ABSTRACT
BACKGROUND: To investigate trajectories of cognitive decline in patients with different types of dementia compared to controls in a longitudinal study. METHOD: In 199 patients with Alzheimer's disease (AD), 10 with vascular dementia (VaD), 26 with dementia with Lewy bodies (DLB), 20 with behavioural variant frontotemporal dementia (bvFTD), 15 with language variant frontotemporal dementia (lvFTD) and 112 controls we assessed five cognitive domains: memory, language, attention, executive and visuospatial functioning, and global cognition (Mini-Mental State Examination, MMSE). All subjects had at least two neuropsychological assessments (median 2, range 2-7). Neuropsychological data were standardized into z scores using baseline performance of controls as reference. Linear mixed models (LMMs) were used to estimate baseline cognitive functioning and cognitive decline over time for each group, adjusted for age, gender and education. RESULTS: At baseline, patients with dementia performed worse than controls in all cognitive domains (p < 0.05) except visuospatial functioning, which was only impaired in patients with AD and DLB (p < 0.001). During follow-up, patients with AD declined in all cognitive domains (p < 0.001). DLB showed decline in every cognitive domain except language and global cognition. bvFTD showed rapid decline in memory, language, attention and executive functioning (all p < 0.01) whereas visuospatial functioning remained fairly stable. lvFTD declined mostly in attention and executive functioning (p < 0.01). VaD showed decline in attention and executive functioning. CONCLUSIONS: We show cognitive trajectories of different types of dementia. These estimations of natural disease course have important value for the design of clinical trials as neuropsychological measures are increasingly being used as outcome measures.
Subject(s)
Alzheimer Disease/psychology , Cognition Disorders/psychology , Dementia, Vascular/psychology , Frontotemporal Dementia/psychology , Lewy Body Disease/psychology , Aged , Alzheimer Disease/physiopathology , Case-Control Studies , Cognition Disorders/physiopathology , Dementia, Vascular/physiopathology , Disease Progression , Executive Function , Female , Frontotemporal Dementia/physiopathology , Humans , Language , Lewy Body Disease/physiopathology , Longitudinal Studies , Male , Memory , Middle Aged , Neuropsychological Tests , Prospective StudiesABSTRACT
BACKGROUND: Although there are theoretical grounds for using hormone therapy to treat depressive symptoms in patients with hypothyroidism, the clinical evidence for this is unclear. objective To investigate the efficacy of treating depression with thyroid hormone in a population with subclinical hypothyroidism. METHOD: Literature search in various databases for double-blind randomised placebo-controlled studies that provided clinical evidence for the effect of thyroid hormone on depressive symptoms in a population with subclinical hypothyroidism. results Three randomized controlled trials (RCTS) were included. None of these was concerned primarily with patients suffering from depressive disorder, but focused mainly on subjects with subclinical hypothyroidism, with the score on the depressive scale as secondary outcome. In all the studies selected subclinical hypothyroidism was treated with levothyroxine which had no beneficial effect on depression. CONCLUSION: Since there is a lack of evidence of beneficial effects in a population with subclinical hypothyroidism and a lack of research into the effects in a depressive population, no definite answer can yet be given to the question posed in the title.
