Differential associations of Head and Body Symptoms with depression and physical comorbidity in patients with cognitive impairment

Objective. To test the hypothesis that physical symptoms referred to the head might be specifically associated with depression in patients with cognitive impairment. Methods. Subjects were taken from those enrolled in 'The Mild Project' a prospective study on the natural history of mild dementia (Mini Mental State Examination ≥18) and with a diagnosis of Alzheimer's disease, vascular dementia, and mild cognitive impairment. A total of 129 subjects were included in the study. Physical symptoms were assessed with a checklist investigating nine different body organs or apparati. Physical symptoms were grouped into those referred to the head (Head Symptoms: ear and hearing; eyes and sight; and head and face) and all the others (Body Symptoms). Depressive symptoms were assessed with the Geriatric Depression Scale (GDS) and physical comorbidity with Greenfield's Index of Disease Severity (IDS). Results. The number of patients reporting one or more Head Symptoms linearly increased with increasing depression severity (Mantel-Haenszel test=6.497, df=1, p=0.011), while the number of patients reporting one or more Body Symptoms linearly increased with increasing physical comorbidity (Mantel-Haenszel test=4.726, df=1, p=0.030). These associations were confirmed in multivariate logistic regression models with adjustment for potential confounders (age, gender, education, cognitive performance, daily function, and diagnosis). Conclusions. Head Symptoms are specifically associated with depression while Body Symptoms with physical comorbidity, in patients with cognitive impairment. Recognizing these associations in individual patients may help clinicians decide whether to initiate or continue antidepressant therapy or whether to carry out physical instrumental investigations. Copyright