Cognitive Status Exam

Breaking the Spell

All patients were recruited from the outpatient clinics of Teikyo University Chiba Medical Center (Ichihara, Chiba, Japan), and met the DSM-IV criteria (American Psychiatric Association) for a major depressive episode or AD. Inclusion criteria for this study were (1) a 26 and below score on the MMSE, (2) a 14 and above score on the 17-item Hamilton Rating Scale for Depression (HAM-D), and (3) aged above 65 years. In order to accurately determine the diagnosis, imaging data from CT, MRI, MRA, and/or SPECT were obtained in some cases. Patients with cerebral vascular disease were excluded from the study. We also tried to exclude patients with mild cognitive impairment . This study was approved by ethics committee of Teikyo University Chiba Medical Center (study number 13–226), and performed in accordance with the declaration of Helsinki. All patients and their caregivers provided written informed consent.

Study design

At the initial visit, 34 subjects were administered the COGNISTAT. Then, all subjects were diagnosed and divided into a late-life depression group ( = 24) or late-onset AD group ( = 10) during the first month of study. Diagnoses were not changed during this period. Next, patients were prescribed either antidepressant drugs or cholinesterase inhibitors.

After remission or 6 months of treatment (the study endpoint), a second COGNISTAT was administered to the late-life depression group ( = 15) and late-onset AD group ( = 7) to determine any changes in cognitive function. The late-life depression group comprised patients who received mirtazapine ( = 10), escitalopram ( = 3), and paroxetine ( = 2). The late-onset AD group received donepezil ( = 4), galantamine ( = 2), and paroxetine ( = 1).

For further analysis, we divided patients with late-life depression into remission group ( = 10) and non-remission group ( = 5), depending on whether they achieved remission during the study. We defined remission as a score of 7 or less on the HAM-D.

Measurement of cognitive function

COGNISTAT is typically utilized for assessing multiple cognitive functions, using a screen-metric method . Generally, it takes 15–20 min to administer. The COGNISTAT consists of 10 subsets, including orientation, attention, comprehension, repetition, naming, construction, memory, calculation, similarities, and judgment. The three components, namely comprehension, repetition, and naming, determine the language ability. The two components of similarities and judgment determine the ability to reason. However, these subtests lack the strength of detection compared with other neurocognitive tests, such as WMS and WAIS. The normative data of elderly people were developed to aid diagnosis of cognitive impairment, since aging influences some components of construction, memory, and similarities on the COGNISTAT [–].

Statistical analysis

Multiple analysis of variance (MANOVA) was used to determine the simultaneous existence of significant differences. Statistical analysis was performed using Student’s -test or paired t-test for parametric data, or the Chi square test for non-parametric data. Correlations among scores from COGNISTAT were examined using the Pearson correlation coefficient. Differences were considered significant when values were less than 0.05 for ANOVA, -test, and Chi square test, and 0.01 for correlation coefficient.

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