Objective:Disability is a major burden afflicting older people and their carers. Both cognitive impairment and depression contribute to disability. The cognitive decline due to primary degenerative dementia is exacerbated by minor or silent cerebral infarcts, and these subcortical lesions are considered the etiological basis of vascular depression, characterized, besides depressive symptoms, by psychomotor slowing and withdrawal. Design:to evaluate the influence of a vascular lesions on cognitive impairment and depression and their relationship with disability. Materials and Methods:A sample of 234 outpatients (134 females and 100 males, mean age 72.7, sd 7.1), fulfilling the criteria for mild to moderate dementia was administered the CAMDEX. We primarily considered its three main indices Camcog (a neuropsychological battery measuring cognitive performance), Depress (a check-list of depressive signs and symptoms) and Organicity (a measure of functional competence). Depress items were grouped into two components: Mood and Motivation.The Hachinsky score was computed to assess the vascular component of the clinical picture. Results:102 subjects had a probable "pure" degenerative dementia (Hachinscky score °Ü 4) and 132 subjects had a vascular component (Hachinsky score °Ý 5). Subjects with probable vascular or degenerative dementia did not differ with respect to Camcog and Organicity scores, whereas vascular patients showed a significant higher Depress score (F=15,897; p=.000). Pearson correlation analysis showed that Hachinsky score significantly correlated with Depress (p=.000) and Organicity (p=.026), whereas no significant correlation with Camcog score emerged. Moreover, the two components of the Depress index showed strong and significant correlations with both Hachinscky (p=.000) and Organicity scores (vs mood -p=.000; vs motivation -p=.011) A partial correlation analysis, controlling for the influence of Hachinsky score on the relationship between Depress and Organic scores, remained high and significant (p=.000). Conversely, when the level of Depression was considered as controlling factor, Organic and Hachinsky scores were no longer correlated (p=.065). The same held true when the two components of Depression were considered as controlling factors, and the relationships between Organicity and Hachinsky did not reach significance (p=.264). Conclusion:In our sample, a vascular component of the dementia profile was strongly related to increased depressive symptoms and disability but did not significantly impact cognitive functioning. The Mood and Motivation components of the depression profile were significantly related to the vascular index and disability index. The negative impact of depressive symptoms on the competence level in everyday activity was unaffected by the presence/absence of the vascular lesions. On the contrary, the influence of vascular component per se on disability did not reach significance when the level or the components of depression were taken as controlling factor. The negative impact of vascular symptoms on the level of competence might thus somehow be mediated by depressive symptoms
The impact of vascular signs and symptoms on cognitive, affective profile and disability / Neri, M; Neviani, F; Martini, E; Rubichi, S; Suzzi, E; Cipolli, C. - In: INTERNATIONAL PSYCHOGERIATRICS. - ISSN 1041-6102. - STAMPA. - 15:(2003), pp. 116-116. (Intervento presentato al convegno International Psychogeriatrics tenutosi a Roma nel 22/03/203).