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Lin YJ, Huang MF, Yeh YC, Chen CS. Predicting risk of dementia among the elderly with major depressive disorder in remission: A prospective study. Int J Geriatr Psychiatry 2024; 39:e6065. [PMID: 38319233 DOI: 10.1002/gps.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Cognitive impairment and change are a focus of research into late-life depression. The aims of this 5-year prospective study were (1) to observe cognitive status change; (2) to investigate the rate and risk ratio of dementia or cognitive decline; and (3) to examine the cognitive domain predictors for conversion to dementia within 5 years among a clinical cohort with remitted major depressive disorder (MDD). METHODS The study cohort included 130 elderly persons with late-life remitted MDD and 100 normal controls. Comprehensive neuropsychological tests were conducted to determine cognitive domain status. Diagnoses of mild cognitive impairment (MCI) and dementia were made at baseline and at a follow-up visit at the 5-year point. In total, 98 cases and 55 normal controls completed the 5-year follow-up assessment. RESULTS Of the study cohort with late-life remitted MDD, 28.6% had MCI and 25.5% developed dementia within 5 years. Patients with late-life remitted MDD had an approximate 3 times higher risk of subsequent cognitive decline as compared with the normal controls. Information-processing speed (p = 0.009) and memory (p = 0.041) could predict subsequent progression to dementia within 5 years among patients with MDD. CONCLUSIONS This study demonstrated that compared with the general elderly population, elderly patients with depression have more significant impairment in cognitive function after 5 years. Further, we found that in depressed patients, deficits in information-processing speed and memory domains were highly suggestive of progression to dementia within 5 years.
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Affiliation(s)
- Yen-Ju Lin
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Mei-Feng Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Liu J, Chen Q. Sequential link in depression, sleep and cognition: Longitudinal evidence from a serial multiple mediation analysis of older adults in China. Arch Gerontol Geriatr 2024; 117:105249. [PMID: 37952418 DOI: 10.1016/j.archger.2023.105249] [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: 07/19/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND A growing body of literature examines the link between depression, sleep and cognition, but little is known regarding the extent to which this relationship holds among older adults over time. OBJECTIVE This study examines how sleep duration mediates the relationship between depressive symptoms and cognitive performance, by utilizing partial least squares structural equation modelling (PLS-SEM) estimation. METHODS This study utilizes the 2013-18 China Health and Retirement Longitudinal Study (CHARLS) dataset, of which 3557 participants over the age of 50 satisfied inclusion criteria. Depressive symptoms and cognitive performance are measured by the Center for Epidemiological Studies Depression Scale (CESD) and the Mini-Mental State Examination (MMSE); sleep duration is assessed using the adapted Pittsburgh Sleep Quality Index (PSQI). A serial multiple mediation model was built to assess how depressive symptoms in 2013 and in 2018 are related, in addition to assessing their links with sleep duration and cognitive performance. FINDINGS Results indicate that early depression positively predicts depression progression (std.β = 0.564, 95 % Confidence Interval: 0.534, 0.594), but negatively predicts sleep duration (std.β = -0.081, 95 % CI: -0.128, -0.034) and cognitive performance (std.β = -0.118, 95 % CI: -0.165, -0.072). The sequential indirect effect of early depression operating via depression progression and sleep duration is evaluated to be -0.083 (95 % CI: -0.110, -0.056), representing as much as 41.29 % of the total effect. CONCLUSIONS Early depressive symptoms are directly associated with increased depressive symptoms and shortened sleep, which are identified as key channels through which early depression is linked with worsened cognition. CLINICAL IMPLICATIONS Many older adults may underestimate the adverse costs of early depression, since its net effects on cognition could be channeled indirectly and discretely via depression progression and sleep, which is worth highlighting in health guidelines and clinical recommendations.
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Affiliation(s)
- Ji Liu
- Faculty of Education, Shaanxi Normal University, Xian, Shaanxi, China
| | - Qiaoyi Chen
- School of Basic Medical Sciences, Xian Jiaotong University, Xian, Shaanxi, China.
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3
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Batail JMV, Feyder MT, Bentzley BS, Williams NR. An Avenue for Optimization of Theta Burst Stimulation Protocols? Comments on the FOUR-D Randomized Noninferiority Clinical Trial. Am J Psychiatry 2024; 181:68-70. [PMID: 37915217 DOI: 10.1176/appi.ajp.20230236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Jean-Marie V Batail
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA (Batail, Williams); Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, Rennes, France (Batail); Magnus Medical Inc, Burlingame, CA, USA (Feyder, Bentzley)
| | - Michael T Feyder
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA (Batail, Williams); Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, Rennes, France (Batail); Magnus Medical Inc, Burlingame, CA, USA (Feyder, Bentzley)
| | - Brandon S Bentzley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA (Batail, Williams); Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, Rennes, France (Batail); Magnus Medical Inc, Burlingame, CA, USA (Feyder, Bentzley)
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA (Batail, Williams); Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, Rennes, France (Batail); Magnus Medical Inc, Burlingame, CA, USA (Feyder, Bentzley)
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Giannakou K, Golenia A, Liabeuf S, Malyszko J, Mattace-Raso F, Farinha A, Spasovski G, Hafez G, Wiecek A, Capolongo G, Capasso G, Massy ZA, Pépin M. Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease. Front Med (Lausanne) 2023; 10:1215583. [PMID: 37621458 PMCID: PMC10446481 DOI: 10.3389/fmed.2023.1215583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.
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Affiliation(s)
- Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | | | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Francesco Mattace-Raso
- Department of Geriatric Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ana Farinha
- Department of Nephrology, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Goce Spasovski
- University Department of Nephrology, Clinical Centre “Mother Theresa”University Sts Cyril and Methodius, Skopje, North Macedonia
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Türkiye
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Biogem Research Institute, Ariano Irpino, Italy
| | - Ziad A. Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris & Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Marion Pépin
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Équipe 5, Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
- Departement of Geriatric Medicine, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
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Kang MJ, Cho SY, Choi JK, Yang YS. fNIRS Assessment during Cognitive Tasks in Elderly Patients with Depressive Symptoms. Brain Sci 2023; 13:1054. [PMID: 37508986 PMCID: PMC10377292 DOI: 10.3390/brainsci13071054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to investigate differences in prefrontal cortex activation between older adults with and without depressive symptoms during cognitive tasks using functional near-infrared spectroscopy (fNIRS). We examined 204 older participants without psychiatric or neurological disorders who completed the Geriatric Depression Scale, digit span, Verbal Fluency Test, and Stroop test. At the same time, prefrontal cortex activation was recorded using fNIRS. During the Stroop test, significantly reduced hemodynamics were observed in the depressive-symptom group. The mean accΔHbO2 of all channel averages was 0.14 μM in the control group and -0.75 μM in the depressive-symptom group (p = 0.03). The right hemisphere average was 0.13 μM and -0.96 μM, respectively (p = 0.02), and the left hemisphere average was 0.14 μM and -0.54 μM, respectively (p = 0.12). There was no significant difference in hemodynamic response (mean accΔHbO2) between the two groups during the digit span backward and VFT. In conclusion, reduced hemodynamics in the frontal cortex of the depressive-symptom group has been observed. The frontal fNIRS signal and the Stroop task may be used to measure depressive symptoms sensitively in the elderly.
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Affiliation(s)
- Min-Ju Kang
- Department of Neurology, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
- Veterans Medical Research Institute, Seoul 05368, Republic of Korea
| | - Su-Yeon Cho
- Veterans Medical Research Institute, Seoul 05368, Republic of Korea
| | | | - Young-Soon Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan 31151, Republic of Korea
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Belsiyal C X, Kalyani C V, Deol R, Sharma SK, Mery A. Depression in hospitalized older adults with chronic illness from a hilly Indian state. Perspect Psychiatr Care 2022; 58:2228-2236. [PMID: 35148435 DOI: 10.1111/ppc.13051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The study estimated the prevalence and determinants of depression among older adults with chronic illness. METHODS A cross-sectional descriptive survey was done among 337 hospitalized older adults with chronic illness during February 2019-2020 at a selected tertiary care hospital, Rishikesh, India using total enumerative sampling by Geriatric Depression Scale. RESULTS Among hospitalized older adults, depressive symptoms (80%) were highly prevalent and closely linked to an extended hospital stay [odds ratio = 2.106; 95% confidence interval [CI]: (1.30-3.411)], life events [odds ratio = 3.41; 95% CI: (1.48-7.88)], and multiple chronicity [odds ratio = 2.44; 95% CI: (1.49-3.98)]. IMPLICATIONS This study demands liaison psychiatric nurses deployed at Indian tertiary care hospitals who can efficiently conduct screening and management of depression among older adults with chronic illness.
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Affiliation(s)
- Xavier Belsiyal C
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Rupinder Deol
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Amali Mery
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Jellinger KA. The enigma of vascular depression in old age: a critical update. J Neural Transm (Vienna) 2022; 129:961-976. [PMID: 35705878 DOI: 10.1007/s00702-022-02521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
Depression is common in older individuals and is associated with high disability and increased mortality, yet the factors predicting late-life depression (LLD) are poorly understood. The relationship between of depressive disorder, age- and disease-related processes have generated pathogenic hypotheses and provided new treatment options. LLD syndrome is often related to a variety of vascular mechanisms, in particular hypertension, cerebral small vessel disease, white matter lesions, subcortical vascular impairment, and other processes (e.g., inflammation, neuroimmune regulatory dysmechanisms, neurodegenerative changes, amyloid accumulation) that may represent etiological factors by affecting frontolimbic and other neuronal networks predisposing to depression. The "vascular depression" hypothesis suggests that cerebrovascular disease (CVD) and vascular risk factors may predispose, induce or perpetuate geriatric depressive disorders. It is based on the presence of various cerebrovascular risk factors in many patients with LLD, its co-morbidity with cerebrovascular lesions, and the frequent development of depression after stroke. Other findings related to vascular depression are atrophy of the medial temporal cortex or generalized cortical atrophy that are usually associated with cognitive impairment. Other pathogenetic hypotheses of LLD, such as metabolic or inflammatory ones, are briefly discussed. Treatment planning should consider there may be a modest response to antidepressants, but several evidence-based and novel treatment options for LLD exist, such as electroconvulsive therapy, transcranial magnetic stimulation, neurobiology-based psychotherapy, as well as antihypertension and antiinflammatory drugs. However, their effectiveness needs further investigation, and new methodologies for prevention and treatment of depression in older individuals should be developed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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8
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Belvederi Murri M, Grassi L, Caruso R, Nanni MG, Zerbinati L, Andreas S, Ausín B, Canuto A, Härter M, Lopez MM, Weber K, Wittchen HU, Volkert J, Alexopoulos GS. Depressive symptom complexes of community-dwelling older adults: a latent network model. Mol Psychiatry 2022; 27:1075-1082. [PMID: 34642459 DOI: 10.1038/s41380-021-01310-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
Late-life depression has multiple, heterogeneous clinical presentations. The aim of the study was to identify higher-order homogeneous clinical features (symptom complexes), while accounting for their potential causal interactions within the network approach to psychopathology. We analyzed cross-sectional data from community-dwelling adults aged 65-85 years recruited by the European MentDis_ICF65+ study (n = 2623, mean age 74, 49% females). The severity of 33 depressive symptoms was derived from the age-adapted Composite International Diagnostic Interview. Symptom complexes were identified using multiple detection algorithms for symptom networks, and their fit to data was assessed with latent network models (LNMs) in exploratory and confirmatory analyses. Sensitivity analyses included the Partial Correlation Likelihood Test (PCLT) to investigate the data-generating structure. Depressive symptoms were organized by the Walktrap algorithm into eight symptom complexes, namely sadness/hopelessness, anhedonia/lack of energy, anxiety/irritability, self-reproach, disturbed sleep, agitation/increased appetite, concentration/decision making, and thoughts of death. An LNM adequately fit the distribution of individual symptoms' data in the population. The model suggested the presence of reciprocal interactions between the symptom complexes of sadness and anxiety, concentration and self-reproach and between self-reproach and thoughts of death. Results of the PCLT confirmed that symptom complex data were more likely generated by a network, rather than a latent-variable structure. In conclusion, late-life depressive symptoms are organized into eight interacting symptom complexes. Identification of the symptom complexes of late-life depression may streamline clinical assessment, provide targets for personalization of treatment, and aid the search for biomarkers and for predictors of outcomes of late-life depression.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Sylke Andreas
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute for Psychology, Universität Klagenfurt, A-9020, Klagenfurt, Austria
| | - Berta Ausín
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Alessandra Canuto
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Muñoz Lopez
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, University Complutense of Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain
| | - Kerstin Weber
- Division of Institutional Measures, University Hospitals of Geneva, 1208, Geneva, Switzerland
| | - Hans-Ulrich Wittchen
- Clinical Psychology & Psychotherapy RG, Department of Psychiatry & Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jana Volkert
- Department of Psychosocial Prevention, University of Heidelberg, Bergheimer Str. 54, 69115, Heidelberg, Germany.,Institute of Psychology, University of Kassel, Holländische Str. 36-38, 34127, Kassel, Germany
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, USA.
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Lin CH, Wang SH, Lane HY. Effects of Sodium Benzoate, a D-Amino Acid Oxidase Inhibitor, on Perceived Stress and Cognitive Function Among Patients With Late-Life Depression: A Randomized, Double-Blind, Sertraline- and Placebo-Controlled Trial. Int J Neuropsychopharmacol 2022; 25:545-555. [PMID: 35023557 PMCID: PMC9352177 DOI: 10.1093/ijnp/pyac006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Compared with adults with depression in the general population, elderly depressive patients are prone to poor treatment response, more side effects, and early withdrawal with current antidepressants (which principally modulate monoamines). Whether N-methyl-D-aspartate receptor enhancement can benefit treatment of late-life depression deserves study. This study aims to compare sodium benzoate (a D-amino acid oxidase inhibitor and an indirect N-methyl-D-aspartate receptor enhancer), sertraline (a selective serotonin reuptake inhibitor), and placebo in the treatment of late-life depression. METHODS In this randomized, double-blind trial, 117 patients with major depressive disorder aged 55 years or older received 8-week treatment of 250-1500 mg/d of sodium benzoate, 25-150 mg/d of sertraline, or placebo in 2 medical centers. The primary outcome measures were Hamilton Depression Rating Scale and Perceived Stress Scale scores. RESULTS Three treatments similarly decreased clinicians-rated Hamilton Depression Rating Scale scores. Compared with placebo, sodium benzoate but not sertraline substantially improved Perceived Stress Scale scores and cognitive function. Sertraline, but not benzoate, significantly reduced self-report Geriatric Depression Scale scores. Benzoate and placebo showed similar safety profiles, while sertraline was more likely to raise low-density lipoprotein than benzoate and placebo. Benzoate-treated patients were less likely to drop out than sertraline or placebo recipients. CONCLUSIONS Sertraline can reduce subjective depressive symptoms, while benzoate can decrease perceived stress, improve cognitive function, and enhance treatment adherence in late-life depression patients. The results show promise for D-amino acid oxidase inhibition as a novel approach for perceived stress and cognitive decline among patients with late-life depression. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03414931. Registered January 2016.
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Affiliation(s)
- Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Hsien-Yuan Lane
- Correspondence: Hsien-Yuan Lane, MD, PhD, Department of Psychiatry, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan ()
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10
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Late-life depression accentuates cognitive weaknesses in older adults with small vessel disease. Neuropsychopharmacology 2022; 47:580-587. [PMID: 33564103 PMCID: PMC8674355 DOI: 10.1038/s41386-021-00973-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging features of small vessel disease (SVD) are highly prevalent in older adulthood and associated with significant variability in clinical symptoms, yet the factors predicting these symptom disparities are poorly understood. We employed a novel metric of SVD, peak width of skeletonized mean diffusivity (PSMD), to elucidate the relationship of late-life depression (LLD) to the cognitive presentation of vascular pathology. A total of 109 older adults without a diagnosis of a neurocognitive disorder were enrolled in the study; 44 with major depressive disorder and 65 age-matched controls. Subjects completed neuropsychological testing and magnetic resonance imaging including FLAIR and diffusion tensor imaging sequences, from which white matter hyperintensity volume and diffusion metrics (fractional anisotropy, mean diffusivity, PSMD) were quantified. In hierarchical models, the relationship between vascular burden and cognitive performance varied as a function of diagnostic status, such that the negative association between PSMD and processing speed was significantly stronger in participants with LLD compared to controls. Greater PSMD also predicted poorer performance on delayed memory and executive function tasks specifically among those with LLD, while there were no associations between PSMD and task performance among controls. PSMD outperformed conventional SVD and diffusion markers in predicting cognitive performance and dysexecutive behaviors in participants with LLD. These data suggest that LLD may confer a vulnerability to the cognitive manifestations of white matter abnormalities in older adulthood. PSMD, a novel biomarker of diffuse microstructural changes in SVD, may be a more sensitive marker of subtle cognitive deficits stemming from vascular pathology in LLD.
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Jellinger KA. Pathomechanisms of Vascular Depression in Older Adults. Int J Mol Sci 2021; 23:ijms23010308. [PMID: 35008732 PMCID: PMC8745290 DOI: 10.3390/ijms23010308] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto-limbic and other important neuronal networks, may contribute to the development of LLD. The "vascular depression" hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150 Vienna, Austria
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12
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Feng J, Lu X, Wang S, Li H. The assessment of cognitive impairment in maintenance hemodialysis patients and the relationship between cognitive impairment and depressive symptoms. Semin Dial 2021; 35:504-510. [PMID: 34726291 DOI: 10.1111/sdi.13031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Cognitive impairment and depression are common mental health problems in chronic kidney disease (CKD) patients with maintenance hemodialysis (MHD). Previous studies have proven that cognitive impairment and depression were risk factors for poor prognosis in MHD patients. However, the related factors of cognitive function and the association between cognitive impairment and depression in MHD patients are still unclear. The purpose of this study is to explore the related factors affecting the cognitive function of MHD patients and evaluate the relationship between cognitive function and depression in MHD patients. METHODS This single-center, cross-sectional study enrolled 160 MHD patients. Cognitive function and depressive symptoms were measured using Montreal Cognitive Assessment (MoCA) and Patient Health Questionnaire-9 (PHQ-9), respectively. RESULTS Cognitive impairment was detected in 58.1% of 160 MHD patients. Multivariate linear regression analysis showed that age, level of education and homocysteine (HCY) were independent influencing factors of MoCA scores and the scores of attention and abstract thinking were independently correlated with PHQ-9 score after adjusting for confounding factors CONCLUSIONS: These findings indicated that age, level of education and HCY were independently associated with cognitive function, and attention and abstract thinking could independently affect depressive symptoms in MHD patients.
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Affiliation(s)
- Jianan Feng
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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13
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Failoc-Rojas VE, Meoño ADP. Factors related to depression in elderly patients attending primary health care centres in Chiclayo (Peru). REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50:285-289. [PMID: 34742699 DOI: 10.1016/j.rcpeng.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/25/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this work is to evaluate the factors related to depression in older adults seen in the health centres of Chiclayo. METHODS An observational, prospective, analytical study that included adults over 60 years of age residing in the Chiclayo district (Peru). The abbreviated depression scale of Yesavage was used. Univariate analysis was performed, presented as frequencies and percentages, as well as bivariate analysis using chi-squared. Adjusted logistic regressions were calculated for age and gender. RESULTS A total of 302 older adults participated in this study. The median age was 73 years. It was found that 30.8 % had depressive signs, and 18.2 % had some degree of cognitive deterioration. Just over half (160, 52.98 %) had a socio-familial risk, and 29 (9.60 %) were detected in the dependent functional assessment. There was an association in the analysis of depression, age group, cognitive impairment, socio-family assessment (P < .05). In the multivariate analysis adjusted for age and gender, cognitive deterioration and socio-family assessment continued to be risk factors. CONCLUSIONS Depression is associated with a deficiency in the cognitive state, with familial partner risk being an influential factor that may be preventable.
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Affiliation(s)
- Virgilio E Failoc-Rojas
- Unidad De Investigación Para La Generación y Síntesis De Evidencias En Salud, Universidad San Ignacio De Loyola, Lima, Peru.
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14
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Yuan Y, Lapane KL, Rothschild AJ, Ulbricht CM. Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis. Aging Ment Health 2021; 25:1903-1912. [PMID: 33222506 PMCID: PMC8141058 DOI: 10.1080/13607863.2020.1849021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents. METHOD Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission. RESULTS Four latent statuses of depressive symptoms were identified: 'Multiple Symptoms' (prevalence at admission: 17.3%; 90 days: 13.6%), 'Depressed mood' (20.0%; 19.5%), 'Fatigue' (27.4%; 25.7%), and 'Minimal Symptoms' (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in 'Multiple Symptoms' and 'Fatigue' statuses; those with severe impairment had lower odds of belonging to 'Multiple Symptoms', 'Depressed Mood', and 'Fatigue' statuses. CONCLUSION By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.
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Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony J. Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Healthcare, Worcester, MA, USA
| | - Christine M. Ulbricht
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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15
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Dotson VM, Gradone AM, Bogoian HR, Minto LR, Taiwo Z, Salling ZN. Be Fit, Be Sharp, Be Well: The Case for Exercise as a Treatment for Cognitive Impairment in Late-life Depression. J Int Neuropsychol Soc 2021; 27:776-789. [PMID: 34154693 PMCID: PMC10436256 DOI: 10.1017/s1355617721000710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD). METHOD This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD. RESULTS Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention. CONCLUSIONS Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.
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Affiliation(s)
- Vonetta M. Dotson
- Department of Psychology, Georgia State University
- Gerontology Institute, Georgia State University
| | | | | | - Lex R. Minto
- Department of Psychology, Georgia State University
| | - Zinat Taiwo
- Department of Psychology, Georgia State University
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16
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McClintock SM, Minto L, Denney DA, Bailey KC, Cullum CM, Dotson VM. Clinical Neuropsychological Evaluation in Older Adults With Major Depressive Disorder. Curr Psychiatry Rep 2021; 23:55. [PMID: 34255167 PMCID: PMC8764751 DOI: 10.1007/s11920-021-01267-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE REVIEW Older adults with major depressive disorder are particularly vulnerable to MDD-associated adverse cognitive effects including slowed processing speed, decreased attention, and executive dysfunction. The purpose of this review is to describe the approach to a clinical neuropsychological evaluation in older adults with MDD. Specifically, this review compares and contrasts neurocognitive screening and clinical neuropsychological evaluation procedures and details the multiple components of the clinical neuropsychological evaluation. RECENT FINDINGS Research has shown that neurocognitive screening serves a useful purpose to provide an acute and rapid assessment of global cognitive function; however, it has limited sensitivity and specificity. The clinical neuropsychological evaluation process is multifaceted and encompasses a review of available medical records, neurobehavioral status and diagnostic interview, comprehensive cognitive and clinical assessment, examination of inclusion and diversity factors as well as symptom and performance validity, and therapeutic feedback. As such, the evaluation provides invaluable information on multiple cognitive functions, establishes brain and behavior relationships, clarifies neuropsychiatric diagnoses, and can inform the etiology of cognitive impairment. Clinical neuropsychological evaluation plays a unique and critical role in integrated healthcare for older adults with MDD. Indeed, the evaluation can serve as a nexus to synthesize information across healthcare providers in order to maximize measurement-based care that can optimize personalized medicine and overall health outcomes.
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Affiliation(s)
- Shawn M McClintock
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA.
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Lex Minto
- Georgia State University, Atlanta, GA, USA
| | - David A Denney
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - K Chase Bailey
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - C Munro Cullum
- Division of Psychology, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8898, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA
- Gerontology Institute, Georgia State University, Atlanta, GA, USA
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17
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Wei YC, Huang LY, Lin C, Shyu YC, Chen CK. Taiwanese Depression Questionnaire and AD8 Questionnaire for Screening Late-Life Depression in Communities. Neuropsychiatr Dis Treat 2021; 17:747-755. [PMID: 33727818 PMCID: PMC7955745 DOI: 10.2147/ndt.s298233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) presents with emotional and somatic symptoms and sometimes subjective cognitive complaints (SCCs). This study developed a collaborative method to integrate SCC assessment for evaluating late-life MDD. METHODS Residents aged >50 years in the Community Medicine Research Center of Keelung Chang Gung Memorial Hospital in Taiwan during 2017-2018 were prospectively recruited in this study. The participants were asked to report their depressive tendency and SCCs using the Taiwanese Depression Questionnaire (TDQ) and the AD8, respectively, and were administered psychiatric evaluation through the Mini-International Neuropsychiatric Interview (MINI). The participants were divided into elderly (age≥65 years) and older adult (age 50-65) groups. The MDD predictive powers were assessed using logistic regression and receiver operating characteristic (ROC) curve analyses. RESULTS Of the 118 enrolled participants (mean age: 64.81±4.99, female-to-male ratio: 1.62), 9, 21, and 88 were categorized as those with current MDD, past MDD, and non-MDD on the basis of the MINI results, respectively. After adjustments for age, sex, and sleep quality, the TDQ score (odds ratio: 1.152, p=0.003) and AD8 score (odds ratio: 1.710, p=0.020) were used individually to predict current MDD. Overall, the TDQ individually predicted current MDD well with area under the ROC curve (AUC) of 0.835 (p=0.001). However, in the elderly group (N=63), the TDQ score did not identify current MDD well (AUC: 0.780, p=0.063). After co-considering SCCs, the linear combination of the sum of the TDQ score and four folds of the AD8 score could effectively distinguished elderly people with current MDD from those without it (AUC: 0.875, p=0.013)-with the cutoff of the aforementioned combined score being ≥32. CONCLUSION The self-reported response to the TDQ is a feasible approach of identifying MDD in community-dwelling people. Combining TDQ and AD8 scores further improved depression detection in elderly people.
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Affiliation(s)
- Yi-Chia Wei
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yuan Huang
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chemin Lin
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Chih-Ken Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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19
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Study of neuropsychological deficits in late onset depression. Asian J Psychiatr 2020; 54:102435. [PMID: 33271715 DOI: 10.1016/j.ajp.2020.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/27/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older adults with depression often have cognitive deficits contributing to higher morbidity and increased risk for conversion to dementia. Research on this area is limited from India. OBJECTIVE The objective of the current study is to examine the neuropsychological measures in older adults with Late-onset depression (LOD) compared to healthy controls (HC). METHOD Sample included older adults with depression as per DSM-IV TR criteria seeking treatment from Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS). Geriatric depression scale, Montgomery Asberg depression rating scale and Hamilton anxiety rating scale were applied to screen and measure the severity of depression. Comprehensive assessment of neurocognitive function was done using NIMAHNS Neuropsychological Battery for Elderly (NNBE, 2013). RESULTS Sample included 76 LOD patients and 76 healthy controls (HC) who were matched for age, gender and education. The mean age of onset of illness was 63.17(SD-6.54) years and median duration of total illness was 29.5 months. In the standard assessments, the mean score on GDS was 9.28 (SD-3.32) and MADRS was 18.88 (SD-6.07). The LOD group had lower Hindi Mental Status Examination (HMSE) score compared to HC (28.64 ± 2.09 vs 30.05 ± 1.26, p < 0.001). Compared to HC, LOD group performed poorly on tasks of attention, executive function, verbal and visual memory, verbal fluency and visuo-spatial skills. Recognition memory and logical memory were relatively preserved in LOD compared to HC. DISCUSSION AND CONCLUSION Cognitive deficits were seen predominantly in attention and executive function, visuo-spatial skills and memory similar to previous studies. It is advisable to routinely assess cognitive symptoms in older adults presenting with depression.
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20
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Van Dyk K, Siddarth P, Rossetti M, Ercoli LM, Milillo MM, Lavretsky H. Memantine can protect against inflammation-based cognitive decline in geriatric depression. Brain Behav Immun Health 2020; 9:100167. [PMID: 34589902 PMCID: PMC8474499 DOI: 10.1016/j.bbih.2020.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Geriatric depression is frequently accompanied by cognitive complaints and inflammation that increase risk for treatment-resistant depression and dementia. Memantine, a neuroprotective drug, can improve depression, inflammation, and help prevent cognitive decline. In our six-month clinical trial, escitalopram/memantine (ESC/MEM) improved mood and cognition compared to escitalopram/placebo treatment (ESC/PBO; NCT01902004). In this report, we examined the impact of baseline inflammation on mood and cognitive outcomes. MATERIALS AND METHODS We measured a panel of inflammatory cytokine markers using Human 38-plex magnetic cytokine/chemokine kits (EMD Millipore, HCYTMAG-60K-PX38) in 90 older adults 60 years and older with major depression enrolled in a 6-month double-blind placebo-controlled trial of escitalopram + memantine (ESC/MEM) in depressed older adults with subjective memory complaints. Four cytokine factors were derived and linear models were estimated to examine the predictive ability of cytokine levels on treatment induced change in depression and cognition. RESULTS Of the 90 randomized participants, 62 completed the 6-month follow up assessment. Both groups improved significantly on depression severity (HAM-D score), but not on cognitive outcomes at six months. Cytokine factor scores were not significantly different between ESC/MEM (n = 45) and ESC/PBO (n = 45) at baseline. Pro-inflammatory biomarkers at baseline predicted a decline in executive functioning in the ESC/PBO group but not in the ESC/MEM group, interaction F(1,52) = 4.63, p = .04. DISCUSSION In this exploratory analysis, the addition of memantine to escitalopram provided a protective effect on executive functioning in older depressed adults. Future studies are needed to replicate the association of cytokine markers to antidepressant and neuroprotective treatment-related change in cognition in geriatric depression.
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Affiliation(s)
- Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Maura Rossetti
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda M. Ercoli
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Michaela M. Milillo
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
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21
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Thompson LI, Jones RN. Depression screening in cognitively normal older adults: Measurement bias according to subjective memory decline, brain amyloid burden, cognitive function, and sex. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12107. [PMID: 33015310 PMCID: PMC7521597 DOI: 10.1002/dad2.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Understanding the associations among depression, subjective cognitive decline, and prodromal Alzheimer's disease (AD) has important implications for both depression and dementia screening in older adults. The Geriatric Depression Scale (GDS) is a depression screening tool for older adults that queries memory concerns. To determine whether depression symptoms on the GDS (15-item version), including self-reported memory problems, differ by levels of brain amyloid beta (Aβ), a pathological hallmark of early stage AD, we investigated potential measurement bias with regard to Aβ level. We also examined measurement bias attributable to level of cognitive functioning and sex as positive controls. METHODS We examined 3961 cognitively normal older adults from the A4/LEARN Study. We used the MIMIC (multiple indicators, multiple causes) approach to detect measurement bias. RESULTS We found measurement bias with small-to-moderate range effect sizes in several GDS-15 items with respect to Aβ level, cognitive functioning, and sex. There was negligible impact of measurement bias attributable to Aβ level on overall depressive symptom level. DISCUSSION GDS-15 item responses are sensitive to Aβ burden, cognitive functioning, and sex over and above what would be expected given the effect of those factors on depressive symptom severity overall. However, these direct effects for GDS item measurement bias are of small magnitude and do not appreciably impact the validity of inferences about depression based on the GDS-15.
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Affiliation(s)
- Louisa I Thompson
- Department of Psychiatry, Alpert Medical School Brown University Providence Rhode Island USA
| | - Richard N Jones
- Department of Psychiatry, Alpert Medical School Brown University Providence Rhode Island USA
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22
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Failoc-Rojas VE, Meoño ADP. Factors Related to Depression in Elderly Patients Attending Primary Health Care Centres in Chiclayo (Peru). REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2020; 50:S0034-7450(20)30067-6. [PMID: 33735029 DOI: 10.1016/j.rcp.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/08/2019] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of this work is to evaluate the factors related to depression in older adults seen in the health centres of Chiclayo. METHODS An observational, prospective, analytical study that included adults over 60 years of age residing in the Chiclayo district (Peru). The abbreviated depression scale of Yesavage was used. Univariate analysis was performed, presented as frequencies and percentages, as well as bivariate analysis using chi-squared. Adjusted logistic regressions were calculated for age and gender. RESULTS A total of 302 older adults participated in this study. The median age was 73 years. It was found that 30.8% had depressive signs, and 18.2% had some degree of cognitive deterioration. Just over half (160, 52.98%) had a socio-familial risk, and 29 (9.60%) were detected in the dependent functional assessment. There was an association in the analysis of depression, age group, cognitive impairment, socio-family assessment (P<.05). In the multivariate analysis adjusted for age and gender, cognitive deterioration and socio-family assessment continued to be risk factors. CONCLUSIONS Depression is associated with a deficiency in the cognitive state, with familial partner risk being an influential factor that may be preventable.
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Affiliation(s)
- Virgilio E Failoc-Rojas
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú.
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The symptom network structure of depressive symptoms in late-life: Results from a European population study. Mol Psychiatry 2020; 25:1447-1456. [PMID: 30171210 DOI: 10.1038/s41380-018-0232-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/09/2018] [Accepted: 06/08/2018] [Indexed: 11/08/2022]
Abstract
The network theory conceptualizes mental disorders as complex networks of symptoms influencing each other by creating feedback loops, leading to a self-sustained syndromic constellation. Symptoms central to the network have the greatest impact in sustaining the rest of symptoms. This analysis focused on the network structure of depressive symptoms in late-life because of their distinct etiologic factors, clinical presentation, and outcomes. We analyzed cross-sectional data from wave 2 of the 19 country Survey of Health, Ageing, and Retirement in Europe (SHARE) and included non-institutionalized adults aged 65 years or older (mean age 74 years, 59% females) endorsing at least one depressive symptom on the EURO-D scale for depression (N =8,557). We characterized the network structure of depressive symptoms in late-life and used indices of "strength", "betweenness", and "closeness" to identify symptoms central to the network. We used a case-dropping bootstrap procedure to assess network stability. Death wishes, depressed mood, loss of interest, and pessimism had the highest values of centrality. Insomnia, fatigue and appetite changes had lower centrality values. The identified network remained stable after dropping 74.5% of the sample. Sex or age did not significantly influence the network structure. In conclusion, death wishes, depressed mood, loss of interest, and pessimism constitute the "backbone" that sustains depressive symptoms in late-life. Symptoms central to the network of depressive symptoms may be used as targets for novel, focused interventions and in studies investigating neurobiological processes central to late-life depression.
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24
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Sieber F, Neufeld K, Oh ES, Gottschalk A, Wang NY. Effect of baseline cognitive impairment on association between predicted propofol effect site concentration and Bispectral index or sedation score. BMC Anesthesiol 2020; 20:129. [PMID: 32466776 PMCID: PMC7254641 DOI: 10.1186/s12871-020-01043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background This study determined whether the relationship between predicted propofol effect site concentration (Ce) and observer’s assessment of alertness/sedation scale (OAA/S) or Bispectral Index (BIS) was similar comparing cognitively intact vs impaired patients undergoing hip fracture repair with spinal anesthesia and sedation. Methods Following informed consent baseline mini-mental status exam (MMSE), Clinical Dementia Rating (CDR) and geriatric depression scale (GDS) were obtained. Intraoperatively OAA/S, BIS, and propofol (timing and exact amounts) administered were recorded. Cerebrospinal fluid was collected for Alzheimer’s (AD) biomarkers. Mean Ce level (AvgCe) during surgery was calculated using the area under the Ce measurement series from incision to closure, divided by surgical time. Average OAA/S (AvgOAA/S), and BIS (AvgBIS) were similarly calculated. Pearson correlations of AvgCe with AvgOAA/S and AvgBIS were calculated overall and by CDR. Nonparametric locally weighted scatterplot smoothing (LOWESS) fits of AvgOAA/S and AvgBIS on AvgCe were produced, stratified by CDR. Multivariable regression incorporating baseline cognitive measurements or AD biomarkers assessed AvgOAA/S or AvgBIS associations with AvgCe. Results In 186 participants AvgBIS and AvgOAA/S correlated with AvgCe (Pearson ρ = − 0.72; p < 0.0001 and Pearson ρ = − 0.81; p < 0.0001, respectively), and remained unchanged across CDR levels. Association patterns of AvgOAA/S or AvgBIS on AvgCe guided by LOWESS fits and modeled through regression, were similar when stratified by CDR (p = 0.16). Multivariable modeling found no independent effect on AvgBIS or AvgOAA/S by MMSE, CDR, GDS, or AD biomarkers after accounting for AvgCe. Conclusions When administering sedation in conjunction with spinal anesthesia, cognitive impairment does not affect the relationship between predicted propofol AvgCe and AvgOAA/S or AvgBIS.
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Affiliation(s)
- Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Karin Neufeld
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, A4Center Suite 457, 4940 Eastern Ave, Baltimore, USA
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, Psychiatry and Behavioral Sciences & Neuropathology, Johns Hopkins University School of Medicine, Mason F. Lord Building, Center Tower, 5200 Eastern Avenue, 7th Floor, Baltimore, MD, 21224, USA
| | - Allan Gottschalk
- Departments of Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Nae-Yuh Wang
- Medicine, Biostatistics and Epidemiology, The Johns Hopkins University, 2024 E. Monument Street, Suite 2-500, Baltimore, MD, 21287, USA
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25
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Prospective associations between depressive symptoms and cognitive functions in middle-aged and elderly Chinese adults. J Affect Disord 2020; 263:692-697. [PMID: 31744738 DOI: 10.1016/j.jad.2019.11.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/14/2019] [Accepted: 11/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine prospective associations of clinically relevant depressive symptoms with cognitive functions and rates of cognitive decline among Chinese adults aged 45 years and older. METHODS Data was from the China Health and Retirement Longitudinal Study (CHARLS) with a follow-up of 4 years. Based on the Chinese version of 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), clinically relevant depressive symptoms were defined with a CESD-10 score≥10 points. Cognitive functions were measured in three domains: episodic memory, mental status and global cognition. Linear mixed models were used to assess the associations between clinically relevant depressive symptoms and cognitive functions. RESULTS A total of 7335 participants (50.10% men; mean age: 57.47) were included in analyses. Participants with clinically relevant depressive symptoms showed poorer episodic memory (β=-0.35; 95% CI:-0.41, -0.29), mental status (β=-0.48; 95% CI: -0.57, -0.39), and global cognition (β=-0.82; 95% CI: -0.94, -0.70) during the follow-up. Compared with counterparts, rates of decline in episodic memory, mental status, and global cognition increased by 0.04 (β=0.04; 95% CI: 0.02, 0.06), 0.06 (β=0.06; 95% CI: 0.02, 0.09) and 0.11 (β=0.11; 95% CI: 0.06, 0.15) units per year in participants with clinically relevant depressive symptoms. LIMITATIONS A major limitation is that clinically relevant depressive symptoms were assessed by a screening tool and the follow-up was short. CONCLUSION More severe clinically relevant depressive symptoms were associated with poorer cognitive functions and moderately faster cognitive decline in episodic memory, mental status and global cognition in middle-aged and elderly Chinese adults.
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Belvederi Murri M, Triolo F, Coni A, Tacconi C, Nerozzi E, Escelsior A, Respino M, Neviani F, Bertolotti M, Bertakis K, Chiari L, Zanetidou S, Amore M. Instrumental assessment of balance and gait in depression: A systematic review. Psychiatry Res 2020; 284:112687. [PMID: 31740213 DOI: 10.1016/j.psychres.2019.112687] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 12/19/2022]
Abstract
Psychomotor symptoms of depression are understudied despite having a severe impact on patient outcomes. This review aims to summarize the evidence on motor features of depression assessed with instrumental procedures, and examine age-related differences. We included studies investigating posture, balance and gait ascertained with instrumental measurements among individuals with depressive symptoms or disorders. Studies on subjects with specific physical illnesses were excluded. Methodological quality was assessed with the Newcastle - Ottawa Scale (NOS) and PRISMA guidelines were followed. 33 studies (13 case-control, five cross-sectional, nine longitudinal and six intervention) with overall low-medium quality were included. Different instruments were employed to assess posture (e.g. digital cameras), balance (balance, stepping platform) or gait (e.g. Six-Minute-Walking Test, instrumented walkways). Results suggest that depression in adults is associated with significant impairments of posture, balance and gait. Motor abnormalities among depressed older adults may depend on the interplay of physical diseases, cognitive impairment and mood. Very few intervention studies measured motor symptoms as outcome. Available evidence suggests, however, that antidepressant drugs and physical exercise may be beneficial for motor abnormalities. Despite the lack of high-quality studies, instrumental assessments confirm the presence and importance of motor abnormalities in depression, with potential age-related differences in their pathophysiology.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Institute of Psychiatry, Via Fossato di Mortara 64a, Ferrara 44121, Italy.
| | - Federico Triolo
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Alice Coni
- Biomedical Engineering Unit, Department of Electronics, Computer Science & Systems, University of Bologna, Italy.
| | - Carlo Tacconi
- Biomedical Engineering Unit, Department of Electronics, Computer Science & Systems, University of Bologna, Italy.
| | - Erika Nerozzi
- Department for Life Quality Studies, University of Bologna, Italy.
| | - Andrea Escelsior
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy.
| | - Matteo Respino
- Weill Cornell Medicine, White Plains, Institute for Geriatric Psychiatry, New York, NY, USA
| | - Francesca Neviani
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy.
| | - Marco Bertolotti
- Department of Geriatrics, Nuovo Ospedale Civile S. Agostino Estense, Modena and Reggio Emilia University, Modena, Italy.
| | - Klea Bertakis
- Department of Family and Community Medicine and Center for Healthcare Policy and Research, UC Davis School of Medicine, Sacramento, CA, USA.
| | - Lorenzo Chiari
- Biomedical Engineering Unit, Department of Electronics, Computer Science & Systems, University of Bologna, Italy.
| | - Stamatula Zanetidou
- Consultation Liaison Psychiatry Service, Department of Mental Health, Bologna, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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Abstract
This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. In addition, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are discussed, including psychotherapy models, holistic treatments, pharmacologic approaches, and brain stimulation therapies.
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Affiliation(s)
- Ryan D Greene
- Department of Psychology in Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA; University of Indianapolis, Indianapolis, IN, USA.
| | - Alex Cook
- University of Indianapolis, Indianapolis, IN, USA
| | - Dustin Nowaskie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sophia Wang
- Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Hospital, Indianapolis, IN, USA
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28
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Lenze EJ, Bowie CR, Avidan MS. Cognitive Training for Optimizing Perioperative Brain Health. Am J Geriatr Psychiatry 2019; 27:1228-1231. [PMID: 31326344 DOI: 10.1016/j.jagp.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022]
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Nie XD, Wang Q, Zhang YH, Xiong ZY, Liao JL, Hao L, Liu GL, Duan LP, Zheng ZX, Ren YP, Dong J. Depression at Baseline is an Independent Risk Factor for Cognitive Decline in Patients on Peritoneal Dialysis: A Multicenter Prospective Cohort Study. Perit Dial Int 2019; 39:465-471. [PMID: 31501292 DOI: 10.3747/pdi.2018.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/26/2019] [Indexed: 11/15/2022] Open
Abstract
Background Depression has been recognized as a risk factor for cognitive impairment (CI) from cross-sectional datasets. This multicenter prospective study investigated the association between depression and cognitive decline in peritoneal dialysis (PD) patients. Methods This multicenter prospective cohort study included 458 PD patients who were followed up for 2 years. The Modified Mini-Mental State Examination (3MS) was used for assessment of global cognitive function, Trail-Making Tests A and B for executive function, subtests of the Battery for the Assessment of Neuropsychological Status for immediate and delayed memory, visuospatial skill, and language ability. Depression was assessed using Zung's Self-Rating Depression Scale. Results During the 2-year follow-up, patients with moderate/severe depression at baseline showed a significant decline in global cognitive function (80.5 ± 15.2 vs 76.6 ± 15.5, p = 0.008), while patients without depression or with mild depression kept a stable global cognitive function. In the meantime, patients without depression showed significant improvements in immediate memory, visuospatial skill, and language ability. However, no significant improvement in these parameters was shown in depression groups. In multivariable linear regression analysis, depression at baseline was a significant predictor of worsening global cognitive function, whether depression was analyzed as a continuous variable (odds ratio [OR] = -0.14, 95% confidence interval [CI] -0.27, -0.01, p = 0.031) or a rank variable (OR = -1.88, 95% CI -3.30, -0.45, p = 0.010). Moreover, higher depression score or more severe depression degradation was significantly associated with decline of immediate memory, delayed memory, and language skill. Conclusion Depression was a significant risk factor for worsening of CI in PD patients.
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Affiliation(s)
- Xue-dan Nie
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Qin Wang
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Yu-hui Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zu-ying Xiong
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jin-lan Liao
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Hao
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Gui-ling Liu
- Renal Division, The Second Hospital of Anhui Medical University, Anhui, China
| | - Li-ping Duan
- Renal Division, Handan Central Hospital, Hebei, China
| | | | - Ye-ping Ren
- Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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30
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The effect of anxiety on cognition in older adult inpatients with depression: results from a multicenter observational study. Heliyon 2019; 5:e02235. [PMID: 31497664 PMCID: PMC6722253 DOI: 10.1016/j.heliyon.2019.e02235] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2019] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Late-life depression is associated with reduced cognitive function beyond normal age-related cognitive deficits. As comorbid anxiety frequently occur in late-life depression, this study aimed to examine the association between anxiety symptoms and cognitive function among older inpatients treated for depression. We hypothesized that there would be an overall additive effect of comorbid anxiety symptoms on dysfunction across cognitive domains. The study included 142 patients treated for late-life depression in hospital, enrolled in the Prognosis of Depression in the Elderly study. Anxiety symptoms were measured at admission using the anxiety subscale of the Hospital Anxiety and Depression Scale. Patients completed cognitive tasks at admission and discharge. Linear mixed and generalized linear mixed models were estimated to investigate the effect of anxiety, on continuous and categorical cognitive scores, respectively, while controlling for depression. Anxiety severity at admission was not associated with performance in any of the cognitive domains. Patients with more symptoms of anxiety at admission demonstrated a significant improvement in immediate recall during the hospital stay. Patients with a score above cutoff indicating clinically significant symptoms on the anxiety subscale performed better on general cognitive function, as measured by the Mini Mental Status Examination at admission, than those below cutoff for anxiety. In conclusion, comorbid anxiety symptoms had no additive effect on cognitive dysfunction in late-life depression in our sample of inpatients.
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Abstract
OBJECTIVES Individuals aged 90 or older (oldest-old), the fastest growing segment of the population, are at increased risk of developing cognitive impairment compared with younger old. Neuropsychological evaluation of the oldest-old is important yet challenging in part because of the scarcity of test norms for this group. We provide neuropsychological test norms for cognitively intact oldest-old. METHODS Test norms were derived from 403 cognitively intact participants of The 90+ Study, an ongoing study of aging and dementia in the oldest-old. Cognitive status of intact oldest-old was determined at baseline using cross-sectional approach. Individuals with cognitive impairment no dementia or dementia (according to DSM-IV criteria) were excluded. Participants ranged in age from 90 to 102 years (mean=94). The neuropsychological battery included 11 tests (Mini-Mental Status Examination, Modified Mini-Mental State Examination, Boston Naming Test - Short Form, Letter Fluency Test, Animal Fluency Test, California Verbal Learning Test-II Short Form, Trail Making Tests A/B/C, Digit Span Forward and Backwards Test, Clock Drawing Test, CERAD Construction Subtests), and the Geriatric Depression Scale. RESULTS Data show significantly lower scores with increasing age on most tests. Education level, sex, and symptoms of depression were associated with performance on several tests after accounting for age. CONCLUSIONS Provided test norms will help to distinguish cognitively intact oldest-old from those with cognitive impairment. (JINS, 2019, 25, 530-545).
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32
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Wu CR, Chen PY, Hsieh SH, Huang HC, Chen YT, Chen TJ, Chiu HY. Sleep Mediates the Relationship Between Depression and Cognitive Impairment in Older Men. Am J Mens Health 2019; 13:1557988319825765. [PMID: 30819067 PMCID: PMC6440061 DOI: 10.1177/1557988319825765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Sleep and depression are strongly associated with cognitive impairment. The role of sleep disturbances in the adverse effect of depression on cognitive dysfunction in older adults remains unclear. This study explored the mediating effect of self-reported sleep disturbances on the relationship between depression and cognitive impairment in older adults according to sex differences. This study derived data from the 2009 Taiwan National Health Interview Survey and included 2,175 community-dwelling adults aged 65 years and older (men = 991; women = 1,184). Sleep disturbances were measured using self-reported survey questions. The Center for Epidemiological Studies Depression scale was used to assess depression. The Mini-Mental State Examination was used to evaluate cognitive impairment. A higher proportion of female older persons had cognitive impairment and depression than male older persons (cognition: 24.4% vs. 11.5%; depression: 17.0% vs. 10.8%). The meditating effect of sleep was detected in only men. Difficulty in initiating sleep was a complete mediator of the adverse effect of depression on cognitive impairment (Sobel test: p = .03). In summary, difficultly in initiating sleep may be a crucial, treatable mediator of the adverse effect of depression on cognitive impairment in older men.
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Affiliation(s)
- Chia-Rung Wu
- 1 Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,2 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pin-Yuan Chen
- 3 Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan.,4 School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hua Hsieh
- 1 Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hui-Chuan Huang
- 2 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ting Chen
- 5 School of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Jhen Chen
- 2 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- 2 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,6 Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Farioli Vecchioli S, Sacchetti S, Nicolis di Robilant V, Cutuli D. The Role of Physical Exercise and Omega-3 Fatty Acids in Depressive Illness in the Elderly. Curr Neuropharmacol 2018; 16:308-326. [PMID: 28901279 PMCID: PMC5843982 DOI: 10.2174/1570159x15666170912113852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 06/20/2017] [Accepted: 07/30/2017] [Indexed: 02/07/2023] Open
Abstract
Background: In adulthood, depression is the most common type of mental illness and will be the second leading cause of disease by 2020. Major depression dramatically affects the function of the central nervous system and degrades the quality of life, especially in old age. Several mechanisms underlie the pathophysiology of depressive illness, since it has a multifactorial etiology. Human and an-imal studies have demonstrated that depression is mainly associated with imbalances in neurotransmitters and neurotrophins, hypothalamic-pituitary-adrenal axis alterations, brain volume changes, neurogenesis dysfunction, and dysregulation of in-flammatory pathways. Also the gut microbiota may influence mental health outcomes. Although depression is not a consequence of normal aging, depressive disorders are common in later life, even if often undi-agnosed or mis-diagnosed in old age. When untreated, depression reduces life expectancy, worsens medical illnesses, en-hances health care costs and is the primary cause of suicide among older people. To date, the underpinnings of depression in the elderly are still to be understood, and the pharmacological treatment is the most commonly used therapy. Objective: Since a sedentary lifestyle and poor eating habits have recently emerged as crucial contributors to the genesis and course of depression, in the present review, we have focused on the effects of physical activity and omega-3 fatty acids on depressive illness in the elderly. Results: A growing literature indicates that both exercise and dietary interventions can promote mental health throughout one’s lifespan. Conclusion: There thus emerges the awareness that an active lifestyle and a balanced diet may constitute valid low-cost pre-vention strategies to counteract depressive illness in the elderly.
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Affiliation(s)
- Stefano Farioli Vecchioli
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Stefano Sacchetti
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
| | - V Nicolis di Robilant
- Institute of Cell Biology and Neurobiology, CNR/Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy
| | - Debora Cutuli
- Laboratory of Experimental and Behavioral Neurophysiology, Fondazione Santa Lucia, Via del Fosso di Fiorano 64, 00143, Rome, Italy.,Department of Psychology, University Sapienza of Rome, Via dei Marsi 78, 00185, Rome, Italy
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34
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Hui J, Zhang J, Pu M, Zhou X, Dong L, Mao X, Shi G, Zou J, Wu J, Jiang D, Xi G. Modulation of GSK-3β/β-Catenin Signaling Contributes to Learning and Memory Impairment in a Rat Model of Depression. Int J Neuropsychopharmacol 2018; 21:858-870. [PMID: 29688389 PMCID: PMC6119296 DOI: 10.1093/ijnp/pyy040] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/16/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND It is widely accepted that cognitive processes, such as learning and memory, are affected in depression, but the molecular mechanisms underlying the interactions of these 2 disorders are not clearly understood. Recently, glycogen synthase kinase-3 beta (GSK-3β)/β-catenin signaling was shown to play an important role in the regulation of learning and memory. METHODS The present study used a rat model of depression, chronic unpredictable stress, to determine whether hippocampal GSK-3β/β-catenin signaling was involved in learning and memory alterations. RESULTS Our results demonstrated that chronic unpredictable stress had a dramatic influence on spatial cognitive performance in the Morris water maze task and reduced the phosphorylation of Ser9 of GSK-3β as well as the total and nuclear levels of β-catenin in the hippocampus. Inhibition of GSK3β by SB216763 significantly ameliorated the cognitive deficits induced by chronic unpredictable stress, while overexpression of GSK3β by AAV-mediated gene transfer significantly decreased cognitive performance in adult rats. In addition, chronic unpredictable stress exposure increased the expression of the canonical Wnt antagonist Dkk-1. Furthermore, chronic administration of corticosterone significantly increased Dkk-1 expression, decreased the phosphorylation of Ser9 of GSK-3β, and resulted in the impairment of hippocampal learning and memory. CONCLUSIONS Our results indicate that impairment of learning and memory in response to chronic unpredictable stress may be attributed to the dysfunction of GSK-3β/β-catenin signaling mediated by increased glucocorticoid signaling via Dkk-1.
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Affiliation(s)
- Jiaojie Hui
- Department of Critical Care Medicine, Wuxi, China
| | - Jianping Zhang
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Mengjia Pu
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Xingliang Zhou
- Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research at USC, Department of Cell and Neurobiology, University of Southern California, Los Angeles, California
| | - Liang Dong
- Department of Critical Care Medicine, Wuxi, China
| | - Xuqiang Mao
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Guofeng Shi
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jian Zou
- Department of Clinical Laboratory Science, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Jingjing Wu
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Dongmei Jiang
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Guangjun Xi
- Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, China,Correspondence: Guangjun Xi, MD, PhD, The Department of Neurology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, No.299 Qingyang Road, Wuxi, PR China, 214023 ()
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35
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Gatchel JR, Donovan NJ, Locascio JJ, Schultz AP, Becker JA, Chhatwal J, Papp KV, Amariglio RE, Rentz DM, Blacker D, Sperling RA, Johnson KA, Marshall GA. Depressive Symptoms and Tau Accumulation in the Inferior Temporal Lobe and Entorhinal Cortex in Cognitively Normal Older Adults: A Pilot Study. J Alzheimers Dis 2018; 59:975-985. [PMID: 28697559 DOI: 10.3233/jad-170001] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depressive symptoms are common in older adults and associated with increased morbidity and cognitive decline. These symptoms occur during preclinical and prodromal stages of Alzheimer's disease (AD), but their relationship to tau, one of the main AD proteinopathies, is poorly understood. OBJECTIVE The objective of this study was to investigate the cross-sectional association between depressive symptoms and cerebral tau [18F T807 (also known as 18F-AV-1451) tau positron emission tomography (PET) imaging] in cognitively normal (CN) older adults. METHODS We measured depressive symptoms using the Geriatric Depression Scale (GDS), and in vivo cerebral tau using T807 PET in 111 CN older adults. We employed general linear regression models to evaluate the relationship of GDS score regressed on entorhinal cortex (EC) or inferior temporal (IT) tau in separate backward elimination models. Other predictors included age, sex, and in secondary analyses, amyloid (Pittsburgh Compound B PET). RESULTS Higher GDS was significantly associated with greater IT tau (partial r = 0.188, p = 0.050) and marginally associated with greater EC tau (partial r = 0.183, p = 0.055). In additional analyses including both linear and quadratic age terms, we found a significant U-shaped relation of GDS to age (p = 0.001). CONCLUSIONS Results suggest that IT and EC tau are modestly associated with depressive symptoms in CN older adults. Findings suggest a link between depressive symptoms and tau-mediated neurodegeneration in a region vulnerable in AD. Future longitudinal studies examining the association of more severe depressive symptoms and cerebral tau accumulation are needed to substantiate this finding and to guide prevention and treatment in AD.
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Affiliation(s)
- Jennifer R Gatchel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Nancy J Donovan
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron P Schultz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Alex Becker
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jasmeer Chhatwal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathryn V Papp
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E Amariglio
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dorene M Rentz
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reisa A Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith A Johnson
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gad A Marshall
- Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
This article covers current research on the relationship between depression and cognitive impairment in older adults. First, it approaches the clinical assessment of late-life depression and comorbid cognitive impairment. Cognitive risk factors for suicide are discussed. Research is then provided on neuropsychological changes associated with depression, discussing subjective cognitive impairment, mild cognitive impairment, and dementia profiles. Additionally, literature regarding neuroimaging and biomarker findings in depressed older adults is presented. Finally, therapeutic models for treatment of late-life depression are also discussed, including psychotherapy models, holistic treatments, pharmacologic approaches, and brain-stimulation therapies.
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Lazar RM, Pavol MA, Bormann T, Dwyer MG, Kraemer C, White R, Zivadinov R, Wertheimer JC, Thöne-Otto A, Ravdin LD, Naugle R, Mechanic-Hamilton D, Garmoe WS, Stringer AY, Bender HA, Kapadia SR, Kodali S, Ghanem A, Linke A, Mehran R, Virmani R, Nazif T, Parhizgar A, Leon MB. Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:384-392. [DOI: 10.1016/j.jcin.2017.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
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Belvederi Murri M, Ekkekakis P, Magagnoli M, Zampogna D, Cattedra S, Capobianco L, Serafini G, Calcagno P, Zanetidou S, Amore M. Physical Exercise in Major Depression: Reducing the Mortality Gap While Improving Clinical Outcomes. Front Psychiatry 2018; 9:762. [PMID: 30687141 PMCID: PMC6335323 DOI: 10.3389/fpsyt.2018.00762] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Major depression shortens life while the effectiveness of frontline treatments remains modest. Exercise has been shown to be effective both in reducing mortality and in treating symptoms of major depression, but it is still underutilized in clinical practice, possibly due to prevalent misperceptions. For instance, a common misperception is that exercise is beneficial for depression mostly because of its positive effects on the body ("from the neck down"), whereas its effectiveness in treating core features of depression ("from the neck up") is underappreciated. Other long-held misperceptions are that patients suffering from depression will not engage in exercise even if physicians prescribe it, and that only vigorous exercise is effective. Lastly, a false assumption is that exercise may be more harmful than beneficial in old age, and therefore should only be recommended to younger patients. This narrative review summarizes relevant literature to address the aforementioned misperceptions and to provide practical recommendations for prescribing exercise to individuals with major depression.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Psychological Medicine, King's College London, London, United Kingdom
| | | | - Marco Magagnoli
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Domenico Zampogna
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Simone Cattedra
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Laura Capobianco
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Stamatula Zanetidou
- Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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39
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Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. Am J Geriatr Psychiatry 2018; 26:107-122. [PMID: 28735658 DOI: 10.1016/j.jagp.2017.06.011] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.
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40
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The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0126-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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41
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Seo EH, Kim H, Choi KY, Lee KH, Choo IH. Association of subjective memory complaint and depressive symptoms with objective cognitive functions in prodromal Alzheimer's disease including pre-mild cognitive impairment. J Affect Disord 2017; 217:24-28. [PMID: 28380342 DOI: 10.1016/j.jad.2017.03.062] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/28/2017] [Accepted: 03/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subjective memory complaints (SMC) and depressive symptoms (SDS) are common in the elderly population. However, the relationship among SMC, SDS, and cognitive function remains unclear. We investigated these associations in the elderly from cognitively normal (CN), pre-mild cognitive impairment (MCI), and amnestic MCI (aMCI) groups. METHODS Participants (CN, 299; pre-MCI, 106; aMCI, 267) underwent comprehensive clinical and neuropsychological assessment. and self-report SMC and SDS questionnaires. SMC and SDS were administered in a self-report format. For each neuropsychological test z-score, stepwise multiple linear regressions were performed to assess the relative contribution of SMC, SDS, and their interactions. RESULTS SMC are associated with lower objective memory, while SDS are associated with lower psychomotor speed. Interactions between SMC and SDS were significant for tests of memory, executive function, psychomotor speed, and global cognition. Additional analyses revealed that SDS moderated the SMC-cognition relationship such that only individuals with higher SDS showed significant SMC-cognition associations. LIMITATIONS Due to the cross-sectional design, associations among SMC, SDS, and cognitive function was rather weak, albeit significant. Additionally, future biomarker studies, such as those assessing amyloid burden, are needed to explore the mechanisms underlying the relationship among SMC, SDS, and cognitive function. CONCLUSION Early identification of individuals at risk for developing abnormal cognitive changes is critical. Our findings from the study involving a large sample of carefully selected participants suggest that SMC and SDS could be used as early detection markers of Alzheimer's disease.
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Affiliation(s)
- Eun Hyun Seo
- National Research Center for Dementia, Gwangju 61452, South Korea; Premedical Science, College of Medicine, Chosun University, Gwangju 61452, South Korea
| | - Hoowon Kim
- National Research Center for Dementia, Gwangju 61452, South Korea; Department of Neurology, School of Medicine, Chosun University/Chosun University Hospital, Gwangju 61452, South Korea
| | - Kyu Yeong Choi
- National Research Center for Dementia, Gwangju 61452, South Korea; Premedical Science, College of Medicine, Chosun University, Gwangju 61452, South Korea
| | - Kun Ho Lee
- National Research Center for Dementia, Gwangju 61452, South Korea; College of Natural Sciences, Chosun University, Gwangju 61452, South Korea
| | - Il Han Choo
- National Research Center for Dementia, Gwangju 61452, South Korea; Department of Neuropsychiatry, School of Medicine, Chosun University/Chosun University Hospital, Gwangju 61452, South Korea.
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42
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Abstract
BACKGROUND Late-life depression is often associated with cognitive impairments and disability, which may persist even after adequate antidepressant drug treatment. Physical exercise is increasingly recognized as an effective antidepressant agent, and may exert positive effects on these features too. However, few studies examined this issue, especially by comparing different types of exercises. METHODS We performed secondary analyses on data from the Safety and Efficacy of Exercise for Depression in Seniors study, a trial comparing the antidepressant effectiveness of sertraline (S), sertraline plus thrice-weekly non-progressive exercise (S+NPE), and sertraline plus thrice-weekly progressive aerobic exercise (S+PAE). Exercise was conducted in small groups and monitored by heart rate meters. Patients with late-life depression without severe cognitive impairment were recruited from primary care and assessed at baseline and 24 weeks, using the Montreal Cognitive Assessment (MOCA, total and subdomain scores) and Brief Disability Questionnaire. Analyses were based on Generalized Linear Models. RESULTS In total, 121 patients (mean age 75, 71% females) were randomized to the study interventions. Compared with the S group, patients in the S+PAE group displayed greater improvements of MOCA total scores (p=0.006, effect size=0.37), visuospatial/executive functions (p=0.001, effect size=0.13), and disability (p=0.02, effect size=-0.31). Participants in the S+NPE group did not display significant differences with the control group. CONCLUSIONS Adding aerobic, progressive exercise to antidepressant drug treatment may offer significant advantages over standard treatment for cognitive abilities and disability. These findings suggest that even among older patients exercise may constitute a valid therapeutic measure to improve patients' outcomes.
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43
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Klojčnik M, Kavcic V, Bakracevic Vukman K. Relationship of Depression With Executive Functions and Visuospatial Memory in Elderly. Int J Aging Hum Dev 2017; 85:490-503. [PMID: 28592136 DOI: 10.1177/0091415017712186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive deficits are a potential part of the clinical picture of depression, especially when it comes to late-life depression. The present study was carried out to establish whether distinctive cognitive deficiencies can be linked with depression in the late-life period, especially in executive functioning, working memory, and visuospatial memory. Our sample consisted of 71 seniors in the age range between 69 and 85 years. A battery of neurocognitive tests was used, including tests of executive functioning (Trail Making Test [TMT], part B, Stroop color word test, semantic word fluency test, and partially Rey-Osterrieth Complex Figure test [ROCF]), tests of attention and working memory (TMT, part A and digit span), and test of visuospatil ability and memory (ROCF). Results demonstrated that depression scores were significantly negatively correlated with scores on Verbal Fluency test, Stroop test, and ROCF immediate copy and recall. Depression was also linked to slower functioning on Trail Making A and Trail Making B subtest. In general, higher depression scores were correlated with lower performance on neuropsychological tests. However, digit span showed no significant correlation with depression. In addition, results of regression analyses revealed that the strongest predictors of depression were performance on the Rey-Osterrieth test-immediate recall and Stroop test. Thus, we could ascertain that difficulties in executive functioning and visuospatial memory are the best predictors of depression in elderly.
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Affiliation(s)
- Monika Klojčnik
- 1 Department of Psychology, Faculty of Arts, University of Maribor, Slovenia
| | - Voyko Kavcic
- 2 Institute of Gerontology, Wayne State University, Detroit, MI, USA
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44
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Karstens AJ, Rubin LH, Shankman SA, Ajilore O, Libon DJ, Kumar A, Lamar M. Investigating the separate and interactive associations of trauma and depression on neurocognition in urban dwelling adults. J Psychiatr Res 2017; 89:6-13. [PMID: 28130995 PMCID: PMC5373989 DOI: 10.1016/j.jpsychires.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/06/2017] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trauma and depression have each been associated with neurocognitive alterations, but their combined effect on neurocognition is unclear. We investigated the separate and interactive associations of trauma and depression on neurocognition in a sample of ethnically diverse urban dwellers, and explored the impact of age on these effects. METHODS 284 adults aged 30-89 were divided into groups based on their current depression and trauma history. Individuals meeting DSM-IV criteria for depression were considered Depressed (D+) and individuals rated through diagnostic interview as having trauma history were considered positive for Trauma (T+). Resulting Ns were 73 D+T+, 56 D+T-, 68 D-T+, and 87 D-T-. A principal component analysis of neuropsychological scores resulted in a 3-factor solution representing verbal learning/memory/recognition (VERBAL-LMR), visual learning/memory/recognition, and speeded attention/cognitive flexibility accounting for 70.21% of the variance. RESULTS Multivariable linear regressions adjusting for age revealed that Trauma, regardless of Depression, is associated with worse VERBAL-LMR performance. This Trauma association was driven by verbal list and prose passages learning and memory, but not recognition memory. Age-stratified (<60 versus ≥60 years) regressions revealed the Trauma association was only significant for older adults. No main or interactive effects for Depression were observed. CONCLUSIONS Trauma, regardless of Depression, is associated with worse verbal learning and memory, but not recognition performance. These results suggest that trauma exposure may negatively impact neurocognition. Clinicians working with adults in urban settings should query for trauma in addition to depression when considering subjective and objective measures of neurocognitive functioning, particularly in older adults.
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Affiliation(s)
| | - Leah H. Rubin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612
| | - Stewart A. Shankman
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60612,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612
| | - David J. Libon
- Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, School of Osteopathic Medicine-Rowan University, Stratford, NJ 08084
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, 60612
| | - Melissa Lamar
- Department of Psychology, University of Illinois at Chicago, Chicago, IL 60612, United States; Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, United States.
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Carrière I, Norton J, Farré A, Wyart M, Tzourio C, Noize P, Pérès K, Fourrier-Réglat A, Ritchie K, Ancelin ML. Antidepressant use and cognitive decline in community-dwelling elderly people - The Three-City Cohort. BMC Med 2017; 15:81. [PMID: 28424070 PMCID: PMC5397783 DOI: 10.1186/s12916-017-0847-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cognitive impairment is very common in late-life depression, principally affecting executive skills and information processing speed. The aim of the study was to examine the effect of antidepressant treatment on cognitive performances over a 10-year period. METHODS The community-based cohort included 7381 participants aged 65 years and above. Five cognitive domains (verbal fluency, psychomotor speed, executive function, visuospatial skills and global cognition) were assessed up to five times over 10 years of follow-up. Treatment groups included participants under a specific antidepressant class at both baseline and the first follow-up and their follow-up cognitive data were considered until the last consecutive follow-up with a report of antidepressant use of the same class. Linear mixed models were used to compare baseline cognitive performance and cognitive decline over time according to antidepressant treatment. The models were adjusted for multiple confounders including residual depressive symptoms assessed by the Center for Epidemiologic Studies-Depression scale. RESULTS At baseline, 4.0% of participants were taking antidepressants. Compared to non-users, tricyclic antidepressant users had lower baseline performances in verbal fluency, visual memory and psychomotor speed, and selective serotonin reuptake inhibitor users in verbal fluency and psychomotor speed. For the two other cognitive abilities, executive function and global cognition, no significant differences were found at baseline irrespective of the antidepressant class. Regarding changes over time, no significant differences were observed in comparison with non-users whatever the cognitive domain, except for a slight additional improvement over the follow-up in verbal fluency skills for tricyclic antidepressant users. CONCLUSIONS In this large elderly general population cohort, we found no evidence for an association between antidepressant use and post-treatment cognitive decline over 10 years of follow-up in various cognitive domains.
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Affiliation(s)
- Isabelle Carrière
- Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France. .,Univ. Montpellier, U1061, Montpellier, France.
| | - Joanna Norton
- Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.,Univ. Montpellier, U1061, Montpellier, France
| | - Amandine Farré
- Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.,Univ. Montpellier, U1061, Montpellier, France
| | - Marilyn Wyart
- Department of Psychiatry, CHU Caremeau, Nîmes, France
| | - Christophe Tzourio
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000, Bordeaux, France
| | - Pernelle Noize
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000, Bordeaux, France.,Department of Clinical Pharmacology, CHU Bordeaux, Bordeaux, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000, Bordeaux, France
| | - Annie Fourrier-Réglat
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000, Bordeaux, France.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Karen Ritchie
- Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.,Univ. Montpellier, U1061, Montpellier, France.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marie Laure Ancelin
- Inserm U1061, Neuropsychiatry: epidemiological and clinical research, 39 avenue Charles Flahault, BP 34493, 34093, Montpellier cedex 05, France.,Univ. Montpellier, U1061, Montpellier, France
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46
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Brailean A, Aartsen MJ, Muniz-Terrera G, Prince M, Prina AM, Comijs HC, Huisman M, Beekman A. Longitudinal associations between late-life depression dimensions and cognitive functioning: a cross-domain latent growth curve analysis. Psychol Med 2017; 47:690-702. [PMID: 27834162 PMCID: PMC5426346 DOI: 10.1017/s003329171600297x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected. METHOD The study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall). RESULTS Poorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time. CONCLUSIONS Our findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.
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Affiliation(s)
- A. Brailean
- Department of Health Service and Population
Research, King's College London, Institute of Psychiatry,
Psychology and Neuroscience, Centre for Global Mental Health,
London, UK
| | - M. J. Aartsen
- NOVA - Norwegian Social Research, Center for
Welfare and Labor Research, Oslo,
Norway
| | | | - M. Prince
- Department of Health Service and Population
Research, King's College London, Institute of Psychiatry,
Psychology and Neuroscience, Centre for Global Mental Health,
London, UK
| | - A. M. Prina
- Department of Health Service and Population
Research, King's College London, Institute of Psychiatry,
Psychology and Neuroscience, Centre for Global Mental Health,
London, UK
| | - H. C. Comijs
- VU University Medical Centre, Department of
Psychiatry and the EMGO Institute for Health and Care Research,
Amsterdam, The Netherlands
| | - M. Huisman
- VU University Medical Center, Department of
Epidemiology and Biostatistics and the EMGO Institute for Health and Care
Research, Amsterdam, The Netherlands
- Department of Sociology, VU
University, Amsterdam, The
Netherlands
| | - A. Beekman
- VU University Medical Centre, Department of
Psychiatry and the EMGO Institute for Health and Care Research,
Amsterdam, The Netherlands
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47
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Renn BN, Areán PA. Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. ACTA ACUST UNITED AC 2017; 4:1-12. [PMID: 28932652 DOI: 10.1007/s40501-017-0100-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients' preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD.
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Affiliation(s)
- Brenna N Renn
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Patricia A Areán
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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48
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Approval of psychotherapy and medication for the treatment of mental disorders over the lifespan. An age period cohort analysis. Epidemiol Psychiatr Sci 2017; 26:61-69. [PMID: 26753632 PMCID: PMC6998652 DOI: 10.1017/s2045796015001134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS Previous cross-sectional studies revealed inconsistent results regarding mental health treatment preferences among the general population. In particular, it is unclear to what extent specific age groups approve psychotherapy or psychotropic medication for the treatment of mental disorders. We explore whether treatment recommendations of either psychotherapy or psychiatric medication change over the lifespan which includes age-related effects due to increasing age of a person, cohort effects that reflect specific opinions during the time a person was born and period effects that reflect societal changes. METHODS Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined n = 9046), we performed age-period-cohort analyses to determine the pure age, birth cohort and time period effects associated with the specific treatment recommendations for a person with either depression or schizophrenia, using logistic Partial Least-Squares regression models. RESULTS For both disorders, approval of both psychotherapy and medication for a person with mental illness increases with age. At the same time, younger cohorts showed stronger recommendations particularly for psychotherapy (OR around 1.07 per decade). The strongest effects could be observed for time period with an increase in recommendation between 1990 and 2001 with odds ratio of 2.36 in depression and 2.97 in schizophrenia, respectively. In general, the treatment option that showed the strongest increase in recommendation was medication for schizophrenia and psychotherapy for depression. CONCLUSION Underutilisation of psychotherapy in old age seems not to reflect treatment preferences of older persons. Thus, special treatment approaches need to be offered for this group that seems to be willing for psychotherapy but do not yet use it. Cohort patterns suggest that approval of psychotherapy among older persons will likely further increase in the coming years as these people get older. Finally, strong period effects underpin the importance of changing attitudes in the society. These could reflect reporting changes about psychiatric topics in the media or a general increase in the perception of treatment options. Nevertheless, more treatment offers especially for older people are needed.
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Zanetidou S, Belvederi Murri M, Menchetti M, Toni G, Asioli F, Bagnoli L, Zocchi D, Siena M, Assirelli B, Luciano C, Masotti M, Spezia C, Magagnoli M, Neri M, Amore M, Bertakis KD. Physical Exercise for Late-Life Depression: Customizing an Intervention for Primary Care. J Am Geriatr Soc 2016; 65:348-355. [PMID: 27869986 DOI: 10.1111/jgs.14525] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify which individual- and context-related factors influence the translation into clinical practice of interventions based on physical exercise (PE) as an adjunct to antidepressants (AD) for the treatment of late-life major depression (LLMD). DESIGN Secondary analysis of a randomized controlled trial. SETTING Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders. PARTICIPANTS Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121). INTERVENTION Participants with LLMD were randomized to AD (sertraline) or AD plus PE (AD + PE). MEASUREMENTS Participant characteristics that were associated with greater effectiveness of AD + PE (moderators) were identified, and effect sizes were calculated from success rate differences. Whether the characteristics of the study setting influenced participant flow and attendance at exercise sessions was then explored, and primary care physicians (PCPs) were surveyed regarding their opinions on PE as a treatment for LLMD. RESULTS The following participant characteristics were associated with greater likelihood of achieving remission from depression with AD + PE than with AD alone: aged 75 and older (effect size 0.32), polypharmacy (0.35), greater aerobic capacity (0.48), displaying psychomotor slowing (0.49), and less-severe anxiety (0.30). The longer the PCLP had been established at a particular center, the more individuals were recruited at that center. After participating in the study, PCPs expressed positive views on AD + PE as a treatment for LLMD and were more likely to use this as a therapeutic strategy. CONCLUSIONS The combination of PE and sertraline could improve the management of LLMD, especially when customized for individuals with specific clinical features. Liaison programs might influence the implementation of similar interventions in primary care, and PCPs viewed them positively.
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Affiliation(s)
- Stamatula Zanetidou
- Department of Mental Health, Consultation Liaison Psychiatry Service, Bologna, Italy
| | - Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy.,Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Marco Menchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulio Toni
- Cardiology Unit, S. Sebastiano Hospital, Correggio, Italy
| | | | | | | | | | | | - Claudia Luciano
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mattia Masotti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | | | | | - Mirco Neri
- Department of Geriatrics, Nuovo Ospedale Civile, Modena and Reggio Emilia University, Modena, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Klea D Bertakis
- Department of Family and Community Medicine, School of Medicine, University of California, Davis, Sacramento, California.,Center for Healthcare Policy and Research, School of Medicine, University of California, Davis, Sacramento, California
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Shi Z, Xiao S, Li X. Treatment resistant depression or dementia: a case report. SHANGHAI ARCHIVES OF PSYCHIATRY 2016; 28:109-14. [PMID: 27605868 PMCID: PMC5004096 DOI: 10.11919/j.issn.1002-0829.215085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The current case describes a 78-year-old female with two previous episodes of major depression who presented with both symptoms of depression (amotivation and flattened affect) and typical symptoms of dementia (impaired memory and executive functioning). Even after a detailed clinical exam and neuropsychiatric testing, it remained difficult to definitively classify the diagnosis as either treatment-resistant depression or old-age dementia. After 8 weeks of inpatient treatment, including changing her reserpine-based antihypertensive medication, adjusting her antidepressants, and providing psychotherapy, her depressive and anxiety symptoms improved, but most of her cognitive symptoms persisted. Her symptoms did not change over 7 months of post-hospitalization follow-up. She subsequently developed advanced breast cancer and started chemotherapy; at this point her depressive and cognitive symptoms became more pronounced. We conclude that it will take two-to-three years of follow-up to determine whether the cognitive symptoms are residual to her depression or a newly emerging dementia (or both). This case shows that for elderly patients who have symptoms of both depression and dementia, detailed clinical examination and neuropsychiatric testing may need to be combined with longitudinal assessment of their responsiveness to treatment before a definitive diagnosis can be assigned.
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Affiliation(s)
- Zhongyong Shi
- Shanghai Tenth People's Hospital, Shanghai Tong Ji University, Shanghai, China ; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shifu Xiao
- Shanghai Tenth People's Hospital, Shanghai Tong Ji University, Shanghai, China ; Alzheimer Diagnosis and Treatment center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Li
- Shanghai Tenth People's Hospital, Shanghai Tong Ji University, Shanghai, China ; Alzheimer Diagnosis and Treatment center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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