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Ahuja M, Siddhpuria S, Karimi A, Lewis K, Wong E, Lee J, Reppas-Rindlisbacher C, Sood E, Gabor C, Patterson C. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing 2023; 52:afad205. [PMID: 37993407 DOI: 10.1093/ageing/afad205] [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] [Received: 05/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. OBJECTIVE To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. METHODS Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. RESULTS Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. CONCLUSION In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors.
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Affiliation(s)
- Manan Ahuja
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shailee Siddhpuria
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arian Karimi
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Kaitlin Lewis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Emma Sood
- Faculty of Science, Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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Malhi GS, Bell E, Bassett D, Boyce P, Hopwood M, Mulder R, Porter R. Difficult decision-making in major depressive disorder: Practical guidance based on clinical research and experience. Bipolar Disord 2023; 25:355-378. [PMID: 37258062 DOI: 10.1111/bdi.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To extend current published guidance regarding the management of major depression in clinical practice, by examining complex cases that reflect real-world patients, and to integrate evidence and experience into recommendations. METHODS The authors who contributed to recently published clinical practice guidelines were invited to identify important gaps in extant guidance. Drawing on clinical experience and shared knowledge, they then generated four fictional case studies to illustrate the real-world complexities of managing mood disorders. The cases focussed specifically on issues that are not usually addressed in clinical practice guidelines. RESULTS The four cases are discussed in detail and each case is summarised using a life chart and accompanying information. The four cases reflect important real-world challenges that clinicians face when managing mood disorders in day-to-day clinical practice. To partly standardise the presentation of each case and for ease of reference we provide a Time Line, History Box and Management Chart, along with a synopsis where relevant. Discussion and formulation of the cases illustrate how to manage the complexities of each case and provide one possible pathway to achieving functional recovery. CONCLUSION These cases draw on the combined clinical experience of the authors and illustrate how to approach diagnostic decision-making when treating major depressive disorder and having to contend with complex presentations. The cases are designed to stimulate discussion and provide a real-world context for the formulation of mood disorders.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erica Bell
- Academic Department of Psychiatry, Faculty of Medicine and Health, Kolling Institute, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
| | - Darryl Bassett
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, Victoria, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Tao X, Yang C, He J, Liu Q, Wu S, Tang W, Wang J. Serum alkaline phosphatase was independently associated with depression in patients with cerebrovascular disease. Front Psychiatry 2023; 14:1184673. [PMID: 37469359 PMCID: PMC10352498 DOI: 10.3389/fpsyt.2023.1184673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023] Open
Abstract
Background and purpose Blood markers have important value in the diagnosis of depressive disorders. Serum alkaline phosphatase (ALP) not only predicts stroke recurrence and poor functional prognosis in cerebrovascular disease (CVD) patients but also increases significantly in middle-aged women with depression. Thus, it has not been reported whether serum ALP is associated with the development of depression and/or vascular depression (VDe) in CVD patients. Methods This was a cross-sectional study of 353 CVD patients (stroke patients, n = 291; cerebral small vessel disease (CSVD) patients, n = 62). Baseline demographic information, fasting blood markers (such as blood counts, liver function, kidney function and lipids), and brain CT/MRI scans were collected. CVD patients were divided into non-depression, suspected vascular depression (SVD), and positive vascular depression (PVD) groups according to their Hamilton Rating Scale for Depression (HAMD) scores. Univariate analysis of baseline data, blood markers, and the prevalence of lesions (> 1.5 cm) was performed. Subsequently, the diagnostic performance of the univariate and combined variables for SVD and PVD was analyzed using binary logistic regression. The diagnostic value of the multivariate model for VDe was analyzed by ordinal logistic regression. Results (1) Serum ALP (p = 0.003) and hypersensitive C-reactive protein (hs-CRP, p = 0.001) concentrations increased as HAMD scores increased, and the prevalence of brain atrophy (p = 0.016) and lesions in the basal ganglia (p = 0.001) and parietal (p = 0.001), temporal (p = 0.002), and frontal lobes (p = 0.003) also increased, whereas the concentrations of hemoglobin (Hb, p = 0.003), cholinesterase (ChE, p = 0.001), and high-density lipoprotein cholesterol (HDL-C, p = 0.005) declined. Among these variables, hs-CRP (r = 0.218, p < 0.001) had a weak positively association with HAMD scores, and ChE (r = -0.226, p < 0.001) had a weak negative association. (2) The combination of Hb, hs-CRP, ChE, ALP, and HDL-C improved diagnostic performance for VDe [AUC = 0.775, 95% CI (0.706, 0.844), p < 0.001]. (3) Hb (OR = 0.986, p = 0.049), ChE (OR = 0.999, p = 0.020), ALP (OR = 1.017, p = 0.003), and basal ganglia lesions (OR = 2.197, p < 0.001) were important factors impacting VDe development. After adjusting for Hb, hs-CRP, ChE, HDL-C, lesions in the above mentioned four locations, sex, age and the prevalence of CSVD and brain atrophy, ALP [OR = 1.016, 95% CI (1.005, 1.027), p = 0.004] was independently associated with VDe. Conclusion Hb, hs-CRP, ChE, ALP, and HDL-C concentrations are potential blood markers of depression in CVD patients and, when combined, may improve diagnostic performance for VDe. Serum ALP was independently associated with VDe in patients with CVD.
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Affiliation(s)
- Xi Tao
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
- Clinical Research Center for Cerebrovascular Disease Rehabilitation in Hunan Province, Changsha, Hunan Province, China
- Hunan Provincical Key Laboratory of Neurorestoratology, Hunan Normal University, Changsha, Hunan, China
| | - Chen Yang
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
| | - Juan He
- Department of Neurosurgery, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
| | - Qianrong Liu
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
- Clinical Research Center for Cerebrovascular Disease Rehabilitation in Hunan Province, Changsha, Hunan Province, China
| | - Siyuan Wu
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
| | - Wenjing Tang
- Department of Rehabilitation, Rehabilitation Hospital of Hunan Province, Changsha, Hunan Province, China
| | - Jia Wang
- Department of Scientific Research, Hunan Provincial People’s Hospital, Hunan Normal University, Changsha, Hunan Province, China
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Zawadzki RS, Grill JD, Gillen DL. Frameworks for estimating causal effects in observational settings: comparing confounder adjustment and instrumental variables. BMC Med Res Methodol 2023; 23:122. [PMID: 37217854 PMCID: PMC10201752 DOI: 10.1186/s12874-023-01936-2] [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: 10/24/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
To estimate causal effects, analysts performing observational studies in health settings utilize several strategies to mitigate bias due to confounding by indication. There are two broad classes of approaches for these purposes: use of confounders and instrumental variables (IVs). Because such approaches are largely characterized by untestable assumptions, analysts must operate under an indefinite paradigm that these methods will work imperfectly. In this tutorial, we formalize a set of general principles and heuristics for estimating causal effects in the two approaches when the assumptions are potentially violated. This crucially requires reframing the process of observational studies as hypothesizing potential scenarios where the estimates from one approach are less inconsistent than the other. While most of our discussion of methodology centers around the linear setting, we touch upon complexities in non-linear settings and flexible procedures such as target minimum loss-based estimation and double machine learning. To demonstrate the application of our principles, we investigate the use of donepezil off-label for mild cognitive impairment. We compare and contrast results from confounder and IV methods, traditional and flexible, within our analysis and to a similar observational study and clinical trial.
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Affiliation(s)
- Roy S Zawadzki
- Department of Statistics, University of California, Irvine, Irvine, USA.
| | - Joshua D Grill
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, USA
| | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, Irvine, USA
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Colwell MJ, Tagomori H, Chapman S, Gillespie AL, Cowen PJ, Harmer CJ, Murphy SE. Pharmacological targeting of cognitive impairment in depression: recent developments and challenges in human clinical research. Transl Psychiatry 2022; 12:484. [PMID: 36396622 PMCID: PMC9671959 DOI: 10.1038/s41398-022-02249-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Impaired cognition is often overlooked in the clinical management of depression, despite its association with poor psychosocial functioning and reduced clinical engagement. There is an outstanding need for new treatments to address this unmet clinical need, highlighted by our consultations with individuals with lived experience of depression. Here we consider the evidence to support different pharmacological approaches for the treatment of impaired cognition in individuals with depression, including treatments that influence primary neurotransmission directly as well as novel targets such as neurosteroid modulation. We also consider potential methodological challenges in establishing a strong evidence base in this area, including the need to disentangle direct effects of treatment on cognition from more generalised symptomatic improvement and the identification of sensitive, reliable and objective measures of cognition.
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Affiliation(s)
- Michael J Colwell
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Hosana Tagomori
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sarah Chapman
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Amy L Gillespie
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Yoshida K, Seo M, Luo Y, Sahker E, Cipriani A, Leucht S, Iwatsubo T, Efthimiou O, Furukawa TA. Personalized Prediction of Alzheimer’s Disease and Its Treatment Effects by Donepezil: An Individual Participant Data Meta-Analysis of Eight Randomized Controlled Trials. J Alzheimers Dis 2022; 89:1143-1157. [DOI: 10.3233/jad-220263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patient characteristics may predict the progression of Alzheimer’s disease (AD) and may moderate the effects of donepezil. Objective: To build a personalized prediction model for patients with AD and to estimate patient-specific treatment effects of donepezil, using individual patient characteristics. Methods: We systematically searched for all double-masked randomized controlled trials comparing oral donepezil and pill placebo in the treatment of AD and requested individual participant data through its developer, Eisai. The primary outcome was cognitive function at 24 weeks, measured with the Alzheimer’s Disease Assessment Scale-cognitive component (ADAS-cog). We built a Bayesian meta-analytical prediction model for patients receiving placebo and we performed an individual patient data meta-analysis to estimate patient-level treatment effects. Results: Eight studies with 3,156 participants were included. The Bayesian prediction model suggested that more severe cognitive and global function at baseline and younger age were associated with worse cognitive function at 24 weeks. The individual participant data meta-analysis showed that, on average, donepezil was superior to placebo in cognitive function (ADAS-cog scores, –3.2; 95% Credible Interval (CrI) –4.2 to –2.1). In addition, our results suggested that antipsychotic drug use at baseline might be associated with a lower effect of donepezil in ADAS-cog (2.0; 95% CrI, –0.02 to 4.3). Conclusion: Although our results suggested that donepezil is somewhat efficacious for cognitive function for most patients with AD, use of antipsychotic drugs may be associated with lower efficacy of the drug. Future research with larger sample sizes, more patient covariates, and longer treatment duration is needed.
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Affiliation(s)
- Kazufumi Yoshida
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Michael Seo
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Ethan Sahker
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
- Population Health and Policy Research Unit, Medical Education Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Toshiaki A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
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Efficacy of Donepezil Hydrochloride plus Olanzapine for Senile Dementia and Its Effect on the Recovery of Cognitive Function. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4156312. [PMID: 35990821 PMCID: PMC9388230 DOI: 10.1155/2022/4156312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
Objective To investigate the efficacy of donepezil hydrochloride plus olanzapine for senile dementia and its effect on the recovery of cognitive function. Methods A total of 60 patients with senile dementia admitted to our hospital from April 2020 to July 2021 were recruited and assigned to receive either olanzapine alone (observation group) or donepezil hydrochloride plus olanzapine (experimental group) via the random number table method, with 30 patients in each group. Results The combined therapy resulted in significantly higher clinical efficacy versus monotherapy of olanzapine (P < 0.05). Before treatment, the difference in the scores of cognitive function between the two groups did not come up to the statistical standard (P > 0.05). Donepezil hydrochloride plus olanzapine was associated with significantly higher scores of cognitive function in patients versus olanzapine alone (P < 0.05). The two groups had a similar incidence of adverse reactions (P > 0.05). Conclusion Donepezil hydrochloride plus olanzapine substantially enhances the recovery of cognitive function of patients with senile dementia and features a manageable safety. Further trials are, however, required prior to clinical promotion.
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Pozdnyakov DI, Zolotych DS, Rukovitsyna VM, Oganesyan ET. Chromone derivatives suppress neuroinflammation and improve mitochondrial function in the sporadic form of Alzheimer's disease under experimental conditions. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:871-881. [PMID: 36033947 PMCID: PMC9392576 DOI: 10.22038/ijbms.2022.65377.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
Objectives The study aims to estimate the neuroprotective effect of chromone derivatives in the sporadic form of Alzheimer's disease in the context of the relationship between changes in mitochondrial function and neuroinflammation. Materials and Methods Alzheimer's disease was modeled by injecting Aβ 1-42 fragments into the CA1 part of the hippocampus of animals. The test compounds and memantine were administered orally for 60 days from the moment the pathology was reproduced. The change in cognitive deficit in rats was assessed in the Y-maze test. In the hippocampus of rats, intensity of cellular respiration, activity of mitochondrial enzymes (citrate synthase, aconitase, cytochrome-c-oxidase, and succinate dehydrogenase), concentrations of IL - 6; IL -1β; TNF -α; IL - 10, and cardiolipin were determined. Results Of the 18 substances, only C3AACP6 and C3AACP7 compounds contributed to the recovery of aerobic metabolism, increased activity of mitochondrial enzymes, and reduced neuroinflammation in the hippocampus of rats. Furthermore, administration of these substances reduced the manifestation of cognitive deficit in animals with Alzheimer's disease to a degree comparable with memantine. Moreover, in terms of the effect on changes in the activity of mitochondrial enzymes and aerobic metabolism, these substances significantly exceeded memantine. Conclusion The study showed that from the analyzed chromone derivatives, two compounds C3AACP6 and C3AACP7 could have a neuroprotective effect in Alzheimer's disease, which is realized through the axis: recovery of mitochondrial function, decrease extramitochondrial cardiolipin, decrease neuroinflammation, neuroprotection.
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Affiliation(s)
- Dmitry I. Pozdnyakov
- Department of Pharmacology with Course of Clinical Pharmacology Pyatigorsk Medical Pharmaceutical Institute - A Branch of VolgGMU of the Ministry of Health of Russia, Pyatigorsk, Kalinin Ave., 11, 357532, Russia,Corresponding author: Dmitry I. Pozdnyakov. Department of Pharmacology with Course of Clinical Pharmacology Pyatigorsk Medical Pharmaceutical Institute - A Branch of VolgGMU of the Ministry of Health of Russia, Pyatigorsk, Kalinin Ave., 11, 357532, Russia.
| | - Denis S Zolotych
- Department of Analytical Chemistry, Pyatigorsk Medical Pharmaceutical Institute - A Branch of VolgGMU of the Ministry of Health of Russia, Pyatigorsk, Kalinin Ave., 11, 357532, Russia
| | - Viktoriya M Rukovitsyna
- Department of Organic Chemistry, Pyatigorsk Medical Pharmaceutical Institute - A Branch of VolgGMU of the Ministry of Health of Russia, Pyatigorsk, Kalinin Ave., 11, 357532, Russia
| | - Eduard T Oganesyan
- Department of Organic Chemistry, Pyatigorsk Medical Pharmaceutical Institute - A Branch of VolgGMU of the Ministry of Health of Russia, Pyatigorsk, Kalinin Ave., 11, 357532, Russia
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Efficacy and safety of donepezil for mild cognitive impairment: A systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 213:107134. [DOI: 10.1016/j.clineuro.2022.107134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
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Wang H, Zong Y, Han Y, Zhao J, Liu H, Liu Y. Compared of efficacy and safety of high-dose donepezil vs standard-dose donepezil among elderly patients with Alzheimer’s disease: a systemic review and meta-analysis. Expert Opin Drug Saf 2022; 21:407-415. [DOI: 10.1080/14740338.2022.2027905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Hecheng Wang
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin 124221, Liao Ning, China
| | - Yu Zong
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin 124221, Liao Ning, China
| | - Yanshuo Han
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin 124221, Liao Ning, China
| | - Jing Zhao
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin 124221, Liao Ning, China
| | - Hongqun Liu
- Medical School, Changchun sci-tech university, Changchun, 130600, Ji Lin, China
| | - Yong Liu
- School of Life and Pharmaceutical Sciences, Dalian University of Technology, Panjin 124221, Liao Ning, China
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Dobielska M, Bartosik NK, Zyzik KA, Kowalczyk E, Karbownik MS. Mechanisms of Cognitive Impairment in Depression. May Probiotics Help? Front Psychiatry 2022; 13:904426. [PMID: 35757204 PMCID: PMC9218185 DOI: 10.3389/fpsyt.2022.904426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Depression is the major cause of disability globally. Apart from lowered mood and accompanying symptoms, it leads to cognitive impairment that altogether predicts disadvantaged social functioning. Reduced cognitive function in depression appears a bit neglected in the field of clinical and molecular psychiatry, while it is estimated to occur in two-thirds of depressed patients and persist in at least one third of remitted patients. This problem, therefore, requires elucidation at the biomolecular and system levels and calls for improvement in therapeutic approach. In this review study, we address the above-mentioned issues by discussing putative mechanisms of cognitive decline in depression: (1) increased oxidative stress and (2) inflammation, (3) disturbed hypothalamus-pituitary-adrenals axis, and (4) reduced monoamines functionality. Moreover, we acknowledge additional underpinnings of cognitive impairment in depressed elderly: (5) vascular-originated brain ischemia and (6) amyloid-beta plaque accumulation. Additionally, by reviewing molecular, pre-clinical and clinical evidence, we propose gut microbiota-targeted strategies as potential adjuvant therapeutics. The study provides a consolidated source of knowledge regarding mechanisms of cognitive impairment in depression and may path the way toward improved treatment options.
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Affiliation(s)
- Maria Dobielska
- Students' Research Club, Department of Pharmacology and Toxicology, Medical University of Łódź, Łódź, Poland
| | - Natalia Karina Bartosik
- Students' Research Club, Department of Pharmacology and Toxicology, Medical University of Łódź, Łódź, Poland
| | - Kamil A Zyzik
- Institute of Sociology, Jagiellonian University, Kraków, Poland
| | - Edward Kowalczyk
- Department of Pharmacology and Toxicology, Medical University of Łódź, Łódź, Poland
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Choi J, Lee S, Motter JN, Kim H, Andrews H, Doraiswamy PM, Devanand DP, Goldberg TE. Models of depressive pseudoamnestic disorder. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12335. [PMCID: PMC9746884 DOI: 10.1002/trc2.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Jongwoo Choi
- Division of Mental Health Data Science New York State Psychiatric Institute New York New York USA
| | - Seonjoo Lee
- Division of Mental Health Data Science New York State Psychiatric Institute New York New York USA
- Department of Biostatistics Mailman School of Public Health Columbia University New York New York USA
- Department of Psychiatry Columbia University Medical Center New York New York USA
| | - Jeffrey N. Motter
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Hyun Kim
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Howard Andrews
- Department of Biostatistics Mailman School of Public Health Columbia University New York New York USA
- Department of Psychiatry Columbia University Medical Center New York New York USA
| | - P. Murali Doraiswamy
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham North Carolina USA
| | - D. P. Devanand
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
| | - Terry E. Goldberg
- Department of Psychiatry Columbia University Medical Center New York New York USA
- Division of Geriatric Psychiatry New York State Psychiatric Institute New York New York USA
- Department of Anesthesiology Columbia University Medical Center New York New York USA
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13
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Cesur S, Cam ME, Sayin FS, Gunduz O. Electrically controlled drug release of donepezil and BiFeO3 magnetic nanoparticle-loaded PVA microbubbles/nanoparticles for the treatment of Alzheimer's disease. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2021.102977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Li X, Li J, Huang Y, Gong Q, Fu Y, Xu Y, Huang J, You H, Zhang D, Zhang D, Mao F, Zhu J, Wang H, Zhang H, Li J. The novel therapeutic strategy of vilazodone-donepezil chimeras as potent triple-target ligands for the potential treatment of Alzheimer's disease with comorbid depression. Eur J Med Chem 2021; 229:114045. [PMID: 34922191 DOI: 10.1016/j.ejmech.2021.114045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/24/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
Depression is one of the most frequent comorbid psychiatric symptoms of Alzheimer's disease (AD), and no efficacious drugs have been approved specifically for this purpose thus far. Herein, we proposed a novel therapeutic strategy that merged the key pharmacophores of the antidepressant vilazodone (5-HT1A receptor partial agonist and serotonin transporter inhibitor) and the anti-AD drug donepezil (acetylcholinesterase inhibitor) together to develop a series of multi-target-directed ligands for potential therapy of the comorbidity of AD and depression. Accordingly, 55 vilazodone-donepezil chimeric derivatives were designed and synthesized, and their triple-target activities against acetylcholinesterase, 5-HT1A receptor, and serotonin transporter were systematically evaluated. Among them, compound 5 displayed strong triple-target bioactivities in vitro, low hERG potassium channel inhibition and acceptable brain distribution. Importantly, oral intake of 5 mg/kg of the compound 5 dihydrochloride significantly alleviated the depressive symptoms and ameliorated cognitive dysfunction in mouse models. In brief, these results highlight vilazodone-donepezil chimeras as a prospective therapeutic approach for the treatment of the comorbidity of AD and depression.
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Affiliation(s)
- Xiaokang Li
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Jinwen Li
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Yunyuan Huang
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Qi Gong
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Yan Fu
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Yixiang Xu
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Junyang Huang
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Haolan You
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Dong Zhang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Dan Zhang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China
| | - Fei Mao
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Jin Zhu
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China
| | - Huan Wang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China.
| | - Haiyan Zhang
- CAS Key Laboratory of Receptor Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai, 201203, China.
| | - Jian Li
- State Key Laboratory of Bioreactor Engineering, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 130 Mei Long Road, Shanghai, 200237, China; Yunnan Key Laboratory of Screening and Research on Anti-pathogenic Plant Resources from West Yunnan, College of Pharmacy, Dali University, 5 Xue Ren Road, Dali, Yunnan, 671000, China; Clinical Medicine Scientific and Technical Innovation Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200092, China.
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15
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Motter JN, Lee S, Sneed JR, Doraiswamy PM, Pelton GH, Petrella JR, Devanand DP. Cortical thickness predicts remission of depression with antidepressants in patients with late-life depression and cognitive impairment. J Affect Disord 2021; 295:438-445. [PMID: 34507224 PMCID: PMC8551049 DOI: 10.1016/j.jad.2021.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression (DEP) and cognitive impairment (CI) share etiological risk factors, anatomical underpinnings, and interact to produce deleterious treatment outcomes. Both DEP and CI exhibit altered patterns of cortical thickness which may impact the course of antidepressant treatment, though inconsistencies in directionality and affected brain regions have been reported. In this study, we examined the relationship between cortical thickness and treatment outcome in older adults with comorbid DEP-CI. METHODS 55 patients with DEP-CI received baseline MRI scans as part of a larger clinical trial at NYSPI/Columbia University Medical Center and Duke University Medical Center. Mood was assessed using the Hamilton Depression Rating Scale. Patients received open antidepressant treatment for 8 weeks followed by another 8 weeks of the same medication or switch to another antidepressant for a total of 16 weeks. Cortical thickness was extracted using an automated brain segmentation program (FreeSurfer). Vertex-wise analyses evaluated the relationship between cortical thickness and treatment outcome. RESULTS Remitters exhibited diffuse clusters of greater cortical thickness and reduced cortical thickness compared to non-remitters. Thicker baseline middle frontal gyrus most consistently predicted greater likelihood and faster rate of remission. White matter hyperintensities and hippocampal volume were not associated with antidepressant treatment outcome. LIMITATIONS MRI was conducted at baseline only and sample size was small. DISCUSSION Cortical thickness predicts treatment remission and magnitude of early improvement. Results indicate that individuals with DEP-CI exhibit unique patterns of structural abnormalities compared to their depressed peers without CI that have consequences for their recovery with antidepressant treatment.
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Affiliation(s)
| | - Seonjoo Lee
- Columbia University and the New York State Psychiatric Institute
| | - Joel R. Sneed
- Columbia University and the New York State Psychiatric Institute,Queens College, City University of New York,The Graduate Center, City University of New York
| | | | | | | | - D. P. Devanand
- Columbia University and the New York State Psychiatric Institute,Correspondence: Jeffrey N. Motter, Department of Psychiatry, Division of Geriatric Psychiatry, 1051 Riverside Drive, New York, NY 10032,
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16
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Walczak-Nowicka ŁJ, Herbet M. Acetylcholinesterase Inhibitors in the Treatment of Neurodegenerative Diseases and the Role of Acetylcholinesterase in their Pathogenesis. Int J Mol Sci 2021; 22:9290. [PMID: 34502198 PMCID: PMC8430571 DOI: 10.3390/ijms22179290] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022] Open
Abstract
Acetylcholinesterase (AChE) plays an important role in the pathogenesis of neurodegenerative diseases by influencing the inflammatory response, apoptosis, oxidative stress and aggregation of pathological proteins. There is a search for new compounds that can prevent the occurrence of neurodegenerative diseases and slow down their course. The aim of this review is to present the role of AChE in the pathomechanism of neurodegenerative diseases. In addition, this review aims to reveal the benefits of using AChE inhibitors to treat these diseases. The selected new AChE inhibitors were also assessed in terms of their potential use in the described disease entities. Designing and searching for new drugs targeting AChE may in the future allow the discovery of therapies that will be effective in the treatment of neurodegenerative diseases.
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Affiliation(s)
| | - Mariola Herbet
- Chair and Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8bStreet, 20-090 Lublin, Poland;
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17
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Alexopoulos GS. Mechanisms and Treatment of Late-Life Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:340-354. [PMID: 34690604 DOI: 10.1176/appi.focus.19304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
(Appeared originally in Translational Psychiatry 2019; 9:188).
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA
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18
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Sutthapitaksakul L, Dass CR, Sriamornsak P. Donepezil—an updated review of challenges in dosage form design. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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19
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Sánchez-Carro Y, Portella MJ, Leal-Leturia I, Salvat-Pujol N, Etxandi M, de Arriba-Arnau A, Urretavizcaya M, Pousa E, Toll A, Álvarez P, Soria V, López-García P. Age at illness onset and physical activity are associated with cognitive impairment in patients with current diagnosis of major depressive disorder. J Affect Disord 2021; 279:343-352. [PMID: 33099048 DOI: 10.1016/j.jad.2020.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/04/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cognitive impairment has been reported in patients with Major Depressive Disorder (MDD). This study aims to explore the association between lifestyle habits and health-related factors and the presence of cognitive symptoms in MDD patients. METHODS Demographic, clinical, health-related variables and cognitive scores measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB) were compared between 74 patients with current MDD and 68 healthy controls (HC). To test the hypothesis of associated factors to cognitive symptoms, multivariate backward stepwise linear regression models were run. RESULTS Significant neuropsychological deficits were evident in MDD compared with HC in the global cognitive index (F=8.29; df=1, 140; p=0.005). In the regression analysis performed on MDD and HC, years of schooling (β=-0.11; p=<0.001), job status (β=-0.50; p=0.016), physical activity (β=-0.25; p=0.04) and age at illness onset (β=0.17; p=0.017) were statistically significant factors associated to cognitive impairment. The regression model ran in HC showed that only years of schooling were significant (β=-0.07; p=<0.001) in this group. LIMITATIONS Sample size was relatively small. Everyday cognitive skills were not evaluated. CONCLUSIONS MDD patients have cognitive deficits. These deficits are linked with the years of education, job status, age of onset of the disease and the performance of physical activity. These results support the importance of the implementation of interventions targeting the cognitive reserve and lifestyle habits of MDD patients, in addition to the conventional therapeutic approach focused on symptoms control.
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Affiliation(s)
- Yolanda Sánchez-Carro
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain.
| | - Maria J Portella
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autonoma de Barcelona (UAB), Catalonia, Spain
| | - Itziar Leal-Leturia
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Neus Salvat-Pujol
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. Barcelona, Spain
| | - Mikel Etxandi
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. Barcelona, Spain
| | - Aida de Arriba-Arnau
- Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. Barcelona, Spain
| | - Mikel Urretavizcaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Esther Pousa
- Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Toll
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, IMIM, Barcelona, Spain
| | - Pilar Álvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Institute of Neuropsychiatry and Addictions, Hospital del Mar, IMIM, Barcelona, Spain
| | - Virginia Soria
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Bellvitge University Hospital, Psychiatry Department. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Pilar López-García
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
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20
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Fitzgerald PJ, Hale PJ, Ghimire A, Watson BO. Repurposing Cholinesterase Inhibitors as Antidepressants? Dose and Stress-Sensitivity May Be Critical to Opening Possibilities. Front Behav Neurosci 2021; 14:620119. [PMID: 33519395 PMCID: PMC7840590 DOI: 10.3389/fnbeh.2020.620119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
When stress becomes chronic it can trigger lasting brain and behavioral changes including Major Depressive Disorder (MDD). There is conflicting evidence regarding whether acetylcholinesterase inhibitors (AChEIs) may have antidepressant properties. In a recent publication, we demonstrated a strong dose-dependency of the effect of AChEIs on antidepressant-related behavior in the mouse forced swim test: whereas the AChEI donepezil indeed promotes depression-like behavior at a high dose, it has antidepressant-like properties at lower doses in the same experiment. Our data therefore suggest a Janus-faced dose-response curve for donepezil in depression-related behavior. In this review, we investigate the mood-related properties of AChEIs in greater detail, focusing on both human and rodent studies. In fact, while there have been many studies showing pro-depressant activity by AChEIs and this is a major concept in the field, a variety of other studies in both humans and rodents show antidepressant effects. Our study was one of the first to systematically vary dose to include very low concentrations while measuring behavioral effects, potentially explaining the apparent disparate findings in the field. The possibility of antidepressant roles for AChEIs in rodents may provide hope for new depression treatments. Importantly, MDD is a psychosocial stress-linked disorder, and in rodents, stress is a major experimental manipulation for studying depression mechanisms, so an important future direction will be to determine the extent to which these depression-related effects are stress-sensitive. In sum, gaining a greater understanding of the potentially therapeutic mood-related effects of low dose AChEIs, both in rodent models and in human subjects, should be a prioritized topic in ongoing translational research.
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Affiliation(s)
- Paul J Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Pho J Hale
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Anjesh Ghimire
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Brendon O Watson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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21
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Agüera-Ortiz L, García-Ramos R, Grandas Pérez FJ, López-Álvarez J, Montes Rodríguez JM, Olazarán Rodríguez FJ, Olivera Pueyo J, Pelegrin Valero C, Porta-Etessam J. Depression in Alzheimer's Disease: A Delphi Consensus on Etiology, Risk Factors, and Clinical Management. Front Psychiatry 2021; 12:638651. [PMID: 33716830 PMCID: PMC7953133 DOI: 10.3389/fpsyt.2021.638651] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Alzheimer's disease (AD) and other forms of dementia are among the most common causes of disability in the elderly. Dementia is often accompanied by depression, but specific diagnostic criteria and treatment approaches are still lacking. This study aimed to gather expert opinions on dementia and depressed patient management to reduce heterogeneity in everyday practice. Methods: Prospective, multicenter, 2-round Modified Delphi survey with 53 questions regarding risk factors (11), signs and symptoms (7), diagnosis (8), and treatment (27) of depression in dementia, with a particular focus on AD. The questionnaire was completed by a panel of 37 expert physicians in neurodegenerative diseases (19 neurologists, 17 psychiatrists, and 1 geriatrician). Results: Consensus was achieved in 40 (75.5%) of the items: agreement in 33 (62.3%) and disagreement in 7 (13.2%) of them. Among the most relevant findings, depression in the elderly was considered an early sign (prodromal) and/or a dementia risk factor, so routine cognitive check-ups in depressed patients should be adopted, aided by clinical scales and information from relatives. Careful interpretation of neuropsychological assessment must be carried out in patients with depression as it can undermine cognitive outcomes. As agreed, depression in early AD is characterized by somatic symptoms and can be differentiated from apathy by the presence of sadness, depressive thoughts and early-morning awakening. In later-phases, symptoms of depression would include sleep-wake cycle reversal, aggressive behavior, and agitation. Regardless of the stage of dementia, depression would accelerate its course, whereas antidepressants would have the opposite effect. Those that improve cognitive function and/or have a dual or multimodal mode of action were preferred: Duloxetine, venlafaxine/desvenlafaxine, vortioxetine, tianeptine, and mirtazapine. Although antidepressants may be less effective than in cognitively healthy patients, neither dosage nor treatment duration should differ. Anti-dementia cholinesterase inhibitors may have a synergistic effect with antidepressants. Exercise and psychological interventions should not be applied alone before any pharmacological treatment, yet they do play a part in improving depressive symptoms in demented patients. Conclusions: This study sheds light on several unresolved clinical challenges regarding depression in dementia patients. Further studies and specific recommendations for this comorbid patient population are still needed.
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Affiliation(s)
- Luis Agüera-Ortiz
- Service of Psychiatry, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rocío García-Ramos
- Movement Disorders Unit, Hospital Clínico San Carlos, Complutense University, Madrid, Spain
| | - Francisco J Grandas Pérez
- Service of Neurology, Hospital General Universitario Gregorio Marañón, Complutense University, Madrid, Spain
| | - Jorge López-Álvarez
- Service of Psychiatry, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - F Javier Olazarán Rodríguez
- Service of Neurology, HGU Gregorio Marañón, Madrid, Spain.,Memory Disorders Unit, HM Hospitales, Madrid, Spain
| | | | - Carmelo Pelegrin Valero
- Service of Psychiatry, Hospital Universitario San Jorge, Huesca, Spain.,University of Zaragoza Associate Professor, Zaragoza, Spain
| | - Jesús Porta-Etessam
- Service of Neurology, Instituto de Neurociencias, Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, Spain
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22
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Hayajneh AA, Rababa M, Alghwiri AA, Masha'al D. Factors influencing the deterioration from cognitive decline of normal aging to dementia among nursing home residents. BMC Geriatr 2020; 20:479. [PMID: 33208090 PMCID: PMC7672837 DOI: 10.1186/s12877-020-01875-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A dearth of differential research exists regarding the determinants of mild cognitive impairment (MCI) and moderate cognitive impairment or dementia among nursing home residents. This study aimed to identify and examine the association between medical factors (number of comorbidities, hospitalization, disability, depression, frailty and quality of life) and moderate cognitive impairment or dementia in nursing homes residents. METHODS A cross-sectional design was used in this study. Convenience sampling of 182 participants was conducted in nursing homes located in the central part of Jordan. Montreal cognitive assessment (MoCA) was used to screen both MCI and moderate cognitive impairment or dementia. Bivariate analysis, including t-test and ANOVA test, and logistic and linear regression models were used to examine and identify the medical factors associated with moderate cognitive impairment or dementia compared to mild cognitive impairment. RESULTS Most nursing home residents had MCI (87.4%) compared to a few with moderate cognitive impairment or dementia. Age (t = - 2.773), number of comorbidities (t = - 4.045), depression (t = - 4.809), frailty (t = - 4.038), and quality of life physical (t = 3.282) and mental component summaries (t = 2.469) were significantly different between the stages of cognitive impairment. Marital status (t = - 4.050, p < 0.001), higher-income (t = 3.755, p < 0.001), recent hospitalization (t = 2.622,p = 0.01), depression (t = - 2.737, p = 0.007), and frailty (t = 2.852, p = 0.005) were significantly associated with mental ability scores among nursing home residents. CONCLUSION The coexistence of comorbidities and depression among nursing home residents with MCI necessitates prompt management by healthcare providers to combat depressive symptoms in order to delay the dementia trajectory among at-risk residents. TRAIL REGISTRATION ClinicalTrials.gov NCT04589637 , October 15,2020, Retrospectively registered.
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Affiliation(s)
- Audai A Hayajneh
- Adult health-nursing department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Mohammad Rababa
- Adult health-nursing department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Alia A Alghwiri
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Dina Masha'al
- Adult health-nursing department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
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23
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Kumar S, Batist J, Ghazala Z, Zomorrodi RM, Brooks H, Goodman M, Blumberger DM, Daskalakis ZJ, Mulsant BH, Rajji TK. Effects of bilateral transcranial direct current stimulation on working memory and global cognition in older patients with remitted major depression: A pilot randomized clinical trial. Int J Geriatr Psychiatry 2020; 35:1233-1242. [PMID: 32525222 DOI: 10.1002/gps.5361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the effects of a 10-day course of bilateral anodal transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) on working memory and global cognition in elderly participants with remitted major depressive disorder at 14 days (primary outcome) and 90 days (secondary outcome) post intervention. DESIGN Randomized double blind controlled trial (clinicaltrials.gov # NCT02212366). SETTING Community dwelling outpatient setting. PARTICIPANTS Sixty or older with previous single or recurrent episodes of major depression currently in full remission. INTERVENTION A 10 day course of active or sham bilateral DLPFC anodal tDCS. MEASUREMENTS (a) Working memory assessed by a computerized N back task, and (b) global cognition assessed by a standard paper and pencil neuropsychological test battery. RESULTS Thirty-three participants, (mean (SD) age = 66. 5 (5.7) year) were enrolled, out of which 18 (mean (SD) age = 66. 3 (5.8) year) were randomized to active tDCS and 15 (mean (SD) age = 66. 7 (5.8) years) to sham tDCS. All randomized participants except one from the sham group -completed the tDCS course. There were no differences between the groups on working memory performance or global cognition at 14 or 90 days post intervention. Both groups showed promising changes in working memory and global cognition over time. CONCLUSIONS tDCS was well tolerated in older patients with remitted MDD, however, as compared to the sham group, it did not improve working memory or global cognition. Future studies should investigate tDCS with alternative parameters to enhance cognition in this population.
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Affiliation(s)
- Sanjeev Kumar
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Judah Batist
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zaid Ghazala
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Reza M Zomorrodi
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather Brooks
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Goodman
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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The cholinesterase inhibitor donepezil has antidepressant-like properties in the mouse forced swim test. Transl Psychiatry 2020; 10:255. [PMID: 32712627 PMCID: PMC7382650 DOI: 10.1038/s41398-020-00928-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 11/08/2022] Open
Abstract
Finding new antidepressant agents is of high clinical priority given that many cases of major depressive disorder (MDD) do not respond to conventional monoaminergic antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. Recent findings of effective fast-acting antidepressants indicate that there are biological substrates to be taken advantage of for fast relief of depression and that we may find further treatments in this category. In this vein, the cholinergic system may be a relatively overlooked target for antidepressant medications, given its major role in motivation and attention. Furthermore, the classically engaged monoaminergic neurotransmitter systems in depression treatment-serotonin, norepinephrine, and dopamine-interact directly at times with cholinergic signaling. Here we investigate in greater detail how the cholinergic system may impact depression-related behavior, by administering widely ranging doses of the cholinesterase inhibitor drug, donepezil, to C57BL/6J mice in the forced swim test. First, we confirm prior findings that this drug, which is thought to boost synaptic acetylcholine, promotes depression-like behavior at a high dose (2.0 mg/kg, i.p.). But we also find paradoxically that it has an antidepressant-like effect at lower doses (0.02 and 0.2 mg/kg). Further this antidepressant-like effect is not due to generalized hyperactivity, since we did not observe increased locomotor activity in the open field test. These data support a novel antidepressant-like role for donepezil at lower doses as part of an overall u-shaped dose-response curve. This raises the possibility that donepezil could have antidepressant properties in humans suffering from MDD.
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Matsunaga S, Fujishiro H, Takechi H. Efficacy and Safety of Cholinesterase Inhibitors for Mild Cognitive Impairment:A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 71:513-523. [PMID: 31424411 DOI: 10.3233/jad-190546] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical benefit of cholinesterase inhibitors (ChEIs) for mild cognitive impairment (MCI) remains inconclusive. OBJECTIVE We performed a systematic review and meta-analysis of the efficacy/safety of ChEIs on subjects with MCI. METHODS We included randomized controlled trials (RCTs) of ChEIs in subjects with MCI, using cognitive function scores as a primary outcome measure. RESULTS Fourteen RCTs (six using donepezil, four using galantamine, and four using rivastigmine) with 5,278 subjects were included. We found no significant difference in cognitive function scores between the ChEIs and placebo groups [standardized mean difference (SMD) = -0.06, p = 0.38, I2 = 76% ]. However, in the secondary outcomes, ChEIs were associated with a lower incidence of progression to dementia compared with placebo (risk ratio = 0.76, the number needed to treat = 20). For safety outcomes, ChEIs were associated with a lower prevalence of fall than placebo. On the other hand, compared with placebo, ChEIs were associated with a higher incidence of discontinuation due to all causes, discontinuation due to adverse events, at least one adverse event, abnormal dreams, diarrhea, dizziness, headache, insomnia, loose stools, muscle cramps, nausea, vomiting, and weight loss. CONCLUSIONS Although ChEIs have a slight efficacy in the treatment of MCI, there are many safety issues. Therefore, ChEIs are difficult to recommend for MCI. However, the efficacy and safety of ChEIs on MCI with a biomarker-based diagnosis is unclear. Further RCTs are needed to confirm the efficacy and safety of ChEIs when used for individual neuropathological classifications of MCI.
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Affiliation(s)
- Shinji Matsunaga
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Kawasaki Memorial Hospital, Miyamae, Kawasaki, Kanagawa, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
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Estrada S, Arancibia M, Stojanova J, Papuzinski C. General concepts in biostatistics and clinical epidemiology: Experimental studies with randomized clinical trial design. Medwave 2020; 20:e7869. [PMID: 32469850 DOI: 10.5867/medwave.2020.02.7869] [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: 01/07/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
In experimental studies, researchers apply an intervention to a group of study participants and analyze the effects over a future or prospective timeline. The prospective nature of these types of studies allows for the determination of causal relationships, but the interventions they are based on require rigorous bioethical evaluation, approval from an ethics committee, and registration of the study protocol prior to implementation. Experimental research includes clinical and preclinical testing of a novel intervention or therapy at different phases of development. The main objective of clinical trials is to evaluate an interventions efficacy and safety. Conventional clinical trials are blinded, randomized, and controlled, meaning that participants are randomly assigned to either the study intervention group or a comparator (a control group exposed to a placebo intervention or another non-placebo or active interventionor not exposed to any intervention) to reduce selection and confounding biases, and researchers are also unaware of the type of intervention being applied. Intention-to-treat analysis (inclusion of all originally randomized subjects) should be done to avoid the effects of attrition (dropout) and crossover (variance in the exposure or treatment over time). A quasi-experimental design and external controls may also be used. Metrics used to measure the magnitude of effects include relative risk, absolute and relative risk reductions, and numbers needed to treat and harm. Confounding factors are controlled by randomization. Other types of bias to consider are selection, performance, detection, and reporting. This review is the fifth of a methodological series on general concepts in biostatistics and clinical epidemiology developed by the Chair of Scientific Research Methodology at the School of Medicine, University of Valparaíso, Chile. It describes general theoretical concepts related to randomized clinical trials and other experimental studies in humans, including fundamental elements, historical development, bioethical issues, structure, design, association measures, biases, and reporting guidelines. Factors that should be considered in the execution and evaluation of a clinical trial are also covered.
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Affiliation(s)
- Sebastián Estrada
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
| | - Marcelo Arancibia
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
| | - Jana Stojanova
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
| | - Cristian Papuzinski
- Cátedra de Metodología de la Investigación Científica, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile; Centro Interdisciplinario de Estudios en Salud (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
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Abstract
The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer’s disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly – or at least a subgroup of them – and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aβ42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established.
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Affiliation(s)
- Natália S Dias
- Neuroscience Program, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Izabela G Barbosa
- Neuroscience Program, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Department of Mental Health, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Weihong Kuang
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Antonio L Teixeira
- Neuroscience Program, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.,Department of Psychiatry and Behavioral Sciences, UT Health, Houston, United States.,Instituto de Ensino e Pesquisa, Santa Casa BH, Belo Horizonte, MG, Brazil
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28
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Alexopoulos GS. Mechanisms and treatment of late-life depression. Transl Psychiatry 2019; 9:188. [PMID: 31383842 PMCID: PMC6683149 DOI: 10.1038/s41398-019-0514-6] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023] Open
Abstract
Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson's disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.
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Affiliation(s)
- George S. Alexopoulos
- 000000041936877Xgrid.5386.8Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605 USA
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