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Depression in Alzheimer's disease: Concordance between patient and informant
Abstracts from the 19th Annual Meeting
625
tigated. Immediate and delayed recall on the logical memory portion of the Russell Revision of the Wechsler Memory Scale was examined in depressed and demented patients to determine the extent to which delayed recall consisted of items recalled initially. It was predicted that depressed patients would have more new memories and a greater proportion of new memories on delayed recall than demented patients. Patients between 60 and 80 years old and who had no history of alcoholism, head injury, cerebrovascular accident, or psychosis were selected from the clinical referrals to a hospital-based neuropsychology service. Depressed patients (n = 16) had scores in the depressed range on a standard depression inventory of the MMPI-2. Demented patients (n = 12) scored in the normal range on measures of depression and met diagnostic criteria for dementia. The two groups did not differ in average age or education. Thirteen of the 16 depressed patients (81%) had new items on delayed recall compared to 7 of 12 demented patients (58%). Depressed patients recalled significantly more total items and more new items than demented patients. However, the ratio of new to total items in delayed recall was not different for the two groups. The results indicate that depressed patients encode more material than demented patients but the consistency of recall is not different in the two groups.
Bush, B. A., Thurstin, A. H., Kinney, F. C., Jewell, G., & Pierce, C. A. Utility of a WAIS-R Short Form in Differentiating Dementia from Ma}or Depression in Geriatric Patients. This study evaluated the utility of a WAIS-R short form in differentiating dementia from Major Depressive Disorder in geriatric psychiatry patients, and compared the results to the estimated premorbid functioning using Barona estimates. Ninety-four patients with Probable Dementia of the Alzheimer's Type (DAT, N = 33), Vascular Dementia (VaD, N = 32), and Major Depressive Disorder (MDD, N = 29) participated. Subjects were predominantly Caucasian (87.2%) females (61.7%) with a high school education or less (66%) who ranged in premorbid occupational status from farm and domestic workers to professionals. Mean age was 75.34 years (SD = 7.06). The short form of the WAIS-R was comprised of six subscales: Information, Digit Span, Similarities, Picture Completion, Block Design, and Digit Symbol. The WAIS-R estimated Verbal, Performance, and Full Scale IQ scores were correlated with the corresponding Barona estimates: Verbal IQ r = .444, p = .000; Performance IQ r = .316, p = .003; Full Scale IQ r = .436, p = .000. As has been previously reported, the Barona indexes were restricted in range and displayed poor ability to discriminate among the three groups. Discriminant function analysis resulted in 34.9% of cases correctly classified: 55.9% for DAT, 39.4% for VaD, and 12.8% for MDD patients. The WAIS-R displayed improved discriminant ability, with an overall classification rate of 69.1%: 69.7% for DAT, 65.6% for VaD, and 72.4% for MDD patients. Estimated WAIS-R, but not Barona, IQ scores were consistent with diagnostic expectations. Patients with MDD obtained WAIS-R scores significantly higher than patients with other forms of dementia, who did not differ significantly from each other. Pattern of performance on WAIS-R subtests was also consistent with clinical and empirical expectations for all three patient groups. These results support the utility of a short form of the WAIS-R as part of a neuropsychological examination for differential diagnosis in geriatric patients.
Andrikopoulos, J. Depression in Alzheimer's Disease: Concordance Between Patient and Informant. The present study investigated the degree to which patients with Alzheimer's disease (AD) and family member informants concurred on the presence or absence of depression in the patient. It was hypothesized that there would be a lack of concordance based
626
Abstracts from the 19th Annual Meeting
on differing perceptions between informant and patient on what constitutes depression. Sixty-three consecutive patients diagnosed with probable Alzheimer's disease were administered the Geriatric Depression Scale (GDS). A cut-off of 10 or greater was used to identify depression. A patient symptom questionnaire was completed by the family member, that included among other patient symptoms, the nine DSM-IV criteria for Major Depression worded as follows: (1) he/she seems depressed; (2) lost interest in activities that he/she found pleasurable; (3) change in his/her weight; (4) has problems sleeping; (5) motor agitation (i.e., unable to sit still, wringing of hands, pacing) or motor retardation (i.e., slower movements and physical reactions); (6) overall energy level has decreased lately; (7) experiencing feelings of worthlessness or excessive guilt; (8) he/she is more indecisive now (i.e., more difficult for him/her to make decisions); (9) talked about suicide, has made plans to hurt himself/herself or thinks of death. In order to meet the DSM-IV criteria the informant must have acknowledged five of the nine symptoms, including at least one of the first two symptoms. A chi-square analysis failed to reveal agreement between patient and informant regarding the presence or absence of depression. Results revealed 42.9% (n = 27) concurred on the absence of depression and 44.4% (n = 28) failed to concur. Of those that failed to concur, 15 informants reported depression but the GDS scores did not reveal depression. Thirteen patients had GDS scores consistent with depression yet the informants did not endorse enough symptoms to meet the criteria for depression. Only 12.7% (n = 8) of the sample agreed on the presence of depression. It is argued that the lack of concordance results from the informant interpreting neurovegetative symptoms as depression instead of primarily organic personality changes related to the disease. The patient on the other hand denies mood symptoms, which are uncommon in Alzheimer's disease.
Dunn, R. H., Dickson, A. L., Edwards, C. L., & Logue, P. E. Semantic and Episodic Memory Performance in Alzheimer's Disease and Vascular Dementia. One of the most frequent differential diagnoses considered by clinicians working with geriatric populations involves the discrimination between vascular dementia (VAD) and Alzheimer's dementia (DAT). VAD and DAT patients often perform characteristically different on memory measures based primarily on the respective neural substrate involved in each disorder. The objective of this study was to determine whether semantic memory and episodic memory are impaired in vascular dementia, and to evaluate the utility of specific semantic and episodic memory measures in differentiating vascular dementia from dementia of the Alzheimer's type. Using tests of semantic and episodic memory, 44 D A T patients were compared to 44 patients having subcortical vascular changes using archival methodology. All participants were classified as having mild dementia, as indicated by Mini-Mental State Examination (MMSE) scores between 20 and 25. Results revealed that the VAD group performance was indeed better than that of the D A T patients on all three of the semantic memory tests included in the study (Information F(1, 86) = 8.49, p < .004, Vocabulary F(1, 86) = 7.79, p < .006, and Similarities F(1, 86) = 7.66, p < .006 subtests of the WAIS-R). Comparison of the VAD and D A T groups on five episodic measures revealed that VAD patients performed better on three of the five measures (Logical Memory I F(1, 86) = 20.57, p < .0001, and II F(1, 86) = 33.21, p < .0001 from the WMS-R, and Recognition F(1, 65) = 8.93, p < .004 from the Levin Selective Reminding Task). Discriminant function analysis revealed Logical Memory II as the best test measure discriminator of group membership, while education emerged as the best demographic discriminator of group membership. Additional analysis of storage versus retrieval scores from the Levin Selective Reminding Task revealed
625
tigated. Immediate and delayed recall on the logical memory portion of the Russell Revision of the Wechsler Memory Scale was examined in depressed and demented patients to determine the extent to which delayed recall consisted of items recalled initially. It was predicted that depressed patients would have more new memories and a greater proportion of new memories on delayed recall than demented patients. Patients between 60 and 80 years old and who had no history of alcoholism, head injury, cerebrovascular accident, or psychosis were selected from the clinical referrals to a hospital-based neuropsychology service. Depressed patients (n = 16) had scores in the depressed range on a standard depression inventory of the MMPI-2. Demented patients (n = 12) scored in the normal range on measures of depression and met diagnostic criteria for dementia. The two groups did not differ in average age or education. Thirteen of the 16 depressed patients (81%) had new items on delayed recall compared to 7 of 12 demented patients (58%). Depressed patients recalled significantly more total items and more new items than demented patients. However, the ratio of new to total items in delayed recall was not different for the two groups. The results indicate that depressed patients encode more material than demented patients but the consistency of recall is not different in the two groups.
Bush, B. A., Thurstin, A. H., Kinney, F. C., Jewell, G., & Pierce, C. A. Utility of a WAIS-R Short Form in Differentiating Dementia from Ma}or Depression in Geriatric Patients. This study evaluated the utility of a WAIS-R short form in differentiating dementia from Major Depressive Disorder in geriatric psychiatry patients, and compared the results to the estimated premorbid functioning using Barona estimates. Ninety-four patients with Probable Dementia of the Alzheimer's Type (DAT, N = 33), Vascular Dementia (VaD, N = 32), and Major Depressive Disorder (MDD, N = 29) participated. Subjects were predominantly Caucasian (87.2%) females (61.7%) with a high school education or less (66%) who ranged in premorbid occupational status from farm and domestic workers to professionals. Mean age was 75.34 years (SD = 7.06). The short form of the WAIS-R was comprised of six subscales: Information, Digit Span, Similarities, Picture Completion, Block Design, and Digit Symbol. The WAIS-R estimated Verbal, Performance, and Full Scale IQ scores were correlated with the corresponding Barona estimates: Verbal IQ r = .444, p = .000; Performance IQ r = .316, p = .003; Full Scale IQ r = .436, p = .000. As has been previously reported, the Barona indexes were restricted in range and displayed poor ability to discriminate among the three groups. Discriminant function analysis resulted in 34.9% of cases correctly classified: 55.9% for DAT, 39.4% for VaD, and 12.8% for MDD patients. The WAIS-R displayed improved discriminant ability, with an overall classification rate of 69.1%: 69.7% for DAT, 65.6% for VaD, and 72.4% for MDD patients. Estimated WAIS-R, but not Barona, IQ scores were consistent with diagnostic expectations. Patients with MDD obtained WAIS-R scores significantly higher than patients with other forms of dementia, who did not differ significantly from each other. Pattern of performance on WAIS-R subtests was also consistent with clinical and empirical expectations for all three patient groups. These results support the utility of a short form of the WAIS-R as part of a neuropsychological examination for differential diagnosis in geriatric patients.
Andrikopoulos, J. Depression in Alzheimer's Disease: Concordance Between Patient and Informant. The present study investigated the degree to which patients with Alzheimer's disease (AD) and family member informants concurred on the presence or absence of depression in the patient. It was hypothesized that there would be a lack of concordance based
626
Abstracts from the 19th Annual Meeting
on differing perceptions between informant and patient on what constitutes depression. Sixty-three consecutive patients diagnosed with probable Alzheimer's disease were administered the Geriatric Depression Scale (GDS). A cut-off of 10 or greater was used to identify depression. A patient symptom questionnaire was completed by the family member, that included among other patient symptoms, the nine DSM-IV criteria for Major Depression worded as follows: (1) he/she seems depressed; (2) lost interest in activities that he/she found pleasurable; (3) change in his/her weight; (4) has problems sleeping; (5) motor agitation (i.e., unable to sit still, wringing of hands, pacing) or motor retardation (i.e., slower movements and physical reactions); (6) overall energy level has decreased lately; (7) experiencing feelings of worthlessness or excessive guilt; (8) he/she is more indecisive now (i.e., more difficult for him/her to make decisions); (9) talked about suicide, has made plans to hurt himself/herself or thinks of death. In order to meet the DSM-IV criteria the informant must have acknowledged five of the nine symptoms, including at least one of the first two symptoms. A chi-square analysis failed to reveal agreement between patient and informant regarding the presence or absence of depression. Results revealed 42.9% (n = 27) concurred on the absence of depression and 44.4% (n = 28) failed to concur. Of those that failed to concur, 15 informants reported depression but the GDS scores did not reveal depression. Thirteen patients had GDS scores consistent with depression yet the informants did not endorse enough symptoms to meet the criteria for depression. Only 12.7% (n = 8) of the sample agreed on the presence of depression. It is argued that the lack of concordance results from the informant interpreting neurovegetative symptoms as depression instead of primarily organic personality changes related to the disease. The patient on the other hand denies mood symptoms, which are uncommon in Alzheimer's disease.
Dunn, R. H., Dickson, A. L., Edwards, C. L., & Logue, P. E. Semantic and Episodic Memory Performance in Alzheimer's Disease and Vascular Dementia. One of the most frequent differential diagnoses considered by clinicians working with geriatric populations involves the discrimination between vascular dementia (VAD) and Alzheimer's dementia (DAT). VAD and DAT patients often perform characteristically different on memory measures based primarily on the respective neural substrate involved in each disorder. The objective of this study was to determine whether semantic memory and episodic memory are impaired in vascular dementia, and to evaluate the utility of specific semantic and episodic memory measures in differentiating vascular dementia from dementia of the Alzheimer's type. Using tests of semantic and episodic memory, 44 D A T patients were compared to 44 patients having subcortical vascular changes using archival methodology. All participants were classified as having mild dementia, as indicated by Mini-Mental State Examination (MMSE) scores between 20 and 25. Results revealed that the VAD group performance was indeed better than that of the D A T patients on all three of the semantic memory tests included in the study (Information F(1, 86) = 8.49, p < .004, Vocabulary F(1, 86) = 7.79, p < .006, and Similarities F(1, 86) = 7.66, p < .006 subtests of the WAIS-R). Comparison of the VAD and D A T groups on five episodic measures revealed that VAD patients performed better on three of the five measures (Logical Memory I F(1, 86) = 20.57, p < .0001, and II F(1, 86) = 33.21, p < .0001 from the WMS-R, and Recognition F(1, 65) = 8.93, p < .004 from the Levin Selective Reminding Task). Discriminant function analysis revealed Logical Memory II as the best test measure discriminator of group membership, while education emerged as the best demographic discriminator of group membership. Additional analysis of storage versus retrieval scores from the Levin Selective Reminding Task revealed