title: Incidence and predictive factors of depressive symptoms in Alzheimer's disease: the REAL.FR study.
abstract: BACKGROUND
  Many patients develop psychiatric and behavioral disturbances in the course of Alzheimer's disease (AD). Among these disturbances, depressive symptoms are frequent and affect nearly 40% of patients. The natural history and course of such symptoms in AD, and in particular the predictive factors, are little known. We studied the incidence and risk factors for the development of the first depressive symptoms in AD.
  
  
  METHODS
  Multicenter prospective study.
  
  
  METHODS
  Three hundred twelve AD patients from the French Network on AD (REAL.FR) without depression and without antidepressant treatment at baseline were followed up and assessed every 6 months for 4 years. During follow-up, all events occurring between two visits were carefully recorded.
  
  
  METHODS
  We used the Neuropsychiatric Inventory (NPI) for comprehensive evaluation of behavioral and psychological symptoms and depressive symptoms in particular. A multivariate analysis was performed using a backward stepwise Cox proportional hazards model.
  
  
  RESULTS
  The incidence of depressive symptoms was 17.45% person/years, 95%CI (13.88-21.02). Among non-time dependent variables, duration of disease (RR=0.51; 95%CI: 0.30-0.85, p=0.0102) and the number of comorbid conditions (RR=0.45; 95%CI: 0.24-0.83, p=0.0115) were protective factors against the development of depressive symptoms. Agitation/aggression (RR=1.96; 95%CI: 1.19-3.23, p=0.0078) and sleep disturbances (RR=2.65; 95%CI: 1.40-5.00, p=0.0026) were time-dependent variables predictive of depressive symptoms.
  
  
  CONCLUSIONS
  Better knowledge of predictive factors of mood disturbances in AD will enable clinicians to set up appropriate management of their patients. As published longitudinal studies are few, further works should be carried out to improve knowledge of the pattern and course of depression and depressive symptoms in AD.
authors.affiliation: Toulouse University, UPS, Traumatic Stress Laboratory-LST (Je2511), Hopital Casselardit, 170 av. de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France. arbus.c@chu-toulouse.fr
authors.forename: C
authors.initials: C
authors.lastname: Arbus
authors.forename: V
authors.initials: V
authors.lastname: Gardette
authors.forename: C E
authors.initials: CE
authors.lastname: Cantet
authors.forename: S
authors.initials: S
authors.lastname: Andrieu
authors.forename: F
authors.initials: F
authors.lastname: Nourhashémi
authors.forename: L
authors.initials: L
authors.lastname: Schmitt
authors.forename: B
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders