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The prevalence of depression in the elderly is high and remains high into old age, perhaps due to increased functional disability.

Our study demonstrated high estimates where anxiety and depression occurred in parallel both as disorders and as subthreshold syndromes.

Consistent with previous estimates, depression was highly prevalent in institutions, particularly in younger individuals with severe functional impairment. Those in institutions report considerably more symptoms of depression. Finding interventions which address these symptoms might improve quality of life for people in institutions, irrespective of formal diagnoses.

BackgroundLower cognitive ability in childhood is associated with increased risk of future schizophrenia, but its relationship with adult psychotic-like experiences and other psychopathology is less understood.AimsTo investigate whether this childhood risk factor is shared with adult subclinical psychiatric phenotypes including psychotic-like experiences and general psychiatric morbidity.MethodA population-based sample of participants born in Great Britain during 1 week in March 1946 was contacted up to 20 times between ages 6 weeks and 53 years. Cognition was assessed at ages 8, 11 and 15 years using a composite of age-appropriate verbal and non-verbal cognitive tests. At age 53 years, psychotic-like experiences were self-reported by 2918 participants using four items from the Psychosis Screening Questionnaire and general psychiatric morbidity was assessed using the scaled version of the General Health Questionnaire (GHQ-28).ResultsPsychotic-like experiences were reported by 22% of participants, and were highly comorbid with other psychopathology. Their presence in adults was significantly associated with poorer childhood cognitive test scores at ages 8 and 15 years, and marginally so at age 11 years. In contrast, high GHQ scores were not associated with poorer childhood cognition after adjustment for the presence of psychotic-like experiences.ConclusionsPsychotic and non-psychotic psychopathologic symptoms are highly comorbid in the general population. Lower childhood cognitive ability is a risk factor for psychotic-like experiences in mid-life; these phenomena may be one end of a continuum of phenotypic expression driven by variation in early neurodevelopment.

BACKGROUND: The Clinical Dementia Rating–Sum of Boxes (CDR-SB) has been proposed as a primary outcome for use in prodromal AD trials. However, the psychometric properties of this, and of other commonly used measures, have not been well-established in this patient population. OBJECTIVE: To describe the psychometric properties of commonly used efficacy measures in a clinical trial of prodromal AD. SETTING: Data were gathered as part of a two-year clinical trial. PARTICIPANTS: Patients had biomarker confirmed prodromal AD. MEASUREMENTS: Clinical Dementia Rating (CDR), Functional Activities Questionnaire (FAQ), Alzheimer’s Disease Assessment Scale – Cognition Subscale 11 and 13 (ADAS-Cog), Mini Mental State Exam (MMSE), and Free and Cued Selective Reminding Test (FCSRT-IR [words]). Assessments were conducted at least every 24 weeks. RESULTS: For the CDR-SB, test-retest reliability was good (intra-class correlation coefficient [ICC]=0.83); internal consistency was 0.65 at baseline but above 0.8 at later assessments. Relationships between the CDR-SB and other measures were as expected (higher correlations with more closely related constructs), and the CDR-SB differentiated between patients with different severities of dementia (-2.9 points difference between CDR-Global Score 0.5 and 1, P<.0001). Floor and ceiling effects on the CDR-SB total score were minimal; however, at baseline there were ceiling effects in the personal care domain. Further detail is provided on the psychometric properties of ADAS-Cog, MMSE, FCSRT-IR and FAQ in this population. CONCLUSION: The psychometric properties of the CDR-SB are adequate in prodromal AD and continued use is warranted in clinical trials. However, there remains scope for improvement in the assessment of functional constructs and development of novel measures should continue.

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