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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] [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.
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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
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152
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Cross N, Terpening Z, Rogers NL, Duffy SL, Hickie IB, Lewis SJ, Naismith SL. Napping in older people ‘at risk’ of dementia: relationships with depression, cognition, medical burden and sleep quality. J Sleep Res 2015; 24:494-502. [DOI: 10.1111/jsr.12313] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 05/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Nathan Cross
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
| | - Zoe Terpening
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
| | - Naomi L. Rogers
- Concord Medical School; Concord Centre for Cardiometabolic Health in Psychosis; The University of Sydney; Sydney NSW Australia
| | - Shantel L. Duffy
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
| | - Ian B. Hickie
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
| | - Simon J.G. Lewis
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
| | - Sharon L. Naismith
- Healthy Brain Ageing Program; Brain & Mind Research Institute; The University of Sydney; Camperdown NSW Australia
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153
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Cockayne NL, Duffy SL, Bonomally R, English A, Amminger PG, Mackinnon A, Christensen HM, Naismith SL, Hickie IB. The Beyond Ageing Project Phase 2--a double-blind, selective prevention, randomised, placebo-controlled trial of omega-3 fatty acids and sertraline in an older age cohort at risk for depression: study protocol for a randomized controlled trial. Trials 2015; 16:247. [PMID: 26037484 PMCID: PMC4469257 DOI: 10.1186/s13063-015-0762-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-life depression is associated with high rates of morbidity, premature mortality, disability, functional decline, caregiver burden and increased health care costs. While clinical and public health approaches are focused on prevention or early intervention strategies, the ideal method of intervention remains unclear. No study has set out to evaluate the role of neurobiological agents in preventing depressive symptoms in older populations at risk of depression. METHODS/DESIGN Subjects with previously reported sub-threshold depressive symptoms, aged 60 to 74 years, will be screened to participate in a single-centre, double-blind, randomised controlled trial with three parallel groups involving omega-3 fatty acid supplementation or sertraline hydrochloride, compared with matching placebo. Subjects will be excluded if they have current depression or suicide ideation; are taking antidepressants or any supplement containing omega-3 fatty acid; or have a prior history of stroke or other serious cerebrovascular or cardiovascular disease, neurological disease, significant psychiatric disease (other than depression) or neurodegenerative disease. The trial will consist of a 12 month treatment phase with follow-up at three months and 12 months to assess outcome events. At three months, subjects will undergo structural neuroimaging to assess whether treatment effects on depressive symptoms correlate with brain changes. Additionally, proton spectroscopy techniques will be used to capture brain-imaging markers of the biological effects of the interventions. The trial will be conducted in urban New South Wales, Australia, and will recruit a community-based sample of 450 adults. Using intention-to-treat methods, the primary endpoint is an absence of clinically relevant depression scores at 12 months between the omega-3 fatty acid and sertraline interventions and the placebo condition. DISCUSSION The current health, social and economic costs of late-life depression make prevention imperative from a public health perspective. This innovative trial aims to address the long-neglected area of prevention of depression in older adults. The interventions are targeted to the pathophysiology of disease, and regardless of the effect size of treatment, the outcomes will offer major scientific advances regarding the neurobiological action of these agents. The main results are expected to be available in 2017. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12610000032055 (12 January 2010).
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Affiliation(s)
- Nicole L Cockayne
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Rosalind Bonomally
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Amelia English
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Paul G Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, VIC, 3052, Australia.
| | - Andrew Mackinnon
- Orygen - The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, VIC, 3052, Australia.
| | - Helen M Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Ian B Hickie
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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154
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Seripa D, Pilotto A, Paroni G, Fontana A, D'Onofrio G, Gravina C, Urbano M, Cascavilla L, Paris F, Panza F, Padovani A, Pilotto A. Role of the serotonin transporter gene locus in the response to SSRI treatment of major depressive disorder in late life. J Psychopharmacol 2015; 29:623-33. [PMID: 25827644 DOI: 10.1177/0269881115578159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
It has been suggested that the serotonin or 5-hydroxytriptamine (5-HT) transporter (5-HTT) and its gene-linked polymorphic region (5-HTTLPR) are selective serotonin reuptake inhibitor (SSRI) response modulators in late-life depression (LLD), and particularly in late-life major depressive disorder (MDD). Previous studies differed in design and results. Our study aimed to investigate the solute carrier family 6 (neurotransmitter transporter and serotonin) member 4 (SLC6A4) gene locus, encoding 5-HTT and SSRI treatment response in late-life MDD. For a prospective cohort study, we enrolled 234 patients with late-life MDD to be treated with escitalopram, sertraline, paroxetine or citalopram for 6 months. The SLC6A4 polymorphisms rs4795541 (5-HTTLPR), rs140701 and rs3813034 genotypes spanning the SLC6A4 locus were investigated in blinded fashion. No placebo group was included. We assessed responder or non-responder phenotypes according to a reduction in the 21-item version of the Hamilton Depression Rating Scale (HDRS-21) score of ⩾ 50%. At follow-up, 30% of the late-life MDD patients were non-responders to SSRI treatment. No time-course of symptoms and responses was made. A poor response was associated with a higher baseline HDRS-21 score. We observed a significant over-representation of the rs4795541-S allele in the responder patients (0.436 versus 0.321; p = 0.023). The single S-allele dose-additive effect had OR = 1.74 (95% CI 1.12-2.69) in the additive regression model. Our findings suggested a possible influence of 5-HTTLPR on the SSRI response in patients with late-life MDD, which is potentially useful in identifying the subgroups of LLD patients whom need a different pharmacological approach.
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Affiliation(s)
- Davide Seripa
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Paroni
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Andrea Fontana
- Biostatistics Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Grazia D'Onofrio
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Carolina Gravina
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maria Urbano
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Leandro Cascavilla
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Paris
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Pilotto
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy Geriatrics Unit, San Antonio Hospital, Padova, Italy
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155
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Yokoyama K, Yamada T, Mitani H, Yamada S, Pu S, Yamanashi T, Matsumura H, Nakagome K, Kaneko K. Relationship between hypothalamic-pituitary-adrenal axis dysregulation and insulin resistance in elderly patients with depression. Psychiatry Res 2015; 226:494-8. [PMID: 25757913 DOI: 10.1016/j.psychres.2015.01.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 01/09/2015] [Accepted: 01/19/2015] [Indexed: 12/22/2022]
Abstract
Cortisol dysregulation has been proposed to be involved in depression. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation associated with major depressive disorder (MDD) was previously reported to be higher in the elderly. Furthermore, insulin resistance and the prevalence of type 2 diabetes are known to increase with aging. The aim of the present study was to determine whether a relationship existed between plasma cortisol levels following the dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test and insulin resistance evaluated by the homeostasis model assessment of insulin resistance (HOMA-R) in elderly MDD subjects. Fifteen unmedicated MDD inpatients and 17 age- and sex-matched healthy controls participated in this study. After overnight fasting, blood samples were collected to measure plasma glucose and insulin concentrations, estimate HOMA-R, and perform the DEX/CRH test to evaluate HPA axis function. The value of the area under the time curve of plasma cortisol concentrations (CortAUC) and peak cortisol values (Cortpeak) following the administration of DEX/CRH both correlated with HOMA-R in MDD group. In contrast, neither CortAUC nor Cortpeak correlated with HOMA-R in controls. This is the first study to directly demonstrate the relationship between HPA axis dysregulation assessed with the DEX/CRH test and the index of insulin resistance estimated as HOMA-R in elderly MDD patients.
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Affiliation(s)
- Katsutoshi Yokoyama
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan.
| | - Takeshi Yamada
- Division of Psychiatry, Kurayoshi Hospital, 43 Yamane, Kurayoshi, Japan
| | - Hideaki Mitani
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Sayaka Yamada
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Takehiko Yamanashi
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Hiroshi Matsumura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
| | - Kazuyuki Nakagome
- National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University, Faculty of Medicine, 36-1 Nishi-cho, Yonago, Japan
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Abstract
BACKGROUND Altered cardiac autonomic control has often been reported in depressed persons and might play an important role in the increased risk for cardiovascular disease (CVD). A negative association between cardiac autonomic control and depression might become specifically clinically relevant in persons 60 years or older as CVD risk increases with age. METHODS This study included data of 321 persons with a depressive disorder and 115 controls participating in the Netherlands Study of Depression in Older Persons (mean age = 70.3 years, 65.7% female). Respiratory sinus arrhythmia (RSA), heart rate (HR), and preejection period (PEP) were measured and compared between depressed persons and controls. In addition, the role of antidepressants and clinical characteristics (e.g., age of depression onset and comorbid anxiety) was examined. RESULTS Compared with controls, depressed persons had lower RSA (mean [standard error of the mean] = 23.5 [1.2] milliseconds versus 18.6 [0.7] milliseconds, p = .001, d = 0.373) and marginally higher HR (73.1 [1.1] beats/min versus 75.6 [0.6] beats/min, p = .065, d = 0.212), but comparable PEP (113.9 [2.1] milliseconds versus 112.0 [1.2] milliseconds, p = .45, d = 0.087), fully adjusted. Antidepressants strongly attenuated the associations between depression and HR and RSA. Antidepressant-naïve depressed persons had similar HR and RSA to controls, whereas users of antidepressants showed significantly lower RSA. In addition, tricyclic antidepressant users had higher HR (p < .001, d = 0.768) and shorter PEP (p = .014, d = 0.395) than did controls. CONCLUSIONS Depression was not associated with cardiac autonomic control, but antidepressants were in this sample. All antidepressants were associated with low cardiac parasympathetic control and specifically tricyclic antidepressants with high cardiac sympathetic control.
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157
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Ghio L, Gotelli S, Cervetti A, Respino M, Natta W, Marcenaro M, Serafini G, Vaggi M, Amore M, Belvederi Murri M. Duration of untreated depression influences clinical outcomes and disability. J Affect Disord 2015; 175:224-8. [PMID: 25658495 DOI: 10.1016/j.jad.2015.01.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The duration of untreated depression (DUD) might have a substantial impact on the clinical outcomes; however, there are important knowledge gaps including the effects on disability and potential differences between first-episode and recurrent episodes of depression. METHODS We recruited 121 outpatients with first episode and recurrent major depression, and conducted prospective clinical assessments over six months. Clinical outcomes included response to antidepressant therapy, remission and changes in disability. RESULTS Patients with a DUD of six months or shorter were more frequently young, unemployed and had higher levels of physical illnesses than those with a longer DUD (all p<0.05). A shorter DUD was associated with significantly higher odds of response at 12 weeks (adjusted odds ratio 2.8; 95% CI: 1.2-6.8) and remission at 24 weeks (4.1; 95% CI: 1.6-10.5) after adjusting for relevant confounders. Changes in disability ratings were analyzed with growth curve analysis and showed steeper declines among those with a shorter DUD. The associations of DUD on clinical outcomes were evident both in patients with first-episode and recurrent depression. LIMITATIONS Naturalistic design. Self-rated assessment of disability. Findings from subgroup analyses should be replicated in larger sample size. CONCLUSIONS A shorter duration of untreated depression is associated with more favorable outcomes for major depression, including depression-related disability. This association seems to work both at the first and recurrent episodes, which might have direct implications for both primary and secondary prevention.
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Affiliation(s)
- Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy.
| | | | - Alice Cervetti
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Matteo Respino
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Werner Natta
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Maurizio Marcenaro
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Marco Vaggi
- Department of Mental Health, ASL3, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
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158
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Simon SS, Cordás TA, Bottino CMC. Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review. Int J Geriatr Psychiatry 2015; 30:223-33. [PMID: 25521935 DOI: 10.1002/gps.4239] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/28/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the effectiveness of cognitive behavioral therapies (CBTs) in improving depressive symptoms, disability, and cognition in older adults with depression and cognitive deficits. DESIGN It was performed a systematic search for articles published between 1994 and February 2014 in the MEDLINE/Pubmed, PsycINFO, and SCIELO. The studies should have provided information about benefits after CBTs to older adults with depression and cognitive deficits. RESULTS Cognitive behavioral therapy focused on problem solving is the main approach studied, having better effectiveness than supportive therapy in randomized clinical trials. Significant improvements in mood and disability were consistent, although evidence of changes in cognitive measures is controversial, less studied, and limited. Nevertheless, improvements in executive functions, processing speed, and changes in patients' perspectives of problem solving skills, such as generating alternatives and decision-making, were described. Also, it would be necessary that future studies more often evaluate cognitive status of depressed elders, as well as cognitive changes after psychotherapy. It should be emphasized that there is a lack of studies in this field, and more approaches in CBTs need to be investigated to this population. CONCLUSION Older adults with depression and cognitive deficits can benefit from CBTs. Improvements in mood and disability are more consistent than changes in cognition, which are little studied after CBTs. It is necessary more studies in the field, as well as, to investigate more approaches in CBTs to older adults with depression and cognitive deficits.
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Affiliation(s)
- Sharon Sanz Simon
- Old Age Research Group (PROTER), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil
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159
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Richieri R, Boyer L, Faget-Agius C, Farisse J, Mundler O, Lançon C, Guedj E. Determinants of brain SPECT perfusion and connectivity in treatment-resistant depression. Psychiatry Res 2015; 231:134-40. [PMID: 25561373 DOI: 10.1016/j.pscychresns.2014.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 05/08/2014] [Accepted: 11/19/2014] [Indexed: 12/23/2022]
Abstract
This study aims to characterize and compare functional brain single photon emission tomography (SPECT) perfusion and connectivity in treatment-resistant depression (TRD) according to distinct demographic or clinical profiles (male vs. female; old vs. young; unipolar vs. bipolar) and to study their relationship to the severity and the duration of episode/illness. We retrospectively included 127 consecutive patients who met DSM-IV criteria for a nonpsychotic major TRD episode. All patients were studied using (99m)Tc-ethyl cysteinate dimer SPECT. Whole-brain, voxel-based, between-groups analyses were performed according to demographic and clinical data and in comparison to 37 healthy subjects. Voxel-wise interregional correlation was also performed to compare functional SPECT connectivity. Finally, relationships were searched for regarding severity and duration of episode/illness. The whole group of patients exhibited significant hypoperfusion within bilateral fronto-temporal, insular, and anterior cingulate cortices, as well as within the left caudate. Functional connectivity between left frontal and left cerebellar regions was higher in patients than in healthy subjects. Gender, age, and type of mood disorder did not influence these SPECT patterns. A significant relationship was found between brain SPECT perfusion and either duration or global severity of illness in particular frontal areas. Our data support the hypothesis of a shared SPECT pattern, whatever the profile of TRD, involving fronto-temporal regions and the cerebellum.
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Affiliation(s)
- Raphaëlle Richieri
- Aix-Marseille Université, EA 3279, 13005 Marseille, France; APHM, Hôpital de La Conception, Pôle Psychiatrie Centre, 13005 Marseille, France.
| | - Laurent Boyer
- Aix-Marseille Université, EA 3279, 13005 Marseille, France; APHM, Hôpital de la Conception, Département de Santé Publique, 13005 Marseille, France
| | - Catherine Faget-Agius
- Aix-Marseille Université, EA 3279, 13005 Marseille, France; APHM, Hôpital de La Conception, Pôle Psychiatrie Centre, 13005 Marseille, France
| | - Jean Farisse
- Aix-Marseille Université, EA 3279, 13005 Marseille, France
| | - Olivier Mundler
- APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005, Marseille, France; Aix-Marseille Université, CERIMED, 13005, Marseille, France; Aix-Marseille Université, CNRS, UMR7289, INT, 13005, Marseille, France
| | - Christophe Lançon
- Aix-Marseille Université, EA 3279, 13005 Marseille, France; APHM, Hôpital de La Conception, Pôle Psychiatrie Centre, 13005 Marseille, France
| | - Eric Guedj
- APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005, Marseille, France; Aix-Marseille Université, CERIMED, 13005, Marseille, France; Aix-Marseille Université, CNRS, UMR7289, INT, 13005, Marseille, France
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160
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Iwabuchi SJ, Krishnadas R, Li C, Auer DP, Radua J, Palaniyappan L. Localized connectivity in depression: a meta-analysis of resting state functional imaging studies. Neurosci Biobehav Rev 2015; 51:77-86. [PMID: 25597656 DOI: 10.1016/j.neubiorev.2015.01.006] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/10/2014] [Accepted: 01/08/2015] [Indexed: 12/31/2022]
Abstract
Resting-state fMRI studies investigating the pathophysiology of depression have identified prominent abnormalities in large-scale brain networks. However, it is unclear if localized dysfunction of specialized brain regions contribute to network-level abnormalities. We employed a meta-analytical procedure and reviewed studies conducted in China investigating changes in regional homogeneity (ReHo), a measure of localized intraregional connectivity, from resting-state fMRI in depression. Exploiting the statistical power gained from pooled analysis, we also investigated the effects of age, gender, illness duration and treatment on ReHo. The medial prefrontal cortex (MPFC) showed the most robust and reliable increase in ReHo in depression, with greater abnormality in medication-free patients with multiple episodes. Brain networks that relate to this region have been identified previously to show aberrant connectivity in depression, and we propose that the localized neuronal inefficiency of MPFC exists alongside wider network level disruptions involving this region.
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Affiliation(s)
- Sarina J Iwabuchi
- Centre for Translational Neuroimaging, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK.
| | - Rajeev Krishnadas
- Psychological Medicine, Sackler Institute, Neurology Block SGH, University of Glasgow, Glasgow G51 4TF, UK.
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Dorothee P Auer
- Division of Imaging and Radiological Sciences, University of Nottingham, Nottingham, UK.
| | - Joaquim Radua
- Institute of Psychiatry, King's College London, UK; FIDMAG Germanes Hospitalàries, CIBERSAM, Barcelona, Spain.
| | - Lena Palaniyappan
- Centre for Translational Neuroimaging, Division of Psychiatry & Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK; Nottinghamshire Healthcare NHS Trust, Nottingham, UK.
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161
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Hahn C, Lim HK, Won WY, Joo SH, Ahn KJ, Jung WS, Lee CU. Sub-regional volumes changes of the corpus callosum in the drug naive patients with late-onset depression. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:46-51. [PMID: 25134843 DOI: 10.1016/j.pnpbp.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022]
Abstract
Although sub-regional analysis methods of the corpus callosum (CC) have been developed, there has been no in vivo magnetic resonance imaging (MRI) study on a sub-regional volume analysis of the CC of late-onset depression (LOD). The aim of this study was to investigate the CC volume differences between LOD subjects and healthy elderly controls using a sub-regional analysis technique. Forty subjects with LOD and thirty nine group-matched healthy control subjects underwent 3T MRI scanning, and sub-regional volumes of the CC were measured and compared between the groups. The volumes of total (F=5.8, p=0.001), the anterior (F=5.2, p=0.001) and the posterior CC (F=5.1, p=0.001) were significantly reduced in the LOD group as compared to the control group. We measured cognitive functions in several different domains (language functions, verbal learning, visuospatial functions, delayed recall, memory consolidation, recognition memory, and executive functions) through the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease. The anterior CC volume in the LOD group showed significant positive correlation with the Verbal Fluency scores. The posterior CC volume in the LOD group was positively correlated significantly with the Word List Memory, the Word List Recall and the Constructional Praxis scores. This study is the first to elaborate the sub-regional volume differences of the CC between controls and LOD patients. These structural changes in the CC might be at the core of the underlying neurobiological mechanisms in LOD.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Catholic Argo-Medical Center, Seoul, Republic of Korea
| | - Hyun-Kook Lim
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Wang Youn Won
- Department of Psychiatry, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Soo-Hyun Joo
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Kook Jin Ahn
- Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Won-Sang Jung
- Department of Radiology, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Catholic Argo-Medical Center, Seoul, Republic of Korea.
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162
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Hegeman JM, de Waal MWM, Comijs HC, Kok RM, van der Mast RC. Depression in later life: a more somatic presentation? J Affect Disord 2015; 170:196-202. [PMID: 25254617 DOI: 10.1016/j.jad.2014.08.032] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Depression later in life may have a more somatic presentation compared with depression earlier in life due to chronic somatic disease and increasing age. This study examines the influence of the presence of chronic somatic diseases and increasing age on symptom dimensions of late-life depression. METHODS Baseline data of 429 depressed and non-depressed older persons (aged 60-93 years) in the Netherlands Study of Depression in Old Age were used, including symptom dimension scores as assessed with the mood, somatic and motivation subscales of the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Linear regression was performed to investigate the effect of chronic somatic diseases and age on the IDS-SR subscale scores. RESULTS In depressed older persons a higher somatic disease burden was associated with higher scores on the mood subscale (B = 2.02, p = 0.001), whereas higher age was associated with lower scores on the mood (B = -2.30, p < 0.001) and motivation (B = -1.01, p = 0.006) subscales. In depressed compared with non-depressed persons, a higher somatic disease burden showed no different association with higher scores on the somatic subscale (F(1,12) = 9.2; p = 0.003; partial η(2)=0.022). LIMITATIONS Because the IDS-SR subscales are specific for old age, it was not feasible to include persons aged < 60 years to investigate differences between earlier and later life. CONCLUSIONS It seems that neither higher somatic disease burden nor higher age contributes to more severe somatic symptoms in late-life depression. In older old persons aged ≥ 70 years, late-life depression may not be adequately recognized because they may show less mood and motivational symptoms compared with younger old persons.
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Affiliation(s)
- J M Hegeman
- Department of Psychiatry, St. Antoniusziekenhuis, Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - M W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - H C Comijs
- Department of Psychiatry, EMGO Institute of Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
| | - R M Kok
- Department of Old Age Psychiatry, Parnassia, Den Haag, The Netherlands
| | - R C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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163
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Marano CM, Workman CI, Lyman CH, Munro CA, Kraut MA, Smith GS. Structural imaging in late-life depression: association with mood and cognitive responses to antidepressant treatment. Am J Geriatr Psychiatry 2015; 23:4-12. [PMID: 24238925 PMCID: PMC3997617 DOI: 10.1016/j.jagp.2013.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Recent positron emission tomography studies of cerebral glucose metabolism have identified the functional neural circuitry associated with mood and cognitive responses to antidepressant treatment in late life depression (LLD). The structural alterations in these networks are not well understood. The present study used magnetic resonance (MR) imaging and voxel-based morphometry to evaluate the association between gray matter volumes and changes in mood symptoms and cognitive function with treatment with the antidepressant citalopram. DESIGN Open-label trial with baseline brain MR scan. Mood and cognitive assessments performed at baseline and during citalopram treatment. SETTING Outpatient clinics of an academic medical center. PARTICIPANTS 17 previously unmedicated patients age 55 years or older with a major depressive episode and 17 non-depressed comparison subjects. INTERVENTION 12-week trial of flexibly dosed citalopram. MEASUREMENTS Gray matter volumes, Hamilton Depression Rating Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System. RESULTS In LLD, higher gray matter volumes in the cingulate gyrus, superior and middle frontal gyri, middle temporal gyrus, and precuneus was associated with greater mood improvement. Higher gray matter volumes in primarily frontal areas were associated with greater improvement in verbal memory and verbal fluency performance. CONCLUSIONS Associations with antidepressant induced improvements in mood and cognition were observed in several brain regions previously correlated with normalization of glucose metabolism after citalopram treatment in LLD. Future studies will investigate molecular mechanisms underlying these associations (e.g., beta-amyloid, inflammation, glutamate).
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Affiliation(s)
- Christopher M. Marano
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifford I. Workman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher H. Lyman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cynthia A. Munro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A. Kraut
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Naismith SL, Lagopoulos J, Hermens DF, White D, Duffy SL, Robillard R, Scott EM, Hickie IB. Delayed circadian phase is linked to glutamatergic functions in young people with affective disorders: a proton magnetic resonance spectroscopy study. BMC Psychiatry 2014; 14:345. [PMID: 25496061 PMCID: PMC4276104 DOI: 10.1186/s12888-014-0345-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/19/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While the association between affective disorders and sleep and circadian disturbance is well established, little is known about the neurobiology underpinning these relationships. In this study, we sought to determine the relationship between a marker of circadian rhythm and neuronal integrity (N-Acetyl Aspartate, NAA), oxidative stress (glutathione, GSH) and neuronal-glial dysfunction (Glutamate + Glutamine, Glx). METHODS Fifty-three young adults (age range 15-33 years, mean = 21.8, sd = 4.3) with emerging affective disorders were recruited from a specialized tertiary referral service. Participants underwent clinical assessment and actigraphy monitoring, from which sleep midpoint was calculated as a marker of circadian rhythm. Proton magnetic resonance spectroscopy was performed in the anterior cingulate cortex (ACC). The metabolites NAA, GSH and Glx were obtained, and expressed as a ratio to Creatine. RESULTS Neither NAA or GSH were associated with sleep midpoint. However, higher levels of ACC Glx were associated with later sleep midpoints (rho = 0.35, p = 0.013). This relationship appeared to be independent of age and depression severity. CONCLUSIONS This study is the first to demonstrate that delayed circadian phase is related to altered glutamatergic processes. It is aligned with animal research linking circadian rhythms with glutamatergic neurotransmission as well as clinical studies showing changes in glutamate with sleep interventions. Further studies may seek to examine the role of glutamate modulators for circadian misalignment.
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Affiliation(s)
- Sharon L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Jim Lagopoulos
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Django White
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Shantel L Duffy
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Rebecca Robillard
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | - Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, NSW, 2050, Australia.
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165
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Kirton JW, Resnick SM, Davatzikos C, Kraut MA, Dotson VM. Depressive symptoms, symptom dimensions, and white matter lesion volume in older adults: a longitudinal study. Am J Geriatr Psychiatry 2014; 22:1469-77. [PMID: 24211028 PMCID: PMC3984387 DOI: 10.1016/j.jagp.2013.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/18/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE White matter lesions (WMLs) are associated with depressive symptoms in older adults. However, it is not clear whether different symptom dimensions of depression have distinct associations with WMLs. The authors assessed the longitudinal relationships of the Center for Epidemiologic Studies Depression Scale (CES-D) total score and subscale scores with WML volume in the Baltimore Longitudinal Study of Aging. METHODS Using a prospective observational design, the authors examined WML volume and depressive symptoms at 1- to 2-year intervals for up to 9 years in 116 dementia-free participants (mean age: 68.78 ± 7.68). At each visit, depressive symptoms were measured with the CES-D and WML volumes were quantified from structural magnetic resonance imaging scans. RESULTS Higher CES-D full-scale scores were associated with greater WML volume and with a faster rate of volume increases over time in women, especially at older ages. Higher depressed mood and somatic symptoms subscale scores were associated with greater increases in WML volume over time at older ages. In men, depressed mood and somatic symptoms were associated with larger WML volume at baseline. CONCLUSION Findings confirm an association between WMLs and depressive symptoms and suggest that depressed mood and somatic symptoms may be stronger predictors of depression-related brain changes than lack of well-being. Age and sex may moderate the relationships between depressive symptoms and WMLs. Understanding particular symptom dimensions of depressive symptoms has implications for treatment and may lead to targeted interventions and more precise knowledge of mechanisms underlying depression.
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Affiliation(s)
- Joshua W Kirton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Michael A Kraut
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Vonetta M Dotson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
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166
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Nakagawa Y, Chiba K. Role of microglial m1/m2 polarization in relapse and remission of psychiatric disorders and diseases. Pharmaceuticals (Basel) 2014; 7:1028-48. [PMID: 25429645 PMCID: PMC4276905 DOI: 10.3390/ph7121028] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 12/27/2022] Open
Abstract
Psychiatric disorders such as schizophrenia and major depressive disorder were thought to be caused by neurotransmitter abnormalities. Patients with these disorders often experience relapse and remission; however the underlying molecular mechanisms of relapse and remission still remain unclear. Recent advanced immunological analyses have revealed that M1/M2 polarization of macrophages plays an important role in controlling the balance between promotion and suppression in inflammation. Microglial cells share certain characteristics with macrophages and contribute to immune-surveillance in the central nervous system (CNS). In this review, we summarize immunoregulatory functions of microglia and discuss a possible role of microglial M1/M2 polarization in relapse and remission of psychiatric disorders and diseases. M1 polarized microglia can produce pro-inflammatory cytokines, reactive oxygen species, and nitric oxide, suggesting that these molecules contribute to dysfunction of neural network in the CNS. Alternatively, M2 polarized microglia express cytokines and receptors that are implicated in inhibiting inflammation and restoring homeostasis. Based on these aspects, we propose a possibility that M1 and M2 microglia are related to relapse and remission, respectively in psychiatric disorders and diseases. Consequently, a target molecule skewing M2 polarization of microglia may provide beneficial therapies for these disorders and diseases in the CNS.
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Affiliation(s)
- Yutaka Nakagawa
- Research Strategy and Planning Department, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama 227-0033, Japan.
| | - Kenji Chiba
- Advanced Medical Research Laboratories, Research Division, Mitsubishi Tanabe Pharma Corporation, Yokohama 227-0033, Japan.
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167
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Du M, Liu J, Chen Z, Huang X, Li J, Kuang W, Yang Y, Zhang W, Zhou D, Bi F, Kendrick KM, Gong Q. Brain grey matter volume alterations in late-life depression. J Psychiatry Neurosci 2014; 39:397-406. [PMID: 24949867 PMCID: PMC4214874 DOI: 10.1503/jpn.130275] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Voxel-based morphometry (VBM) studies have demonstrated that grey matter abnormalities are involved in the pathophysiology of late-life depression (LLD), but the findings are inconsistent and have not been quantitatively reviewed. The aim of the present study was to conduct a meta-analysis that integrated the reported VBM studies, to determine consistent grey matter alterations in individuals with LLD. METHODS A systematic search was conducted to identify VBM studies that compared patients with LLD and healthy controls. We performed a meta-analysis using the effect size signed differential mapping method to quantitatively estimate regional grey matter abnormalities in patients with LLD. RESULTS We included 9 studies with 11 data sets comprising 292 patients with LLD and 278 healthy controls in our meta-analysis. The pooled and subgroup meta-analyses showed robust grey matter reductions in the right lentiform nucleus extending into the parahippocampus, the hippocampus and the amygdala, the bilateral medial frontal gyrus and the right subcallosal gyrus as well as a grey matter increase in the right lingual gyrus. Meta-regression analyses showed that mean age and the percentage of female patients with LLD were not significantly related to grey matter changes. LIMITATIONS The analysis techniques, patient characteristics and clinical variables of the studies included were heterogeneous, and most participants were medicated. CONCLUSION The present meta-analysis is, to our knowledge, the first to overcome previous inconsistencies in the VBM studies of LLD and provide robust evidence for grey matter alterations within fronto-striatal-limbic networks, thereby implicating them in the pathophysiology of LLD. The mean age and the percentage of female patients with LLD did not appear to have a measurable impact on grey matter changes, although we cannot rule out the contributory effects of medication.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Qiyong Gong
- Correspondence to: Q. Gong, Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan 610041, PR China;
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168
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Neuropsychological impairment: the disturbed effect of self-processing in patients with major depressive disorder. CHINESE SCIENCE BULLETIN-CHINESE 2014. [DOI: 10.1007/s11434-014-0198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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169
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Sabbagh JJ, O'Leary JC, Blair LJ, Klengel T, Nordhues BA, Fontaine SN, Binder EB, Dickey CA. Age-associated epigenetic upregulation of the FKBP5 gene selectively impairs stress resiliency. PLoS One 2014; 9:e107241. [PMID: 25191701 PMCID: PMC4156438 DOI: 10.1371/journal.pone.0107241] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/07/2014] [Indexed: 12/22/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in the FK506 binding protein 5 (FKBP5) gene combine with traumatic events to increase risk for post-traumatic stress and major depressive disorders (PTSD and MDD). These SNPs increase FKBP51 protein expression through a mechanism involving demethylation of the gene and altered glucocorticoid signaling. Aged animals also display elevated FKBP51 levels, which contribute to impaired resiliency to depressive-like behaviors through impaired glucocorticoid signaling, a phenotype that is abrogated in FKBP5−/− mice. But the age of onset and progressive stability of these phenotypes remain unknown. Moreover, it is unclear how FKBP5 deletion affects other glucocorticoid-dependent processes or if age-associated increases in FKBP51 expression are mediated through a similar epigenetic process caused by SNPs in the FKBP5 gene. Here, we show that FKBP51-mediated impairment in stress resiliency and glucocorticoid signaling occurs by 10 months of age and this increased over their lifespan. Surprisingly, despite these progressive changes in glucocorticoid responsiveness, FKBP5−/− mice displayed normal longevity, glucose tolerance, blood composition and cytokine profiles across lifespan, phenotypes normally associated with glucocorticoid signaling. We also found that methylation of Fkbp5 decreased with age in mice, a process that likely explains the age-associated increases in FKBP51 levels. Thus, epigenetic upregulation of FKBP51 with age can selectively impair psychological stress-resiliency, but does not affect other glucocorticoid-mediated physiological processes. This makes FKBP51 a unique and attractive therapeutic target to treat PTSD and MDD. In addition, aged wild-type mice may be a useful model for investigating the mechanisms of FKBP5 SNPs associated with these disorders.
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Affiliation(s)
- Jonathan J. Sabbagh
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
| | - John C. O'Leary
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
| | - Laura J. Blair
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
| | - Torsten Klengel
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, Unites States of America
- Department of Translational Research, Max Planck Institute of Psychiatry, Munich, Germany
| | - Bryce A. Nordhues
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
| | - Sarah N. Fontaine
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
| | - Elisabeth B. Binder
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, Unites States of America
- Department of Translational Research, Max Planck Institute of Psychiatry, Munich, Germany
| | - Chad A. Dickey
- Department of Molecular Medicine, Byrd Alzheimer's Research Institute, University of South Florida, Tampa, Florida, United States of America
- * E-mail:
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McKinnon A, Terpening Z, Hickie IB, Batchelor J, Grunstein R, Lewis SJG, Naismith SL. Prevalence and predictors of poor sleep quality in mild cognitive impairment. J Geriatr Psychiatry Neurol 2014; 27:204-11. [PMID: 24687189 DOI: 10.1177/0891988714527516] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the prevalence of and contributors to poor sleep quality in patients with mild cognitive impairment (MCI). METHODS Data were collected for 158 patients meeting the criteria for MCI. Measures included the Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Mini-Mental State Examination. Demographic, lifestyle, medication, and substance use data were also collected. RESULTS A total of 63% of patients with MCI demonstrated sleep disturbance, a significantly higher rate than that of the controls (44%; chi-square = 8.77; P = .003). Depressive symptoms, cognition, antidepressant usage, alcohol consumption, age, and education were identified as significant predictors of self-reported sleep quality in patients with MCI (R(2) = .327, F 6,145 = 11.729, P < .0001). CONCLUSIONS Sleep disturbance occurs in around two-thirds of patients with MCI. Interventions addressing depression, cognition, and substance and medication use may improve sleep quality in MCI.
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Affiliation(s)
- Andrew McKinnon
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Zoe Terpening
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Batchelor
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Ron Grunstein
- Woolcock Institute of Medical Research, NSW, Australia
| | - Simon J G Lewis
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
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171
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Zhang LJ, Wu S, Ren J, Lu GM. Resting-state functional magnetic resonance imaging in hepatic encephalopathy: current status and perspectives. Metab Brain Dis 2014; 29:569-82. [PMID: 24562590 DOI: 10.1007/s11011-014-9504-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 02/06/2014] [Indexed: 02/06/2023]
Abstract
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome which develops in patients with severe liver diseases and/or portal-systemic shunting. Minimal HE, the earliest manifestation of HE, has drawn increasing attention in the last decade. Minimal HE is associated with a series of brain functional changes, such as attention, working memory, and so on. Blood oxygen level dependent (BOLD) functional MRI (fMRI), especially resting-state fMRI has been used to explore the brain functional changes of HE, yielding important insights for understanding pathophysiological mechanisms and functional reorganization of HE. This paper briefly reviews the principles of BOLD fMRI, potential applications of resting-state fMRI with advanced post-processing algorithms such as regional homogeneity, amplitude of low frequency fluctuation, functional connectivity and future research perspective in this field.
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Affiliation(s)
- Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nangjing, Jiangsu Province, China, 210002,
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Diniz BS, Teixeira AL, Machado-Vieira R, Talib LL, Radanovic M, Gattaz WF, Forlenza OV. Reduced cerebrospinal fluid levels of brain-derived neurotrophic factor is associated with cognitive impairment in late-life major depression. J Gerontol B Psychol Sci Soc Sci 2014; 69:845-51. [PMID: 25149921 DOI: 10.1093/geronb/gbu096] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Late-life depression (LLD) is associated with reduced neurotrophic support and abnormalities in neurodegenerative cascades. The aim of the present study is to determine the concentrations of brain-derived neurotrophic factor (BDNF), amyloid-β42, total Tau, and phosphorylated Tau in the cerebrospinal fluid (CSF) of patients with LLD and cognitive impairment compared to healthy older adults. METHOD We included 25 antidepressant-free patients with LLD (10 with mild cognitive impairment [LLD + MCI] and 15 with no cognitive decline [LLD + NCD]) and 25 healthy older adults as a comparison group. Depressive symptoms were assessed by the 21-item Hamilton Depression Rating Scale (HDRS-21) and cognitive performance by a comprehensive cognitive battery. RESULTS Patients with LLD + MCI showed significantly lower CSF BDNF levels compared to LLD + NCD and healthy controls (p = .003). There were no significant differences in Alzheimer's disease-related CSF biomarkers between groups. CSF BDNF concentrations were positively correlated with Cambridge Cognitive Test (CAMCOG) scores (r = .36, p = .02). DISCUSSION The present study adds to the growing body of evidence that abnormalities in the BDNF system are involved in the pathophysiology of LLD. The reduction of the availability of BDNF in the central nervous system may indicate increased vulnerability to the development of several age-related neuropsychiatric disorders as well as to adverse cognitive outcomes.
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Affiliation(s)
| | - Antonio L Teixeira
- Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo Machado-Vieira
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil. National Institute of Mental Health (NIMH), National Institutes of Health, Bethesda, Maryland
| | - Leda L Talib
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - Marcia Radanovic
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - Wagner F Gattaz
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
| | - Orestes V Forlenza
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
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173
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Carvalho N, Noiret N, Vandel P, Monnin J, Chopard G, Laurent E. Saccadic eye movements in depressed elderly patients. PLoS One 2014; 9:e105355. [PMID: 25122508 PMCID: PMC4133355 DOI: 10.1371/journal.pone.0105355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/21/2014] [Indexed: 11/19/2022] Open
Abstract
The primary aim of this study was to characterize oculomotor performances in elderly depressed patients. The second aim was to investigate whether cognitive inhibition measured by the antisaccade task was associated with a psychomotor retardation or rather with a more specific cognitive-motor inhibition deficit. Twenty patients with a major depressive disorder and forty-seven healthy subjects performed two eye movement tasks. Saccadic reaction time and error rates were analyzed in the prosaccade task to obtain basic parameters of eye movements. Saccade latency, error rates and correction rates were evaluated in the antisaccade task to investigate inhibition capacities. Performances were impaired in patients, who exhibited a higher reaction time and error rates compared to controls. The higher time cost of inhibition suggested that the reaction time was not related to global psychomotor retardation alone. The higher time cost of inhibition could be explained by a specific alteration of inhibition processes evaluated by the antisaccade task. These changes were associated with the severity of depression. These findings provide a new perspective on cognitive inhibition in elderly depressed patients and could have important clinical implications for our understanding of critical behaviors involving deficits in inhibitory processes in the elderly.
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Affiliation(s)
- Nicolas Carvalho
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- E.A. 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- * E-mail: (NC); (EL)
| | - Nicolas Noiret
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- E.A. 3188, Laboratory of Psychology, University of Franche-Comté, Besançon, France
| | - Pierre Vandel
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- E.A. 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-IT 808 Inserm, Besançon University Hospital, Besançon, France
| | - Julie Monnin
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- E.A. 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-IT 808 Inserm, Besançon University Hospital, Besançon, France
| | - Gilles Chopard
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- E.A. 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
| | - Eric Laurent
- E.A. 3188, Laboratory of Psychology, University of Franche-Comté, Besançon, France
- UMSR 3124/FED 4209 MSHE Ledoux, CNRS and University of Franche-Comté, Besançon, France
- * E-mail: (NC); (EL)
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174
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Small vessel disease and memory loss: what the clinician needs to know to preserve patients' brain health. Curr Cardiol Rep 2014; 15:427. [PMID: 24105643 DOI: 10.1007/s11886-013-0427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Small vessel disease (SVD) in the brain manifests in the periventricular and deep white matter and radiographically is described as "leukoaraiosis". It is increasingly recognized as a cause of morbidity from middle age onward and this clinical relevance has paralleled advances in the field of neuroradiology. Overall, SVD is a heterogenous group of vascular disorders that may be asymptomatic, or a harbinger of many conditions that jeopardize brain health. Management and prevention focuses on blood pressure control, lifestyle modification, and symptomatic treatment.
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175
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Elcombe EL, Lagopoulos J, Mowszowski L, Diamond K, Paradise M, Hickie IB, Lewis SJG, Naismith SL. Clinical and Cognitive Correlates of Structural Hippocampal Change in "At-Risk" Older Adults. J Geriatr Psychiatry Neurol 2014; 27:67-76. [PMID: 24196661 DOI: 10.1177/0891988713509137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 09/05/2013] [Indexed: 12/25/2022]
Abstract
With estimates of dementia expected to rise over the coming decades, there is interest in understanding the factors associated with promoting neuroprotection and limiting neurodegeneration. In this study, we examined the change in the volume of the hippocampus over a 2-month period in 34 older people "at risk" of cognitive decline (mean age = 66.8 years, 38% male). Factors that were examined included cognitive reserve, neuropsychological functioning, depression as well as a lifestyle (cognitive training) intervention. The results showed that over a 2-month period, increases in hippocampal size were associated with having higher premorbid intellect, greater occupational attainment, superior memory, and higher levels of functioning. Conversely, depression and disability were associated with decreases in hippocampal volume. Cognitive training was not associated with changes in hippocampal volume. These findings suggest that factors associated with cognitive reserve, cognition and depression may play an integral pathophysiological role in determining hippocampal volumes in "at-risk" older adults.
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Affiliation(s)
- Emma L Elcombe
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Jim Lagopoulos
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Keri Diamond
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Matthew Paradise
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Ian B Hickie
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, New South Wales, Australia
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176
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Chen CM, Huang GH, Chen CCH. Older patients’ depressive symptoms 6 months after prolonged hospitalization: Course and interrelationships with major associated factors. Arch Gerontol Geriatr 2014; 58:339-43. [DOI: 10.1016/j.archger.2013.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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177
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Abstract
This brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient's symptoms.
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178
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Eurelings LSM, Ligthart SA, van Dalen JW, Moll van Charante EP, van Gool WA, Richard E. Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study. Int J Geriatr Psychiatry 2014; 29:454-63. [PMID: 24105658 DOI: 10.1002/gps.4026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/12/2013] [Accepted: 08/27/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Although depression is considered to be associated with cardiovascular disease (CVD), specifically symptoms of apathy have been strongly associated with a history of CVD in recent studies. In this study, we prospectively assess whether symptoms of apathy and depression are independent risk factors for incident CVD and stroke. METHODS We carried out a prospective cohort study of 1810 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. Symptoms of apathy and depression were assessed with the 15-item Geriatric Depression Scale. Incident CVD and stroke were assessed after 2 years follow-up. The associations of symptoms of apathy and depression with incident CVD and stroke were analyzed separately using logistic regression analysis. RESULTS Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants, respectively. Incident CVD occurred in 62 (3.5%) participants and stroke in 55 (3.1%) participants. Apathy was associated with incident CVD after adjustment for demographics and cardiovascular risk factors (odds ratio (OR) = 2.60, 95% CI = 1.46-4.65). Exclusion of subjects with depressive symptoms yielded a similar OR (2.94, 95% CI = 1.45-5.96, n = 1544). No association was found between depressive symptoms and incident CVD. Neither apathy symptoms nor depressive symptoms were associated with incident stroke. CONCLUSIONS Apathy, but not depression, is a strong, independent risk factor for incident CVD. It may be a marker of underlying vascular disease. By its nature, apathy may cause non-adherence to a healthy lifestyle, diminished activities, and possibly even withdrawal from clinical care aimed at improving vascular risk profiles.
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Affiliation(s)
- Lisa S M Eurelings
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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179
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Tadayonnejad R, Yang S, Kumar A, Ajilore O. Multimodal brain connectivity analysis in unmedicated late-life depression. PLoS One 2014; 9:e96033. [PMID: 24763508 PMCID: PMC3999134 DOI: 10.1371/journal.pone.0096033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 04/02/2014] [Indexed: 02/07/2023] Open
Abstract
Late-life depression (LLD) is a common disorder associated with emotional distress, cognitive impairment and somatic complains. Structural abnormalities have been suggested as one of the main neurobiological correlates in LLD. However the relationship between these structural abnormalities and altered functional brain networks in LLD remains poorly understood. 15 healthy elderly comparison subjects from the community and 10 unmedicated and symptomatic subjects with geriatric depression were selected for this study. For each subject, 87 regions of interest (ROI) were generated from whole brain anatomical parcellation of resting state fMRI data. Whole-brain ROI-wise correlations were calculated and compared between groups. Group differences were assessed using an analysis of covariance after controlling for age, sex and education with multiple comparison correction using the false discovery rate. Structural connectivity was assessed by tract-based spatial statistics (TBSS). LLD subjects had significantly decreased connectivity between the right accumbens area (rA) and the right medial orbitofrontal cortex (rmOFC) as well as between the right rostral anterior cingulate cortex (rrACC) and bilateral superior frontal gyrus (bsSFG). Altered connectivity of rrACC with the bsSFG was significantly correlated with depression severity in depressed subjects. TBSS analysis showed a 20% reduction in fractional anisotropy (FA) in the right Forceps Minor (rFM) in depressed subjects. rFM FA values were positively correlated with rA-rmOFC and rrACC-bsFG functional connectivity values in our total study sample. Coordinated structural and functional impairment in circuits involved in emotion regulation and reward pathways play an important role in the pathophysiology of LLD.
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Affiliation(s)
- Reza Tadayonnejad
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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180
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Schwartz B. New criteria for supplementation of selected micronutrients in the era of nutrigenetics and nutrigenomics. Int J Food Sci Nutr 2014; 65:529-38. [PMID: 24625102 DOI: 10.3109/09637486.2014.898258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Advances in molecular biology, emergence of novel techniques and huge amount of information generated in the post-Human Genome Project era have fostered the emergence of new disciplines in the field of nutritional research: Nutrigenomics deals with the effect of diet on gene expression whereas nutrigenetics refers to the impact of inherited traits on the response to a specific dietary pattern, functional food or supplement. Understanding the role of micronutrient supplementation with specific genetic backgrounds may provide an important contribution to a new optimum health strategy based on individualized nutritional treatment and may provide the strategies for the development of safer and more effective dietary interventions. This overview of the various aspects of supplementation of micronutrients in the era of nutrigenetics and nutrigenomics may provide a better understanding of novel nutritional research approach and provide an additional insight that can be applied to the daily dietary practice.
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Affiliation(s)
- Betty Schwartz
- The Robert H. Smith Faculty of Agriculture, Food and Environment, Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem , Rehovot , Israel
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181
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Hahn C, Lim HK, Lee CU. Neuroimaging findings in late-onset schizophrenia and bipolar disorder. J Geriatr Psychiatry Neurol 2014; 27:56-62. [PMID: 24401535 DOI: 10.1177/0891988713516544] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, there has been an increasing interest in late-onset mental disorders. Among them, geriatric schizophrenia and bipolar disorder are significant health care risks and major causes of disability. We discussed whether late-onset schizophrenia (LOS) and late-onset bipolar (LOB) disorder can be a separate entity from early-onset schizophrenia (EOS) and early-onset bipolar (EOB) disorder in a subset of late-life schizophrenia or late-life bipolar disorder through neuroimaging studies. A literature search for imaging studies of LOS or LOB was performed in the PubMed database. Search terms used were "(imaging OR MRI OR CT OR SPECT OR DTI OR PET OR fMRI) AND (schizophrenia or bipolar disorder) AND late onset." Articles that were published in English before October 2013 were included. There were a few neuroimaging studies assessing whether LOS and LOB had different disease-specific neural substrates compared with EOS and EOB. These researches mainly observed volumetric differences in specific brain regions, white matter hyperintensities, diffusion tensor imaging, or functional neuroimaging to explore the differences between LOS and LOB and EOS and EOB. The aim of this review was to highlight the neural substrates involved in LOS and LOB through neuroimaging studies. The exploration of neuroanatomical markers may be the key to the understanding of underlying neurobiology in LOS and LOB.
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Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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182
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Tadayonnejad R, Ajilore O. Brain network dysfunction in late-life depression: a literature review. J Geriatr Psychiatry Neurol 2014; 27:5-12. [PMID: 24381233 DOI: 10.1177/0891988713516539] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As a common psychiatric disorder in the growing geriatric population, late-life depression (LLD) has a negative impact on the cognitive, affective, and somatic domains of the lives of the elderly individuals. Accumulating evidence from the structural and functional imaging studies on LLD supports a "network dysfunction model" rather than a "lesion pathology model" for understanding the underlying biological mechanism in this mental disorder. In this work, we used network dysfunction model as a conceptual framework for reviewing recent neuroimaging findings in LLD. Our focus was on 4 major neurocircuits that have been shown to be involved in LLD: default mood network, cognitive control network, affective/frontolimbic network, and corticostriatal circuits. Findings of LLD-related gray and white matter structural abnormalities and resting-state and task-based functional changes were discussed for each network separately. We extended our review by summarizing the latest works that apply graph theory-based network analysis techniques for testing alterations in whole-brain network properties associated with LLD.
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Affiliation(s)
- Reza Tadayonnejad
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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183
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Belvederi Murri M, Pariante C, Mondelli V, Masotti M, Atti AR, Mellacqua Z, Antonioli M, Ghio L, Menchetti M, Zanetidou S, Innamorati M, Amore M. HPA axis and aging in depression: systematic review and meta-analysis. Psychoneuroendocrinology 2014; 41:46-62. [PMID: 24495607 DOI: 10.1016/j.psyneuen.2013.12.004] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
Abstract
One of the most consistent findings in the biology of depression is an altered activity of the hypothalamic-pituitary-adrenal (HPA) axis. However, data concerning this issue have never been examined with a focus on the older population. Here we present a systematic review and meta-analysis, based on studies investigating levels of cortisol, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) in depressed participants older than 60 and compared with healthy controls. We found 20 studies, for a total of 43 comparisons on different indices of HPA axis functioning. Depression had a significant effect (Hedges' g) on basal cortisol levels measured in the morning (0.89), afternoon (0.83) and night (1.39), but a smaller effect on cortisol measured continuously (0.51). The effect of depression was even higher on post-dexamethasone cortisol levels (3.22), whereas it was non-significant on morning ACTH and CRH levels. Subgroup analyses indicated that various methodological and clinical factors can influence the study results. Overall, older participants suffering from depression show a high degree of dysregulation of HPA axis activity, with differences compared with younger adults. This might depend on several mechanisms, including physical illnesses, alterations in the CNS and immune-endocrinological alterations. Further studies are needed to clarify the implications of altered HPA axis activity in older patients suffering from depression. Novel pharmacological approaches might be effective in targeting this pathophysiological feature, thus improving the clinical outcomes.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK; Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy.
| | - Carmine Pariante
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Valeria Mondelli
- Institute of Psychiatry, Department of Psychological Medicine, King's College London, London, UK
| | - Mattia Masotti
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences - Psychiatry, University of Bologna, Italy
| | - Zefiro Mellacqua
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, London, UK
| | - Marco Antonioli
- Department of Biomedical and NeuroMotor Sciences - Psychiatry, University of Bologna, Italy
| | - Lucio Ghio
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Marco Menchetti
- Section of Psychiatry, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Marco Innamorati
- Department of Neurosciences Division of Psychiatry, University of Parma, Parma, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Oftalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
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184
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Subjective memory complaints, depressive symptoms and cognition in patients attending a memory outpatient clinic. Int Psychogeriatr 2014; 26:463-73. [PMID: 24308705 DOI: 10.1017/s1041610213002263] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The goals of this study were to establish prevalence of subjective memory complaints (SMC) and depressive symptoms (DS) and their relation to cognitive functioning and cognitive status in an outpatient memory clinic cohort. METHODS Two hundred forty-eight cognitively healthy controls and 581 consecutive patients with cognitive complaints who fulfilled the inclusion criteria were included in the study. RESULTS A statistically significant difference (p < 0.001) between control group and patient group regarding mean SMC was detected. 7.7% of controls reported a considerable degree of SMC, whereas 35.8% of patients reported considerable SMC. Additionally, a statistically significant difference (p < 0.001) between controls and patient group regarding Beck depression score was detected. 16.6% of controls showed a clinical relevant degree of DS, whereas 48.5% of patients showed DS. An analysis of variance revealed a statistically significant difference across all four groups (control group, SCI group, naMCI group, aMCI group) (p < 0.001). Whereas 8% of controls reported a considerable degree of SMC, 34% of the SCI group, 31% of the naMCI group, and 54% of the aMCI group reported considerable SMC. A two-factor analysis of variance with the factors cognitive status (controls, SCI group, naMCI group, aMCI group) and depressive status (depressed vs. not depressed) and SMC as dependent variable revealed that both factors were significant (p < 0.001), whereas the interaction was not (p = 0.820). CONCLUSIONS A large proportion of patients seeking help in a memory outpatient clinic report considerable SMC, with an increasing degree from cognitively healthy elderly to aMCI. Depressive status increases SMC consistently across groups with different cognitive status.
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185
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Duffy SL, Paradise M, Hickie IB, Lewis SJ, Naismith SL, Lagopoulos J. Cognitive impairment with and without depression history: an analysis of white matter microstructure. J Psychiatry Neurosci 2014; 39:135-43. [PMID: 24359878 PMCID: PMC3937282 DOI: 10.1503/jpn.130079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) and late-life depression are clinical syndromes that often co-occur and may represent an early manifestation of neurodegenerative disease. The present study examined white matter microstructure in patients with MCI with and without a history of major depression compared with healthy controls. METHODS Older adults with MCI and no history of major depression (MCI), adults with MCI and euthymic major depression (MCI-MD) and healthy controls underwent comprehensive medical, psychiatric and neuropsychological assessments. Participants also underwent diffusion tensor imaging, which was analyzed using tract-based spatial statistics. White matter hyperintensity (WMH) burden and medical burden were also quantified. RESULTS We enrolled 30 participants in the MCI group, 36 in the MCI-MD group and 22 in the control group. Compared with controls, participants in the MCI group had significantly reduced fractional anisotropy (FA) in the corpus callosum, superior longitudinal fasciculus (SLF), corona radiata and posterior thalamic radiation. Participants in the MCI-MD group had significantly reduced FA in the corpus callosum, internal capsule, external capsule, corona radiata, posterior thalamic radiation, sagittal striatum, fornix, SLF, uncinate fasciculus and right cingulum compared with controls. No significant differences in FA were observed between the MCI and MCI-MD groups. Participants in the MCI-MD group had greater medical burden (p = 0.020) and WMH burden than controls (p = 0.013). LIMITATIONS Study limitations include the cross-sectional design and antidepressant medication use. CONCLUSION To our knowledge, this study is the first to compare white matter microstructure in patients with MCI with and without a history of major depression and suggests that a common underlying structural white matter change may underpin cognitive impairment in both MCI groups. Further research is needed to delineate the pathophysiological mechanisms underlying these microstructural changes.
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Affiliation(s)
| | | | | | | | - Sharon L. Naismith
- Correspondence to: S.L. Naismith, Ageing Brain Centre, 94 Mallett St., Camperdown NSW 2050 Australia;
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186
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Robillard R, Naismith SL, Smith KL, Rogers NL, White D, Terpening Z, Ip TKC, Hermens DF, Whitwell B, Scott EM, Hickie IB. Sleep-wake cycle in young and older persons with a lifetime history of mood disorders. PLoS One 2014; 9:e87763. [PMID: 24586290 PMCID: PMC3934865 DOI: 10.1371/journal.pone.0087763] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022] Open
Abstract
Considering the marked changes in sleep and circadian rhythms across the lifespan, age may contribute to the heterogeneity in sleep-wake profiles linked to mood disorders. This study aimed to investigate the contributions of age and depression severity to sleep-wake disturbances. The Hamilton Depression Rating Scale (HDRS) was administered to assess current symptoms severity in 238 persons with a history of a mood disorder between 12 and 90 years of age (y.o.). Actigraphy was recorded over five to 22 days. Regression analyses and analyses of variance [age (12–19 y.o., 20–39 y.o., 40–59 y.o., and ≥60 y.o.) by depression severity (HDRS< and ≥8)] were conducted. The 12–19 y.o. and 20–39 y.o. groups had a delayed sleep schedule and acrophase compared to all other groups. The ≥60 y.o. group had a lower rhythmicity and amplitude (p≤.006) than the 12–19 y.o. group (p≤.046). Participants with a HDRS≥8 spent longer time in bed, had later sleep offset times and had lower circadian rhythmicity than those with a HDRS<8 (p≤.036). Younger age and higher HDRS score correlated with later sleep onset and offset times, longer time in bed, higher WASO, lower sleep efficiency and later acrophase (p≤.023). Age was a significant predictor of delayed sleep and activity schedules (p≤.001). The profile of sleep-wake cycle disturbances associated with mood disorders changes with age, with prominent sleep phase delay during youth and reduced circadian strength in older persons. Conversely, disruptions in sleep consolidation seem more stable across age.
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Affiliation(s)
- Rébecca Robillard
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L. Naismith
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kristie Leigh Smith
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Naomi L. Rogers
- Concord Clinical School, The University of Sydney, Concord, New South Wales, Australia
| | - Django White
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Zoe Terpening
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
- Healthy Brain Ageing Clinic, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tony K. C. Ip
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel F. Hermens
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bradley Whitwell
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M. Scott
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian B. Hickie
- Clinical Research Unit, Brain & Mind Research Institute, The University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
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187
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Ajilore O, Lamar M, Leow A, Zhang A, Yang S, Kumar A. Graph theory analysis of cortical-subcortical networks in late-life depression. Am J Geriatr Psychiatry 2014; 22:195-206. [PMID: 23831171 PMCID: PMC3858393 DOI: 10.1016/j.jagp.2013.03.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 02/26/2013] [Accepted: 03/07/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Late-life major depression (LLD) is characterized by distinct epidemiologic and psychosocial factors, as well as medical comorbidities that are associated with specific neuroanatomical differences. The purpose of this study was to use interregional correlations of cortical and subcortical volumes to examine cortical-subcortical structural network properties in subjects with LLD compared with healthy comparison subjects. METHODS This was a cross-sectional neuroimaging study conducted in the general community. We recruited 73 healthy elderly comparison subjects and 53 subjects with LLD who volunteered in response to advertisements. Brain network connectivity measures were generated by correlating regional volumes after controlling for age, gender, and intracranial volume by using the Brain Connectivity Toolbox. RESULTS Results for overall network strength revealed that LLD networks showed a greater magnitude of associations for both positive and negative correlation weights compared with healthy elderly networks. LLD networks also demonstrated alterations in brain network structure compared with healthy comparison subjects. LLD networks were also more vulnerable to targeted attacks compared with healthy elderly comparison subjects, and this vulnerability was attenuated when controlling for white matter alterations. CONCLUSIONS Overall, this study demonstrates that cortical-subcortical network properties are altered in LLD and may reflect the underlying neuroanatomical vulnerabilities of the disorder.
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Affiliation(s)
- Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL.
| | - Melissa Lamar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Alex Leow
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anand Kumar
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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188
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Beheydt LL, Schrijvers D, Docx L, Bouckaert F, Hulstijn W, Sabbe B. Psychomotor retardation in elderly untreated depressed patients. Front Psychiatry 2014; 5:196. [PMID: 25674065 PMCID: PMC4306283 DOI: 10.3389/fpsyt.2014.00196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/19/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Psychomotor retardation (PR) is one of the core features in depression according to DSM V (1), but also aging in itself causes cognitive and psychomotor slowing. This is the first study investigating PR in relation to cognitive functioning and to the concomitant effect of depression and aging in a geriatric population ruling out contending effects of psychotropic medication. METHODS A group of 28 non-demented depressed elderly is compared to a matched control group of 20 healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests. Statistical analysis consisted of a General Linear Method multivariate analysis of variance to compare the clinical, cognitive, and psychomotor outcomes of the two groups. RESULTS Patients performed worse on all clinical, cognitive, and PR measures. Both groups showed an effect of cognitive load on fine motor function but the influence was significantly larger for patients than for healthy elderly except for the initiation time. LIMITATIONS Due to the restrictive inclusion criteria, only a relatively limited sample size could be obtained. CONCLUSION With a medication free sample, an additive effect of depression and aging on cognition and PR in geriatric patients was found. As this effect was independent of demand of effort (by varying the cognitive load), it was apparently not a motivational slowing effect of depression.
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Affiliation(s)
- Lieve Lia Beheydt
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Didier Schrijvers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Lise Docx
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Filip Bouckaert
- University Psychiatric Center KU Leuven , Kortenberg , Belgium
| | - Wouter Hulstijn
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University , Antwerp , Belgium
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189
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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] [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.
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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
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Abstract
The diagnosis of dysthymic disorder was created in DSM-III and maintained in DSM-IV to describe a depressive syndrome of mild to moderate severity of at least two years' duration that did not meet criteria for major depressive disorder. The prevalence of dysthymic disorder is approximately 2% in the elderly population where subsyndromal depressions of lesser severity are more common. Dysthymic disorder was replaced in DSM-V by the diagnosis of "persistent depressive disorder" that includes chronic major depression and dysthymic disorder. In older adults, epidemiological and clinical evidence supports the use of the term "dysthymic disorder." In contrast to young adults with dysthymic disorder, older adults with dysthymic disorder commonly present with late age of onset, without major depression and other psychiatric disorders, and with a low rate of family history of mood disorders. They often have stressors such as loss of social support and bereavement, and some have cerebrovascular or neurodegenerative pathology. A minority has chronic depression dating from youth with psychiatric comorbidity similar to young adults with dysthymic disorder. In older adults, both dysthymic disorder and subsyndromal depression increase disability and lead to poor medical outcomes. Elderly patients with dysthymic disorder are seen mainly in primary care where identification and treatment are often inadequate. Treatment with antidepressant medication shows marginal superiority over placebo in controlled trials, and problem-solving therapy shows similar efficacy. Combined treatment and collaborative care models show slightly better results, but cost effectiveness is a concern. Further work is needed to clarify optimal approaches to the treatment of dysthymic disorder in elderly patients.
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191
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Abstract
This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of tests useful for screening and diagnosis of depression in the elderly are presented. Each test is reviewed according to time to administer, sensitivity and specificity, outcomes, advantages, and disadvantages. The importance of clinical history and the diagnostic interview, as well as the role of laboratory studies and neuroimaging in the clinical evaluation are discussed.
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Affiliation(s)
- Juliet Glover
- Geriatric Psychiatry Fellowship Program, Palmetto Health, University of South Carolina School of Medicine, 3555 Harden Street, Suite 301, Columbia, SC 29203, USA
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192
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Concerto C, Lanza G, Cantone M, Pennisi M, Giordano D, Spampinato C, Ricceri R, Pennisi G, Aguglia E, Bella R. Different patterns of cortical excitability in major depression and vascular depression: a transcranial magnetic stimulation study. BMC Psychiatry 2013; 13:300. [PMID: 24206945 PMCID: PMC4226249 DOI: 10.1186/1471-244x-13-300] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinical and functional studies consider major depression (MD) and vascular depression (VD) as different neurobiological processes. Hypoexcitability of the left frontal cortex to transcranial magnetic stimulation (TMS) is frequently reported in MD, whereas little is known about the effects of TMS in VD. Thus, we aimed to assess and compare motor cortex excitability in patients with VD and MD. METHODS Eleven VD patients, 11 recurrent drug-resistant MD patients, and 11 healthy controls underwent clinical, neuropsychological and neuroimaging evaluations in addition to bilateral resting motor threshold, cortical silent period, and paired-pulse TMS curves of intracortical excitability. All patients continued on psychotropic drugs, which were unchanged throughout the study. RESULTS Scores on one of the tests evaluating frontal lobe abilities (Stroop Color-Word interference test) were worse in patients compared with controls. The resting motor threshold in patients with MD was significantly higher in the left hemisphere compared with the right (p < 0.05), and compared with the VD patients and controls. The cortical silent period was bilaterally prolonged in MD patients compared with VD patients and controls, with a statistically significant difference in the left hemisphere (p < 0.01). No differences were observed in the paired-pulse curves between patients and controls. CONCLUSIONS This study showed distinctive patterns of motor cortex excitability between late-onset depression with subcortical vascular disease and early-onset recurrent drug resistant MD. The data provide a TMS model of the different processes underlying VD and MD. Additionally, our results support the "Vascular depression hypothesis" at the neurophysiological level, and confirm the inter-hemispheric asymmetry to TMS in patients with MD. We were unable to support previous findings of impaired intracortical inhibitory mechanisms to TMS in patients with MD, although a drug-induced effect on our results cannot be excluded. This study may aid the understanding of the pathogenetic differences underlying the clinical spectrum of depressive disorders.
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Affiliation(s)
- Carmen Concerto
- Unit of Psychiatry, Department of Clinical and Molecular Biomedicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Giuseppe Lanza
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Mariagiovanna Cantone
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Manuela Pennisi
- Department of Chemistry, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Daniela Giordano
- Department of Electrical, Electronics and Informatics Engineering, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Concetto Spampinato
- Department of Electrical, Electronics and Informatics Engineering, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Riccardo Ricceri
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Giovanni Pennisi
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Eugenio Aguglia
- Unit of Psychiatry, Department of Clinical and Molecular Biomedicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Rita Bella
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
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Kasala ER, Bodduluru LN, Maneti Y, Thipparaboina R. Effect of meditation on neurophysiological changes in stress mediated depression. Complement Ther Clin Pract 2013; 20:74-80. [PMID: 24439650 DOI: 10.1016/j.ctcp.2013.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 12/11/2022]
Abstract
Meditation is a complex mental practice involving changes in sensory perception, cognition, hormonal and autonomic activity. It is widely used in psychological and medical practices for stress management as well as stress mediated mental disorders like depression. A growing body of literature has shown that meditation has profound effects on numerous physiological systems that are involved in the pathophysiology of major depressive disorder (MDD). Although meditation-based interventions have been associated with improvement in depressive symptoms and prevention of relapse, the physiological mechanisms underlying the therapeutic effects of meditation are not clearly defined and even paradoxical. This paper reviews many of the physiological abnormalities found in cytokine & stress mediated depression and the reversal of these anomalies by different meditation techniques.
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Affiliation(s)
- Eshvendar Reddy Kasala
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Bhangagarh, Guwahati 781032, Assam, India.
| | - Lakshmi Narendra Bodduluru
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Bhangagarh, Guwahati 781032, Assam, India
| | - Yogeshwar Maneti
- Department of Pharmacology & Toxicology, National Institute of Pharmaceutical Education and Research, Bhangagarh, Guwahati 781032, Assam, India
| | - Rajesh Thipparaboina
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Balanagar, Hyderabad 500037, Andhra Pradesh, India
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194
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Weisskopf MG, Moisan F, Tzourio C, Rathouz PJ, Elbaz A. Pesticide exposure and depression among agricultural workers in France. Am J Epidemiol 2013; 178:1051-8. [PMID: 23851580 DOI: 10.1093/aje/kwt089] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pesticides are ubiquitous neurotoxicants, and several lines of evidence suggest that exposure may be associated with depression. Epidemiologic evidence has focused largely on organophosphate exposures, while research on other pesticides is limited. We collected detailed pesticide use history from farmers recruited in 1998-2000 in France. Among 567 farmers aged 37-78 years, 83 (14.6%) self-reported treatment or hospitalization for depression. On the basis of the reported age at the first such instance, we used adjusted Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals for depression (first treatment or hospitalization) by exposure to different pesticides. The hazard ratio for depression among those who used herbicides was 1.93 (95% confidence interval (CI): 0.95, 3.91); there was no association with insecticides or fungicides. Compared with nonusers, those who used herbicides for <19 years and ≥19 years (median for all herbicide users, 19 years) had hazard ratios of 1.51 (95% CI: 0.62, 3.67) and 2.31 (95% CI: 1.05, 5.10), respectively. Similar results were found for total hours of use. Results were stronger when adjusted for insecticides and fungicides. There is widespread use of herbicides by the general public, although likely at lower levels than in agriculture. Thus, determining whether similar associations are seen at lower levels of exposure should be explored.
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195
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Grayson L, Thomas A. A systematic review comparing clinical features in early age at onset and late age at onset late-life depression. J Affect Disord 2013; 150:161-70. [PMID: 23623421 DOI: 10.1016/j.jad.2013.03.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although evidence suggests that there are neurobiological differences between unipolar depression in younger versus older adults, conflicting evidence exists about whether these manifest as clinically identifiable differences. METHOD We conducted a systematic review of aetiological, phenomenological and outcome studies to examine the evidence for a distinction between early onset (EOD) and late onset (LOD) depression. A literature search was completed using the computer databases MEDLINE, EMBASE, PSYCHINFO and PUBMED for papers published between January 1982 and December 2012 which compared groups with EOD and LOD. Studies were included if they were of older people and compared symptoms, aetiological factors or outcomes. We conducted a quality assessment of included articles. RESULTS We identified 23 articles which met entry criteria. The only clinical feature which was different between the groups was a higher frequency of a family history of mood disorders in EOD. LIMITATIONS The number of studies identified was low and their quality was generally poor. CONCLUSIONS Although neurobiological studies have reported differences between EOD and LOD, generally these do not appear to translate into identifiable distinguishing clinical features.
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Affiliation(s)
- Louise Grayson
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
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196
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Tascone LDS, Bottino CMDC. Neurobiology of neuropsychiatric symptoms in Alzheimer's disease: A critical review with a focus on neuroimaging. Dement Neuropsychol 2013; 7:236-243. [PMID: 29213845 PMCID: PMC5619193 DOI: 10.1590/s1980-57642013dn70300002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The objective of this critical review of the literature was to reveal the neural
circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in
Alzheimer's disease (AD) patients through the association of these symptoms with
neuroimaging findings. The search for articles was performed on PUBMED from
January 2000 to May 2013, using the key words: Dementia AND BPSD; Dementia AND
Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions,
Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition,
Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six
articles were reviewed and important contributions, especially regarding the
psychopathological concepts discussed, were also considered even if not included
in this time period. The available evidence suggests the three most relevant
neurobiological models for neuropsychiatric symptoms in Alzheimer's disease are
the frontal-subcortical circuits, the cortico-cortical networks, and the
monoaminergic system. We discussed the association of the individual symptoms or
syndromes with these models.
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197
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Nagpal K, Singh SK, Mishra D. Evaluation of safety and efficacy of brain targeted chitosan nanoparticles of minocycline. Int J Biol Macromol 2013; 59:20-8. [DOI: 10.1016/j.ijbiomac.2013.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
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198
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Nagpal K, Singh S, Mishra D. Optimization of brain targeted gallic acid nanoparticles for improved antianxiety-like activity. Int J Biol Macromol 2013; 57:83-91. [DOI: 10.1016/j.ijbiomac.2013.03.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 02/06/2013] [Accepted: 03/08/2013] [Indexed: 11/15/2022]
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Hickie IB, Scott J, Hermens DF, Scott EM, Naismith SL, Guastella AJ, Glozier N, McGorry PD. Clinical classification in mental health at the cross-roads: which direction next? BMC Med 2013; 11:125. [PMID: 23672522 PMCID: PMC3653738 DOI: 10.1186/1741-7015-11-125] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/18/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND After 30 years of consensus-derived diagnostic categories in mental health, it is time to head in new directions. Those categories placed great emphasis on enhanced reliability and the capacity to identify them via standardized checklists. Although this enhanced epidemiology and health services planning, it failed to link broad diagnostic groupings to underlying pathophysiology or specific treatment response. DISCUSSION It is time to adopt new goals that prioritize the validation of clinical entities and foster alternative strategies to support those goals. The value of new dimensions (notably clinical staging), that are both clinically relevant and directly related to emerging developmental and neurobiological research, is proposed. A strong emphasis on 'reverse translation' (that is, working back from the clinic to the laboratory) underpins these novel approaches. However, it relies on using diagnostic groupings that already have strong evidence of links to specific risk factors or patterns of treatment response. SUMMARY The strategies described abandon the historical divides between clinical neurology, psychiatry and psychology and adopt the promotion of pathways to illness models.
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Affiliation(s)
- Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
- FondaMental Foundation, Fondation de Coopération Scientifique Hôpital A. Chenevier, 40 Rue de Mesly, Creteil, F-94000, France
- INSERM, U 955, IMRB, Psychiatry Genetic, Creteil, F-94000, France
| | - Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
- School of Medicine, The University of Notre Dame, 160 Oxford Street, Darlinghurst, Sydney, 2010, Australia
| | - Sharon L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Adam J Guastella
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Nick Glozier
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia
- Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia
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200
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Pitychoutis PM, Kokras N, Sanoudou D, Dalla C, Papadopoulou-Daifoti Z. Pharmacogenetic considerations for late life depression therapy. Expert Opin Drug Metab Toxicol 2013; 9:989-99. [DOI: 10.1517/17425255.2013.794786] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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