Late-Life Depression, Antidepressant Treatment, and Cognition: The Short Haul and the Long Haul

Efficacy and Safety of Transcranial Magnetic Stimulation for Treating Late-Life Depression: A Scoping Review

Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, to evaluate the efficacy, safety, and clinical applications of TMS in older adults with depression. Results: The review examines various TMS modalities, including repetitive TMS (rTMS), deep TMS, and theta burst stimulation (TBS), with most protocols targeting the dorsolateral prefrontal cortex (DLPFC). Adverse effects were rare, mild, and transient, supporting the treatment's safety profile. Pharmacological co-treatment was common but not essential for clinical improvement, highlighting TMS's potential as a standalone therapy. A subset of studies used neuroplasticity (SICI, ICF, CSP) or neuroimaging measures (MRI and MRI-based neuronavigation), revealing that age-related cortical inhibition may limit plasticity rather than depression itself. Conclusions: Overall, TMS demonstrates promising effectiveness and tolerability in managing late-life depression. Across studies, remission rates varied from 20% to 63%, with higher efficacy generally observed in bilateral stimulation or high-frequency protocols. Standardization of protocols and further research into individualized targeting and long-term outcomes are warranted to support broader clinical adoption.

Longitudinal associations between late-life depression, cerebrovascular disease and cognition

BACKGROUND

Depression and vascular disease can both be risk factors for cognitive decline. This study assessed whether indicators of vascular disease are associated with depression over time, and whether depression is associated with cognition independent of vascular disease.

METHODS

Participants were 1032 community-dwelling, older adults from the Sydney Memory and Ageing Study. Depressive symptoms were measured on the 15-item Geriatric Depression Scale, and depression trajectories were classified using latent class growth modelling. Global cognition and individual cognitive domains were assessed. Indicators of vascular disease were history of stroke or transient ischaemic attack (TIA) and total white matter hyperintensities (TWMH). Generalised linear mixed modelling assessed whether vascular markers were associated with change in depressive symptoms over time. Linear mixed modelling examined relationships between depression, vascular disease indicators, and cognition.

RESULTS

History of stroke/TIA or TWMH did not predict depression over time (p = 0.11 and p = 0.70). Baseline stroke/TIA history was associated with a decline in attention over time (b = -0.05, p = 0.04). Significant differences between latent depression trajectories classes in cognitive decline were observed, with participants who became depressed over time experiencing decline in global cognition (b = -0.04, p < 0.001), attention (b = -0.05, p < 0.001) and executive function (b = -0.05, p < 0.001), compared to the non-depressed group.

CONCLUSION

Our findings suggest that depression in later life may not precede cognitive decline. Instead, depressive symptoms and cognitive decline, particularly in attention and executive function, may evolve in tandem over time. This reinforces the importance of early identification and treatment of depression in older adults to potentially mitigate cognitive deterioration.

The global, regional, and national late-life depression burden and trends from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Late-life depression (LLD) represents a growing global public health concern. This study aimed to assess the worldwide burden of LLD using comprehensive data.

METHODS

Leveraging the latest evidence from the Global Burden of Disease Study, we analyzed trends in LLD burden from 1990 to 2021, encompassing incidence, prevalence, and disability-adjusted life years (DALYs). We quantified disparities in LLD burden across socioeconomic, gender, regional, and national dimensions. Decomposition analysis was employed to identify key drivers of LLD burden variation. Frontier analysis illustrated the potential for burden reduction in various countries.

RESULTS

Globally, there were 49,137,544 new cases, 46,672,175 prevalent cases, and 7,351,377 DALYs attributed to LLD in 2021. Between 1990 and 2021, the agestandardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), and age-standardised DALYs rate (ASDR) of LLD all rose. In 2021, low SDI regions exhibited the highest all ASRs, while middle SDI regions had the fastest growth rates in these indicators. Regionally, Central and Eastern Sub-Saharan Africa had the highest ASIR, ASPR, and ASDR, respectively. Nationally, Uganda ranked highest in all ASRs in 2021. Women had higher burdens than men. Population growth was a primary driver of DALYs increase in middle SDI regions that had the greatest potential for improvement.

CONCLUSIONS

The global burden of LLD has risen, with marked inequities across SDI, gender, region, and country. The burden is most pronounced in low and middle SDI regions. These findings offer guidance for developing LLD screening guidelines and enhancing prevention and intervention strategies in relevant countries, particularly Uganda.

Assessing the efficacy and safety of combined buspirone and venlafaxine treatment in late-life depression accompanied by cognitive impairment: A randomized controlled trial

BACKGROUND

Late-life depression, often accompanied by cognitive impairment, poses significant clinical challenges owing to its complex etiology and diverse manifestations. While antidepressants like venlafaxine and anxiolytics such as buspirone are effective for treating depression, their effects on cognitive function remain less well-understood. With the aging population increasingly experiencing geriatric depression, there is an urgent need for innovative treatment approaches that address both depressive symptoms and cognitive impairments.

OBJECTIVE

This study aimed to evaluate the clinical efficacy and safety of combined buspirone and venlafaxine therapy in elderly patients diagnosed with geriatric depression accompanied by cognitive impairment.

METHODS

A 12-week, randomized controlled trial was conducted involving 170 elderly patients. Participants were randomized into two groups: one receiving venlafaxine alone (control group) and the other receiving a combination of venlafaxine and buspirone (experimental group). The primary analysis was performed using an Intent-to-Treat (ITT) approach with mixed-effects linear models to assess changes in depressive symptoms, cognitive function, and anxiety levels. A supplementary Per-Protocol (PP) analysis, utilizing repeated measures ANOVA, was also conducted.

RESULTS

The ITT analysis showed that the combination therapy significantly reduced depressive symptoms, as indicated by the HAMD-17 scores (p = 0.033 at week 12). Cognitive function, as measured by MoCA scores, also improved significantly in the experimental group by week 12 (p = 0.025). However, no statistically significant differences were observed in anxiety reduction between the groups (p = 0.127). The PP analysis confirmed these findings, demonstrating consistent improvements in depressive symptoms and cognitive function, particularly in those who completed the full course of treatment. The incidence of adverse events was comparable between groups, primarily mild and manageable symptoms like dry mouth, dizziness, and fatigue.

CONCLUSION

The combination of buspirone and venlafaxine was found to be effective in reducing depressive symptoms and enhancing cognitive function in elderly patients with geriatric depression. However, the long-term benefits, especially regarding anxiety reduction, require further investigation. Future studies should consider larger sample sizes, longer follow-up periods, and the inclusion of placebo controls to fully assess the efficacy and safety of this treatment approach.