Development and validation of a geriatric depression screening scale: A preliminary report

Diagnostic criteria for 14 psychiatric illnesses (and for secondary depression) along with the validating evidence for these diagnostic categories comes from workers outside our group as well as from those within; it consists of studies of both outpatients and inpatients, of family studies, and of follow-up studies. These criteria are the most efficient currently available; however, it is expected that the criteria be tested and not be considered a final, closed system. It is expected that the criteria will change as various illnesses are studied by different groups. Such criteria provide a framework for comparison of data gathered in different centers, and serve to promote communication between investigators.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=PSYCH&articleId=490573&pdfFileName=archpsyc_26_1_011.pdf

Diagnostic criteria for use in psychiatric research.

2016 Alzheimer's disease facts and figures

This report describes the historical evolution, development, rationale and validation of the Hopkins Symptom Checklist (HSCL), a self-report symptom inventory. The HSCL is comprised of 58 items which are representative of the symptom configurations commonly observed among outpatients. It is scored on five underlying symptom dimensions—sommatization, obsessive-compulsive, interpersonal sensitivity, anxiety and depression—which have been identified in repeated factor analyses. A series of studies have established the factorial invariance of the primary symptom dimensions, and substantial evidence is given in support of their construct validity. Normative data in terms of both discrete symptoms and primary symptom dimensions are presented on 2,500 subjects—1,800 psychiatric outpatients and 700 normals. Indices of pathology reflect both intensity of distress and prevalence of symptoms in the normative samples. Standard indices of scale reliability are presented, and a broad range of criterion-related validity studies, in particular an important series reflecting sensitivity to treatment with psychotherapeutic drugs, are reviewed and discussed.

The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory

Objective. —To examine more closely the association between apolipoprotein E (APOE) genotype and Alzheimer disease (AD) by age and sex in populations of various ethnic and racial denominations. Data Sources. —Forty research teams contributed data onAPOEgenotype, sex, age at disease onset, and ethnic background for 5930 patients who met criteria for probable or definite AD and 8607 controls without dementia who were recruited from clinical, community, and brain bank sources. Main Outcome Measures. —Odds ratios (ORs) and 95% confidence intervals (Cls) for AD, adjusted for age and study and stratified by major ethnic group (Caucasian, African American, Hispanic, and Japanese) and source, were computed forAPOEgenotypes ∈2/∈2,∈2/∈3,∈2/∈4,∈3/∈4 and ∈4/∈4 relative to the ∈3/∈3 group. The influence of age and sex on the OR for each genotype was assessed using logistic regression procedures. Results. —Among Caucasian subjects from clinic- or autopsy-based studies, the risk of AD was significantly increased for people with genotypes ∈2/∈4 (OR=2.6, 95% Cl=1.6-4.0), ∈3/∈4 (OR=3.2, 95% Cl=2.8-3.8), and ∈4/∈4 (OR=14.9, 95% CI=10.8-20.6); whereas, the ORs were decreased for people with genotypes ∈2/∈2 (OR=0.6, 95% Cl=0.2-2.0) and ∈2/∈3 (OR=0.6, 95% Cl=0.5-0.8). TheAPOE∈4-AD association was weaker among African Americans and Hispanics, but there was significant heterogeneity in ORs among studies of African Americans (P Conclusions. —TheAPOE∈4 allele represents a major risk factor for AD in all ethnic groups studied, across all ages between 40 and 90 years, and in both men and women. The association betweenAPOE∈4 and AD in African Americans requires clarification, and the attenuated effect ofAPOE∈4 in Hispanics should be investigated further.

https://jamanetwork.com/journals/jama/articlepdf/418446/jama_278_16_041.pdf

Effects of Age, Sex, and Ethnicity on the Association Between Apolipoprotein E Genotype and Alzheimer Disease: A Meta-analysis

https://academiccommons.columbia.edu/doi/10.7916/D8D520C5/download

Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease

Objective. —Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Design. —Cohort incidence study. Setting. —General community. Participants. —A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. Interventions. —We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Main Outcome Measure. —Incident dementia. Results. —We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [CI], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% CI, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% CI, 1.32 to 3.84). Conclusions. —The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations. (JAMA. 1994;271:1004-1010)

/pdf/influence-of-education-and-occupation-on-the-incidence-of-5dlj6xkhg3.pdf

Influence of Education and Occupation on the Incidence of Alzheimer's Disease

Context.—Although the association between Alzheimer disease (AD) and the apolipoprotein
E ∊4 (APOE-∊4) allele has been confirmed
worldwide, it appears to be inconsistent among African Americans, Hispanics,
and Nigerians.Objective.—To investigate the association between the APOE-∊4
allele and AD in elderly African Americans, Hispanics, and whites.Design.—Prospective, population-based, longitudinal study over a 5-year period
(1991-1996).Setting.—The Washington Heights–Inwood community of New York City.Participants.—A total of 1079 Medicare recipients without AD or a related disorder
at baseline.Main Outcome Measures.—Risk of clinically diagnosed AD in the 3 ethnic groups and among individuals
with and without an APOE-∊4 allele.Results.—Compared with individuals with the APOE-∊3/∊3
genotype, the relative risk (RR) of AD associated with 1 or more copies of
the APOE-∊4 allele was significantly increased
among whites (RR, 2.5; 95% confidence interval [CI], 1.1-6.4), but not among
African Americans (RR, 1.0; 95% CI, 0.6-1.6) or Hispanics (RR, 1.1; 95% CI,
0.7-1.6). In the absence of the APOE-∊4 allele,
the cumulative risks of AD to age 90 years, adjusted for education and sex,
were 4 times higher for African Americans (RR, 4.4; 95% CI, 2.3-8.6) and 2
times higher for Hispanics (RR, 2.3; 95% CI, 1.2-4.3) than for whites. In
the presence of an APOE-∊4 allele, the cumulative
risk of AD to age 90 years was similar for individuals in all 3 ethnic groups.Conclusion.—The presence of an APOE-∊4 allele is a
determinant of AD risk in whites, but African Americans and Hispanics have
an increased frequency of AD regardless of their APOE
genotype. These results suggest that other genes or risk factors may contribute
to the increased risk of AD in African Americans and Hispanics.

https://jamanetwork.com/journals/jama/articlepdf/187321/joc71546.pdf

The Apoe-Epsilon4 Allele and the Risk of Alzheimer Disease among African Americans, Whites, and Hispanics

Background: It remains unclear whether depression increases the risk for dementia in the elderly. We evaluated the relationship between depressed mood at baseline and the incidence of dementia, particularly Alzheimer's disease, in the elderly living in the community. Methods: A total of 1070 elderly individuals, aged 60 years or older, were identified as part of a registry for dementia in the Washington Heights community of North Manhattan, NY. In a prospective, longitudinal design with follow-up for 1 to 5 years, annual physician evaluation and neuropsychological testing were used to assess levels of cognitive impairment and to diagnose dementia. Depressive symptoms were evaluated with the 17-item Hamilton Rating Scale for Depression. Based on clinical considerations and a validity study, a positive score for the depressed mood item was used in statistical analyses. To confirm the results, the total Hamilton Rating Scale for Depression score was also evaluated as the "depression" variable. Results: Of the 1070 subjects, 218 met criteria for dementia at baseline evaluation. In the 852 subjects without dementia, depressed mood was more common in individuals with greater cognitive impairment. In a follow-up study of 478 of these subjects without dementia (mean±SD, 2.54±1.12 years of follow-up), the effect of baseline depressed mood on the end-point diagnosis of dementia (93% had possible or probable Alzheimer's disease) was evaluated in a Cox proportional hazards model. Depressed mood at baseline was associated with an increased risk of incident dementia (relative risk, 2.94; 95% confidence interval, 1.76 to 4.91;P Conclusions: Depressed mood moderately increased the risk of developing dementia, primarily Alzheimer's disease. Whether depressed mood is a very early manifestation of Alzheimer's disease, or increases susceptibility through another mechanism, remains to be determined.

/pdf/depressed-mood-and-the-incidence-of-alzheimer-s-disease-in-xmk0acx0fd.pdf

Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community.

Sex and ethnic differences in the frequency of Parkinson's disease have become increasingly important, because putative genetic and environmental risk factors have been identified. The authors estimated the prevalence and incidence of Parkinson's disease in a culturally diverse community in New York City over a 4-year period (January 1, 1988-December 31, 1991) using a disease registry substantiated, for older individuals, by a subsequent survey of a random sample of Medicare recipients between January 1, 1992, and December 31, 1993. The prevalence rate was 107 per 100,000 persons, and over a 3-year period the average incidence rate was 13 per 100,000 person-years. Age-adjusted prevalence rates were lower for women than for men in each ethnic group and were lower for blacks than for whites and Hispanics. Incidence rates were highest among black men, but they were otherwise comparable across the sex and ethnic groups. The estimated cumulative incidence of Parkinson's disease up to age 90 years was lower for women than for men, which could partially explain the lower prevalence rate. By ethnic group, the cumulative incidence was higher for blacks than for whites and Hispanics, but more deaths occurred among incident black cases. Discrepant prevalence and incidence rates of Parkinson's disease among blacks and women warrant further investigation. While selective mortality could partially account for this paradox, it is also possible that a delay in diagnosis due to limited access to appropriate health services among these individuals could have resulted in the observed discordant rates of disease.

Barry J. Gurland

Papers

Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease

Influence of Education and Occupation on the Incidence of Alzheimer's Disease

The Apoe-Epsilon4 Allele and the Risk of Alzheimer Disease among African Americans, Whites, and Hispanics

Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community.

The Frequency of Idiopathic Parkinson's Disease by Age, Ethnic Group, and Sex in Northern Manhattan, 1988–1993