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Lee S, Zide BS, Palm ST, Drew WJ, Sperling RA, Jacobs HIL, Siddiqi SH, Donovan NJ. Specific Association of Worry With Amyloid-β But Not Tau in Cognitively Unimpaired Older Adults. Am J Geriatr Psychiatry 2024:S1064-7481(24)00327-0. [PMID: 38763835 DOI: 10.1016/j.jagp.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Anxiety disorders and subsyndromal anxiety symptoms are highly prevalent in late life. Recent studies support that anxiety may be a neuropsychiatric symptom during preclinical Alzheimer's disease (AD) and that higher anxiety is associated with more rapid cognitive decline and progression to cognitive impairment. However, the associations of specific anxiety symptoms with AD pathologies and with co-occurring subjective and objective cognitive changes have not yet been established. METHODS Baseline data from the A4 and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration studies were analyzed. Older adult participants (n = 4,486) underwent assessments of anxiety (State-Trait Anxiety Inventory-6 item version [STAI]), and cerebral amyloid-beta (Aβ; 18F-florbetapir) PET and a subset underwent tau (18F-flortaucipir) PET. Linear regressions estimated associations of Aβ in a cortical composite and tau in the amygdala, entorhinal, and inferior temporal regions with STAI-Total and individual STAI item scores. Models adjusted for age, sex, education, marital status, depression, Apolipoprotein ε4 genotype, and subjective and objective cognition (Cognitive Function Index-participant; Preclinical Alzheimer Cognitive Composite). RESULTS Greater Aβ deposition was significantly associated with higher STAI-Worry, adjusting for all covariates, but not with other STAI items or STAI-Total scores. In mediation analyses, the association of Aβ with STAI-Worry was partially mediated by subjective cognition with a stronger direct effect. No associations were found for regional tau deposition with STAI-Total or STAI-Worry score. CONCLUSION Greater worry was associated with Aβ but not tau deposition, independent of subjective and objective cognition in cognitively unimpaired (CU) older adults. These findings implicate worry as an early, specific behavioral marker and a possible therapeutic target in preclinical AD.
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Affiliation(s)
- Soyoung Lee
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women's Hospital (SL, BSZ, NJD), Harvard Medical School, Boston, MA; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital (SL, STP, WJD, SHS), Boston, MA.
| | - Benjamin S Zide
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women's Hospital (SL, BSZ, NJD), Harvard Medical School, Boston, MA
| | - Stephan T Palm
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital (SL, STP, WJD, SHS), Boston, MA; Department of Neurology, Brigham and Women's Hospital (STP, WJD, RAS, NJD), Harvard Medical School, Boston, MA
| | - William J Drew
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital (SL, STP, WJD, SHS), Boston, MA; Department of Neurology, Brigham and Women's Hospital (STP, WJD, RAS, NJD), Harvard Medical School, Boston, MA
| | - Reisa A Sperling
- Department of Neurology, Brigham and Women's Hospital (STP, WJD, RAS, NJD), Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital (RAS, NJD), Harvard Medical School, Boston, MA
| | - Heidi I L Jacobs
- Department of Radiology, Massachusetts General Hospital (HILJ), Harvard Medical School, Boston, MA; School for Mental Health and Neuroscience, Alzheimer Centre Limburg (HILJ), Maastricht University, Maastricht, The Netherlands
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital (SL, STP, WJD, SHS), Boston, MA; Department of Psychiatry, Brigham and Women's Hospital (SHS), Harvard Medical School, Boston, MA
| | - Nancy J Donovan
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women's Hospital (SL, BSZ, NJD), Harvard Medical School, Boston, MA; Department of Neurology, Brigham and Women's Hospital (STP, WJD, RAS, NJD), Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital (NJD), Harvard Medical School, Boston, MA
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Gerlach AR, Karim HT, Lee S, Kolobaric A, Tudorascu DL, Butters MA, Andreescu C. White Noise-Is Anxiety in Late-Life Associated With White Matter Hyperintensity Burden? Am J Geriatr Psychiatry 2024; 32:83-97. [PMID: 37718134 PMCID: PMC10843002 DOI: 10.1016/j.jagp.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety phenotypes (global anxiety, worry, and rumination) and white matter hyperintensities (WMH), with special consideration for the roles of age and executive function (EF). Our hypotheses were 1) anxiety phenotypes would be associated with WMH and 2) EF would moderate this relationship. DESIGN Cross-sectional. SETTING Participants were recruited from the local community (Pittsburgh, PA). PARTICIPANTS We recruited 110 older adults (age ≥ 50) with varying worry severity and clinical comorbidity. INTERVENTIONS Not applicable. MEASUREMENTS Demographics (age, sex, race, education), clinical measures (cumulative illness burden, global anxiety, worry, and rumination), EF, and WMH quantified with magnetic resonance imaging. RESULTS Lower global anxiety and worry severity were significantly correlated with higher WMH volume, though the global anxiety relationship was not significant after controlling for age. Rumination as not associated with WMH burden. EF was not correlated with either global anxiety, worry, rumination, or WMH. However, in those with advanced age and/or greater WMH burden, there was an association between worry and EF as well as EF and WMH. CONCLUSION Longitudinal studies are needed in order to clarify the complex interactions between anxiety phenotypes, WMH, and EF.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Helmet T Karim
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering (HTK), University of Pittsburgh, Pittsburgh, PA
| | - Soyoung Lee
- Department of Psychiatry (SL), Brigham and Women's Hospital, Boston, MA; Department of Psychiatry (SL), Harvard Medical School, Boston, MA
| | | | - Dana L Tudorascu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics (DLT), University of Pittsburgh, Pittsburgh, PA
| | - Meryl A Butters
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA
| | - Carmen Andreescu
- Department of Psychiatry (ARG, HTK, DLT, MAB, CA), University of Pittsburgh, Pittsburgh, PA.
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Pak V, Hashmi JA. Top-down threat bias in pain perception is predicted by higher segregation between resting-state networks. Netw Neurosci 2023; 7:1248-1265. [PMID: 38144683 PMCID: PMC10631789 DOI: 10.1162/netn_a_00328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/23/2023] [Indexed: 12/26/2023] Open
Abstract
Top-down processes such as expectations have a strong influence on pain perception. Predicted threat of impending pain can affect perceived pain even more than the actual intensity of a noxious event. This type of threat bias in pain perception is associated with fear of pain and low pain tolerance, and hence the extent of bias varies between individuals. Large-scale patterns of functional brain connectivity are important for integrating expectations with sensory data. Greater integration is necessary for sensory integration; therefore, here we investigate the association between system segregation and top-down threat bias in healthy individuals. We show that top-down threat bias is predicted by less functional connectivity between resting-state networks. This effect was significant at a wide range of network thresholds and specifically in predefined parcellations of resting-state networks. Greater system segregation in brain networks also predicted higher anxiety and pain catastrophizing. These findings highlight the role of integration in brain networks in mediating threat bias in pain perception.
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Affiliation(s)
- Veronika Pak
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, QC, Canada
| | - Javeria Ali Hashmi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
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Sundermann B, Feldmann R, Mathys C, Rau JMH, Garde S, Braje A, Weglage J, Pfleiderer B. Functional connectivity of cognition-related brain networks in adults with fetal alcohol syndrome. BMC Med 2023; 21:496. [PMID: 38093292 PMCID: PMC10720228 DOI: 10.1186/s12916-023-03208-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) can result in cognitive dysfunction. Cognitive functions affected are subserved by few functional brain networks. Functional connectivity (FC) in these networks can be assessed with resting-state functional MRI (rs-fMRI). Alterations of FC have been reported in children and adolescents prenatally exposed to alcohol. Previous reports varied substantially regarding the exact nature of findings. The purpose of this study was to assess FC of cognition-related networks in young adults with FAS. METHODS Cross-sectional rs-fMRI study in participants with FAS (n = 39, age: 20.9 ± 3.4 years) and healthy participants without prenatal alcohol exposure (n = 44, age: 22.2 ± 3.4 years). FC was calculated as correlation between cortical regions in ten cognition-related sub-networks. Subsequent modelling of overall FC was based on linear models comparing FC between FAS and controls. Results were subjected to a hierarchical statistical testing approach, first determining whether there is any alteration of FC in FAS in the full cognitive connectome, subsequently resolving these findings to the level of either FC within each network or between networks based on the Higher Criticism (HC) approach for detecting rare and weak effects in high-dimensional data. Finally, group differences in single connections were assessed using conventional multiple-comparison correction. In an additional exploratory analysis, dynamic FC states were assessed. RESULTS Comparing FAS participants with controls, we observed altered FC of cognition-related brain regions globally, within 7 out of 10 networks, and between networks employing the HC statistic. This was most obvious in attention-related network components. Findings also spanned across subcomponents of the fronto-parietal control and default mode networks. None of the single FC alterations within these networks yielded statistical significance in the conventional high-resolution analysis. The exploratory time-resolved FC analysis did not show significant group differences of dynamic FC states. CONCLUSIONS FC in cognition-related networks was altered in adults with FAS. Effects were widely distributed across networks, potentially reflecting the diversity of cognitive deficits in FAS. However, no altered single connections could be determined in the most detailed analysis level. Findings were pronounced in networks in line with attentional deficits previously reported.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Reinhold Feldmann
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus Oldenburg, Universitätsmedizin Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Johanna M H Rau
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Department of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Stefan Garde
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Anna Braje
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Josef Weglage
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University of Münster, Albert- Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
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Sudol K, Conway C, Szymkowicz SM, Elson D, Kang H, Taylor WD. Cognitive, Disability, and Treatment Outcome Implications of Symptom-Based Phenotyping in Late-Life Depression. Am J Geriatr Psychiatry 2023; 31:919-931. [PMID: 37385899 PMCID: PMC10592463 DOI: 10.1016/j.jagp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Late-life depression is associated with substantial heterogeneity in clinical presentation, disability, and response to antidepressant treatment. We examined whether self-report of severity of common symptoms, including anhedonia, apathy, rumination, worry, insomnia, and fatigue were associated with differences in presentation and response to treatment. We also examined whether these symptoms improved during treatment with escitalopram. DESIGN Eighty-nine older adults completed baseline assessments, neuropsychological testing and providing self-reported symptom and disability scales. They then entered an 8-week, placebo-controlled randomized trial of escitalopram, and self-report scales were repeated at the trial's end. Raw symptom scale scores were combined into three standardized symptom phenotypes and models examined how symptom phenotype severity was associated with baseline measures and depression improvement over the trial. RESULTS While rumination/worry appeared independent, severity of apathy/anhedonia and fatigue/insomnia were associated with one another and with greater self-reported disability. Greater fatigue/insomnia was also associated with slower processing speed, while rumination/worry was associated with poorer episodic memory. No symptom phenotype severity score predicted a poorer overall response to escitalopram. In secondary analyses, escitalopram did not improve most phenotypic symptoms more than placebo, aside for greater reductions in worry and total rumination severity. CONCLUSION Deeper symptom phenotype characterization may highlight differences in the clinical presentation of late-life depression. However, when compared to placebo, escitalopram did not improve many of the symptoms assessed. Further work is needed to determine whether symptom phenotypes inform longer-term course of illness, and which treatments may best benefit specific symptoms.
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Affiliation(s)
- Katherin Sudol
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Conway
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah M Szymkowicz
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Damian Elson
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN
| | - Warren D Taylor
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research (WDT), Education and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN.
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Cao B, Yang E, Wang L, Mo Z, Steffens DC, Zhang H, Liu M, Potter GG. Brain morphometric features predict depression symptom phenotypes in late-life depression using a deep learning model. Front Neurosci 2023; 17:1209906. [PMID: 37539384 PMCID: PMC10394384 DOI: 10.3389/fnins.2023.1209906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives Our objective was to use deep learning models to identify underlying brain regions associated with depression symptom phenotypes in late-life depression (LLD). Participants Diagnosed with LLD (N = 116) and enrolled in a prospective treatment study. Design Cross-sectional. Measurements Structural magnetic resonance imaging (sMRI) was used to predict five depression symptom phenotypes from the Hamilton and MADRS depression scales previously derived from factor analysis: (1) Anhedonia, (2) Suicidality, (3) Appetite, (4) Sleep Disturbance, and (5) Anxiety. Our deep learning model was deployed to predict each factor score via learning deep feature representations from 3D sMRI patches in 34 a priori regions-of-interests (ROIs). ROI-level prediction accuracy was used to identify the most discriminative brain regions associated with prediction of factor scores representing each of the five symptom phenotypes. Results Factor-level results found significant predictive models for Anxiety and Suicidality factors. ROI-level results suggest the most LLD-associated discriminative regions in predicting all five symptom factors were located in the anterior cingulate and orbital frontal cortex. Conclusions We validated the effectiveness of using deep learning approaches on sMRI for predicting depression symptom phenotypes in LLD. We were able to identify deep embedded local morphological differences in symptom phenotypes in the brains of those with LLD, which is promising for symptom-targeted treatment of LLD. Future research with machine learning models integrating multimodal imaging and clinical data can provide additional discriminative information.
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Affiliation(s)
- Bing Cao
- College of Intelligence and Computing, Tianjin University, Tianjin, China
| | - Erkun Yang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lihong Wang
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Zhanhao Mo
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Han Zhang
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mingxia Liu
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Guy G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
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Gerlach AR, Karim HT, Peciña M, Ajilore O, Taylor WD, Butters MA, Andreescu C. MRI predictors of pharmacotherapy response in major depressive disorder. Neuroimage Clin 2022; 36:103157. [PMID: 36027717 PMCID: PMC9420953 DOI: 10.1016/j.nicl.2022.103157] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
Major depressive disorder is among the most prevalent psychiatric disorders, exacting a substantial personal, social, and economic toll. Antidepressant treatment typically involves an individualized trial and error approach with an inconsistent success rate. Despite a pressing need, no reliable biomarkers for predicting treatment outcome have yet been discovered. Brain MRI measures hold promise in this regard, though clinical translation remains elusive. In this review, we summarize structural MRI and functional MRI (fMRI) measures that have been investigated as predictors of treatment outcome. We broadly divide these into five categories including three structural measures: volumetric, white matter burden, and white matter integrity; and two functional measures: resting state fMRI and task fMRI. Currently, larger hippocampal volume is the most widely replicated predictor of successful treatment. Lower white matter hyperintensity burden has shown robustness in late life depression. However, both have modest discriminative power. Higher fractional anisotropy of the cingulum bundle and frontal white matter, amygdala hypoactivation and anterior cingulate cortex hyperactivation in response to negative emotional stimuli, and hyperconnectivity within the default mode network (DMN) and between the DMN and executive control network also show promise as predictors of successful treatment. Such network-focused measures may ultimately provide a higher-dimensional measure of treatment response with closer ties to the underlying neurobiology.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marta Peciña
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
| | - Warren D Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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Wang LQ, Zhang TH, Dang W, Liu S, Fan ZL, Tu LH, Zhang M, Wang HN, Zhang N, Ma QY, Zhang Y, Li HZ, Wang LC, Zheng YN, Wang H, Yu X. Heterogenous Subtypes of Late-Life Depression and Their Cognitive Patterns: A Latent Class Analysis. Front Psychiatry 2022; 13:917111. [PMID: 35873245 PMCID: PMC9298648 DOI: 10.3389/fpsyt.2022.917111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Late-life depression (LLD), characterized by cognitive deficits, is considered heterogeneous across individuals. Previous studies have identified subtypes with diverse symptom profiles, but their cognitive patterns are unknown. This study aimed to investigate the subtypes of LLD and the cognitive profile of each group. METHODS In total, 109 depressed older adults were enrolled. We performed latent class analysis using Geriatric Depression Scale items as indicators to generate latent classes. We compared the sociodemographic and clinical characteristics with cognitive functions between groups and conducted regression analysis to investigate the association between class membership and variables with significant differences. RESULTS Two classes were identified: the "pessimistic" group was characterized by pessimistic thoughts and the "worried" group with a relatively high prevalence of worry symptoms. The two groups did not differ in sociodemographic characteristics. The "pessimistic" group showed a higher rate of past history of depression and lower age of onset. The "worried" group had more physical comorbidities and a higher rate of past history of anxiety. The "pessimistic" group was more impaired in general cognitive function, executive function, information processing speed, and attention. Lower general and executive functions were associated with the membership in the "pessimistic" group. CONCLUSIONS Subjects with pessimistic symptoms and subjects with a propensity to worry may form two distinct subtypes of late-life depression with different cognitive profiles. Further, the cognitive evaluation of subjects with pessimistic symptoms is of utmost importance.
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Affiliation(s)
- Li-Qi Wang
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Tian-Hong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Dang
- Department of Psychiatry, Xi'an Mental Health Center, Xi'an, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Zi-Li Fan
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China.,Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li-Hui Tu
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China.,Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ming Zhang
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China.,Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Nan Zhang
- Department of Neurology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qin-Ying Ma
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ying Zhang
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Hui-Zi Li
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Lu-Chun Wang
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Yao-Nan Zheng
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Huali Wang
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
| | - Xin Yu
- Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China.,Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders (Peking University), NHC Key Laboratory of Mental Health, Beijing, China
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