ABSTRACT
OBJECTIVE: To determine whether the presence of depression predicts higher rate of progression to Alzheimer disease (AD) in patients with amnestic mild cognitive impairment (aMCI) and whether donepezil treatment beneficially affect this relationship. METHODS: The study sample was composed of 756 participants with aMCI from the 3-year, double-blind, placebo-controlled Alzheimer's Disease Cooperative Study drug trial of donepezil and vitamin E. Beck Depression Inventory (BDI) was used to assess depressive symptoms at baseline and participants were followed either to the end of study or to the primary endpoint of progression to probable or possible AD. RESULTS: Cox proportional hazards regression, adjusted for age at baseline, gender, apolipoprotein genotype, and NYU paragraph delayed recall score, showed that higher BDI scores were associated with progression to AD (p = 0.03). The sample was stratified into depressed (BDI score > or =10; n = 208) and nondepressed (BDI <10; n = 548) groups. Kaplan-Meier analysis showed that among the depressed subjects, the proportion progressing to AD was lower for the donepezil group than the combined vitamin E and placebo groups at 1.7 years (p = 0.023), at 2.2 years (p = 0.025), and remained marginally lower at 2.7 years (p = 0.070). The survival curves among the three treatment groups did not differ within the nondepressed participants. CONCLUSIONS: Results suggest that depression is predictive of progression from amnestic mild cognitive impairment (aMCI) to Alzheimer disease (AD) and treatment with donepezil delayed progression to AD among depressed subjects with aMCI. Donepezil appears to modulate the increased risk of AD conferred by the presence of depressive symptoms.
Subject(s)
Alzheimer Disease/drug therapy , Cognition Disorders/complications , Cognition Disorders/drug therapy , Depressive Disorder/complications , Indans/administration & dosage , Piperidines/administration & dosage , Aged , Aged, 80 and over , Alzheimer Disease/prevention & control , Alzheimer Disease/psychology , Antioxidants/administration & dosage , Brain/drug effects , Brain/metabolism , Brain/physiopathology , Cholinesterase Inhibitors/administration & dosage , Cognition Disorders/psychology , Depressive Disorder/physiopathology , Disease Progression , Donepezil , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Placebos , Severity of Illness Index , Time Factors , Tocopherols/administration & dosage , Treatment OutcomeABSTRACT
Abbreviated versions of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) have been developed as time saving devices that provide accurate estimates of overall level of general intellectual functioning while decreasing test administration time. The Satz-Mogel short form of the WAIS-R has received substantial attention in the literature as an accurate measure of intellectual functions when compared with the Full WAIS-R. However, most studies comparing the Satz-Mogel version to the Full WAIS-R have only provided correlational analyses. Our study was an attempt to apply a more rigorous statistical methodology in determining if the Full WAIS-R and abbreviated versions are equivalent. We explored the impact of level of global mental status and age on the Satz-Mogel version. Although the two forms of the test correlated highly, repeated measures design indicated significant differences between Satz-Mogel and Full WAIS-R when participants were divided into groups based on level of global impairment and age. Our results suggest that the Satz-Mogel version of the test may not be equivalent to the full WAIS-R and is likely to misrepresent a patient's level of intellectual functioning, particularly for patients with progressive degenerative conditions. The implications of applying Satz-Mogel scoring to the Wechsler Adult Intelligence Scale-III (WAIS-III) are discussed.
Subject(s)
Intelligence , Wechsler Scales/standards , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Female , Humans , Male , Middle Aged , Psychometrics , Reproducibility of Results , Retrospective Studies , Statistics, NonparametricABSTRACT
It is widely accepted that therapeutic intervention is an important and effective component in the treatment of the sexually abused child. The goal of this study was to identify children who are at risk for not receiving mental health services following sexual victimization. Nine-hundred and seventy-two children were followed for 6 months, and intervention by the Department of Children's Services (DCS), law enforcement agencies, and mental health professionals was monitored. Those children who were most likely to enter therapy were Caucasian, between the ages of 7 and 13, had cases in which DCS or law enforcement were involved, were placed outside the home, and experienced abuse of greater frequency. Implications of this study for intervention with child sexual abuse victims are discussed. Recommendations are made for future research.
