Objective: The aim of the present study was to estimate the frequency of cognitive deficits suggestive of Alzheimer's disease (AD) in a population of french ambulatory elderly depressed patients with the Short Cognitive Evaluation Battery (SCEB). A second objective was to compare the frequency of cognitive deficits suggestive of AD in function of the presence of a personal history of depression before or after 50 years of age.
Design: This study was a national, cross-sectional, observational epidemiological trial.
Materials and Methods: Population: Subjects were recruited from ambulatory psychiatric consultations. Psychiatrists included the first 5 patients who met the inclusion criteria (age>70 years, antidepressant treatment initiated from a minimum duration of 15 days). Subjects were not included if they did not consent to being evaluated with the SCEB, if they had been diagnosed as having AD or other neurological disease, if they were receiving treatment with an acetylcholinesterase inhibitor, or if they had comorbid schizophrenia or paranoid disorder. The SCEB consists of a combination of four individual tasks derived from classical neuropsychological tasks : temporal orientation test, enhanced verbal memory test (free and cued recall), clock drawing test, and the semantic verbal fluency test.
Statistical analysis: Statistical analyses were performed using SAS software (version 8.2). Depressed patients were classified into two groups (presence or absence of cognitive deficits suggestive of AD) according to their global performance at the SCEB using a statistical model described in the validation of the SCEB in French. A bivariate analysis was performed to compare the two groups of depressed patients according to their cognitive status at the SCEB.
Results: In 135 centres, 566 patients were enrolled and 522 of them (mean age : 77.0 +- 5.5) were analysed. In regard of the results at the SCEB, 34.5% (180/522) (IC95% : [ 30.4-38.6]) of the depressed patients presented cognitive deficits suggestive of AD. The cognitively impaired depressed patients were significantly (3 years in mean)older (p<0.001) and they had a lower level of education (p<0.001) and a lower social status (p<0.01) than the non-cognitively impaired patients. The current depressive episode being the first (p=0.03) and a higher level at the MADRS score of depressive symptoms (p=0.01) were significantly associated with the presence of cognitive impairment at the battery. Besides, cognitively impaired patients were preferentially treated by specific serotonergic recapture inhibitors (p=0.01) while non cognitively impaired patients received a larger variety of antidepressants.
Conclusion: The main objective of this study was to provide an estimation of the frequency of cognitive impairment suggestive of AD in a French psychiatric elderly population, using a novel method of screening for AD that can be administered easily and quickly by psychiatrists in a single consultation. In such conditions, 35% of depressed patients presented cognitive deficits that needed further exploration and a close neuropsychological follow-up in order to make a clinical diagnosis of AD at the early stages of the disease, which benefits mostly from acetyl-cholinesterase inhibitors.
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