Biomedical subjects

Jason Brandt

Publications and source records attributed to Jason Brandt.

At least 19 recordsLinked to original sources

PubMed2007

A comparison of small and large assisted living facilities for the diagnosis and care of dementia: the Maryland Assisted Living Study.

OBJECTIVES: To compare the demographic, clinical, and psychiatric characteristics of residents living in small (< or = 15 beds) and large assisted living (AL) facilities in the United States. METHODS: One hundred and ninety-eight residents in 10 large and 12 small assisted living facilities were comprehensively assessed as part of the Maryland Assisted Living Study (MD-AL). The presence or absence of dementia and psychiatric disturbances and the facilities' recognition and management of these disorders were compared across the two types of AL. Aspects of care delivery were also compared. RESULTS: Small facilities had a higher prevalence of dementia (81%) compared to larger facilities (63%) and the mean Mini-Mental State Examination (MMSE) across all residents in small facilities (mean 13.04) was than in large facilities (mean 19.93)(p = 0.000). Almost all (98%) of the residents of small homes carried a diagnosis of a dementia or other psychiatric diagnosis, compared to 74% of residents in large facilities (p < 0.001). Psychosis in particular was more prevalent in the smaller homes and the mean Neuropsychiatric Inventory score, a measure of neuropsychiatric symptoms, was higher compared to large homes. Falls were more common in larger homes despite a greater number of personal care hours per week. The use of safety devices and restraints was significantly less common in large facilities compared to smaller homes, where 'geri-chair' and bedrails were more often used. CONCLUSIONS: Rates of dementia and psychiatric disorder differ in assisted living facilities depending on size of facility.

Accidental Falls↗

PubMed2006

The progression of cognition, psychiatric symptoms, and functional abilities in dementia with Lewy bodies and Alzheimer disease.

BACKGROUND: Although dementia with Lewy bodies (DLB) may be one of most common forms of dementia, relatively little is known about its cognitive and functional course. OBJECTIVE: To compare change over time in general cognitive status, memory test performance, psychiatric symptoms, neurological signs, and functional abilities in patients with probable DLB and probable Alzheimer disease (AD). DESIGN: Twenty-eight patients who met diagnostic criteria for DLB were recruited into the study from 3 sites. Patients with AD (n = 55) were selected from a larger cohort and matched 2 to 1 to the patients with DLB on age and baseline global cognitive status. Patients were followed up at 6-month intervals for an average of 6.2 visits and assessed at each visit with tests of global cognitive functioning and verbal learning and memory and measures of psychiatric, neurological, and functional status. RESULTS: At the baseline evaluation, patients with DLB performed more poorly on a measure of constructional praxis and all measures of functional status. They also had more severe psychiatric symptoms and neurological signs than the AD group. Despite these initial differences, generalized estimating equations applied to regression analyses with repeated measures determined that the only difference between the 2 groups in change in cognitive test performance was on a measure of recognition memory; patients with AD declined, while patients with DLB remained relatively stable. Patients with DLB had relatively stable behavioral symptoms and visual illusions, whereas patients with AD had a significant increase in these symptoms over time. Neurological and functional changes over time were similar in the 2 groups. CONCLUSIONS: Both baseline and longitudinal differences between patients with DLB and patients with AD were noted; these have implications for clinical diagnosis and treatment.

Aged↗

PubMed2006

Relation of quantitative indexes of concurrent alpha-synuclein abnormalities to clinical outcome in autopsy-proven Alzheimer disease.

BACKGROUND: Lewy bodies (LBs) and Lewy neurites are frequent concomitant neuropathologic observations in clinical and neuropathologically defined Alzheimer disease (AD), but their relation to clinical features in AD is uncertain. Most studies used semiquantitative measures to determine the presence or absence of LB abnormalities. OBJECTIVE: To determine the clinical consequences of LB abnormalities in the setting of AD. DESIGN: Prospective study. SETTING: Three outpatient research and treatment centers. PARTICIPANTS: Fourteen autopsy cases with a pathologic diagnosis of AD abnormalities and concomitant LBs followed semiannually for up to 8 years (mean age at intake, 72 years; mean age at death, 77 years; mean education, 15 years; 12 women). MAIN OUTCOME MEASURES: The modified Mini-Mental State Examination was used to assess cognitive function. The Unified Parkinson Disease Rating Scale was used to rate extrapyramidal motor signs. Hallucinations were evaluated using the Columbia University Scale for Psychopathology in Alzheimer's Disease. Time from the first evaluation in which diagnostic criteria for probable AD were met to death was used to determine illness duration. Quantitative measures of LB abnormalities were obtained for the frontal cortex, entorhinal cortex, substantia nigra, and hippocampus. RESULTS: Independent-samples t tests were used to assess whether the degree of LB abnormality varied as a function of the presence or absence of hallucinations and extrapyramidal signs. Pearson r correlations were run to examine whether there was a relation among LB abnormalities, cognitive function, and illness duration. There was no relation between quantitative neuropathologic indexes of LB abnormalities and clinical outcome. CONCLUSION: The variability of clinical features in AD was not related to the presence or degree of LB abnormalities.

Aged↗

PubMed2006

Use of an Italian version of the telephone interview for cognitive status in Alzheimer's disease.

OBJECTIVES: Validation of an Italian version of the Telephone Interview for Cognitive Status (I-TICS). METHODS: Telephone administration of the I-TICS within 6 weeks of face-to-face testing with the Mini Mental State Examination (MMSE), in Probable Alzheimer's disease (AD) patients and healthy controls. Two hundred and seven consecutive outpatients with cognitive impairment were recruited from Dementia Clinic of University Campus BioMedico. Of these, 45 probable AD patients with complete data were analyzed. Other dementias, Mild Cognitive Impairment (MCI), and patients with incomplete data were excluded. The control sample consisted of 64 age- and sex-matched healthy subjects. For diagnosis, an extensive clinical evaluation, laboratory testing, brain imaging, EEG, neuropsychological battery and a depression scale were used. For I-TICS validation, telephone I-TICS and face-to-face MMSE were administered. RESULTS: The I-TICS correlated highly and linearly with the MMSE (Pearson's r=0.904). Conversion equations are provided. Sensitivity and specificity were similar between tests (area under curve=0.894 for the I-TICS; 0.966 for the MMSE). I-TICS sensitivity was 84% and specificity 86% at a cut-off score of 28. No significant difference in accuracy with the MMSE was present. Total agreement between I-TICS and MMSE was 'substantial' at 86% (Cohen's K=0.717). Repeated testing in a subset of patients showed a disease progression related decrease of 4.2 points/year (t=2.664; p=0.018) in I-TICS scores. CONCLUSION: The I-TICS is a valid instrument in clinical and research screening and monitoring of AD. Potential applications in other dementias and MCI are worth further studies.

Aged↗

PubMed2006

Functional ("psychogenic") amnesia.

Patients who present with severely impaired memory functioning without a discernable neurological cause typically have experienced one or more severely stressful life events. These patients, who are described as having "psychogenic" or "dissociative" amnesia, typically differ from patients with the neurologic amnestic syndrome in that memory for their personal life histories is much more severely affected than is their ability to learn and retain new information; that is, they have isolated retrograde amnesia. Recent cognitive and brain imaging research has begun to reveal some of the cerebral mechanisms underlying functional amnesia, but this disorder remains best conceptualized as a relatively rare form of illness-simulating behavior rather than a disease. Neuropsychological assessment is often useful in revealing the circumscribed nature of the patient's performance deficits, the spared functions that can be brought to bear in rehabilitation, and the emotional disorders requiring psychiatric treatment. Controlled treatment trials are nonexistent, but case reports suggest that supportive psychotherapy, systematic relaxation training, hypnosis, and sedative/anxiolytic medications are useful in facilitating recovery. These treatments are often combined with a psychoeducational approach that essentially reteaches the patient his or her life story.

Adult↗

PubMed2006

Correlates of caregiver-rated quality of life in assisted living: the Maryland Assisted Living study.

We used a cross-sectional study to examine the correlates of caregiver-rated quality of life (QOL) in 198 randomly selected residents from a stratified random sample of 22 assisted living facilities in central Maryland. We measured QOL by using the Alzheimer's Disease-Related Quality of Life Questionnaire. In general, despite cognitive impairment, residents in assisted living were rated as having a high QOL. In a multivariate regression, we found that nonmood neuropsychiatric symptoms were the strongest correlate of QOL, explaining 37% of the variance. Depressive symptoms, functional dependence, marital status, and cognition also contributed to the model, but only minimally. Because of the strong association of neuropsychiatric symptoms with QOL, special attention should be given to their recognition and amelioration.

Activities of Daily Living↗

PubMed2006

Predictors of caregiver unawareness and nontreatment of dementia among residents of assisted living facilities: the Maryland Assisted Living Study.

OBJECTIVE: Assisted living (AL) is a rapidly expanding residential option for the senior population. With increased utilization, it becomes important to understand the detection and treatment of dementia in this setting, but little is known. The objective of this study was to identify and evaluate factors associated with caregiver unawareness of dementia and failure to treat dementia in AL. METHODS: The setting was a cross-sectional study of a random sample of AL facilities in central Maryland (The Maryland Assisted Living Study). Geriatric psychiatrists evaluated 198 participants and assigned dementia diagnoses to 134 residents (67.7%). The extent to which dementia was recognized and treated in these facilities was estimated on the basis of caregiver interview and chart review data. Using logistic regression models, demographic, cognitive, and functional measures were evaluated as predictors of caregiver unawareness and nontreatment of dementia. RESULTS: Severity of cognitive and functional impairment, number of neuropsychiatric symptoms, and male gender were all independent predictors of caregiver unawareness of dementia. Family and caregiver unawareness of dementia and female gender were predictors of failure to treat dementia. Detection and treatment were not associated with race, age, or overall medical health. CONCLUSIONS: Caregivers were more likely to be unaware of dementia in residents who did not have severe cognitive impairment or obvious behavioral and functional problems. Caregiver and family unawareness were in turn associated with nontreatment. Observed gender differences in detection and treatment will require replication and further study. These observations suggest that systematic educational interventions for caregivers and families may improve detection and hence treatment in the AL setting.

Aged↗

PubMed2006

Depression in assisted living is common and related to physical burden.

OBJECTIVE: The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland. METHOD: One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians. Those scoring >7 on the CSDD, a cut point repeatedly associated with poor outcomes, were considered clinically depressed. RESULTS: Participants had an average age of 86 years, most were female and widowed, and 68% met consensus criteria for dementia. Twenty-four percent (47 of 196) of the sample was depressed. In bivariate analyses, depression was significantly related to medical comorbidity, need for activities of daily living (ADLs) assistance, more days spent in bed, and less participation in organized activities. After controlling for pertinent covariates in a regression model, only need for ADL assistance remained significantly associated with depression. Forty-three percent of those currently depressed were receiving antidepressants and were more likely to receive them if they lived in a large AL facility. Sixty percent of depressed residents had no regular source of psychiatric care. CONCLUSIONS: In the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, undertreated, and related to physical burden. AL is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression.

Aged, 80 and over↗

PubMed2006

Clinical characteristics and longitudinal changes of informal cost of Alzheimer's disease in the community.

Most estimates of the cost of informal caregiving in patients with Alzheimer's disease (AD) remain cross-sectional. Longitudinal estimates of informal caregiving hours and costs are less frequent and are from assessments covering only short periods of time. The objectives of this study were to estimate long-term trajectories of the use and cost of informal caregiving for patients with AD and the effects of patient characteristics on the use and cost of informal caregiving. The sample is drawn from the Predictors Study, a large, multicenter cohort of patients with probable AD, prospectively followed annually for up to 7 years in three university-based AD centers in the United States (n=170). Generalized linear mixed models were used to estimate the effects of patient characteristics on use and cost of informal caregiving. Patients' clinical characteristics included cognitive status (Mini-Mental State Examination), functional capacity (Blessed Dementia Rating Scale (BDRS)), comorbidities, psychotic symptoms, behavioral problems, depressive symptoms, and extrapyramidal signs. Results show that rates of informal care use and caregiving hours (and costs) increased substantially over time but were related differently to patients' characteristics. Use of informal care was significantly associated with worse cognition, worse function, and higher comorbidities. Conditional on receiving informal care, informal caregiving hours (and costs) were mainly associated with worse function. Each additional point on the BDRS increased informal caregiving costs 5.4%. Average annual informal cost was estimated at $25,381 per patient, increasing from $20,589 at baseline to $43,030 in Year 4.

Aged↗

PubMed2006

A four-year prospective study of cognitive functioning in Huntington's disease.

The contribution of neurologic, genetic, and demographic variables to decline in cognition was examined in 70 early- to mid-stage patients with Huntington's disease (HD) using random effects modeling. Study participants were followed prospectively at baseline and at four annual reevaluations. Only modest decline was noted on most neuropsychological variables. Neurologic dysfunction, assessed using the Quantified Neurologic Examination (QNE), proved to be the strongest predictor of cognitive decline. While significantly predictive of more rapid decline in neurologic functioning, CAG repeat length was not generally related to cognitive decline after adjusting for QNE, with the exception of performance on a single test of visual scanning and psychomotor speed (i.e., Trail Making Test, Part A). We propose that CAG repeat length is more closely linked with changes in basal ganglia that predominate in early- to mid-stage HD than with cortical degeneration seen later in disease progression. Such a relationship would explain the predictive value that CAG repeat length plays in changes associated with automatic motor response programs (e.g., QNE and Trail Making Test, Part A) but not in dysfunction on tasks requiring higher-order processing.

Adult↗

PubMed2005

Regional white matter change in pre-symptomatic Huntington's disease: a diffusion tensor imaging study.

The pathology of Huntington's disease (HD) is characterized by diffuse brain atrophy, with the most substantial neuronal loss occurring in the caudate and putamen. Recent evidence suggests that there may be more widespread neuronal degeneration with significant involvement of extrastriate structures, including white matter. In this study of pre-symptomatic carriers of the HD genetic mutation, we have used diffusion tensor imaging to examine the integrity and organization of white matter in a group of individuals who previously demonstrated abnormalities in response to a functional magnetic resonance imaging paradigm. Our results indicate that, before the onset of manifest HD, there are regional decreases in fractional anisotropy, indicating early white matter disorganization.

Adult↗

PubMed2005

Transition to nursing home from assisted living is not associated with dementia or dementia-related problem behaviors.

OBJECTIVES: To examine risk factors for transition from assisted living (AL) care to skilled nursing facility (SNF) care in a random sample of adults residing in AL. DESIGN: Baseline clinical evaluation and telephone follow-up at 6-month intervals for up to 36 months. SETTING: AL facilities in central Maryland. PARTICIPANTS: There were 198 participants randomly sampled from AL facilities stratified by facility size. MEASUREMENTS: Consensus diagnoses by multidisciplinary geriatric psychiatry team as well as a broad range of neuropsychiatric and functional scales including Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, Mini-Mental State Exam, and Alzheimer's Disease Related Quality of Life Scale, as well as cognitive tests. Possible risk factors for transition to SNF were assessed in Cox proportional-hazards multivariate regression methods, using a P value less than .05 for statistical significance. RESULTS: Twenty-nine participants transitioned to SNF care. Mean AL survival time from baseline evaluation was 0.8 (SD 0.6) years for residents transitioned to SNF and 1.4 (SD 0.7) years for residents remaining in AL at follow-up. Risk factors for transition to SNF included declining health, chronic pain, appetite changes, and being widowed, while insomnia was protective against transition to SNF. Surprisingly, dementia and neuropsychiatric symptoms did not increase risk of transition to SNF. CONCLUSION: Survival time in AL is determined by factors similar to those operating on community-dwelling elderly, but dementia and neuropsychiatric symptoms do not alter survival time.

Activities of Daily Living↗

PubMed2005

Delusions and hallucinations are associated with worse outcome in Alzheimer disease.

BACKGROUND: Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality. OBJECTIVE: To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD. DESIGN, SETTING, AND PARTICIPANTS: A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors. MAIN OUTCOME MEASURES: Cognitive (Columbia MMSE score of < or =20/57 [approximate Folstein MMSE score of < or =10/30]), functional (Blessed Dementia Rating Scale [parts I and II] score of > or =10), institutionalization equivalent index, and death. RESULTS: During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Their presence was associated with increased risk for cognitive (risk ratio [RR], 1.50; 95% confidence interval [CI], 1.07-2.08) and functional decline (RR, 1.41; 95% CI, 1.02-1.94). Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive decline (RR, 1.62; 95% CI, 1.06-2.47), functional decline (RR, 2.25; 95% CI, 1.54-2.27), institutionalization (RR, 1.60; 95% CI, 1.13-2.28), and death (RR, 1.49; 95% CI, 1.03-2.14). CONCLUSIONS: Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Presence of hallucinations is also associated with institutionalization and mortality.

Aged↗

PubMed2005

Sleep disturbances in the elderly residing in assisted living: findings from the Maryland Assisted Living Study.

INTRODUCTION: A majority of the elderly suffer from some sort of sleep disturbance. Common sleep disturbances are insomnia and excessive daytime sleepiness. There are no published studies on the prevalence of sleep disturbance in the assisted living (AL) setting. OBJECTIVE: To estimate the prevalence, types, and associations of sleep disturbance in a stratified random sample of AL residents, and to explore the effect of sleep disturbance on cognitive and physical functioning, as assessed by the Mini- Mental State Exam (MMSE) and the Psychogeriatric Dependency Rating Scale (PGDRS). METHODS: Participants were 198 randomly selected assisted living residents in 22 Maryland facilities. Participants were rated on an 11-item sleep questionnaire regarding insomnia and daytime sleepiness. RESULTS: Sleep disturbance was present in 69% of residents, insomnia (IN) in 42% and excessive daytime sleepiness (DS) in 34.6%. IN and DS scores were not significantly correlated(r = 0.10, p = 0.19). Use of hypnotics, sedating antidepressants, and depression were associated with insomnia. Depression and poor general medical health were associated with daytime sleepiness. On a cognitive task (Mini Mental State Examination) participants with insomnia only out-performed participants with no sleep disturbance and daytime sleepiness; on a measure of physical function (PsychoGeriatric Dependency Rating Scale- physical domain), participants with insomnia fared better than those with daytime sleepiness only and those with both insomnia and daytime sleepiness. Participants with DS only performed worse on both measures compared to those with no sleep disturbance, those with insomnia only, and those with both insomnia and daytime sleepiness. CONCLUSION: The prevalence of sleep disturbance in AL is similar to that reported in nursing homes. Daytime sleepiness is associated with poorer cognitive and day-to-day functioning, while insomnia is associated with better outcomes. Effective management of DS may lead to improved functioning in the AL residents.

Aged↗

PubMed2005

Validation of the Hopkins Medication Schedule to identify difficulties in taking medications.

BACKGROUND: Medications often represent the first line of defense in preventing or delaying the progression of chronic diseases. The health implications of improper medication compliance, and failure to identify it, are considerable. The authors thus developed and validated the Hopkins Medication Schedule (HMS), a new objective test of one's ability to understand and implement a routine prescription medication. METHODS: The authors gave a hypothetical physician's prescription for two common medications (antibiotics and aspirin) to 360 high-functioning, community-dwelling, older participants in the Women's Health and Aging Study II and asked them to fill in a daily schedule for taking these medications and to fill in the compartments of a daily pillbox. These scored and timed performances were evaluated for their ability to predict concurrent and 3-year participant-reported difficulty in performing instrumental activities of daily living (IADLs) and for their associations with memory and attention. RESULTS: Although fewer than 2% of participants reported difficulty in taking medications, nearly 22% were completely unable to complete the schedule, fill the pillbox, or both. The 7% of participants who reported difficulty in any IADL also performed poorly on the HMS. In addition, performance on the schedule and the pillbox predicted concurrent difficulty. In adjusted regression analyses, the schedule was most highly associated with memory and the pillbox with learning and executive function. CONCLUSIONS: The HMS had concurrent validity for participant-reported IADL difficulty. Furthermore, in community-dwelling older women who largely reported no difficulty in taking medications, the HMS identified nearly 22% who could not write or implement a routine medication regimen. This standardized measure may identify those at increased risk for poor medication adherence and, more broadly, IADL difficulty.

Activities of Daily Living↗

PubMed2005

Predictors of functional impairment in residents of assisted-living facilities: the Maryland Assisted Living study.

BACKGROUND: Assisted living is a popular residential option for older individuals, yet little research has been done on people choosing this option. This study examines predictors of functional impairment in assisted living residents in the domains of cognition, mood, and health. METHODS: An experienced team of neuropsychiatrists, nurses, and technicians using a number of cognitive, behavioral, health, and functional status tests and a cross-sectional study design assessed 198 residents of 22 assisted living facilities in Maryland. Data from these evaluations were used in univariate and multiple regression models to identify predictors of functional impairment, operationalized as the sum of the scores on two scales, one measuring impairment in basic activities of daily living and one measuring impairment in instrumental activities of daily living. RESULTS: Greater cognitive impairment, worse depression, and worse medical health were significant independent predictors of functional impairment, together explaining a sizeable portion of the variance (adjusted R2=0.434). None of the demographic variables examined individually, including age and education, was predictive of functional impairment. In an analysis of specific cognitive domains, executive dysfunction, impairment of visuospatial skills, and amnesia were significant predictors of impairment, whereas inattention was not. CONCLUSION: Executive dysfunction, apraxia, memory impairment, depression, and general medical health are all significant predictors of functional impairment in assisted living residents, with executive dysfunction being the strongest. These results may be instrumental in developing a more efficient model of care for residents of assisted living facilities, one based on having accurate predictive models of degree of impairment.

Activities of Daily Living↗

PubMed2005

The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia.

PURPOSE: We conducted this study to determine whether neuropsychiatric symptoms and environmental characteristics are associated with quality of life in assisted living residents with dementia. DESIGN AND METHODS: We used a cross-sectional study of 134 residents from 22 facilities and employed the Alzheimer's Disease-Related Quality of Life Scale and the Neuropsychiatric Inventory. A scale was developed to capture the homelike climate of each facility. Linear regression analyses were used to estimate the relationship of neuropsychiatric symptoms and homelike climate with quality of life, controlling for sociodemographics, cognition, functional dependence, and physical health. Exploratory analyses and graphical techniques were employed to test for environmental-level moderating effects. RESULTS: Agitation, depression, apathy, and irritability were significant predictors of quality of life, explaining 29% of the variance. Neither facility size nor homelike environment was significantly associated with quality of life in univariate analyses. Size of facility moderated the relationship between agitation and quality of life. IMPLICATIONS: Neuropsychiatric symptoms impair quality of life in residents with dementia. Further research should investigate the role of other environmental aspects.

Aged, 80 and over↗

PubMed2005

Depressive symptoms in Alzheimer's disease: natural course and temporal relation to function and cognitive status.

OBJECTIVES: To examine the natural course of depressive symptoms in patients with probable Alzheimer's disease (AD), specifically, the temporal relationship between depressive symptoms, function, and cognitive status. DESIGN: Multicenter cohort study with follow-up of up to 14 years. SETTING: Patients from the two Multicenter Study of Predictors of Disease Course in Alzheimer's Disease (Predictors Study) cohorts were recruited at five sites in the United States and Europe. PARTICIPANTS: Patients diagnosed with probable AD (n=536) enrolled in a longitudinal study (Predictors Study). MEASUREMENTS: Depressive symptoms were evaluated at 6-month intervals using the Columbia Scale for Psychopathology in Alzheimer's Disease. The Modified Mini-Mental State (3MS) and Blessed Dementia Rating Scale (BDRS) were used to assess cognitive status and functional activity, respectively. RESULTS: The prevalence of depressive symptoms was stable over the first 3 years of follow-up, at approximately 40%. There was a significant drop to 28% and 24% in the fourth and fifth years of follow-up, respectively. Time-dependent Cox analysis revealed that functional activity (BDRS) but not cognitive status (3MS) was a significant predictor of the first episode of depressive symptoms during follow-up. Generalized estimating equation analyses showed that AD duration and functional activity but not cognitive status were significantly related to depressive symptoms over the entire follow-up period. CONCLUSION: Depressive symptoms are common in AD, but their prevalence decreases over time. Examination of the temporal relationship between depressive symptoms and risk factors suggests that decline in function but not in cognition precedes the first episode of depressive symptoms in patients with probable AD.

Activities of Daily Living↗