Insight in Alzheimer’s Disease and Its Relation to Psychiatric and Behavioral Disturbances.

Insight in Alzheimer’s disease and its relation to psychiatric and behavioral disturbances.

Int J Geriatr Psychiatry. 2013 May 14;
Horning SM, Melrose R, Sultzer D

OBJECTIVE: Individuals suffering from Alzheimer’s disease (AD) often have impaired awareness or a lack of insight into their cognitive deficits and functional abilities, especially in the later stages of the disease. Previous research has documented a relationship between depression and insight in AD, such that greater awareness of one’s disease has been associated with a higher degree of depression. However, little is known about the relationship between insight, cognitive decline, and other psychiatric or behavioral problems associated with AD. METHODS: This study included 107 outpatients who met criteria for probable AD. Instruments included the Neurobehavioral Rating Scale, the Apathy Evaluation Scale, and the mini mental state exam. A series of hierarchical regression analyses were conducted to determine the relationship between insight and depressed mood, anxiety, psychosis, apathy, agitation, and behavioral retardation in AD patients after controlling for cognitive skills. RESULTS: Insight was found to significantly predict depressed mood, anxiety, and apathy even after controlling for global cognition. Greater insight was found to be associated with depressed mood and anxiety. However, impaired insight was associated with higher levels of apathy. CONCLUSION: Insight may be differentially related to mood symptoms and apathy within AD, such that patients with intact insight are more depressed, whereas patients with impaired insight are more apathetic. This suggests that assessment of insight in AD may complement the clinical evaluation of depression and apathy in AD and help guide the most appropriate interventions. Published 2013. This article is a U.S. Government work and is in the public domain in the USA. HubMed – depression


Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial.

J Neurol Neurosurg Psychiatry. 2013 May 13;
Martínez-Lapiscina EH, Clavero P, Toledo E, Estruch R, Salas-Salvadó J, San Julián B, Sanchez-Tainta A, Ros E, Valls-Pedret C, Martinez-Gonzalez MA

OBJECTIVE: Previous observational studies reported beneficial effects of the Mediterranean diet (MedDiet) on cognitive function, but results were inconsistent. We assessed the effect on cognition of a nutritional intervention using MedDiets in comparison with a low-fat control diet. METHODS: We assessed 522 participants at high vascular risk (44.6% men, age 74.6 ± 5.7 years at cognitive evaluation) enrolled in a multicentre, randomised, primary prevention trial (PREDIMED), after a nutritional intervention comparing two MedDiets (supplemented with either extra-virgin olive oil (EVOO) or mixed nuts) versus a low-fat control diet. Global cognitive performance was examined by Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) after 6.5 years of nutritional intervention. Researchers who assessed the outcome were blinded to group assignment. We used general linear models to control for potential confounding. RESULTS: After adjustment for sex, age, education, Apolipoprotein E genotype, family history of cognitive impairment/dementia, smoking, physical activity, body mass index, hypertension, dyslipidaemia, diabetes, alcohol and total energy intake, participants allocated to the MedDiet+EVOO showed higher mean MMSE and CDT scores with significant differences versus control (adjusted differences: +0.62 95% CI +0.18 to +1.05, p=0.005 for MMSE, and +0.51 95% CI +0.20 to +0.82, p=0.001 for CDT). The adjusted means of MMSE and CDT scores were also higher for participants allocated to the MedDiet+Nuts versus control (adjusted differences: +0.57 (95% CI +0.11 to +1.03), p=0.015 for MMSE and +0.33 (95% CI +0.003 to +0.67), p=0.048 for CDT). These results did not differ after controlling for incident depression. CONCLUSIONS: An intervention with MedDiets enhanced with either EVOO or nuts appears to improve cognition compared with a low-fat diet.ISRCTN:35739639. HubMed – depression


[Screening for Depression by Telephone Using the German Version of the Center for Epidemiological Studies Depression Scale (CES-D).]

Psychiatr Prax. 2013 May 13;
Stein J, Luppa M, Mahnke J, Weyerer S, Schomerus G, Riedel-Heller SG

Objective: Analyses of the reliability and validity of the German version of the Center for Epidemiological Studies Depression Scale (CES-D) and the assessment of normative values.Method: A representative sample of 868 people (German population, 18 to 94 years) was assessed via structured interviews in a telephone survey.Results: According to the cut-off score of 16 points, 8.5 % of the total sample (11.0 % women and 5.6 % men) showed relevant depressive symptoms. When using the cut-off score of 22 points, 3.5 % of the subjects of the total sample, 4.2 % of the women and 2.5% of the men, were classified as depressed. The analysis of the psychometric properties of the instrument such as internal consistency, test-retest reliability, construct validity and factor structure revealed moderate to good results. Percentile standard values were determined.Conclusion: The German version of the CES-D can be described as a reliable and valid instrument for detecting depressive symptoms. The present study offers current normative data for the specific use in telephone surveys. HubMed – depression


Exploring factors and caregiver outcomes associated with feelings of preparedness for caregiving in family caregivers in palliative care: A correlational, cross-sectional study.

Palliat Med. 2013 May 13;
Henriksson A, Arestedt K

Background:Family caregivers in palliative care often report feeling insufficiently prepared to handle the caregiver role. Preparedness has been confirmed as a variable that may actually protect family caregiver well-being. Preparedness refers to how ready family caregivers perceive they are for the tasks and demands in the caregiving role.Aim:The aim of this study was to explore factors associated with preparedness and to further investigate whether preparedness is associated with caregiver outcomes.Design:This was a correlational study using a cross-sectional design.Setting/participants:The study took place in three specialist palliative care units and one haematology unit. A total of 125 family caregivers of patients with life-threatening illness participated.Result:Preparedness was significantly associated with higher levels of hope and reward and with a lower level of anxiety. In contrast, preparedness was not associated with depression or health. Being female and cohabiting with the patient were significantly associated with a higher level of preparedness. The relationship to the patient was significantly associated with preparedness, while social support, place of care, time since diagnosis and age of the patients showed no association.Conclusion:Feelings of preparedness seem to be important for how family caregivers experience the unique situation when caring for a patient who is severely ill and close to death. Our findings support the inclusion of preparedness in support models for family caregivers in palliative care. Psycho-educational interventions could preferably be designed aiming to increase family caregiver’s preparedness to care, including practical care, communication and emotional support. HubMed – depression


[Depression in Late Life – What does Epidemiology Add?].

Psychiatr Prax. 2013 May; 40(4): 173-5
Riedel-Heller SG, Luppa M

HubMed – depression