1
|
Taylor WD, Ajilore O, Karim HT, Butters MA, Krafty R, Boyd BD, Banihashemi L, Szymkowicz SM, Ryan C, Hassenstab J, Landman BA, Andreescu C. Assessing depression recurrence, cognitive burden, and neurobiological homeostasis in late life: Design and rationale of the REMBRANDT Study. J Mood Anxiety Disord 2024; 5:100038. [PMID: 38523701 PMCID: PMC10959248 DOI: 10.1016/j.xjmad.2023.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background Late-life depression is characterized by disability, cognitive impairment and decline, and a high risk of recurrence following remission. Aside from past psychiatric history, prognostic neurobiological and clinical factors influencing recurrence risk are unclear. Moreover, it is unclear if cognitive impairment predisposes to recurrence, or whether recurrent episodes may accelerate brain aging and cognitive decline. The purpose of the REMBRANDT study (Recurrence markers, cognitive burden, and neurobiological homeostasis in late-life depression) is to better elucidate these relationships and identify phenotypic, cognitive, environmental, and neurobiological factors contributing to and predictive of depression recurrence. Methods Across three sites, REMBRANDT will enroll 300 depressed elders who will receive antidepressant treatment. The goal is to enroll 210 remitted depressed participants and 75 participants with no mental health history into a two-year longitudinal phase focusing on depression recurrence. Participants are evaluated every 2 months with deeper assessments occurring every 8 months, including structural and functional neuroimaging, environmental stress assessments, deep symptom phenotyping, and two weeks of 'burst' ecological momentary assessments to elucidate variability in symptoms and cognitive performance. A broad neuropsychological test battery is completed at the beginning and end of the longitudinal study. Significance REMBRANDT will improve our understanding of how alterations in neural circuits and cognition that persist during remission contribute to depression recurrence vulnerability. It will also elucidate how these processes may contribute to cognitive impairment and decline. This project will obtain deep phenotypic data that will help identify vulnerability and resilience factors that can help stratify individual clinical risk.
Collapse
Affiliation(s)
- Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL
| | - Helmet T. Karim
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA
| | - Brian D. Boyd
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sarah M. Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Claire Ryan
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN
| | - Jason Hassenstab
- Departments of Neurology and Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Bennett A. Landman
- Departments of Computer Science, Electrical Engineering, and Biomedical Engineering, Vanderbilt University; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| |
Collapse
|
2
|
Szymkowicz SM, May PE, Weeks JW, O'Connell D, Nelson Sheese AL. Psychometric properties of the Montreal Cognitive Assessment (MoCA) in inpatient liver transplant candidates. Appl Neuropsychol Adult 2024; 31:19-26. [PMID: 34622723 DOI: 10.1080/23279095.2021.1986510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hepatic encephalopathy (HE) is a consequence of liver disease and often diagnosed via psychometric testing. With inpatients, the Montreal Cognitive Assessment (MoCA) may be used as part of cognitive screening for transplant candidacy. However, the MoCA was developed to detect mild cognitive impairment in aging populations and its psychometric properties in inpatients with liver disease have not been determined. Retrospective chart review identified inpatient liver transplant candidates who were administered a MoCA as part of their neuropsychological screening and had either no cognitive dysfunction or a diagnosis of HE made by a neuropsychologist (n = 57, mean age = 48.8 ± 12.6 years). Psychometric analyses were conducted and regression analysis was performed to determine the predictive value of different variables on total MoCA scores. Internal consistency of MoCA domain scores was good (α = 0.80). Significant inverse relationships were found with Trail Making Test, Parts A and B (r's = -0.43 and -0.71, respectively). A cutoff score of 24 or below had the best sensitivity (0.72) and specificity (0.77) for identifying those with a diagnosis of HE. Increasing age and the presence of altered mental status were the strongest predictors of lower MoCA scores (both p's < 0.05, ηp2 = 0.10-0.14). The MoCA is appropriate to use with inpatient liver transplant candidates, with a cutoff of 24 or below to detect abnormal cognition. In addition to the clinical interview and other neuropsychological tests (including, but not limited to, the Trail Making Test, Parts A and B), low MoCA scores can help determine the presence of HE.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela E May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Justin W Weeks
- Department of Psychology, Nebraska Medicine, Omaha, NE, USA
| | - Debra O'Connell
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amelia L Nelson Sheese
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
3
|
Sudol K, Conway C, Szymkowicz SM, Elson D, Kang H, Taylor WD. Cognitive, Disability, and Treatment Outcome Implications of Symptom-Based Phenotyping in Late-Life Depression. Am J Geriatr Psychiatry 2023; 31:919-931. [PMID: 37385899 PMCID: PMC10592463 DOI: 10.1016/j.jagp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Late-life depression is associated with substantial heterogeneity in clinical presentation, disability, and response to antidepressant treatment. We examined whether self-report of severity of common symptoms, including anhedonia, apathy, rumination, worry, insomnia, and fatigue were associated with differences in presentation and response to treatment. We also examined whether these symptoms improved during treatment with escitalopram. DESIGN Eighty-nine older adults completed baseline assessments, neuropsychological testing and providing self-reported symptom and disability scales. They then entered an 8-week, placebo-controlled randomized trial of escitalopram, and self-report scales were repeated at the trial's end. Raw symptom scale scores were combined into three standardized symptom phenotypes and models examined how symptom phenotype severity was associated with baseline measures and depression improvement over the trial. RESULTS While rumination/worry appeared independent, severity of apathy/anhedonia and fatigue/insomnia were associated with one another and with greater self-reported disability. Greater fatigue/insomnia was also associated with slower processing speed, while rumination/worry was associated with poorer episodic memory. No symptom phenotype severity score predicted a poorer overall response to escitalopram. In secondary analyses, escitalopram did not improve most phenotypic symptoms more than placebo, aside for greater reductions in worry and total rumination severity. CONCLUSION Deeper symptom phenotype characterization may highlight differences in the clinical presentation of late-life depression. However, when compared to placebo, escitalopram did not improve many of the symptoms assessed. Further work is needed to determine whether symptom phenotypes inform longer-term course of illness, and which treatments may best benefit specific symptoms.
Collapse
Affiliation(s)
- Katherin Sudol
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Conway
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah M Szymkowicz
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Damian Elson
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Hakmook Kang
- Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN
| | - Warren D Taylor
- The Vanderbilt Center for Cognitive Medicine (KS, CC, SMS, DE, WDT), Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN; Geriatric Research (WDT), Education and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN.
| |
Collapse
|
4
|
Ahmed R, Boyd BD, Elson D, Albert K, Begnoche P, Kang H, Landman BA, Szymkowicz SM, Andrews P, Vega J, Taylor WD. Influences of resting-state intrinsic functional brain connectivity on the antidepressant treatment response in late-life depression. Psychol Med 2023; 53:6261-6270. [PMID: 36482694 PMCID: PMC10250562 DOI: 10.1017/s0033291722003579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Late-life depression (LLD) is characterized by differences in resting state functional connectivity within and between intrinsic functional networks. This study examined whether clinical improvement to antidepressant medications is associated with pre-randomization functional connectivity in intrinsic brain networks. METHODS Participants were 95 elders aged 60 years or older with major depressive disorder. After clinical assessments and baseline MRI, participants were randomized to escitalopram or placebo with a two-to-one allocation for 8 weeks. Non-remitting participants subsequently entered an 8-week trial of open-label bupropion. The main clinical outcome was depression severity measured by MADRS. Resting state functional connectivity was measured between a priori key seeds in the default mode (DMN), cognitive control, and limbic networks. RESULTS In primary analyses of blinded data, lower post-treatment MADRS score was associated with higher resting connectivity between: (a) posterior cingulate cortex (PCC) and left medial prefrontal cortex; (b) PCC and subgenual anterior cingulate cortex (ACC); (c) right medial PFC and subgenual ACC; (d) right orbitofrontal cortex and left hippocampus. Lower post-treatment MADRS was further associated with lower connectivity between: (e) the right orbitofrontal cortex and left amygdala; and (f) left dorsolateral PFC and left dorsal ACC. Secondary analyses associated mood improvement on escitalopram with anterior DMN hub connectivity. Exploratory analyses of the bupropion open-label trial associated improvement with subgenual ACC, frontal, and amygdala connectivity. CONCLUSIONS Response to antidepressants in LLD is related to connectivity in the DMN, cognitive control and limbic networks. Future work should focus on clinical markers of network connectivity informing prognosis. REGISTRATION ClinicalTrials.gov NCT02332291.
Collapse
Affiliation(s)
- Ryan Ahmed
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Brian D. Boyd
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Damian Elson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Kimberly Albert
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Patrick Begnoche
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A. Landman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Sarah M. Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Patricia Andrews
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Jennifer Vega
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, The Vanderbilt Center for Cognitive Medicine, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| |
Collapse
|
5
|
Szymkowicz SM, Gerlach AR, Homiack D, Taylor WD. Biological factors influencing depression in later life: role of aging processes and treatment implications. Transl Psychiatry 2023; 13:160. [PMID: 37160884 PMCID: PMC10169845 DOI: 10.1038/s41398-023-02464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Late-life depression occurring in older adults is common, recurrent, and malignant. It is characterized by affective symptoms, but also cognitive decline, medical comorbidity, and physical disability. This behavioral and cognitive presentation results from altered function of discrete functional brain networks and circuits. A wide range of factors across the lifespan contributes to fragility and vulnerability of those networks to dysfunction. In many cases, these factors occur earlier in life and contribute to adolescent or earlier adulthood depressive episodes, where the onset was related to adverse childhood events, maladaptive personality traits, reproductive events, or other factors. Other individuals exhibit a later-life onset characterized by medical comorbidity, pro-inflammatory processes, cerebrovascular disease, or developing neurodegenerative processes. These later-life processes may not only lead to vulnerability to the affective symptoms, but also contribute to the comorbid cognitive and physical symptoms. Importantly, repeated depressive episodes themselves may accelerate the aging process by shifting allostatic processes to dysfunctional states and increasing allostatic load through the hypothalamic-pituitary-adrenal axis and inflammatory processes. Over time, this may accelerate the path of biological aging, leading to greater brain atrophy, cognitive decline, and the development of physical decline and frailty. It is unclear whether successful treatment of depression and avoidance of recurrent episodes would shift biological aging processes back towards a more normative trajectory. However, current antidepressant treatments exhibit good efficacy for older adults, including pharmacotherapy, neuromodulation, and psychotherapy, with recent work in these areas providing new guidance on optimal treatment approaches. Moreover, there is a host of nonpharmacological treatment approaches being examined that take advantage of resiliency factors and decrease vulnerability to depression. Thus, while late-life depression is a recurrent yet highly heterogeneous disorder, better phenotypic characterization provides opportunities to better utilize a range of nonspecific and targeted interventions that can promote recovery, resilience, and maintenance of remission.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Damek Homiack
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
| | - Warren D Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, Nashville, TN, USA.
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA.
| |
Collapse
|
6
|
Szymkowicz SM, Ryan C, Elson DM, Kang H, Taylor WD. Cognitive phenotypes in late-life depression. Int Psychogeriatr 2023; 35:193-205. [PMID: 35766159 PMCID: PMC9797624 DOI: 10.1017/s1041610222000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify cognitive phenotypes in late-life depression (LLD) and describe relationships with sociodemographic and clinical characteristics. DESIGN Observational cohort study. SETTING Baseline data from participants recruited via clinical referrals and community advertisements who enrolled in two separate studies. PARTICIPANTS Non-demented adults with LLD (n = 120; mean age = 66.73 ± 5.35 years) and non-depressed elders (n = 56; mean age = 67.95 ± 6.34 years). MEASUREMENTS All completed a neuropsychological battery, and individual cognitive test scores were standardized across the entire sample without correcting for demographics. Five empirically derived cognitive domain composites were created, and cluster analytic approaches (hierarchical, k-means) were independently conducted to classify cognitive patterns in the depressed cohort only. Baseline sociodemographic and clinical characteristics were then compared across groups. RESULTS A three-cluster solution best reflected the data, including "High Normal" (n = 47), "Reduced Normal" (n = 35), and "Low Executive Function" (n = 37) groups. The "High Normal" group was younger, more educated, predominantly Caucasian, and had fewer vascular risk factors and higher Mini-Mental Status Examination compared to "Low Executive Function" group. No differences were observed on other sociodemographic or clinical characteristics. Exploration of the "High Normal" group found two subgroups that only differed in attention/working memory performance and length of the current depressive episode. CONCLUSIONS Three cognitive phenotypes in LLD were identified that slightly differed in sociodemographic and disease-specific variables, but not in the quality of specific symptoms reported. Future work on these cognitive phenotypes will examine relationships to treatment response, vulnerability to cognitive decline, and neuroimaging markers to help disentangle the heterogeneity seen in this patient population.
Collapse
Affiliation(s)
- Sarah M. Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Claire Ryan
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Damian M. Elson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| |
Collapse
|
7
|
Hemphill L, Valenzuela Y, Luna K, Szymkowicz SM, Jones JD. Synergistic Associations of Depressive Symptoms and Aging on Cognitive Decline in Early Parkinson’s Disease. Clin Park Relat Disord 2023; 8:100192. [PMID: 36968523 PMCID: PMC10034501 DOI: 10.1016/j.prdoa.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
Objective Parkinson's disease (PD) is the second most common progressive neurodegenerative disorder. About 40%-50% of PD patients experience depression, making it one of the most common neuropsychiatric disturbances in PD. Cognitive deficits (e.g., difficulties with memory, attention) are an additional common complication in PD. Past studies among healthy aging individuals suggest that depression is a risk factor for cognitive decline, and the risk increases with older age. This study aims to examine the association between depressive symptoms on cognitive decline as a function of age among patients with PD. It is hypothesized that older PD patients with more severe depressive symptoms will be at greater risk of cognitive decline than their younger or less depressed counterparts. Methods Four hundred and eighty-seven newly diagnosed patients with PD, were assessed for depression and cognition over a five-year period. Participants completed neuropsychological tests that assessed memory, learning, attention, visuospatial functioning, processing speed, and verbal fluency. Multilevel-modeling was used to examine the longitudinal association between cognition, age, and depressive symptoms. Results Our results indicated a significant three-way interaction (age X occasion X depressive symptoms) predicting language and working memory/attention performance. More specifically, detrimental associations of depressive symptoms on cognitive decline in these domains were more pronounced among older adults. Conclusions Our findings support that older PD patients with comorbid depressive symptoms experience greater cognitive decline compared to their younger counterparts. Findings suggest that older individuals with PD may be more vulnerable to neurotoxic effects of depression (e.g., neuroinflammation, HPA axis disruption), and better management of depression could potentially reduce cognitive decline and dementia risk.
Collapse
Affiliation(s)
- Lea Hemphill
- California State University San Bernardino, San Bernardino, CA, USA
| | - Yenny Valenzuela
- California State University San Bernardino, San Bernardino, CA, USA
| | - Kenya Luna
- California State University San Bernardino, San Bernardino, CA, USA
| | - Sarah M. Szymkowicz
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob D. Jones
- California State University San Bernardino, San Bernardino, CA, USA
- Corresponding author.
| |
Collapse
|
8
|
Vega JN, Newhouse PA, Conley AC, Szymkowicz SM, Gong X, Cote S, Mayer I, Taylor WD, Morimoto SS. Use of focused computerized cognitive training (Neuroflex) to improve symptoms in women with persistent chemotherapy-related cognitive impairment. Digit Health 2023; 9:20552076231192754. [PMID: 37588161 PMCID: PMC10426301 DOI: 10.1177/20552076231192754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose Chemotherapy-related cognitive impairment (CRCI) is a distressing and increasingly recognized long-term sequela reported by breast cancer patients following cancer treatment. There is an urgent but unmet clinical need for treatments that improve CRCI. In this context, we proposed the use of a novel cognitive enhancement strategy called Neuroflex to target CRCI experienced by breast cancer survivors. Methods The primary aim of this pilot study was to evaluate the feasibility and acceptability of Neuroflex, a novel digital cognitive enhancement strategy, in breast and gynecologic cancer survivors with CRCI. Secondary analyses focused on whether improvements in performance on Neuroflex were associated with improvement in subjective cognitive complaints and objective cognitive performance measures. Results Participants (N = 21) completed an average of 7.42 hours of Neuroflex training per week, an average of 44.5 (±1.01) hours total, and had a 100% completion rate. Participants exhibited significant improvement in self-reported cognitive function as well as significant improvement on tasks of verbal learning and memory and auditory working memory. Participants also exhibited improvement in mood, as well as improvement on a disability assessment. Conclusions Results demonstrate feasibility and that breast cancer survivors are capable of completing a lengthy and challenging cognitive training program. Secondly, Neuroflex may confer specific cognitive benefits to both self-reported and objective performance. Results strongly support further investigation of Neuroflex in a larger controlled trial to establish efficacy for CRCI symptoms. Further studies may also result in optimization of this digital intervention for women with CRCI.
Collapse
Affiliation(s)
- Jennifer N. Vega
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Alexander C. Conley
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Szymkowicz
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Xuewen Gong
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cote
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ingrid Mayer
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt–Ingram Cancer Center, Nashville, TN, USA
| | - Warren D. Taylor
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Sarah Shizuko Morimoto
- Department of Population Health Sciences, Division of Health Systems Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Ahmed R, Ryan C, Christman S, Elson D, Bermudez C, Landman BA, Szymkowicz SM, Boyd BD, Kang H, Taylor WD. Structural MRI-Based Measures of Accelerated Brain Aging do not Moderate the Acute Antidepressant Response in Late-Life Depression. Am J Geriatr Psychiatry 2022; 30:1015-1025. [PMID: 34949526 PMCID: PMC9142760 DOI: 10.1016/j.jagp.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Late-life depression (LLD) is characterized by accelerated biological aging. Accelerated brain aging, estimated from structural magnetic resonance imaging (sMRI) data by a machine learning algorithm, is associated with LLD diagnosis, poorer cognitive performance, and disability. We hypothesized that accelerated brain aging moderates the antidepressant response. DESIGN AND INTERVENTIONS Following MRI, participants entered an 8-week randomized, controlled trial of escitalopram. Nonremitting participants then entered an open-label 8-week trial of bupropion. PARTICIPANTS Ninety-five individuals with LLD. MEASUREMENTS A machine learning algorithm estimated each participant's brain age from sMRI data. This was used to calculate the brain-age gap (BAG), or how estimated age differed from chronological age. Secondary sMRI measures of aging pathology included white matter hyperintensity (WMH) volumes and hippocampal volumes. Mixed models examined the relationship between sMRI measures and change in depression severity. Initial analyses tested for a moderating effect of MRI measures on change in depression severity with escitalopram. Subsequent analyses tested for the effect of MRI measures on change in depression severity over time across trials. RESULTS In the blinded initial phase, BAG was not significantly associated with a differential response to escitalopram over time. BAG was also not associated with a change in depression severity over time across both arms in the blinded phase or in the subsequent open-label bupropion phase. We similarly did not observe effects of WMH volume or hippocampal volume on change in depression severity over time. CONCLUSION sMRI markers of accelerated brain aging were not associated with treatment response in this sequential antidepressant trial.
Collapse
Affiliation(s)
- Ryan Ahmed
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Claire Ryan
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Seth Christman
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Damian Elson
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Camilo Bermudez
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Bennett A Landman
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Sarah M Szymkowicz
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Brian D Boyd
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Hakmook Kang
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN
| | - Warren D Taylor
- School of Medicine (RA), Vanderbilt University, Nashville, TN; Department of Psychiatry and Behavioral Sciences (SC, DE, BAL, SMS, BDB, WDT), Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Engineering (CB, BAL), Vanderbilt University, Nashville TN; Department of Electrical Engineering and Computer Science (BAL), Vanderbilt University, Nashville, TN; Department of Biostatistics (HK), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education, and Clinical Center (WDT), Veterans Affairs Tennessee Valley Health System, Nashville, TN.
| |
Collapse
|
10
|
Szymkowicz SM, Jones JD, Timblin H, Ryczek CA, Taylor WD, May PE. Apathy as a Within-Person Mediator of Depressive Symptoms and Cognition in Parkinson's Disease: Longitudinal Mediation Analyses. Am J Geriatr Psychiatry 2022; 30:664-674. [PMID: 34922823 PMCID: PMC9106826 DOI: 10.1016/j.jagp.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Greater depressive symptoms are associated with worse cognitive functions in Parkinson's disease (PD); however, it is unclear what underlying factors drive this association. Apathy commonly develops in PD and may be a pathway through which depressive symptoms negatively influence cognition. Prior research examining depressive symptoms, apathy, and cognition in PD is limited by being predominantly cross-sectional. This study examined the role of apathy as a within- and between-person mediator for the longitudinal relationships between depression severity and cognitive functioning in patients with early PD. METHODS Participants included 487 individuals newly diagnosed with PD followed annually for up to 5 years by the Parkinson's Progression Marker Initiative. At each visit, participants completed depressive symptom measures, apathy ratings, and cognitive tests. Multi-level structural equation models examined both the within- and between-person effects of depressive symptoms on cognition through apathy, controlling for demographics and motor severity. RESULTS At the within-person level, apathy mediated the association between depressive symptoms and select cognitive functions (global cognition, attention/working memory, visuospatial functions, and immediate verbal memory; indirect effects, bootstrap p's <0.05). Significant between-person direct effects were found for depressive symptoms predicting apathy (boostrap p <0.001) and lower scores on most cognitive tests (bootstrap p's <0.05). However, the indirect effects did not reach significance, suggesting between-person mediation did not occur. CONCLUSION Findings suggest worsening of depressive symptoms over time in patients with PD may be a risk factor for increased apathy and subsequent decline in specific cognitive functions.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Psychiatry and Behavioral Sciences (SMS, WDT), Vanderbilt University Medical Center, Nashville, TN.
| | - Jacob D Jones
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Holly Timblin
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Cameron A Ryczek
- Department of Psychology (JDJ, HT, CAR), California State University San Bernardino, San Bernardino, CA
| | - Warren D Taylor
- Department of Psychiatry and Behavioral Sciences (SMS, WDT), Vanderbilt University Medical Center, Nashville, TN
| | - Pamela E May
- Department of Neurological Sciences (PEM), University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
11
|
Szymkowicz SM, Ellis LJ, May PE. The 3-Item "Apathy" Subscale Within the GDS-15 Is Not Supported in De Novo Parkinson's Disease Patients: Analysis of the PPMI Cohort. J Geriatr Psychiatry Neurol 2022; 35:309-316. [PMID: 33461367 PMCID: PMC9637029 DOI: 10.1177/0891988720988908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined individual components of the Geriatric Depression Scale-15 (GDS-15) to determine whether the 3-item Withdrawal-Apathy-Lack of Vigor (WAV) subscale, which has been validated in older adults and advanced Parkinson's disease (PD), was applicable to newly diagnosed patients with PD. Baseline Parkinson's Progression Markers Initiative (PPMI) data (n = 345), including GDS-15 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) depression, apathy, and anxiety scores, were examined. Data reduction techniques (i.e., principal components, confirmatory factor analyses) were used. Model fit was poor for the previously identified GDS-15 factor structures. Via principal components analysis, 5 components were identified, none of which reflected the 3-item WAV subscale previously reported in the literature. Internal consistency of the GDS-15 was acceptable, as was the internal consistency for the largest component (labeled "Dysphoria"). All 5 components significantly correlated with the MDS-UPDRS depression, apathy, and anxiety items. Model fit was fair for the "Dysphoria" factor only. Overall, the 3-item WAV factor reported in previous literature was not supported in this sample of de novo PD patients.
Collapse
Affiliation(s)
- Sarah M. Szymkowicz
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Pamela E. May
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
12
|
Szymkowicz SM, Taylor WD, Woods AJ. Augmenting cognitive training with bifrontal tDCS decreases subclinical depressive symptoms in older adults: Preliminary findings. Brain Stimul 2022; 15:1037-1039. [PMID: 35931378 PMCID: PMC9637028 DOI: 10.1016/j.brs.2022.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Sarah M. Szymkowicz
- Corresponding author. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN, 37212, USA. Tel.: +1 615-875-0032; fax: +1 615 875 0686. (S.M. Szymkowicz)
| | - Warren D. Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA; Deparment of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Department of Neuroscience, University of Florida, Gainesville, FL, USA
| |
Collapse
|
13
|
Szymkowicz SM, Dotson VM, Vanderploeg RD. Weak associations between depressive symptom severity, depressive symptom clusters, and cognitive performance in young to middle-aged men without clinical depression. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020; 28:921-935. [PMID: 33119426 DOI: 10.1080/13825585.2020.1840505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence suggests different depressive symptoms are related to specific aspects of cognition, especially in older adults. The current study extended this literature by examining depressive symptom severity, symptom clusters, and cognitive functioning in young-to-middle aged adults. A sample of 2,560 men (mean age = 38.12 ± 2.41 years) withvalid Minnesota Multiphasic Personality Inventories (MMPI) and completed cognitive measures was drawn from a Vietnam veterans study. Bootstrapped regressions examined relationships between cognitive performance, MMPI Depression scores, and Harris-Lingoes depression subscales after covariate adjustments. Follow-up analyses investigated non-elevated and elevated depressive symptom groups. We found inverse relationships between specific subscales (Subjective Depression and Mental Dullness) and attentional control. No significant relationships were evident for total depressive symptoms or for the group analyses. Findings suggest weak associations between depressive symptoms and cognition in young to middle-aged men without clinical depression, which adds to the literature on inconsistent findings in depressive symptom-cognition relationships.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, GA, USA.,Gerontology Institute, Georgia State University, Atlanta, GA, USA
| | - Rodney D Vanderploeg
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| |
Collapse
|
14
|
Jones JD, Kurniadi NE, Kuhn TP, Szymkowicz SM, Bunch J, Rahmani E. Depressive symptoms precede cognitive impairment in de novo Parkinson's disease patients: Analysis of the PPMI cohort. Neuropsychology 2019; 33:1111-1120. [PMID: 31343240 PMCID: PMC6823115 DOI: 10.1037/neu0000583] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Nonmotor symptoms, including depression, anxiety, apathy, and cognitive dysfunction, are common in Parkinson's disease (PD). Although a link between mood symptoms and cognitive impairment in PD has been theorized vis-à-vis striatal dopamine depletion, studies have been inconsistent regarding the relationship between mood symptoms and cognitive function. Inconsistencies may reflect the cross-sectional nature of previous studies. The current study examined the bidirectional longitudinal relationship between mood and cognition. METHOD Data were obtained from 310 individuals newly diagnosed with PD, who were followed up to 4 years (baseline, 1st, 2nd, 3rd, and 4th annual follow-ups). Apathy, anxiety, depressive symptoms, motor severity, and neurocognitive functioning were assessed at each annual assessment. The longitudinal relationship between apathy, anxiety, depressive symptoms, and cognition was analyzed with multilevel models. RESULTS Over the 4-year period, more severe depressive symptoms were related to worse performance on tasks of processing speed, verbal learning, and verbal delayed recall. Additionally, there was a significant Depression × Time interaction, suggesting that individuals with more severe depressive symptoms experience more rapid declines in global cognitive functioning and verbal learning. Apathy and anxiety were not significantly related to performance in any cognitive test. Lagged models revealed that changes in depression precede declines in working memory, verbal learning, delayed verbal recall, and global cognition. CONCLUSION Findings suggest depressive symptoms may be a harbinger for future cognitive decline among individuals with PD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
15
|
Szymkowicz SM, Woods AJ, Dotson VM, Porges EC, Nissim NR, O’Shea A, Cohen RA, Ebner NC. Associations between subclinical depressive symptoms and reduced brain volume in middle-aged to older adults. Aging Ment Health 2019; 23:819-830. [PMID: 29381390 PMCID: PMC6066456 DOI: 10.1080/13607863.2018.1432030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The associations between subclinical depressive symptoms, as well specific symptom subscales, on brain structure in aging are not completely elucidated. This study investigated the extent to which depressive symptoms were related to brain volumes in fronto-limbic structures in a sample of middle-aged to older adults. METHOD Eighty participants underwent structural neuroimaging and completed the Beck Depression Inventory, 2nd Edition (BDI-II), which comprises separate affective, cognitive, and somatic subscales. Gray matter volumes were extracted from the caudal and rostral anterior cingulate, posterior cingulate, hippocampus, and amygdala. Hierarchical regression models examined the relationship between brain volumes and (i) total depressive symptoms and (ii) BDI-II subscales were conducted. RESULTS After adjusting for total intracranial volume, race, and age, higher total depressive symptoms were associated with smaller hippocampal volume (p = 0.005). For the symptom subscales, after controlling for the abovementioned covariates and the influence of the other symptom subscales, more somatic symptoms were related to smaller posterior cingulate (p = 0.025) and hippocampal (p < 0.001) volumes. In contrast, the affective and cognitive subscales were not associated with brain volumes in any regions of interest. CONCLUSION Our data showed that greater symptomatology was associated with smaller volume in limbic brain regions. These findings provide evidence for preclinical biological markers of major depression and specifically advance knowledge of the relationship between subclinical depressive symptoms and brain volume. Importantly, we observed variations by specific depressive symptom subscales, suggesting a symptom-differential relationship between subclinical depression and brain volume alterations in middle-aged and older individuals.
Collapse
Affiliation(s)
- Sarah M. Szymkowicz
- Sarah M. Szymkowicz, M.S., 1Department of Clinical & Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610-0165. Phone: +1 (352) 273-6058.
| | - Adam J. Woods
- Adam J. Woods, Ph.D., 1Department of Clinical & Health Psychology, University of Florida, 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida, P.O. Box 100015, Gainesville, FL, 32610-0015, 3Department of Neuroscience, University of Florida, P.O. Box 100244, Gainesville, FL, 32610-0244. Phone: +1 (352) 294-5842.
| | - Vonetta M. Dotson
- Vonetta M. Dotson, Ph.D., 4Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010. Phone: +1 (404) 413-6207.
| | - Eric C. Porges
- Eric C. Porges, Ph.D., 1Department of Clinical & Health Psychology, University of Florida, 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida. Phone: +1 (352) 294-5838.
| | - Nicole R. Nissim
- Nicole R. Nissim, M.S., 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida, 3Department of Neuroscience, University of Florida. Phone: +1 (352) 294-5742.
| | - Andrew O’Shea
- Andrew O’Shea, M.S., 1Department of Clinical & Health Psychology, University of Florida, 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida. Phone: +1 (352) 294-5827.
| | - Ronald A. Cohen
- Ronald A. Cohen, Ph.D., 1Department of Clinical & Health Psychology, University of Florida, 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida. Phone: +1 (352) 294-5840.
| | - Natalie C. Ebner
- Natalie C. Ebner, Ph.D., 2Center for Cognitive Aging & Memory, McKnight Brain Institute, University of Florida, 5Department of Psychology, University of Florida, P.O. Box 112250, Gainesville, FL, 32611, 6Department of Aging & Geriatric Research, University of Florida, 2004 Mowry Road, Gainesville, FL, 32611. Phone: +1 (203) 691-0371.
| |
Collapse
|
16
|
Abstract
OBJECTIVES Both depression and apathy, alone and in combination, have been shown to negatively affect cognition in patients with Parkinson's disease (PD). However, the influence of specific symptom dimensions of depression and apathy on cognition is not well understood. The current study investigated the relationship between symptom dimensions of depression and apathy, based on factors identified in Kirsch-Darrow et al. (2011), and memory and executive function in PD. METHODS A sample of 138 non-demented individuals with PD (mean age=64.51±7.43 years) underwent neuropsychological testing and completed the Beck Depression Inventory, 2nd Edition, and Apathy Scale. Separate hierarchical regression models examined the relationship between symptom dimensions of depression and apathy ("pure" depressive symptoms, "pure" apathy, loss of interest/pleasure [anhedonia], and somatic symptoms) and three cognitive domain composites: immediate verbal memory, delayed verbal memory, and executive function. RESULTS After adjusting for general cognitive status and the influence of the other symptom dimensions, "pure" depressive symptoms were negatively associated with the delayed verbal memory composite (p<.034) and somatic symptoms were positively associated with the executive function composite (p<.026). No symptom dimensions were significantly related to the immediate verbal memory composite. CONCLUSIONS Findings suggest that specific mood symptoms are associated with delayed verbal memory and executive function performance in non-demented patients with PD. Further research is needed to better understand possible mechanisms through which specific symptom dimensions of depression and apathy are associated with cognition in PD. (JINS, 2018, 24, 269-282).
Collapse
Affiliation(s)
- Sarah M. Szymkowicz
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Vonetta M. Dotson
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jacob D. Jones
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
| | - Michael S. Okun
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- Center for Movement Disorders & Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
- Center for Movement Disorders & Neurorestoration, College of Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
17
|
Jones JD, Kuhn TP, Szymkowicz SM. Reverters from PD-MCI to cognitively intact are at risk for future cognitive impairment: Analysis of the PPMI cohort. Parkinsonism Relat Disord 2018; 47:3-7. [PMID: 29233608 PMCID: PMC5803409 DOI: 10.1016/j.parkreldis.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Past studies have shown that a large portion of individuals with Parkinson's disease (PD) and mild cognitive impairment (MCI) will revert to a cognitively intact (CI) status in the future. Aging studies have shown that individuals who revert from MCI to CI are at increased risk for reconverting to MCI or dementia in the future. The current study examined if individuals who revert from PD-mild cognitive impairment (PD-MCI) to CI will be at increased risk for future PD-MCI and Parkinson's disease dementia (PDD). METHOD The study utilized data from the Parkinson's Progression Markers Initiative (PPMI). The sample included 364 newly diagnosed PD participants who were followed annually for up to 4 years. Based on the first and second assessments, we identified individuals who were CI at each assessment (CI-Stable) and individuals who were PD-MCI at baseline but then reverted to CI (Reversion). Analyses examined if participants in the Reversion group were at greater risk, relative to the CI-Stable group, for cognitive impairment at future assessments. RESULTS Participants in the Reversion group were at greater risk for future cognitive impairment (PD-MCI or PDD) at the 2nd, 3rd and 4th annual follow-up, relative to the CI-Stable group. The Reversion group continued to be at increased risk for future cognitive impairment when adjusting for age, gender, education, depressive symptoms, and motor severity. CONCLUSION A large proportion of individuals with PD-MCI will not show evidence of cognitive impairment within a year. However, these "reverters" continue to be at risk for future development of cognitive impairment.
Collapse
Affiliation(s)
- Jacob D Jones
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Taylor P Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah M Szymkowicz
- Department of Clinical & Health Psychology, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| |
Collapse
|
18
|
Szymkowicz SM, Dotson VM, McLaren ME, De Wit L, O'Shea DM, Talty FT, O'Shea A, Porges EC, Cohen RA, Woods AJ. Precuneus abnormalities in middle-aged to older adults with depressive symptoms: An analysis of BDI-II symptom dimensions. Psychiatry Res 2017; 268:9-14. [PMID: 28837829 PMCID: PMC5593781 DOI: 10.1016/j.pscychresns.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/28/2017] [Accepted: 08/11/2017] [Indexed: 12/11/2022]
Abstract
We recently reported age-related increases in left precuneus cortical thickness (CT) in older adults with elevated total depressive symptoms. However, it is unclear whether abnormalities in precuneus surface area (SA) are also evident and whether specific symptom dimensions of depression moderated age effects on these measurements. Seventy-three adults completed the Beck Depression Inventory - 2nd edition (BDI-II) and underwent structural neuroimaging. Measures of CT and SA were extracted from the right and left precuneus via FreeSurfer. Regression models included regions of interest as dependent variables, with age, BDI-II subscale scores (e.g., affective, cognitive, and somatic symptoms), and their interactions as independent variables, controlling for mean hemispheric thickness (for CT) or total intracranial volume (for SA). A significant age × somatic symptom interaction was found for left precuneus CT, such that elevated levels of somatic symptoms were significantly associated with age-related cortical thinning. No depressive symptom dimensions moderated the relationship between age and SA, suggesting that CT may be a more sensitive measure of brain abnormalities in middle-aged to older adults with depressive symptoms.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
| | - Vonetta M Dotson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Department of Neuroscience, University of Florida, Gainesville, FL, USA
| | - Molly E McLaren
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deirdre M O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Francis T Talty
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Andrew O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; Department of Neuroscience, University of Florida, Gainesville, FL, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
19
|
McLaren ME, Szymkowicz SM, O'Shea A, Woods AJ, Anton SD, Dotson VM. Vertex-wise examination of depressive symptom dimensions and brain volumes in older adults. Psychiatry Res 2017; 260:70-75. [PMID: 28039796 PMCID: PMC5272855 DOI: 10.1016/j.pscychresns.2016.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 12/05/2016] [Accepted: 12/10/2016] [Indexed: 12/30/2022]
Abstract
Differences in brain volumes have commonly been reported in older adults with both subthreshold and major depression. Few studies have examined the association between specific symptom dimensions of depression and brain volumes. This study used vertex-wise analyses to examine the association between specific symptom dimensions of depression and brain volumes in older adults with subthreshold levels of depressive symptoms. Forty-three community-dwelling adults between the ages of 55 and 81 years underwent a structural Magnetic Resonance Imaging scan and completed the Center for Epidemiologic Studies Depression Scale (CES-D). Vertex-wise analyses were conducted using Freesurfer Imaging Suite to examine the relationship between CES-D subscale scores and gray matter volumes while controlling for sex, age, and education. We found distinct associations between depressed mood, somatic symptoms, and lack of positive affect subscales with regional volumes, including primarily positive relationships in temporal regions and a negative association with the lingual gyrus. The relationship between higher depressed mood subscale scores and larger volumes in the left inferior temporal lobe withstood Monte-Carlo correction for multiple comparisons. Results from this preliminary study highlight the importance of examining depression on a symptom dimension level and identify brain regions that may be important in larger studies of depression.
Collapse
Affiliation(s)
- Molly E McLaren
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA
| | - Sarah M Szymkowicz
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA
| | - Andrew O'Shea
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, USA; Department of Neuroscience, University of Florida, PO Box 100244, Gainesville, FL 32610, USA
| | - Stephen D Anton
- Department of Aging & Geriartric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL, USA
| | - Vonetta M Dotson
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA; Center for Cognitive Aging and Memory, McKnight Brain Institute, 1149 Newell Drive, Gainesville, FL 32611, USA; Department of Neuroscience, University of Florida, PO Box 100244, Gainesville, FL 32610, USA.
| |
Collapse
|
20
|
Szymkowicz SM, McLaren ME, Suryadevara U, Woods AJ. Transcranial Direct Current Stimulation Use in the Treatment of Neuropsychiatric Disorders: A Brief Review. Psychiatr Ann 2016; 46:642-646. [PMID: 27885309 DOI: 10.3928/00485713-20161006-01] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has grown in popularity over the past two decades as an alternative treatment option for various neuropsychiatric disorders. tDCS modulates cortical excitability through the application of a weak direct current to the scalp via electrodes placed over cortical regions of interest. It has been shown to be a promising and relatively safe treatment tool with few adverse events. In this article, we will briefly review the efficacy of tDCS in depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. We will also discuss biomarkers of tDCS efficacy in depression, as it is the most studied neuropsychiatric disorder using tDCS application. We will then offer suggestions for future directions. Although efficacy results show promise, more studies with larger samples and longer treatment periods are needed to better understand the benefits of using tDCS as an alternative treatment option for neuropsychiatric disorders.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Clinical and Health Psychology at the University of Florida
| | - Molly E McLaren
- Department of Clinical and Health Psychology at the University of Florida
| | - Uma Suryadevara
- North Florida/South Georgia VA Medical Center; and an Assistant Professor, University of Florida College of Medicine
| | - Adam J Woods
- Center for Cognitive Aging and Memory, McKnight Brain Institute, Institute on Aging, Department of Aging and Geriatric Research, University of Florida College of Medicine
| |
Collapse
|
21
|
Szymkowicz SM, McLaren ME, O'Shea A, Woods AJ, Anton SD, Dotson VM. Depressive symptoms modify age effects on hippocampal subfields in older adults. Geriatr Gerontol Int 2016; 17:1494-1500. [PMID: 27696657 DOI: 10.1111/ggi.12901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/05/2016] [Accepted: 07/24/2016] [Indexed: 12/27/2022]
Abstract
AIM Major depression is associated with hippocampal volume changes, especially in late-life depression. These changes usually consist of volume reductions, but depression-related increases in hippocampal volume have also been reported. Subfield analysis has identified structural changes primarily in the cornu ammonis (CA) 1, CA2-3 and subiculum of the hippocampus in individuals with major depression; however, it is unclear whether lower levels of depressive symptoms are also associated volume reduction, or if depressive symptoms interact with age to impact hippocampal subfields. The current study addressed these questions. METHODS A total of 43 community-dwelling older adults completed the Center for Epidemiologic Studies Depression Scale and underwent magnetic resonance imaging. Hippocampal subfield segmentation was carried out using an automated procedure, and left and right volumes from CA1, CA2-3, and the subiculum served as outcome measures. Multiple hierarchical regressions were carried out with age, Center for Epidemiologic Studies Depression Scale scores and their interaction as the independent variables, and sex and total intracranial volume as covariates. RESULTS Higher Center for Epidemiologic Studies Depression Scale scores were associated with less age-related volumetric decreases in the right subiculum and right CA1. CONCLUSIONS Age-related atrophy in the hippocampus might be counteracted by depressive symptom-related enlargement of CA1 and the subiculum. More research is required to better understand the functional significance of this relationship. Geriatr Gerontol Int 2017; 17: 1494-1500.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Molly E McLaren
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Andrew O'Shea
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, USA.,Department of Center for Cognitive Aging & Memory, University of Florida, Gainesville, Florida, USA
| | - Adam J Woods
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, USA.,Department of Center for Cognitive Aging & Memory, University of Florida, Gainesville, Florida, USA.,Department of Neuroscience, University of Florida, Gainesville, Florida, USA
| | - Stephen D Anton
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Vonetta M Dotson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA.,Department of Neuroscience, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
22
|
O'Shea DM, De Wit L, Szymkowicz SM, McLaren ME, Talty F, Dotson VM. Anxiety Modifies the Association between Fatigue and Verbal Fluency in Cognitively Normal Adults. Arch Clin Neuropsychol 2016; 31:1043-1049. [PMID: 27600443 DOI: 10.1093/arclin/acw045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE In the present study, we examined the association between self-reported fatigue and verbal fluency in a sample of healthy adults. Given the co-occurrence of anxiety and depressive symptoms with fatigue, we examined whether these affective dimensions would modify this association. METHOD Fifty-nine cognitively normal adults took part in the study. Fatigue symptoms were assessed using the Fatigue Severity Scale (FSS), depressive symptomatology with the Center for Epidemiologic Studies Depression Scale (CES-D), and situational anxiety using the state subscale of the State-Trait Anxiety Inventory (STAI-S).We used a composite measure of verbal fluency comprising letter fluency and semantic fluency as the outcome measure. RESULTS Multiple regression analyses revealed higher fatigue was associated with better verbal fluency when STAI-S scores were high. We did not find a significant interaction between the FSS and CES-D. CONCLUSION Greater situational anxiety levels may buffer against the negative influence of fatigue on verbal fluency in non-clinical populations, consistent with previous research showing that moderate levels of anxiety can benefit cognitive function. Whether subthreshold depressive symptoms modify the association between fatigue and verbal fluency is still unclear. Measures that assess different symptom dimensions specific to depression would help to clarify this issue.
Collapse
Affiliation(s)
- Deirdre M O'Shea
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA
| | - Liselotte De Wit
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA
| | - Sarah M Szymkowicz
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA
| | - Molly E McLaren
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA
| | - Francis Talty
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA
| | - Vonetta M Dotson
- Department of Clinical and Health Psychology, University of Florida, PO Box 100165 , Gainesville, FL32610, USA.,Department of Neuroscience, University of Florida, PO Box 100244, Gainesville, FL32610, USA
| |
Collapse
|
23
|
Szymkowicz SM, Persson J, Lin T, Fischer H, Ebner NC. Hippocampal Brain Volume Is Associated with Faster Facial Emotion Identification in Older Adults: Preliminary Results. Front Aging Neurosci 2016; 8:203. [PMID: 27610082 PMCID: PMC4997967 DOI: 10.3389/fnagi.2016.00203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Quick correct identification of facial emotions is highly relevant for successful social interactions. Research suggests that older, compared to young, adults experience increased difficulty with face and emotion processing skills. While functional neuroimaging studies suggest age differences in neural processing of faces and emotions, evidence about age-associated structural brain changes and their involvement in face and emotion processing is scarce. Using structural magnetic resonance imaging (MRI), this study investigated the extent to which volumes of frontal and temporal brain structures were related to reaction time in accurate identification of facial emotions in 30 young and 30 older adults. Volumetric segmentation was performed using FreeSurfer and gray matter volumes from frontal and temporal regions were extracted. Analysis of covariances (ANCOVAs) models with response time (RT) as the dependent variable and age group and regional volume, and their interaction, as independent variables were conducted, controlling for total intracranial volume (ICV). Results indicated that, in older adults, larger hippocampal volumes were associated with faster correct facial emotion identification. These preliminary observations suggest that greater volume in brain regions associated with face and emotion processing contributes to improved facial emotion identification performance in aging.
Collapse
Affiliation(s)
- Sarah M Szymkowicz
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Jonas Persson
- Aging Research Center, Karolinska Institute Stockholm, Sweden
| | - Tian Lin
- Department of Psychology, University of Florida Gainesville, FL, USA
| | - Håkan Fischer
- Department of Psychology, Stockholm University Stockholm, Sweden
| | - Natalie C Ebner
- Department of Psychology, University of FloridaGainesville, FL, USA; Department of Aging and Geriatric Research, University of FloridaGainesville, FL, USA
| |
Collapse
|
24
|
De Wit L, Kirton JW, O'Shea DM, Szymkowicz SM, McLaren ME, Dotson VM. Effects of body mass index and education on verbal and nonverbal memory. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2016; 24:256-263. [PMID: 27302740 DOI: 10.1080/13825585.2016.1194366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We previously reported that higher education protects against executive dysfunction related to higher body mass index (BMI) in younger, but not older, adults. We now extend the previous analyses to verbal and nonverbal memory. Fifty-nine healthy, dementia-free community-dwelling adults ranging in age from 18 to 81 years completed the Hopkins Verbal Learning Test - Revised (HVLT-R) and the Brief Visuospatial Memory Test - Revised (BVMT-R). Self-reported years of education served as a proxy for cognitive reserve. We found that more highly educated individuals maintained their BVMT-R immediate recall performance across the range of BMI, but in less educated individuals, higher BMI was associated with worse performance. Our findings suggest that education may play a protective role against BMI-related nonverbal learning deficits, similar to previous reports for verbal memory and executive functioning. Results highlight the importance of considering educational background when determining the risk for BMI-related cognitive impairment in clinical settings.
Collapse
Affiliation(s)
- Liselotte De Wit
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Joshua W Kirton
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Deirdre M O'Shea
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Sarah M Szymkowicz
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Molly E McLaren
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Vonetta M Dotson
- a Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA.,b Department of Neuroscience , University of Florida , Gainesville , FL , USA
| |
Collapse
|
25
|
Szymkowicz SM, McLaren ME, Kirton JW, O’Shea A, Woods AJ, Manini TM, Anton SD, Dotson VM. Depressive symptom severity is associated with increased cortical thickness in older adults. Int J Geriatr Psychiatry 2016; 31. [PMID: 26205176 PMCID: PMC4724336 DOI: 10.1002/gps.4324] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Structural neuroimaging studies in older adults have consistently shown volume reductions in both major and subthreshold depression. Cortical thickness, another measure of brain structure, has not been well studied in this population. We examined cortical thickness in older adults across a range of depressive symptom (DS) severity. METHODS Forty-three community-dwelling older adults (mean age = 68.80 ± 7.00 years) underwent magnetic resonance imaging. Based on a priori hypotheses, we examined cortical thickness in regions of interest in the rostral anterior cingulate, orbitofrontal cortex, middle frontal gyrus, and isthmus cingulate using multiple linear regressions with depression questionnaire scores as the independent variable and age, sex, and mean hemispheric thickness as covariates. We also performed an exploratory vertex-wise analysis. RESULTS After correction for multiple comparisons, we found an association between increased DSs and greater cortical thickness in the right isthmus cingulate (F(1, 38) = 8.09, false discovery rate corrected p = 0.028; R(2) = 35.78) in the region of interest analysis and in the left precuneus (cluster size = 413, p = 0.00002) in the vertex-wise analysis. CONCLUSIONS Older adults with higher DSs also have greater cortical thickness in the isthmus cingulate and precuneus, areas important for emotion regulation and self-referential processing. Additional research is needed to elucidate the mechanisms and potential clinical significance underlying this relationship.
Collapse
Affiliation(s)
| | - Molly E. McLaren
- Department of Clinical & Health Psychology, University of Florida
| | - Joshua W. Kirton
- Department of Clinical & Health Psychology, University of Florida
| | - Andrew O’Shea
- Department of Aging & Geriatric Research, University of Florida,Cognitive Aging and Memory Clinical Translational Research Program, University of Florida
| | - Adam J. Woods
- Department of Aging & Geriatric Research, University of Florida,Cognitive Aging and Memory Clinical Translational Research Program, University of Florida,Department of Neuroscience, University of Florida
| | - Todd M. Manini
- Department of Aging & Geriatric Research, University of Florida
| | | | - Vonetta M. Dotson
- Department of Clinical & Health Psychology, University of Florida,Department of Neuroscience, University of Florida
| |
Collapse
|
26
|
Dotson VM, Szymkowicz SM, Sozda CN, Kirton JW, Green ML, O'Shea A, McLaren ME, Anton SD, Manini TM, Woods AJ. Age Differences in Prefrontal Surface Area and Thickness in Middle Aged to Older Adults. Front Aging Neurosci 2016; 7:250. [PMID: 26834623 PMCID: PMC4717301 DOI: 10.3389/fnagi.2015.00250] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/21/2015] [Indexed: 02/02/2023] Open
Abstract
Age is associated with reductions in surface area and cortical thickness, particularly in prefrontal regions. There is also evidence of greater thickness in some regions at older ages. Non-linear age effects in some studies suggest that age may continue to impact brain structure in later decades of life, but relatively few studies have examined the impact of age on brain structure within middle-aged to older adults. We investigated age differences in prefrontal surface area and cortical thickness in healthy adults between the ages of 51 and 81 years. Participants received a structural 3-Tesla magnetic resonance imaging scan. Based on a priori hypotheses, primary analyses focused on surface area and cortical thickness in the dorsolateral prefrontal cortex, anterior cingulate cortex, and orbitofrontal cortex. We also performed exploratory vertex-wise analyses of surface area and cortical thickness across the entire cortex. We found that older age was associated with smaller surface area in the dorsolateral prefrontal and orbitofrontal cortices but greater cortical thickness in the dorsolateral prefrontal and anterior cingulate cortices. Vertex-wise analyses revealed smaller surface area in primarily frontal regions at older ages, but no age effects were found for cortical thickness. Results suggest age is associated with reduced surface area but greater cortical thickness in prefrontal regions during later decades of life, and highlight the differential effects age has on regional surface area and cortical thickness.
Collapse
Affiliation(s)
- Vonetta M Dotson
- Department of Clinical and Health Psychology, University of FloridaGainesville, FL, USA; Department of Neuroscience, University of FloridaGainesville, FL, USA
| | - Sarah M Szymkowicz
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Christopher N Sozda
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Joshua W Kirton
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Mackenzie L Green
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Andrew O'Shea
- Department of Aging & Geriatric Research, University of FloridaGainesville, FL, USA; Center for Cognitive Aging and Memory, Institute on Aging, University of FloridaGainesville, FL, USA
| | - Molly E McLaren
- Department of Clinical and Health Psychology, University of Florida Gainesville, FL, USA
| | - Stephen D Anton
- Department of Aging & Geriatric Research, University of Florida Gainesville, FL, USA
| | - Todd M Manini
- Department of Aging & Geriatric Research, University of Florida Gainesville, FL, USA
| | - Adam J Woods
- Department of Neuroscience, University of FloridaGainesville, FL, USA; Department of Aging & Geriatric Research, University of FloridaGainesville, FL, USA; Center for Cognitive Aging and Memory, Institute on Aging, University of FloridaGainesville, FL, USA
| |
Collapse
|
27
|
McLaren ME, Szymkowicz SM, Kirton JW, Dotson VM. Impact of Education on Memory Deficits in Subclinical Depression. Arch Clin Neuropsychol 2015; 30:387-93. [PMID: 26109434 DOI: 10.1093/arclin/acv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 02/04/2023] Open
Abstract
Elevated depressive symptoms are associated with cognitive deficits, while higher education protects against cognitive decline. This study was conducted to test if education level moderates the relationship between depressive symptoms and cognitive function. Seventy-three healthy, dementia-free adults aged 18-81 completed neuropsychological tests, as well as depression and anxiety questionnaires. Controlling for age, sex, and state anxiety, we found a significant interaction of depressive symptoms and education for immediate and delayed verbal memory, such that those with a higher education level performed well regardless of depressive symptomatology, whereas those with lower education and high depressive symptoms had worse performance. No effects were found for executive functioning or processing speed. Results suggest that education protects against verbal memory deficits in individuals with elevated depressive symptoms. Further research on cognitive reserve in depression-related cognitive deficits and decline is needed to understand the mechanisms behind this phenomenon.
Collapse
Affiliation(s)
- Molly E McLaren
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sarah M Szymkowicz
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Joshua W Kirton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Vonetta M Dotson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA Department of Neuroscience, University of Florida, Gainesville, FL, USA
| |
Collapse
|
28
|
Dotson VM, Szymkowicz SM, Kirton JW, McLaren ME, Green ML, Rohani JY. Unique and interactive effect of anxiety and depressive symptoms on cognitive and brain function in young and older adults. ACTA ACUST UNITED AC 2014; Suppl 1. [PMID: 25383262 DOI: 10.4172/2167-1044.s1-003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Depression and anxiety and are associated with cognitive deficits and brain changes, especially in older adults. Despite the frequent co-occurrence of these conditions, cognitive neuroscience studies examining comorbid depression and anxiety are limited. The goal of the present study was to examine the unique and combined effect of depressive and anxiety symptoms on cognitive and brain functioning in young and older adults. METHODS Seventy-one healthy, community-dwelling adults between the ages of 18 and 81 were administered a neuropsychological battery and completed the Center for Epidemiologic Studies Depression Scale (CES-D) and the trait form of the State-Trait Anxiety Inventory (STAI-T). A subset of 25 participants also underwent functional magnetic resonance imaging (fMRI) scanning while completing the n-back working memory task. RESULTS Total depressive symptoms, depressed mood symptoms, and somatic symptoms were associated with deficits in speed, working memory and executive functions, especially in older adults. Symptoms of lack of well-being were not associated with any neuropsychological test. Anxiety was associated with better attention and working memory. Moreover, anxiety modified the relationship between depressive symptoms and executive functioning in older adults, as elevated depressive symptoms were associated with worse performance at low levels of anxiety, but not at higher anxiety levels. Similarly, analysis of fMRI data showed that total depressive symptoms and depressed mood symptoms were associated with decreased activity in the superior frontal gyrus at low anxiety levels, but not at high anxiety levels. CONCLUSION Results confirm previous reports that subthreshold depression and anxiety impact cognitive and brain functioning and suggest that the interaction of depression and anxiety results in distinct cognitive and brain changes. Findings highlight the importance of assessing and controlling for symptoms of depression and anxiety in research studies of either condition.
Collapse
Affiliation(s)
- Vonetta M Dotson
- Department of Clinical & Health Psychology, University of Florida ; Department of Neuroscience, University of Florida
| | | | - Joshua W Kirton
- Department of Clinical & Health Psychology, University of Florida
| | - Molly E McLaren
- Department of Clinical & Health Psychology, University of Florida
| | | | - Jessica Y Rohani
- Department of Clinical & Health Psychology, University of Florida
| |
Collapse
|