• global functioning
• geriatric depression
• MBI

Background: Geriatric depression is the most common psychiatric disorder afflicting the elderly, with prevalence rates of 0,4-35% (mean 12.3%) in subjects over 65 years of age. It reduces the quality of life of older people through an increased risk of morbidity, physical, cognitive and functional impairment, as well as greater self-neglect and suicide, all of which are associated with increased mortality. Depression is also one of the most frequent neuropsychiatric symptoms (NPS) in patients with Mild Cognitive Impairment and early forms of dementia. Depression is also included among the core symptoms of the new clinical construct of Mild Behavioral Impairment (MBI). Several studies have investigated the relationship between NPS and dementia, however clinical studies on their presence in pre-dementia stages are still limited.
Methods: A prospective longitudinal study was conducted to investigate the course of a major depressive episode in elderly patients and to study the impact of Mild Behavioral Impairment on short-term outcome in patients with late-life depression. Sixty-four patients were selected based on the following inclusion criteria: 1) age ≥ 60 years, 2) diagnosis of depressive episode according to the International Classification of Diseases, Tenth Edition (ICD-10), 3) a follow-up duration ≥ 3 weeks. The presence of a previous diagnosis of dementia or Parkinson’s disease was considered as an exclusion criterion. Global functioning, cognitive status, psychiatric symptoms severity, and depressive symptomatology were assessed at each visit by means of specific tools, respectively GAF scale, MMSE and BPRS total score. The presence of Mild Behavioral Impairment was assessed through the MBI-Checklist.
Results: The sample of the recruited patients consisted of thirty subjects, of which ten were affected by MBI. The mean follow-up duration of the whole sample was 72.33 ± 31.32 days. We found that BPRS total score at follow-up (mean ± SD, 31.5 ± 4.86) was lower than BPRS total score at baseline (mean ± SD, 38.2 ± 5.99; t = 7.59, p < 0.001, d = 1.23). The presence of MBI syndrome had no significant effect, nor any interaction effect, on clinical/symptomatological course of the depressive episode. At final evaluation BPRS total scores improvements from patients with and without MBI were similar overall. BPRS depressive symptoms showed the same longitudinal pattern. On the contrary, a significant negative interaction between MBI and global functioning was found. In fact, while patients without MBI showed higher GAF score at follow-up (mean ± SD, 67.4 ± 16.90) compared to GAF score at baseline (mean ± SD, 55.8 ± 17.30; t = 4.18, p < 0.001; d = 0.68), patients with MBI showed the same GAF score at follow-up (mean ± SD, 55.5 ± 11.7) and at baseline (mean ± SD, 55.5 ± 12.1; t = 0.00, p = 1.000; d = 0.00).
Conclusions: The presence of Mild Behavioral Impairment in patients with late-life depression affects the short-term outcomes, impairing the improvement in overall functioning. Our results confirm the need for closer control over time in this type of patients. Further longitudinal research is necessary in order to confirm our results.