The relationship between structural changes in grey matter and treatment response in patients with late-life depression remains an intriguing area of research. This magnetic resonance imaging (MRI) study compares the baseline grey matter volume of elderly people with and without major depression (according to the DSM-IV-TR criteria) and assesses its association with antidepressant treatment response. Brain MRI scans were processed using statistical parametric mapping and voxel-based morphometry. The sample consisted of 30 patients with depression and 22 healthy controls. We found a significant volumetric reduction in the orbitofrontal cortex bilaterally in patients in comparison with controls. According to their remission status after antidepressant treatment, patients were classified as remitted or not remitted. Compared with controls, remitted patients showed a volumetric reduction in the orbitofrontal cortex bilaterally and in another cluster in the right middle temporal pole. Non-remitted patients showed an even greater volumetric reduction in the orbitofrontal cortex bilaterally compared with controls. To investigate predictive factors of remission after antidepressant treatment, we used a logistic regression. Both baseline Mini Mental State Examination score and baseline left superior lateral orbitofrontal cortex volume (standardized to the total grey matter volume) were associated with remission status. Our findings support the use of regional brain atrophy as a potential biomarker for depression. In addition, baseline cognitive impairment and regional grey matter abnormalities predict antidepressant response in patients with late-life depression.
This is a study on burden of caregivers of patients with Alzheimer’s disease
attended at a Reference Center for Cognitive Disorders.ObjectiveTo evaluate the profile and burden on caregivers of patients with Alzheimer’s
disease attended at a Reference Center for Cognitive Disorders.MethodsWe collected demographic information and data on the relationship with the
patient from caregivers, and measured burden with the Zarit scale. The
patients were evaluated with the following scales: the Cambridge Cognitive
Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory
for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ
for functional impairment.ResultsOf the 31 caregivers, 77.4% were female, predominantly, and daughters, having
a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers
co-resided with the patient and 71% did not work. The mean time as a
caregiver was 3 years. Twenty-seven percent of the caregivers presented mild
to severe burden. The variables presenting significant association with
caregiver burden were scores on the NPI and CAMCOG.ConclusionThe social demographic characteristics of the sample were similar to those of
studies performed in other countries. The average time as a caregiver and
the frequency of caregivers with mild to intense burden were lower than
those reported in international studies. Neuropsychiatric symptoms and
severity of cognitive decline were the main factors associated to burden in
this sample of mostly mild to moderate demented AD patients. Further studies
are necessary to verify whether the burden is indeed less intense in our
milieu.
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