Numerous epidemiological reports have found that adolescent, young adult, and middle-aged adult girls and women are more likely to be diagnosed with unipolar depression and report greater symptoms of depression when compared to boys and men of similar ages. What is less well-known is whether this gender difference persists into late life. This literature review examines whether the well-known gender difference in unipolar depression continues into old age, and, if it does, whether the variables that are known to contribute to the gender difference in unipolar depression from adolescence through adulthood continue to contribute to the gender difference in the elderly, and/or whether there are new variables that arise in old age and contribute to the gender difference in the elderly. In this review of 85 empirical studies from every continent except for Antarctica, we find substantial support for the gender difference in depression in individuals who are 60 and older. More research is necessary to determine which factors are the strongest predictors of the gender difference in depression in late life, and particularly whether the factors that seem to be responsible for the gender difference in depression in earlier life stages continue to predict the gender difference in the elderly, and/or whether new factors come into play in late life. Longitudinal research, meta-analyses, and model-based investigations of predictors of the gender difference in depression are needed to provide insights into how and why the gender difference in depression persists in older age.
The neuropathology associated with chronic alcohol abuse varies across studies, though research suggests generalized reductions in cortical and subcortical grey and white matter. Neuropsychological findings also differ within the literature. The inconsistent findings with respect to the neuropathology and neurobehavior of patients with histories of alcohol abuse may be due, at least in part, to differing nosology and the highly variable inclusion/exclusion criteria employed by researchers. Oslin et al. [Int J Geriatr Psychiatry 1998;13:203–212] have proposed and recently validated specific criteria for probable alcohol-related dementia (ARD). We were interested in comparing the neuropsychological profile of ARD patients with the neurocognitive profiles of typical cortical and subcortical dementia patients. Participants included 14 ARD patients, 15 patients diagnosed with Alzheimer’s disease (AD), 13 patients diagnosed with subcortical vascular dementia (VaD), and 20 normal controls. Patient subgroups were similar with respect to age (mean = 79), education (mean = 12 years) and dementia severity (MMSE; mean = 22.1). The three dementia patient subgroups demonstrated significantly worse performance than the normal controls subgroup on all neuropsychological tests. The ARD subgroup exhibited very similar executive control deficits to VaD patients. However, the different neurocognitive profiles of the patient subgroups suggest that ARD patients may also, in fact, demonstrate some degree of amnesia given that they perform slightly worse than subcortical patients on delayed verbal free recall and recognition. Nonetheless, the ARD patients did not display as severe impairment as the AD patients on the memory tasks. No significant differences between the three patient groups were identified on language tests. In sum, we present preliminary evidence of a distinct neuropsychological profile for ARD patients that includes impairment on both executive control and memory tests. This pattern of performance suggests that long-term alcohol abuse, in comparison to AD and VaD, may be associated with both cortical and subcortical neuropathology.
Patients and spouses perceive patient QOL and predictors of patient QOL differently. Implications include the need to be aware of negative bias in spouse ratings of patients of QOL and other psychosocial variables, especially when spouse perceptions are considered by health care professionals. Discussing differences in patient and spouse perceptions in clinical settings with both patients and spouses will allow for a more comprehensive understanding of patient status.
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