Objective: To determine the sensitivity and specificity of three depression screening scales to diagnose major depressive episodes in the elderly. Methods: Participants (n=129, 88% female) answered a semi-structured psychiatric interview (Mini International Neuropsychiatric Interview) to determine the diagnosis of major depressive disorder. After this, depressive symptoms in depressed and non-depressed subjects were assessed by independent administration of the 15-item Geriatric Depression Scale (GDS-15), Patient Health Questionnaire-9 (PHQ-9), and 17-item Hamilton Rating Scale for Depression . Results: Patients with major depression and controls did not differ in age and gender distribution. The sensitivity and specificity of all scales to identify a major depressive episode in older adults were X 90%. There were no significant differences between the areas under the curve for PHQ-9 vs. HDRS-17 (z = 1.2, p = 0.2), PHQ-9 vs. GDS-15 (z = 0.26, p = 0.8), or HDRS-17 vs. GDS-15 (z = 1.2, p = 0.2). Conclusion: This study provides evidence supporting the use of PHQ-9 and GDS-15, both of which are simple to administer and easy to interpret, to diagnose major depressive episodes in older adults without neurocognitive disorders.

ABSTRACT. In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer's disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly -or at least a subgroup of them -and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aβ42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established. A relação entre transtornos depressivos em idosos e demência, particularmente a doença de Alzheimer (DA), é altamente complexa. Embora a natureza desse relacionamento ainda seja motivo de debate, o diagnóstico e o tratamento diferenciais continuam sendo um grande desafio clínico. Revisamos descobertas recentes sobre o dilema de transtornos depressivos em idosos e DA. Existe um contínuo biológico entre os transtornos depressivos em idosos -ou pelo menos um subgrupo deles -e a DA. Enquanto indivíduos idosos com depressão e pacientes com DA exibem níveis circulantes mais altos de moléculas pró-inflamatórias e menor BDNF do que os controles correspondentes, os níveis de Aβ42 no LCR podem discriminar a DA de distúrbios depressivos em idosos. O papel do tratamento antidepressivo como estratégia para minimizar o risco de DA ainda precisa ser estabelecido. Palavras-chave: depressão, demência, Alzheimer, diagnóstico diferencial, terapêutica.

Objective: A consistent body of research has confirmed that patients with major depressive disorder (MDD) have increased concentrations of pro-inflammatory cytokines, including IL-6, TNF-a, IL-1b, the soluble IL-2 receptor, and C-reactive protein, compared to controls; however, there is limited information on IL-17A in MDD. Moreover, information about IL-17A in older populations, i.e., patients with late-life depression (LLD), is conspicuously missing from the literature. The purpose of this study was to investigate the role of IL-17A in LLD. Methods: A convenience sample of 129 individuals, 74 with LLD and 55 non-depressed controls, were enrolled in this study. The Mann-Whitney U test was used to compare plasma IL-17A levels between LLD and controls subjects, and Spearman's rank order correlation was used to investigate correlation of these levels with clinical, neuropsychological, and cognitive assessments. Results: Plasma IL-17A levels were not statistically different between LLD patients and controls (p = 0.94). Among all subjects (LLD + control), plasma IL-17A did not correlate significantly with depressive symptoms (rho = -0.009, p = 0.92) but a significant correlation was observed with cognitive assessments (rho = 0.22, p = 0.01). Conclusion: Our findings do not support an association between plasma IL-17A levels and LLD. Nevertheless, IL-17A may be associated with cognitive impairment in LLD patients. If this finding is confirmed in future longitudinal studies, modulation of the T-helper 17 cell (T h 17) immune response may be a treatment target for cognitive impairment in this population.

Background: Alzheimer's disease (AD) biomarkers are of great relevance in clinical research, especially after the AT(N) framework. They enable early diagnosis, disease staging and research with new promising drugs, monitoring therapeutic response. However, the high cost and low availability of the most well-known methods limits their use in low and medium-income countries. In this context, Millipore xMap® Luminex may be a cost-effective alternative. In our study, using INNOTEST® as reference, we assess the diagnostic accuracy of Millipore xMap® and propose a cutoff point for AD.Methods: We performed lumbar puncture of seven older individuals with clinically defined AD, 17 with amnestic mild cognitive impairment (aMCI) and 11 without objective cognitive impairment-control group (CG). Cerebrospinal fluid (CSF) biomarkers concentrations for aB42, p-Tau, and t-Tau were measured by INNOTEST® and Millipore xMap®, and then the techniques were compared to assess the diagnostic accuracy of the new test and to define a cutoff.Results: INNOTEST® and Millipore xMap® measurements showed all correlations >0.8 for the same biomarker, except for t-Tau that was 0.66. Millipore xMap® measurements showed a robust accuracy for all biomarkers, with AUC higher than 0.808 (t-Tau), and the best for Aβ42 (AUC = 0.952). The most accurate cutoffs were found at 1012.98 pg/ml (Aβ42), 64.54 pg/ml (p-tau), 3251.81 pg/ml (t-tau), 3.370 (t-Tau/Aβ42), and 0.059 (p-Tau/Aβ42).Conclusion: Given its good accuracy and cost-effectiveness, Milliplex xMap® tests seems a reliable and promising tool, especially for low and middle-income countries.

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Background Comparison between functionality and cognition in elderly patients with Alzheimer’s dementia (AD) and without cognitive impairment with positive and negative Aβ‐42 and p‐Tau biomarkers evaluated using the Luminex technique. Method Patients with Alzheimer’s dementia and normal cognition (control) were recruited. They were divided in two groups according to their clinical diagnosis: AD group (n=30) and control group (CTRL) (n=10). The AD group was then divided in patients with positive (n=21) and negative (n=9) Aβ‐42 and p‐Tau biomarkers. The participants were submitted to sociodemographic. The general cognition was evaluated through the following instruments: the Mini‐Mental State Examination (MMSE), semantic verbal fluency (SVF), animal fluency, short term memory, and recognition of CERAD battery, and functionality was evaluated by the Pfeffer scale. Samples from the cerebrospinal fluid (CSF) of patients were collected, processed, and stored at ‐80°C until use. The Luminex technique was then used for the Aβ‐42, t‐Tau, p‐Tau, t‐Tau/Aβ‐42 ratio, and p‐Tau/Aβ‐42 ratio biomarker analysis. Obtained data was processed and analyzed through the software SPSS 22.0. Result Comparison between control patients and patients with AD, as defined by clinical diagnosis, did not show significant differences regarding to Aβ‐42 expression in CSF (U=91,000; p=0,067), (AD=1119,0360, SD=708,98952 vs CTRL=775,2623 SD=341,67835). However, there was a significant difference between groups concerning t‐Tau protein, (U=198,500; p=0,028), p‐Tau (U=250,00, p=0,001) and p‐Tau/Aβ‐42 ratio (U=238,00; p=0,005). In terms of cognitive variables, all showed significant differences between groups: MMSE (U=46,500, p=0,001), SVF (U=39,000; p<0,001), short term memory (U=27,000, p<0,001), recognition (U=72,500,p=0,014), as well as functionality (U=258,500, p<0,001). There was no difference regarding the age (U= 201,500; p=0,109) and formal education (U=201,500, p=0,109). As for the AD groups with positive and negative biomarkers, there was no significant difference in cognitive variables, age, formal education, and functionality. Conclusion AD group with negative biomarkers non differ in terms of cognition. Comparing the control and AD groups, there were differences in functionality, cognition, and biomarkers. However, comparing AD groups in terms of biomarkers, there was no difference in functionality performance, short‐term memory, fluency and general cognition. Therefore, the biomarkers do not indicate significant cognitive differences in the group of patients with dementia.

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