe and moderate forms; 18-23 for mild cases). Our data suggest new cut-off points for the MMSE when used as a staging scale.

Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education

We studied the prevalence of different types of dementia in an elderly population in Stockholm, Sweden, in relation to age, sex, and education. The study confirmed Alzheimer's disease (AD) as the most frequent type of dementia and the positive association of dementias with age, even in the most advanced ages. In contrast to previously reported data, we found the same proportion of AD and vascular dementia in the different age strata, and no sex differences regarding the prevalence of different dementia types. Finally, less educated people had a higher prevalence of all dementias, due essentially to a higher prevalence of alcoholic dementia and unspecified type of dementia. The prevalence of AD was similar across different levels of education.