Development and validation of the Ascertain Dementia 8 (AD8) Thai version.

BACKGROUND: The Ascertain Dementia 8 (AD8) is a brief informant-based questionnaire which reliably distinguishes patients with neurocognitive disorder (NCD) and normal cognition. Our objective was to translate the AD8 into Thai and test its validity as a potentially useful measure to detect patients with the mild stage of major NCD due to Alzheimer disease (major NCD-AD). METHODS: Evaluations of 144 informant-patient dyads were made. Participants were patients who attended the memory clinic at Ramathibodi Hospital and non-patient volunteers. The AD8-Thai version was administered separately from doctor's interviews and neuropsychological assessments. Diagnostic workups included a complete medical history, physical and neurological examinations, neuropsychological testing, the Clinical Dementia Rating Scale-Sum of Boxes (CDR-SOB), Montreal Cognitive Assessment (MoCA), blood tests and brain imaging, preferably with magnetic resonance imaging. All researchers were blinded to the AD8 results. RESULTS: An AD8 score ≥3 had a sensitivity of 95.5%, a specificity of 89.5%, a positive predictive value of 84%, and a negative predictive value of 97.1% for screening major NCD-AD and those with normal cognition. A subgroup analysis with participants aged ≥65 years and with ≥12 years of education revealed comparable ability to the whole group. AD8 scores had a moderate negative relationship with MoCA scores (r = -0.470) and a strong positive relationship with CDR-SOB scores (r = 0.547). The performance of AD8 scores in differentiating mild NCD from normal cognition was not as good as for major NCD-AD. CONCLUSIONS: AD8-Thai version is an acceptable screening tool for major NCD-AD. For patients aged 65 years or older, with at least 12 years of education, and with cognitive complaints in memory clinic, an AD8-Thai score of 3 or more would be sufficient to work on major NCD diagnosis. The performance of the AD8-Thai in mild NCD needs further investigation.

Predictors for quality of life among older adults with depressive disorders: A prospective 3-month follow-up cohort study.

PURPOSE: The study aimed to investigate the predictive factors for quality of life among subjects with late-life depression. DESIGN AND METHODS: Data including depressive symptoms assessed by the Hamilton Rating Scale of Depression (HAMD), geriatric depression scale (GDS), perceived stress scale (PSS), multidimensional scale for perceived social support, and the EQ-5D scale were collected at baseline and at 3-month follow-up from 264 participants. FINDINGS: After controlling for covariates, time, GDS, PSS, HAMD, and living alone were confirmed predictors for change of EQ-5D scores. PRACTICE IMPLICATIONS: Perceived stress is important, and intervention to reduce stress especially in early treatment of depressive disorder should be encouraged.

Association of Body Dysmorphic Disorder with Leptin Levels in Patients with Normal Weight Undergoing Liposuction: A Matched Case Study.

BACKGROUND: Liposuction is the most common aesthetic surgical procedure performed globally. Some of the patients with normal weight who seek liposuction may suffer from body dysmorphic disorder (BDD). Leptin, which is mainly produced by adipose tissue, may be associated with this condition. The aim of this study was to determine the prevalence of BDD and leptin levels in patients with normal weight seeking liposuction. METHODS: Thirty-two nonobese women who sought liposuction were matched with 32 healthy volunteers by age and body mass index. Blood biochemistry, leptin levels, and BDD-Yale-Brown Obsessive-Compulsive Scale (BDD-YBOCS) questionnaires were evaluated and compared between the groups. RESULTS: Patients who underwent liposuction had significantly higher median (interquartile range) of total BDD-YBOCS scores than healthy volunteers [25 (22-27) versus 12 (8-20); P < 0.001]. Overall, 28 (87.5%) patients had total BDD-YBOCS scores of >20, whereas 10 (31.5%) volunteers had scores of >20. Patients with total BDD-YBOCS scores of >20 had significantly lower levels of serum leptin [12.43 (7.15-16.98) ng/ml versus 15.57 (9.59-22.28) ng/ml; P = 0.043]. CONCLUSIONS: Patients who underwent liposuction had a significantly higher total score of BDD-YBOCS than healthy volunteers matched by sex, age, and body mass index. Subjects with higher BDD-YBOCS scores had significantly lower serum leptin levels.

The effectiveness of a cognitive training program in people with mild cognitive impairment: A study in urban community.

OBJECTIVE: To assess the effectiveness of a cognitive training program on global cognition among people with mild cognitive impairment. METHODS: In this experimental study, using purposive sampling, 60 participants age 50 years and over who complained of subjective memory impairment were screened in their communities by public health volunteers with the Abbreviated Mental Test. Those with dementia were excluded as well as those with depression, which were screened out by the Thai Geriatric Depression Scale (TGDS-15). Mild cognitive impairment was diagnosed and confirmed by the Montreal Cognitive Assessment (MoCA) and joint agreement between a psychiatrist and a neurologist. The participants were alternately assigned to receive a cognitive training program (intervention group) while the other half received their normal usual therapy (control group). The program involved training of 4 aspects of cognition through 6 sessions; 2 sessions per month for 3 months. The MoCA and TGDS-15 scales were given at baseline and again at week 13, and at months 6 and 9. Independent t-tests were used to compare changes in global cognition among the two groups. RESULTS: MoCA scores at 9 months were significantly higher than at baseline in both groups. However, the mean difference in intervention group was significantly higher than control group. TGDS-15 scores at 6 months was significantly lower than at baseline among the intervention group but not the control group. CONCLUSION: This cognitive training program helped to improve global cognition and reduce depressive symptoms.

DUPLICATE: The effectiveness of a cognitive training program in people with mild cognitive impairment: A study in urban community.

OBJECTIVE: To assess the effectiveness of a cognitive training program on global cognition among people with mild cognitive impairment. METHODS: In this experimental study, using purposive sampling, 60 participants age 50 years and over who complained of subjective memory impairment were screened in their communities by public health volunteers with the Abbreviated Mental Test. Those with dementia were excluded as well as those with depression, which were screened out by the Thai Geriatric Depression Scale (TGDS-15). Mild cognitive impairment was diagnosed and confirmed by the Montreal Cognitive Assessment (MoCA) and joint agreement between a psychiatrist and a neurologist. The participants were alternately assigned to receive a cognitive training program (intervention group) while the other half received their normal usual therapy (control group). The program involved training of 4 aspects of cognition through 6 sessions; 2 sessions per month for 3 months. The MoCA and TGDS-15 scales were given at baseline and again at week 13, and at months 6 and 9. Independent t-tests were used to compare changes in global cognition among the two groups. RESULTS: MoCA scores at 9 months were significantly higher than at baseline in both groups. However, the mean difference in intervention group was significantly higher than control group. TGDS-15 scores at 6 months was significantly lower than at baseline among the intervention group but not the control group. CONCLUSION: This cognitive training program helped to improve global cognition and reduce depressive symptoms.

The impact of residual symptoms on relapse and quality of life among Thai depressive patients.

PURPOSE: Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates, and quality of life among patients with depressive disorder. PATIENTS AND METHODS: Data were collected during the Thai Study of Affective Disorder (THAISAD) project. The Hamilton Rating Scale for Depression (HAMD) was used to measure the severity and residual symptoms of depression, and EQ-5D instrument was used to measure the quality of life. Demographic and clinical data at the baseline were described by mean ± standard deviation (SD). Prevalence of residual symptoms of depression was determined and presented as percentage. Regression analysis was utilized to predict relapse and patients' quality of life at 6 months postbaseline. RESULTS: A total of 224 depressive disorder patients were recruited. Most of the patients (93.3%) had at least one residual symptom, and the most common was anxiety symptoms (76.3%; 95% confidence interval [CI], 0.71-0.82). After 3 months postbaseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (odds ratio [OR] =5.290, 95% CI, 1.42-19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ-5D scores at 6 months postbaseline (B =-2.670, 95% CI, -0.181 to -0.027 and B =-3.109, 95% CI, -0.172 to -0.038, respectively). CONCLUSION: Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorder, so that prompt action can be taken to mitigate the risk of relapse.

Depression and pain: testing of serial multiple mediators.

PURPOSE: Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders. PARTICIPANTS AND METHODS: An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed. RESULTS: Perceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator. CONCLUSION: Serial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application.

Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study.

PURPOSE: Whether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found. PATIENTS AND METHODS: This was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months. RESULTS: Among the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet's AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD. CONCLUSION: The level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.

Baseline characteristics of depressive disorders in Thai outpatients: findings from the Thai Study of Affective Disorders.

BACKGROUND: The Thai Study of Affective Disorders was a tertiary hospital-based cohort study developed to identify treatment outcomes among depressed patients and the variables involved. In this study, we examined the baseline characteristics of these depressed patients. METHODS: Patients were investigated at eleven psychiatric outpatient clinics at tertiary hospitals for the presence of unipolar depressive disorders, as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of any depression found was measured using the Clinical Global Impression and 17-item Hamilton Depression Rating Scale (HAMD) clinician-rated tools, with the Thai Depression Inventory (a self-rated instrument) administered alongside them. Sociodemographic and psychosocial variables were collected, and quality of life was also captured using the health-related quality of life (SF-36v2), EuroQoL (EQ-5D), and visual analog scale (EQ VAS) tools. RESULTS: A total of 371 outpatients suffering new or recurrent episodes were recruited. The mean age of the group was 45.7±15.9 (range 18-83) years, and 75% of the group was female. In terms of diagnosis, 88% had major depressive disorder, 12% had dysthymic disorder, and 50% had a combination of both major depressive disorder and dysthymic disorder. The mean (standard deviation) scores for the HAMD, Clinical Global Impression, and Thai Depression Inventory were 24.2±6.4, 4.47±1.1, and 51.51±0.2, respectively. Sixty-two percent had suicidal tendencies, while 11% had a family history of depression. Of the major depressive disorder cases, 61% had experienced a first episode. The SF-36v2 component scores ranged from 25 to 56, while the mean (standard deviation) of the EQ-5D was 0.50±0.22 and that of the EQ VAS was 53.79±21.3. CONCLUSION: This study provides an overview of the sociodemographic and psychosocial characteristics of patients with new or recurrent episodes of unipolar depressive disorders.