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      Patients with carotid atherosclerosis who underwent or did not undergo carotid endarterectomy: outcome on mood, cognition and quality of life

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          Abstract

          Background

          To compare the six-month outcome on mood, cognition and quality of life (QoL) in patients with severe carotid atherosclerosis (CA) who underwent carotid endarterectomy (CEA) with subjects who refused treatment.

          Methods

          Cohort study on consecutive inpatients with CA (stenosis ≥ 50 %) ( N = 46; age 72.56 ± 7.26; male 65.2 %). Intervention cohort: subjects who decided to undergo CEA ( N = 35); Control cohort patients who refused CEA ( N = 11). DSM-IV-Psychiatric diagnosis made by clinicians using interviews, QoL measured by Short Form Health Survey (SF-12); cognitive performance by WAIS Intelligent Coefficient (IC).

          Results

          The study showed a better improvement during six months in Overall IC, Performance IC and Verbal IC in the group that underwent CEA. QoL in the two cohorts did not reach statistical significance. Percentages of patients who improved in the CEA group were significantly higher with regard to Overall and Verbal IC scores, and at the limits of statistical significance in Performance IC. The differences of subject with improvement in SF-12 score in the two groups did not reach statistical significance. Ages below 68 were found to be determinant of a good outcome in Overall IC score. Limit: study conducted with a small sample size.

          Conclusions

          Patients with severe carotid atherosclerosis who underwent CEA enhanced their cognitive performance.

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          Most cited references29

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          Cardiovascular disease in the developing world: prevalences, patterns, and the potential of early disease detection.

          Over the past decade or more, the prevalence of traditional risk factors for atherosclerotic cardiovascular diseases has been increasing in the major populous countries of the developing world, including China and India, with consequent increases in the rates of coronary and cerebrovascular events. Indeed, by 2020, cardiovascular diseases are predicted to be the major causes of morbidity and mortality in most developing nations around the world. Techniques for the early detection of arterial damage have provided important insights into disease patterns and pathogenesis and especially the effects of progressive urbanization on cardiovascular risk in these populations. Furthermore, certain other diseases affecting the cardiovascular system remain prevalent and important causes of cardiovascular morbidity and mortality in developing countries, including the cardiac effects of rheumatic heart disease and the vascular effects of malaria. Imaging and functional studies of early cardiovascular changes in those disease processes have also recently been published by various groups, allowing consideration of screening and early treatment opportunities. In this report, the authors review the prevalences and patterns of major cardiovascular diseases in the developing world, as well as potential opportunities provided by early disease detection. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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            Frontal white matter microstructure and treatment response of late-life depression: a preliminary study.

            This study tested the hypothesis that microstructural abnormalities in white matter areas of the brain containing frontostriatal tracts are associated with a low rate of remission of geriatric depression. Thirteen older patients with major depression received open, but controlled, treatment with citalopram at a target daily dose of 40 mg for 12 weeks. Diffusion tensor imaging was used to determine fractional anisotropy in preselected white matter regions. Survival analysis with Cox's proportional hazards model revealed that lower fractional anisotropy of the right and the left frontal white matter regions 15 mm above the anterior commissure-posterior commissure plane was associated with a low remission rate after age was considered. Remission was not significantly associated with fractional anisotropy of lower frontal regions or a temporal region. Microstructural white matter abnormalities lateral to the anterior cingulate may be associated with a low rate of remission of geriatric depression.
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              The Use of Antidepressant Drugs and the Lifetime Prevalence of Major Depressive Disorders in Italy

              Background: The increased use of antidepressant drugs (ADs) improved the response to the needs of care although some community surveys have shown that subjects without lifetime psychiatric diagnosis (anxiety/depression) used ADs. Objectives: To evaluate the appropriateness and amount of prescription of psychotropic drugs in people with lifetime diagnosis of Major Depressive Disorder (MDD) by means of community survey with a semi-structured interview as a diagnostic instrument, administered by clinicians. Methods: Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4.999 people were drawn in 7 centres of 6 Italian regions. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview for DSM-IV modified (ANTAS); Training: interviewers were trained psychologists or medical doctors. Results: 3.398 subjects were interviewed (68% of the recruited sample). The lifetime prevalence of DSM-IV MDD was 4.3% in males and 11.5% in females; antidepressant drugs were taken by 4.7% of subjects, 2.9% male and 5.9% female. 38% of males and 57% of females with lifetime diagnosis of MDD were taking ADs. Conclusions: Compared with studies using lay interviewers and structured tools the prevalence of the MDD was quite lower; ADs use was higher and tallied well with the data regarding antidepressant sales in Italy; the correspondence between lifetime diagnosis of MDD and ADs use was closer.
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                Author and article information

                Contributors
                mgcarta@tiscali.it
                mefi81@hotmail.it
                lucasaba@tiscali.it
                sanfilippo@pacs.unica.it
                pintuselisa@yahoo.it
                michela.cadoni91@gmail.com
                federicasancassiani@yahoo.it
                mfmoro@gmail.com
                davcrab@pacs.unica.it
                logiudice@pacs.unica.it
                gabriele.finco@gmail.com
                mmusu@unica.it
                roberto.montisci@iol.it
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                12 November 2015
                12 November 2015
                2015
                : 15
                : 277
                Affiliations
                [ ]Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
                [ ]Center for Liaison Psychiatry, Psychosomatics, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari, Cagliari, Italy
                [ ]Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), of Cagliari, Polo di Monserrato s.s. 554, Monserrato, 09045 Cagliari, Italy
                [ ]Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), of Cagliari, Polo di Monserrato, s.s. 554 Monserrato, Cagliari, 09045 Italy
                [ ]Department of Medical Science, University of Cagliari, Cagliari, Italy
                Article
                663
                10.1186/s12888-015-0663-y
                4642779
                26563766
                76198dd2-9de1-4f4b-884d-c367855c8787
                © Carta et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 20 February 2015
                : 27 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Clinical Psychology & Psychiatry
                carotid atherosclerosis,carotid endarterectomy,depressive disorders,cognitive impairment,quality of life

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