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A Papassotiropoulos

Publications and source records attributed to A Papassotiropoulos.

51 records · Page 3Linked to original sources
PubMed1999

Screening for depression in the elderly: a study on misclassification by screening instruments and improvement of scale performance.

1. The study compares the psychometric performance of the CES-D and the GHQ-12 in a sample of elderly community residents. Misclassification rates of the questionnaires were analyzed and suggestions for improvement of scale performance are made. 2. 287 subjects out of the general population aged 60-99 years were personally interviewed with standardized diagnostic tools and completed both the GHQ-12 and the CES-D. Best-estimate diagnoses served as standards for receiver operating characteristics (ROC) analysis. 3. Both the GHQ-12 and the CES-D discriminated well between depressive and nondepressive subjects (AUROC = 0.794 and AUROC = 0.782, respectively). The amount of false positive results was high for both questionnaires (GHQ-12: 80.6%, CES-D: 90.1%). Increasing age led to more false positive results on the GHQ-12, whereas the CES-D yielded more false positive results in subjects living in an old age residence or together with family members when compared to those living together with their spouse. 4. The GHQ-12 and the CES-D were valid screening instruments for depression in a community sample of elderly subjects. However, both questionnaires yielded a considerable proportion of false positive results. Elevation of the cut-off score may reduce the misclassification rate of the GHQ-12 but not that of the CES-D.

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PubMed1999

The impact of dementia on the detection of depression in elderly subjects from the general population.

BACKGROUND: The performance of the CES-D in a sample of elderly community residents was assessed. The influence of dementia on test performance and the necessity for the use of four factor scores instead of a single summary score of the CES-D were studied. METHOD: Two hundred and eighty-seven subjects out of the general population aged 60-99 years were personally interviewed with standardized diagnostic tools and completed the CES-D. Best-estimate diagnoses served as 'gold standards' for receiver operating characteristics (ROC) analysis. RESULTS: The CES-D discriminated well between depressive and non-depressive subjects. Exclusion of demented subjects from the sample did not markedly increase test performance. Current depressive illness and dementia led to high scores on the CES-D. Unlike the factors 'depressive affect', 'somatic/vegetative complaints', and 'interpersonal relations', the factor' positive affect' of the CES-D discriminated well between demented and non-demented participants. CONCLUSIONS: The CES-D is a valid instrument for screening for depression in a community sample of elderly subjects. Its use can be recommended even if the presence of dementia is likely. The use of factor scores of the CES-D does not substantially contribute to an improvement of overall test performance, but, nevertheless, allows a more detailed insight and better interpretation of test results.

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PubMed1999

The risk of acute suicidality in psychiatric inpatients increases with low plasma cholesterol.

Several studies suggest that the reduction of total cholesterol in blood by lipid-lowering agents is accompanied by a decrease in the incidence of coronary heart disease, but not in total mortality. Likewise, epidemiological studies show that low total cholesterol concentrations appear to be associated with an increased risk of death from suicide and injuries. There is little information with respect to acute suicidality and cholesterol in psychiatric inpatients; therefore the aim of the present study was to examine exactly this relation between plasma cholesterol and acute suicidality. The study comprised 45 acutely suicidal psychiatric inpatients, 95 nonsuicidal inpatients with affective disorder, and 20 healthy subjects. Psychopathological measures (Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, Beck's Suicide Intent Scale) were established in these patients as well as the plasma concentrations of cholesterol in patients and healthy subjects. The most important finding of this study is that the risk of acute suicidality decreases with increasing total cholesterol levels irrespective of age, gender, and nutritional status (i.e., body mass index). Comparison of total cholesterol levels between age- and sex-matched suicidal and nonsuicidal patients with affective disorder supports this observation: Despite the slightly higher body mass index, suicidal patients have significantly lower cholesterol levels than nonsuicidal patients. Our findings support the notion that acute suicidality is associated with low plasma cholesterol; this observation needs to be further studied in the context of a biological marker for suicide risk.

Adult↗
PubMed1999

Detection of subthreshold depression and subthreshold anxiety in the elderly.

OBJECTIVE: To assess the ability of screening instruments to detect subthreshold depression or subthreshold anxiety and to make suggestions for the improvement of instrument performance. DESIGN: Group definition relied on the presence or absence of major psychiatric disorders or of subthreshold disorders (Composite International Diagnostic Interview). SETTING: A community-based study in Germany. PARTICIPANTS: The total sample comprised 274 subjects over 60 years of age; 57 subjects suffered from acute subthreshold depression, 26 subjects suffered from acute subthreshold anxiety, 173 subjects were defined as being healthy (i.e. no acute or lifetime major psychiatric disorder, no acute subthreshold disorder). MEASURES: The short version of the General Health Questionnaire (GHQ-12), the Center for Epidemiologic Studies--Depression Scale (CES-D), the Structured Interview for the Diagnosis of Dementia of the Alzheimer-type, Multiinfarct Dementia and Dementias of other Etiology (SIDAM) for cognitive impairment. RESULTS: Subjects with subthreshold disorders scored higher on the CES-D and the GHQ-12 than healthy individuals. The most distinct increase was observed in the CES-D score of subjects with subthreshold anxiety. The CES-D factor for the presence of somatic/vegetative symptoms performed slightly better compared to the other CES-D factors. CONCLUSIONS: The CES-D moderately detected subthreshold anxiety. Subthreshold depression could not be efficiently detected by either questionnaire. The combination of items indicating the presence of somatic symptoms and depressive affect could improve instrument performance when screening for subthreshold anxiety but not for subthreshold depression.

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PubMed1998

The validity of psychometric instruments for detection of dementia in the elderly general population.

OBJECTIVE: To compare the validity of different instruments for screening and diagnosis of dementia and to provide threshold scores for these purposes, ie screening focusing on a high sensitivity and diagnosis focusing on a high specificity. SETTING: 287 subjects from a general population sample who had completed more than one of these psychometric tests. METHODS: The performances of the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-Infarct Dementia and Dementias of Other Aetiology according to ICD-10 and DSM-III-R, the Mini-Mental State Examination, the Blessed Dementia Rating Scale, the Global Deterioration Scale, the Verbal Fluency Test, the Word list Learning Task, the Trail Making Test and the Labyrinth Test were compared using receiver operating characteristics analysis. RESULTS: The validity of composite instruments for the discrimination of dementia and cognitive health was higher than the validity of individual tests. However, some cognitive tests, ie verbal fluency and immediate recall of words, reached a high validity, making them useful and short screening instruments for dementia. CONCLUSION: There is no perfect instrument for screening and diagnosis of dementia. Different threshold scores for different purposes were provided in the present study. Recommendations for improving the validity of the Delayed Word List Learning Task for discriminating dementia and cognitive health include the expansion of list length and shortening of delay.

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PubMed1998

Differential validity of informant-based diagnoses of dementia and depression in index subjects and in their first-degree relatives.

There is no study indicating that informant-derived information on dementia and depression (i.e. family history information) is equivalently valid for first-degree relatives and for index subjects (i.e. patients and control subjects). However, this unproven assumption is the basis for the frequent, possibly inappropriate, use of instruments validated for patients and control subjects in family studies which focus on frequencies of psychiatric disorders in first-degree relatives. Consequently, there is a need to compare the validity of family history information for both disorders in index subjects and their first-degree relatives. Validity was assessed by comparison of family history information for dementia and depression with interview-derived diagnoses in 75 index subjects and 195 age-matched first-degree relatives. The validity of informant-derived information varied for different disorders, i.e. dementia and depression, and different samples, i.e. index subjects and first-degree relatives. In agreement with the study hypothesis, the sensitivity of surrogate information on dementia was significantly reduced in first-degree relatives in comparison with index subjects. In contrast, the sensitivity to detect depression was equivalent in subjects and in relatives. The results indicate the necessity to assess the validity of the psychiatric diagnoses of interest in the sample of interest, e.g. dementia or depression in first-degree relatives of patients and of control subjects. Observations in selected samples, i.e. subjects treated, hospitalised and/or autopsied, cannot be generalised to first-degree relatives in family studies.

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PubMed1998

Upregulation of the platelet Serotonin2A receptor and low blood serotonin in suicidal psychiatric patients.

Suicidality has been found to be associated with low pre- and postsynaptic serotonin functioning. The purpose of this study was to examine whether in acutely suicidal psychiatric inpatients, the blood serotonin concentration was related to the underlying psychiatric disorder and whether it was associated with changes in the affinity (dissociation constant, KD) or in the maximal binding capacity (Bmax) of the platelet serotonin2A receptor. We therefore determined the blood serotonin concentrations and the platelet serotonin2A receptor activities of 45 suicidal psychiatric patients and 20 healthy subjects. We found that the blood serotonin concentrations were significantly lower in suicidal patients compared to healthy subjects. In all diagnostic categories (affective disorder, schizophrenia and adjustment disorder) we noted a significantly higher maximal binding capacity of the platelet serotonin2A receptor. These findings support the notion that a reduction in the availability of serotonin and an upregulation of the serotonin2A receptors in psychiatric patients are associated with a loss of control over suicidal impulses.

Acute Disease↗
PubMed1996

Induction of apoptosis and secondary necrosis in rat dorsal root ganglion cell cultures by oxidized low density lipoprotein.

Neural cell degeneration underlies central and peripheral nervous system disorders. In this study we examined the influence of oxidized low density lipoprotein (Ox-LDL) on rat dorsal root ganglion (DRG) cells in culture. Methods used were cell morphology, lactate dehydrogenase (LDH) release, the TUNEL-reaction and DNA fragmentation. Exposure of DRG cells to Ox-LDL for 24 h led to elevation of LDH in the culture medium; short term exposure (4 h) induced apoptosis, evidenced by DNA fragmentation and a positive TUNEL-reaction. DRG cells modified LDL in the presence of Cu2+ to mildly oxidized and to a small extent to fully oxidized forms; these in situ-generated LDL oxidation products were strongly toxic. These results suggest that Ox-LDL is a neurotoxin; it initiates apoptotic cell injury which progresses to necrosis and cell death.

Animals↗
PubMed1994

Autoaggressive behavior is closely related to serotonin availability in schizoaffective disorder.

Lowered serotonin turnover has been observed in impulsive hetero- and auto-aggressive behavior. Most notably the CSF 5-hydroxyindole acetic acid concentrations were decreased. However, data on CSF or blood serotonin are far from clear-cut, since similar levels in suicidal and non-suicidal patients have also been noted. Longitudinal studies of suicidal patients have revealed pronounced shifts in blood serotonin levels, whereas healthy subjects' blood serotonin levels remained stable. We investigated blood serotonin levels of female schizoaffective patients and healthy women to test whether the fluctuations correlated with changes in autoaggressive behavior. The patients were divided into three groups: nonsuicidal, acutely suicidal, and postsuicidal. Nonsuicidal and postsuicidal schizoaffective patients' and healthy women's blood serotonin levels were similar. Suicidal patients' blood serotonin levels were significantly lower than those of healthy subjects and postsuicidal patients. We interpret the serotonin augmentation after a suicide attempt as a psychobiological correlate of increased neurotransmitter function.

Adult↗
PubMedDate not supplied

Age and cognitive impairment influence the performance of the General Health Questionnaire.

The General Health Questionnaire (GHQ) is a screening instrument designed to detect nonpsychotic psychiatric disorders. Its discriminating ability can be influenced by factors such as the presence of physical illness, comorbidity with other psychiatric disorders, and the presence of cognitive impairment, which are more frequent in the elderly. The present study examines the influence of age and cognitive impairment on the performance of the GHQ-12, and was performed in the course of a family study designed to evaluate the risks for dementia, depression, and geriatric depression in the relatives of elderly subjects with dementia of Alzheimer type or major depression. Four hundred subjects who had completed the GHQ-12 were included. Test performance was evaluated by receiver-operating characteristic (ROC) analysis. Our results indicate that (1) the GHQ-12 is applicable to elderly subjects (>65 years), (2) its performance is comparable in different age groups, (3) the cutoff value for case identification is higher in the elderly (3/4) compared with younger individuals (1/2) and (4) mild cognitive impairment does not influence the good performance of the GHQ-12 in elderly subjects. In conclusion, our study verifies the usefulness of the GHQ-12 as an instrument to identify states of depression; this applies also to subjects with mild intellectual impairment. To optimize the discriminative ability of the questionnaire, we propose the use of different cutoff values for the GHQ-12 score for case identification depending on the age of each individual.

Adult↗
PubMedDate not supplied

24S-hydroxycholesterol in cerebrospinal fluid is elevated in early stages of dementia.

The brain is the most cholesterol-rich organ in the human body. Accumulation of excess cholesterol in hippocampal neurons promotes the cleavage of the amyloid precursor protein (APP) into amyloidogenic components with the consequence of the acceleration of neuronal degeneration. Conversion of cholesterol to 24S-hydroxycholesterol mediated by cholesterol 24S-hydroxylase (CYP46) is the major pathway for the elimination of brain cholesterol and the maintenance of brain cholesterol homeostasis. We examined whether cerebrospinal fluid (CSF) 24S-hydroxycholesterol levels differ between patients with dementia, patients with mild cognitive impairment (MCI), and cognitively intact control subjects. Plasma and CSF concentrations of 24S-hydroxycholesterol and cholesterol in 32 patients with Alzheimer's disease (AD), 11 patients with vascular dementia, seven patients with MCI, and seven cognitively intact control subjects were measured by combined gas-chromatography/mass spectrometry. We show elevated concentrations of 24S-hydroxycholesterol in the CSF of AD patients and we interpret this finding as a consequence of increased cholesterol turnover in the central nervous system during neurodegeneration. The observed influence of the apolipoprotein E epsilon4 (APOE4) allele on CSF 24S-hydroxycholesterol concentrations with a gene-dosage effect suggests the existence of a link between the AD risk factor APOE4 and CNS cholesterol metabolism. The elevation of CSF 24S-hydroxycholesterol appears to occur early in the disease process, since patients with mild cognitive impairment had also increased CSF concentrations of this compound. We believe that the CSF concentration of 24S-hydroxycholesterol is altered in AD-related neurodegeneration and thus, CSF 24S-hydroxycholesterol may be a marker for monitoring the onset and progression of the disease.

Aged↗
PubMedDate not supplied

Genetics of interleukin 6: implications for Alzheimer's disease.

Alzheimer's disease (AD) is a neurodegenerative disorder that preferentially affects individuals above 60 years, with increasing risk in older ages. Neuropathological hallmarks of AD include brain atrophy, senile plaques, and neurofibrillary tangles. In addition, inflammatory processes frequently accompany the neuropathology of AD. Among several mediators of the inflammatory response, interleukin 6 (IL6) may play a role in these inflammatory processes. Polymorphisms of the IL6 gene are associated with changed IL6 gene expression, and with altered immune responses resulting in such phenotypes as early transplant rejection, the development of anti-histone antibodies in systemic lupus erythematosus, or altered bone resorption in osteoporosis. Recent data suggested that IL6 is also genetically associated with AD, but many questions remain to be answered. Which polymorphic sites can be identified within functional regions of IL6, and how do they affect gene expression, neurobiological function and pathophysiological events in health and AD? Are there interactions of other genes with IL6 that affect the development and progression of AD? Are such interactions additive, sub-additive, synergistic, or epistatic in nature? How do IL6 polymorphisms influence the therapy of AD? Answering some of these questions will be a good start toward assessing the role of IL6 in the genetics of AD.

Alzheimer Disease↗
PubMedDate not supplied

Early-onset and late-onset depression are independent of the genetic polymorphism of apolipoprotein E.

The recently shown association between apolipoprotein E (APOE) genotype and depressive illness has been challenged by subsequent studies. However, controversial results may derive from the different diagnostic criteria used for depression and from the small numbers of depressed patients included in the studies. We examined the association between depression and the genetic polymorphism of APOE in a large sample of depressed patients, Alzheimer's disease (AD) patients, and healthy controls following clear definitions for late-life depression. The cumulative incidence of depression depending on the age at onset of the first episode was examined by survival analysis. Our data do not disconfirm the hypothesis of depression sharing some common pathophysiologic features with AD, however, it seems very unlikely that the APOE genotype will elucidate the assumed common mechanisms.

Age Factors↗
PubMedDate not supplied

Alpha-1-antichymotrypsin gene polymorphism and risk for sporadic Alzheimer's disease in a German population.

The A allele of a common A-T polymorphism in the signal peptide of alpha(1)-antichymotrypsin gene (ACT) has been reported to contribute a two- to threefold increased risk to Alzheimer's disease (AD) patients who carry the apolipoprotein E epsilon4 (APOE epsilon4) genotype. Since the ACT expression in AD brains is enhanced in particular in areas that develop amyloid plaques, the ACT polymorphism is considered to be a good candidate gene. We have analyzed this polymorphism in 102 AD patients and 191 matched controls, all originating from Western Germany. No statistically significant differences in allele frequencies and in genotype distribution of ACT could be shown between AD patients and controls. When we analyzed the polymorphism in APOE epsilon4 carriers, no overrepresentation in our AD group could be shown for the ACT*AA genotype carriers. Copyrightz1999S.KargerAG,Basel

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