RESUMO
To find associations of age, sex, and education with neuropsychological test performance in cognitively normal Spanish-speaking Costa Rican nonagenarians with little education; to provide norms; and to compare their performance with similar Puerto Ricans. For 95 Costa Ricans (90-102 years old, 0-6 years of education), multiple regression assessed associations with demographics of performance on six neuropsychological tests. Analyses of covariance compared them with 23 Puerto Ricans (90-99 years old). Younger age and being female-but not education-were associated with better performance on some neuropsychological tests, in particular episodic memory. The Puerto Ricans performed better on learning and memory tasks. In cognitively intact Spanish-speaking nonagenarians with little or no education, education did not affect test performance. Additional studies of the effect of education on cognitive performance are warranted in other samples with extremely low education or old age. National differences in performance highlight the importance of group-specific norms.
Assuntos
Envelhecimento/psicologia , Cognição/fisiologia , Comparação Transcultural , Escolaridade , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Testes Neuropsicológicos/estatística & dados numéricos , Fatores Etários , Idoso de 80 Anos ou mais , Costa Rica , Educação , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Porto Rico , Fatores SexuaisRESUMO
OBJECTIVE: To study the association of dementia with apolipoprotein E-e4 (APOE-e4) and its interaction with age in a nonagenarian Costa Rican group (N-sample) and a general elderly contrast group (GE-sample). METHODS: In both case-control studies, participants were cognitively intact or diagnosed with dementia. The N-sample (N = 112) was at least age 90 years; the GE-sample (N = 98) was at least age 65 years. RESULTS: Dementia and APOE-e4 were not significantly associated in the N-sample, but were in the GE-sample. There was a significant interaction of age with APOE-e4 in the N-sample, but not in the GE-sample. Descriptively dividing the N-sample at the median (age 93 years) showed a group interaction: APOE-e4 was more associated with dementia in the younger N-sample than in the older N-sample, where six of seven APOE-e4 carriers were cognitively intact. CONCLUSIONS: The results support the reduction in association of APOE-e4 with dementia in extreme old age, consistent with a survivor effect model for successful cognitive aging.
Assuntos
Envelhecimento/genética , Envelhecimento/psicologia , Apolipoproteína E4/genética , Demência/genética , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Costa Rica , Feminino , Estudos de Associação Genética , Genótipo , Humanos , MasculinoRESUMO
BACKGROUND: This study reports the comparison and associations of demographic, clinical and psychosocial correlates with three unipolar depressive disorders: dysthymia (DYS), major depression (MD) and double depression (DD), and examines to which extent these variables predict the disorders. SAMPLING AND METHOD: Previously collected data from 563 adults from a community in Puerto Rico were analyzed. One hundred and thirty individuals with DYS, 260 with MD and 173 with DD were compared by demographic variables, psychiatric and physical comorbidity, familial psychopathology, psychosocial stressors, functional impairment, self-reliance, problem recognition and formal use of mental health services. Multinomial regression was used to assess the association of the predictor variables with each of the three disorders. RESULTS: Similarities outweighed the discrepancies between the disorders. The main differences observed were between MD and DD, while DYS shared common characteristics with both MD and DD. After other variables were controlled, anxiety, functional impairment and problem recognition most strongly predicted a DD diagnosis, while age predicted a DYS diagnosis. CONCLUSION: MD, DYS and DD are not completely different disorders, but they do differ in key aspects that might be relevant for nosology, research and practice. A dimensional system that incorporates specific categories of disorders would better reflect the different manifestations of unipolar depressive disorders.
Assuntos
Ansiedade , Transtorno Depressivo Maior/psicologia , Transtorno Distímico/psicologia , Adolescente , Adulto , Fatores Etários , Comorbidade , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Distímico/diagnóstico , Transtorno Distímico/epidemiologia , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Análise Multivariada , Valor Preditivo dos Testes , Resolução de Problemas , Porto Rico/epidemiologia , Projetos de Pesquisa , Autoeficácia , Apoio SocialRESUMO
We sought to identify cognitive phenotypes for family/genetic studies of successful cognitive aging (SCA; maintaining intact cognitive functioning while living to late old age). We administered a battery of neuropsychological tests to nondemented nonagenarians (n = 65; mean age = 93.4 ± 3.0) and their offspring (n = 188; mean age = 66.4 ± 5.0) from the Central Valley of Costa Rica. After covarying for age, gender, and years of education, as necessary, heritability was calculated for cognitive functions at three pre-defined levels of complexity: specific neuropsychological functions (e.g., delayed recall, sequencing), three higher level cognitive domains (memory, executive functions, attention), and an overall neuropsychological summary. The highest heritability was for delayed recall (h² = 0.74, se = 0.14, p < 0.0001) but significant heritabilities involving memory were also observed for immediate recall (h² = 0.50), memory as a cognitive domain (h² = 0.53), and the overall neuropsychological summary (h² = 0.42). Heritabilities for sequencing (h² = 0.42), fluency (h² = 0.39), abstraction (h² = 0.36), and the executive functions cognitive domain (h² = 0.35) were also significant. In contrast, the attention domain and memory recognition were not significantly heritable in these families. Among the heritable specific cognitive functions, a strong pleiotropic effect (i.e., evidence that these may be influenced by the same gene or set of genes) for delayed and immediate recall was identified (bivariate statistic = 0.934, p < 0.0001) and more modest but significant effects were found for four additional bivariate relationships. The results support the heritability of good cognitive function in old age and the utilization of several levels of phenotypes, and they suggest that several measures involving memory may be especially useful for family/genetic studies of SCA.
Assuntos
Envelhecimento/genética , Transtornos Cognitivos/genética , Saúde da Família , Transtornos da Memória/genética , Reconhecimento Psicológico/fisiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atenção/fisiologia , Transtornos Cognitivos/epidemiologia , Costa Rica/epidemiologia , Função Executiva/fisiologia , Feminino , Ligação Genética , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Irmãos , Aprendizagem VerbalRESUMO
APOE epsilon4 is a major risk factor for Alzheimer's disease. It has also been associated with cognitive impairment and cognitive decline in young-olds, but the impact of the epsilon4 allele on cognitive function in very late life is still unclear. The object of this study was to evaluate the association of the epsilon4 allele of APOE with the cognitive performance of a sample of non-demented oldest-olds. Eighty-seven Spanish-speaking Puerto Rican non-demented nonagenarians were administered a complete neuropsychological assessment and provided a blood sample used for APOE genotyping. A factor analysis generated two factors: 1) verbal memory; and 2) visuo-spatial, naming and attention tasks, accounting for 43.6% of the overall variance in the 13 original neuropsychological variables. The multivariate analysis reflected, after controlling for gender, education, and age, the APOE epsilon4 carriers performed better in overall cognition (both factors analyzed together) than non-carriers (T
Assuntos
Apolipoproteína E4/genética , Transtornos Cognitivos/genética , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Feminino , Genótipo , Humanos , Masculino , Testes Neuropsicológicos , Porto Rico/epidemiologia , Índice de Gravidade de DoençaRESUMO
Many studies have found that individuals with schizophrenia have been born in winter months in disproportionately high numbers. Temperature and weather effects, such as hot summers or cold winters, have been among the suggested explanations for this seasonality effect. We studied the relationship between schizophrenia and season of birth in Puerto Rico, a tropical island with mild seasonal variation of temperature and virtually no cold periods. Our sample consisted of 132 subjects (57 with schizophrenia, 75 without) from 24 multiplex families. Schizophrenic family members were significantly more likely to be born during the winter months (21/57; 36.8%) than their unaffected relatives (16/75; 21.3%). These results suggest that extreme temperatures are not a sufficient explanation for the seasonality effect and that other factors associated with seasonality may have an effect on the later development of schizophrenia. The fact that a seasonality effect was found in a group likely to have an increased genetic loading for schizophrenia suggests that seasonality may be associated with a second, environmental "hit" in a "two-hit hypothesis" of schizophrenia.
Assuntos
Parto , Esquizofrenia/epidemiologia , Estações do Ano , Clima Tropical , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Esquizofrenia/genéticaRESUMO
A substantial body of evidence from dozens of studies in many different countries suggests an excess number of individuals with schizophrenia are born in winter months. The presence of a seasonality effect in regions with year-round warm climate, however, has rarely been examined. The major purpose of this project was to better understand if the seasonality effect on schizophrenic births that has been reported in other, mostly cold regions of the Northern Hemisphere, also can be detected in a warm, tropical climate. We set out to study birth months as risk factors, quantifying the risk for being born with schizophrenia for every month of the winter season in terms of incidence rate ratios (IRRs) in the central region of Puerto Rico. We also analyzed climatic data in order to determine if there was any correlation between the rate of schizophrenic births (n=710) to births in the general population (n=101,248) and average rainfall and temperature for every month of the year in our period of study (January 1932-December 1967). Our results suggest that the risk of developing schizophrenia is 36.5% higher for people born in February than for people born in the other months of the year (95% C.I.=6.6-74.8%). We also found correlations between the rate of schizophrenic to control births for any given month, and rainfall 4 months earlier (r=0.66, p=0.010), and temperature 5 months earlier (r=0.64, p=0.013) that remained significant after correcting for multiple comparisons.