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We would like to use our own data to debate the article by Modrego and Ferrandez1 on the risk of developing dementia of Alzheimer type (AD) for patients with depression and mild cognitive impairment (MCI). The authors conclude that patients with MCI and depression are at more than twice the risk of developing AD as those without depression.
In our sample, 46 consecutive patients with MCI, fulfilling the criteria proposed by Petersen et al,2 were included and re-evaluated after 2 years. According to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the number of patients with depression at baseline was 22 (47.8%). All patients with depression were treated with a selective serotonin reuptake inhibitor. Of the 24 patients without depression, 17 developed dementia at follow-up and 7 did not; in contrast, 8 patients with depression developed dementia and 14 did not. Furthermore, patients with depression remained more stable on cognitive performances than patients with MCI who did not have depression. (Mean ± SD change of Mini-Mental State Examination scores in patients with depression was −0.8 ± 3.1, and in patients without depression, it was −3.1 ± 3.8; P = .03.)
Our data are in contrast with those by Modrego and Ferrandez, who hypothesize that patients with MCI and depression are at a greater risk of developing dementia in a short period than are patients with MCI who do not have depression. At the 2-year follow-up, we also observed that patients with MCI and depression show an improvement in the symptoms of depression (mean ± SD change in Geriatric Depression Scale short form score, −2.6 ± 2.3; P<.001) and that there was no change in mood in patients without depression (mean ± SD change in Geriatric Depression Scale score, 0.5 ± 2.3; P = not significant).
A possible explanation of this result is that at baseline, our patient subgroups showed no cognitive differences, as outlined in the Table; on the contrary, in the study by Modrego and Ferrandez, patients with depression were more compromised in memory function at baseline. Longitudinal studies have found that the symptoms of depression are related to cognitive decline and the risk of clinical AD, suggesting that symptoms of depression might be an early sign of AD.3 Our results provide no support for this hypothesis but show that depression could have a different pathophysiological basis from AD, as demonstrated in a recent paper showing that the symptoms of depression neither correlated with summary measures of plaques and tangles in cortical regions nor altered the relation of these pathologic indices to clinical disease.4
Correspondence: Dr Rozzini, Department of Neurology, University of Brescia, Piazzale Spedali Civili, 1 Brescia 25100, Italy (lrozzini@iol.it).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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