Association of depressed mood and mortality in older adults with and without cognitive impairment in a prospective naturalistic study

Antidepressant medications in dementia: evidence and potential mechanisms of treatment-resistance

Depression in dementia is common, disabling and causes significant distress to patients and carers. Despite widespread use of antidepressants for depression in dementia, there is no evidence of therapeutic efficacy, and their use is potentially harmful in this patient group. Depression in dementia has poor outcomes and effective treatments are urgently needed. Understanding why antidepressants are ineffective in depression in dementia could provide insight into their mechanism of action and aid identification of new therapeutic targets. In this review we discuss why depression in dementia may be a distinct entity, current theories of how antidepressants work and how these mechanisms of action may be affected by disease processes in dementia. We also consider why clinicians continue to prescribe antidepressants in dementia, and novel approaches to understand and identify effective treatments for patients living with depression and dementia.

Mini-Mental State Examination predicts mortality in patients on chronic hemodialysis

BACKGROUND

No available and easy to administer cognitive test has been evaluated for the prediction of mortality in prevalent patients on chronic hemodialysis. The aim of the present study was to determine if the Mini-Mental State Examination (MMSE) was predictor of mortality in patients on chronic hemodialysis.

METHODS

One hundred twenty-seven prevalent patients on chronic hemodialysis were studied. All patients underwent assessment of cognitive function through the MMSE. The MMSE was administered during a midweek hemodialysis session, avoiding the beginning and the end of each treatment to minimize the effects of fluctuations in uremic syndrome or blood pressure in accordance with a previous study. An MMSE score ≤23 was used as indicative of cognitive impairment. Demographic, clinical, and laboratory parameters were recorded for each patient.

RESULTS

Mean (SD) MMSE was 23.2 ± 4.1. Median MMSE was 24 (min-max: 2-30). MMSE was ≤23 in 72 patients and >23 in 55. With data updated in March 2021, after a mean follow-up of 58.8 ± 41 months (range: 2-156 months), 75 patients died, and 17 were transplanted. None was lost to follow-up or was transferred to another unit. Dead participants, as compared with alive ones, were significantly older, had a higher Charlson Index score, had lower Activities daily living and Instrumental activities daily living, and had a lower MMSE score and lower serum albumin levels. Kaplan-Meier analysis showed that survival was significantly lower in patients with MMSE ≤23 than in those with MMSE >23 (log-rank χ² : 8.825, p = 0.003). According to Cox regression analysis, mortality was associated with age and inversely associated with MMSE.

CONCLUSION

We show that the MMSE predicts mortality in prevalent patients on chronic hemodialysis.

Anhedonia and anergia predict mortality in older Australians living in residential aged care

OBJECTIVES

Depression is common in older adults and is linked to morbidity and mortality. The aim of this study was to investigate whether specific symptoms of depression (dysphoria, anhedonia and anergia) predicted mortality in older Australian Aged Care residents.

METHODS

Eighty older adults (M = 83.16 ± 7.14) without cognitive impairment residing in 14 Residential Aged Care facilities located in Melbourne, Australia, completed the 15-item Geriatric Depression Scale-Short Form (GDS-15) and the Standardized Mini Mental State Examination. Residential Aged Care facilities provided the primary end-point of all-cause mortality at follow-up (M = 5.4 years ± 0.1).

RESULTS

Univariate Kaplan-Meier survival curves and Cox Proportional Hazards regression analyses were used to evaluate whether symptoms of depression predicted all-cause mortality, with known prognostic factors controlled. The results indicated that anhedonia (Hazard Ratio = 2.931 [95% CI 1.278-6.722], p = .011) and anergia (Hazard Ratio = 2.783 [95% CI 1.065-7.276], p = .037) were associated with almost a threefold increased risk of mortality in older adults living in RAC in adjusted analyses. Dysphoria did not predict mortality.

CONCLUSIONS

These findings advance understanding of the mortality risks of anhedonia and anergia in an understudied population. Symptoms of anhedonia and anergia should be targeted for screening in older adults living in Aged Care to increase the detection and potential for referral to treatment for depressive presentation.

Neuropsychiatric symptoms and mortality among patients with mild cognitive impairment and dementia due to Alzheimer's disease

BACKGROUND

Neuropsychiatric symptoms (NPS) could increase mortality risk in people with dementia due to Alzheimer's disease (AD). However, whether NPS affects mortality risk in people with mild cognitive impairment (MCI) and whether any specific syndrome of NPS influences this risk are still unclear.

METHODS

In total, 984 participants with dementia due to AD, 338 with MCI, and 365 controls were enrolled. Over a mean of 5-year follow-up, cause of death data were obtained from the Ministry of Health and Welfare in Taiwan. NPS were assessed using Neuropsychiatric Inventory Questionnaire (NPI-Q), and psychosis, mood, and frontal domain scores were determined. Survival analyses were conducted to determine the hazard ratio (HR) of death.

RESULTS

In controlled analyses, HR of death for AD was 2.19 (95% confidence interval [CI] = 1.29-3.71) compared with the control group, whereas no statistical significance was noted for the MCI group. A high NPI-Q score (above the median score) increased mortality risk for both the MCI and AD groups, with HRs of 2.32 (95% CI = 1.07-5.03) and 2.60 (95% CI = 1.51-4.47), respectively. Among NPI-Q domain scores, only high mood domain, but not psychosis or frontal domain, scores increased death risk for both the MCI (HR = 2.89, 95% CI = 1.00-8.51) and AD (HR = 2.59, 95% CI = 1.47-4.55) groups.

CONCLUSION

Mortality risk is high for patients with AD. Not only for AD, patients with MCI presenting with NPS, particularly mood symptoms, have high death risk.

Global mortality from dementia: Application of a new method and results from the Global Burden of Disease Study 2019

Introduction

Dementia is currently one of the leading causes of mortality globally, and mortality due to dementia will likely increase in the future along with corresponding increases in population growth and population aging. However, large inconsistencies in coding practices in vital registration systems over time and between countries complicate the estimation of global dementia mortality.

Methods

We meta‐analyzed the excess risk of death in those with dementia and multiplied these estimates by the proportion of dementia deaths occurring in those with severe, end‐stage disease to calculate the total number of deaths that could be attributed to dementia.

Results

We estimated that there were 1.62 million (95% uncertainty interval [UI]: 0.41–4.21) deaths globally due to dementia in 2019. More dementia deaths occurred in women (1.06 million [0.27–2.71]) than men (0.56 million [0.14–1.51]), largely but not entirely due to the higher life expectancy in women (age‐standardized female‐to‐male ratio 1.19 [1.10–1.26]). Due to population aging, there was a large increase in all‐age mortality rates from dementia between 1990 and 2019 (100.1% [89.1–117.5]). In 2019, deaths due to dementia ranked seventh globally in all ages and fourth among individuals 70 and older compared to deaths from other diseases estimated in the Global Burden of Disease (GBD) study.

Discussion

Mortality due to dementia represents a substantial global burden, and is expected to continue to grow into the future as an older, aging population expands globally.

Impact of psychosocial status on liver transplant process

Liver transplant candidates and recipients are at high risk of psychological distress. Social, psychological and psychiatric patterns seem to influence morbidity and mortality of patients before and after transplant. An accurate organ allocation is mandatory to guarantee an optimal graft and recipient survival. In this context, the pre-transplant social, psychological and psychiatric selection of potential candidates is essential for excluding major psychiatric illness and for estimating the patient compliance. Depression is one of the most studied psychological conditions in the field of organ transplantation. Notably, an ineffectively treated depression in the pre-transplant period has been associated to a worst long-term recipient survival. After transplant, personalized psychological intervention might favor recovery process, improvement of quality of life and immunosuppressant adherence. Active coping strategy represents one of the most encouraging ways to positively influence the clinical course of transplanted patients. In conclusion, multidisciplinary team should act in three directions: prevention of mood distress, early diagnosis and effective treatment. Active coping, social support and multidisciplinary approach might improve the clinical outcome of transplanted patients.

Predictors of mortality in people with late-life depression: A retrospective cohort study

OBJECTIVES

Late-life depression (LLD) is associated with an increased mortality risk in the general older population. It remains however unclear which signs or symptoms are predictive of mortality in those suffering from LLD.

SETTING AND PARTICIPANTS

Patients aged 65 years or older with depressive disorder diagnosed in Southeast London between January 2008 and December 2017.

METHODS

We assembled patients diagnosed with late-life depression from the Maudsley Biomedical Research Centre Case Register, which is linked to national mortality data. Using depression diagnosis as index date, we followed patients until death or censoring point. Sociodemographic data, scores of Health of the Nation Outcome Scales (HoNOS65+), which include a physical illness scale, profiles of depressive symptoms, and psychotropic medications were extracted and modeled in multivariable survival analyses to determine predictors of mortality.

RESULTS

Of 4,243 patients with LLD (mean age 77.0 years; 61.2% female), 2,327 (54.8%) died over a median follow-up time of 3.5 years. In multivariable Cox regression models, an increased risk of all-cause mortality was associated with older age, cognitive problems, physical illness/disability, impaired activities of daily living, apathy, lack of appetite and mirtazapine prescription; conversely, female gender, non-white ethnicity, guilt feelings, tearfulness, impaired concentration, disturbed sleep and delusions were associated with lower mortality risk.

CONCLUSIONS

Besides demographic factors, physical health, functioning and cognition, different depressive symptoms were significantly associated with the prognosis of LLD. Elderly patients presenting with depressive symptoms predicting higher mortality risk should be examined and followed more closely.

Impact of Expression and Genetic Variation of microRNA-34b/c on Cognitive Dysfunction in Patients with Major Depressive Disorder

BACKGROUND

Patients suffering from major depressive disorder (MDD) commonly demonstrate lower performance across multiple cognitive domains. Cognitive impairment is an intrinsic characteristic of MDD status and is often influenced by genetic factors. microRNAs (miRNAs or miRs) have been shown to have important implications in the etiology of MDD. Therefore, we aimed to identify and analyze the impact of expression and genetic variation of miR-34b/c on cognitive dysfunction in MDD.

METHODS

First, we analyzed miR-34c-5p expression in 48 cases of MDD and 54 healthy controls in a Chinese population using qRT-PCR. We assessed the relationship between the level of miR-34c-5p expression and cognitive performance by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test (TMT). Second, in order to characterize allelic effects of miR-34b/c on cognitive performance in MDD patients, we performed genetic association analysis of single-nucleotide polymorphism (SNP) loci of the MIR34B/C genes with cognitive function in a second group consisting of 531 MDD patients and 267 healthy controls.

RESULTS

We found a significant negative correlation between the level of miR-34c-5p expression and both the language and delayed memory index scores in patients with MDD. We also found a significant positive correlation between the level of miR-34c-5p expression and the time required to complete tests A and B of the TMT. The interaction between the rs2187473 genotype and the disease was significant for both immediate memory and delayed memory. In the patient group, the rs2187473 CC genotype was significantly associated with higher performance on immediate memory (F = 6.683, p < 0.05) and delayed memory tasks (F = 4.221, p < 0.05).

CONCLUSION

Our findings suggest that changes in miR-34c expression level have important impacts on cognitive function in patients with MDD. In particular, the polymorphism rs2187473 is a potential genetic risk factor for cognitive function in MDD, which may be of clinical use.

Updating Apathy: Using Research Domain Criteria to Inform Clinical Assessment and Diagnosis of Disorders of Motivation

Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term "apathy" and "related phenomena" in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.

Physical Activity Attenuates Total and Cardiovascular Mortality Associated With Physical Disability: A National Cohort of Older Adults

Background

Regular physical activity (PA) has been shown to protect against disability onset but, once the disability is present, it is unclear if PA might attenuate its harmful health consequences. Thus, we examined if mortality risk associated with physical disability can be offset by PA among older adults.

Methods

We used data from a cohort of 3,752 individuals representative of the noninstitutionalized population aged 60 years and older in Spain. In 2000-2001, participants self-reported both PA levels (inactive, occasionally, monthly, weekly) and five physical disabilities (agility, mobility, global daily activities, instrumental activities of daily living, and self-care). Individuals were prospectively followed through 2014 to assess incident deaths.

Results

The mean follow-up was 10.8 years, with a total of 1,727 deaths, 638 of them due to cardiovascular disease (CVD). All disability types were associated with higher total and CVD mortality. Being physically active (ie, doing any PA) was associated with a statistically significant 26%-37% and 35%-50% lower risk of total and CVD death, respectively, across types of disability. As compared with those being physically active and without disability, those who were inactive and had a disability showed the highest mortality risk from total (hazard ratios from 1.52 to 1.90 across disabilities, all p < .05) and from CVD (hazard ratios from 1.99 to 2.24 across disabilities, all p < .05). Total and CVD mortality risk was similar in physically active participants with disabilities and in inactive individuals without disability.

Conclusions

In older adults, PA could attenuate the increased risk of mortality associated with physical disability.

Clinical correlates of resilience factors in geriatric depression

ABSTRACTBackground:Traditional perspectives conceptualize resilience as a trait and depression as resulting from resilience deficiency. However, research indicates that resilience varies substantially even among adults who are clinically depressed, as well as across the lifespan of an individual. Few studies have investigated resilience in depression, and even fewer have examined resilience in depressed older adults.

METHODS

Three hundred thirty-seven adults ≥60 years with major depressive disorder completed the Connor-Davidson Resilience Scale (CD-RISC) and measures of mental health, quality of life (QOL), and medical comorbidity. Exploratory factor analysis was used to explore the factor structure of the CD-RISC. Correlations and general linear models were used to examine associations between resilience and other variables.

RESULTS

The rotated component matrix indicated a four-factor model. Sorting of items by highest factor loading revealed constructs associated with (1) grit, (2) active coping self-efficacy, (3) accommodative coping self-efficacy, and (4) spirituality. Resilience was significantly correlated with increased age, lower cognitive functioning, greater cerebrovascular risk, and greater medical comorbidity. Resilience was negatively associated with mental health symptoms (depression, apathy, and anxiety) and positively associated with QOL. The final optimal model identified less depression, less apathy, greater medical comorbidity, higher QOL, and minority (non-White) race as factors that significantly explained variability in resilience.

CONCLUSIONS

Resilience was significantly associated with a range of mental health constructs in a sample of older adults with depression. Future clinical trials and dismantling studies may help determine whether interventions targeting grit, active coping, accommodative coping, and spirituality can increase resilience and help prevent and treat depression in older adults.

Impact of hepatitis C virus infection on health-related quality of life before and after liver transplantation: a multidisciplinary point of view

INTRODUCTION

Hepatitis C negatively changes patient quality of life even in the absence of advanced liver disease. The specific patterns of quality of life of hepatitis C positive patients waiting for transplant or after surgery are not widely studied. Areas covered: A significant percentage of infected patients show cognitive impairment, fatigue, and/or a 'brain fog', that cannot be explained by the liver disease. Depression can be diagnosed in one third of hepatitis C positive patients. Conflicting data are available regarding the possible role of Model for End-Stage Liver Disease score as predictor of impaired quality of life. In the first period after liver transplant, quality of life tends to increase at the pre-transplant period but in the medium and long-term period, it declines. The recurrence of hepatitis C infection represents a strong predictor of morbidity and mortality and can significantly affect the global quality of life of patients. Expert commentary: Hepatologists, surgeons and psychologists should collaborate to support infected patients in all phases of transplant including the long-term period after surgery. Education and information should be implemented especially regarding the positive role of new direct antivirals.

Apathy in early and late-life depression

BACKGROUND

Late-life depression is thought to differ in clinical presentation from early-life depression. Particularly, late-life depression is considered to be more characterized by apathy than is early-life depression. Lacking convincing evidence, this study examines the presence and associated socio-demographic/clinical characteristics of apathy in older compared to younger depressed persons.

METHODS

This cross-sectional study used data from two naturalistic cohort studies, i.e. the Netherlands Study of Depression in Older Persons (NESDO) and the Netherlands Study of Depression and Anxiety (NESDA). These studies included 605 persons (aged 18-93 years) with a major depressive disorder, divided into 217 early-life (< 60 years) and 388 late-life (≥ 60 years) depressed persons. Apathy was considered present if a score of ≥14 on the Apathy Scale.

RESULTS

Apathy was strongly associated with age: it was more frequently present in persons with late-life depression (74.5%) than in those with early-life depression (53.5%). Independent of age, the following characteristics were associated with the presence of apathy: male gender, low education, use of benzodiazepines, chronic diseases, and more severe depression. Of all potential risk factors, only former and current smoking was associated with the presence of apathy in older depressed persons but not in younger depressed persons (p-value for age interaction = 0.01).

LIMITATIONS

No causal relationships can be drawn due to the cross-sectional design of the study.

CONCLUSIONS

In depressed individuals, clinically relevant apathy was more frequently present in older compared to younger persons. Both age groups showed largely the same associated risk factors. Apathy was independently associated with older age, male gender and more severe depression.

Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

OBJECTIVE

The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality.

METHODS

This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study.

RESULTS

Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions.

CONCLUSIONS

This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.

Serum ApoB levels in depressive patients: associated with cognitive deficits

Cognitive deficits have been regarded as one of the most significant clinical symptoms of depressive disorder. Accumulating evidence has shown that apolipoprotein B (ApoB) levels, which are responsible for inducing neurodegeneration, may be involved in cognitive deficits. This study examines cognitive deficits, and the correlation of serum ApoB levels with cognitive deficits of depressive disorder. 90 depressive patients and 90 healthy controls with matched age and gender were recruited. Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Serum ApoB levels in depressive patients were measured by immunoturbidimetric method. Our results showed that depressive patients had lower scores of cognition including RBANS total score and subscales of language and delayed memory (all, p < 0.001) than healthy controls after controlling for the variables. The differences in cognitive functions also passed Bonferroni corrections. Serum ApoB levels were negatively correlated with delayed memory score in depressive patients (r = −0.30, p = 0.01). Furthermore, stepwise multivariate regression analysis indicated that serum ApoB levels independently contributed to delayed memory in depressive patients (t = −2.68, p = 0.01). Our findings support that serum ApoB levels may be involved in delayed memory decline in depressive patients. Depressive patients also experience greater cognitive deficits, especially in delayed memory and language than healthy controls.

Vascular depression consensus report - a critical update

BACKGROUND

Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression".

DISCUSSION

This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed.

CONCLUSION

The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.

Mortality in Mild Cognitive Impairment Diagnosed with DSM-5 Criteria and with Petersen's Criteria: A 17-Year Follow-Up in a Community Study

OBJECTIVE

To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5-MCI) will be higher than using Petersen's criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI.

METHODS

A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5-MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups.

RESULTS

Compared with noncases, the mortality rate ratio was approximately double in DSM-5-MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5-MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories.

CONCLUSION

The mortality risk in comparison with noncases was higher in DSM-5-MCI than in P-MCI. The PAF of mortality in DSM-5-MCI individuals was ~ 1% over a 17-year period.

Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients

Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70 %) and HE (77 %) were highly prevalent in this sample, with 58 % actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P = .05). Depressive symptoms were significantly associated with fatigue (P < .001), daytime sleepiness (P < .001), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). HE was significantly associated with fatigue (P = .02), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P < .001), with depressive symptoms alone accounting for 58.8 % of the variance. Depressive symptoms and HE accounted for 68.0 % of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.

Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality: Results From a Cohort of Community-Dwelling Elderly Individuals in Rural Greece

OBJECTIVE

To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.

METHODS

Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.

RESULTS

Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS > 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.

CONCLUSION

COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.

Apathy in Older Persons With Depression: Course and Predictors: The NESDO Study

OBJECTIVES

Apathy is a common behavioral syndrome, influencing different areas of daily functioning and often seen in depression. Little is known about the course of apathy in depression. In this study, we examine the course and predicting factors of apathy in older persons with depression.

METHOD

Data of 266 older persons with depression participating in the Netherlands Study of Depression in Older Persons, all aged at least 60 years with complete Apathy Scale scores at baseline and 2-year follow-up, were included in this study. Associations between several baseline variables and severity, incidence, and persistence of apathy were examined using regression analyses.

RESULTS

At 2-year follow-up, the severity of apathy was predicted by the severity of apathy at baseline, and incidence rate of apathy was 36%, with a lower baseline Mini-Mental State Examination score being an independent predictor. Older persons with incident apathy did not differ in remission rate of depression compared to those without apathy at follow-up. Persistence rate of apathy was 80% and was independently predicted by a higher baseline Apathy Scale score and, surprisingly, by less use of benzodiazepines. Persons with persistent apathy were less likely to recover from depression than those who remitted from apathy.

CONCLUSION

Severity of apathy at baseline, but not depression, predicted apathy at follow-up. Incident apathy was predicted by poorer cognitive function, whereas severe apathy at baseline predicted its persistence. Remarkably, new apathy was not associated with worse outcome of depression whereas persistent apathy was.

Survival in Subcortical Vascular Dementia: Predictors and Comparison to Probable Alzheimer's Disease in a Tertiary Memory Clinic Population

BACKGROUND

Subcortical vascular dementia (SVaD) is one of the most common dementias, after Alzheimer's disease (AD) dementia. Few survival analyses in SVaD patients have been reported.

METHODS

The dates and causes of death of 146 SVaD and 725 AD patients were included. We used the Cox proportional hazards model to compare survival between SVaD and AD patients and to explore possible factors related to survival of SVaD patients.

RESULTS

The median survival time after the onset of SVaD (109 months) was shorter than that recorded for AD (152 months). The most common cause of death in SVaD was stroke (47.1%). Factors associated with shorter survival in SVaD were late onset, male sex, worse baseline cognition, absence of hypertension and a family history of stroke.

CONCLUSIONS

Stroke prevention may be important in SVaD treatment because 47.1% of SVaD patients died of stroke. A family history of stroke and absence of hypertension were associated with a shorter survival in SVaD, suggesting the existence of genetic or unknown risk factors.

Brain hyperintensity location determines outcome in the triad of impaired cognition, physical health and depressive symptoms: A cohort study in late life

PURPOSE OF THE STUDY

Brain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Here we test the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location.

DESIGN AND METHODS

244 members of the Aberdeen 1936 Birth Cohort were recruited to this study. 227 participants completed brain MRI and their hyperintensities were scored using Scheltens's scale. 205 had complete imaging, cognitive, physical health and depressive symptom score data. The relationships between hyperintensity location and depressive symptoms, cognitive ability and physical health were examined by correlation and structural equation analysis.

RESULTS

We found that depressive symptoms correlated with hyperintensity burden in the grey matter (r=0.14, p=0.04) and infratentorial regions (r=0.17, p=0.01). Infratentorial hyperintensities correlated with reduced peak expiratory flow rate (r=-0.26, p<0.001) and impaired gait (r=0.13, p=0.05). No relationship was found between white matter and periventricular (supratentoral) hyperintensities and depressive symptoms. Hyperintensities in the supratentorial and infratentorial regions were associated with reduced cognitive performance. Using structural equation modelling we found that the association between hyperintensities and depressive symptoms was mediated by negative effects on physical health and cognitive ability.

CONCLUSIONS

Hyperintensities in deep brain structures are associated with depressive symptoms, mediated via impaired physical health and cognitive ability. Participants with higher cognitive ability and better physical health are at lower risk of depressive symptoms.

Predictors for Nursing Home Admission and Death among Community-Dwelling People 70 Years and Older Who Receive Domiciliary Care

AIM

The aim of this study was to analyze which variables predicted nursing home admission (NHA) and death.

METHODS

1,001 recipients of domiciliary care were assessed three times in a 3-year period. Through bivariate and multivariate Cox proportional hazards regression models, associations between a covariate and the outcomes were analyzed.

RESULTS

Participants with dementia had a higher risk of NHA (odds ratio 3.88, 95% confidence interval 2.92-5.16) compared to participants without dementia. The Neuropsychiatric Inventory sub-syndrome psychosis, poorer functional impairment and age were associated with NHA. Female sex, age, worse medical health and functional impairment were associated with death.

CONCLUSION

Support to the caregiver and education on how to meet and cope with behavioral disturbance, depressive mood and sub-syndrome psychosis will probably enable the family to better adapt to late life changes.

Effectiveness of a life story work program on older adults with intellectual disabilities

OBJECTIVE

This study examines the effectiveness of a life story work program (LSWp) in older adults with mild-to-moderate levels of intellectual disability (ID).

METHODS

Using a quasiexperimental design, this study assigned 60 older adults who were between 50-90 years old with mild-to-moderate levels of ID to receive either the LSWp (intervention group, N=32) or usual activities (control group, N=28) during a period of 6 months. Evaluation was made based on the outcomes assessed by the Mood Interest and Pleasure Questionnaire, the Vineland Adaptive Behavior Scales, and the Personal Wellbeing Index - ID.

RESULTS AND CONCLUSION

LSWp shows potential for improving the quality of life and preventing the loss of interest and pleasure in older adults with ID. It also shows promise in enhancing their socialization skills. Patients with better communication abilities seemed to benefit more from the LSWp.

Methodological approaches and magnitude of the clinical unmet need associated with amotivation in mood disorders

BACKGROUND

There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration.

METHODS

This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders.

RESULTS

The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively.

DISCUSSION

There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders.

Mini-mental state examination as a predictor of mortality among older people referred to secondary mental healthcare

Background

Lower levels of cognitive function have been found to be associated with higher mortality in older people, particularly in dementia, but the association in people with other mental disorders is still inconclusive.

Methods and Findings

Data were analysed from a large mental health case register serving a geographic catchment of 1.23 million residents, and associations were investigated between cognitive function measured by the Mini-Mental State Examination (MMSE) and survival in patients aged 65 years old and over. Cox regressions were carried out, adjusting for age, gender, psychiatric diagnosis, ethnicity, marital status, and area-level socioeconomic index. A total of 6,704 subjects were involved, including 3,368 of them having a dementia diagnosis and 3,336 of them with depression or other diagnoses. Descriptive outcomes by Kaplan-Meier curves showed significant differences between those with normal and impaired cognitive function (MMSE score<25), regardless of a dementia diagnosis. As a whole, the group with lower cognitive function had an adjusted hazard ratio (HR) of 1.42 (95% CI: 1.28, 1.58) regardless of diagnosis. An HR of 1.23 (95% CI: 1.18, 1.28) per quintile increment of MMSE was also estimated after confounding control. A linear trend of MMSE in quintiles was observed for the subgroups of dementia and other non-dementia diagnoses (both p-values<0.001). However, a threshold effect of MMSE score under 20 was found for the specific diagnosis subgroups of depression.

Conclusion

Current study identified an association between cognitive impairment and increased mortality in older people using secondary mental health services regardless of a dementia diagnosis. Causal pathways between this exposure and outcome (for example, suboptimal healthcare) need further investigation.

Impaired verbal memory is a significant predictor of early cerebral-cardiovascular death, an 18-year follow-up of a national cohort

BACKGROUND

The mortality pattern of individuals with impaired verbal memory (IVM) has not yet been well described. We sought to describe the risk of all-causes, as well as specific causes of death associated with IVM.

METHOD

We used the data of 4151 nationally representative adults ≥60 years old who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and completed one non-contextual (i.e., word list memory) and one contextual delayed-recall tests (i.e., short story recall). The participants were passively followed up through 31 December 2006. We determined the hazard ratio of death from all-causes and specific cause through Cox proportional hazard regression.

RESULTS

Severe and moderate IVM were present in 268 (6.5%) and 495 (11.9%) participants at baseline survey, and 2550 deaths occurred by the end of 18-year follow-up (median = 12 years). The medians of survival time adjusted for all-causes death were 6.17 (95% CI: 5.50, 6.92), 9.50 (8.92, 10.25), and 13.17 (12.75, 13.58) years, respectively for the individuals with severe, moderate, and no IVM. Severe IVM was significantly associated with death from cardio-cerebral vascular diseases [hazard ratio = 1.70, 95% CI = (1.36-2.12)], stroke [2.60 (1.69-3.99)], and Alzheimer's disease [3.50 (1.40-8.76)]. The shortened survival time of the participants with IVM was mainly driven by the deaths of cerebral-cardiovascular diseases, which accounted for almost half of all deaths.

CONCLUSION

The predictability of memory scores to early cerebral-cardiovascular deaths demonstrated that central challenge among individuals with cognitive impairment was cardiovascular diseases management.

Depressive symptoms in Chinese-American subjects with cognitive impairment

OBJECTIVES

To compare the prevalence of depressive symptoms and frequency of antidepressant use between a group of elderly Chinese-American subjects with and without cognitive impairment and a group of matched white subjects. A secondary aim was to examine the clinical and demographic predictors of depressive symptoms across these groups.

METHODS

The study was conducted at an academic neurology subspecialty clinic. This was a case-control study with 140 Chinese-American subjects and 140 demographically and cognitively matched white subjects. In each group, there were 48 cognitively normal and 92 cognitively impaired participants (49 with mild cognitive impairment, 43 with Alzheimer disease). The proportion of individuals with significant depressive symptoms, as indicated by a Geriatric Depression Scale score ≥6 of 15, and frequency of antidepressant use were compared across groups by using χ(2) analysis. Factors predicting depressive symptoms, including racial and diagnostic group, age, gender, Mini-Mental State Examination score, level of functional impairment, education level, and medical comorbidities, were assessed by using linear regression analysis.

RESULTS

Significant depressive symptoms were more common in cognitively impaired Chinese-American (35%) than cognitively impaired white (15%; χ(2)[1] = 9.4; p = 0.004) subjects. Chinese-American subjects with cognitive impairment were less likely to be receiving treatment for depression (12%) than white subjects with cognitive impairment (37%; χ(2)[1] = 15.6; p = 0.002). Racial and diagnostic group, age, level of functional impairment, Mini-Mental State Examination score, and education level were all statistically significant independent predictors of Geriatric Depression Scale score.

CONCLUSIONS

Elderly Chinese-American subjects with cognitive impairment are at increased risk for unrecognized and untreated depressive symptoms compared with elderly white subjects with cognitive impairment. Education level may contribute to this risk or it may be a surrogate marker for other factors contributing to depressive symptoms in this group.

Lacunar stroke, deep white matter disease and depression: a meta-analysis

BACKGROUND

Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms.

METHODS

A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models.

RESULTS

None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88-2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85-2.20), p = 0.19), deep white matter (RR = 1.16 (0.85-1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81-2.22), p = 0.25), or the volume of lacunes (MD = -4.71 (-351.59-342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (-1.57-3.48), p = 0.46).

CONCLUSIONS

The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.

When optimism hurts: inflated predictions in psychiatric neuroimaging

The ability to predict outcomes from neuroimaging data has the potential to answer important clinical questions such as which depressed patients will respond to treatment, which abstinent drug users will relapse, or which patients will convert to dementia. However, many prediction analyses require methods and techniques, not typically required in neuroimaging, to accurately assess a model's predictive ability. Regression models will tend to fit to the idiosyncratic characteristics of a particular sample and consequently will perform worse on unseen data. Failure to account for this inherent optimism is especially pernicious when the number of possible predictors is high relative to the number of participants, a common scenario in psychiatric neuroimaging. We show via simulated data that models can appear predictive even when data and outcomes are random, and we note examples of optimistic prediction in the literature. We provide some recommendations for assessment of model performance.

Factors associated with depressive symptoms in older Taiwanese adults in a long-term care community

BACKGROUND

This study was to examine culturally based factors as potential predictors of depressive symptoms in older Taiwanese adults living in eight long-term care institutions in southern Taiwan.

METHOD

A cross-sectional, exploratory design study was used with a purposive sample of 156 participants with a mean age of 79.80 ± 7.14 years. Measurements included filial responsibility expectation questions, two questions about degrees of acceptance of institutionalization, Perceived Stress Scale, Self-Transcendence Scale, and Geriatric Depression Scale.

RESULTS

An elder's willingness to be institutionalized, an elder's willingness to remain institutionalized, perceived stress, and self-transcendence were significantly associated with depressive symptoms (r = -0.35; -0.49; 0.60; and -0.67, respectively). Although no evidence for the relationship between filial responsibility and depressive symptoms was found in this study, there was evidence that filial responsibility was highly valued. Self-transcendence was the strongest predictor of depressive symptoms, accounting for 45% of the variance.

CONCLUSION

These findings provide insight into the cultural factors associated with depressive symptoms and support the need of timely interventions for institutionalized Taiwanese elderly population.

Vascular depression and frailty: a compound threat to longevity among older-old women

OBJECTIVES

The vascular depression hypothesis posits that cerebrovascular burden contributes to the development of depression symptoms in late life. Building on work that suggests that vascular depression is a prodrome for frailty, this paper tests a theoretical framework that vascular depression symptoms are an early marker of a broader pattern of decline characterized by more frailty symptoms and shortened lifespan, and that vascular depression symptoms predict mortality through frailty.

METHODS

The sample was drawn from the Health and Retirement Study and included 1361 stroke-free women over the age of 80. Data were included from six biannual waves from 1998 to 2008 (waves 4-9). A vascular depression symptomatology variable was based on Center for Epidemiological Studies Depression Scale (CES-D) scores and number of cerebrovascular risk factors (hypertension, diabetes, cardiac disease, and smoking). Frailty was measured based on wasting, slowness, weakness, fatigue, and falls. Vascular depression and frailty symptoms were modeled using slope and intercept terms. Mortality was modeled using a discrete-time survival term.

RESULTS

The data supported the proposed model (RMSEA = 0.051; CFI = 0.971; X² = 234.84, p < 0.001). Higher vascular depression symptom slope and intercept scores significantly predicted higher frailty slope and intercept scores, respectively. Frailty intercept scores significantly predicted mortality. The vascular depression symptoms indirectly predicted mortality through frailty symptoms. A second model testing the competing hypothesis - that frailty symptoms lead to vascular depression symptoms and indirectly to mortality - was not supported by the data.

CONCLUSIONS

Results suggest that vascular depression symptoms are associated with a clinical trajectory that includes greater frailty and shortened remaining lifespan.

Survival of bipolar depression, other type of depression and comorbid ailments: ten-year longitudinal follow-up of 10,922 Taiwanese patients with depressive disorders (KCIS no. PSY1)

OBJECTIVE

The effect of type of depressive disorder on mortality has been rarely addressed in the relevant literature. It is especially true in considering comorbid disorders and by population-based longitudinal cohort sample. The aims of this study are to compare all-cause and unnatural (suicides and accidents) mortality rates between subjects with bipolar depression (BD) and those with other types of depression (OTD).

METHOD

A cohort of patients diagnosed as clinically depressed between 1999 and 2004 according to the National Health Insurance Dataset (NHID) were followed until the end of 2008. The occurrence of death was identified by the National Mortality Registry (NMR) in Taiwan. Patients in this cohort were further classified into BD and OTD groups. Proportional hazards regression model were used to evaluate the different mortality risks between two groups.

RESULTS

BD (n = 1542) was associated with a significantly greater risk in all-cause mortality (adjusted hazard ratio = 1.3, 95% CI: 1.1, 1.5) than was OTD (n = 17,480), even after controlling for demographic features and comorbid disorders. BD was associated with approximately twice the risk for suicide and accidental death compared with OTD after other variables were held constant. Bipolar depression (v.s. OTD) exerted adjusted hazard ratio 3.76 (95% CI: 2.17, 6.51) in depressed patients with CVD but only aHR 1.43 (95% CI: 0.79, 2.58) in those without CVD.

CONCLUSIONS

Compared with OTD, BD was related to a significantly increased risk for all-cause mortality, suicide, and accidental death. Under the comorbidity with CVD, the risk of suicide was 4-fold times more likely in BD than in OTD. This magnitude of suicide risk among BD patients comorbid with CVD was also higher than those BD without CVD. Thus, patients with both BD and CVD may constitute one of groups at highest risk for suicide and accidental death.

Vascular burden and cognitive functioning in depressed older adults

BACKGROUND

Vascular burden is known to contribute to geriatric depression and cognitive impairment. The objective of our study was to evaluate the relationship between vascular burden and pattern of cognitive impairment in older adults with depression.

METHODS

Ninety-four community-dwelling older adults (mean age = 70.8 years; SD = 7.63) diagnosed with major depression were recruited to participate in the tai chi complementary use study aimed to improve antidepressant response to an antidepressant medication. All participants received comprehensive evaluations of depression, apathy, and vascular risk factors, and completed a battery of cognitive measures of memory, cognitive control, verbal fluency, and attention.

RESULTS

The severity of vascular burden was significantly correlated with depression severity and impaired performance on measures of cognitive control (i.e., inhibition/mental flexibility), and attention, but not memory or verbal fluency. Neither the severity of comorbid apathy nor medical illness burden was related to cognitive impairment.

CONCLUSIONS

Vascular burden in older depressed adults contributes to cognitive impairment, particularly in domains of attention and cognitive control. Our findings suggest that aggressive treatment of vascular risk factors may reduce risk for further cognitive decline in depressed older adults.

A psychometric evaluation of a negative mood scale in the MDS-HC using a large sample of community-dwelling Hong Kong Chinese older adults

BACKGROUND

negative mood is an important construct when assessing the health of older persons. The profile of mood states questionnaire is commonly used to measure mood; however, it might not be suitable for older adults with low education level and those who are not originated North American.

OBJECTIVE

to examine a negative mood scale formed by nine items in the Mood Section of the Minimum Data Set-Home Care of the Resident Assessment Instrument.

METHODS

a secondary analysis of data from 3,523 older persons aged 60 or over who had first applied for the long-term care services in Hong Kong and completed the screening tool in 2006. Exploratory and confirmatory factor analyses were used to test the factor structure and multiple-group confirmatory factor analysis to test the gender invariance of the Negative Mood Scale in the Minimum Data Set-Home Care. Its reliability using Cronbach's alpha was examined.

RESULTS

both a three-factor model at the first level and a one-factor model at the second level provided excellent fits to the overall data, and held equally well for both males and females, and two randomly split samples. Multiple-group confirmatory factor analyses revealed both genders demonstrating an equivalent pattern of factor loadings. Cronbach's alpha value was acceptable for the overall data (0.66).

CONCLUSIONS

the Negative Mood Scale is a reliable and valid scale and both genders responded to it using the same framework and metric, suggesting it could be used to measure negative mood in Chinese community-dwelling older adults. Further testing of the instrument is needed.

Anemia associated with depressive symptoms in mild cognitive impairment with severe white matter hyperintensities

Depression with mild cognitive impairment (MCI) may be associated with a high risk of dementia. Likewise, anemia and subcortical ischemic changes might be associated with depression in the elderly individuals. We examined the relationship between anemia, subcortical ischemic changes, and depressive symptoms in 388 elderly patients with MCI (74.0% women, mean age = 71.8) who were evaluated at the Clinical Research Center for Dementia of South Korea. Blood samples were drawn from all consenting participants and depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). We also evaluated the severity of white matter hyperintensities (WMH) on brain using magnetic resonance imaging (MRI). After a multivariable adjustment, we found no significant differences in GDS-15 score between anemic and nonanemic groups (F = 3.0, P = .085) and among WMH level groups (F = 0.6, P = .574) independently. However, the interaction between anemia and the severity of WMH was significantly associated with depressive symptoms (analysis of covariance, F = 7.8, P < .001). In post hoc tests, a higher depressive symptom score was observed in anemic participants with severe WMH. Anemia with severe subcortical ischemic changes appears to be related to depressive symptoms in patients with MCI.