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Xu Y, Chen A, Chen R, Zheng W. Association between depressive symptoms and cognitive function in the older population, and the mediating role of neurofilament light chain: Evidence from NHANES 2013-2014. J Affect Disord 2024; 360:221-228. [PMID: 38823588 DOI: 10.1016/j.jad.2024.05.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE This study aimed to investigate the potential mediating role of the neurofilament light chain (NfL) level between depressive symptoms and cognitive function in older population. METHODS A total of 495 adults (age ≥60 years) from the National Health and Nutrition Examination Survey (NHANES) participated in this study. Cognitive function was assessed using a combination of the Animal Fluency Test (AFT), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Digit Symbol Substitution Test (DSST). Word List Learning Test. Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Data on serum NfL(sNfL) were collected. Multiple linear regressions and mediation analysis were utilized to examine the associations. RESULTS After adjusting for potential confounding factors, the proportions mediated by the sNfL level between depressive symptoms and cognitive function was 19.65 %. The indirect effect mediated by the sNfL level between depressive symptoms and cognitive function was significant (β[95 % CI]:-0.0089 [-0.0191, -0.0017],p = 0.040), while the direct effect in the absence of sNfL was non-significant (β[95 % CI]: -0.0365 [-0.0739 0.0008],p = 0.055). LIMITATIONS This is an explorative cross-sectional study with its limits in generalizability and ability to establish definitive causal associations. The results should be interpreted with caution due to the constraints imposed by the characteristics of the population with a relatively low overall level of depressive symptoms. CONCLUSION The sNfL level, depressive symptoms, and cognitive decline are interconnected, and the sNfL level could mediate the relationship between depressive symptoms and cognitive decline among older adults.
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Affiliation(s)
- Ying Xu
- School of Public Health, Zhejiang Chinese Medical University, No.548 Binwen Rd, Hangzhou, Zhejiang, China
| | - An Chen
- School of Public Health, Zhejiang Chinese Medical University, No.548 Binwen Rd, Hangzhou, Zhejiang, China; University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, Helsinki, Finland.
| | - Rucheng Chen
- School of Public Health, Zhejiang Chinese Medical University, No.548 Binwen Rd, Hangzhou, Zhejiang, China
| | - Weijun Zheng
- School of Public Health, Zhejiang Chinese Medical University, No.548 Binwen Rd, Hangzhou, Zhejiang, China.
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Yu J, Ng TKS, Mahendran R. Cognitive and physical age gaps in relation to mild cognitive impairment and behavioral phenotypes. GeroScience 2024; 46:1129-1140. [PMID: 37428365 PMCID: PMC10828169 DOI: 10.1007/s11357-023-00864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
We can study how fast our biological aging clocks tick by calculating the difference (i.e., age gaps) between machine learning estimations of biological age and chronological age. While this approach has been increasingly used to study various aspects of aging, few had applied this approach to study cognitive and physical age gaps; not much is known about the behavioral and neurocognitive factors associated with these age gaps. In the present study, we examined these age gaps in relation to behavioral phenotypes and mild cognitive impairment (MCI) among community-dwelling older adults. Participants (N = 822, Agemean = 67.6) were partitioned into equally-sized training and testing samples. Cognitive and physical age-prediction models were fitted using nine cognitive and eight physical fitness test scores, respectively, within the training samples, and subsequently used to estimate cognitive and physical age gaps for each subject in the testing sample. These age gaps were then compared among those with and without MCI and correlated with 17 behavioral phenotypes in the domains of lifestyle, well-being, and attitudes. Across 5000 random train-test split iterations, we showed that older cognitive age gaps were significantly associated with MCI (versus cognitively normal) and worse outcomes across several well-being and attitude-related measures. Both age gaps were also significantly correlated with each other. These results suggest accelerated cognitive and physical aging were linked to worse well-being and more negative attitudes about the self and others and reinforce the link between cognitive and physical aging. Importantly, we have also validated the use of cognitive age gaps in the diagnosis of MCI.
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Affiliation(s)
- Junhong Yu
- Psychology, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, 639798, Singapore, Singapore.
| | - Ted Kheng Siang Ng
- Department of Internal Medicine, Rush University Medical Center, Illinois, Chicago, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rathi Mahendran
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore.
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Wang X, Chen H, Liu Y, Zhao Z, Zang S. Association between depression status in adolescents and cognitive performance over the subsequent six years: A longitudinal study. J Affect Disord 2023; 329:105-112. [PMID: 36806595 DOI: 10.1016/j.jad.2023.02.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/08/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Adolescent depression is a common mental health problem and is sometimes associated with cognitive impairments. However, existing research regarding the association between depression status in adolescents and cognitive performance over the subsequent years is relatively paucity. METHODS The present study used longitudinal data from four waves (2012, 2014, 2016, and 2018) of the China Family Panel Studies (CFPS) to explore the associations between adolescent depression status in 2012 and cognitive performance (measured by immediate word recall, delayed word recall, number series tests, mathematics, and vocabulary) over the subsequent years. A total of 1055 (51.72 %), 1115 (54.66 %), and 879 (43.09 %) of the 2040 adolescents identified in 2012 were followed up in 2014, 2016, and 2018, respectively. RESULTS We found that adolescent depression status consistently showed a negative association with cognitive performance at the measurement points over six years. The associations were retained for most cognitive outcomes after controlling for a variety of confounding factors (adolescents, parental, and family characteristics). CONCLUSIONS The findings of this study provide more evidence of the association between depression status in adolescents and cognitive performance. Additionally, it highlights the importance of focusing on cognitive impairment in patients with depression more broadly, especially during adolescence, a critical period for cognitive development.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China
| | - Hefang Chen
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China
| | - Yu Liu
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China
| | - Zhe Zhao
- Institute of International Medical Education, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province 110122, China.
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Mehta K, Mohebbi M, Pasco JA, Williams LJ, Walder K, Ng BL, Gupta VB. Impact of Mood Disorder History and Bone Health on Cognitive Function Among Men Without Dementia. J Alzheimers Dis 2023; 96:381-393. [PMID: 37781798 DOI: 10.3233/jad-230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Poor cognitive function, a major disabling condition of older age, is often considered a prodromal feature of dementia. High mortality and the lack of a cure for dementia have necessitated a focus on the identification of potentially modifiable risk factors. Mental and physical health conditions such as mood disorders and bone loss have been previously linked with poor cognition individually although their combined effect remains largely unknown. OBJECTIVE Considering the multifactorial nature of dementia pathology, we investigated whether mood disorders, bone health and their interaction are associated with cognitive function in a population-based sample of men. METHODS Four hundred and forty-two male participants were drawn from the Geelong Osteoporosis Study. Cognitive function was assessed using the CogState Brief Battery, which measured cognitive performance across four domains and was used to compute overall cognitive function. Mood disorders and hip bone mineral density (BMD) were determined using a semi-structured clinical interview and dual-energy X-ray absorptiometry, respectively. RESULTS Hip BMD (Bcoeff = 0.56, 95% CI: [0.07, 1.05], p = 0.025) but not mood disorder (Bcoeff = -0.50, 95% CI: [-0.20, 0.10], p = 0.529) was associated with overall cognitive function after accounting for potential confounders. Interaction effects were observed between the two exposures (Bcoeff = -1.37, 95% CI: [-2.49, -0.26], p = 0.016) suggesting that individuals without a mood disorder displayed better cognitive performance with increasing BMD, while those with a lifetime history of mood disorder displayed poorer cognitive function with increasing BMD. CONCLUSIONS These findings highlight the importance of exploring interactions among potentially modifiable health conditions associated with cognitive function.
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Affiliation(s)
- Kanika Mehta
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
- Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Lana J Williams
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Ken Walder
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
| | - Boon Lung Ng
- Department of Geriatric Medicine, Barwon Health, Geelong, VIC, Australia
| | - Veer Bala Gupta
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, VIC, Australia
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Kim H, Yoo J, Han K, Lee DY, Fava M, Mischoulon D, Jeon HJ. Hormone therapy and the decreased risk of dementia in women with depression: a population-based cohort study. Alzheimers Res Ther 2022; 14:83. [PMID: 35710453 PMCID: PMC9202170 DOI: 10.1186/s13195-022-01026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/29/2022] [Indexed: 12/27/2022]
Abstract
Abstract
Background
The literature has shown depression to be associated with an increased risk of dementia. In addition, hormone therapy can be a responsive treatment option for a certain type of depression. In this study, we examined the association between hormone therapy, including lifetime oral contraceptive (OC) use, and hormone replacement therapy (HRT) after menopause with the occurrence of dementia among female patients with depression.
Methods
The South Korean national claims data from January 1, 2005, to December 31, 2018, was used. Female subjects aged 40 years or older with depression were included in the analyses. Information on hormone therapy was identified from health examination data and followed up for the occurrence of dementia during the average follow-up period of 7.72 years.
Results
Among 209,588 subjects, 23,555 were diagnosed with Alzheimer’s disease (AD) and 3023 with vascular dementia (VD). Lifetime OC usage was associated with a decreased risk of AD (OC use for < 1 year: HR, 0.92 [95% CI, 0.88–0.97]; OC use for ≥ 1 year: HR, 0.89 [95% CI, 0.84–0.94]), and HRT after menopause was associated with a decreased risk of AD (HRT for < 2 years: HR, 0.84 [95% CI, 0.79–0.89]; HRT for 2–5 years: HR, 0.80 [95% CI, 0.74–0.88]; and HRT for ≥ 5 years : HR, 0.78 [95% CI, 0.71–0.85]) and VD (HRT < 2 years: HR, 0.82 [95% CI, 0.71–0.96]; HRT for 2–5 years: HR, 0.81 [95% CI, 0.64–1.02]; and HRT for ≥ 5 years: HR, 0.61 [95% CI, 0.47–0.79]).
Conclusions
In this nationwide cohort study, lifetime OC use was associated with a decreased risk of AD, and HRT after menopause was associated with a decreased risk of AD and VD among female patients with depression. However, further studies are needed to establish causality.
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Shaw S, Jana A, Kundu S. An analytical pathway of consumption expenditure with neighborhood deprivation and depression on cognitive health among elderly in India: A moderated mediation approach. J Affect Disord 2022; 308:249-258. [PMID: 35429519 DOI: 10.1016/j.jad.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/22/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to find the linkage between neighborhood deprivation and cognition with depression as a mediating factor while economic condition as a moderator. METHODS We have used the recent baseline wave-1 data of Longitudinal Aging Study in India (LASI), 2017-2018. The study was restricted to 60 and above population, consisting of males (14,931) and females (16,533). We have used moderated mediating model to understand the relationship between deprivation (X), cognition (Y) mediated through depression (M), moderated by economic condition (W), while controlling all possible confounders. RESULTS Neighborhood deprivation was positively associated with depression (β: 0.12; SE: 0.01) and inversely linked to cognition (β: -0.4; SE: 0.02). Deprivation had a strong indirect effect on cognition that was mediated by depression. Further, interaction of depression (M) and economic condition (W) was negatively associated (β = -0.03; SE: 0.01) with cognition (Y), indicating that lower economic section being more depressed with lower cognitive function. LIMITATIONS The study failed to capture other mental health aspects like stress and anxiety using the Depression, Anxiety and Stress Scale-21 items (DASS-21). CONCLUSIONS This study has found a link between higher economic condition with low deprivation and depression. Older individuals with better financial situation have improved cognitive level than their counterparts, who are also depressed. This study provides an opportunity to conduct future research on cognitive health in the face of population aging in India.
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Affiliation(s)
- Subhojit Shaw
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai 400088, India
| | - Arup Jana
- Department of Population and Development, International Institute for Population Sciences, Deonar, Mumbai 400088, India
| | - Sampurna Kundu
- Center of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi 110067, India.
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Depression and bone loss as risk factors for cognitive decline: A systematic review and meta-analysis. Ageing Res Rev 2022; 76:101575. [PMID: 35093615 DOI: 10.1016/j.arr.2022.101575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is linked to Alzheimer's disease (AD) but it is unclear whether depression is also associated with cognitive decline in the preclinical phase and mild cognitive impairment (MCI). Previous meta-analyses have only investigated AD as an outcome without accounting for individuals showing cognitive decline that does not meet the diagnostic criteria for AD. Other potentially modifiable risk factors such as bone loss have also been less explored and there remains uncertainty around their temporal relationship with cognitive decline. AIMS To conduct a systematic review and meta-analysis investigating depression and bone loss as risk factors for subsequent cognitive decline. METHODS A comprehensive search strategy was developed and applied using four databases; MEDLINE Complete, Embase, PsycINFO and CINAHL Complete. The pooled summary effects were estimated as odds ratios with 95% confidence intervals using a random-effects model. The study protocol was registered with PROSPERO (ID: CRD42020159369). RESULTS A total of 75 longitudinal cohort studies were identified for meta-analysis, of which 70 examined the impact of depression on cognitive decline and five examined the impact of bone loss. Prior exposure to depression was found to be associated with cognitive score reduction (OR 1.33 95% CI 1.17, 1.51), MCI incidence (OR 1.52 95% CI 1.28, 1.79) and AD incidence (OR 1.79 95% CI 1.46, 2.2). Bone loss was also associated with the incidence of AD (OR=1.81 95% CI 1.28, 2.55). CONCLUSIONS Overall, the results support the hypothesis that depression is associated with subsequent cognitive decline. Bone loss was also found to be associated with AD incidence; however, due to the small number of studies, the results should be viewed with caution.
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8
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Depressive subfactors and cognitive function in midlife. J Affect Disord 2021; 295:752-758. [PMID: 34517249 DOI: 10.1016/j.jad.2021.08.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/01/2021] [Accepted: 08/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to evaluate the heterogeneous association of depressive subtypes with cognitive function, according to age and sex. METHODS This cross-sectional study utilized the baseline data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort and included 5271 midlife participants. For identifying depressive subtypes of the Beck Depression Inventory Ⅱ items, factor analyses were utilized and yielded two factors -melancholic- and somatic-depressive subtypes. The information of Mini-Mental State Examination was used for screening cognitive function. The association between depressive subtypes and cognitive function was analysed using multiple regression after adjusting for all covariates. RESULTS We observed heterogeneous association between depressive subtypes and cognitive dysfunction in midlife participants. The results of sex- and age- stratified analyses indicated that the somatic subtype was associated with dysfunction in cognitive ability. Among women, especially those aged over 60 years, MMSE scores decreased as the somatic depression scores increased. These results might suggest that the somatic subtype, rather than the melancholic subtype, has a greater association with cognitive assessment in a general midlife population, particularly older women. LIMITATIONS Although a confirmatory factor analysis was performed, depressive subtypes need validation and reliability tests. CONCLUSIONS Given this heterogeneity, characterisation of depressive subtypes according to sex and age may improve our understanding of how each depressive symptom is associated differently with cognitive dysfunction in midlife.
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Yu J, Rawtaer I, Feng L, Kua EH, Mahendran R. The functional and structural connectomes associated with geriatric depression and anxiety symptoms in mild cognitive impairment: Cross-syndrome overlap and generalization. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110329. [PMID: 33865926 DOI: 10.1016/j.pnpbp.2021.110329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Geriatric depression and anxiety disorders often manifest as neuropsychiatric symptoms among those with mild cognitive impairment. Both tend to co-occur, and overlap in symptomology and etiology. Such commonalities are likely to be reflected in the brain as common neural correlates. Using connectome-based predictive modeling (CPM), we examined the functional and structural connectomes predicting depression and anxiety symptoms, and subsequently the overlap and cross-syndrome generalization of the connectomes associated with either disorder. Ninety-one older adults completed self-reported measures of depression and anxiety, and underwent diffusion tensor imaging and resting-state functional magnetic resonance imaging. Functional connectivity (FC) and structural connectivity (SC) matrices were derived from these scans and, in various combinations, entered into CPM models to predict either type of symptoms. Leave-one-out cross-validation was performed. Predictive accuracy was assessed via the correlation between predicted and observed scores (ρpredicted-observed). While FC or SC features alone significantly predicted either type of symptoms, these symptoms were best predicted by models that consisted of both FC and SC features (depression: ρpredicted-observed = 0.497; anxiety: ρpredicted-observed = 0.455). The features common to depression and anxiety were identified and entered into another model which was similarly accurate in predicting either type of symptoms. Moreover, cross-syndrome generalization was observed- the depression-associated features significantly predicted anxiety symptoms (ρpredicted-observed = 0.403) and vice-versa (ρpredicted-observed = 0.378). These FC and SC features are complementary biomarkers of geriatric depression and anxiety symptoms. Both types of symptoms are largely underpinned by common patterns of altered FC and SC, alluding to the transdiagnostic neurobiological susceptibility in both disorders.
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Affiliation(s)
- Junhong Yu
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore.
| | - Iris Rawtaer
- Department of Psychological Medicine, Sengkang General Hospital, 110 Sengkang E way, 544886, Singapore
| | - Lei Feng
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore
| | - Ee-Heok Kua
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, Mind Science Centre, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore; Academic Development Department, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
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10
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Robinson AC, Roncaroli F, Davidson YS, Minshull J, Heal C, Montaldi D, Payton A, Horan MA, Pendleton N, Mann DM. Mid to late-life scores of depression in the cognitively healthy are associated with cognitive status and Alzheimer's disease pathology at death. Int J Geriatr Psychiatry 2021; 36:713-721. [PMID: 33176024 PMCID: PMC8048934 DOI: 10.1002/gps.5470] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Early diagnosis of Alzheimer's disease (AD) is essential for early interventions. Symptoms of depression could represent a prodromal stage of AD. Very early mood alterations may help to stratify those at highest risk of late-life AD. We aim to investigate associations between baseline/longitudinal scores for depression, presence of cognitive impairment and/or AD pathology at death. METHODS/DESIGN Between 1991 and 2015, participants from The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age underwent 10 waves of assessment using the Geriatric Depression Scale (GDS). AD pathology at death was evaluated in 106 eligible cases. Analyses aimed to examine associations between GDS scores, cognitive status and AD pathology (as measured by Braak stage, Thal phase and CERAD). RESULTS Baseline GDS scores were significantly higher for those cognitively impaired at death than those cognitively normal. Significantly higher baseline GDS scores were found for those with greater Consortium to Establish a Registry for Alzheimer's Disease (CERAD) scores than those with lower CERAD scores. Similarly, significantly higher baseline GDS scores were found for those with a greater Braak stage than those with lower tau burden. These correlations remained after controlling for age at death, education and APOE ε4, but were less robust. Mean longitudinal GDS scores associated with cognition but not pathology. CONCLUSIONS GDS scores collected approximately 20 years before death were associated with cognitive status and AD pathology at death. We postulate that early AD-related pathological change produces raised GDS scores due to an overlapping neural basis with depression, and that this may be considered as an early diagnostic marker for AD.
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Affiliation(s)
- Andrew C. Robinson
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
- Geoffrey Jefferson Brain Research CentreManchester Academic Health Science Centre (MAHSC)ManchesterUK
| | - Federico Roncaroli
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
- Geoffrey Jefferson Brain Research CentreManchester Academic Health Science Centre (MAHSC)ManchesterUK
| | - Yvonne S. Davidson
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
| | - James Minshull
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
| | - Calvin Heal
- Centre for BiostatisticsFaculty of Biology, Medicine and HealthSchool of Health SciencesThe University of ManchesterManchesterUK
| | - Daniela Montaldi
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterManchesterUK
| | - Antony Payton
- Division of Informatics, Imaging & Data SciencesFaculty of Biology, Medicine and HealthSchool of Health SciencesThe University of ManchesterManchesterUK
| | - Michael A. Horan
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
| | - Neil Pendleton
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
| | - David M.A. Mann
- Division of Neuroscience & Experimental PsychologyFaculty of Biology, Medicine and HealthSchool of Biological SciencesThe University of ManchesterSalford Royal HospitalSalfordUK
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Formánek T, Csajbók Z, Wolfová K, Kučera M, Tom S, Aarsland D, Cermakova P. Trajectories of depressive symptoms and associated patterns of cognitive decline. Sci Rep 2020; 10:20888. [PMID: 33257789 PMCID: PMC7705007 DOI: 10.1038/s41598-020-77866-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/13/2020] [Indexed: 01/27/2023] Open
Abstract
The aim was to investigate the pattern and rate of cognitive decline across distinctive trajectories of depressive symptoms in older adults. In this prospective multinational cohort study on 69,066 participants (on average 64 years at baseline, 55% women), assessments of cognitive functions (immediate recall, delayed recall, verbal fluency) and depressive symptoms (EURO-D scale) were conducted at 2-year intervals. The trajectories of depressive symptoms were obtained using latent growth mixture modelling, cognitive decline was assessed using smoothing splines and linear mixed effects models. Four distinct trajectories of depressive symptoms were identified: constantly low (n = 49,660), constantly high (n = 2999), increasing (n = 6828) and decreasing (n = 9579). Individuals with increasing and constantly high depressive symptoms showed linear cognitive decline, while those with constantly low and decreasing depressive symptoms had fluctuating cognition. Participants with increasing depressive symptoms had the fastest decline, while those with decreasing symptoms were spared from decline in cognition. This study suggests that the pattern as well as the rate of cognitive decline co-occurs with specific patterns of changes in depressive symptoms over time. The most pronounced cognitive decline is present in individuals, in whom depressive symptoms increase late in life. Unique mechanisms of cognitive decline may exist for subgroups of the population, and are associated with the trajectory of depressive symptoms.
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Affiliation(s)
- Tomáš Formánek
- National Institute of Mental Health, Klecany, Czech Republic
| | - Zsófia Csajbók
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Prague 10, Czech Republic
| | - Katrin Wolfová
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Prague 10, Czech Republic
| | - Matěj Kučera
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Prague 10, Czech Republic
| | - Sarah Tom
- Departments of Neurology and Epidemiology, Columbia University, New York, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Centre of Age-Related Medicine, University Hospital Stavanger, Stavanger, Norway
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, Czech Republic. .,Third Faculty of Medicine, Charles University Prague, Ruská 87, 100 00, Prague 10, Czech Republic. .,Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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12
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Kim S, Nam Y, Shin SJ, Park YH, Jeon SG, Kim JI, Kim MJ, Moon M. The Potential Roles of Ghrelin in Metabolic Syndrome and Secondary Symptoms of Alzheimer's Disease. Front Neurosci 2020; 14:583097. [PMID: 33071750 PMCID: PMC7543232 DOI: 10.3389/fnins.2020.583097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/26/2020] [Indexed: 12/12/2022] Open
Abstract
Although the major causative factors of Alzheimer's disease (AD) are the accumulation of amyloid β and hyperphosphorylated tau, AD can also be caused by metabolic dysfunction. The major clinical symptom of AD is cognitive dysfunction. However, AD is also accompanied by various secondary symptoms such as depression, sleep-wake disturbances, and abnormal eating behaviors. Interestingly, the orexigenic hormone ghrelin has been suggested to have beneficial effects on AD-related metabolic syndrome and secondary symptoms. Ghrelin improves lipid distribution and alters insulin sensitivity, effects that are hypothesized to delay the progression of AD. Furthermore, ghrelin can relieve depression by enhancing the secretion of hormones such as serotonin, noradrenaline, and orexin. Moreover, ghrelin can upregulate the expression of neurotrophic factors such as brain-derived neurotrophic factor and modulate the release of proinflammatory cytokines such as tumor necrosis factor α and interleukin 1β. Ghrelin alleviates sleep-wake disturbances by increasing the levels of melatonin, melanin-concentrating hormone. Ghrelin reduces the risk of abnormal eating behaviors by increasing neuropeptide Y and γ-aminobutyric acid. In addition, ghrelin increases food intake by inhibiting fatty acid biosynthesis. However, despite the numerous studies on the role of ghrelin in the AD-related pathology and metabolic disorders, there are only a few studies that investigate the effects of ghrelin on secondary symptoms associated with AD. In this mini review, our purpose is to provide the insights of future study by organizing the previous studies for the role of ghrelin in AD-related pathology and metabolic disorders.
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Affiliation(s)
- Sujin Kim
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
| | - Yunkwon Nam
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
| | - Soo Jung Shin
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
| | - Yong Ho Park
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
| | - Seong Gak Jeon
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea.,Department of Neural Development and Disease, Korea Brain Research Institute (KBRI), Daegu, South Korea
| | - Jin-Il Kim
- Department of Nursing, College of Nursing, Jeju National University, Jeju-si, South Korea
| | - Min-Jeong Kim
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
| | - Minho Moon
- Department of Biochemistry, College of Medicine, Konyang University, Daejeon, South Korea
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13
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Association of depressive symptoms with decline of cognitive function-Rugao longevity and ageing study. Neurol Sci 2020; 41:1873-1879. [PMID: 32095947 DOI: 10.1007/s10072-020-04279-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/02/2020] [Indexed: 01/01/2023]
Abstract
Cognitive decline is a central feature in the aging process. Previous studies have indicated an association between depressive symptoms and cognitive decline in Caucasian populations. However, few studies have examined the effect of changes in depression on the trajectory of cognitive decline. Here, we included 580 participants with normal cognitive ability and complete cognitive and depression data from the Rugao Longevity and Ageing Study (RuLAS). We explored the relationship between depressive symptoms and cognitive decline in these participants. We examined how the change in depressive symptoms affected the trajectory in the HDS-R (the Revised Hasegawa Dementia Scale) scores by comparing cognition function in both the depression deterioration group and the depression steady group by using a linear mixed model. The results indicated that those with deteriorating depression tended to have faster cognitive declines than those with steady depression, indicated by the significance of the interaction term of GDS (Geriatric Depression Scale) groups and time (unadjusted model, β = - 0.673, p < 0.001). The results remained significant after adding demographic covariates. Moreover, we found that those with the worst depressive symptoms at baseline had the worst cognition in subsequent years (GDS = 0 group vs. GDS ≥ group in the unadjusted model: β = - 1.522, p < 0.003), while the slope of change was not significantly different among groups (GDS = 0 group × time vs. GDS > =4 group × time in the unadjusted model: β = - 0.045, p = 0.857). Therefore, we found that depressive symptom deterioration was significantly associated with faster cognitive decline. Medical interventions for depression may decrease the number of older Chinese individuals who experience early-stage cognitive decline.
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14
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Xu Z, Wang J, Lyu H, Wang R, Hu Y, Guo Z, Xu J, Hu Q. Alterations of White Matter Microstructure in Subcortical Vascular Mild Cognitive Impairment with and without Depressive Symptoms. J Alzheimers Dis 2020; 73:1565-1573. [PMID: 31958086 DOI: 10.3233/jad-190890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ziyun Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jianjun Wang
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Hanqing Lyu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Runshi Wang
- School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanming Hu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Zhouke Guo
- Department of Neurology and Psychiatry, Shenzhen Traditional Chinese Medicine Hospital / the Fourth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, P. R. China
| | - Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- University of Chinese Academy of Sciences, Beijing, China
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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15
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Bell G, John A, Gaysina D. Affective symptoms across the life course and resilience in cognitive function. Ann Hum Biol 2020; 47:116-124. [DOI: 10.1080/03014460.2020.1745886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Georgia Bell
- School of Psychology, University of Sussex, Brighton, UK
| | - Amber John
- School of Psychology, University of Sussex, Brighton, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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16
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Wang J, Zhu WH, Li YF, Zhu WW. Interaction between worsening cognitive function and deteriorating functional status on depressive symptoms among Chinese community-dwelling elders. Geriatr Gerontol Int 2020; 20:343-347. [PMID: 32064723 DOI: 10.1111/ggi.13887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/29/2019] [Accepted: 01/24/2020] [Indexed: 12/20/2022]
Abstract
AIM Cognitive impairment and functional deterioration are common in later life and often co-occur with depressive symptoms (DS). This study aims to examine the individual effects and possible interaction between worsening cognitive function (CF) and deteriorating functional status (FS) on DS using large sample, longitudinal data. METHODS Elderly people who completed the baseline survey of China Health and Retirement Longitudinal Study (CHARLS 2011) and the third wave survey (2015) were included. A multivariable logistic regression model was used to assess the individual effects. The relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP) and synergy index (SI) were calculated to evaluate the additive interaction. RESULTS Worsening CF and deteriorating FS were associated with the increase in DS, while unchanged or improved CF and FS were associated with the decrease in DS. In addition, decreased (increased) FS led to more severe (improved) DS than decreased (increased) CF. The additive interaction between worsening CF and deteriorating FS on the increase in DS was significant. The estimates and 95% CI of the RERI, AP and SI were 0.626 (0.061, 1.190), 0.222 (0.042, 0.402) and 1.526 (1.016, 2.291) respectively. CONCLUSIONS Both worsening CF and deteriorating FS have positive interactions with the increase in DS. It is vital to focus on DS of elderly people with worsening CF and/or FS and to adopt interventions. Geriatr Gerontol Int 2020; 20: 343-347.
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Affiliation(s)
- Juan Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, China.,The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Heng Zhu
- College of Information Science and Technology, Jinan University, Guangzhou, China
| | - You-Fu Li
- Department of Neurology of The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei-Wen Zhu
- Department of Neurology of The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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17
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Wiels W, Baeken C, Engelborghs S. Depressive Symptoms in the Elderly-An Early Symptom of Dementia? A Systematic Review. Front Pharmacol 2020; 11:34. [PMID: 32116710 PMCID: PMC7020568 DOI: 10.3389/fphar.2020.00034] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background Depression and dementia are common incapacitating diseases in old age. The exact nature of the relationship between these conditions remains unclear, and multiple explanations have been suggested: depressive symptoms may be a risk factor for, a prodromal symptom of, or a coincidental finding in dementia. They may even be unrelated or only connected through common risk factors. Multiple studies so far have provided conflicting results. Objectives To determine whether a systematic literature review can clarify the nature of the relation between depressive symptoms and dementia. Methods Using the Patient/Problem/Population, Intervention, Comparator, Outcome or PICO paradigm, a known framework for framing healthcare and evidence questions, we formulated the question “whether depressive symptoms in cognitively intact older adults are associated with a diagnosis of dementia later in life.” We performed a systematic literature review of MEDLINE and PsycINFO in November 2018, looking for prospective cohort studies examining the aforementioned question. Results We critically analyzed and listed 31 relevant papers out of 1,656 and grouped them according to the main hypothesis they support: depressive symptoms as a risk factor, not a risk factor, a prodromal symptom, both, or some specific other hypothesis. All but three studies used clinical diagnostic criteria for dementia alone (i.e., no biomarkers or autopsy confirmation). Several studies contain solid arguments for the hypotheses they support, yet they do not formally contradict other findings or suggested explanations and are heterogeneous. Conclusions The exact nature of the relationship between depressive symptoms and dementia in the elderly remains inconclusive, with multiple studies supporting both the risk factor and prodromal hypotheses. Some provide arguments for common risk factors. It seems unlikely that there is no connection at all. We conclude that at least in a significant part of the patients, depressive symptoms and dementia are related. This may be due to common risk factors and/or depressive symptoms being a prodromal symptom of dementia and/or depression being a risk factor for dementia. These causal associations possibly overlap in some patients. Further research is warranted to develop predictive biomarkers and to develop interventions that may attenuate the risk of “conversion” from depressive symptoms to dementia in the elderly.
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Affiliation(s)
- Wietse Wiels
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Chris Baeken
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Biomedical Sciences and Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
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18
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Fu H, Xu Z, Zhang XL, Zheng GQ. Kaixinsan, a Well-Known Chinese Herbal Prescription, for Alzheimer's Disease and Depression: A Preclinical Systematic Review. Front Neurosci 2020; 13:1421. [PMID: 32009890 PMCID: PMC6971218 DOI: 10.3389/fnins.2019.01421] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/16/2019] [Indexed: 01/30/2023] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia, is highly prevalent worldwide with no modifying therapy. Behavioral and psychological symptoms of dementia (BPSD) occur in most patients with AD, and depression is one of the most common AD-related BPSD. Kaixinsan (KXS) is an ancient Chinese herbal prescription widely used to treat dementia and forgetfulness. In this systematic review, we conducted a meta-analysis to assess preclinical evidence for the effects of KXS on cognitive impairment and depression. Thirty-eight articles involving 1,050 animals were included after searching from six databases from the inception up to June 2019. The primary outcome measures were behavioral outcome. Indicators of cognitive function in AD included escape latency, time spent on the target quadrant, and the number of target platform crossings in the Morris water maze (MWM) test. Indicators of depression included number of rearing events and total distance in the open-field test, duration of immobility in the forced swim test, and sucrose consumption or sucrose preference index in the sucrose preference test. The secondary outcomes were mechanisms of KXS for treatment of AD and depression. The results showed that KXS significantly reduced escape latency (P < 0.01), increased time spent in the target quadrant (P < 0.01), and increased the number of target platform crossings (P < 0.01) in the MWM test in AD models compared with control. The possible mechanisms for KXS-mediated improvements in cognitive function were antioxidant activity, anti-inflammatory activity, antiapoptotic activity, neuroprotection, and synapse protection. In addition, the results demonstrated that KXS significantly increased the number of rearing instances (P < 0.01) in the open-field test, decreased the duration of immobility (P < 0.01) in forced swim test, and increased sucrose consumption or sucrose preference index (P < 0.01) in the sucrose preference test in depression models compared with control. The mechanisms of KXS-mediated anti-depressive effects were HPA axis regulation, antioxidant activity, anti-inflammatory activity, synapse protection, and neuroprotection. The results of this study suggested that KXS can be used to effectively treat AD and depression through multiple mechanisms, extrapolating the therapeutic potential of KXS for treating AD-related BPSD.
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Affiliation(s)
- Huan Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xi-le Zhang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guo-Qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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19
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Chen ST, Volle D, Jalil J, Wu P, Small GW. Health-Promoting Strategies for the Aging Brain. Am J Geriatr Psychiatry 2019; 27:213-236. [PMID: 30686664 DOI: 10.1016/j.jagp.2018.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
As the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.
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Affiliation(s)
- Stephen T Chen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
| | - Dax Volle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Jason Jalil
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Pauline Wu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Gary W Small
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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20
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John A, Patel U, Rusted J, Richards M, Gaysina D. Affective problems and decline in cognitive state in older adults: a systematic review and meta-analysis. Psychol Med 2019; 49:353-365. [PMID: 29792244 PMCID: PMC6331688 DOI: 10.1017/s0033291718001137] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 12/23/2022]
Abstract
Evidence suggests that affective problems, such as depression and anxiety, increase risk for late-life dementia. However, the extent to which affective problems influence cognitive decline, even many years prior to clinical diagnosis of dementia, is not clear. The present study systematically reviews and synthesises the evidence for the association between affective problems and decline in cognitive state (i.e., decline in non-specific cognitive function) in older adults. An electronic search of PubMed, PsycInfo, Cochrane, and ScienceDirect was conducted to identify studies of the association between depression and anxiety separately and decline in cognitive state. Key inclusion criteria were prospective, longitudinal designs with a minimum follow-up period of 1 year. Data extraction and methodological quality assessment using the STROBE checklist were conducted independently by two raters. A total of 34 studies (n = 71 244) met eligibility criteria, with 32 studies measuring depression (n = 68 793), and five measuring anxiety (n = 4698). A multi-level meta-analysis revealed that depression assessed as a binary predictor (OR 1.36, 95% CI 1.05-1.76, p = 0.02) or a continuous predictor (B = -0.008, 95% CI -0.015 to -0.002, p = 0.012; OR 0.992, 95% CI 0.985-0.998) was significantly associated with decline in cognitive state. The number of anxiety studies was insufficient for meta-analysis, and they are described in a narrative review. Results of the present study improve current understanding of the temporal nature of the association between affective problems and decline in cognitive state. They also suggest that cognitive function may need to be monitored closely in individuals with affective disorders, as these individuals may be at particular risk of greater cognitive decline.
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Affiliation(s)
- A. John
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| | - U. Patel
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
| | - J. Rusted
- School of Psychology, University of Sussex, Brighton, UK
| | - M. Richards
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - D. Gaysina
- EDGE Lab, School of Psychology, University of Sussex, Brighton, UK
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21
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Choi EY, Kim YS, Lee HY, Shin HR, Park S, Cho SE. The moderating effect of subjective age on the association between depressive symptoms and cognitive functioning in Korean older adults. Aging Ment Health 2019; 23:38-45. [PMID: 29052424 DOI: 10.1080/13607863.2017.1390733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Depressive symptoms are greatly associated with cognitive impairment in older adults. Recent growing body of literature has reported that the subjective perception of one's own age (subjective age) predicts both cognitive performance and mental well-being in old age. This study aims to examine whether subjective age moderates the association between depressive symptoms and cognitive functioning in a representative sample of Korean older adults. To address this research question, we employed the Stereotype-Embodiment Theory as a theoretical guide. METHOD Data are from the 2016 Dementia Literacy Survey collected by Kyung Hee University, and 526 community-dwelling Korean older adults (ages 60-79) completed the questionnaire about depressive symptoms, cognitive functioning, and subjective age. RESULTS According to the hierarchical regression analysis, both higher levels of depressive symptoms and older subjective age were associated with poorer cognitive functioning. Further analyses showed that subjective age attenuated the effect of depressive symptoms on cognitive functioning: when older adults have a higher level of depression, those with younger subjective age reported a higher level of cognitive functioning than those with older subjective age. CONCLUSION Based on the findings from this study, both theoretical and practical implications were discussed.
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Affiliation(s)
- Eun Young Choi
- a Graduate School of East-West Medical Science , Kyung Hee University , Yongin-si , Republic of Korea
| | - Young Sun Kim
- a Graduate School of East-West Medical Science , Kyung Hee University , Yongin-si , Republic of Korea
| | - Hee Yun Lee
- b School of Social Work , University of Minnesota , St. Paul , MN , USA
| | - Hye Ri Shin
- a Graduate School of East-West Medical Science , Kyung Hee University , Yongin-si , Republic of Korea
| | - SeolWoo Park
- a Graduate School of East-West Medical Science , Kyung Hee University , Yongin-si , Republic of Korea
| | - Sung Eun Cho
- a Graduate School of East-West Medical Science , Kyung Hee University , Yongin-si , Republic of Korea
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22
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Zheng F, Zhong B, Song X, Xie W. Persistent depressive symptoms and cognitive decline in older adults. Br J Psychiatry 2018; 213:638-644. [PMID: 30132434 DOI: 10.1192/bjp.2018.155] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Little is known about the effect of persistent depressive symptoms on the trajectory of cognitive decline.AimsWe aimed to investigate the longitudinal association between the duration of depressive symptoms and subsequent cognitive decline over a 10-year follow-up period. METHOD The English Longitudinal Study of Ageing cohort is a prospective and nationally representative cohort of men and women living in England aged ≥50 years. We examined 7610 participants with two assessments of depressive symptoms at wave 1 (2002-2003) and wave 2 (2004-2005), cognitive data at wave 2 and at least one reassessment of cognitive function (wave 3 to wave 7, 2006-2007 to 2014-2015). RESULTS The mean age of the 7610 participants was 65.2 ± 10.1 years, and 57.0% were women. Of these, 1157 (15.2%) participants had episodic depressive symptoms and 525 participants (6.9%) had persistent depressive symptoms. Compared with participants without depressive symptoms at wave 1 and wave 2, the multivariable-adjusted rates of global cognitive decline associated with episodic depressive symptoms and persistent depressive symptoms were faster by -0.065 points/year (95% CI -0.129 to -0.000) and -0.141 points/year (95% CI -0.236 to -0.046), respectively (P for trend < 0.001). Similarly, memory, executive and orientation function also declined faster with increasing duration of depressive symptoms (all P for trend < 0.05). CONCLUSIONS Our results demonstrated that depressive symptoms were significantly associated with subsequent cognitive decline over a 10-year follow-up period. Cumulative exposure of long-term depressive symptoms in elderly individuals could predict accelerated subsequent cognitive decline in a dose-response pattern.Declaration of interestNone.
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Affiliation(s)
- Fanfan Zheng
- Associate Research Fellow,Brainnetome Center Institute of Automation,Chinese Academy of Sciences,China and Visiting Research Fellow,Institute of Cognitive Neuroscience,University College London,UK
| | - Baoliang Zhong
- Associate Professor,Department of Geriatric Psychiatry,Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology,China
| | - Xiaoyu Song
- Assistant Professor,Department of Population Health Science and Policy,Icahn School of Medicine at Mount Sinai,USA
| | - Wuxiang Xie
- Associate Research Fellow,Peking University Clinical Research Institute, Peking University Health Science Center,China and Newton International Fellow,Department of Epidemiology and Biostatistics,School of Public Health,Imperial College London,UK
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23
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Yu J, Lim HY, Abdullah FNDM, Chan HM, Mahendran R, Ho R, Kua EH, Power MJ, Feng L. Directional associations between memory impairment and depressive symptoms: data from a longitudinal sample and meta-analysis. Psychol Med 2018; 48:1664-1672. [PMID: 29113607 DOI: 10.1017/s0033291717003154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis. METHODS A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model. RESULTS In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms. CONCLUSIONS These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed.
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Affiliation(s)
- Junhong Yu
- Department of Psychological Medicine,National University Hospital,Singapore,Singapore
| | | | | | | | | | | | | | - Michael John Power
- Department of Psychology,National University of Singapore,Singapore,Singapore
| | - Lei Feng
- Department of Psychological Medicine,Yong Loo Lin School of Medicine,National University of Singapore,Singapore,Singapore
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24
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Ryu SH, Jung HY, Lee KJ, Moon SW, Lee DW, Hong N, Kee BS, Kim DH, Han C, Lee CU. Incidence and Course of Depression in Patients with Alzheimer's Disease. Psychiatry Investig 2017; 14:271-280. [PMID: 28539945 PMCID: PMC5440429 DOI: 10.4306/pi.2017.14.3.271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/26/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Depressive symptoms are common in Alzheimer's disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. METHODS This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. RESULTS Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. CONCLUSION The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.
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Affiliation(s)
- Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, College of Medicine, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seok Woo Moon
- Department of Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Dong Woo Lee
- Department of Psychiatry, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Narei Hong
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Baik Seok Kee
- Department of Psychiatry, Chung-Ang University, College of Medicine, Seoul, Republic of Korea
| | - Do Hoon Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Neuropsychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Sex Differences in the Relationship between Depressive Symptoms and Risk of Amnestic Mild Cognitive Impairment. Am J Geriatr Psychiatry 2017; 25:13-22. [PMID: 27986237 PMCID: PMC5215465 DOI: 10.1016/j.jagp.2016.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The relationship between depressive symptoms and subsequent cognitive impairment in older adults is controversial. Sex differences and the differences in the method of categorizing depressive symptoms may contribute to the inconsistencies. The authors examined the effect of severity of baseline depressive symptoms on risk of incident amnestic mild cognitive impairment (aMCI) separately in men and women. METHODS Community-dwelling and cognitively healthy older adults (aged ≥ 70 years) from the Einstein Aging Study completed the 15-item Geriatric Depression Scale (GDS-15) at their baseline visit. Participants were categorized into "no/low symptoms" (GDS-15 score = 0-2), "mild symptoms" (GDS-15 score = 3-5), and "moderate/severe symptoms" (GDS-15 score > 6) groups. Sex-stratified Cox proportional hazards models, adjusted for age, education, and antidepressant medication, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident aMCI as a function of depressive symptoms group. RESULTS We followed 572 women (mean age: 78) and 345 men (mean age: 77) for 4.2 years on average (range: 1.0-14.6 years). Ninety women and 64 men developed aMCI during follow-up. Cox models revealed that compared with no/low depressive symptoms, mild symptoms were associated with a two times greater risk of developing aMCI in men (HR: 2.22; 95% CI: 1.26-3.89) but not in women (HR: 1.26; 95% CI: 0.77-2.06). Conversely, moderate/severe depressive symptoms were associated with a two times greater risk of developing aMCI in women (HR: 1.99; 95% CI: 1.05-3.77) but not in men (HR: 0.28; 95% CI: 0.04-2.11), possibly because of low statistical power in this subgroup. CONCLUSION Results indicate that mild depressive symptoms in men and moderate/severe symptoms in women may represent a marker for future cognitive impairment.
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Ylli A, Miszkurka M, Phillips SP, Guralnik J, Deshpande N, Zunzunegui MV. Clinically relevant depression in old age: An international study with populations from Canada, Latin America and Eastern Europe. Psychiatry Res 2016; 241:236-41. [PMID: 27183110 DOI: 10.1016/j.psychres.2016.04.096] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 02/15/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
Our aim is to assess cross-national variations in prevalence of clinically relevant depression and to examine the relationships of social and health factors with depression in five diverse populations of older adults, from Canada, Brazil, Colombia and Albania. We used the data from the International Mobility in Aging Study. Clinically relevant depression was defined as a score of ≥16 on the Center for Epidemiologic Study Depression Scale (CES-D). Poisson regressions with robust covariance correction were used to estimate prevalence ratios associated with potential risk factors. Prevalence of clinically relevant depression across research sites varied widely, being consistently higher in women than in men. It was lowest in men from Brazil (6.3%) and highest in women from Albania (46.6%). Low education and insufficient income, living alone, multiple chronic conditions, and poor physical performance were all significantly associated with depression prevalence. Poor physical performance was more strongly associated with depression in men than in women. Similar factors are associated with clinically relevant depression among men and women and across research sites. The large variation in depression prevalence population rates is unexplained by the classical individual factors considered in the study suggesting the impact of country characteristics on depression among older populations.
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Affiliation(s)
- Alban Ylli
- Institute of Public Health, Tirana, Albania; University of Medicine, Tirana, Albania.
| | - Malgorzata Miszkurka
- Institut de recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Canada
| | - Susan P Phillips
- Department of Family Medicine, Queens University, Kingston, Ontario, Canada
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, USA
| | - Nandini Deshpande
- School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
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Abstract
Depression is among the most frequent psychiatric comorbid conditions in dementia. There is no strong consensus as to what criteria should be used to diagnose depression in AD. This is at least partially explained by the overlap between symptoms of depression and symptoms of AD. Recent studies using latent class analysis provided clarification to this diagnostic dilemma. All nine DSM-IV symptoms of major depression were found to characterize a class with a high chance (96% ) of having a clinical diagnosis of major depression, and symptoms of anxiety were also frequent. Other psychiatric symptoms may also be included under the construct of depression in AD, since both apathy and anxiety are among the most frequent comorbid conditions for major depression in AD. Subtypes of depression should also be validated in this condition. For instance, increased awareness of cognitive and functional deficits is significantly associated with dysthymia but not with major depression, suggesting that different depressive syndromes in AD may have different etiology.
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Affiliation(s)
- Filipa Novais
- Serviço de Psiquiatria e Saúde Mental, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal
| | - Sergio Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia, and Fremantle Hospital, Fremantle, Western Australia
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O'Shea DM, Dotson VM, Fieo RA, Tsapanou A, Zahodne L, Stern Y. Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high. Int J Geriatr Psychiatry 2016; 31:783-90. [PMID: 26679474 PMCID: PMC5817980 DOI: 10.1002/gps.4392] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory. METHODS Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list. RESULTS Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196). CONCLUSION Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one's mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.
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Affiliation(s)
- Deirdre M O'Shea
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Vonetta M Dotson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Robert A Fieo
- The Robert N. Butler Columbia Aging Center, New York, NY, USA
| | - Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Laura Zahodne
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, New York, NY, USA
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Beydoun MA, Beydoun HA, Gamaldo AA, Rostant OS, Dore GA, Zonderman AB, Eid SM. Nationwide Inpatient Prevalence, Predictors, and Outcomes of Alzheimer's Disease among Older Adults in the United States, 2002-2012. J Alzheimers Dis 2016; 48:361-75. [PMID: 26402000 DOI: 10.3233/jad-150228] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimer's disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD ± standard error: 474, 410 ± 6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p < 0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p < 0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p < 0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p < 0.001), with mean total co-morbidities increasing over time. AD was linked to higher MR and longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD.
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Affiliation(s)
- May A Beydoun
- National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Ola S Rostant
- National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Greg A Dore
- National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | | | - Shaker M Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bélanger E, Ahmed T, Vafaei A, Curcio CL, Phillips SP, Zunzunegui MV. Sources of social support associated with health and quality of life: a cross-sectional study among Canadian and Latin American older adults. BMJ Open 2016; 6:e011503. [PMID: 27354077 PMCID: PMC4932270 DOI: 10.1136/bmjopen-2016-011503] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults. DESIGN Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living. SETTING Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil. PARTICIPANTS 1600 community-dwelling adults aged 65-74 years, n=400 at each site. OUTCOME MEASURES Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale. RESULTS Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67). CONCLUSIONS Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL.
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Affiliation(s)
- Emmanuelle Bélanger
- Department of Social and Preventive Medicine, Université de Montréal, Public Health Research Institute (IRSPUM), Montreal, Quebec, Canada
| | - Tamer Ahmed
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Afshin Vafaei
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Carmen Lucia Curcio
- Faculty of Health Sciences, Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Centre, University of Caldas, Manizales, Colombia
| | - Susan P Phillips
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Maria Victoria Zunzunegui
- Department of Social and Preventive Medicine, Public Health Research Institute (IRSPUM), Université de Montréal, Montreal, Quebec, Canada
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Pelton GH, Harper OL, Roose SP, Marder K, D'Antonio K, Devanand DP. Combined treatment with memantine/es-citalopram for older depressed patients with cognitive impairment: a pilot study. Int J Geriatr Psychiatry 2016; 31:648-55. [PMID: 26559790 DOI: 10.1002/gps.4375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The objective of the study is to assess combined antidepressant and memantine treatment in older patients presenting with depression and cognitive impairment. METHODS Thirty-five depressed patients with cognitive impairment participated in this open-label pilot study. We evaluated whether, over a 48-week period, combined antidepressant (primarily es-citalopram) and memantine treatment was effective in the treatment of cognitive impairment and depression. Neuropsychological testing was performed, and antidepressant response monitored at baseline and at the 12, 24, and 48-week time points. RESULTS Treatment with escitalopram (mean daily dose 18.62 mg, SD 5.15) and memantine (mean daily dose 13.62 mg, SD 6.67) was associated with improvement in Hamilton Depression Rating Scale scores over the 48-week study period. Patients demonstrated significant improvement in the primary outcome of cognitive performance (Selective Reminding Test total immediate recall; SRT-IR) over the 48-week treatment period (p = 0.0147). Significant improvement was also observed in measures of naming and verbal fluency but not in the other cognitive domains. One of the 35 patients (2.9%) converted to Alzheimer's disease over the 48-week treatment period. In the amnestic mild cognitive impairment subsample (n = 22), the conversion rate was 4.5%, a rate lower than in other reports of patients with DEP-CI. CONCLUSIONS In this open-label trial, combined antidepressant and memantine treatment in patients with DEP-CI was associated with improved cognition and a low rate of conversion to dementia compared with published studies in patients with DEP-CI. Although limited by the open-label study design that incorporates practice effects that can improve cognitive test performance, the findings suggest the need for a larger randomized placebo-controlled trial.
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Affiliation(s)
- Gregory H Pelton
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Oliver L Harper
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Steven P Roose
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Karen Marder
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Kristina D'Antonio
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - D P Devanand
- Late Life Depression Clinic, The Memory Disorders Center, and The Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY, USA
- The College of Physicians and Surgeons of Columbia University, New York, NY, USA
- Department of Neurology, Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Graziane JA, Beer JC, Snitz BE, Chang CCH, Ganguli M. Dual Trajectories of Depression and Cognition: A Longitudinal Population-Based Study. Am J Geriatr Psychiatry 2016; 24:364-73. [PMID: 26560510 PMCID: PMC4841743 DOI: 10.1016/j.jagp.2015.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the relationships over time between dual trajectories of depressive symptoms and several cognitive domains. METHODS In a 5-year longitudinal study, 1,978 randomly selected individuals aged 65+ years at recruitment were assessed annually. Repeated measures were of depressive symptoms on the modified Center for Epidemiologic Studies Depression Scale and composite scores in the cognitive domains of attention, executive function, memory, language, and visuospatial function. Latent class trajectories were identified for depression and for each cognitive domain and their associations investigated using dual trajectory modeling. Cognitive trajectories with z scores below -1 were designated as persistently low. RESULTS Five depressive symptom trajectories were observed: rarely depressed (60.5%); low-grade, decreasing symptoms (18.5%); low-grade, increasing symptoms (9.6%); moderate-grade symptoms (7.4%); and consistent higher-grade symptoms (4.0%). For each cognitive domain six trajectories were observed. The rarely depressed and low-grade decreasing symptom groups were the least likely to have persistently low cognition. The symptom trajectory most strongly associated with persistently low functioning in each domain was not the higher-grade group but rather the low-grade increasing group in the case of attention and the moderate-grade trajectory in the other four domains. CONCLUSION Consistently higher-grade depressive symptoms are less strongly associated with poor cognitive functioning than with either moderate- or low-grade increasing depressive symptom trajectories, over time and across different domains. Examining both depression and cognition longitudinally allows heterogeneity of both to be addressed, revealing latent groups with potential diagnostic and prognostic implications.
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Affiliation(s)
- Julie A. Graziane
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Joanne C. Beer
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Beth E. Snitz
- University of Pittsburgh School of Medicine, Department of Neurology
| | - Chung-Chou H. Chang
- University of Pittsburgh School of Medicine, Department of Medicine,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics
| | - Mary Ganguli
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Neurology,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
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Chiao C, Weng LJ. Mid-life socioeconomic status, depressive symptomatology and general cognitive status among older adults: inter-relationships and temporal effects. BMC Geriatr 2016; 16:88. [PMID: 27099153 PMCID: PMC4839082 DOI: 10.1186/s12877-016-0257-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/13/2016] [Indexed: 11/11/2022] Open
Abstract
Background Few longitudinal studies have analyzed how socioeconomic status (SES) influences both depressive and cognitive development over an individual’s life course. This study investigates the change trajectories of both depressive symptomatology and general cognitive status, as well as their associations over time, focusing on the effects of mid-life SES. Methods Data were obtained from the Taiwan Longitudinal Study on Aging (1993–2007), a nationally representative cohort study of older adults in Taiwan. The short form of the Center of Epidemiological Studies-Depression (CES-D) scale that measures depressive symptomatology in two domains (negative affect and lack of positive affect) was used. General cognitive status was assessed using the brief Short Portable Mental Status Questionnaire scale. Assessments of the subjects’ mid-life SES included measurement of the participant’s education and occupation. Analyses were conducted by the parallel latent growth curve modeling. Results The participants’ initial levels of depressive symptomatology and general cognitive status were significantly and negatively correlated; furthermore, any changes in these two outcomes were also correlated over time. The initial assessment of general cognitive status significantly contributed to any advancement towards more severe depressive symptomatology over time, particularly when this occurred in a negative manner. Furthermore, a mid-life SES advantage resulted in a significant reduction in late-life depressive symptomatology and also produced a slower decline in general cognitive status during later life. In contrast, lower mid-life SES exacerbated depressive symptomatology during old age, both at the initial assessment and in terms of the change over time. In addition, female gender was significantly associated with lower general cognitive status and more severe depressive symptomatology in negative affect. Conclusions These findings suggest a complex and longitudinal association between depressive symptomatology and general cognitive status in later life and this complicated relationship seems to be affected by mid-life SES over time.
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Affiliation(s)
- Chi Chiao
- Insitute of Health and Welfare Policy, Research Center for Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| | - Li-Jen Weng
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan, R.O.C
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Abstract
The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa.
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35
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Francoeur RB. Symptom profiles of subsyndromal depression in disease clusters of diabetes, excess weight, and progressive cerebrovascular conditions: a promising new type of finding from a reliable innovation to estimate exhaustively specified multiple indicators-multiple causes (MIMIC) models. Diabetes Metab Syndr Obes 2016; 9:391-416. [PMID: 28003768 PMCID: PMC5158170 DOI: 10.2147/dmso.s118432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used. These population-weighted data combined a stratified, systematic, clustered random sample from independent residences and a census of senior housing. Physical conditions included progressive cerebrovascular disease (CVD; hypertension, silent CVD, stroke, and vascular cognitive impairment [VCI]) and co-occurring excess weight and/or diabetes. These conditions and interactions (clusters) simultaneously predicted 20 depression items and a latent trait of depression in participants with subsyndromal (including subthreshold) depression (11≤ Center for Epidemiologic Studies Depression Scale [CES-D] score ≤27). The option for maximum likelihood estimation with standard errors that are robust to non-normality and non-independence in complex random samples (MLR) in Mplus and an innovation created by the author were used for estimating unbiased effects from latent trait models with exhaustive specification. Symptom profiles reveal masked depression in 1) older males, related to the metabolic syndrome (hypertension-overweight-diabetes; silent CVD-overweight; and silent CVD-diabetes) and 2) older females or the full sample, related to several diabetes and/or overweight clusters that involve stroke or VCI. Several other disease clusters are equivocal regarding masked depression; a couple do emphasize dysphoric mood. Replicating findings could identify subgroups for cost-effective screening of subsyndromal depression.
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Affiliation(s)
- Richard B Francoeur
- School of Social Work, Adelphi University, Garden City, NY, USA
- Correspondence: Richard B Francoeur, School of Social Work, Social Work Building, Adelphi University, 1 South Avenue, Garden City, NY 11530, USA, Tel +1 917 254 7271, Email
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Lee JJ, Lee EY, Lee SB, Park JH, Kim TH, Jeong HG, Kim JH, Han JW, Kim KW. Impact of White Matter Lesions on Depression in the Patients with Alzheimer's Disease. Psychiatry Investig 2015; 12:516-22. [PMID: 26508963 PMCID: PMC4620309 DOI: 10.4306/pi.2015.12.4.516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/16/2015] [Accepted: 05/16/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Comorbid depression is common in patients with Alzheimer's disease (AD). An increase in white matter lesions (WMLs) has been associated with depression in both elderly individuals with normal cognition and patients with Alzheimer's disease. We investigated whether the severity and location of WMLs influence the association between WMLs and comorbid depression in AD. METHODS We enrolled 93 AD patients from Seoul National University Bundang Hospital. We administered both the Mini International Neuropsychiatric Inventory (MINI) and the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) clinical and neuropsychological battery. Subjects also underwent brain magnetic resonance imaging (MRI). We diagnosed AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. We diagnosed depressive disorders according to the DSM-IV diagnostic criteria, and evaluated the severity of depressive symptoms using the Korean version of the Geriatric Depression Scale (GDS-K). We quantified the WML volumes from the brain MRI using a fully automated segmentation algorithm. RESULTS The log of the WML volume in the frontal lobe was significantly associated with depressive disorders (odds ratio=1.905, 95% CI=1.027-3.533, p=0.041), but not with the severity of depressive symptoms as measured by the GDS-K. CONCLUSION The WML volume in the frontal lobe conferred a risk of comorbid depressive disorders in AD, which implies that comorbid depression in AD may be attributed to vascular causes.
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Affiliation(s)
- Jung Jae Lee
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Eun Young Lee
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Joon Hyuk Park
- Department of Psychiatry, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Zimprich D, Kurtz T. Subjective and Objective Memory Changes in Old Age across Five Years. Gerontology 2015; 61:223-31. [DOI: 10.1159/000369927] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
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Nelson LA, Noonan CJ, Goldberg J, Buchwald DS. Social engagement and physical and cognitive health among American Indian participants in the health and retirement study. J Cross Cult Gerontol 2014; 28:453-3. [PMID: 24122523 DOI: 10.1007/s10823-013-9213-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Social engagement has many demonstrated benefits for aging non-Hispanic Whites in the U.S. This study examined data from the U.S. Health and Retirement Study to determine whether these benefits were similar among American Indians and Alaska Natives older than 50 years. Linear regression techniques were used to examine the associations between level of social engagement, scores for memory and mental status, and self-reported health among 203 American Indian and Alaska Native elders who participated in the Health and Retirement Study and had data available between 1998 and 2010. Level of social engagement was significantly associated with memory, mental status, and self-reported health. However, only the association of social engagement with mental status and self-reported health remained significant (p = 0.04 and p = 0.05, respectively) after adjusting for sociodemographic variables, number of known health conditions, and scores on the Center for Epidemiologic Studies Depression scale. Level of social engagement was not associated with patterns of decline across time in cognitive or physical health. Higher levels of social engagement are associated with better physical and cognitive functioning in American Indian and Alaska Native elders. Future studies should examine whether this association acts through cognitive stimulation, increase in physical activity resulting from social engagement, or access to resources that support physical and cognitive health.
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Abstract
Knowledge of the relationship between depressive symptoms and cognition in older adults has primarily come from studies of clinically depressed, functionally impaired or cognitively impaired individuals, and in predominately White samples. Limited minority representation in depression research exposes the need to examine these associations in more ethnic/racially diverse populations. We sought to examine the relationship between depressive symptoms and cognition in a sample of non-demented older African Americans recruited from surrounding U.S. cities of New York, Greensboro, Miami, and Nashville (N=944). Depressive symptoms were evaluated with the Geriatric Depression Scale (GDS). Cognition was evaluated with a comprehensive neuropsychological battery. Test scores were summarized into attention, executive function, memory, language, and processing speed composites. Controlling for age, education, reading level, and sex, African American older adults who endorsed more symptoms obtained significantly lower scores on measures of memory, language, processing speed, and executive functioning. Further investigation of the causal pathway underlying this association, as well as potential mediators of the relationship between depressive symptoms and cognitive test performance among older African Americans, such as cardiovascular and cerebrovascular disease, may offer potential avenues for intervention.
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Physical activity and cognitive functioning in the oldest old: Within- and between-person cognitive activity and psychosocial mediators. Eur J Ageing 2014; 11:333-347. [PMID: 25598770 DOI: 10.1007/s10433-014-0314-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The current study examines the role of social contact intensity, cognitive activity, and depressive symptoms as within- and between-person mediators for the relationships between physical activity and cognitive functioning. METHOD All three types of mediators were considered simultaneously using multilevel structural equations modeling with longitudinal data. The sample consisted of 470 adults ranging from 79.37 to 97.92 years of age (M = 83.4; SD = 3.2) at the first occasion. RESULTS Between-person differences in cognitive activity mediated the relationship between physical activity and cognitive functioning, such that individuals who participated in more physical activities, on average, engaged in more cognitive activities and, in turn, showed better cognitive functioning. Mediation of between-person associations between physical activity and memory through social contact intensity was also significant. At the within-person level, only cognitive activity mediated the relationship between physical activity and change in cognition; however, the indirect effect was small. Depressive symptomatology was not found to significantly mediate within- or between-person effects on cognitive change. DISCUSSION Our findings highlight the implications of physical activity participation for the prevention of cognitive decline and the importance of meditational processes at the between-person level. Physical activity can provide older adults with an avenue to make new friendships and engage in more cognitive activities which, in turn, attenuates cognitive decline.
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Defrancesco M, Kemmler G, Huber R, Deisenhammer EA. [Correlation of mental activity with cognitive functions in mild cognitive impairment and early stage dementia]. DER NERVENARZT 2014; 85:350-355. [PMID: 23455983 DOI: 10.1007/s00115-013-3738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Mental activities have been suggested to influence the risk and course of dementia. This study was performed in order to assess the association of various mental activities with diagnosis and cognitive functions in an elderly population. METHODS A total of 191 memory clinic patients (mean age 71.7 ± 10.7 years) were included in this study. Participants completed a standardized neuropsychological test battery, a clinical interview, and a semistructured interview to assess mental activities. RESULTS Of the 191 patients, 39 were diagnosed as cognitively intact, 72 had mild cognitive impairment, and 80 mild Alzheimer's disease. Group comparisons of mental activity scores revealed differences for the variables art, culture, media consumption, travelling, and cognitive activities. Correlation analysis showed a significant association of culture, media consumption, travelling, and cognitive activities with cognitive functions. CONCLUSION Our results suggest that mental activities may influence the extent of cognitive impairment and possibly the risk for Alzheimer's disease.
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Affiliation(s)
- M Defrancesco
- Universitätsklinik für Allgemeine und Sozialpsychiatrie, Abteilung für Psychiatrie und Psychotherapie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich,
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Tomita T, Sugawara N, Kaneda A, Okubo N, Iwane K, Takahashi I, Kaneko S, Yasui-Furukori N. Sex-specific effects of subjective memory complaints with respect to cognitive impairment or depressive symptoms. Psychiatry Clin Neurosci 2014; 68:176-81. [PMID: 24895733 DOI: 10.1111/pcn.12102] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to investigate the association between subjective memory complaints (SMC) and sex. METHODS We researched the prevalence of SMC in a sample of 394 participants who were at least 60 years of age (138 male and 256 female). We also administered the Mini-Mental State Examination (MMSE) and the Center for Epidemiologic Studies for Depression (CES-D) scale. A multiple logistic regression analysis, which included SMC in association with the MMSE or CES-D scores and other confounding factors, was performed to determine the influence of sex on SMC. A P-value < 0.05 was considered statistically significant. RESULTS The durations of education of male participants were significantly higher than those of female participants. MMSE scores for female participants were significantly higher than those for male participants. There was no significant difference in CES-D scores between male and female participants. Twenty-four male participants and 72 female participants showed evidence of SMC. The incidence of SMC was more frequent in female participants than in male participants. In all participants, sex difference and CES-D score were significantly associated with SMC. In male participants, MMSE score was independently and significantly associated with SMC. Both in female participants and all participants, CES-D score was independently and significantly associated with SMC. CONCLUSION SMC varied by sex and were associated with the degree of cognitive impairment in male participants, while they were associated with depressive symptoms in female participants.
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Affiliation(s)
- Tetsu Tomita
- Department of Neuropsychiatry; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Norio Sugawara
- Department of Neuropsychiatry; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Ayako Kaneda
- Department of Neuropsychiatry; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Noriyuki Okubo
- Department of Social Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Kaori Iwane
- Department of Social Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Ippei Takahashi
- Department of Social Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Sunao Kaneko
- Department of Neuropsychiatry; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry; Hirosaki University Graduate School of Medicine; Hirosaki Japan
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Hsieh CJ, Chang C, Tsai G, Wu HF. Empirical study of the influence of a Laughing Qigong Program on long-term care residents. Geriatr Gerontol Int 2014; 15:165-73. [PMID: 24533887 DOI: 10.1111/ggi.12244] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting. METHODS Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels. RESULTS Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P<0.05), improved mood states (Z=-4.47; P<0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P<0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P<0.011), increased Geriatric Depression Scale scores (Z=4.34; P<0.001) and significant increases in cortisol levels (Z=2.62; P<0.009). CONCLUSIONS The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.
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Affiliation(s)
- Chia-Jung Hsieh
- College of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan
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Zahodne LB, Stern Y, Manly JJ. Depressive symptoms precede memory decline, but not vice versa, in non-demented older adults. J Am Geriatr Soc 2014; 62:130-4. [PMID: 25093232 DOI: 10.1111/jgs.12600] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether depressive symptoms typically precede or follow memory declines. DESIGN An autoregressive latent trajectory model was used to examine the direction of the relationship between depressive symptoms and memory decline observed over 12 years. SETTING Washington/Hamilton Heights Inwood Columbia Aging Project, a community-based longitudinal study of aging and dementia in northern Manhattan. PARTICIPANTS Older adults initially without dementia(n = 2,425). MEASUREMENTS Memory composite scores were computed from three subscores of the Selective Reminding Test. Depressive symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression Scale. Analyses controlled for age, sex, recruitment wave,education, black race, and Hispanic ethnicity measured at baseline and chronic disease burden measured at each study visit. RESULTS Initial depressive symptoms predicted worse memory scores at the second study visit (B weight = − 0.03; P = .003) and accelerated memory decline over the entire study period (B weight = − 0.02; P = .03). Memory scores did not predict subsequent depressive symptoms. CONCLUSION These findings suggest that depressive symptoms precede memory decline, but not vice versa, in late life. This pattern of results is consistent with hypotheses that depression is a prodrome of dementia or a causal contributor to memory decline. Clinicians should be aware that depressive symptoms may represent an early indicator not only of dementia, as reported previously, but also of memory decline more generally.
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Affiliation(s)
- Laura B Zahodne
- Institute, Columbia University, 630 West 168th Street, P & S Box 16, New York, NY 10032.
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Tsuno N, Homma A. What is the association between depression and Alzheimer’s disease? Expert Rev Neurother 2014; 9:1667-76. [DOI: 10.1586/ern.09.106] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Progressive supranuclear palsy (PSP) is a neurodegenerative extrapyramidal syndrome. Studies have demonstrated that PSP can present clinically as an atypical dementing syndrome dominated by a progressive apraxia of speech (AOS) and aphasia. AIM We aimed to investigate the clinical presentation of PSP, using a comprehensive multidimensional evaluation, and the disease response to various pharmacological treatments. METHODS A 72-year-old right-handed male, with 17 years education, who first presented with aphasia, AOS, depression, apathy, and postural instability at 69 years; a complete neuropsychological evaluation, tapping the different cognitive domains, was performed. RESULTS Testing revealed a moderate global cognitive deficit (Mini-Mental State Examination test score =20), low memory test scores (story recall, Rey's 15-word Immediate and Delayed Recall), and poor phonemic and semantic fluency. The patient's language was characterized by AOS, with slow speech rate, prolonged intervals between syllables and words, decreased articulatory accuracy, sound distortions, and anomia. Behavioral changes, such as depression, anxiety, apathy, and irritability, were reported. The neurological examination revealed supranuclear vertical gaze palsy, poor face miming, and a mild balance deficit. Magnetic resonance imaging showed only widespread cortical atrophy. Single photon emission computed tomography demonstrated left > right frontotemporal cortical abnormalities. After 6 months, a further neuropsychological assessment showed a progression in cognitive deficits, with additional attention deficits. The patient reported frequent falls, but the neurological deficits remained unchanged. Neuroimaging tests showed the same brain involvement. CONCLUSION Our case highlights the heterogeneity of the clinical features in this syndrome, demonstrating that atypical PSP can present as AOS and aphasia, without the classical features or involvement of the subcortical gray and brainstem region, commonly affected in typical PSP.
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Affiliation(s)
| | | | - Angela Craca
- IRCCS Salvatore Maugeri Foundation, Cassano Murge, Bari, Italy
| | - Anna Loverre
- IRCCS Salvatore Maugeri Foundation, Cassano Murge, Bari, Italy
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Verdelho A, Madureira S, Moleiro C, Ferro JM, O'Brien JT, Poggesi A, Pantoni L, Fazekas F, Scheltens P, Waldemar G, Wallin A, Erkinjuntti T, Inzitari D. Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study. J Neurol Neurosurg Psychiatry 2013; 84:1250-4. [PMID: 23715914 DOI: 10.1136/jnnp-2012-304191] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC). METHODS The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3. RESULTS 639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline. CONCLUSIONS DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction.
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Affiliation(s)
- Ana Verdelho
- Department of Neurociences, University of Lisbon, Santa Maria Hospital, , Lisbon, Portugal
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DeCaporale-Ryan LN, Steffen AM, Marwit SJ, Meuser TM. Extension of the Enright Forgiveness Inventory to Middle‐Aged and Older Wives. JOURNAL OF RELIGION, SPIRITUALITY & AGING 2013. [DOI: 10.1080/15528030.2013.789462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Diniz BS, Butters MA, Albert SM, Dew MA, Reynolds CF. Late-life depression and risk of vascular dementia and Alzheimer's disease: systematic review and meta-analysis of community-based cohort studies. Br J Psychiatry 2013; 202:329-35. [PMID: 23637108 PMCID: PMC3640214 DOI: 10.1192/bjp.bp.112.118307] [Citation(s) in RCA: 798] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Late-life depression may increase the risk of incident dementia, in particular of Alzheimer's disease and vascular dementia. AIMS To conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia, Alzheimer's disease and vascular dementia in individuals with late-life depression in population-based prospective studies. METHOD A total of 23 studies were included in the meta-analysis. We used the generic inverse variance method with a random-effects model to calculate the pooled risk of dementia, Alzheimer's disease and vascular dementia in older adults with late-life depression. RESULTS Late-life depression was associated with a significant risk of all-cause dementia (1.85, 95% CI 1.67-2.04, P<0.001), Alzheimer's disease (1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI 1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed that the risk of vascular dementia was significantly higher than for Alzheimer's disease (P = 0.03). CONCLUSIONS Late-life depression is associated with an increased risk for all-cause dementia, vascular dementia and Alzheimer's disease. The present results suggest that it will be valuable to design clinical trials to investigate the effect of late-life depression prevention on risk of dementia, in particular vascular dementia and Alzheimer's disease.
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