Symptoms of anxiety and depression in the course of cognitive decline

Sustained Preservation of Cognition and Prevention of Patient-Reported Symptoms With Hippocampal Avoidance During Whole-Brain Radiation Therapy for Brain Metastases: Final Results of NRG Oncology CC001

PURPOSE

Initial report of NRG Oncology CC001, a phase 3 trial of whole-brain radiation therapy plus memantine (WBRT + memantine) with or without hippocampal avoidance (HA), demonstrated neuroprotective effects of HA with a median follow-up of fewer than 8 months. Herein, we report the final results with complete cognition, patient-reported outcomes, and longer-term follow-up exceeding 1 year.

METHODS AND MATERIALS

Adult patients with brain metastases were randomized to HA-WBRT + memantine or WBRT + memantine. The primary endpoint was time to cognitive function failure, defined as decline using the reliable change index on the Hopkins Verbal Learning Test-Revised (HVLT-R), Controlled Oral Word Association, or the Trail Making Tests (TMT) A and B. Patient-reported symptom burden was assessed using the MD Anderson Symptom Inventory with Brain Tumor Module and EQ-5D-5L.

RESULTS

Between July 2015 and March 2018, 518 patients were randomized. The median follow-up for living patients was 12.1 months. The addition of HA to WBRT + memantine prevented cognitive failure (adjusted hazard ratio, 0.74, P = .016) and was associated with less deterioration in TMT-B at 4 months (P = .012) and HVLT-R recognition at 4 (P = .055) and 6 months (P = .011). Longitudinal modeling of imputed data showed better preservation of all HVLT-R domains (P < .005). Patients who received HA-WBRT + Memantine reported less symptom burden at 6 (P < .001 using imputed data) and 12 months (P = .026 using complete-case data; P < .001 using imputed data), less symptom interference at 6 (P = .003 using complete-case data; P = .0016 using imputed data) and 12 months (P = .0027 using complete-case data; P = .0014 using imputed data), and fewer cognitive symptoms over time (P = .043 using imputed data). Treatment arms did not differ significantly in overall survival, intracranial progression-free survival, or toxicity.

CONCLUSIONS

With median follow-up exceeding 1 year, HA during WBRT + memantine for brain metastases leads to sustained preservation of cognitive function and continued prevention of patient-reported neurologic symptoms, symptom interference, and cognitive symptoms with no difference in survival or toxicity.

Functional role of frontal electroencephalogram alpha asymmetry in the resting state in patients with depression: A review

Depression is a psychological disorder that affects the general public worldwide. It is particularly important to make an objective and accurate diagnosis of depression, and the measurement methods of brain activity have gradually received increasing attention. Resting electroencephalogram (EEG) alpha asymmetry in patients with depression shows changes in activation of the alpha frequency band of the left and right frontal cortices. In this paper, we review the findings of the relationship between frontal EEG alpha asymmetry in the resting state and depression. Based on worldwide studies, we found the following: (1) Compared with individuals without depression, those with depression showed greater right frontal EEG alpha asymmetry in the resting state. However, the pattern of frontal EEG alpha asymmetry in the resting state in depressive individuals seemed to disappear with age; (2) Compared with individuals without maternal depression, those with maternal depression showed greater right frontal EEG alpha asymmetry in the resting state, which indicated that genetic or experience-based influences have an impact on frontal EEG alpha asymmetry at rest; and (3) Frontal EEG alpha asymmetry in the resting state was stable, and little or no change occurred after antidepressant treatment. Finally, we concluded that the contrasting results may be due to differences in methodology, clinical characteristics, and participant characteristics.

James A, Dupuis K, Cohen D. Developing a music-based digital therapeutic to help manage the neuropsychiatric symptoms of dementia

The greying of the world is leading to a rapid acceleration in both the healthcare costs and caregiver burden that are associated with dementia. There is an urgent need to develop new, easily scalable modalities of support. This perspective paper presents the theoretical background, rationale, and development plans for a music-based digital therapeutic to manage the neuropsychiatric symptoms of dementia, particularly agitation and anxiety. We begin by presenting the findings of a survey we conducted with key opinion leaders. The findings highlight the value of a music-based digital therapeutic for treating neuropsychiatric symptoms, particularly agitation and anxiety. We then consider the neural substrates of these neuropsychiatric symptoms before going on to evaluate randomized control trials on the efficacy of music-based interventions in their treatment. Finally, we present our development plans for the adaptation of an existing music-based digital therapeutic that was previously shown to be efficacious in the treatment of adult anxiety symptoms.

Emotional and Affective Disorders in Cognitive Aging

The increased aging population who have aging-related diseases poses a serious challenge to health services, including mental health services. Due to the changes of body, brain, living environment, and lifestyle, the elderly will have different psychological changes from other age stages, some of which would develop into mental disorders, and affect the cognition of the elderly in turn. This elderly mental health condition has drawn wide attention from scientists. This chapter introduces the two most common emotional and affective disorders, late-life depression and anxiety, and focuses on their epidemiology and impact on the elderly. Furthermore, this chapter also reviews the effects of these two disorders on cognitive function and cognitive impairment in the elderly, and tries to explain the underlying mechanism of this effect from the perspective of related disease, cerebral circuit, and molecular biology.

S-Glutathionylation and S-Nitrosylation in Mitochondria: Focus on Homeostasis and Neurodegenerative Diseases

Redox post-translational modifications are derived from fluctuations in the redox potential and modulate protein function, localization, activity and structure. Amongst the oxidative reversible modifications, the S-glutathionylation of proteins was the first to be characterized as a post-translational modification, which primarily protects proteins from irreversible oxidation. However, a growing body of evidence suggests that S-glutathionylation plays a key role in core cell processes, particularly in mitochondria, which are the main source of reactive oxygen species. S-nitrosylation, another post-translational modification, was identified >150 years ago, but it was re-introduced as a prototype cell-signaling mechanism only recently, one that tightly regulates core processes within the cell’s sub-compartments, especially in mitochondria. S-glutathionylation and S-nitrosylation are modulated by fluctuations in reactive oxygen and nitrogen species and, in turn, orchestrate mitochondrial bioenergetics machinery, morphology, nutrients metabolism and apoptosis. In many neurodegenerative disorders, mitochondria dysfunction and oxidative/nitrosative stresses trigger or exacerbate their pathologies. Despite the substantial amount of research for most of these disorders, there are no successful treatments, while antioxidant supplementation failed in the majority of clinical trials. Herein, we discuss how S-glutathionylation and S-nitrosylation interfere in mitochondrial homeostasis and how the deregulation of these modifications is associated with Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis and Friedreich’s ataxia.

Trajectories analysis of comorbid depression and anxiety among Israeli veterans: The implications on cognitive performance

BACKGROUND

Among war veterans, research has indicated high rates of depression, anxiety, and comorbidity of these disorders, with even higher rates among prisoners-of-war. However, little is known about the longitudinal effects of comorbidity profiles on cognitive performance, particularly in the case of aging war veterans.

METHOD

This longitudinal study focuses on Israeli veterans from the 1973 Yom Kippur War, with assessments at four time-points: 1991 (T1), 2003 (T2), 2008 (T3), and 2015 (T4). Two groups were included: veterans who were held captive (ex-POWs; n = 196), and veterans who were not (war veterans; n = 159). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA).

RESULTS

Three distinct profiles of comorbidity were identified: resiliency (57.5%, n = 204); delayed-onset (29.6%, n = 105), and chronic (13.00%, n = 46). The chronic profile identified mostly among ex-POW (91.3%, n = 42), veterans with lower education at T1, and with more cognitively impaired compared to the other profiles (p < .0001). No differences were found between the profiles in age and family status at T1.

CONCLUSIONS

The findings highlight the importance of viewing aging veterans as a high-risk population for cognitive impairments, particularly those suffering from chronic comorbidity of depression and anxiety. Therefore, the appropriate diagnosis and cognitive treatment are required to preserve cognitive abilities and prevent decline.

Efficacy of ICT-based interventions in improving psychological outcomes among older adults with MCI and dementia: A systematic review and meta-analysis

The purpose of this systematic review and meta-analysis was to investigate empirical evidence about the effectiveness of Information and Communication Technology-based interventions (ICTs) on different psychological outcomes in adults aged over 60 years with Mild Cognitive Impairment (MCI) or dementia. We conducted a systematic search on Pubmed, Web of Science, Scopus, and PsycInfo with publication year between January 2010 up to April 2021. Any pre-post quantitative intervention study with at least one of the following domains examined: quality of life (QoL), psychological well-being, social interaction, engagement, mood, anxiety, stress, loneliness, self-efficacy, or self-esteem was included. The risk of bias and quality of evidence were assessed using tools based on the Cochrane Handbook for Systematic Review of Interventions criteria. Forty-eight studies with a total of 1488 participants met the selection criteria. Because of the high heterogeneity, we ran nine different random effects meta-analyses divided by outcome and type of cognitive decline which indicated that these treatments were ineffective overall, with some exceptions. Only anxiety (small effect size =-0.375 [-0.609; -0.140]) and behavioral symptoms (BS) (medium effect size =-0.585 [-1.019; -0.152]) in people with dementia (PwD) were found to change significantly. Moreover, effect sizes for QoL in dementia and for mood in people with MCI became significant when moderated by type of ICT, living situation, and experimental setting. In particular, Virtual Reality (VR) appeared to be more effective than other devices for both PwD and MCI, and nursing homes were found to be the best setting for administering these treatments. The trim and fill method found no evidence of publication bias in any of the 9 analyses. However, quality of evidence within (RoB 2, RoB 2 Crossover, ROBINS) and across (GRADE assessment) studies was low, thus these findings should be interpreted with caution. In general, ICT-based intervention can be considered a promising approach for improving anxiety and BS in PwD, and for improving QoL in PwD and mood in people with MCI, specifically when VR is used, when participants live in nursing homes, and when interventions are carried out in nursing homes.¹.

Relationship among number of close friends, subclinical geriatric depression, and subjective cognitive decline based on regional homogeneity of functional magnetic resonance imaging data

The relationship between geriatric depression and dementia has been widely debated, and the neurological mechanisms underlying subjective cognitive decline (SCD) associated with social relationships remain elusive. Subclinical geriatric depression (SGD) is common in patients with SCD, and close friends (CFs) have a great influence on a person's social life. Studies have proven that communication or leisure activities with CFs can improve the cognitive performance of elderly. However, it remains unclear whether the engagement of specific brain regions mediates having CFs, SGD, and SCD. In this study, we aimed to assess the association between social relationships (that is, CFs), SGD, and SCD from the perspective of brain function. We examined the data of 66 patients with SCD and 63 normal controls (NC). Compared with NC, SGD was significantly inversely correlated with the number of CFs in the SCD group. We calculated regional homogeneity (ReHo) of functional magnetic resonance imaging (MRI) data of each subject. At a corrected threshold, the right occipital gyrus (SOG.R) and right fusiform gyrus (FFG.R) exhibited positive correlation with SGD in patients with SCD. Mediation analyses to query the inter-relationships between the neural markers and clinical variables exhibited a best fit of the model with CFs → FFG.R → SGD → SOG.R → SCD. These findings suggested a pathway whereby social relationships alter the function of specific brain regions, and SGD may be an early symptom of SCD. We observed that the FFG.R mediate social relationships and SGD, and the abnormality of the SOG.R may be a key factor in the SCD caused by depression. Moreover, a greater number of CFs may reduce the risk of developing SGD.

Negative affective burden is associated with higher resting-state functional connectivity in subjective cognitive decline

Subjective cognitive decline (SCD), as expressed by older adults, is associated with negative affect, which, in turn, is a likely risk factor for Alzheimer's Disease (AD). This study assessed the associations between negative affective burden, cognitive functioning, and functional connectivity in networks vulnerable to AD in the context of SCD. Older participants (60-90 years) with SCD (n = 51) and healthy controls (n = 50) were investigated in a cross-sectional study. Subclinical negative affective burden, quantified through a composite of self-reported negative affective factors, was related to cognitive functioning (self-perceived and objective) and functional connectivity. Seed-to-voxel analyses were carried out in default mode network (DMN) and salience network (SAL) nodes using resting-state functional magnetic resonance imaging. Greater negative affective burden was associated with lower self-perceived cognitive functioning and lower between-network functional connectivity of DMN and SAL nodes in the total sample. In addition, there was a significant moderation of SCD status. Greater negative affective burden related to higher functional connectivity within DMN (posterior cingulate-to-precuneus) and within SAL (anterior cingulate-to-insula) nodes in the SCD group, whereas in controls the inverse association was found. We show that negative affective burden is associated with functional brain alterations in older adults, regardless of SCD status. Specifically in the SCD phenotype, greater negative affective burden relates to higher functional connectivity within brain networks vulnerable to AD. Our findings imply that negative affective burden should be considered a potentially modifiable target for early intervention.

Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment

INTRODUCTION

Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment.

METHODS

Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke's Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate).

RESULTS

Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores.

CONCLUSIONS

Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.

Photobiomodulation Therapy Attenuates Anxious-Depressive-Like Behavior in the TgF344 Rat Model

BACKGROUND

Anxious-depressive-like behavior has been recognized as an early endophenotype in Alzheimer's disease (AD). Recent studies support early treatment of anxious-depressive-like behavior as a potential target to alleviate memory loss and reduce the risk of developing dementia. We hypothesize that photobiomodulation (PBM) could be an effective method to alleviate depression and anxiety at the early stage of AD pathogenesis.

OBJECTIVE

To analyze the effect of PBM treatment on anxious-depressive-like behavior at the early stage of AD.

METHODS

Using a novel transgenic AD rat model, animals were divided into wild-type, AD+sham PBM, and AD+PBM groups. Two-minute daily PBM (irradiance: 25 mW/cm2 and fluence: 3 J/cm2 at the cortical level) was applied transcranially to the brain of AD animals from 2 months of age to 10 months of age. After completing PBM treatment at 10 months of age, behavioral tests were performed to measure learning, memory, and anxious-depressive-like behavior. Neuronal apoptosis, neuronal degeneration, neuronal damage, mitochondrial function, neuroinflammation, and oxidative stress were measured to test the effects of PBM on AD animals.

RESULTS

Behavioral tests showed that: 1) no spatial memory deficits were detected in TgF344 rats at 10 months of age; 2) PBM alleviated anxious-depressive-like behavior in TgF344 rats; 3) PBM attenuated neuronal damage, degeneration, and apoptosis; and 4) PBM suppresses neuroinflammation and oxidative stress.

CONCLUSION

Our findings support our hypothesis that PBM could be an effective method to alleviate depression and anxiety during the early stage of AD development. The mechanism underlying these beneficial effects may be due to the improvement of mitochondria function and integrity and the inhibition of neuroinflammation and oxidative stress.

Administering crocin ameliorates anxiety-like behaviours and reduces the inflammatory response in amyloid-beta induced neurotoxicity in rat

Anxiety, hippocampus synaptic plasticity deficit, as well as pro-inflammatory cytokines, are involved in Alzheimer's disease (AD). The present study is designed to evaluate the possible therapeutic effect of crocin on anxiety-like behaviours, hippocampal synaptic plasticity and neuronal shape, as well as pro-inflammatory cytokines in the hippocampus using in vivo amyloid-beta (Aβ) models of AD. The Aβ peptide (1-42) was bilaterally injected into the frontal-cortex. Five hours after the surgery, the rats were given intraperitoneal (IP) crocin (30 mg/kg) daily up to 12 days. Elevated plus maze results showed that crocin treatment after bilateral Aβ injection significantly increased the percentage of spent time into open arms, frequency of entries, and percentage of entries into open arms as compared with the Aβ group. In the open field test, the Aβ+crocin group showed a higher percentage of spent time in the centre and frequency of entries into central zone as compare with the Aβ treated animals. Administering crocin increased the number of soma, dendrites and axonal arbores in the CA1 neurons among the rats with Aβ neurotoxicity. Cresyl violet (CV) staining showed that crocin increased the number of CV-positive cells in the CA1 region of the hippocampus compared with the Aβ group. Silver-nitrate staining indicated that crocin reduced neurofibrillary tangle formation induced by Aβ. Crocin treatment attenuated the expression of TNF-α and IL-1β mRNA in the hippocampus compared with the Aβ group. Our results suggest that crocin attenuated Aβ-induced anxiety-like behaviours and neuronal damage, and synaptic plasticity loss in hippocampal CA1 neurons may via its anti-inflammatory effects.

Effects of Exercise Training on Anxious-Depressive-like Behavior in Alzheimer Rat

PURPOSE

This study aimed to examine the effects of treadmill training on anxious-depressive-like behaviors of transgenic Alzheimer rats in the early stage of Alzheimer's disease (AD) and provided evidence of exercise in alleviating fear-avoidance behavior deficits.

METHODS

Male 2-month-old TgF344-AD and wild-type rats were divided into wild-type (n = 9), AD (n = 8), and AD + treadmill exercise (Exe) groups (n = 12). After 8 months of exercise, the passive avoidance test, Barnes maze task, novel object recognition test, and object location test were used to measure learning and memory function. The open-field test, elevated plus maze, sucrose preference test, and forced swim test were conducted to determine the anxious-depressive-like behavior of AD rats. Immunofluorescence staining, Western blot analysis, enzyme-linked immunosorbent assay analysis, and related assay kits were used to measure inflammatory cytokines, oxidative stress, amyloid-β production, and tau hyperphosphorylation.

RESULTS

Behavioral tests revealed that 12-month-old animals did not show any spatial learning and memory deficits but did display anxious-depressive-like behavior (open field, center time: P = 0.008; center entries: P = 0.009; line crossings: P = 0.001). However, long-term exercise significantly inhibited anxious-depressive-like behavior in AD rats (center time: P = 0.016; center entries: P = 0.004; line crossings: P = 0.033). In addition, these animals displayed increased amyloid-β deposition, tau hyperphosphorylation, microgliosis, inflammatory cytokines release, and oxidative damage, which were attenuated significantly by long-term exercise training.

CONCLUSION

Long-term exercise training alleviated anxious-depressive-like behavior and improved fear-avoidance behavior in transgenic AD rats, supporting exercise training as an effective approach to prevent anxiety, depression, and fear-avoidance behavior deficits in the early stages of AD pathogenesis.

Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

Threats to Belonging-Stressful Life Events and Mental Health Symptoms in Aging Men-A Longitudinal Cohort Study

Objectives: Stressful life events, especially relationship events, are frequent in adult life. We investigated the impact of a variety of stressful life events on symptoms of depression, anxiety, and hostility. Methods: We analyzed data from a large prospective cohort study of men (n = 1,437) in the Boston area (assessed in 1985, 1988, and 1991). Main outcomes were measures of depression, anxiety and hostility symptoms. We used the Elders Life Stress Inventory (ELSI) to measure stressful life events in the past 12 months and examine their association with symptoms of depression, anxiety and hostility. First, we analyzed the association of stressful life events with symptom changes; second, we categorized stressful life events into finance/work, health, relationships, loss, living situations events; and third, we estimated the specific association between relationship events and depression, anxiety and hostility symptoms using multilevel models. Results: The most frequent stressful life events were health, relationship, and financial events. Depression, anxiety, and hostility symptoms were relatively stable among men who did not experience these life events. However, those who reported life events in the past 12 months had a greater increase in symptoms of depression (+0.05; 95% CI: 0.01 to 0.10) and of hostility (+0.05; 95% CI: 0.01 to 0.09) than those who did not. Additionally, we found a significant decrease in hostility (-0.05; 95% CI: -0.08 to -0.01) in those experiencing no life events. Conclusion: Relationship events were more important than any other type of events, and were significantly associated with increased depression and hostility in aging men. Although the effects were small, the results point to a need to understand better the impact of relationships on psychopathology in the aging population.

Music Training Improves Depressed Mood Symptoms in Elderly People: A Randomized Controlled Trial

The effectiveness of music training on depressed mood and general cognitive function in elderly participants is verified in this study. Music activities consisted of improvisation exercises for stimulating interpersonal skills, mood, and cognitive functions. A mixed research method was adopted, including standardized measures (Mini-Mental State Examination and Geriatric Depression Scale) and follow-up semistructured interviews. The research design included pre- and postevaluation with randomized experimental and control groups. Participants were 45 care residents aged 62 to 95, healthy and with cognitive impairment. Results revealed a significant improvement in depression index (Geriatric Depression Scale) for the experimental period (t = 1.450; p < .005; d = 0.453) while the control group had no improvement (t = 0.080; p > .1; d = 0.025). In addition, a significant improvement was found in the cognitive level (Mini-Mental State Examination) for the experimental (t = 2.300; p < .005; d = 0.668) than the control group that had a significant reduction (t = 1.240; p < .05; d = 0.273). This study provides evidence that music training has a positive impact on depressed mood and general cognitive function in elderly participants. These types of music training sessions could provide aid to control the symptoms of depression, delay the deterioration of cognitive function, and enhance social-cognitive function, especially in individuals presenting with cognitive impairment.

Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia

BACKGROUND

The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia-associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy.

OBJECTIVE

This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture-verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better-known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections.

METHODS

We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre-post design. The treatment groups completed 12-week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies.

RESULTS

The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention.

CONCLUSION

Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.

Longitudinal associations between hearing loss and general cognitive ability: The Lothian Birth Cohort 1936

Hearing impairment is associated with poorer cognitive function in later life. We tested for the potential contribution of childhood cognitive ability to this relationship. Childhood cognitive ability is strongly related to cognitive function in older age, and may be related to auditory function through its association with hearing impairment risk factors. Using data from the Lothian Birth Cohort, 1936, we tested whether childhood cognitive ability predicted later-life hearing ability then whether this association was mediated by demographic or health differences. We found that childhood cognitive ability was negatively associated with hearing impairment risk at age 76 (odds ratio = .834, p = .042). However, this association was nonsignificant after subsequent adjustment for potentially mediating demographic and health factors. Next, we tested whether associations observed in older age between hearing impairment and general cognitive ability level or change were accounted for by childhood cognitive ability. At age 76, in the minimally adjusted model, hearing impairment was associated with poorer general cognitive ability level (β = -.119, p = .030) but was not related to decline in general cognitive ability. The former association became nonsignificant after additional adjustment for childhood cognitive ability (β = -.068, p = .426) suggesting that childhood cognitive ability contributes (potentially via demographic and health differences) to the association between levels of hearing and cognitive function in older age. Further work is needed to test whether early life cognitive ability also contributes to the association (documented in previous studies) between older-age hearing impairment and cognitive decline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cross-sectional and longitudinal characterization of SCD patients recruited from the community versus from a memory clinic: subjective cognitive decline, psychoaffective factors, cognitive performances, and atrophy progression over time

Background

Subjective cognitive decline (SCD) defines a heterogeneous population, part of which having Alzheimer’s disease (AD). We aimed at characterizing SCD populations according to whether or not they referred to a memory clinic, by assessing the factors associated with increased AD risk.

Methods

Seventy-eight cognitively unimpaired older adults from the IMAP+ study (Caen) were included, amongst which 28 healthy controls (HC) and 50 SCD recruited from the community (SCD-community; n = 23) or from a memory clinic (SCD-clinic; n = 27). Participants underwent cognitive, psychoaffective, structural MRI, FDG-PET, and amyloid-PET assessments. They were followed up over a mean period of 2.4 ± 0.8 years. The groups were compared in terms of baseline and follow-up levels of SCD (self- and informant-reported), cognition, subclinical anxiety and depression, and atrophy progression over time. We also investigated SCD substrates within each SCD group through the correlations between self-reported SCD and other psychometric and brain measures.

Results

Compared to HC, both SCD groups showed similar cognitive performances but higher informant-reported SCD and anxiety. Compared to SCD-community, SCD-clinic showed higher informant-reported SCD, depression score, and atrophy progression over time but similar brain amyloid load. A significant increase over time was found for depression in the SCD-community and for self-reported praxis-domestic activities SCD factor in the SCD-clinic. Higher self-reported SCD correlated with (i) lower grey matter volume and higher anxiety in SCD-community, (ii) greater informant-reported SCD in SCD-clinic, and (iii) lower glucose metabolism in both SCD groups.

Conclusions

Higher subclinical depression and informant-reported SCD specifically characterize the SCD group that refers to a memory clinic. The same group appears as a frailer population than SCD-community as they show greater atrophy progression over time. Yet, both the SCD groups were quite similar otherwise including for brain amyloid load and the SCD-community showed increased depression score over time. Altogether, our findings highlight the relevance of assessing psychoaffective factors and informant-reported SCD in SCD populations and point to both differences and similarities in SCD populations referring or not to a memory clinic.

Electronic supplementary material

The online version of this article (10.1186/s13195-019-0514-z) contains supplementary material, which is available to authorized users.

Detection of anxiety symptoms in persons with dementia: A systematic review

Introduction

Anxiety is a common symptom for those experiencing dementia and is associated with worse outcomes. The aim of the study was to examine which anxiety tools have been validated compared with a gold standard diagnostic criterion in persons with dementia.

Methods

We completed a systematic review of the literature, which was registered a priori with PROSPERO (CRD42016042123). Three databases were searched, MEDLINE, EMBASE, and PsycINFO, as well as the gray literature. Abstracts and full text were searched in duplicate for inclusion. Risk of bias was assessed in duplicate.

Results

We identified 9626 citations from all sources after duplicates were removed. Many excluded studies used tools for anxiety, for which no diagnostic accuracy study was identified. Four articles were included in the final synthesis. Included articles had between 32 to 101 participants with mild to moderate dementia. The gold standard criteria focused on either generalized anxiety or all anxiety subtypes. The prevalence of anxiety was between 27.7% and 63.4%. Three tools were examined, the Geriatric Anxiety Inventory, Penn State Worry Questionnaire, and the Rating Anxiety in Dementia (RAID) scale. Sensitivity varied but was the highest in the RAID at 90% and lowest in the self-rated version of the Geriatric Anxiety Inventory (58%).

Discussion

Given how burdensome the symptoms of anxiety are to persons with dementia, valid tools are needed to help identify symptoms. We identified three validated tools, but further validation of these and other tools are needed. Practitioners should consider the use of tools with high sensitivity such as the RAID in persons with dementia.

Aerobic exercise program with or without motor complexity as an add-on to the pharmacological treatment of depression - study protocol for a randomized controlled trial

BACKGROUND

Patients with major depression disorder presents increased rates of cognitive decline, reduced hippocampal volume, poor sleep quality, hypertension, obesity, suicidal ideation and behavior, and decreased functionality. Although continuous aerobic exercise (CAE) improves some of the aforementioned symptoms, comorbidities, and conditions, recent studies have suggested that performing aerobic exercise with motor complexity (AEMC) may be more beneficial for cognitive decline, hippocampal volume, and functionality. Therefore, this randomized controlled trial will compare the effects of CAE and AEMC on depression score, cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs in patients with depression.

METHODS/DESIGN

Seventy-five medicated patients with depression will be recruited from a Basic Healthcare Unit to participate in this prospective, parallel group, single blinded, superiority, randomized controlled trial. Patients with depression according to DSM-V criteria will be balanced and randomly assigned (based on depression scores and number of depressive episodes) to a non-exercising control (C), CAE, and AEMC groups. The CAE and AEMC groups will exercise for 60 min, twice a week for 24 weeks (on non-consecutive days). Exercise intensity will be maintained between 12 and 14 points of the rating of perceived exertion scale (~ 70-80% of the maximum heart rate). The CAE group will perform a continuous aerobic exercise while the AEMC group will perform exercises with progressively increased motor complexity. Blinded raters will assess patients before and after the intervention period. The primary outcome measure will be the change in depression score measured by the Montgomery-Asberg Depression Rating Scale. Secondary outcomes will include measures of cognitive function, hippocampal volume, brain-derived neurotrophic factor expression, sleep parameters, cardiovascular risk parameters, suicidal behavior, functionality, and treatment costs.

DISCUSSION

This study was selected in the call of public policy programs for the Brazilian Unified National Health System - "PPSUS 2015". To our knowledge, this is the first pragmatic trial to test the effect of adding AEMC to the pharmacological treatment of patients with depression and to evaluate the possible reductions in depression symptoms and healthcare costs.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry (ReBec) - RBR-9zgxzd - Registered on 4 Jan. 2017.

Gender differences in the trajectory classes of depressive symptoms in Korean older adults

OBJECTIVES

This study aimed (1) to identify gender-specific heterogeneous longitudinal patterns of depressive symptoms, (2) to explore the effects of economic status and various health conditions as risk factors in depressive symptom trajectories.

METHOD

Data came from the Korean Longitudinal Study of Aging (2006-2012) focuing on older adults aged 65 and older. Latent class growth analysis was used to identify the depressive symptom trajectory groups. Multinomial logistic regression was used to examine the association between economic and health status changes and the depresison trajectories.

RESULTS

Among older women, three change groups were identified: stable low, stable high, and moderate but slightly increasing groups. Among older men, four groups were found: stable low, moderate but rapidly increasing, high but decreasing, and moderate but slightly increasing groups. Among women, poverty experience and sustained poor health, particularly constantly low cognition, were significantly associated with the stable high group. Among men, deteriorating economic and health status were significant predictors of membership in the most vulnerable subgroup, the moderate but rapidly increasing group.

CONCLUSION

This study demonstrated among older adults, depressive symptoms change heterogeneously by gender. Identification of the most at risk subgroups among older men and women provides important initial empirical information to target clinical programs and policy development.

The Isoquinoline Alkaloid Dauricine Targets Multiple Molecular Pathways to Ameliorate Alzheimer-Like Pathological Changes In Vitro

Alzheimer's disease (AD), the most common neurodegenerative disease, has no effective treatment. Dauricine (DAU), a benzyl tetrahydroisoquinoline alkaloid isolated from the root of Menispermum dauricum DC, reportedly has neuroprotective effects in cerebral ischemia. Here, we investigated the effects of DAU on N2a cells stably transfected with Swedish mutant amyloid precursor protein (N2a/APP), an AD-like cell model. ELISA and Western blot analysis revealed that DAU inhibited APP processing and reduced Aβ accumulation. In addition, DAU ameliorated tau hyperphosphorylation via PP2A, p35/25, and CDK5 pathways in N2a/APP cells. The amelioration of tau hyperphosphorylation by DAU was also validated in HEK293/Tau cells, another cell line with tau hyperphosphorylation. Proteomic analysis revealed 85 differentially expressed proteins in the lysates between the wild-type N2a cells (N2a/WT) and the N2a/APP cells in the presence or absence of DAU; these were classified into 6 main categories according to their functions: endoplasmic reticulum (ER) stress-associated proteins, oxidative stress-associated proteins, cytoskeleton proteins, molecular chaperones, mitochondrial respiration and metabolism-related proteins, and signaling proteins. Taken together, we demonstrated that DAU treatment reduces AD-like pathology, thereby suggesting that DAU has potential therapeutic utility in AD.

Anxiety, Anxiety Symptoms, and Their Correlates in Persons with Dementia in Norwegian Nursing Homes: A Cause for Concern

BACKGROUND/AIMS

Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes.

METHODS

In all, 298 participants with dementia ≥65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models.

RESULTS

Anxiety, according to a cutoff of ≥12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores.

CONCLUSION

Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.

The effect of cognitive impairment on prosthesis use in older adults who underwent amputation due to vascular-related etiology: A systematic review of the literature

BACKGROUND

Older adults with amputations secondary to vascular etiologies may additionally present with cognitive impairment. Cognition plays an important role in the adoption of a prosthetic limb, although the degree and type of impact are debated. Previous literature reviews have not been directed at the specific population of older adults who underwent vascular-related lower limb amputation.

OBJECTIVES

First, to assess extant literature for relationships between cognitive function and prosthesis-related outcomes in older adults who underwent lower limb amputation for vascular-related etiologies. Second, to perform a critical analysis of prosthesis-related outcomes and cognitive assessments performed in the studies.

STUDY DESIGN

Systematic literature review.

METHODS

A systematic review of the literature was performed in databases using keyword combinations. A total of nine articles were selected to be included in this review.

RESULTS

Seven of the nine included studies found a relationship between decreased cognitive function and reduced performance on a prosthesis-related outcome. There were eight different prosthesis-related outcome measures, with only one study utilizing a comprehensive outcome measure.

CONCLUSION

Cognitive impairment can negatively impact successful prosthesis use in older adults with lower limb amputation secondary to vascular complications. Future studies should utilize comprehensive outcome measures that represent the multifaceted constructs of cognition and prosthesis use. Clinical relevance Cognitive assessment of older adults who have undergone lower limb amputation secondary to diabetes related complications or vascular disease can be used to inform clinical decision-making. Clinicians should consider selecting prosthesis-related outcome measures that capture the full breadth of prosthesis use when evaluating patients with cognitive impairment.

Factors underlying cognitive decline in old age and Alzheimer's disease: the role of the hippocampus

There are many factors that strongly influence the aetiology, development, and progression of cognitive decline in old age, mild cognitive impairment (MCI), and Alzheimer's disease (AD). These factors include not only different personality traits and moods but also lifestyle patterns (e.g. exercise and diet) and awareness levels that lead to cognitive decline in old age. In this review, we discuss how personality traits, mood states, and lifestyle impact brain and behaviour in older adults. Specifically, our review shows that these lifestyle and personality factors affect several brain regions, including the hippocampus, a region key for memory that is affected by cognitive decline in old age as well as AD. Accordingly, appropriate recommendations are presented in this review to assist individuals in decreasing chances of MCI, dementia, AD, and associated symptoms.

Anxious Depression and Neurocognition among Middle-Aged and Older Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Results

OBJECTIVE

The purpose of this study is to examine the association between verbal learning, fluency, and processing speed with anxious depression symptomatology (ADS) among diverse Hispanics. We hypothesized an inverse association of anxious depression with neurocognition among Hispanics of different heritage.

DESIGN

Data are from the Hispanic Community Health Study/Study of Latinos. The sample included 9,311participants aged 45-74 years (mean: 56.5 years). A latent class analysis of items from the Center for Epidemiological Studies for Depression scale and the Spielberger Trait Anxiety Inventory was used to derive an anxious depression construct. Neurocognitive measures included scores on the Brief Spanish English Verbal Learning Test (B-SEVLT, learning and recall trials), Word Fluency (WF), Digit Symbol Substitution (DSS) test, and a Global Cognitive Score (GCS). We fit survey linear regression models to test the associations between anxious depression symptomatology and cognitive function. We tested for effect modification by sex, Hispanic heritage, and age groups.

RESULTS

Among men, 71.6% reported low, 23.3% moderate, and 5.1% high ADS. Among women, 55.1% reported low, 33.2% moderate, and 11.8% high ADS. After controlling for age, sex, sociodemographic characteristics, cardiovascular risk factors and disease, and antidepressant use, we found significant inverse associations between moderate and high anxious depression (ref:low) with B-SEVLT learning and recall, DSS and GCS. Moderate, but not high, anxious depression was inversely associated with WF. Associations were not modified by sex, Hispanic heritage, or age.

CONCLUSIONS

Increased anxious depression symptomatology is associated with decreased neurocognitive function among Hispanics. Longitudinal studies are needed to establish temporality and infer if negative emotional symptoms precede cognitive deficits.

Symptoms of Anxiety in Older Adults with Depression, Dementia, or Psychosis: A Principal Component Analysis of the Geriatric Anxiety Inventory

AIMS

The primary aim of this study was to examine anxiety symptoms as measured by the Geriatric Anxiety Inventory (GAI) in older patients with depression, dementia, or psychotic disorders. The secondary aim was to conduct a principal component analysis (PCA) of the GAI and to examine whether its subscales differ between the 3 disorders.

METHODS

We included data from 428 patients who were admitted to a department of geriatric psychiatry and examined according to a standardized protocol. The GAI was used to measure current anxiety symptoms.

RESULTS

The GAI symptoms occurred more frequently in the group with depression than in the other 2 groups. The PCA of the GAI with oblimin rotation resulted in a 2-component solution, labelled as "worries" (explained variance 46.3%, Cronbach's α 0.92) and "physical symptoms" (explained variance 7.1%, Cronbach's α 0.85).

CONCLUSION

The results indicate that in old age, anxiety is especially prevalent in depression. The 2-component solution indicates that the GAI measures 2 different aspects of anxiety with different symptomatology.

Norwegian version of the rating anxiety in dementia scale (RAID-N): a validity and reliability study

OBJECTIVES

Dementia-specific anxiety scales in the Norwegian language are lacking; the aim of this study was to investigate the validity and inter-rater reliability of a Norwegian version of the Rating Anxiety in Dementia (RAID-N) scale.

METHOD

The validity of the RAID-N was tested in a sample of 101 patients with dementia from seven Norwegian nursing homes. One psychogeriatrician (n = 50) or a physician with long experience with nursing home patients (n = 51) 'blind' to the RAID-N score diagnosed anxiety according to DSM-5 criteria of generalised anxiety disorder (GAD). A receiver operating characteristic (ROC) analysis assessed the best cut-off point for the RAID-N, and the area under the curve (AUC) was calculated. Inter-rater reliability was tested in a subgroup of 53 patients by intraclass correlation (ICC) and Cohen's kappa.

RESULTS

Twenty-eight of 101 (27.7%) met the GAD criteria. The mean RAID-N score for patients with GAD was 16.1 (SD 6.3) and without GAD, 8.8 (SD 6.5) (p < 0.001). A cut-off score of ≥12 on the RAID-N gave a sensitivity of 82.1%, specificity of 70.0%, and 73.3% accuracy in identifying clinically significant GAD in patients with dementia. Inter-rater reliability on overall RAID-N items was good (ICC = 0.82), Cohen's kappa was 0.58 for total RAID-N score, with satisfactory internal consistency (Cronbach's alpha = 0.81).

CONCLUSION

The RAID-N has fairly good validity and inter-rater reliability, and could be useful to assess GAD in patients with dementia. Further studies should investigate the optimal RAID-N cut-off score in different settings.

The Feasibility and Potential Impact of Brain Training Games on Cognitive and Emotional Functioning in Middle-Aged Adults

Objectives:To investigate whether a commercially available brain training program is feasible to use with a middle-aged population and has a potential impact on cognition and emotional well-being (proof of concept).

Method: Fourteen participants (ages 46–55) completed two 6-week training conditions using a crossover (counterbalanced) design: (1) experimental brain training condition and (2) active control “find answers to trivia questions online” condition. A comprehensive neurocognitive battery and a self-report measure of depression and anxiety were administered at baseline (first time point, before training) and after completing each training condition (second time point at 6 weeks, and third time point at 12 weeks). Cognitive composite scores were calculated for participants at each time point.

Results: Study completion and protocol adherence demonstrated good feasibility of this brain training protocol in healthy middle-aged adults. Exploratory analyses suggested that brain training was associated with neurocognitive improvements related to executive attention, as well as improvements in mood.

Conclusion: Overall, our findings suggest that brain training programs are feasible in middle-aged cohorts. We propose that brain training games may be linked to improvements in executive attention and affect by promoting cognitive self-efficacy in middle-aged adults.

Melatonin ameliorates anxiety and depression-like behaviors and modulates proteomic changes in triple transgenic mice of Alzheimer's disease

Alzheimer's disease (AD) is a devastating neurodegenerative disease accompanied by neuropsychiatric symptoms, such as anxiety and depression. The levels of melatonin decrease in brains of AD patients. The potential effect of melatonin on anxiety and depression behaviors in AD and the underlying mechanisms remain unclear. In this study, we treated 10-month-old triple transgenic mice of AD (3xTg-AD) with melatonin (10 mg/kg body weight/day) for 1 month and explored the effects of melatonin on anxiety and depression-like behaviors in 3xTg-AD mice and the protein expression of hippocampal tissues. The behavioral test showed that melatonin ameliorated anxiety and depression-like behaviors of 3xTg-AD mice as measured by open field test, elevated plus maze test, forced swimming test, and tail suspension test. By carrying out two-dimensional fluorescence difference gel electrophoresis (2D-DIGE) coupled with mass spectrometry, we revealed a total of 46 differentially expressed proteins in hippocampus between the wild-type (WT) mice and non-treated 3xTg-AD mice. A total of 21 differentially expressed proteins were revealed in hippocampus between melatonin-treated and non-treated 3xTg-AD mice. Among these differentially expressed proteins, glutathione S-transferase P 1 (GSTP1) (an anxiety-associated protein) and complexin-1 (CPLX1) (a depression-associated protein) were significantly down-regulated in hippocampus of 3xTg-AD mice compared with the WT mice. The expression of these two proteins was modulated by melatonin treatment. Our study suggested that melatonin could be used as a potential candidate drug to improve the neuropsychiatric behaviors in AD via modulating the expression of the proteins (i.e. GSTP1 and CPLX1) involved in anxiety and depression behaviors. © 2017 BioFactors, 43(4):593-611, 2017.

Anxiety in Dementia

Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affecting from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presentation of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer's disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. However, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia.

Efficacy and Safety of MMFS-01, a Synapse Density Enhancer, for Treating Cognitive Impairment in Older Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

Background:

Cognitive impairment is a major problem in elderly, affecting quality of life. Pre-clinical studies show that MMFS-01, a synapse density enhancer, is effective at reversing cognitive decline in aging rodents.

Objective:

Since brain atrophy during aging is strongly associated with both cognitive decline and sleep disorder, we evaluated the efficacy of MMFS-01 in its ability to reverse cognitive impairment and improve sleep.

Methods:

We conducted a randomized, double-blind, placebo-controlled, parallel-designed trial in older adult subjects (age 50–70) with cognitive impairment. Subjects were treated with MMFS-01 (n = 23) or placebo (n = 21) for 12 weeks and cognitive ability, sleep quality, and emotion were evaluated. Overall cognitive ability was determined by a composite score of tests in four major cognitive domains.

Results:

With MMFS-01 treatment, overall cognitive ability improved significantly relative to placebo (p = 0.003; Cohen’s d = 0.91). Cognitive fluctuation was also reduced. The study population had more severe executive function deficits than age-matched controls from normative data and MMFS-01 treatment nearly restored their impaired executive function, demonstrating that MMFS-01 may be clinically significant. Due to the strong placebo effects on sleep and anxiety, the effects of MMFS-01 on sleep and anxiety could not be determined.

Conclusions:

The current study demonstrates the potential of MMFS-01 for treating cognitive impairment in older adults.

Subjective cognitive decline in cognitively normal elders from the community or from a memory clinic: Differential affective and imaging correlates

INTRODUCTION

Subjective cognitive decline (SCD) could indicate preclinical Alzheimer's disease, but the existing literature is confounded by heterogeneous approaches to studying SCD. We assessed the differential cognitive, affective, and neuroimaging correlates of two aspects of SCD: reporting high cognitive difficulties on a self-rated questionnaire versus consulting at a memory clinic.

METHODS

We compared 28 patients from a memory clinic with isolated SCD, 35 community-recruited elders with similarly high levels of self-reported cognitive difficulties, and 35 community-recruited controls with low self-reported cognitive difficulties.

RESULTS

Increased anxiety and amyloid β deposition were observed in both groups with high self-reported difficulties, whereas subclinical depression and (hippocampal) atrophy were specifically associated with medical help seeking. Cognitive tests showed no group differences.

DISCUSSION

These results further validate the concept of SCD in both community- and clinic-based groups. Yet, recruitment methods influence associated biomarkers and affective symptomatology, highlighting the heterogeneous nature of SCD depending on study characteristics.

Clinicians' experiences of anxiety in patients with dementia

Since anxiety in patients with dementia is a complex, understudied phenomenon, this paper presents clinicians' experiences of anxiety in this population. Semi-structured interviews were conducted with seven clinicians experienced with dementia in elderly patients (65 years and above), and then evaluated via qualitative content analysis. Analysis revealed three main categories: A reaction to loss and worries, symptoms of anxiety and depression interfere with each other, and anxiety in dementia-a multidisciplinary task. Anxiety in this population is perhaps best understood as a reaction to loss and worries, and existential in nature by the participants. Care interventions can reduce or prevent anxiety symptoms in this population. However, when anxiety co-exists with depression it might be difficult to attenuate these symptoms through care measures alone. To better identify and treat the condition, valid dementia-specific anxiety-screening instruments are necessary.

Dual Trajectories of Depression and Cognition: A Longitudinal Population-Based Study

OBJECTIVE

To examine the relationships over time between dual trajectories of depressive symptoms and several cognitive domains.

METHODS

In a 5-year longitudinal study, 1,978 randomly selected individuals aged 65+ years at recruitment were assessed annually. Repeated measures were of depressive symptoms on the modified Center for Epidemiologic Studies Depression Scale and composite scores in the cognitive domains of attention, executive function, memory, language, and visuospatial function. Latent class trajectories were identified for depression and for each cognitive domain and their associations investigated using dual trajectory modeling. Cognitive trajectories with z scores below -1 were designated as persistently low.

RESULTS

Five depressive symptom trajectories were observed: rarely depressed (60.5%); low-grade, decreasing symptoms (18.5%); low-grade, increasing symptoms (9.6%); moderate-grade symptoms (7.4%); and consistent higher-grade symptoms (4.0%). For each cognitive domain six trajectories were observed. The rarely depressed and low-grade decreasing symptom groups were the least likely to have persistently low cognition. The symptom trajectory most strongly associated with persistently low functioning in each domain was not the higher-grade group but rather the low-grade increasing group in the case of attention and the moderate-grade trajectory in the other four domains.

CONCLUSION

Consistently higher-grade depressive symptoms are less strongly associated with poor cognitive functioning than with either moderate- or low-grade increasing depressive symptom trajectories, over time and across different domains. Examining both depression and cognition longitudinally allows heterogeneity of both to be addressed, revealing latent groups with potential diagnostic and prognostic implications.

Personality-Related Determinants of Subtle Cognitive Decline in Old Age: A Population-Based Study

Background/Aims: Recent studies of cases with mild cognitive impairment (MCI) suggested that besides Alzheimer disease (AD)-related biomarkers, some personality dimensions are associated with progression to AD. To date, there are no studies addressing the psychological determinants of subtle cognitive decline in healthy elderly controls. Methods: 488 community-dwelling healthy controls were assessed with a detailed neuropsychological battery at baseline and an 18-month follow-up. Personality factors and facets were investigated at baseline using the NEO-Personality Inventory-Revised (NEO-PI-R). Upon follow-up, there were 264 stable controls (sCON) and 224 deteriorating controls (dCON). Their personality data were compared to those of the 102 MCI cases using one-way analysis of variance and logistic regression models. Results: Significantly higher scores of Openness factor (as well as Aesthetics, Ideas and Values facets) were found in sCON than in both dCON and MCI cases. The three groups did not differ in the other NEO-PI-R factor and facet scores. Openess factor (and the same facets) was associated with cognitive preservation in healthy controls (OR: 0.72, 95% CI: 0.59, 0.87). Lower scores in the same factor and facets conferred higher risk to have MCI (OR: 0.61, 95% CI: 0.46, 0.79). Conclusion: Higher openness to new experiences and thoughts may be a protective factor against early cognitive decline in brain aging.

Cognitive performance and the course of depressive symptoms over 7 years of follow-up: the SMART-MR study

BACKGROUND

Depressive symptoms and cognitive impairment often co-occur, but their interactive relationship is complex and the direction of causation is still a topic of research. We examined the influence of cognitive performance on the course of depressive symptoms during 7 years of follow-up in patients with vascular disease.

METHOD

Within the SMART-MR study, 736 patients (mean age 62 ± 10 years) had neuropsychological assessment on four cognitive domains at baseline [memory (MEM), working memory (WMEM), executive functioning (EXEC), and information processing speed (SPEED)]. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) at baseline and every 6 months during 7 years of follow-up. Generalized Estimating Equation (GEE) models were used to assess the association between cognitive performance with depressive symptoms at multiple time points during follow-up. Interaction terms between the respective cognitive domains and time was included to examine if the course of depressive symptoms differed according to baseline cognitive performance.

RESULTS

The GEE analyses showed no significant interactions between the respective cognitive domains and time indicating no different course of depressive symptoms according to baseline cognitive performance. Lower MEM, EXEC or SPEED, but not WMEM performance, was significantly associated with more depressive symptoms during follow-up per z score decrease: MEM [B = 0.70, 95% confidence interval (CI) 0.35-1.05]; EXEC (B = 0.88, 95% CI 0.41-1.36), and SPEED (B = 0.57, 95% CI 0.21-0.92).

CONCLUSIONS

Poorer cognitive performance on the domains MEM, EXEC and SPEED, but not WMEM, was associated with higher levels of depressive symptoms over 7 years of follow-up, but not with a different course of depressive symptoms over time.

Geriatric anxiety inventory: factor structure and associations with cognitive status

OBJECTIVES

The factor structure and clinical correlates of the Geriatric Anxiety Inventory were determined within a sample of patients with cognitive impairment.

METHODS

Using a cross-sectional design, data were collected within an outpatient Memory Disorders Center. Clinical participants were diagnosed with either mild dementia (N = 45) or cognitive impairment, no dementia (N = 55). A comparison group of participants without subjective memory complaints (N = 50) was also included. The Geriatric Anxiety Inventory was administered and scored as both the 20-item version and 5-item short form. Measures of cognitive status, depressive symptoms, and functioning were also completed.

RESULTS

Clinical participants reported more severe anxiety than did participants in the comparison group; however, the two patient groups did not differ. Principal components analysis revealed a four-factor structure of the Geriatric Anxiety Inventory. Item endorsement on factors characterized by excessive worry and difficulty making decisions were associated with a nearly twofold (odds ratio [OR]: 1.86) and nearly sixfold (OR: 5.70) odds of having cognitive impairment, respectively. The short-form version was composed of a single factor, and item endorsement was associated with a twofold increased odds of having cognitive impairment (OR: 2.02).

CONCLUSION

Psychometric properties of the Geriatric Anxiety Inventory are acceptable among patients with cognitive impairment. Anxiety symptoms were common, and symptoms characterized by excessive worry and difficulty making decisions demonstrated the strongest associations with cognitive status.

Anxiety among community-dwelling U.S. Chinese older adults

BACKGROUND

This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults.

METHODS

Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between 2011 and 2013.

RESULTS

Of 3,159 older adults surveyed, 8.5% had anxiety disorders and 65.0% reported having any anxiety symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptoms. Living with fewer people and having fewer children were only correlated with any anxiety symptoms and lower income was only correlated with anxiety disorders.

CONCLUSIONS

This study emphasizes that interventions for anxiety among Chinese older adults should give special attention to older women, those who are unmarried, with impaired health status, and poorer quality of life. Further longitudinal studies should be conducted to better understand risk factors and outcomes associated with anxiety among U.S. Chinese older adults.

Cognitive psychosocial intervention in dementia: a systematic review

BACKGROUND

The evolution of dementia depends on the underlying pathology, early diagnosis and the availability of effective treatment for some of the symptoms that interfere with the patients' or caregivers' quality of life. Even though there is no specific treatment to reverse dementia, some interventions such as reality orientation and skills training can retard cognitive impairment.

AIM

To review existing scientific evidence regarding the efficacy of therapies included in the category of cognition-oriented approaches for people suffering from dementia.

METHODS

Papers were retrieved from several bibliographic databases (last publication date: 2009) with pre-specified selection criteria, data extraction and methodological quality assessment.

RESULTS

Nine reality orientation and 8 skills training trials were identified as meeting the inclusion criteria.

CONCLUSIONS

Stimulation of cognitive functions, especially by means of reality orientation, improves overall cognitive function in patients suffering from dementia.

Effects of Productive Activities with Reminiscence in Occupational Therapy for People with Dementia: A Pilot Randomized Controlled Study*

Objective/Background

Although a number of studies have considered the effects of reminiscence therapy, none have examined whether a therapy that combines reminiscence with productive activity has a beneficial effect on elderly dementia patients. This study tests our hypothesis that productive activities with reminiscence in occupational therapy (PAROT) can alleviate depressive symptoms and improve task performance of elderly dementia patients.

Methods

Thirty-six patients with dementia were randomly divided into two groups, namely, an intervention group (n = 17) and a control group (n = 19). The intervention group had six activity sessions (making rice balls and cakes; one session/week) while reminiscing about the activity. Measurements were performed using the Cornell Scale for Depression in Dementia (CSDD), Multidimensional Observation Scale for Elderly Subjects (MOSES), Vitality Index, and Mini-Mental State Examination (MMSE). The performance of the patients was assessed based on photographs of the products after the first and sixth sessions.

Results

Six patients dropped out while the study was in progress, thus leaving 15 patients in the intervention group and 15 patients in the control group. The scores of depression symptoms in CSDD and MOSES were significantly improved for the intervention group, while within-group comparison showed no significant differences in CSDD, MOSES, or MMSE total scores. In terms of task performance, 88% of the patients in the intervention group, including two patients with severe dementia, showed significant improvement in making the product.

Conclusion

Our study suggests that PAROT may alleviate depressive symptoms and improve the task performance of elderly people with dementia.

Causal inference in cross-lagged panel analysis: a reciprocal causal relationship between cognitive function and depressive symptoms

Cross-lagged panel analysis (CLPA) is a method of examining one-way or reciprocal causal inference between longitudinally changing variables. It has been used in the social sciences for many years, but not much in nursing research. This article introduces the conceptual and statistical background of CLPA and provides an exemplar of CLPA that examines the reciprocal causal relationship between depression and cognitive function over time in older adults. The 2-year cross-lagged effects of depressive symptoms (T1) on cognitive function (T2) and cognitive function (T1) on depressive symptoms (T2) were significant, which demonstrated a reciprocal causal relationship between cognitive function and depressive mood over time. Although CLPA is a methodologically strong approach to examine the reciprocal causal inferences over time, it is necessary to consider potential sources of spuriousness to lead to false causal relationship and a reasonable time frame to detect the change of the variables.

The impact of early life factors on cognitive function in old age: The Hordaland Health Study (HUSK)

Background

Previous studies have shown that adverse conditions during fetal and early life are associated with lower performance on neurocognitive tests in childhood, adolescence and adult life. There is, however, a paucity in studies investigating these associations into old age. The aim was to investigate the impact of early life factors on cognitive function in old age by taking advantage of the potential for a linkage between a community survey and historical birth records.

Methods

A historical cohort study employing a linkage between a community survey of people aged 72–74 years with the participants’ birth records (n=346). Early life factors included anthropometric measures taken at birth, birth complications, parental socioeconomic status, and maternal health status. The main outcome was a z-scored composite cognitive score, based on test scores from Kendrick Object Learning Test, Trail Making Test A, a modified version of the Digit Symbol Test, Block Design, a modified version of Mini-Mental State Examination and an abridged version of the Controlled Oral Word Association Test (COWAT). The separate cognitive tests were also individually analysed in relation to measures identified at birth.

Results

Higher parental socioeconomic status (SES; based on father’s occupation) was associated with a higher value on the composite cognitive score (by 0.25 SD, p=0.0146) and higher Digit Symbol and Trail Making Test A performance. Higher head circumference at birth was associated with higher COWAT and Trail Making Test A performance. Both higher parental SES and head circumference at birth predicted cognitive function in old age independently of each other. There were no other consistent associations.

Conclusions

In general we found little evidence for a substantial role of early life factors on late-life cognitive function. However, there was some evidence for an association with parental SES status and head circumference on certain cognitive domains.

Positive and negative affect, depression, and cognitive processes in the Cognition in the Study of Tamoxifen and Raloxifene (Co-STAR) Trial

OBJECTIVES

This study examined the relationship between positive and negative affect, depressive symptoms, and cognitive performance.

METHODS

The sample consisted of 1479 non-demented, postmenopausal women (mean age = 67 years) at increased risk of breast cancer enrolled in the National Surgical Adjuvant Breast and Bowel Project's Study of Tamoxifen and Raloxifene. At each annual visit, women completed a standardized neuropsychological battery and self-report measures of affect and depression. Data from three visits were used in linear mixed models for repeated measures using likelihood ratio tests. Separate analyses were performed to relate positive/negative affect and depression to each cognitive measure.

RESULTS

Higher positive affect was associated with better letter fluency (p = .006) and category fluency (p < .0001). Higher negative affect was associated with worse global cognitive function (p < .0001), verbal memory (CVLT List B; p = .002), and spatial ability (p < .0001). Depressive symptoms were negatively associated with verbal knowledge (p = .004), figural memory (p < .0001), and verbal memory (p's ≤ .0001).

DISCUSSION

Findings are consistent with some prior research demonstrating a link between positive affect and increased verbal fluency and between depressive symptoms and decreased memory. The most novel finding shows that negative affect is related to decreased global cognition and visuospatial ability. Overall, this research in a large, longitudinal sample supports the notion that positive affect is related to increases and negative affect to decreases in performance on distinct cognitive measures.

Mild worry symptoms predict decline in learning and memory in healthy older adults: a 2-year prospective cohort study

OBJECTIVE

: Theoretical models of cognitive aging are increasingly recognizing the importance of anxiety and depressive symptoms in predicting age-related cognitive changes and early dementia. This study examined the association between mild worry and depressive symptoms, and cognitive function in healthy, community-dwelling older adults.

METHOD

: A total of 263 healthy older adults participated in an observational prospective cohort study that assessed worry and depression symptoms, and a broad range of cognitive functions over a 2-year period.

RESULTS

: Older adults with mildly elevated worry symptoms at baseline performed worse than older adults with minimal worry symptoms on measures of visual and paired associate learning. They were also more likely to show clinically significant (> 1.5 standard deviation) decline in visual learning and memory at a 2-year follow-up assessment (9.4% versus 2.5%; odds ratio = 3.8).

CONCLUSION

: Assessment of worry symptoms, even mild levels, may have utility in predicting early cognitive decline in healthy, community-dwelling older adults.

Assessment and treatment of behavior problems in dementia in nursing home residents: a comparison of the approaches of physicians, psychologists, and nurse practitioners

OBJECTIVE

To compare physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) regarding their approach to dementia-associated behavior problems in nursing home residents.

METHODS

A web-based questionnaire solicited information about symptoms, assessment methods, suspected etiologies, and interventions with respect to the last resident treated for dementia-associated behavior problems.

RESULTS

Responses were obtained from 108 MDs, 38 PhDs, and 100 NPs. All groups relied similarly on information from the nursing staff, speaking with nursing assistants, and care team meetings in assessment; NPs were more likely to consult with family members. A standard assessment instrument was used most frequently by PhDs (50%), but this generally assessed cognitive status rather than problem behaviors. PhDs most frequently noted depression in residents. Groups were similar in attributing the behavioral symptoms to dementia and to underlying medical conditions, but PhDs were more likely to indicate depression, loneliness/boredom, staff-resident communication, and insufficient activities as etiologies. Use of pharmacological and nonpharmacological interventions of MDs and NPs were similar. PhDs reported least satisfaction with treatment.

CONCLUSION

Awareness of similarities and differences in the approaches of different health professionals can facilitate interdisciplinary interaction in providing care for dementia-associated behavior problems in nursing home residents.

Twelve-month prevalence and correlates of subthreshold and threshold anxiety in community-dwelling older adults with cardiovascular diseases

BACKGROUND

Studies that examined the prevalence of anxiety in older adults with cardiovascular diseases (CVD) were mainly conducted in clinical settings limiting the generalizability of the results to community-based samples. Moreover, among older adults with CVD, little is known about the prevalence of subthreshold anxiety and about which characteristics differentiate those with subthreshold anxiety from those having an anxiety disorder. This study aimed at determining the 12-month prevalence rates of subthreshold and threshold anxiety in community-dwelling older adults with CVD as well as to examine whether older people with CVD reporting an anxiety disorder differ from their counterparts with subthreshold anxiety.

METHOD

From a representative sample of community-dwelling older adults aged 65years and older (N=2811), 613 cases of CVD were identified based on government medical records. Subthreshold and threshold anxiety were assessed using in-home interviews based on the DSM-IV criteria.

RESULTS

The 12-month prevalence rates of anxiety disorders and subthreshold anxiety were, respectively, 5.1 and 14.8%. Compared to older adults with CVD reporting no anxiety, individuals reporting subthreshold or threshold anxiety are more likely to be women, to have high blood pressure, and to suffer from a depression.

LIMITATIONS

No information was gathered regarding alcohol and tobacco use.

CONCLUSIONS

The present study provides evidence for the fact that subthreshold anxiety has a high prevalence among community-dwelling older people with CVD and that clinicians working with this population should screen for anxiety, even at a subthreshold level, since it may be associated with high blood pressure and depression.