Social isolation, cognitive reserve, and cognition in older people with depression and anxiety

Associations between cognitive function, metabolic factors and depression: A prospective study in Quebec, Canada

BACKGROUND

Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age.

METHODS

Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history.

RESULTS

Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83-19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71-2.02), 3.10 (95%CI 1.81-5.24), and 1.39 (95%CI 0.72-2.67), respectively.

LIMITATIONS

Depression was only assessed at follow-up.

CONCLUSION

Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.

Social isolation and cognitive decline among older adults with depressive symptoms: prospective findings from the China Health and Retirement Longitudinal Study

OBJECTIVES

Identifying potentially modifiable risk factors of cognitive decline among people with depressive symptoms could provide insight into strategies for improving treatment effect of depression and prevention of dementia. Quite a few studies have examined the association between social isolation and cognitive function directly among depressed older adults and the results are still mixed. The aim is to examine the association of social isolation and cognitive decline among older adults with depressive symptoms in a non-Western country.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were measured by the Chinese version of the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) (elevated depressive symptom cutoff≥10). Social isolation was assessed based on responses to four items: marital status, residence, contact with children, and social activity. Lagged dependent variable regressions adjusted for confounding factors were used to evaluate the association between baseline social isolation and follow-up cognitive function.

RESULTS

A number of 2,507 participants [mean age (SD)=61.37 (7.26); male, 41.0%] with increased depressive symptoms were available for the present study. Baseline social isolation was significantly associated with 4-year episodic memory (β=-0.08, p<0.001) in depressed women, but not men (β=-0.03, p=0.350). No significant association between baseline social isolation and follow-up mental status was found for women (β=-0.04, p=0.097) or men (β=0.01, p=0.741).

DISCUSSION

This longitudinal study found that social isolation was significantly associated with memory decline over 4 years among depressed women (but not men) in China.

Relationship between Cognitive Performance and Depressive Symptoms in Chinese Older Adults: The China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

In China, an increasing number of people are aging; therefore, attention should be paid to age-related cognitive impairment. With the increasing attention given to geriatric depression in recent years, we focused our investigation on the relationship between depression in the elderly and cognitive decline in a large Chinese community study.

METHODS

We screened 4,771 subjects that met the inclusion criteria from the China Health and Retirement Longitudinal Study database. Depressive symptoms and cognitive performance were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and Mini-Mental State Examination (MMSE), respectively.

RESULTS

We found that 4.46% of the elderly have depression and 35.19% have depressive symptoms. Lower education, higher CESD-10 score, increased age, and more negative marital status were associated with poor cognitive performance in the Chinese elderly. CESD-10 is negatively correlated with each MMSE item, including orientation, memory, attention and computation, and language.

LIMITATIONS

It was difficult to draw conclusions about causation since there was no follow-up data, and high CESD-10 scores do not represent the population study finally diagnosed with depression. Finally, it is not clear whether the decline in cognitive function had an impact on participants' understanding of the problems in the CESD-10.

CONCLUSIONS

This study preliminary prompted severe depressive symptoms associated with worse cognitive performance in a Chinese elderly community population.

Impact of Social Isolation on Subsequent Peptic Ulcer Recurrence in Older Adults With Mild Cognitive Impairment: The Role of Change in Severity of Depression

OBJECTIVE

This study aimed to examine the association between social isolation, change in severity of depression, and subsequent recurrence of peptic ulcer disease (PUD) in older adults with mild cognitive impairment.

METHODS

Older adults (≥55 years) with mild cognitive impairment and Helicobacter pylori-infected PUD (N = 2208) were recruited between 2010 and 2014 from 12 hospitals in the People's Republic of China. H. pylori was eradicated and PUD was cleared in 2015 participants by the end of 2014; 1900 of these were followed up for up to 36 months. The Kaplan-Meier method was used to assess how PUD recurrence varied with social engagement levels and changes in depression severity. Multivariate Cox proportional hazard models were used to examine associations between social isolation, changes in depression severity, and PUD recurrence.

RESULTS

PUD recurrence was more prevalent in socially isolated (10.8%) than in socially engaged participants (5.5%). However, the rates of PUD were lower in socially isolated individuals without (absence of) depression (7.2%) and those with decreased depression (8.2%), whereas socially isolated individuals with unchanged and increased depression had substantially higher rates of PUD (16.3% and 17.8%, respectively; the social isolation by depression group for PUD recurrence was significant (p < .001). Specifically, although social isolation was associated with PUD recurrence during the 36-month follow-up period (hazard ratio [HR] = 2.665 [1.602-4.518]), it did not increase PUD recurrence risk in participants without depression or with reduced depression. However, in participants with unchanged or increased depression, PUD recurrence was more likely to occur in socially isolated (HR = 1.587 [1.125-2.588]; HR = 1.886 [1.012, 3.522] respectively) than in socially engaged participants.

CONCLUSIONS

Social isolation is associated with a greater risk of PUD recurrence; however, the absence of or decreased severity of depression may alter this relationship.

Social Isolation and Loneliness in Older Adults: Review and Commentary of a National Academies Report

The authors of this review both served on the National Academy of Science, Engineering, and Medicine Committee that produced the report, "Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System." In 2018, the AARP Foundation commissioned the National Academies to establish a committee to research and develop a report on social isolation and loneliness in persons 50 years of age and older. Emphasis was placed upon the role of the healthcare system in addressing this fundamental public health problem. The committee released the report in February 2020 as the Corona Virus Disease 2019 pandemic was beginning to spread to North America. In this review, the authors share central findings and conclusions from the report as well as how these findings may be relevant to the care and well-being of older adults during this historic pandemic. The health protective benefits of social distancing must be balanced by the essential need for sustaining social relationships.

Subjective Cognitive Decline, Cognitive Reserve Indicators, and the Incidence of Dementia

OBJECTIVE

Both cognitive reserve and subjective cognitive decline are closely related to the risk of dementia. We investigated whether cognitive reserve can modify the risk of dementia developing from subjective cognitive decline.

DESIGN

Longitudinal population-based study.

SETTING AND PARTICIPANTS

The prospective study analyzed data from 2099 participants aged 65 or over from the Cognitive Function and Ageing Study-Wales (CFAS-Wales).

METHODS

Dementia was ascertained through the comprehensive judgment symptoms of geriatric mental state automated geriatric examination for computer assisted taxonomy (GMS-AGECAT). Subjective cognitive decline was evaluated by 2 questions in the baseline interview. Cognitive reserve indicators were derived from 3 previously identified factors: early life education, mid-life occupational complexity, and late-life cognitive activities. We used logistic regression models to estimate dementia risk in relation to subjective cognitive decline and indicators of cognitive reserve. The interaction between subjective cognitive decline and cognitive reserve were evaluated by additive and multiplicative scales.

RESULTS

Baseline subjective cognitive decline and low cognitive reserve significantly increased the risk of dementia, after 2 years of follow-up. There was an additive interaction between subjective cognitive decline and cognitive reserve [the relative excess risk due to interaction = -0.63, 95% confidence interval (CI) = -0.89 to -0.36, P for additive interaction <0.001]. There was no multiplicative interaction between subjective cognitive decline and cognitive reserve indicator (P = .138). Statistically significant association between subjective cognitive decline and dementia was found only in the low-level and medium-level cognitive reserve group (OR = 3.78, 95% CI = 1.50-9.55 and OR = 3.64, 95% CI = 1.09-12.2, respectively), but not in the high-level groups.

CONCLUSION AND IMPLICATIONS

Cognitive reserve attenuated subjective cognitive decline associated risk of developing dementia. This finding suggests the need for greater emphasis on detecting prodromal dementia when older patients having lower cognitive reserve present with subjective cognitive decline.

Prevalence of loneliness and association with depressive and anxiety symptoms among retirees in Northcentral Nigeria: a cross-sectional study

BACKGROUND

Retirees face numerous challenges, including disassociation from persons in their social networks in Nigeria. Perceived social isolation or loneliness could impair the quality of life in old age, and lead to mental disorders. However, it is uncertain whether perceived loneliness has an independent association with depressive and anxiety symptoms and comorbid conditions in Nigerian retirees. Therefore, we aimed at examining the association between perceived loneliness, depressive and anxiety symptoms, including comorbid conditions among retirees in Northcentral Nigeria.

METHODS

This community-based cross-sectional study enrolled retirees aged 60 years and above in different pension zones from February 2019 to August 2019. A two-stage sampling procedure was used to select the study participants. Data on perceived loneliness, depressive, and anxiety symptoms were collected using the 8-item University of California, Los Angeles Loneliness Scale (ULS-8), and the DASS 21-depression and anxiety subscales, respectively. We collected information on the demographic characteristics using a well-validated structured questionnaire. Descriptive statistics, binary and multivariable logistic regression were used to examine the independent associations between loneliness, depression, anxiety, and anxious depression. P-values below 0.05 were considered statistically significant.

RESULTS

The mean age of participants was 71.3 (± 6.01) years, and 54.4% were men. The prevalence of loneliness, depression, anxiety, and anxious depression was 21.8, 52.0, 27.7, and 20.5%, respectively. Retirees with depression or anxiety symptoms perceived that they were lonelier than those without depression or anxiety. The multivariable logistic regression model showed that female gender (AOR 1.49; 95% CI (1.09, 2.00), having secondary education (AOR 2.24, 95% CI (1.40, 3.57) and having higher education (AOR 3.82, 95%CI (2.37, 6.16) were significantly associated with depression. Also, lonely retirees are 1.19 times (AOR 1.19; 95% CI (0.84, 1.69) more likely to be depressed compared to retirees that are not lonely, and the anxious depressed retirees are 314.58 times (AOR 314.58; 95% CI (508.05, 1941.70) more likely to be depressed than those without anxious depression.

CONCLUSION

The prevalence of loneliness, depression, anxiety, and anxious depression were relatively high among the older retirees. Female gender and advanced age were significantly associated with perceived loneliness, depression and anxiety.

The impact of traumatic brain injury on cognitive and neuropsychiatric symptoms of Parkinson's disease

The objective was to determine whether a history of traumatic brain injury (TBI) was associated with Parkinson's Disease (PD) and specific cognitive, motor, and neuropsychiatric symptoms. A cross-sectional cohort study of 120 participants aged 60-85 years old (48 females) were recruited (69 PD and 51 healthy controls). Assessments included demographic information, neuropsychological tests, a motor evaluation, neuropsychiatric questionnaires, and the Brain Injury Screening Questionnaire. A history of TBI or number of TBIs was not significantly related to an increased risk of developing PD or poorer motor scores on the United Parkinson Disease Rating Scale part 3. There was a significant negative correlation between number of TBI's and mean z-scores of global cognition (r_s(69) = -0.338, p = 0.004), executive function (r_s(69) = -0.251, p = 0.038), memory (r_s(69) = -0.262, p = 0.029), and language (r_s(69) = -0.245, p = 0.042), and a significant positive correlation on the Beck Depression Inventory II (r_s(69) = 0.285, p = 0.018) and the Patient Health Questionnaire-9 (PHQ-9) (r_s(69) = 0.326, p = 0.006) in the PD group only. In conclusion, a history of TBI was negatively associated with cognition and positively associated with depressive symptoms in patients with PD, but not with motor symptoms.

The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review

Background: The sudden and drastic changes due to the Coronavirus Disease 19 (COVID-19) pandemic have impacted people's physical and mental health. Clinically-vulnerable older people are more susceptible to severe effects either directly by the COVID-19 infection or indirectly due to stringent social isolation measures. Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline. People with cognitive impairments may also be at high risk of worsening cognitive and mental health due to the current pandemic. This review provides a summary of the recent literature on the consequences of COVID-19, due to either viral infection or social isolation, on neuropsychiatric symptoms in older adults with and without dementia. Methods: A search was conducted in PubMed and Web of Science to identify all relevant papers published up to the 7th July 2020. Two independent assessors screened and selected the papers suitable for inclusion. Additional suitable papers not detected by literature search were manually added. Results: Fifteen articles were included: 8 focussed on the psychiatric symptoms caused by the COVID-19 infection and 7 investigated the impact of social isolation on older adults' neuropsychiatric symptoms. Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease. All studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia. These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation. Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms. Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia. Conclusion: The available evidence suggests that the COVID-19 pandemic has a wide negative impact on the mental well-being of older adults with and without dementia. Viral infection and the consequent social isolation to limit its spreading have a range of neuropsychiatric consequences. Larger and more robustly designed studies are needed to clarify such effects and to assess the long-term implications for the mental health of older adults, and to test possible mitigating strategies.

Highlighting the Role of Cognitive and Brain Reserve in the Substance use Disorder Field

BACKGROUND

Cognitive reserve (CR) refers to the ability of an individual to cope with brain pathology remaining free of cognitive symptoms. This protective factor has been related to compensatory and more efficient brain mechanisms involved in resisting brain damage. For its part, Brain reserve (BR) refers to individual differences in the structural properties of the brain which could also make us more resilient to suffer from neurodegenerative and mental diseases.

OBJECTIVE

This review summarizes how this construct, mainly mediated by educational level, occupational attainment, physical and mental activity, as well as successful social relationships, has gained scientific attention in the last years with regard to diseases, such as neurodegenerative diseases, stroke or traumatic brain injury. Nevertheless, although CR has been studied in a large number of disorders, few researches have addressed the role of this concept in drug addiction.

METHODS

We provide a selective overview of recent literature about the role of CR and BR in preventing substance use onset. Likewise, we will also discuss how variables involved in CR (healthy leisure, social support or job-related activities, among others) could be trained and included as complementary activities of substance use disorder treatments.

RESULTS

Evidence about this topic suggests a preventive role of CR and BR on drug use onset and when drug addiction is established, these factors led to less severe addiction-related problems, as well as better treatment outcomes.

CONCLUSION

CR and BR are variables not taken yet into account in drug addiction. However, they could give us a valuable information about people at risk, as well as patient's prognosis.