No abstract

The acceleration of incidence rates for AD and dementia slows down with the increase in age, although we find no evidence of a rate decline. Women are at higher risk of developing AD than men.

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine if corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment

Leisure activities in old age may protect against cognitive decline for both women and men, and different types of activities seem to benefit different cognitive domains.

The mechanisms by which antidepressant-induced neurochemical changes lead to physiological changes in brain circuitry and ultimately an antidepressant response remain unclear. This study investigated the effects of sertraline, a selective serotonin reuptake inhibitor antidepressant, on corticolimbic connectivity, using functional magnetic resonance imaging (fMRI). In all, 12 unmedicated unipolar depressed patients and 11 closely matched healthy control subjects completed two fMRI scanning sessions at baseline and after 6 weeks. Depressed patients received treatment with sertraline between the two sessions. During each fMRI session, subjects first completed a conventional block-design experiment. Next, connectivity between cortical and limbic regions was measured using correlations of lowfrequency blood oxygen level-dependent (BOLD) fluctuations (LFBF) during continuous exposure to neutral, positive, and negative pictures. At baseline, depressed patients had decreased corticolimbic LFBF correlations compared to healthy subjects during the resting state and on exposure to emotionally valenced pictures. At rest and on exposure to neutral and positive pictures, LFBF correlation between the anterior cingulate cortex and limbic regions was significantly increased in patients after treatment. However, on exposure to negative pictures, corticolimbic LFBF correlations remained decreased in depressed patients. The results of this study are consistent with the hypothesis that antidepressant treatment may increase corticolimbic connectivity, thereby possibly increasing the regulatory influence of cortical mood-regulating regions over limbic regions.

Cognitive impairment short of dementia affects nearly one in four community-dwelling elders and is a major risk factor for later development of dementia.

The Community Screening Interview for Dementia "CSI {D|# was developed as a screening instrument for dementia for use in cross!cultural studies[ It consists of two components\ a cognitive test for non!literate and literate populations and an informant interview regarding performance in everyday living[ The development of the CSI {D|\ involving harmonization\ translation\ back translation and pilot testing\ for use in _ve sites is described[ The results demonstrate the adaptability and utility of the CSI {D| in populations from very di}erent socioeconomic backgrounds[ The inclusion of informant data adds signi_cantly to the performance of the CSI {D| as a dementia screen[ The combination of informant and cognitive scores in a discriminant score produces better sensitivity and speci_city for dementia than cognitive scores alone[ The informant score has a signi_cant independent e}ect in predicting dementia[ Copyright Þ 1999 John Wiley + Sons\ Ltd[ KEY WORDS*Community Screening for Dementia "CSI {D|#^screening test^dementia^informant interview^cognitive test^cross!cultural studies Cross!cultural studies of dementia\ particularly those involving developing countries\ o}er a unique opportunity for identifying risk factors by providing a much wider diversity of environ! mental exposures than do studies in industrialized countries where important risk factors may be missed because of their very pervasiveness "Osun! tokun et al[\ 0881^Hendrie\ 0888#[ Cross!cultural studies present the researcher with major methodological problems\ however[ Not least of these problems is developing instru! ments for screening and clinical assessment that minimize cultural biases[ This process is par! ticularly challenging in studies of dementing dis!

This is the first report of incidence rate differences for dementia and AD in studies of 2 populations from nonindustrialized and industrialized countries using identical methods and the same group of investigators in both sites. Further explorations of these population differences may identify potentially modifiable environmental or genetic factors to account for site differences in dementia and AD.