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Randomized Controlled Trial
. 2018 Dec;33(12):1604-1612.
doi: 10.1002/gps.4955. Epub 2018 Jul 23.

Clinical and radiological characteristics of early versus late mild cognitive impairment in patients with comorbid depressive disorder

Jeffrey N Motter  1   2 , Gregory H Pelton  3   4 , Kristina D'Antonio  3   4 , Sara N Rushia  1   2 , Monique A Pimontel  1   2 , Jeffrey R Petrella  5 , Ernst Garcon  3   4 , Michaela W Ciovacco  3   4 , Joel R Sneed  1   2   3   4 , P Murali Doraiswamy  5 , Davangere P Devanand  3   4
Affiliations
Randomized Controlled Trial

Clinical and radiological characteristics of early versus late mild cognitive impairment in patients with comorbid depressive disorder

Jeffrey N Motter et al. Int J Geriatr Psychiatry. 2018 Dec.

Abstract

Objective: The classification of mild cognitive impairment (MCI) continues to be debated though it has recently been subtyped into late (LMCI) versus early (EMCI) stages. Older adults presenting with both a depressive disorder (DEP) and cognitive impairment (CI) represent a unique, understudied population. Our aim was to examine baseline characteristics of DEP-CI patients in the DOTCODE trial, a randomized controlled trial of open antidepressant treatment for 16 weeks followed by add-on donepezil or placebo for 62 weeks.

Methods/design: Key inclusion criteria were diagnosis of major depression or dysthymic disorder with Hamilton Depression Rating Scale (HAM-D) score >14, and cognitive impairment defined by MMSE score ≥21 and impaired performance on the WMS-R Logical Memory II test. Patients were classified as EMCI or LMCI based on the 1.5 SD cutoff on tests of verbal memory, and compared on baseline clinical, neuropsychological, and anatomical characteristics.

Results: Seventy-nine DEP-CI patients were recruited of whom 39 met criteria for EMCI and 40 for LMCI. The mean age was 68.9, and mean HAM-D was 23.0. Late mild cognitive impairment patients had significantly worse ADAS-Cog (P < .001), MMSE (P = .004), Block Design (P = .024), Visual Rep II (P = .006), CFL Animal (P = .006), UPSIT (P = .051), as well as smaller right hippocampal volume (P = .037) compared to EMCI patients. MRI indices of cerebrovascular disease did not differ between EMCI and LMCI patients.

Conclusions: Cognitive and neuronal loss markers differed between EMCI and LMCI among patients with DEP-CI, with LMCI being more likely to have the clinical and neuronal loss markers known to be associated with Alzheimer's disease.

Keywords: depression; early mild cognitive impairment; late mild cognitive impairment.

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Figures

Figure 1
Figure 1. ADAS-Cog (13 Item) by MCI subtype
The LMCI group had significantly higher (worse) ADAS-Cog Total scores than EMCI group.
Figure 2
Figure 2. Hippocampus volume by MCI subtype
The LMCI group had significantly smaller right hippocampus volume than the EMCI group. No significant group differences were observed for left hippocampal or total hippocampal volume.
See this image and copyright information in PMC

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