Investigating the relationship between age of onset of depressive disorder and cognitive function

A nomogram to predict the risk of cognitive impairment in patients with depressive disorder

This study was to describe the cognitive function status in patients with depressive disorder and to construct a nomogram model to predict the risk factors of cognitive impairment in these patients. From October 2019 to February 2021, a total of 141 patients with depressive disorder completed the survey in two hospitals. The Montreal cognitive assessment (MoCA) was used with a cutoff score of 26 to differentiate cognitive impairment. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. A nomogram was then constructed based on the results of the multivariable logistic regression analysis. The patients had an average MoCA score of 23.99 ± 3.02. The multivariable logistic regression analysis revealed that age (OR: 1.096, 95% CI: 1.042-1.153, p < 0.001), education (OR: 0.065, 95% CI: 0.016-0.263, p < 0.001), depression severity (OR: 1.878, 95% CI: 1.021-3.456, p = 0.043), and sleep quality (OR: 2.454, 95% CI: 1.400-4.301, p = 0.002) were independent risk factors for cognitive impairment in patients with depressive disorder. The area under receiver operating characteristic (ROC) curves was 0.868 (95% CI: 0.807-0.929), indicating good discriminability of the model. The calibration curve of the model and the Hosmer-Lemeshow test (p = 0.571) demonstrated a well-fitted model with high calibration. Age, education, depression severity, and sleep quality were found to be significant predictors of cognitive function. A nomogram model was developed to predict cognitive impairment in patients with depressive disorder, providing a solid foundation for clinical interventions.

Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans?

Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia.Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans.Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment.Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11-1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98-1.45).Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.

Protective mechanism of the EZH2/microRNA-15a-5p/CXCL10 axis in rats with depressive-like behaviors

OBJECTIVE

Enhancer of zeste homolog 2 (EZH2), microRNA-15a-5p (miR-15a-5p), and chemokine C-X-C ligand 10 (CXCL10) have been studied in many diseases. However, the investigation of the EZH2/miR-15a-5p/CXCL10 axis in depression is not sufficient. Our study aimed to investigate the regulatory functions of the EZH2/miR-15a-5p/CXCL10 axis in rats with depressive-like behaviors.

METHODS

The rat model of depression-like behaviors was established by chronic unpredictable mild stress (CUMS), and EZH2, miR-15a-5p, and CXCL10 expression levels in rats with depression-like behaviors were detected. The silenced EZH2 or enhanced miR-15a-5p recombinant lentivirus was injected into the rats with depression-like behaviors to assess the changes in behavioral tests, hippocampal pathological structure, levels of inflammatory cytokines in the hippocampus, and hippocampal neuron apoptosis. The regulatory relationships among EZH2, miR-15a-5p, and CXCL10 were measured.

RESULTS

miR-15a-5p expression was reduced, and EZH2 and CXCL10 expression levels were elevated in rats with depressive-like behaviors. Downregulation of EZH2 or elevation of miR-15a-5p improved depressive behavior, and inhibited hippocampal inflammatory response and hippocampal neuron apoptosis. EZH2 promoted histone methylation at the promoter of miR-15a-5p, and miR-15a-5p bound to CXCL10 to inhibit its expression.

CONCLUSION

Our study summarizes that EZH2 promotes the hypermethylation of the miR-15a-5p promoter, thereby promoting CXCL10 expression. Upregulation of miR-15a-5p or inhibition of EZH2 can improve the symptoms in rats with depressive-like behaviors.

Linking individual variability in functional brain connectivity to polygenic risk in major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is a highly heterogeneous disease, which brings great difficulties to clinical diagnosis and therapy. Its mechanism is still unknown. Prior neuroimaging studies mainly focused on mean differences between patients and healthy controls (HC), largely ignoring individual differences between patients.

METHODS

This study included 112 MDD patients and 93 HC subjects. Resting-state functional MRI data were obtained to examine the patterns of individual variability of brain functional connectivity (IVFC). The genetic risk of pathways including dopamine, 5-hydroxytryptamine (5-HT), norepinephrine (NE), hypothalamic-pituitary-adrenal (HPA) axis, and synaptic plasticity was assessed by multilocus genetic profile scores (MGPS), respectively.

RESULTS

The IVFC pattern of the MDD group was similar but higher than that in HCs. The inter-network functional connectivity in the default mode network contributed to altered IVFC in MDD. 5-HT, NE, and HPA pathway genes affected IVFC in MDD patients. The age of onset, duration, severity, and treatment response, were correlated with IVFC. IVFC in the left ventromedial prefrontal cortex had a mediating effect between MGPS of the 5-HT pathway and baseline depression severity.

LIMITATIONS

Environmental factors and differences in locations of functional areas across individuals were not taken into account.

CONCLUSIONS

This study found MDD patients had significantly different inter-individual functional connectivity variations than healthy people, and genetic risk might affect clinical manifestations through brain function heterogeneity.

Intra-individual variability identifies individuals vulnerable to contextually induced executive lapses

Contextual stressors, such as engagement in burdensome emotion regulation known as expressive suppression (ES), can result in transient but clinically meaningful decrement in performance on measures of executive functioning (EF). The goal of the present investigation was to examine whether intra-individual variability (IIV-I), which has been identified as an indicator of cognitive weakness, could serve as a marker of vulnerability to EF decrements due to both naturally-occurring and experimentally-manipulated ES.

In Study 1, 180 cognitively healthy older adults completed the Push-Turn-Taptap (PTT) task to assess IIV-I, four Delis-Kaplan Executive Function System (D-KEFS) subtests to assess EF, and the Burden of State Emotion Regulation Questionnaire (B-SERQ) to assess naturally-occurring ES. In Study 2, a subset (n = 81) of participants underwent experimental manipulation to induce ES, followed by second administration of the D-KEFS to examine ES-induced decrements in EF.

In Study 1, hierarchical linear regression yielded a significant interaction between ES and IIV-I as predictors of EF performance, demonstrating that high ES was associated with low EF only among individuals with high IIV-I. In Study 2, repeated measures ANOVA demonstrated an interaction between time (pre- vs. post- manipulation), group (ES vs. control), and IIV-I (high vs. low), such that only individuals who exhibited high IIV-I were negatively impacted by the ES manipulation.

IIV-I moderates the association between ES and EF, such that only individuals with high IIV-I exhibit vulnerability to the impact of ES. Thus, IIV-I may act as a marker of vulnerability to temporary EF depletion.

Age of onset for major depressive disorder and its association with symptomatology

BACKGROUND

The age of onset (AOO) is a key factor for heterogeneity in major depressive disorder (MDD). Looking at the effect of AOO on symptomatology may improve clinical outcomes. This study aims to examine whether and how AOO affects symptomatology using a machine learning approach and latent profile analysis (LPA).

METHODS

The study enrolled 915 participants diagnosed with MDD from eight hospitals across China. Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale. The relationship between symptom profiles and AOO was explored using Random Forest. The effect of AOO on symptom clusters and subtypes was investigated using multiple linear regression and LPA. A continuous AOO indicator was used to conduct the analyses.

RESULTS

Based on the Random Forest, symptom profiles were closely associated with AOO. The regression model showed that the severity of neurovegetative symptoms was positively associated with AOO (β = 0.18, p < 0.001), and the severity of cognitive-behavioral symptoms was negatively associated with AOO (β = -0.12, p < 0.001). LPA demonstrated that the subgroups characterized by suicide and guilt had earlier onset of depression. The subgroup with the lowest global severity of depression had the latest onset.

LIMITATIONS

AOO was recalled retrospectively. The relative scarcity of participants with childhood and adolescence onset depression.

CONCLUSIONS

AOO has an important impact on symptomatology. The findings may enhance clinical evaluations for MDD and assist clinicians in promoting earlier detection and individualized care in vulnerable individuals.

Remote cognitive assessment in severe mental illness: a scoping review

Many individuals living with severe mental illness, such as schizophrenia, present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Remote cognitive assessment presents many opportunities for advancing research and treatment but has yet to be widely used in psychiatric populations. We conducted a scoping review of remote cognitive assessment in severe mental illness to provide an overview of available measures and guide best practices. Overall, 34 studies (n = 20,813 clinical participants) were reviewed and remote measures, psychometrics, facilitators, barriers, and future directions were synthesized using a logic model. We identified 82 measures assessing cognition in severe mental illness across 11 cognitive domains and four device platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement, and poor digital literacy. Our review identified several remote cognitive measures in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures and consideration of potentially influential factors, such as sex and gender. We provide recommendations for conducting remote cognitive assessment in psychiatry and fostering high-quality research using digital technologies.

Towards an understanding of the pathological basis of senile depression and incident dementia: Implications for treatment

Senile depression (SD) is a heterogeneous syndrome. Several clinical profiles are more likely to appear in SD than in early-life depression, but it remains unclear whether the pathophysiology is different. The prevalence of dementia increases with aging, and the underlying pathophysiological processes in the preclinical phase begin even before cognitive deficits or neurological signs appear. SD may be either a risk factor for developing dementia or a prodromal stage of dementia. The inconsistent findings regarding the association between SD and incident dementia may be attributable to the neuropathological heterogeneity underlying SD. Most studies have focused on patients with the clinical diagnosis of Alzheimer disease (AD) as an outcome, but several clinicopathological studies suggest that primary age-related tauopathy and argyrophilic grain disease may account for a proportion of cases clinically misdiagnosed as AD in the elderly population. Furthermore, most AD cases have additional neuropathologic changes such as cerebrovascular disease and Lewy body disease. Here, we review the neuropathological findings linking SD to incident dementia, focusing on common age-related neuropathologies. In particular, the roles of disturbance of neural circuity, imbalance of monoaminergic systems, dysregulation of the hypothalamic-pituitary-adrenal axis, and elevated neuroinflammatory status are discussed. Finally, we review the current treatment of SD in the context of age-related neuropathological changes.

The sociodemographic characteristics and clinical features of the late-life depression patients: results from the Beijing Anding Hospital mental health big data platform

BACKGROUND

The sociodemographic characteristics and clinical features of the Late-life depression (LLD) patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of LLD patients at a psychiatric hospital in China, with a subgroup analysis, such as with or without anxiety, gender differences.

METHODS

This retrospective study examined outpatients with LLD from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records.

RESULTS

In a sample of 47,334 unipolar depression patients, 31,854 (67.30%) were women, and 15,480 (32.70%) were men. The main comorbidities of LDD are generalized anxiety disorder (GAD) (83.62%) and insomnia (74.52%).Among patients with unipolar depression, of which benzodiazepines accounted for the largest proportion (77.77%), Selective serotonin reuptake inhibitors (SSRIs) accounted for 59.00%, a noradrenergic and specific serotonergic antidepressant (NaSSAs) accounted for 36.20%. The average cost of each visit was approximately 646.27 yuan, and the cost of each visit was primarily attributed to Western medicine (22.97%) and Chinese herbal medicine (19.38%). For the cost of outpatient visits, depression comorbid anxiety group had a higher average cost than the non-anxiety group (p < 0.05). There are gender differences in outpatient costs, men spend more than women, for western medicine, men spend more than women, for Chinese herbal medicine, women spend more than men (all p < 0.05). The utilization rate of SSRIs and benzodiazepines in female patients is significantly higher than that in male patients (p < 0.05).

CONCLUSION

LLD patients are more commonly women than men and more commonly used SSRIs and NaSSAs. Elderly patients with depression often have comorbid generalized anxiety. LLD patients spend most of their visits on medicines, and while the examination costs are lower.

Neurocognitive deficits in depression: a systematic review of cognitive impairment in the acute and remitted state

Previous research suggests a broad range of deficits in major depressive disorder. Our goal was to update the current assumptions and investigate the extent of cognitive impairment in depression in the acute and remitted state. A systematic review of the existing literature between 2009 and 2019 assessing the risk of bias within the included studies was performed. Of the 42 articles reviewed, an unclear risk of bias was shown overall. The risk of bias mainly concerned the sample selection, inadequate remedial measures, as well as the lack of blinding the assessors. In the acute phase, we found strong support for impairment in processing speed, learning, and memory. Follow-up studies and direct comparisons revealed less pronounced deficits in remission, however, deficits were still present in attention, learning and memory, and working memory. A positive correlation between the number of episodes and cognitive deficits as well as depression severity and cognitive deficits was reported. The results also demonstrate a resemblance between the cognitive profiles in bipolar disorder and depression. Comparisons of depression with schizophrenia led to unclear results, at times suggesting an overlap in cognitive performance. The main findings support the global deficit hypothesis and align with results from prior meta-analyses and reviews. Recommendations for future research are also presented.

Serum brain-derived neurotrophic factor and glial cell-derived neurotrophic factor in patients with first-episode depression at different ages

OBJECTIVES

We investigated the differences in serum brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) levels and clinical symptoms with first-episode depression at different ages.

METHODS

Ninety patients (15-60 years old) diagnosed with first-episode depression were enrolled as the study group, and they were divided into early-onset, adult and late-onset groups. The age-matched control groups were healthy volunteers. Serum BDNF and GDNF concentrations were determined by enzyme-linked immunosorbent assay (ELISA). GraphPad Prism 9 was used for t tests, one-way ANOVAs, chi-square tests, and correlation analyses. p < 0.05 indicated significant differences.

RESULTS

Serum BDNF and GDNF levels were lower in the whole study group and the three subgroups than in the healthy groups. Illness severity, anxiety and education were higher in the early-onset than late-onset patients. Serum BDNF levels were lower in the adult than late-onset patients. Serum BDNF levels were negatively correlated with patient CGI-SI scores. After the LSD test for multiple comparisons, the results were also significant.

CONCLUSIONS

Low serum BDNF and GDNF levels may be involved in the pathophysiology of first-episode depression, and there were differences in serum BDNF levels at different ages, verifying that serum BDNF and GDNF could serve as potential biomarkers of depression. KEY POINTSDepression is often conceptualised as a systemic illness with different biological mechanisms, but satisfactory explanations have not been provided thus far.The aim of our study was to investigate differences in serum BDNF and GDNF levels and their relationships with clinical symptoms in patients with first-episode depression at different ages.The potential of the neurotrophic factor hypothesis to advance the diagnosis and treatment of depression will be a very exciting new strategy for future research.

Depressive Symptoms and Cognitive Decline Among Chinese Rural Elderly Individuals: A Longitudinal Study With 2-Year Follow-Up

Background

Depressive symptoms and mild cognitive impairment (MCI) are highly prevalent in rural China. The study aimed to investigate the longitudinal associations between changes in depressive symptoms and cognitive decline and MCI incidence among Chinese rural elderly individuals.

Methods

A 2-year follow-up study was conducted among 1,477 participants from the Anhui Healthy Longevity Survey (AHLS). Depressive symptoms were assessed by the 9-item Patient Health Questionnaire (PHQ-9), and cognitive status was evaluated by the Mini Mental State Examination (MMSE). Multivariable linear regression and logistic regression were employed.

Results

Every 1-unit PHQ-9 score increase was significantly associated with more cognitive decline (β = 0.157, 95% CI: 0.092, 0.221, p &lt; 0.001) and a higher risk of MCI incidence (OR = 1.063, 95% CI: 1.025, 1.103, p = 0.001). The participants who experienced worsening of depression symptoms had a larger decline in the 2-year MMSE score (β = 0.650, 95% CI: 0.039, 1.261, p = 0.037) and elevated risks of incident MCI (OR = 1.573, 95% CI: 1.113, 2.223, p = 0.010).

Limitations

Screening tools rather than standard diagnostic procedures were used in the study. Moreover, the long-term associations still need further exploration since the follow-up time was short.

Conclusions

Increased depressive symptoms were associated with more cognitive decline and higher risks of incident MCI among Chinese rural residents.

Features of cognitive impairment and related risk factors in patients with major depressive disorder: A case-control study

BACKGROUND

Cognitive impairment (CI) is a common symptom contributing to functional loss in major depressive disorder (MDD). However, the features of CI and its related risk factors in young and middle-aged MDD patients remain unclear.

METHODS

In this case-control study, 18- to 55-year-old acute-onset MDD patients and healthy controls (HCs) were recruited from nine centers in China. MDD patients were diagnosed based on the DSM-IV, the Mini-International Neuropsychiatric Interview, and a 17-item Hamilton Rating Scale for Depression score ≥ 14. Cognitive function, including attention/vigilance, learning, memory, processing speed and executive function, was assessed with a neuropsychological battery and compared between MDD patients and HCs. MDD patients scoring 1.5 SDs below the mean HC score in at least 2 domains were defined as having CI. Logistic regression analysis was used to identify risk factors for CI in MDD patients.

RESULTS

Compared with HCs (n = 302), MDD patients (n = 631) showed significant impairment in all cognitive domains (P < 0.001); 168 MDD patients (26.6%) had CI. Male sex (OR: 1.712; 95% CI: 1.165-2.514; P < 0.01) was positively correlated with CI; age of first onset (OR: 0.974; 95% CI: 0.957-0.991; P < 0.05) and comorbid anxiety disorders (OR: 0.514; 95% CI: 0.332-0.797; P < 0.01) were negatively correlated with CI.

LIMITATIONS

Biomarkers and neuroimaging were not used to investigate the possible biological mechanism and neural basis of CI in MDD.

CONCLUSIONS

CI was prominent in adults with acute-onset MDD; male sex and younger age of first onset were independent risk factors, and comorbid anxiety disorders were a protective factor.

Relationship between immunometabolic status and cognitive performance among major depression disorder patients

BACKGROUND

Alterations in cognitive performance have been described in patients with major depressive disorder (MDD). However, the specific risk factors of these changes are not yet known. This study aimed to explore whether inmunometabolic parameters are related to cognitive performance in MDD in comparison to healthy controls (HC) METHODS: Sample consisted of 84 MDD patients and 78 HC. Both groups were compared on the results of cognitive performance measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB), the presence of metabolic syndrome (MetS) and an inflammatory/oxidative index calculated by a principal component analysis of peripheral biomarkers (tumor necrosis factor, C-reactive protein and 4-hydroxynonenal). A multiple linear regression was carried out, to study the relationship between inmunometabolic variables and the global cognitive performance, being the latter the dependent variable.

RESULTS

Significant differences were obtained in the inflammatory/oxidative index between both groups (F₍₁₁₅₇₎= 12.93; p < .001), also in cognitive performance (F₍₁₁₅₇₎= 56.75; p < .001). The inmunometabolic covariate regression model (i.e., condition (HC/MDD), sex, age and medication loading, MetS, inflammatory/oxidative index and the interaction between MetS and inflammatory/oxidative index) was statistically significant (F₍₇₁₅₇₎= 11.24; p < .01) and explained 31% of variance. The condition, being either MDD or HD, (B=-0.97; p < .001), age (B=-0.28; p < .001) and the interaction between inflammatory/oxidative index and MetS (B=-0.38; p = .02) were factors associated to cognitive performance.

LIMITATIONS

Sample size was relatively small. The cross-sectional design of the study limits the possibilities of analysis.

CONCLUSIONS

Our results provide evidence on the conjoint influence of metabolic and inflammatory dysregulation on cognitive dysfunction in MDD patients. In this way, our study opens a line of research in immunometabolic agents to deal with cognitive decline associated with MDD.

Heterogenous Subtypes of Late-Life Depression and Their Cognitive Patterns: A Latent Class Analysis

BACKGROUND

Late-life depression (LLD), characterized by cognitive deficits, is considered heterogeneous across individuals. Previous studies have identified subtypes with diverse symptom profiles, but their cognitive patterns are unknown. This study aimed to investigate the subtypes of LLD and the cognitive profile of each group.

METHODS

In total, 109 depressed older adults were enrolled. We performed latent class analysis using Geriatric Depression Scale items as indicators to generate latent classes. We compared the sociodemographic and clinical characteristics with cognitive functions between groups and conducted regression analysis to investigate the association between class membership and variables with significant differences.

RESULTS

Two classes were identified: the "pessimistic" group was characterized by pessimistic thoughts and the "worried" group with a relatively high prevalence of worry symptoms. The two groups did not differ in sociodemographic characteristics. The "pessimistic" group showed a higher rate of past history of depression and lower age of onset. The "worried" group had more physical comorbidities and a higher rate of past history of anxiety. The "pessimistic" group was more impaired in general cognitive function, executive function, information processing speed, and attention. Lower general and executive functions were associated with the membership in the "pessimistic" group.

CONCLUSIONS

Subjects with pessimistic symptoms and subjects with a propensity to worry may form two distinct subtypes of late-life depression with different cognitive profiles. Further, the cognitive evaluation of subjects with pessimistic symptoms is of utmost importance.

Development and validation of a nomogram based on lymphocyte subsets to distinguish bipolar depression from major depressive disorder

OBJECTIVE

Bipolar depression (BD) and major depressive disorder (MDD) are both common affective disorders. The common depression episodes make it difficult to distinguish between them, even for experienced clinicians. Failure to properly diagnose them in a timely manner leads to inappropriate treatment strategies. Therefore, it is important to distinguish between BD and MDD. The aim of this study was to develop and validate a nomogram model that distinguishes BD from MDD based on the characteristics of lymphocyte subsets.

MATERIALS AND METHODS

A prospective cross-sectional study was performed. Blood samples were obtained from participants who met the inclusion criteria. The least absolute shrinkage and selection operator (LASSO) regression model was used for factor selection. A differential diagnosis nomogram for BD and MDD was developed using multivariable logistic regression and the area under the curve (AUC) with 95% confidence interval (CI) was calculated, as well as the internal validation using a bootstrap algorithm with 1,000 repetitions. Calibration curve and decision curve analysis (DCA) were used to evaluate the calibration and clinical utility of the nomogram, respectively.

RESULTS

A total of 166 participants who were diagnosed with BD (83 cases) or MDD (83 cases), as well as 101 healthy controls (HCs) between June 2018 and January 2022 were enrolled in this study. CD19⁺ B cells, CD3⁺ T cells, CD3^-CD16/56⁺ NK cells, and total lymphocyte counts were strong predictors of the diagnosis of BD and MDD and were included in the differential diagnosis nomogram. The AUC of the nomogram and internal validation were 0.922 (95%; CI, 0.879-0.965), and 0.911 (95% CI, 0.838-0.844), respectively. The calibration curve used to discriminate BD from MDD showed optimal agreement between the nomogram and the actual diagnosis. The results of DCA showed that the net clinical benefit was significant.

CONCLUSION

This is an easy-to-use, repeatable, and economical nomogram for differential diagnosis that can help clinicians in the individual diagnosis of BD and MDD patients, reduce the risk of misdiagnosis, facilitate the formulation of appropriate treatment strategies and intervention plans.

Coordinate-Based Network Mapping of Brain Structure in Major Depressive Disorder in Younger and Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVE

Structural neuroimaging findings in younger and older adults with major depressive disorder (MDD) are highly heterogeneous, possibly as a result of methodological limitations, lack of distinction between MDD and late-life depression (LLD), or clinical moderators. Using a novel meta-analytic network mapping approach, the authors sought to identify the circuits affected in different clinical subtypes of MDD.

METHODS

The authors identified all voxel-based and surface-based morphometry studies published through October 2020 that compared younger adults with MDD or older adults with LLD to nonpsychiatric control participants. An activation likelihood estimation (ALE) analysis and a novel coordinate-based network mapping approach were used to identify brain circuits affected in MDD and LLD. Meta-regressions examined the impact of age at onset in older patients with LLD and treatment with antidepressants in younger patients with MDD.

RESULTS

The authors analyzed 145 comparisons from 143 articles, including a total of 14,318 participants (MDD: N=6,362; LLD: N=535; control subjects: N=7,421). Significant ALE results confirmed previous findings implicating the left and right parahippocampus and anterior cingulate in MDD and the anterior cingulate in LLD. In contrast, coordinate-based network mapping showed differences in the frontoparietal, dorsal attention, and visual networks both in MDD and LLD. Meta-regressions showed that late onset was significantly associated with widespread structural abnormalities in LLD, and treatment with antidepressants showed a significant association with abnormalities in the anterior cingulate (Brodmann's area 32) and dorsolateral prefrontal cortex (Brodmann's area 9) in MDD.

CONCLUSIONS

These findings help to clarify the shared circuitry of depression across the adult lifespan and highlight some unique circuitry relevant to late-onset depression, which may explain some of the risk for cognitive decline and dementia.

Age at illness onset and physical activity are associated with cognitive impairment in patients with current diagnosis of major depressive disorder

BACKGROUND

Cognitive impairment has been reported in patients with Major Depressive Disorder (MDD). This study aims to explore the association between lifestyle habits and health-related factors and the presence of cognitive symptoms in MDD patients.

METHODS

Demographic, clinical, health-related variables and cognitive scores measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB) were compared between 74 patients with current MDD and 68 healthy controls (HC). To test the hypothesis of associated factors to cognitive symptoms, multivariate backward stepwise linear regression models were run.

RESULTS

Significant neuropsychological deficits were evident in MDD compared with HC in the global cognitive index (F=8.29; df=1, 140; p=0.005). In the regression analysis performed on MDD and HC, years of schooling (β=-0.11; p=<0.001), job status (β=-0.50; p=0.016), physical activity (β=-0.25; p=0.04) and age at illness onset (β=0.17; p=0.017) were statistically significant factors associated to cognitive impairment. The regression model ran in HC showed that only years of schooling were significant (β=-0.07; p=<0.001) in this group.

LIMITATIONS

Sample size was relatively small. Everyday cognitive skills were not evaluated.

CONCLUSIONS

MDD patients have cognitive deficits. These deficits are linked with the years of education, job status, age of onset of the disease and the performance of physical activity. These results support the importance of the implementation of interventions targeting the cognitive reserve and lifestyle habits of MDD patients, in addition to the conventional therapeutic approach focused on symptoms control.

Evolution and Emerging Trends in Depression Research From 2004 to 2019: A Literature Visualization Analysis

Depression has become a major threat to human health, and researchers around the world are actively engaged in research on depression. In order to promote closer research, the study of the global depression knowledge map is significant. This study aims to map the knowledge map of depression research and show the current research distribution, hotspots, frontiers, and trends in the field of depression research, providing researchers with worthwhile information and ideas. Based on the Web of Science core collection of depression research from 2004 to 2019, this study systematically analyzed the country, journal, category, author, institution, cited article, and keyword aspects using bibliometric and data visualization methods. A relationship network of depression research was established, highlighting the highly influential countries, journals, categories, authors, institutions, cited articles, and keywords in this research field. The study identifies great research potential in the field of depression, provides scientific guidance for researchers to find potential collaborations through collaboration networks and coexistence networks, and systematically and accurately presents the hotspots, frontiers, and shortcomings of depression research through the knowledge map of global research on depression with the help of information analysis and fusion methods, which provides valuable information for researchers and institutions to determine meaningful research directions.

Evidence for Progressive Cognitive Deficits in Patients With Major Depressive Disorder

Background: Cognitive deficits have shown progressive feature in major depressive disorder (MDD). However, it remains unknown which component of cognitive function is progressively impaired across episodes of MDD. Here we aim to identify the progressively impaired cognitive components in patients with MDD. Methods: A comprehensive neurocognitive test battery was used to assess the cognitive components (executive function, attention, processing speed, memory, working memory, inhibition, shifting, and verbal fluency) in 35 patients with first-episode MDD (FED), 60 patients with recurrent MDD (RD) and 111 matched healthy controls (HCs). After 6 months of treatment with antidepressant, 20 FED and 36 RD patients achieved clinical remission and completed their second-time neurocognitive tests. Statistical analyses were conducted to identify the impaired cognitive components in the FED and RD groups before and after treatment, and to assess the relationship between the cognitive components and the number of episodes and total illness duration in the MDD patient group. Results: At baseline, both the FED and RD groups showed impairments in all of the cognitive components; the FED and RD groups showed no significant difference in all of the components except for shifting. After remission, only shifting in the RD group showed no significant improvement and remained in an impaired status. Furthermore, shifting was the only component negatively correlated with the number of episodes as well as the total illness duration. Conclusions: Shifting may serve as the progressive cognitive deficit across episodes of MDD. Clinical Trials Registration: Registry name: HPA function and MRI study of trauma-related depression; Registration number: ChiCTR1800014591; URL: http://www.chictr.org.cn/edit.aspx?pid=24669&htm=4.

Study of neuropsychological deficits in late onset depression

BACKGROUND

Older adults with depression often have cognitive deficits contributing to higher morbidity and increased risk for conversion to dementia. Research on this area is limited from India.

OBJECTIVE

The objective of the current study is to examine the neuropsychological measures in older adults with Late-onset depression (LOD) compared to healthy controls (HC).

METHOD

Sample included older adults with depression as per DSM-IV TR criteria seeking treatment from Geriatric Clinic and Services, National Institute of Mental Health and Neurosciences (NIMHANS). Geriatric depression scale, Montgomery Asberg depression rating scale and Hamilton anxiety rating scale were applied to screen and measure the severity of depression. Comprehensive assessment of neurocognitive function was done using NIMAHNS Neuropsychological Battery for Elderly (NNBE, 2013).

RESULTS

Sample included 76 LOD patients and 76 healthy controls (HC) who were matched for age, gender and education. The mean age of onset of illness was 63.17(SD-6.54) years and median duration of total illness was 29.5 months. In the standard assessments, the mean score on GDS was 9.28 (SD-3.32) and MADRS was 18.88 (SD-6.07). The LOD group had lower Hindi Mental Status Examination (HMSE) score compared to HC (28.64 ± 2.09 vs 30.05 ± 1.26, p < 0.001). Compared to HC, LOD group performed poorly on tasks of attention, executive function, verbal and visual memory, verbal fluency and visuo-spatial skills. Recognition memory and logical memory were relatively preserved in LOD compared to HC.

DISCUSSION AND CONCLUSION

Cognitive deficits were seen predominantly in attention and executive function, visuo-spatial skills and memory similar to previous studies. It is advisable to routinely assess cognitive symptoms in older adults presenting with depression.

Association of trajectories of depressive symptoms with vascular risk, cognitive function and adverse brain outcomes: The Whitehall II MRI sub-study

BACKGROUND

Trajectories of depressive symptoms over the lifespan vary between people, but it is unclear whether these differences exhibit distinct characteristics in brain structure and function.

METHODS

In order to compare indices of white matter microstructure and cognitive characteristics of groups with different trajectories of depressive symptoms, we examined 774 participants of the Whitehall II Imaging Sub-study, who had completed the depressive subscale of the General Health Questionnaire up to nine times over 25 years. Twenty-seven years after the first examination, participants underwent magnetic resonance imaging to characterize white matter hyperintensities (WMH) and microstructure and completed neuropsychological tests to assess cognition. Twenty-nine years after the first examination, participants completed a further cognitive screening test.

OUTCOMES

Using K-means cluster modelling, we identified five trajectory groups of depressive symptoms: consistently low scorers ("low"; n = 505, 62·5%), a subgroup with an early peak in depression scores ("early"; n = 123, 15·9%), intermediate scorers ("middle"; n = 89, 11·5%), a late symptom subgroup with an increase in symptoms towards the end of the follow-up period ("late"; n = 29, 3·7%), and consistently high scorers ("high"; n = 28, 3·6%). The late, but not the consistently high scorers, showed higher mean diffusivity, larger volumes of WMH and impaired executive function. In addition, the late subgroup had higher Framingham Stroke Risk scores throughout the follow-up period, indicating a higher load of vascular risk factors.

INTERPRETATION

Our findings suggest that tracking depressive symptoms in the community over time may be a useful tool to identify phenotypes that show different etiologies and cognitive and brain outcomes.

Relationships between cognitive leisure activities and cognitive function in older adults with depressive symptoms: a cross-sectional study

OBJECTIVES

The current study aimed to elucidate the associations between cognitive leisure activities and cognitive function in an older population stratified by having or not having depressive symptoms.

DESIGN

A retrospective cross-sectional study based on a self-report questionnaire.

SETTING

Annual health check-ups in a rural community in Japan.

PARTICIPANTS

A total of 11 010 community-dwelling older adults aged ≥65 years (mean age: 74.0±5.4 years) was examined. Participants with missing data for the main outcome (n=1630) were excluded.

OUTCOME MEASURES

Cognitive impairment was defined as at least 1.5 SD below the reference threshold (age-adjusted and education-adjusted score) on two of more of the tests in the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Depressive symptoms were defined by a 15-item Geriatric Depression Scale score ≥6. We assessed the frequency of participation in cognitive leisure activities using the validated scale (score: 0-42). A score of ≥8 points was defined as frequent participation in cognitive leisure activities.

RESULTS

A total of 12.6% (n=1186) of the participants had depressive symptoms. There was a significant association between cognitive leisure activities and cognitive impairment in older adults (adjusted OR=0.77, 95% CI=0.65 to 0.94). In older adults with depressive symptoms, a higher frequency of cognitive leisure activities was negatively associated with cognitive impairment (adjusted OR=0.45, 95% CI=0.28 to 0.70). In contrast, there was no significant association in older adults without depressive symptoms (adjusted OR=0.85, 95% CI=0.70 to 1.02).

CONCLUSIONS

Engaging in cognitive leisure activities in late life is associated with better cognitive function in older adults with depressive symptoms.

The relationship between the frequency of number-puzzle use and baseline cognitive function in a large online sample of adults aged 50 and over

OBJECTIVE

Establishing affordable lifestyle interventions that might preserve cognitive function in the aging population and subsequent generations is a growing area of research focus. Data from the PROTECT study has been utilised to examine whether number-puzzle use is related to cognitive function in older adults.

METHODS

Data from 19 078 healthy volunteers aged 50 to 93 years old enrolled on the online PROTECT study were evaluated for self-reported frequency of performing number puzzles. Two cognitive-test batteries were employed to assess core aspects of cognitive function including reasoning, focussed and sustained attention, information processing, executive function, working memory, and episodic memory. Analysis of covariance was used to establish the differences between the six frequency groups.

RESULTS

Highly statistically significant main effects of the frequency of performing number puzzles were seen on all 14 cognitive measures, with P values of less than 0.0004. Interestingly, participants who reported engaging in number puzzles more than once a day had superior cognitive performance on 10 core measures compared with all other frequency groups, although not all were statistically significant.

CONCLUSIONS

This study has identified a close relationship between frequency of number-puzzle use and the quality of cognitive function in adults aged 50 to 93 years old. In order to determine the value of these findings as a potential intervention, further research should explore the type and difficulty of the number puzzles. These findings further contribute to the growing evidence that engaging in mentally stimulating activities could benefit the brain function of the ageing population.