Fatores relacionados ao perfil clínico, funcional, cognitivo, genético e de predição da mortalidade em pacientes idosos com depressão e demência

Abstract

Background and aims: Alzheimer disease (DA) and major depressive disorder are highly prevalent diseases among the elder and which determine high rates of incapacities. Previous studies suggest that depression can represent a risk factor for DA or a precocious manifestation of the disease. These diseases often present associated comorbities, characterized as complex diseases involving multiple physiopathological mechanisms and polymorphisms. For these are diseases which receive symptomatic treatment, are highly expensive and feature significant collateral damage, and also attack a significant number of older people determining irreversible incapacity, it becomes necessary to clarify the mechanisms involved in its origins and progression. This studys objective was to evaluate the comorbities, genotypes, cognition, functional factors and mortality predictors in older patients with dementia and depression. Patients and methods: A transversal study was conducted in a Geriatric Service in Belo Horizonte, Brazil, involving 720 elder patients subdivided in 3 groups: control (112 elders), dementia DA, vascular and mixed (312 elders) and late-lifedepression (296 elders). Several aspects were analysed such as sociodemographical and socioenvironmental variables, comorbities, the Charlson Index, dementia and medicine data, functional decrease (Katz and Lawton-Brody Indexes), Mini Mental State Examination (MMSE) and the ApoE genes polymorphisms genotype. The frequencies and interactions of these variables were analysed through the comparison between the dementia and depression groups and the control group in both uni and multivaried forms, using the following softwares: Access®, 2007; Excel®, R 2.7.1 and Epi-Info 6.04. Ethical issues: This projectwas approved by the Research Ethics Committee of the Federal University of Minas Gerais and every person who took part in it signed the Consent Term. Results: The time span between the symptoms appearance and diagnosis and specific treatment for DA was 28 and34 months respectively. For depression, both averaged 24 months. Regarding sociodemographic variables, the average age was 74 years, 73.5% of the evaluated patients were females, 54.4% were married and tea average education level was three years. The most frequent comorbities were systemic arterial hypertension (74.3%), sleep disorder (48.3%) and hyperlipidemia (28.9%). In the multivaried analysis, there was no difference between the diseases as far as gender was concerned, but there was a difference related to age and thenumber of clinical comorbities. Elder patients, with a greater number of comorbities, greater number of medicines and bad sleep quality were found in the dementia and depression group. Depression revealed itself associated to arthritis when compared to the dementia group.Regarding the MMSE, patients with chronic obstructive pulmonary disease, stroke, cardiac insufficiency and fibrosing hepatopathy presented a lower score in their evaluation when compared to other evaluated comorbities. The presence of the 4 allele was associated withthe DA patients. Regarding the Charlson Index, there was similarity between the groups around the evaluated comorbities, when age corrected, with bigger score to the dementia group. Conclusions: For improved knowledge and handling of the elder with depression anddementia, there should be consideration to variations in the comorbities which can define the most appropriate treatment for each patient. Thus, it is possible to directly interfere in the aimed result with the performed interventions and consequently in the quality of life of theseindividuals and their relatives.