Unrecognized cognitive decline suggestive of dementia in geriatric depressive patients

José A. Ontiveros-Sánchez de la Barquera, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Felipe H. Sandoval-Aviles, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Magdaleno Pérez-Hernández, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Luis A. De la Garza-Garcia, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Guillermo Sánchez-Torres, Departamento de Psiquiatría, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
Ricardo Ruiz-Meza, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Silvia V. Esquivel-García, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
David M. Guerra-Medellin, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
César E. Luna-Gurrola, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Jaime O. Martínez-Velázquez, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico
Sofía Jezzini-Martinez, Departamento de Psiquiatría, Universidad Autónoma de Nuevo León; Departamento de Psiquiatria, Instituto Tecnológico de Monterrey. Monterrey, Mexico

Background: The present study aims to explore the prevalence of undiagnosed neurocognitive impairment among elderly patients exhibiting depressive symptoms. In addition, it seeks to evaluate the differences between patients with and without cognitive impairment (CI). Methods: A comparative study was conducted with outpatient geriatric patients aged 60 and older exhibiting depressive symptoms. Psychiatrists specializing in mood disorders initially conducted clinical interviews. Patients without neurocognitive impairment were further assessed by a geriatric psychiatrist to evaluate potential cognitive decline indicative of dementia. Standardized tools employed included the executive interview (EXIT25), quality of dementia assessment, Hachinski ischemic score, and mini-mental state examination. Demographic variables and symptom severity were compared between those with and without CI. Results: A total of 77 participants were analyzed after excluding six individuals (mean age: 71.5 years; 70.1% female). Among them, 9 patients (11.7%) exhibited dementia symptoms, while 68 (88.3%) did not. Those with CI had significantly fewer years of education (4.48 years) compared to those without CI (6.5 years; p = 0.01). In addition, 45.5% of impaired patients presented with moderate depressive symptoms, with average clinical global impressions severity scores of 4.4 for major depressive disorder (MDD) and 4.7 for CI. The overall mean Hamilton depression rating scale -D score was 24.9, with 25.3 for MDD patients without cognitive symptoms and 22 for those with CI. Conclusions: Our study revealed that nearly 12% of elderly outpatients receiving depression treatment had unrecognized CI potentially linked to dementia. Notably, there were no significant differences in depression severity, highlighting the need for thorough clinical evaluations to identify cognitive deficits in older patients with depressive symptoms.

Keywords: Cognitive impairment. Depression. Dementia. Tests.