In This Issue

In this study by Ehrt et al. (page 269), pain and depressionwere assessed in 227 Parkinson disease (PD) patients and 100healthy elderly people, employing the Nottingham HealthProfile, the Montgomery-Åsberg Depression Rating Scale, andthe Beck Depression Inventory. Sixty-seven percent of PDpatients and 39% of the controls had pain. PD subjects withpain were more likely to suffer frommajor depression than PDpatients without pain. The presence of pain was associatedwith depression. Pain issues should be integrated in the man-agement of depression in PD.

This study by Tenev et al. (page 276) examined whetherpatients who had a recent stroke and a family history ofpsychiatric disorder were more likely than patients without afamily psychiatric history to have a poststroke depression. Theworld’s literature was reviewed and all relevant studies wereincluded in a group (i.e. meta) analysis. Patients with a familyhistory, compared to those without, were one and a half timesmore likely to develop poststroke depression. Thus, family his-tory constitutes a small risk factor for poststroke depression.

In this study by Ettenhofer et al. (page 281), relationshipsbetween age, cognitive impairment, and adherence to antiret-roviral medication regimens were examined in a sample of 431human immunodeficiency virus (HIV)-positive adults. Meanadherence rates were higher among older (�50 years) thanyounger (�50 years) adults overall. However, neurocognitiveimpairment was associated with poorer medication adherenceamong older participants only. These findings highlight theimportance of optimizing medication adherence rates andevaluating neurocognition in the growing population of olderHIV-infected patients.

Depression, apathy, and parkinsonism are well-known comor-bidities of Alzheimer disease (AD), but whether these prob-lems are interrelated is poorly known. Starkstein et al. (page291) assessed 169 patients with AD over a 1 to 4 year periodusing scales to measure depression, apathy, and parkinson-ism. The main finding was that patients with apathy had moresevere parkinsonism at follow-up, suggesting that apathy inADmay be an early manifestation of a more aggressive type ofdementia.

Nursing home residents spend the majority of their time notengaged in meaningful activities. In an attempt to alleviatethis, Cohen-Mansfield et al. (page 299) describe a model offactors affecting engagement of persons with dementia. Usingthe Observational Measurement of Engagement, the most im-portant dimensions of engagement found were refusal, atten-tion, and attitude. This paper lays the foundation for a newtheoretical framework concerning the mechanisms of interac-tions among persons with cognitive impairment, the environ-ment, and stimulation.

Late-life depression is associated with persistent cognitiveimpairment in a subset of individuals. The purpose of thisstudy by Bhalla et al. (page 308) was to compare the rates of

cognitive diagnoses (Mild Cognitive Impairment [MCI] anddementia) in older adults after responding to antidepressanttreatment for Major Depression with those in never-depressedcomparison subjects. Findings revealed that successfullytreated depressed subjects were at significantly greater risk forboth MCI and dementia.

Visual hallucinations are a common, problematic behavior indementia. This study by Tsuang et al. (page 317) examinesvisual hallucinations in a community-based sample of 148dementia subjects who underwent thorough neuropathologi-cal and clinical assessments. The authors found that dementiasubjects with visual hallucinations were clinically more likelyto have problems with walking, balance, delusions, and apa-thy compared to dementia subjects without visual hallucina-tions. Furthermore, subjects with visual hallucinations werealso more likely to have pathological changes of Parkinsondisease (called Lewy-related pathology) at the time of death,in the cortical areas of their brains than dementia subjectswithout visual hallucinations. Findings from this study sug-gest that visual hallucinations in patients with dementia maybe associated with a specific biological substrate (namelyLewy-related pathology). Additional research is necessary todetermine how these findings may translate into improvedtreatment of visual hallucinations in patients with dementia.

In the study by McGuire et al. (page 324), the prevalence andsociodemographic predictors of current depressive symptomswere examined among 45,534 adults ’65 years from the 2006Behavioral Risk Factor Surveillance System. Participants wereclassified as having current depressive symptoms with a Pa-tient Health Questionnaire 8 score ’10. Current depressivesymptoms were not reported by 95.1% of participants, while4.9% reported current depressive symptoms. The value ofcontinued collection of data on current depressive symptomsfrom a population-based sample is discussed.

In this study by Canuto et al. (page 335), personality traitspredicted clinical outcome in 64 elderly depressed patientstreated in a psychotherapeutic day hospital. Outcomes in-cluded scales assessing depressive mood, quality of life, andself perception of clinical progress. Personality was evaluatedwith the NEO Five-Factor Personality Inventory. Treatmentresistance was associated with negative emotionality, whereasimproved quality of life was related to positive emotionality.Low depressiveness, facets of patients’ mental and experien-tial life, and absence of overcompliance favor clinical progress.

Bogner et al. (page 344) found among a sample of elderlyprimary care patients a subgroup with depressive symptoms,cognitive impairment, and a high likelihood of experiencingthoughts of death or suicide may exist that may not be relatedto apolipoprotein E (APOE-�4). The potential existence of thesubgroup suggests that such individuals may or may not meetcriteria for major depression but have impaired cognitivefunctioning and a high likelihood of thoughts of death orsuicide.