Publicação
Subjective memory complaints in patients with Mild Cognitive Impairment and in patients with major depressive disorder
| Resumo: | Memory complaints are considered the initial and the most prominent symptom of Alzheimer’s disease (AD), leading the patients to seek for clinical assistance. Recent revised criteria that incorporate biomarkers maintain the report of memory decline by patients or informants as part of the core diagnostic features for AD. Subjective memory complaints (SMC) thus represent an important symptom in clinical practice, as individuals with SMC are at greater risk to develop dementia. On the other hand, memory complaints are very common in the general population and in the community besides elderly people many young individuals consider they are forgetful. The clinical significance of SMC may depend upon the settings where the participants are recruited and may also depend upon the way they are assessed. Patients with amnestic Mild Cognitive Impairment (aMCI) have memory complaints and objective impairment in memory and/or other cognitive domains, without major repercussions in daily life, and are not demented, although the aMCI is a condition that often progresses to dementia, mainly AD. The clinical use of biomarkers has allowed the possibility of diagnosing AD in patients that present with aMCI, as they reflect pathological alterations in the brain characteristic of AD, in particular amyloid-β (Aβ) biomarkers that ascertain whether an individual is in the Alzheimer’s continuum. However, it is recognized that is unfeasible that all patients with aMCI could presently undergo testing of the whole set of biomarkers. Therefore, we aimed to investigate the hypothesis that aMCI patients with biomarkers of amyloid pathology have more SMC than those without amyloid pathology. More specifically, we test whether the Aβ+ aMCI patients present a higher SMC scale total score compared to the Aβ- aMCI patients. The participants were selected from a cohort of nondemented patients with cognitive complaints (CCC) and a comprehensive neuropsychological evaluation on the basis of a diagnosis of aMCI, a detailed assessment of memory difficulties with the SMC scale and known amyloid status that was determined through either CSFAβ 1–42 concentration or amyloid PET imaging. We studied 176 patients with aMCI (90 were Aβ+ and 86 were Aβ-). We observed that the total score of the SMC scale was not significantly different in the Aβ+ aMCI patients (9.48±4.18) when compared to the one of the Aβ- aMCI patients (10.52±4.57). Interestingly, a statistically significant positive correlation was observed between the SMC total score and the GDS (Geriatric Depression Scale) total score in both Aβ+ aMCI (r = 0.489; p = 0.001) and Aβ- aMCI patients (r = 0.594; p < 0.001). The SMC have been extensively studied in the context of AD and other neurodegenerative disorders, but less is known about the characteristics of SMC in patients with MDD. The SMC along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). For sure, SMC are not specific of MDD as are frequently reported by healthy adults as well as by people in the community who seek for primary clinical care. It was suggested that patients with MDD might report complaints qualitatively different from other disorders. Thus, we investigated SMC and the relationship with objective memory performance in patients with MDD in comparison with patients with Mild Cognitive Impairment due to AD (MCI-AD) and healthy controls (HC). Patients with MDD (n=47), MCI-AD (n=43) and HC (n=45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between episodic memory and the SMCS total score was calculated as a measure of memory awareness. We observed that patients with MDD (12.5±4.4) and patients with MCI-AD (10.9±4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0±3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Therefore, patients with MDD had relatively preserved memory tests and showed inaccurate memory self-awareness as they under-estimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC. In the present thesis, we investigated and discussed the role of the SMC to identifyamong the patients with aMCI those who have AD. The results pointed out that evaluating the SMC may not be helpful at this stage of the disease. A discussion was made regarding the possible reasons and other perspectives to study the SMC were advanced. On the other hand, although we found differences in memory awareness between patients with MCI-AD and patients with MDD, it remains unclear whether memory awareness might be useful to discriminate betwen MCI-AD and MDD. Some other perspectives to investigate the relationship between SMC with depressive symptoms, MDD, objective memory performance and ansognosia were debated. |
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| Autores principais: | Mendes, Tiago Heleno |
| Assunto: | Disfunção cognitiva Transtorno depressivo maior Memória subjectiva Doença de Alzheimer Teses de doutoramento - 2022 |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | tese de doutoramento |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório da Universidade de Lisboa |
| Resumo: | Memory complaints are considered the initial and the most prominent symptom of Alzheimer’s disease (AD), leading the patients to seek for clinical assistance. Recent revised criteria that incorporate biomarkers maintain the report of memory decline by patients or informants as part of the core diagnostic features for AD. Subjective memory complaints (SMC) thus represent an important symptom in clinical practice, as individuals with SMC are at greater risk to develop dementia. On the other hand, memory complaints are very common in the general population and in the community besides elderly people many young individuals consider they are forgetful. The clinical significance of SMC may depend upon the settings where the participants are recruited and may also depend upon the way they are assessed. Patients with amnestic Mild Cognitive Impairment (aMCI) have memory complaints and objective impairment in memory and/or other cognitive domains, without major repercussions in daily life, and are not demented, although the aMCI is a condition that often progresses to dementia, mainly AD. The clinical use of biomarkers has allowed the possibility of diagnosing AD in patients that present with aMCI, as they reflect pathological alterations in the brain characteristic of AD, in particular amyloid-β (Aβ) biomarkers that ascertain whether an individual is in the Alzheimer’s continuum. However, it is recognized that is unfeasible that all patients with aMCI could presently undergo testing of the whole set of biomarkers. Therefore, we aimed to investigate the hypothesis that aMCI patients with biomarkers of amyloid pathology have more SMC than those without amyloid pathology. More specifically, we test whether the Aβ+ aMCI patients present a higher SMC scale total score compared to the Aβ- aMCI patients. The participants were selected from a cohort of nondemented patients with cognitive complaints (CCC) and a comprehensive neuropsychological evaluation on the basis of a diagnosis of aMCI, a detailed assessment of memory difficulties with the SMC scale and known amyloid status that was determined through either CSFAβ 1–42 concentration or amyloid PET imaging. We studied 176 patients with aMCI (90 were Aβ+ and 86 were Aβ-). We observed that the total score of the SMC scale was not significantly different in the Aβ+ aMCI patients (9.48±4.18) when compared to the one of the Aβ- aMCI patients (10.52±4.57). Interestingly, a statistically significant positive correlation was observed between the SMC total score and the GDS (Geriatric Depression Scale) total score in both Aβ+ aMCI (r = 0.489; p = 0.001) and Aβ- aMCI patients (r = 0.594; p < 0.001). The SMC have been extensively studied in the context of AD and other neurodegenerative disorders, but less is known about the characteristics of SMC in patients with MDD. The SMC along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). For sure, SMC are not specific of MDD as are frequently reported by healthy adults as well as by people in the community who seek for primary clinical care. It was suggested that patients with MDD might report complaints qualitatively different from other disorders. Thus, we investigated SMC and the relationship with objective memory performance in patients with MDD in comparison with patients with Mild Cognitive Impairment due to AD (MCI-AD) and healthy controls (HC). Patients with MDD (n=47), MCI-AD (n=43) and HC (n=45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between episodic memory and the SMCS total score was calculated as a measure of memory awareness. We observed that patients with MDD (12.5±4.4) and patients with MCI-AD (10.9±4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0±3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Therefore, patients with MDD had relatively preserved memory tests and showed inaccurate memory self-awareness as they under-estimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC. In the present thesis, we investigated and discussed the role of the SMC to identifyamong the patients with aMCI those who have AD. The results pointed out that evaluating the SMC may not be helpful at this stage of the disease. A discussion was made regarding the possible reasons and other perspectives to study the SMC were advanced. On the other hand, although we found differences in memory awareness between patients with MCI-AD and patients with MDD, it remains unclear whether memory awareness might be useful to discriminate betwen MCI-AD and MDD. Some other perspectives to investigate the relationship between SMC with depressive symptoms, MDD, objective memory performance and ansognosia were debated. |
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