ABSTRACT
In this case study, we present two Holocaust survivors who appeared to have adapted well post-trauma, but developed severe PTSD symptomatology following the onset of neurologic illness in later life. These individuals were referred fro neuropsychological evaluations by their treating neurologists to assess their levels of cognitive functioning. We present the neuropsychological findings, and discuss possible mechanisms for emergence of PTSD symptoms. These case studies demonstrate the need for systematic research to further investigate the potential relationship between aging, degenerative disease, and PTSD symptoms in elderly trauma survivors.
Subject(s)
Holocaust , Mental Processes/physiology , Nervous System Diseases/etiology , Stress Disorders, Post-Traumatic/complications , Survivors , Age of Onset , Aged , Aged, 80 and over , Female , Humans , Life Change Events , Male , Neuropsychological Tests , Psychiatric Status Rating ScalesABSTRACT
Depression induced cognitive impairment, also referred to as the dementia syndrome of depression or pseudodementia, has been well characterized, yet the extent to which the more common mild depressive symptoms influence cognition has not been well studied. We sought to identify the influence of mild depressive symptoms on verbal fluency performance in a large sample of healthy community dwelling older adults. Letter and semantic fluency testing was conducted on 188 participants (ages 60-92 years) with no known history of neurologic or psychiatric disease. Depressive symptoms were assessed with the Geriatric Depression Scale (GDS). A total of 39 subjects obtained GDS scores consistent with mild depressive symptoms (GDS=10-19), and 149 subjects were identified as not depressed (GDS<10). ANOVA indicated that subjects with mild depressive symptoms performed significantly worse than normal controls on letter fluency (p<.05), but there was no significant difference between the groups on semantic fluency. Analysis of the nondepressed group stratified into young-old, middle-old, and oldest-old revealed a significant decline in semantic (p<.001) but not letter fluency with age. The nondepressed young-old showed the expected advantage for word list generation to semantic as compared to letter categories, yet this pattern was reversed in the older age groups, where letter fluency scores exceeded semantic fluency scores. Our results suggest that the presence of even mild depressive symptoms may confound using letter versus category discrepancies in the differential diagnosis of dementia. Further, our findings suggest that the commonly used strategy of examining letter-semantic fluency discrepancies may not be relevant for individuals of advanced age. Age-stratified normative data for fluency testing in older adults is also provided.
Subject(s)
Cognition Disorders/diagnosis , Depressive Disorder/psychology , Verbal Behavior , Age Factors , Aged , Aged, 80 and over , Cognition Disorders/etiology , Depressive Disorder/complications , Female , Humans , Male , Middle Aged , Reference Values , SemanticsABSTRACT
We evaluated prospectively 210 patients with idiopathic Parkinson's disease (PD) to determine whether cognitive deterioration and disease disability affect subject drop out. Subjects who refused to return for follow-up testing had a greater degree of bradykinesia and overall disability, more advanced disease, fewer years of education and greater depressive symptomatology. However, discriminant analysis indicated that performance on the neuropsychological measures, rather than PD severity, significantly predicted whether patients return for follow-up testing. Our findings indicate that cognitive impairment uniquely contributes to subject attrition, which may distort dementia estimates in PD.
Subject(s)
Cognition , Dementia/etiology , Parkinson Disease/complications , Parkinson Disease/psychology , Patient Dropouts/psychology , Aged , Confounding Factors, Epidemiologic , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Parkinson Disease/physiopathology , Patient Selection , Prognosis , Prospective Studies , Severity of Illness IndexABSTRACT
It is controversial whether age of disease onset is related to cognitive decline in Parkinson's disease (PD). We administered 7 cognitive measures assessing visuospatial skills, memory, and executive functions to 222 patients with idiopathic PD and 108 normal control participants. Regression analyses demonstrated that older age of disease onset consistently predicted cognitive decline above and beyond normative aging and duration of illness. These findings suggest that older age of disease onset is a critical determinant of cognitive deterioration in PD.
Subject(s)
Cognition/physiology , Parkinson Disease/psychology , Age of Onset , Aged , Disease Progression , Female , Humans , Male , Neuropsychological Tests , Regression AnalysisABSTRACT
Early cognitive changes in patients with PD are often subtle and influenced by factors that interact with the disease process, including age and age of disease onset, medication, and the specific constellation of motor symptoms. These factors notwithstanding, there is ample evidence that specific cognitive changes occur early in the course of PD. Whereas language processing deficits are infrequent, subtle changes in olfaction and contrast sensitivity have been repeatedly observed. Executive function deficits are often prominent and, as an integral part of many tasks, also influence performance on a wide range of cognitive measures. This is particularly true for memory and visuospatial dysfunction, two areas that rely heavily on executive demands. Finally, depressive symptoms are also frequent in the early stages of the disease. The significance of early behavioral changes and their prognostic implications are largely unknown and need to be assessed prospectively.
