-Objective: To estimate the prevalence of cognitive impairment in an elderly population-based cohort, using several Mini-Mental State Examination (MMSE) cut-off points recommended by Brazilian authors and to examine the percentile distribution of MMSE scores in the study population. Method: A total of 1558 subjects aged ≥60 years (89.4% of the total), living in the city of Bambuí, MG, completed the MMSE and were included in the present study. Results: The estimated prevalences of cognitive impairment varied from 13.2% to 27.0% depending on the cut-off point and agreement varied widely between them (kappa range: 0.38 to 0.88). Cutoff point 13/14 corresponded to the 5 th percentile and 21/22 corresponded to the lower quartile of the MMSE score distribution. Conclusion: In the absence of comparable cut-off points, percentile distributions are more adequate for population-based studies of elderly with low schooling level.KEy wordS: elderly, cognitive symptoms, epidemiology, Brazil. Normas para o uso do Mini-Exame do Estado Mental: adequação do ponto de corte em estudos populacionais (evidências do Projeto Bambuí)Resumo -Objetivo: Estimar a prevalência de déficit cognitivo em uma base populacional de idosos, utilizando-se os diferentes pontos de corte do Mini-Exame do Estado Mental (MEEM) recomendados por autores brasileiros e verificar a distribuição em percentis da pontuação do MEEM na população estudada. Método: Participaram do estudo 1558 (89,4% do total) indivíduos com idade ≥60 anos residentes na cidade de Bambuí, MG, que foram submetidos ao MEEM. Resultados: A prevalência estimada de déficit cognitivo variou de 13,2% a 27,0%, dependendo do ponto de corte utilizado, observando-se grande variação na sua concordância (índices de kappa entre 0,38 e 0,88). o ponto de corte de 13/14 correspondeu ao 5º percentil e o de 21/22, ao quartil inferior da distribuição dos escores do MEEM. Conclusão: Na ausência de pontos de corte comparáveis, a distribuição em percentis é mais adequada para estudos de base populacional de idosos com baixa escolaridade.

Depression is common in Parkinson's disease (PD) and is associated with several poor outcomes. However the literature regarding treatment with antidepressants in this population is controversial. The aim of this paper was to systematically review all randomized controlled trials that studied the efficacy of antidepressants for depression in PD (dPD). Studies were retrieved from PubMed (1966-July 2012), Cochrane Library (-July 2012, issue 7), Embase (1980-July 2012), PsycINFO (1980-July 2012), Lilacs (1982-July 2012), secondary references, clinical trials registries and a thesis database. Only double-blind, randomized controlled trials in which an antidepressant was given as the main treatment and compared with placebo and/or another antidepressant were included. Out of the 1438 studies retrieved, only six could be included. Taking into account the five placebo-controlled trials, the overall risk ratio (RR) for response was 1.36 (0.98, 1.87), indicating no statistically significant superiority of antidepressants over placebo. However, in the sensitivity analysis, the RR for response was 1.41 (1.01, 1.96) and 1.48 (1.05, 2.10) after exclusion of one study with questionable results, and when only studies with low risk of bias were considered, respectively. No specific antidepressant class was superior to placebo. In general antidepressant medications were well tolerated. The results suggest antidepressants may be efficacious in the treatment of dPD. However, the results were unstable. In fact, the small number of trials and methodological drawbacks preclude definitive conclusions about their efficacy and tolerability in dPD.

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The objective was to perform a systematic review and meta-analysis of studies that assessed the effect of the combination of antidepressants from the beginning of the treatment of major depressive disorder. Studies were retrieved from PubMed (1966 to August 2010), Cochrane Library (August 2010), Embase (1980 to August 2010), PsycINFO (1980 to August 2010), Lilacs (1982 to August 2010), clinical trials registry, thesis database (www.capes.gov.br), and secondary references. All randomized controlled trials that compared a combination of antidepressants with a single antidepressant from the beginning of the treatment of major depressive disorder in adults were included. Data analysis was performed using the Review Manager 5.0. Of 3492 studies retrieved, five satisfied the inclusion criteria. In one study, only data about dropouts were included. Antidepressant combination was shown to be better than a single antidepressant considering remission (relative risk [RR], 2.71; 95% confidence interval [CI], 1.69-4.35) and response (RR, 1.55; 95% CI, 1.21-1.97). Mirtazapine plus selective serotonin reuptake inhibitor (SSRI) was superior to an isolated SSRI for remission (RR, 1.88; 95% CI, 1.06-3.33). Tricyclic antidepressant plus SSRI was superior to SSRI for remission and response (RR, 8.58; 95% CI, 1.70-43.32 and RR, 1.78; 95% CI, 1.07-2.93, respectively). There was no difference between combined and monotherapy groups in dropouts owing to adverse effects. The results suggest that antidepressant combination is more efficient than a single antidepressant without a significant decrease in tolerability. However, the small number of clinical trials and methodological problems precludes definitive conclusions.

The CDT scored by the Shulman (2000) method appears to have good to excellent reliability in an elderly population with very low formal educational level. However, difficulties in distinguishing between scores 4 and 5, and a low proportion of score 1 tests suggest these scores may not be totally adequate for this population. Further studies are necessary to determine the consistency of our results in similar populations.

Correlation between tests was moderate. Subjects who performed well on the CDT could be expected to obtain high MMSE scores. Although one test does not substitute for the other, the CDT may be more practical in developing countries where resources are limited and low education is common in the elderly, as well as in situations where time for assessment or screening is limited. Moreover, the CDT may be sensitive to cognitive domains not assessed by the MMSE.

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