Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis

Is Pilates effective in improving depressive disorders? A comprehensive overview

Depressive disorders are disabling conditions that account for high social costs. Pilates demonstrated to have several beneficial effects on health. Objective of this manuscript was to systematically review the literature about the effects of Pilates on depressive disorders. A bibliographic search was conducted in the main database sources (Pubmed, Medline, and Scopus). The inclusion criteria consisted of articles written in English language about the effectiveness of Pilates on depressive symptoms. Most of included studies are randomized controlled trials (10 out of 12). The available literature agrees in indicating that Pilates is effective in improving depressive symptoms especially when compared to inactivity and when this practice is administered for a medium-long period (8-16 weeks). In addition, Pilates seems to have at least comparable effectiveness than aerobic exercise. Pilates can be considered a reliable complementary treatment for people with depressive disorders. These findings should be interpreted considering the different types of practice administered as well as the different duration of the programs or rating scales used to assess mood symptoms. Studies with a more homogenous design are needed to confirm and make generalizable the results presented in this review.

A mediation analysis of the role of total free fatty acids on pertinence of gut microbiota composition and cognitive function in late life depression

BACKGROUND

Extensive evidence demonstrates correlations among gut microbiota, lipid metabolism and cognitive function. However, there is still a lack of researches in the field of late-life depression (LLD). This research targeted at investigating the relationship among gut microbiota, lipid metabolism indexes, such as total free fatty acids (FFAs), and cognitive functions in LLD.

METHODS

Twenty-nine LLD patients from the Cognitive Outcome Cohort Study of Depression in Elderly were included. Cognitive functions were estimated through the Chinese version of Montreal Cognitive Assessment (MoCA). Blood samples were collected to evaluate serum lipid metabolism parameters. Fecal samples were evaluated for gut microbiota determination via 16S rRNA sequencing. Spearman correlation, linear regression and mediation analysis were utilized to explore relationship among gut microbiota, lipid metabolism and cognitive function in LLD patients.

RESULTS

Spearman correlation analysis revealed significant correlations among Akkermansia abundance, total Free Fatty Acids (FFAs) and MoCA scores (P < 0.05). Multiple regression indicated Akkermansia and total FFAs significantly predicted MoCA scores (P < 0.05). Mediation analysis demonstrated that the correlation between decreased Akkermansia relative abundance and cognitive decline in LLD patients was partially mediated by total FFAs (Bootstrap 95%CI: 0.023-0.557), accounting for 43.0% of the relative effect.

CONCLUSION

These findings suggested a significant relationship between cognitive functions in LLD and Akkermansia, as well as total FFAs. Total FFAs partially mediated the relationship between Akkermansia and cognitive functions. These results contributed to understanding the gut microbial-host lipid metabolism axis in the cognitive function of LLD.

Depression screening tool accuracy individual participant data meta-analyses: data contribution was associated with multiple factors

OBJECTIVES

To examine the proportion of eligible primary studies that contributed data, study characteristics associated with data contribution, and reasons for noncontribution using diagnostic test accuracy Individual Participant Data Meta-Analysis (IPDMA) data sets from the DEPRESsion Screening Data project.

STUDY DESIGN AND SETTING

We reviewed data set contributions from four IPDMAs. A multivariable logistic regression model was fitted to evaluate study factors associated with data contribution.

RESULTS

Of 456 eligible studies from four included IPDMAs, 295 (65%) contributed data. More recent year of publication and higher journal impact factor were associated with greater odds of data contribution. Studies conducted in Europe (excluding the United Kingdom), Oceania, Canada, the Middle East, Africa, and Central or South America (reference = the United States), that have recruitment from inpatient care or nonmedical settings (reference = outpatient), that reported screening accuracy results, or that drew negative conclusions (reference = positive conclusions) were more likely to contribute data. Studies of the Geriatric Depression Scale (reference = the Patient Health Questionnaire) or lacking funding information were negatively associated with data contribution. Over 80% of noncontributions were due to authors being unreachable or data being unavailable.

CONCLUSION

The study identified factors associated with data contribution that may support future research to promote data contribution to IPDMAs.

Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score

(1) Background: Elders have higher rates of rehospitalization, especially those with functional decline. We aimed to investigate potential predictors of 30-day readmission risk by comprehensive geriatric assessment (CGA) in hospitalized patients aged 65 years or older and to examine the predictive ability of the LACE index and HOSPITAL score in older patients with a combination of malnutrition and physical dysfunction. (2) Methods: We included patients admitted to a geriatric ward in a tertiary hospital from July 2012 to August 2018. CGA components including cognitive, functional, nutritional, and social parameters were assessed at admission and recorded, as well as clinical information. The association factors with 30-day hospital readmission were analyzed by multivariate logistic regression analysis. The predictive ability of the LACE and HOSPITAL score was assessed using receiver operator characteristic curve analysis. (3) Results: During the study period, 1509 patients admitted to a ward were recorded. Of these patients, 233 (15.4%) were readmitted within 30 days. Those who were readmitted presented with higher comorbidity numbers and poorer performance of CGA, including gait ability, activities of daily living (ADL), and nutritional status. Multivariate regression analysis showed that male gender and moderately impaired gait ability were independently correlated with 30-day hospital readmissions, while other components such as functional impairment (as ADL) and nutritional status were not associated with 30-day rehospitalization. The receiver operating characteristics for the LACE index and HOSPITAL score showed that both predicting scores performed poorly at predicting 30-day hospital readmission (C-statistic = 0.59) and did not perform better in any of the subgroups. (4) Conclusions: Our study showed that only some components of CGA, mobile disability, and gender were independently associated with increased risk of readmission. However, the LACE index and HOSPITAL score had a poor discriminating ability for predicting 30-day hospitalization in all and subgroup patients. Further identifiers are required to better estimate the 30-day readmission rates in this patient population.

Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study

Background and Objectives

Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents.

Research Design and Methods

We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement.

Results

The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories.

Discussion and Implications

Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.

The Association Between Loneliness and Psychiatric Symptomatology in Older Psychiatric Outpatients

PURPOSE

Loneliness in adults increases with age. Although loneliness has been found to be associated with psychiatric disorders and dementia, no information is available on prevalence of loneliness in older psychiatric patients. The aims of this study were to examine prevalence of loneliness in older psychiatric outpatients, including gender differences and associations with psychiatric disorders and social isolation.

METHODS

Cross-sectional study in an outpatient clinic for geriatric psychiatry between September 2013 and February 2018. Interviews were done in 181 patients.

RESULTS

80% of participants were lonely. Loneliness was associated with having contacts in less social network domains, in women but not in men. There were no associations with DSM-IV-TR-classifications. However, loneliness was associated with higher scores on questionnaires for depression and cognitive function. Intensity of treatment did not differ significantly between lonely and non-lonely participants.

CONCLUSION

Loneliness is highly prevalent in older psychiatric outpatients, with men and women equally affected. Loneliness should be assessed in all older psychiatric patients, especially when they show high scores on symptom checklists or have a restricted social network.

Preliminary report of Iranian Registry of Alzheimer's disease in Tehran province: A cross‐sectional study in Iran

Background and Aims

Alzheimer's disease (AD) is the main cause of dementia and over the 55 million people live with dementia worldwide. We aimed to establish the first database called the Iranian Alzheimer's Disease Registry to create a powerful source for future research in the country. In this report, the design and early results of the Iranian Alzheimer's Disease Registry will be described.

Methods

We performed this multicenter investigation and patients' data including age, sex, educational level, disease status, Mini‐Mental State Examination (MMSE), and Geriatric Depression Scale (GDS) from 2018 to 2021 were collected, registered, and analyzed by GraphPad Prism software.

Results

Totally 200 AD patients were registered in our database. 107 (54%) were women and age of 147 (74%) were over 65. The mean age for men and women was 76.20 ± 8.29 and 76.40 ± 8.83 years, respectively. 132 (66%) were married and 64 (32%) were illiterate. Also, 94 (47%) were in the moderate stage of disease, and 150 (75%) lived at home together with their families. The most frequent neurological comorbidity was psychosis (n = 72, 36%), while hypertension was the most common non‐neurological comorbidity (n = 104, 52%). The GDS score of women in the mild stage (5.23 ± 2.9 vs. 6.9 ± 2.6, p = 0.005) and moderate stage (5.36 ± 2.4 vs. 8.21 ± 2.06, p = <0.001) of the disease was significantly greater than men. In univariate analysis, MMSC score was remarkably associated with stroke (β = −2.25, p = 0.03), psychosis (β = −2.18, p = 0.009), diabetes (β = 3.6, p = <0.001), and hypercholesteremia (β = 1.67, p = 0.05). Also, the MMSE score showed a notable relationship with stroke (β = −2.13, p = 0.05) and diabetes (β = 3.26, p = <0.001) in multivariate analysis.

Conclusion

Iranian Alzheimer's Disease Registry can provide epidemiological and clinical data to use for purposes such as enhancing the current AD management in clinical centers, filling the gaps in preventative care, and establishing effective monitoring and cure for the disease.

Validation and Comparison of Three Short Depression Screening Tools Among Chinese Community-Dwelling Older Adults

The current study validated and compared three short Geriatric Depression Scales (GDS), including the GDS-5, D'Ath GDS-4, and van Marwijk GDS-4, among 917 Chinese community-dwelling older adults. The GDS-5, D'Ath GDS-4, and van Marwijk GDS-4 presented satisfactory accuracy against the GDS-15 (area under the curve [AUC] = 0.872 to 0.952), and the GDS-5 and D'Ath GDS-4 had better accuracy than the van Marwijk GDS-4. Satisfactory accuracy (AUC = 0.842 to 0.979) for the three scales was also observed across subgroups by age, sex, education, cognitive function, and multimorbidity. The GDS-5 but not D'Ath GDS-4 and van Marwijk GDS-4 retained a 2-point optimal cutoff for depressive symptoms across subgroups. The GDS-5 (average inter-item correlation coefficient [AIIC] = 0.233) and the D'Ath GDS-4 (AIIC = 0.171) but not van Marwijk GDS-4 (AIIC = 0.128) had acceptable internal consistency. Three scales had stable test-retest reliability within a 1- to 2-week interval (intraclass correlation coefficient = 0.670 to 0.885). The GDS-5 is an accurate and reliable depression screening tool with an invariable optimal cutoff among Chinese community-dwelling older adults. The variable optimal cutoffs for the D'Ath GDS-4 and van Marwijk GDS-4 across subgroups may limit their applicability in this population. [Research in Gerontological Nursing, xx(x), xx-xx.].

Association between physical exercise, executive function, and cerebellar cortex: A cross-sectional study among the elderly in Chinese communities

Background

Previous studies have confirmed that physical exercise may be beneficial for brain health, but there is little data on this among older Chinese.

Objective

The purpose of this study was to explore the relationship between physical exercise and cognitive impairment, and to explore the possible mechanism by which physical exercise prevents cognitive decline.

Materials and methods

192 older adults with dementia, 610 older adults with mild cognitive impairment (MCI), and 2,218 healthy older adults were included in the study. Through standardized questionnaires, we obtained their general demographic information (such as gender, age, education, etc.), disease-related information (hypertension and diabetes) and physical exercise information (such as whether they did physical exercise and the frequency of physical exercise, etc.). The mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess their overall cognitive function, while the Wechsler block diagram was used to assess their executive function. Moreover, 164 healthy, randomly selected older adults also underwent brain MRI scans at the same time, and the target brain regions included hippocampus, gray matter, and cerebellar cortex.

Results

By using stepwise multiple logistics regression analysis, we found that physical exercise was associated with both MCI (p = 0.001*, OR = 0.689, 95%CI: 0.553–0.859) and dementia (p < 0.001*, OR = 0.501, 95%CI: 0.354–0.709), independent of gender, age, education, and other factors. The results of ROC curve showed that the area under the curve of physical exercise in predicting MCI and dementia was 0.551 (p < 0.001*, 95%CI: 0.525–0.577) and 0.628 (p = 0.001*, 95%CI: 0.585–0.671), respectively. The results of partial correlation analysis showed that physical exercise was associated with left cerebellar cortex (r = 0.163, p = 0.023), right cerebellar cortex (r = 0.175, p = 0.015) and Wechsler block diagram score (r = 0.235, p = 0.011). Moreover, the results of linear regression analysis mediation model showed that physical exercise may affect Wechsler block diagram score through influencing the thickness of right cerebellum cortex, and the latter may play a partial mediation effect (indirect B = 0.001, p = 0.045).

Conclusion

Physical exercise might be a protective factor for mild cognitive impairment and dementia among the Chinese elderly, and there might be an association among physical exercise, executive function, and the thickness of the cerebellar cortex.

Development and validation of a risk model for cognitive impairment in the older Chinese inpatients: An analysis based on a 5-year database

Early diagnosis of cognitive impairment is important but difficult. Prediction models may work as an efficient way to identify high risk individuals for this disease. This study aimed to develop a simple and convenient model to identify high-risk individuals of cognitive impairment in the older Chinese inpatients. We enrolled 1300 inpatients aged 60 years or above from the department of geriatrics of the First Affiliated Hospital of Chongqing Medical University during 2013 to 2017. The model for cognitive impairment was established in the developing cohort of 1100 participants and tested in another validating cohort of 200 participants. Logistic regression analyses were used to identify the candidate variables of cognitive impairment. Receiver operating curve was adopted to validate the model. Logistic regression analyses showed that increasing age, diabetes, depression and low educational level were independently associated with cognitive impairment. The model was generated in the following way: P_model = e^y/(1 + e^y), where y = -6.874 + 0.088 * age + 0.317 * diabetes + 0.647 * depression + 0.345 * education level. The value of P_model indicates the probability of cognitive impairment for each patient. The present model proved to be a reliable marker for identifying people at high risk of cognitive impairment (area under curve = 0.790, 95% CI = 0.728-0.852, p < 0.001). It had a high sensitivity (86.2%) but a relatively low specificity (59.4%). It may be helpful to "recognize" those at high risk of cognitive impairment rather than "rule out" those at low risk of this disease.

Predicted Cognitive Conversion in Guiding Early Decision-Tailoring on Patients With Cognitive Impairment

Background

Cognitive decline is the most dominant and patient-oriented symptom during the development of Alzheimer’s disease (AD) and mild cognitive impairment (MCI). This study was designed to test the feasibility of hybrid convolutional neural networks and long-short-term memory (CNN-LSTM) modeling driven early decision-tailoring with the predicted long-term cognitive conversion in AD and MCI.

Methods

Characteristics of patients with AD or MCI covering demographic features, clinical features, and time-dependent neuropsychological-related features were fused into the hybrid CNN-LSTM modeling to predict cognitive conversion based on a 4-point change in the AD assessment scale-cognition score. Treatment reassignment rates were estimated based on the actual and predicted cognitive conversion at 3 and 6 months according to the prespecified principle; that is if the ADAS-cog score of the patient declines less than 4 points or increases at either follow-up time point, the medical treatment recommended upon their diagnosis would be considered insufficient. Therefore, it is recommended to upgrade the medical treatment upon diagnosis. Actual and predicted treatment reassignment rates were compared in the general population and subpopulations categorized by age, gender, symptom severity, and the intervention subtypes.

Results

A total of 224 patients were included in the analysis. The hybrid CNN-LSTM model achieved the mean AUC of 0.735 (95% CI: 0.701–0.769) at 3 months and 0.853 (95% CI: 0.814–0.892) at 6 months in predicting cognitive conversion status. The AUC at 6 months was significantly impacted when data collected at 3 months were withdrawn. The predicted cognitive conversion suggested a revision of medical treatment in 46.43% (104/224) of patients at 3 months and 54.02% (121/224) at 6 months as compared with 62.05% (139/224) at 3 months (p = 0.001) and 62.50% (140/224) at 6 months (p = 0.069) according to their actual cognitive conversion. No significant differences were detected between treatment reassignment rates estimated based on actual and predicted cognitive conversion in all directions at 6 months.

Conclusion

Using the synergistic advances of deep learning modeling and featured longitudinal information, our hypothesis was preliminarily verified with the comparable predictive performance in cognitive conversion. Results provided the possibility of reassigned recommended treatment for those who may suffer from cognitive decline in the future. Considering the limited diversity of treatment strategies applied in this study, the real-world medical situation should be further simulated.

The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy

The prevalence of late-life depression (LLD) depends on the study sample, measurements, and diagnostic approaches. We estimated the 30 item-Geriatric Depression Scale (GDS-30) accuracy against the gold standard LLD diagnosis made with the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, focusing on the prevalence of a late-life major depressive disorder (MDD), in a population-based sample of 843 subjects aged>65 years, subdivided into three groups: normal cognition, subjective memory complaints, and mild cognitive impairment. At the optimal cut-off score (≥4), the GDS-30 showed 65.1% sensitivity and 68.4% specificity for LLD (63% and 66% for late-life MDD, respectively). Using the standard cut-off score (≥10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, indicating a lower screening accuracy [area under the curve(AUC):0.728, 95% confidence interval(CI):0.67-0-78]. The GDS-30 performance was associated with educational level, but not with age, gender, cognition, apathy, and somatic/psychiatric multimorbidity. For subjective memory complaints subjects, at the optimal cut-off score (≥7), the GDS-30 showed better discrimination performances (AUC=0.792,95%CI:0.60-0.98), but again the educational level affected the diagnostic performance. In subjective memory complaints subjects, symptom-based scales like the GDS-30 may feature a better performance for diagnosing depression in older age, but the GDS-30 seems to require adjustment to the patient's educational level.

Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial

BACKGROUND

Maintaining independence in older age is an important aspect of quality of life. We investigated depressive symptoms as an important modifiable risk factor that may mediate the effects of physical and cognitive decline on disability.

METHODS

We prospectively analyzed data from 223 adults (age 50-85; 117 controls and 106 with type-2 diabetes) over 48 weeks who were participating in a clinical trial "Memory Advancement by Intranasal Insulin in Type 2 Diabetes." Data from self-reported disability (World Health Organization Disability Assessment Schedule) and depressive symptoms (Geriatric Depression Scale) were obtained from baseline, week 25, and week 48 visits. Cognition (Mini-mental status examination) and medical comorbidities (Charlson Comorbidity Index) were assessed at baseline. Longitudinal analysis assessed the extent to which change in depressive symptoms predicted worsening disability. Mediation analyses were performed to determine the extent to which depressive symptoms accounted for disability associated with worse cognition, walking speed, and comorbidities.

RESULTS

At baseline, depressive symptoms, cognition, and walking speed were within normal limits, but participants had a high 10-year risk of cardiovascular mortality. Depressive symptoms were related to disability at baseline (p<0.001), and longitudinally (p<0.001). Cognition, walking speed, and comorbidities were associated with disability at baseline (p-values = 0.027-0.001). Depressive symptoms had a large mediating effect on disability longitudinally: the indirect effect on disability via depression accounts for 51% of the effect of cognition, 34% of the effect of mobility, and 24% of the effect of comorbidities.

CONCLUSIONS

Depressive symptoms substantially exacerbated the effects of worsening cognition, gait speed, and comorbidities on disability. In our sample, most individuals scored within the "normal" range of the Geriatric Depression Scale, suggesting that even subclinical symptoms can lead to disability. Treating subclinical depression, which may be under-recognized in older adults, should be a public health priority to help preserve independence with aging.

Expressive suppression and rumination mediate the relationship between frailty and depression among older medical inpatients

OBJECTIVE

Frailty is common among older medical inpatients and has been found to be an independent risk factor for depression. However, few studies have explored the underlying mechanisms of the frailty-depression relationship. The present study was aimed to examine emotional regulation strategies as mediators in the frailty-depression relationship based on the process model of emotional regulation.

METHODS

Older medical inpatients (N=684) completed questionnaires and tests on frailty, emotional regulation strategies, and depressive symptoms.

RESULTS

Structural equation models showed that expressive suppression and rumination, but not cognitive reappraisal, mediated the relationship between frailty and depressive symptoms (RMSEA = 0.059, CFI = 0.963, TLI = 0.957).

CONCLUSIONS

Frail older medical inpatients habitually use expressive suppression and rumination in their daily lives, which may lead to more psychological disturbance. Interventions targeting expressive suppression and rumination might be effective in reducing the detrimental effect of frailty on psychological well-being among older medical inpatients.

Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study

Background

To examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status.

Methods

A cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models.

Results

The mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty).

Conclusions

In particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.

Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers

Objective: Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sports are commonly reported among military service members. However, the clinical implications of remote TBI and RHI in veterans remains a challenge when evaluating older veterans at risk of neurodegenerative conditions including Alzheimer's disease (AD) and Chronic Traumatic Encephalopathy (CTE). This study aimed to test the hypothesis that veterans in a memory disorders clinic with remote head injury would be more likely to have neurodegenerative clinical diagnoses, increased rates of amyloid PET positivity, higher prevalence of cavum septum pellucidi/vergae, and alterations in event-related potential (ERP) middle latency auditory evoked potentials (MLAEPs) and long latency ERP responses compared to those without head injuries. Methods: Older veterans aged 50-100 were recruited from a memory disorders clinic at VA Boston Healthcare system with a history of head injury (n = 72) and without head injury history (n = 52). Patients were classified as reporting prior head injury including TBI and/or RHI exposure based on self-report and chart review. Participants underwent MRI to determine presence/absence of cavum and an ERP auditory oddball protocol. Results: The head injury group was equally likely to have a positive amyloid PET compared to the non-head injury group. Additionally, the head injury group were less likely to have a diagnosis of a neurodegenerative condition than those without head injury. P200 target amplitude and MLAEP amplitudes for standard and target tones were decreased in the head injury group compared to the non-head injury group while P3b amplitude did not differ. Conclusions: Veterans with reported remote head injury evaluated in a memory disorders clinic were not more likely to have a neurodegenerative diagnosis or imaging markers of neurodegeneration than those without head injury. Decreased P200 target and MLAEP target and standard tone amplitudes in the head injury group may be relevant as potential diagnostic markers of remote head injury.

"Age-Related Positivity Effect" in the Relationship Between Pain and Depression Among Chinese Community-Dwelling Older Adults: Sex Differences

PURPOSE

To examine the "age-related positivity effect" and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults.

DESIGN

Cross-sectional design.

METHODS

The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates.

RESULTS

The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an "age-related positivity effect." And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women.

CONCLUSIONS

The study suggests that all older women and "young-old" men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.

Short versions of the Geriatric Depression Scale (GDS) among widowed older people in Taiwan: Comparing their psychometric properties

OBJECTIVE

To compare the psychometric properties of different short versions of the Geriatric Depression Scale (GDS) among community-dwelling widowed older people.

METHODS

A cross-sectional design was conducted between February 2018 and August 2019 in southern Taiwan (n = 330). The GDS short versions included Hoyl et al's 5-item version, Molloy et al's 5-item version and van Marwijk et al's 4-item version.

RESULTS

All GDS short versions had satisfactory internal consistency (α = 0.83-0.90), with strong item loading embedded in the same construct of depression (0.43-0.72). The activity of daily living (ADL) scores had strong associations with van Marwijk et al's 4-item version (absolute standardised coefficient [|β|] = 0.15-0.59), Hoyl et al's 5-item version (|β| = 0.16-0.45) and Molloy et al's 4-item version (|β| = 0.09-0.40).

CONCLUSIONS

Hoyl et al's 5-item version was found to be more suitable than the other two versions of the GDS to assess the precise construct of depression. Meanwhile, van Marwijk et al's 4-item version can be used when the focus is on ADL performance. However, the conclusion should be interpreted with caution since the results were derived only from a widowed population in Taiwan. More research on this topic among other populations is thus needed to corroborate our conclusion.

Dietary patterns and intrinsic capacity among community-dwelling older adults: a 3-year prospective cohort study

PURPOSE

The WHO has proposed a novel model of healthy aging called intrinsic capacity (IC). However, the association between dietary patterns and IC is unclear. We aimed to investigate the prospective associations between dietary patterns and IC trajectories over a 3-year period in community-dwelling Japanese adults aged ≥ 60 years.

METHODS

A prospective cohort study which contained nutritional status, mental status, and physical function was used. A validated 34-item food frequency questionnaire was used to determine dietary intake and to derive five dietary patterns ("fruits and vegetables", "sugar and fat", "salt and pickles", "noodle and alcohol", and "protein-rich") using principal component analysis. The composite IC score was calculated as the mean of the locomotion Z-score, cognition Z-score, psychological Z-score, vitality Z-score, and sensory regression score. A generalized estimating equation was applied for longitudinal analysis.

RESULTS

A total of 666 enrollees were included in the analysis. The mean baseline IC was 0.07 ± 0.47. The "fruits and vegetables" dietary pattern was positively associated with composite IC score changes after adjusting for confounders (Q4 vs. Q1: mean difference [0.069], P = 0.019). Similarly, a positive correlation was observed for the "protein-rich" dietary pattern with the composite IC score changes (Q4 vs. Q1: mean difference [0.092], Q3 vs. Q1: mean difference [0.101], Q2 vs. Q1: mean difference [0.083]; all P < 0.01). However, adherence to the "sugar and fat" dietary pattern was negatively associated with composite IC score changes (Q4 vs. Q1: mean difference [- 0.072], P = 0.026). Furthermore, the percentage of animal protein to total protein intake showed a significant incremental trend in the "protein-rich" dietary pattern (P for trend < 0.001).

CONCLUSION

The "fruits and vegetables" and "protein-rich" (animal-based protein in particular) dietary patterns were positively associated with IC changes, whereas the "sugar and fat" dietary pattern was negatively associated with IC changes. Identification and promotion of healthy dietary patterns in older adults may inform future health policies and research.

Functional disability mediates the relationship between pain and depression among community-dwelling older adults: Age and sex as moderators

OBJECTIVE

To examine the moderating effects of age and sex in the role of functional disability as a mediator between pain and depression.

METHODS

Participants were 1917 community-dwelling older adults from Jinan, China. Data were collected on pain intensity, functional disability in activities of daily living and instrumental activities of daily living, depressive symptoms and covariates.

RESULTS

Functional disability partially mediated the relationship between pain intensity and depressive symptoms (estimate = 0.015, SE = 0.007, 95% CI [0.004, 0.030]). Age and sex moderated both the direct and indirect effect of the mediation model. The mediating effect of functional disability was significant in the old-old men, young-old men, and young-old women, but not in the old-old women.

CONCLUSIONS

Interventions should target both pain and pain-related functional disability to improve their emotional well-being among community-dwelling older adults. Importantly, strategies should be tailored across different age and sex groups to improve their effectiveness.

A 3-year prospective cohort study of dietary patterns and frailty risk among community-dwelling older adults

BACKGROUND & AIMS

The association between dietary patterns and frailty is less investigated in Asia. We aimed to investigate the prospective associations between dietary patterns and frailty index (FI) in community-dwelling Japanese older adults aged 60 years or older.

METHODS

A 3-year cohort collected the data on sociodemographic information, lifestyle behaviors, comorbidities, medication history, depression status, nutrition, and physical function from 2014 to 2017. Five dietary patterns including "Mediterranean-style," "sugar and fat," "salt and pickles," "noodle and alcohol," and "protein-rich" dietary patterns were identified using principal component analysis from 20 food groups obtained using a validated food frequency questionnaire. A 54-item FI was constructed on the basis of a deficit accumulation model. This project aimed to investigate the longitudinal association between dietary pattern and frailty trajectories with annual measurements over a 3-year period using a generalized estimating equation.

RESULT

After excluding 108 participants with incomplete data at baseline, 666 participants (56.5% female, 69.4 ± 4.4 years) were included for longitudinal analysis. Our results demonstrated that adherence score to "sugar and fat" dietary pattern" (Q4 vs. Q1: mean difference [0.017], 95% CI [0.006 to 0.029]) and "salt and pickles" dietary pattern (Q3 vs. Q1: mean difference [0.010], 95% CI [0.001 to 0.020]; Q4 vs. Q1: mean difference [0.014], 95% CI [0.003 to 0.025]) were positively associated with change in FI. Adherence score to a "protein-rich" dietary pattern was negatively associated with change in FI (Q4 vs. Q1: mean difference [-0.013], 95% CI [-0.025 to -0.002]).

CONCLUSIONS

"Salt and pickles" dietary pattern and "sugar and fat" dietary pattern were positively associated with frailty. In contrast, "protein-rich" dietary pattern was negatively associated with frailty.

Diagnostic Accuracy of the SLU AMSAD Scale for Depression in Older Adults Without Dementia

OBJECTIVES

To evaluate the diagnostic accuracy of a short depression screening tool, the Saint Louis University (SLU) AMSAD depression scale, relative to the Geriatric Depression Scale-15 (GDS-15) and Montgomery-Asberg Depression Rating Scale (MADRS), and in relation to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for major depressive disorder, in cognitively intact older adults.

DESIGN

Cross-sectional.

SETTING

Outpatient geriatric psychiatry clinic.

PARTICIPANTS

Fifty older adults (aged ≥65 years) without dementia.

MEASUREMENTS

GDS-15, MADRS, SLU AMSAD, and DSM-5 criteria for major depressive disorder were administered.

RESULTS

Total scores (continuous variables) for the GDS-15, MADRS, and SLU AMSAD correlated significantly with the DMS-5 criteria for major depressive disorder (MDD) [area under the curve (AUC) ≥ 0.93, sensitivity = 0.93, and specificity ≥ 0.80]. Optimal cutoffs were 9+ for GDS-15, 18+ for MADRS, and 7+ for SLU AMSAD. When score results were categorized according to their known cutoffs for mild, moderate, and severe depression, AUC values were again high (range = 0.82-0.89), with adequate levels of sensitivity (0.87-0.93) and specificity (0.71-0.86), distinguishing no or mild depression from moderate or severe depression in relation to the DSM-5 diagnostic criteria for MDD.

CONCLUSIONS AND IMPLICATIONS

Strong diagnostic accuracy was shown for the 3 scales. The SLU AMSAD performed as well as the GDS-15 and slightly better than the MADRS. The superiority of the SLU AMSAD is supported by the fact that it encompasses only 5 simply worded, simply scaled items to be used in busy clinical settings.