Relationship Between Mood, Thinking, and Walking: A Systematic Review Examining Depressive Symptoms, Executive Function, and Gait

The association between gait speed and depressive disorders - A cross-sectional analysis of very old adults in the 21st century

OBJECTIVES

To investigate the association between gait speed and depressive disorders among very old adults (≥85 years).

METHOD

This study utilized the GERDA-database, which encompasses a representative sample of those aged 85, 90, and 95+ years residing in northern Sweden and western Finland. From four data collections between 2000 and 2017, this study included 1794 participants. Self-paced gait speed was measured over 2.4-m and depressive disorders was evaluated by a specialist in geriatric medicine according to the DSM-IV-TR criteria. T-tests and multivariable logistic regressions were used to explore differences and associations between gait speed and depressive disorders.

RESULTS

Gait speed was independently associated with depressive disorders among very old adults (p < .001). The results showed significantly different mean gait speeds (m/s) between individuals with/without a depressive disorder (0.34 ± 0.24/0.52 ± 0.26, p < .001), between individuals with a depressive disorder with/without antidepressant treatment (0.35 ± 0.24/0.44 ± 0.24, p < .001) and between non-responders/responders to antidepressants (0.36 ± 0.21/0.42 ± 0.22, p = .020).

CONCLUSION

This is the first study focusing on very old adults that has shown an independent association between gait speed and depressive disorders. Responders to antidepressant medication had a higher mean gait speed than non-responders, which may imply shifts in function upon successful treatment.

Motor and cognitive function after unipolar depressive episodes: a 6 years longitudinal observational study

Introduction

Unipolar depression is a frequent psychiatric disorder and associated with cognitive and motor deficits. It is also a prodromal or risk marker for various neurodegenerative diseases. Little research has been done on the extent to which motor and cognitive deficits persist in remitted depressive episode, and to what extent these deficits can be progressive.

Methods

A total of 401 healthy subjects of the Tübingen TREND study aged between 50 and 80 years were examined over 6 years at intervals of 2 years. Of those, 81 had a positive history of unipolar depression (Dep+) and 320 had not (Dep-). We ruled out currently depressive participants. Mini-Mental-State Examination (MMSE), Consortium to Establish a Registry for Alzheimer's disease (CERAD), the motor part of the Movement disorder society-revised version of the Unified Parkinson disease rating scale (MDS-UPDRS III), gait speed, and dual tasking parameters were compared between groups.

Results

Dep+ had lower gait velocity than Dep-. No significant change in parameters was found over the observed time.

Discussion

Reduced gait speed in Dep+ may have potential as a diagnostic and prognostic marker for Dep- if confirmed in further studies. The lack of progression of all studied parameters over 6 years specifically in Dep+ argues against a relevant potential of this approach to define prodromal neurodegenerative cohorts by history of depression.

3D-optical motion capturing examination of sensori- and psychomotor abnormalities in mental disorders: Progress and perspectives

Sensori-/psychomotor abnormalities refer to a wide range of disturbances in individual motor, affective and behavioral functions that are often observed in mental disorders. However, many of these studies have mainly used clinical rating scales, which can be potentially confounded by observer bias and are not able to detect subtle sensori-/psychomotor abnormalities. Yet, an innovative three-dimensional (3D) optical motion capturing technology (MoCap) can provide more objective and quantifiable data about movements and posture in psychiatric patients. To draw attention to recent rapid progress in the field, we performed a systematic review using PubMed, Medline, Embase, and Web of Science until May 01st 2024. We included 55 studies in the qualitative analysis and gait was the most examined movement. The identified studies suggested that sensori-/psychomotor abnormalities in neurodevelopmental, mood, schizophrenia spectrum and neurocognitive disorders are associated with alterations in spatiotemporal parameters (speed, step width, length and height; stance time, swing time, double limb support time, phases duration, adjusting sway, acceleration, etc.) during various movements such as walking, running, upper body, hand and head movements. Some studies highlighted the advantages of 3D optical MoCap systems over traditional rating scales and measurements such as actigraphy and ultrasound gait analyses. 3D optical MoCap systems are susceptible to detecting differences not only between patients with mental disorders and healthy persons but also among at-risk individuals exhibiting subtle sensori-/psychomotor abnormalities. Overall, 3D optical MoCap systems hold promise for objectively examining sensori-/psychomotor abnormalities, making them valuable tools for use in future clinical trials.

Efficacy of problem-solving therapy in treating late-life depression with potential cognitive impairment: a systematic review and meta-analysis

INTRODUCTION

Late-life depression (LLD) is a global public health issue, often accompanied by cognitive impairments that can exacerbate the severity of depression and impair social functioning. Despite being a well-established treatment for LLD, the suitability of problem-solving therapy (PST) for individuals with LLD and varying degrees of cognitive impairments warrants further investigation. This paper presents the protocol for a systematic review and meta-analysis of randomised controlled trials (RCTs) aimed at evaluating the effectiveness and acceptability of PST for this specific demographic.

METHODS/ANALYSIS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we will conduct a systematic review to synthesise existing research on PST for individuals in this demographic. We will comprehensively search multiple databases and sources, including PubMed, EMBASE, the Cochrane Database and APA PsycNET from inception to October 2023, without language, publication year or type restrictions. Relevant studies will be manually screened from the references. Only RCTs involving PST for LLD will be included. The primary efficacy outcome will be the standardised mean difference in total scores on continuous depression severity scales across different comparison arms. Data extraction will be conducted independently by two reviewers (CH and J-JW), and methodological rigour will be assessed using the Cochrane Risk of Bias assessment tool. Subgroup and sensitivity analyses will be performed to investigate the impact of concomitant cognitive impairments and to evaluate the robustness of the findings.

ETHICS AND DISSEMINATION

The meta-analysis project is expected to be ethically unproblematic and does not require approval from a research ethics committee. The results of this study will be shared through articles in scholarly peer-reviewed journals and presentations in various formats, both print and digital.

PROSPERO REGISTRATION NUMBER

CRD42023473782.

The effects of trait and state anxiety on gait in healthy young adults

Stable, personality-based (trait), and fluctuating, situational (state) anxiety have both been shown to consume attentional resources and reduce functional cognitive capacity, which may play a role in gait control. However, the role of attention in the relationship between trait and state anxiety has not yet been investigated formally. This study used a virtual reality-threat environment to evaluate whether changes in attention mediate the effects of state and trait anxiety on gait. Thirty adults aged 19-28 completed five walking trials in four conditions: (i) low threat-walking across a virtual plank (0.5 m wide) on flat ground; (ii) low threat + dual task (auditory digit monitoring); (iii) high threat-walking across a virtual plank elevated above a deep pit; and (iv) high threat + dual task. Trait anxiety levels were determined by the State-Trait Anxiety Inventory, while state anxiety was captured using self-assessment manikins. Higher trait anxiety predicted slower gait velocity and longer time in double support in the high-threat condition compared to low-threat condition (i vs iii), but not when dual tasking, compared to single-task walking, in the absence of threat (ii vs i). Additionally, higher trait anxiety predicted increased step length variability in the high compared to low-threat dual-task condition. Overall, trait anxiety predicts a slower, more cautious gait pattern during threatening conditions while dual tasking during the threat.

Tourette syndrome and obsessive-compulsive disorder: A comprehensive review of structural alterations and neurological mechanisms

Currently, it is possible to study the pathogenesis of Tourette's syndrome (TS) in more detail, due to more advanced methods of neuroimaging. However, medical and surgical treatment options are limited by a lack of understanding of the nature of the disorder and its relationship to some psychiatric disorders, the most common of which is obsessive-compulsive disorder (OCD). It is believed that the origin of chronic tic disorders is based on an imbalance of excitatory and inhibitory influences in the Cortico-Striato-Thalamo-Cortical circuits (CSTC). The main CSTCs involved in the pathological process have been identified by studying structural and neurotransmitter disturbances in the interaction between the cortex and the basal ganglia. A neurotransmitter deficiency in CSTC has been demonstrated by immunohistochemical and genetic methods, but it is still not known whether it arises as a consequence of genetically determined disturbances of neuronal migration during ontogenesis or as a consequence of altered production of proteins involved in neurotransmitter production. The aim of this review is to describe current ideas about the comorbidity of TS with OCD, the involvement of CSTC in the pathogenesis of both disorders and the background of structural and neurotransmitter changes in CSTC that may serve as targets for drug and neuromodulatory treatments.

A cross-lagged prospective network analysis of depression and anxiety and cognitive functioning components in midlife community adult women

BACKGROUND

Scar theory proposes that heightened depression and anxiety precede and predict worse cognitive functioning outcomes, whereas the vulnerability theory posits the opposite pathway. However, most investigations on this topic have been cross-sectional, precluding causal inferences. Thus, we used cross-lagged prospective network analyses to facilitate causal inferences in understanding the relations between psychopathology and cognitive functioning components.

METHODS

Racially-diverse midlife women (n = 1816) participated in the Study of Women's Health Across the Nation at two time-points, spanning one year apart. Five psychopathology (anxiety severity, depressed mood, somatic symptoms, positive affect, interpersonal problems) and four cognitive functioning nodes (working memory (WM), processing speed (PS), facial recognition (FCR), and verbal memory (VRM)) were assessed. All analyses adjusted for age, menopausal status, estradiol, and follicle-stimulating hormones.

RESULTS

Contemporaneous networks yielded notable inverse between-node relations (edges) between interpersonal problems and reduced FCR and PS, and between depressed mood and lower FCR, VRM, or PS. Nodes that had the highest likelihood to bridge other constructs were positive affect, anxiety severity, WM, and VRM. Temporal networks produced edges consistent with the scar (v. vulnerability) hypotheses. Higher somatic symptoms were related to reduced PS and WM, and greater depressed mood was correlated with lower future PS and WM. Also, higher anxiety severity coincided with decreased future PS and WM. Greater positive affect was associated with stronger future PS, FCR, and WM. Also, positive affect had the strongest relations with other nodes.

CONCLUSIONS

Findings suggest the importance of targeting symptoms and cognitive functioning simultaneously.

Depressive and Biopsychosocial Frailty Phenotypes: Impact on Late-life Cognitive Disorders

 In older age, frailty is a detrimental transitional status of the aging process featuring an increased susceptibility to stressors defined by a clinical reduction of homoeostatic reserves. Multidimensional frailty phenotypes have been associated with all-cause dementia, mild cognitive impairment (MCI), Alzheimer's disease (AD), AD neuropathology, vascular dementia, and non-AD dementias. In the present article, we reviewed current evidence on the existing links among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders, also examining common pathways and mechanisms underlying these links. The depressive frailty phenotype suggested by the construct of late-life depression (LLD) plus physical frailty is poorly operationalized. The biopsychosocial frailty phenotype, with its coexistent biological/physical and psychosocial dimensions, defines a biological aging status and includes motivational, emotional, and socioeconomic domains. Shared biological pathways/substrates among depressive and biopsychosocial frailty phenotypes and late-life cognitive disorders are hypothesized to be inflammatory and cardiometabolic processes, together with multimorbidity, loneliness, mitochondrial dysfunction, dopaminergic neurotransmission, specific personality traits, lack of subjective/objective social support, and neuroendocrine dysregulation. The cognitive frailty phenotype, combining frailty and cognitive impairment, may be a risk factor for LLD and vice versa, and a construct of depressive frailty linking physical frailty and LLD may be a good dementia predictor. Frailty assessment may enable clinicians to better target the pharmacological and psychological treatment of LLD. Given the epidemiological links of biopsychosocial frailty with dementia and MCI, multidomain interventions might contribute to delay the onset of late-life cognitive disorders and other adverse health-related outcomes, such as institutionalization, more frequent hospitalization, disability, and mortality.

Predictors of cognitive and physical decline: Results from the Health Aging and Body Composition Study

Background

Risk factors for cognitive decline and physical decline have been studied independently, however older adults might experience decline in both areas i.e., dual decline. Risk factors associated with dual decline are largely unknown and have significant implications on health outcomes. The aim of this study is to explore risk factors associated with dual decline.

Methods

Using data from the Health, Aging and Body Composition (Health ABC) study, a longitudinal prospective cohort study, we examined trajectories of decline based on repeated measures of the Modified Mini-Mental State Exam (3MSE) and the Short Physical Performance Battery (SPPB) across 6 years (n=1,552). We calculated four mutually exclusive trajectories of decline and explored predictors of decline: cognitive decline (n = 306) = lowest quartile of slope on the 3MSE or 1.5 SD below mean at baseline, physical decline (n = 231) = lowest quartile of slope on the SPPB or 1.5 SD below mean at baseline, dual decline (n = 110) = lowest quartile in both measures or 1.5 SD below mean in both measures at baseline. Individuals who did not meet criteria for one of the decline groups were classified as the reference group. (n= 905).

Results

Multinomial logistic regression tested the association of 17 baseline risk factors with decline. Odds of dual decline where significantly higher for individuals at baseline with depressive symptoms (CES-D >16) (Odds Ratio (OR)=2.49, 95% Confidence Interval (CI): 1.05-6.29), ApoE-ε4 carrier (OR= 2.09, 95% CI: 1.06-1.95), or if individuals had lost 5+lbs in past year (OR=1.79, 95% CI: 1.13-2.84). Odds were significantly lower for individuals with a higher score on the Digit Symbol Substitution Test per standard deviation (OR per SD: 0.47, 95% CI 0.36-0.62) and faster 400-meter gait (OR per SD= 0.49, 95% CI: 0.37-0.64).

Conclusion

Among predictors, depressive symptoms at baseline significantly increased the odds of developing dual decline but was not associated with decline in the exclusively cognitive or physical decline groups. APOE-ε4 status increased the odds for cognitive decline and dual decline but not physical decline. More research on dual decline is needed because this group represents a high risk, vulnerable subset of older adults.

Motor alterations in depression and anxiety disorders: A systematic review and meta-analysis

BACKGROUND

Psychomotor retardation has long been recognized as a major feature of depression, and anxiety disorders have been linked with freeze and flight motor responses. This systematic review and meta-analysis aimed a) to synthesize available evidence of motor alterations comparing individuals with depression and anxiety disorders to healthy individuals and b) to evaluate the effect of experimental manipulations of motor displays within these clinical groups.

METHOD

The databases PubMed and PsycINFO were searched for studies either assessing motor differences between clinical and healthy control groups or manipulating the motor system within a clinical group.

RESULTS

The literature search yielded 87 relevant papers, comprising 82 studies comparing a clinical group to a healthy group and 5 studies investigating motor manipulations within a clinical sample. The results of the meta-analysis (K = 71) indicated a statistically significant combined estimate of differences between healthy and clinical groups (g = 0.38 [0.31, 0.45], adjusted for publication bias g = 0.26 [0.19, 0.33]) of a small size. This effect did not vary according to type of disorder (anxiety vs. depression, p = .468). From a narrative review of experimental studies within clinical groups, four out of five studies reported statistically significant effects of manipulating the motor system on affective outcomes.

DISCUSSION

This synthesis adds to the accumulating empirical evidence of motor alterations in depression and anxiety disorders. Future research will need to investigate how individuals suffering from depression or anxiety disorders could benefit from psychological, behavioral, and physical interventions directly aimed at the motor system.

The apathy, gait impairment, and executive dysfunction (AGED) triad vascular variant

Apathy, gait disturbances, and executive dysfunction (AGED) often occur together. Although they can arise independently, the presence of one might portend another. This recognition suggests the possible etiology. We focus on the most common, the vascular. We explain the AGED vascular mechanism through the ambibaric brain concept. The brain contains two complementary blood pressure systems: One high in the primitive brain (brainstem, basal ganglia, and thalamus) and a low-pressure system in the Homo sapiens brain (cerebral hemispheres). Hypertension inflicts the most damage on the primitive brain. The frontal systems connect to the basal ganglia, then the thalamus and back to the cortex. Many connections converge on the primitive brain where they are damaged by vascular disease. We need methods of determining optimal, individual blood pressures. Although the AGED triad can result from other causes, it should first signal a vascular etiology, the most prevalent, treatable, and preventable one.

Association Between Passive Body Heating by Hot Water Bathing Before Bedtime and Depressive Symptoms Among Community-Dwelling Older Adults

OBJECTIVE

Passive body heating can have an antidepressant effect by activating warm-sensitive neural pathways associated with affective functions. Interventional studies showed that patients with depression had reduced depressive symptoms after passive body heating. However, the effect of hot water bathing at home on depressive symptoms in the general population remains unclear. Thus, we evaluated the association between objectively measured hot water bathing and depressive symptoms among older adults.

DESIGN

Cross-sectional analysis.

SETTING

A baseline survey of community-based cohort study in Japan.

PARTICIPANTS

Community-dwelling older volunteers (n = 1,103; mean age: 72.0 years).

MEASUREMENTS

The authors evaluated bathing conditions and distal skin temperature for 2 consecutive days. Depressive symptoms were defined as the 15-item Geriatric Depression Scale score of ≥6.

RESULTS

Logistic regression showed that the no bathing group (adjusted odds ratio [OR] 2.60, 95% confidence interval [CI] 1.36-4.95, χ² = 8.40, degrees of freedom [df] = 1) and the either-day bathing group (adjusted OR 1.68, 95% CI 1.11-2.56, χ² = 5.89, df = 1) had higher odds of depressive symptoms than the both-day bathing group independent of potential confounders including age, sex, body mass index, alcohol intake, income, living alone, hypnotic use, diabetes, and physical activity. Shorter interval from bathing to bedtime was significantly associated with lower odds of depressive symptoms and higher nighttime distal skin temperature after adjusting for water temperature and duration.

CONCLUSION

A higher frequency of hot water bathing and shorter interval from bathing to bedtime were associated with lower odds of depressive symptoms.

Mobility and Depressive Symptoms in Persons With Mild Cognitive Impairment and Alzheimer Dementia

BACKGROUND AND PURPOSE

Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD.

METHODS

Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination.

RESULTS

One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69).

DISCUSSION AND CONCLUSIONS

In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A366).

Walking on the bright side: Associations between affect, depression, and gait

Background

Psychomotor change is a core symptom of depression and one of the criteria in diagnosing depressive disorders. Research suggests depressed individuals demonstrate deviations in gait, or walking, compared to non-depressed controls. However, studies are sparse, often limited to older adults and observational gait assessment. It is also unclear if gait changes are due to dysregulation of affect, a core feature of depression. The current study addressed this gap by investigating the relation between positive and negative affect, depressive symptom severity, and gait in young adults.

Methods

Using three-dimensional motion capture, gait parameters (velocity, stride length, and step time) were attained from 90 young adults during a task where they walked ten meters at their own pace overground in a laboratory for ten minutes. Self-report measures of mood and affect were collected.

Results

On average, the study population reported high negative and low positive affect. Contrary to our hypotheses, hierarchical regressions demonstrated no significant associations between gait parameters and affective or depressive symptoms (ps>.05).

Conclusions

Our findings do not support a relation between affective symptoms and gait parameters. The results may indicate age-dependent gait pathology or that other symptoms of depression may influence gait more strongly than affect. They may also reflect an observational bias of gait changes in depressed young adults, one that is unsupported by objective data. Replication is warranted to further examine whether affective symptomology is embodied via gait differences in young adults.

Slowing: A Vascular Geriatric Syndrome?

OBJECTIVES

This study aimed to investigate the interrelation between slowing in walking, thinking and mood, and their relationship with cerebral small vessel disease (CSVD) in a geriatric population.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

566 geriatric outpatients from the Amsterdam Aging Cohort (49% female; age 79 ±6 years), who visited the Amsterdam UMC geriatric outpatient memory clinic.

METHODS

Patients underwent a comprehensive geriatric assessment, brain imaging, and a neuropsychological assessment as part of medical care. Three slowing aspects were investigated: gait speed, processing speed, and apathy symptoms (higher scores indicating more advanced slowing). We visually rated CSVD [white matter hyperintensities (WMHs), strategic lacunes, and microbleeds] on brain imaging.

RESULTS

Regression analyses showed that slowing in walking (gait speed) was associated with slowing in thinking [processing speed; β = 0.35, 95% confidence interval (CI) 0.22, 0.48] and slowing in mood (apathy symptoms; β = 0.21, 95% CI 0.13, 0.30), independent of important confounders. Large confluent areas of WMH (Fazekas 3) were associated with all slowing aspects: gait speed (β = 0.49, 95% CI 0.28, 0.71), processing speed (β = 0.36, 95% CI 0.19, 0.52) and apathy symptoms (β = 0.30, 95% CI 0.09, 0.51). In addition, in patients with more slowing aspects below predefined cutoffs, severe WMH was more common. Presence of ≥3 microbleeds was associated with apathy symptoms (β = 0.39, 95% CI 0.12, 0.66), whereas lacunes were not associated with slowing.

CONCLUSIONS AND IMPLICATIONS

This study provides evidence that slowing in walking, thinking, and mood are closely related and associated with CSVD. This phenotype or geriatric syndrome could be helpful to identify and characterize patients with CSVD.

Subtypes of Late-Life Depression: A Data-Driven Approach on Cognitive Domains and Physical Frailty

BACKGROUND

With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty.

METHODS

A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty.

RESULTS

A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression ("mild" and "severe" depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as "amnestic depression," "frail-depressed, physically dominated," and "frail-depressed, cognitively dominated." The prospective analyses showed that patients in the subgroup of "mild depression" and "amnestic depression" had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates.

CONCLUSIONS

Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.

Impaired Executive Function and Depression as Independent Risk Factors for Reported Delirium Symptoms: An Observational Cohort Study Over 8 Years

BACKGROUND

Acute medical illnesses, surgical interventions, or admissions to hospital in older individuals are frequently associated with a delirium. In this cohort study, we investigated the impact of specific cognitive domains and depression before the occurrence of delirium symptoms in an 8-year observation of older non-hospitalized individuals.

METHODS

In total, we included 807 participants (48-83 years). Deficits in specific cognitive domains were measured using the CERAD test battery, and depressive symptoms were measured using Beck Depression Inventory and the Geriatric Depression Scale (GDS) before the onset of a delirium. Delirium symptoms were retrospectively assessed by a questionnaire based on the established Nursing Delirium Screening Scale.

RESULTS

Fifty-eight of eight hundred seven participants (7.2%) reported delirium symptoms over the 8-year course of the study. Sixty-nine percent (n = 40) of reported delirium symptoms were related to surgeries. In multivariate regression analysis, impaired executive function was an independent risk factor (p = 0.034) for the occurrence of delirium symptoms. Furthermore, age (p = 0.014), comorbidities [captured by the Charlson Comorbidity Index (CCI)] (p < 0.001), and depression (p = 0.012) were significantly associated with reported delirium symptoms.

CONCLUSION

Especially prior to elective surgery or medical interventions, screening for impaired executive function and depression could be helpful to identify patients who are at risk to develop delirium symptoms.

Bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints

PURPOSE

This study examined the bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints.

METHODS

Secondary analyses using data from the Multidomain Alzheimer Preventive Trial (MAPT) study were performed. The participants were 1679 subjects (female, 64.8%; mean age, 75.3 ± 4.4 years). The outcome measures were depressive symptoms assessed by the 15-item Geriatric Depression Scale (GDS) and physical performance assessed by the Short Physical Performance Battery (SPPB) and handgrip strength (HGS). All measurements were performed at baseline and at 6, 12, 24, and 36 months. The bidirectional relationships of GDS with SPPB and HGS were examined using mixed-effect regression analysis.

RESULTS

Baseline physical performance was significantly associated with a decreased GDS score (SPPB score: β = - 0.210, 95% confidence interval [CI], - 0.283 to - 0.137; HGS: β = - 0.038, 95% CI - 0.056 to - 0.019). The baseline GDS score was significantly associated with decreased physical performance (SPPB score: β = - 0.082, 95% CI - 0.107 to - 0.056; HGS: β = - 0.261, 95% CI - 0.370 to - 0.152).

CONCLUSION

Since depressive symptoms and physical performance had a bidirectional relationship, prevention or improvement of decreased physical performance could play a role in reducing depressive symptoms, and addressing depressive symptoms may play a role in improving physical performance.

TRIAL REGISTRATION NUMBER

NCT01513252.

Desynchronized Functional Activities Between Brain White and Gray Matter in Major Depression Disorder

BACKGROUND

Alterations in gray matter (GM) have been recognized as playing an important role in the neurobiological mechanism underlying major depressive disorder (MDD) and antidepressant responses. However, little is known about white matter (WM) connectivity in MDD, leaving an incomplete understanding of the pathophysiology of the disorder.

PURPOSE

To examine the functional connectivity (FC) of WM, GM, and WM-GM in MDD patients and explore the relationship between FC and antidepressant response.

STUDY TYPE

Longitudinal study.

SUBJECTS

In all, 129 MDD patients and 89 healthy controls (HC).

FIELD STRENGTH/SEQUENCE

Whole-brain blood oxygen level-dependent (BOLD) single-shot echo planar imaging was acquired at 3.0T.

ASSESSMENT

At baseline, all participants received Hamilton depression rating scale (HAMD) assessment and an fMRI scan. After 2- and 8-week antidepressant treatment, patients completed the HAMD again. The HAMD reductive rate of 2- and 8-weeks were calculated.

STATISTICAL TESTS

The comparisons of age, education, HAMD scores, and FC values (false discovery rate correction) between patients and controls were calculated with a two-sample t-test. The chi-square test was employed to compare the differences of gender between these two groups. Correlations between FC and HAMD, as well as the reductive rate of HAMD, were analyzed with Pearson or Spearman correlation. Receiver operator curve analysis was performed to predict the antidepressant response.

RESULTS

Compared to HC, MDD patients exhibited widespread decreases in FC of WM-GM. Furthermore, 28 GM regions and 11 WM bundles had lower connectivity in MDD patients. At baseline, four FC of WM-GM showed negative correlations with the HAMD scores. Six FC of WM-GM correlated with the 2-week reductive rate of HAMD. Moreover, FC in GM, WM, and WM-GM also exhibited significantly positive correlations with an 8-week reductive rate of HAMD.

DATA CONCLUSION

The FC of WM-GM was decreased in MDD and may play a role in its pathophysiology and antidepressant responses.

LEVEL OF EVIDENCE

2.

TECHNICAL EFFICACY STAGE

2.

Gait and balance disturbances are common in young urbanites and associated with cognitive impairment. Air pollution and the historical development of Alzheimer's disease in the young

To determine whether gait and balance dysfunction are present in young urbanites exposed to fine particular matter PM2.5 ≥ annual USEPA standard, we tested gait and balance with Tinetti and Berg tests in 575 clinically healthy subjects, age 21.0 ± 5.7 y who were residents in Metropolitan Mexico City, Villahermosa and Reynosa. The Montreal Cognitive Assessment was also applied to an independent cohort n:76, age 23.3 ± 9.1 y. In the 575 cohort, 75.4% and 34.4% had abnormal total Tinetti and Berg scores and high risk of falls in 17.2% and 5.7% respectively. BMI impacted negatively Tinetti and Berg performance. Gait dysfunction worsen with age and males performed worse than females. Gait and balance dysfunction were associated with mild cognitive impairment MCI (19.73%) and dementia (55.26%) in 57/76 and 19 cognitively intact subjects had gait and balance dysfunction. Seventy-five percent of urbanites exposed to PM2.5 had gait and balance dysfunction. For MMC residents-with historical documented Alzheimer disease (AD) and CSF abnormalities, these findings suggest Alzheimer Continuum is in progress. Early development of a Motoric Cognitive Risk Syndrome ought to be considered in city dwellers with normal cognition and gait dysfunction. The AD research frame in PM2.5 exposed young urbanites should include gait and balance measurements. Multicity teens and young adult cohorts are warranted for quantitative gait and balance measurements and neuropsychological and brain imaging studies in high vs low PM2.5 exposures. Early identification of gait and balance impairment in young air pollution-exposed urbanites would facilitate multidisciplinary prevention efforts for modifying the course of AD.

Gait Performance in People with Symptomatic, Chronic Mild Traumatic Brain Injury

There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms after mTBI. The aim of this investigation was to determine whether gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single- and dual-task conditions using five inertial sensors in 57 control subjects and 65 persons with chronic mTBI (1.0 year from mTBI). The single- and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference, single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference, single-task = 0.69; dual-task = 0.70) slower (p < 0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21; p = 0.001). DTC was not different between groups. Higher NSI somatic subscore was related to higher single- and dual-task gait variability as well as slower dual-task pace and turning (p < 0.01). Persons with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.

Mind, Mood, Mobility: Supporting Independence Among Rural Older Adults at Risk for Functional Decline

Rural communities need access to effective interventions that can prevent functional decline among a growing population of older adults. We describe the conceptual framework and rationale for a multicomponent intervention ("Mind, Mood, Mobility") delivered by Area Agency on Aging staff for rural older adults at risk for functional decline due to early impairments in cognition, mood, or mobility. Our proposed model utilizes primary care to identify at-risk older adults, combines evidence-based interventions that address multiple risk factors simultaneously, and leverages a community-based aging services workforce for intervention delivery.