IVAN APRAHAMIAN
Projetos de Pesquisa
Unidades Organizacionais
LIM/66, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Frailty as a Predictor of Cognitive Disorders: A Systematic Review and Meta-Analysis(2019) BORGES, Marcus Kiiti; CANEVELLI, Marco; CESARI, Matteo; APRAHAMIAN, IvanBackground/Aim: Current evidence in the literature supports associations between frailty, cognitive impairment, and dementia. The study aim was to describe the risk of cognitive disorders associated with physical frailty in older adults from community-based studies. Methods: We performed a systematic review and meta-analysis, using MEDLINE, PsycINFO, Scopus, and Web of Science as databases for the search. Cohort and longitudinal studies were included in qualitative analysis and quantitative synthesis. For inclusion, studies had to assess dementia and cognitive impairment as a primary or secondary outcome, and describe the prevalence of frailty among participants at baseline and follow-up. Results: Of the 2,210 studies retrieved by the systematic review, 6 relevant studies were included in ameta-analysis. Baseline frailty was significantly associated with an increased risk of geriatric cognitive disorders (pooled OR = 1.80, 95% CI = 1.11-2.92; p = 0.02). Heterogeneity across the studies was significant (I-2 = 79%). Conclusions: The analyses confirmed that frail older adults were at higher risk of incident cognitive disorders than non-frail elders. Frailty status seems to be most associated with the risk of incident dementia. Frailty may represent a risk factor for dementia and could constitute a novel modifiable target in early cognitive impairment.
- Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?(2021) BORGES, Marcus Kiiti; VOSHAAR, Richard C. Oude; ROMANINI, Carla Fernanda de Vasconcellos; OLIVEIRA, Fabiana Maria; LIMA, Natalia Almeida; PETRELLA, Marina; COSTA, Daniele Lima; MARTINELLI, Jose Eduardo; MINGARDI, Silvana Vieira Bandeira; SIQUEIRA, Alaise; BIELA, Marina; COLLARD, Rose; APRAHAMIAN, IvanObjectives This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. Methods Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a self-report questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30-item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. Results Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. Conclusions Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. Clinical implications Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.
- Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder A systematic review(2018) SIQUEIRA, Alaise Silva Santos de; FLAKS, Mariana Kneese; BIELLA, Marina Maria; MAUER, Sivan; BORGES, Marcus Kiiti; APRAHAMIAN, IvanAbstract Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM). Objective: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD. Methods: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: ‘depression’, ‘depressive’, ‘depressive symptoms’ AND ‘decision making’ OR ‘game task’. Results: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task. Conclusion: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed.
- Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms(2020) BIELLA, Marina Maria; SIQUEIRA, Alaise Silva Santos de; BORGES, Marcus Kiiti; RIBEIRO, Elyse Soares; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; APOLINARIO, Daniel; APRAHAMIAN, IvanObjective: Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment. Design: Cross-sectional analysis of a cohort study on cognitive aging. Participants: 143 older adults. Setting: University-based memory clinic. Methods: Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles. Results: The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007). Conclusion: Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.
- Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence(2019) BIELLA, Marina Maria; BORGES, Marcus Kiiti; STRAUSS, Jason; MAUER, Sivan; MARTINELLI, Jose Eduardo; APRAHAMIAN, IvanThis study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms ""subthreshold depression,"" ""prevalence,"" ""treatment"" and ""older adults"" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.
- Relationship between affective temperament and major depressive disorder in older adults: A case-control study(2020) MAUER, Sivan; SIQUEIRA, Alaise Silva Santos de; BORGES, Marcus Kiiti; BIELLA, Marina Maria; VOSHAAR, Richard C. Oude; APRAHAMIAN, IvanBackground: : In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. Methods: : A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. Results: : In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR = 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR = 2.9, 95%CI 1.1-7.2). Limitations: : The sample was relatively small, and their educational level was very low. Conclusion: : A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.
- Serotonin receptor inhibitor is associated with falls independent of frailty in older adults(2021) LIN, Sumika M.; BORGES, Marcus K.; SIQUEIRA, Alaise S. S. de; BIELLA, Marina M.; JACOB-FILHO, Wilson; CESARI, Matteo; VOSHAAR, Richard C. Oude; APRAHAMIAN, IvanObjectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ? 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.
- Decision-making executive function profile and performance in older adults with major depression: a case-control study(2022) SIQUEIRA, Alaise Silva Santos; BIELLA, Marina Maria; BORGES, Marcus Kiiti; MAUER, Sivan; APOLINARIO, Daniel; ALVES, Tania Correa de Toledo Ferraz; JACOB-FILHO, Wilson; VOSHAAR, Richard C. Oude; APRAHAMIAN, IvanObjectives Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. Method The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. Results In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. Conclusion Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.
- Depression as a determinant of frailty in late life(2021) BORGES, Marcus K.; APRAHAMIAN, Ivan; V, Carla Romanini; OLIVEIRA, Fabiana M.; MINGARDI, Silvana V. B.; LIMA, Natalia A.; CECATO, Juliana F.; PETRELLA, Marina; VOSHAAR, Richard C. OudeObjectives Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. Method Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. Results Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. Conclusion Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.
- Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review(2019) ORTEGA, Luciane de Fatima Viola; APRAHAMIAN, Ivan; BORGES, Marcus Kiiti; CACAO, Joao de Castilho; YASSUDA, Monica SanchesCognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.