Lexical and semantic fluency discrepancy scores in aMCI and early Alzheimer's disease

Episodic memory is compromised in amnestic mild cognitive impairment (aMCI), but lesser deficits in other cognitive domains are also commonly observed and may be helpful in identifying this group. The relative difference in performance on lexical and semantic fluency tasks may be a sensitive and specific measure in aMCI and early Alzheimer's disease (AD). We compared four groups of participants, 35 early AD, 47 aMCI, 24 healthy controls, and 18 depressive out‐patient controls, on semantic and lexical fluency as well as other neuropsychological tests. Early AD and aMCI patients showed a distinct pattern of semantic impairment in the two fluency measures compared with the healthy and depressive controls. The findings implicate early failure of the semantic memory system in aMCI and AD and suggest that consideration of the discrepancy in performance on semantic and lexical fluency measures may help in the early identification of AD.     

Alzheimer's Disease Patients' Cognitive Status and Course Years Prior to Symptom Recognition

This is a prospective examination of the cognitive performance and cognitive course of persons in an asymptomatic “preclinical” phase who eventually developed Alzheimer's disease (AD). We compared performances on the Mayo Cognitive Factor Scales (MCFS) of 20 persons in a neurologically normal cohort who subsequently developed AD to the performances of 60 persons who remained free of dementia symptoms. For the AD patients, exams occurred prior to the appearance of dementia symptoms (an average of 4.2 and 1.5 years prior to symptom onset). Results reveal strong group differences on learning and retention, with eventual AD patients scoring lower than controls years prior to reporting symptoms of the disease. There was no significant interaction effect (group × testing session) for memory retention, suggesting that memory decline in this preclinical period may be too slow to be a useful indicator of future AD. A significant interaction (but no group effect) was seen for verbal comprehension.     

Alzheimer's disease patients' cognitive status and course years prior to symptom recognition

This is a prospective examination of the cognitive performance and cognitive course of persons in an asymptomatic "preclinical" phase who eventually developed Alzheimer's disease (AD). We compared performances on the Mayo Cognitive Factor Scales (MCFS) of 20 persons in a neurologically normal cohort who subsequently developed AD to the performances of 60 persons who remained free of dementia symptoms. For the AD patients, exams occurred prior to the appearance of dementia symptoms (an average of 4.2 and 1.5 years prior to symptom onset). Results reveal strong group differences on learning and retention, with eventual AD patients scoring lower than controls years prior to reporting symptoms of the disease. There was no significant interaction effect (group x testing session) for memory retention, suggesting that memory decline in this preclinical period may be too slow to be a useful indicator of future AD. A significant interaction (but no group effect) was seen for verbal comprehension.     

The association of anxiety,depression, and worry symptoms on cognitive performance in older adults

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS). Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.     

Couple Therapy for Depression Within a Naturalistic Setting in Finland: Factors Related to Change of the Patient and the Spouse

The study examined factors related to change in treatments for depression in couple therapy (CT; N = 29) and treatment-as-usual (TAU; N = 22). Treatments were adapted in accordance with the patient’s need. The patients’ depressive symptoms, general mental health and marital satisfaction were assessed at baseline and at 6 months post-baseline. The Hamilton Depression Rating Scale, the Beck Depression Inventory (BDI), the Symptom Check List-90, and the Dyadic Adjustment Scale (DAS) were used for the patients. The BDI and the DAS were used for the spouses. The couples in CT group assessed their subjective distress (SD) at every session by using the Outcome Rating Scale. The results showed that the spouses’ gender, the spouses’ depressive symptoms at baseline, and the number of therapy sessions were related to differing changes in the CT and TAU groups at the 6-month post-baseline assessment. The spouses in the CT group demonstrated a higher treatment response than those in the TAU group. In the CT group, the spouse’s benefit from the treatment was related to SD at the outset on the part of either the patient or the spouse or both. The change in the patient’s SD predicted the patient’s change in depressive symptoms, general mental health, and was associated with the patient’s change in marital satisfaction. The study emphasizes the importance of the spouse’s involvement in the treatment of depression, the provision of feedback on SD, and discussion of individual well-being and relational issues, in addition to the focus on depression.     

Atrophy of the parietal lobe in preclinical dementia

Cortical grey matter atrophy patterns have been reported in healthy ageing and Alzheimer disease (AD), but less consistently in the parietal regions of the brain. We investigated cortical grey matter volume patterns in parietal areas. The grey matter of the somatosensory cortex, superior and inferior parietal lobule was measured in 75 older adults (38 cognitively stable and 37 individuals with cognitive decline after 3 years). Dementia screening 6 years after scanning resulted in nine AD cases from the cognitively stable (n=3) and cognitive decline group (n=6), who were assigned to a third group, the preclinical AD group. When regional differences in cortical volume in the parietal lobe areas were compared between groups, significant differences were found between either the cognitive decline or stable group on the one hand and preclinical AD individuals on the other hand in the inferior parietal lobule. Group membership was best predicted by the grey matter volume of the inferior parietal lobule, compared to the other parietal lobe areas. The parietal lobe was characterised by a differential atrophy pattern based on cognitive status, which is in agreement with the 'last-developed-first-atrophied' principle. Future studies should investigate the surplus value of the inferior parietal lobe as a potential marker for the diagnosis of AD compared to other brain regions, such as the medial temporal lobe and the prefrontal lobe.     

Neuropsychological findings and depressive symptoms in patients with Huntington''s disease

Twenty patients with Huntington's disease (HD) and a comparison group were studied by a depression scale (MADRS) and a neuropsychological test-battery assessing central areas of cognitive function. The main purpose was to analyze the consistency of findings across patients and focus on the role of specific factors in the impairments. The HD-patients are impaired relative to norms and the comparison-group in all areas but verbal conceptual function. We further divided the HD-patients into subgroups according to severity of neuropsychological impairment. The groups generally show a pattern of increasing deficits. Early changes are found in tests of cognitive efficiency, memory and sensomotor function, but the pattern of impairment is variable. The more severely affected subgroups show an increased decline in performance and progressive involvement of a broader range of functions. The pattern of depressive symptoms in HD-patients indicates that cognitive symptoms of concentration difficulties and lassitude are prominent in all subgroups.     

Cognitive complaints in elderly depressed and pseudodemented patients

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.     

Parenting Behaviors of Mothers and Fathers of Preschool Age Children with Internalizing Disorders

This study investigated parenting behaviors of mothers and fathers of clinically anxious preschool children (with or without depressive comorbidity) and healthy comparison children. Studies assessing children from early school age onwards have found that parental control, rejection, and inconsistent discipline are associated with the presence of children’s internalizing symptoms/disorders. Despite the scarcity of studies investigating these associations at preschool age, we assumed that findings with older children would also apply to children in this age group. In a cross-sectional study we assessed N = 176 children of preschool age (M = 5; 2 years) and both of their parents. A diagnostic interview (Preschool Age Psychiatric Assessment) was conducted to determine children’s psychiatric diagnoses, yielding the following results: a group of n = 67 children with pure anxiety disorders (AD group), a group of n = 38 children with anxiety disorders with depressive comorbidity (AD/DC group), and a comparison group of n = 71 children without psychiatric disorders. Both parents completed the German extended version of the Alabama Parenting Questionnaire. We evaluated maternal depressive symptoms and children’s temperament as further correlates. All variables that differed significantly between groups were entered into multinomial logistic regression analyses to test which variables predict group membership. When comparing each of the two anxiety groups with the comparison group we obtained the following results: (1) Inconsistent paternal discipline and maternal depressive symptoms increased and children’s positive affectivity decreased the probability of children of being in the AD group rather than in the comparison group. (2) Maternal overinvolvement, maternal depressive symptoms and children’s negative affectivity increased and children’s positive affectivity decreased the probability of children of belonging to the AD/DC group rather than to the comparison group. When comparing the two anxiety groups with each other, we found that inconsistent paternal discipline increased and children’s negative affectivity decreased the probability of children of being in the AD group rather than in the AD/DC group. The results suggest that paternal parenting behaviors show different associations with internalizing disorders at preschool age than maternal parenting behaviors. This underlines the importance of including fathers in the prevention and treatment of internalizing disorders at preschool age.     

PREVENTION OF DEPRESSIVE SYMPTOMS IN SCHOOLCHILDREN:

Abstract— After teaching cognitive and social-problem-solving techniques designed to prevent depressive symptoms, we followed 69 fifth- and sixth-grade children at risk for depression for 2 years. We compared these children with 49 children in a matched no-treatment control group The prevention group re- ported fewer depressive symptoms through the 2-year follow-up, and moderate to severe symptoms were reduced by half. Surprisingly, the effects of the prevention program grew larger after the program was over. We suggest that psychological immunization against depression can occur by leaching cognitive and social skills to children as they enter puberty     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children

Research has demonstrated an association between perfectionism and depressive and anxious symptoms in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression, and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms.     

The Role of Dyadic Discord in Outcomes in Acute Phase Cognitive Therapy for Adults With Recurrent Major Depressive Disorder

Major depressive disorder (MDD) and relationship discord between cohabiting partners frequently co-occur, with bidirectional effects established. As relationship quality influences understanding and treatment of MDD, the current analyses clarified the relations of pretreatment dyadic discord with outcomes during and at the end of acute phase cognitive therapy (CT) for adults with recurrent MDD. Married or cohabiting patients (n = 219) completed the Dyadic Adjustment Scale (DYS) before and after a 16–20 session, 12–14 week CT protocol. Lower levels of dyadic adjustment indicated higher levels of dyadic discord. Response to CT was defined as the absence of a major depressive episode and ≤ 12 on the 17-item Hamilton Rating Scale for Depression. Pretreatment dyadic discord, whether defined as a continuous or categorical variable (using DYS cutoff score of 97), was not associated with treatment completion or response but was positively associated with levels of depressive symptoms at the end of acute phase CT. Furthermore, CT was associated with declines in dyadic discord, with 23.3% of initially discordant couples moving to nondiscordant status at the end of CT. Depressive symptoms did not significantly mediate changes in dyadic discord. Finally, pre- (but not mid-) treatment dyadic discord was associated with subsequent changes in depressive symptoms, suggesting limited mediation. These findings replicate prior research indicating that individual CT is associated with reductions in depressive symptoms and dyadic discord while clarifying that lower pre-treatment dyadic discord may predict initial improvement in depressive symptoms.     

Moderators of continuation phase cognitive therapy's effects on relapse, recurrence, remission, and recovery from depression

About half of patients who respond to acute-phase cognitive therapy (CT) for major depressive disorder (MDD) will relapse/recur within 2 years; continuation-phase CT lowers this risk. We analyzed demographic, clinical, cognitive, social-interpersonal, and personality variables to clarify which patients continuation-phase CT helps to avoid relapse and recurrence and achieve remission and recovery. Participants had recurrent MDD, responded to acute-phase CT, were randomized to 8 months of continuation-phase CT (n = 41) or assessment control (n = 43), and were assessed 16 additional months (Jarrett et al., 2001). Consistent with an underlying risk-reduction model, continuation-phase CT was helpful for responders to acute-phase CT with greater risk and/or dysfunction as follows: Younger patients with earlier MDD onset who displayed greater dysfunctional attitudes and lower self-efficacy; personality traits suggesting low positive activation (e.g., reduced energy, enthusiasm, gregariousness); and transiently elevated depressive symptoms late in acute-phase CT and residual symptoms after acute-phase CT response. We emphasize the need for replication of these results before clinical application.     

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

Patients’ beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of [a] biochemical causes and [b] need for medication) and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acute-phase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine) had fewer depressive symptoms and less relapse/recurrence by 32 months after acute-phase CT than did responders who received mismatched continuation treatment. Specific screening and/or intervention targeting patients’ biological beliefs about depression could increase CT efficacy.     

Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study

The impact of specialist psychosocial treatment on health service use costs by patients with personality disorder is not yet sufficiently documented. In this prospective study we compare patterns of health service costs by three groups of people with personality disorder treated in a hospital-based program (IPP), a step down program (SDP), and a general psychiatric program (GPP). Total service use costs at follow up, compared with intake costs, showed that significantly higher savings were achieved by SDP and IIP compared with GPP. Cost reductions in SDP were significantly greater than in IPP. Significant cost reductions were found between treatment programs in social worker and community psychiatric nursing and psychotherapy. The cost-effectiveness of the two specialist treatment programs was indicated by the significant association between total cost reduction and clinical outcome in GPP and IPP, but not in GPP. The effect of Major Depression and Borderline Personality Disorder on health service use alone and in combination was also investigated. The finding that Major Depression was found to be more significantly associated with higher health service use costs than Borderline Personality Disorder is discussed.     

Extreme Nonresponse to Acute Phase Cognitive Therapy for Depression: An Attempt to Replicate and Extend

As with other interventions for major depressive disorder (MDD), cognitive therapy (CT) results in treatment failure for about half of all participants. In 2007, Coffman and colleagues in Seattle studied this topic by identifying a group of patients who demonstrated an extremely poor response to CT (i.e., posttreatment BDI score ≥ 31). They called these patients “extreme nonresponders” (ENR) and described the pretreatment characteristics that predicted response status.     

Visual associations to retrieve episodic memory across healthy elderly,mild cognitive impairment,and patients with Alzheimer’s disease

Episodic memory tests need to determine the degree to which patients with moderate to severe memory deficits can still benefit from retrieval support. Especially in the case of Alzheimer’s disease (AD), this may support health care to be more closely aligned with patients’ memory capacities. We investigated whether the different measures of episodic memory of the Visual Association Test-Extended (VAT-E) can provide a more detailed and informative assessment on memory disturbances across a broad range of cognitive decline, from normal to severe impairment as seen in AD, by examining differences in floor effects. The VAT-E consists of 24 pairs of black-and-white line drawings. In a within-group design, we compared score distributions of VAT-E subtests in healthy elderly controls, mild cognitive impairment (MCI), and AD (n = 144), as well as in relation to global cognitive impairment. Paired associate recall showed a floor effect in 41% of MCI patients and 62% of AD patients. Free recall showed a floor effect in 73% of MCI patients and 84% of AD patients. Multiple-choice cued recognition did not show a floor effect in either of the patient groups. We conclude that the VAT-E covers a broad range of episodic memory decline in patients. As expected, paired associate recall was of intermediate difficulty, free recall was most difficult, and multiple-choice cued recognition was least difficult for patients. These varying levels of difficulty enable a more accurate determination of the level of retrieval support that can still benefit patients across a broad range of cognitive decline.     

Depressive symptoms in Friedreich ataxiaSíntomas depresivos en la ataxia de Friedreich

Background/Objective: Almost no attention has been paid to depression in Friedreich ataxia (FRDA), a highly disabling cerebellar degenerative disease. Our aim was to study the presence and the profile of depressive symptoms in FRDA and their relationship with demographic-disease variables and cognitive processing speed. Method: The study groups consisted of 57 patients with a diagnosis of FRDA. The Beck Depression Inventory-II was used to assess symptoms of depression. Speed of information processing was measured with a Choice Reaction time task. Results: The mean BDI score for patients was significantly higher than the mean score in the general population. Twenty one percent of participants scored in the moderate/severe range. A Cognitive-Affective score and a Somatic-Motivational score was calculated for each patient. Patients’ scores in both dimensions were significantly higher than the scores in the general population. Demographic and disease variables were not related with symptoms of depression, except for severity of ataxia. Depressive symptoms predict cognitive reaction times. The greater proportion of variance was explained by the Cognitive-Affective dimension. Conclusions: Our data show that both somatic-motivational and cognitive affective symptoms of depression are frequent in individuals with FRDA. In addition, depressive symptoms may influence cognition, especially, the cognitive and affective symptoms.     

Cognitive vulnerability to depression in individuals with borderline personality disorder

The goal of the current study was to examine whether individuals with comorbid Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD) exhibit greater severity of depressive symptoms than (1) individuals with MDD without BPD and (2) individuals with neither MDD nor BPD. One hundred and forty-one individuals participated in a semi-structured clinical interview assessing MDD and BPD. They also completed measures assessing depressive symptoms, depressogenic attributional style, hopelessness, self-esteem, rumination, and dysfunctional attitudes. In line with hypotheses, individuals with BPD and MDD exhibited higher levels of depressive symptoms and cognitive vulnerability than individuals in the other two groups. In addition, after controlling for the effects of cognitive vulnerability, the effect of group membership on depressive symptoms was reduced, suggesting that the increased severity of depressive symptoms experienced by those with BPD is partially due to their possessing higher levels of cognitive vulnerability to depression.