Course and outcomes of depression in the elderly

Results and validation of an index to measure health state of patients with depression in automated healthcare databases

Background and objective: A Depressive Health State Index (DHSI) based on 29 parameters routinely collected in an automated healthcare database (AHDB) was developed to evaluate the health state of depressive patients, and its evolution. The study objective was to describe and validate this DHSI. Methods: A historical cohort of patients with at least one episode of depression was identified in the Clinical Practice Research Datalink (CPRD). The DHSI was calculated for each episode of depression. Validation was performed by comparing the DHSI between subgroups and using validated definitions of remission (proxy and PHQ-9). Robustness was studied by assessing the impact of modifying parameters of the DHSI. Results: 309,279 episodes of depression were identified in the CPRD between 1 January 2006 and 31 December 2012. Remission was observed in 8% of the patients showing the lower DHSI scores and in 88% of the patients showing the higher DHSI scores. The DHSI was robust to a modification of the most frequent variables and to the removal of rare parameters. Conclusion: The DHSI is specific to depression severity (with remission rates in accordance with the expected variations of the DHSI) and robust. It represents a promising tool for the analysis of AHDBs.

Safety and Effectiveness of Long-Term Treatment with Lurasidone in Older Adults with Bipolar Depression: Post-Hoc Analysis of a 6-Month, Open-Label Study

OBJECTIVE

To evaluate the safety and effectiveness of 6 months of treatment with lurasidone in older adults with a diagnosis of bipolar I depression.

DESIGN

Post-hoc analysis of a multicenter, 6-month, open-label extension study.

SETTING

Outpatient.

PARTICIPANTS

Patients aged 55 to 75 years with a DSM-IV-TR diagnosis of bipolar I depression who had completed 6 weeks of double-blind, placebo-controlled treatment with either lurasidone monotherapy (1 study) or adjunctive therapy with lithium or valproate (2 studies).

INTERVENTION

Flexible doses of lurasidone, 20 to 120 mg/day, either as monotherapy, or adjunctive with lithium or valproate.

MEASUREMENTS

Effectiveness was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS; change from open-label-baseline to month-6, observed case analysis).

RESULTS

A total of 141 older adults entered the extension study (monotherapy, N = 55; 39%; adjunctive therapy, N = 86; 61%). At the end of 6 months of open-label treatment with lurasidone, as monotherapy or adjunctive therapy, minimal changes were observed in the older adult sample in mean weight (-1.0 kg and -0.4 kg, respectively); and median total cholesterol (-2.0 mg/dL and +6.0 md/dL, respectively), triglycerides (+2.5 mg/dL and +6.0 mg/dL, respectively), and HbA1c (0.0% and -0.1%, respectively). Patients treated with 6 months of lurasidone showed a mean improvement on the MADRS in both the monotherapy (-6.2) and adjunctive therapy (-6.7) groups.

CONCLUSIONS

Results of these post-hoc analyses found that up to 7.5 months of lurasidone treatment for bipolar depression in older adults was associated with minimal effects on weight and metabolic parameters, with low rates of switching to hypomania or mania, and was well tolerated. The antidepressant effectiveness of lurasidone in this age group was maintained over the 6-month treatment period.

Risk factors for late-life depression and correlates of antidepressant use in Costa Rica: Results from a nationally-representative longitudinal survey of older adults

BACKGROUND

Risk factors for late-life depression have been studied in high-income countries, but there have been no longitudinal studies from middle-income countries. This study reports risk factors for late-life depression and correlates of antidepressant using the Costa Rican Longevity and Healthy Aging Study (CRELES), a nationally representative cohort of adults age 60 and over.

METHODS

CRELES contains baseline interviews in 2005 (n=2827) with follow-up interviews in 2007 and 2009. CRELES used the Geriatric Depression Scale Short Form to identify depression using cut-offs for mild and severe depression and contained a 14-question assessment to determine physical disability. Participants self-reported antidepressant use and chronic health conditions. We examined correlates of newly screened depression and new antidepressant use among participants not depressed or not using antidepressants in the previous study wave. We used generalized estimating equations to estimate the association among variables.

RESULTS

Increases in disability were associated with newly screening for mild and severe depression. New medical conditions and recent widowhood were associated with newly screening for severe depression. Recent widowhood was also associated with new use of antidepressant medication.

LIMITATIONS

Limitations of this study include absence of persons living in institutions, inconsistency of screening tools with clinical diagnoses, and possible effects of stigma and recall bias on screening.

CONCLUSIONS

Risk factors for late-life depression in Costa Rica are similar to risk factors in high-income countries. Patterns of antidepressant use suggest providers may recognize the role of bereavement as a risk factor for late-life depression but not of disability or chronic conditions.

Transportation Planning and Quality of Life: Where Do They Intersect?

Policy makers and researchers are increasingly recognizing the connections between public health and transportation, but health improvements are typically framed from a physical health perspective rather than considering broader quality of life (QOL) impacts. Currently, there is a limited understanding of the ways in which transportation and QOL intersect, and little is known about how metropolitan planning organizations (MPOs) in the United States are addressing QOL outcomes. This study addressed these gaps by developing a conceptual framework holistically linking transportation to QOL. The proposed framework identified four transportation-related QOL dimensions-physical, mental, social, and economic well-being-which are predominantly influenced by three components of the transportation system: mobility/accessibility, the built environment, and vehicle traffic. This framework then formed the basis for a content analysis of 148 long-range transportation plans in the United States to evaluate the extent to which QOL is being considered in the planning process. The results of the analysis and a follow-up examination of 13 plans revealed that MPOs are inconsistently addressing QOL. Plans primarily targeted QOL enhancement from the perspective of physical well-being, while mental and social well-being were rarely considered. Policy recommendations were provided to more comprehensively integrate QOL into the transportation planning process.

BDNF promoter methylation and genetic variation in late-life depression

The regulation of the brain-derived neurotrophic factor (BDNF) is important for depression pathophysiology and epigenetic regulation of the BDNF gene may be involved. This study investigated whether BDNF methylation is a marker of depression. One thousand and twenty-four participants were recruited as part of a longitudinal study of psychiatric disorders in general population elderly (age ⩾ 65). Clinical levels of depression were assessed using the Mini International Neuropsychiatric Interview for the diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorder IV criteria, and the Centre for Epidemiologic Studies Depression Scale (CES-D) for assessment of moderate to severe depressive symptoms. Buccal DNA methylation at the two most widely studied BDNF promoters, I and IV, was investigated using the Sequenom MassARRAY platform that allows high-throughput investigation of methylation at individual CpG sites within defined genomic regions. In multivariate linear regression analyses adjusted for a range of participant characteristics including antidepressant use, depression at baseline, as well as chronic late-life depression over the 12-year follow-up, were associated with overall higher BDNF methylation levels, with two sites showing significant associations (promoter I, Δ mean = 0.4%, P = 0.0002; promoter IV, Δ mean = 5.4%, P = 0.021). Three single-nucleotide polymorphisms (rs6265, rs7103411 and rs908867) were also found to modify the association between depression and promoter I methylation. As one of the largest epigenetic studies of depression, and the first investigating BDNF methylation in buccal tissue, our findings highlight the potential for buccal BDNF methylation to be a biomarker of depression.

Insufficient glucocorticoid signaling and elevated inflammation in coronary heart disease patients with comorbid depression

Coronary heart disease (CHD) and depression are very common and often co-existing disorders. In addition to psychological and social morbidity, depression exacerbates adverse cardiac outcomes in CHD patients. Inflammation has been proposed as one of the mechanisms involved in the association between these two debilitating diseases. Therefore, the present study aimed to evaluate inflammatory responses as well as to investigate the pathophysiological mechanisms underlying the putative inflammatory activation in CHD patients with and without depression, by assessing the function of two important biological factors regulating inflammation, the hypothalamus-pituitary-adrenal (HPA) axis and the glucocorticoid receptor (GR). Eighty-three CHD patients with (n=28) and without (n=55) comorbid depression were recruited from primary care services in South London. Depression status was assessed by means of Clinical Interview Schedule Revised for diagnosis of depression, and Beck Depression Inventory for the presence of depressive symptoms. Serum C-reactive protein (CRP), plasma vascular endothelial growth factor (VEGF), and plasma and salivary cortisol were measured using commercially available ELISA kits. Gene expression of GR and interleukin-6 (IL-6) were conducted via qPCR. GR sensitivity was evaluated in vitro in isolated peripheral blood mononuclear cells using the dexamethasone inhibition of lipopolysaccharide-stimulated IL-6 levels. Serum levels of kynurenine pathway metabolites were measured using high performance liquid chromatography. Our results show that CHD patients with depression had higher levels of CRP, IL-6 gene expression, and VEGF compared with CHD non-depressed, as well as lower plasma and saliva cortisol levels. The CHD depressed group also exhibited a reduction in GR expression and sensitivity. Finally, tryptophan levels were significantly lower in patients with depression, who also showed an increased kynurenine/tryptophan ratio. In conclusion, CHD patients with depression had elevated levels of inflammation in the context of HPA axis hypoactivity, GR resistance, and increased activation of the kynurenine pathway. Reduced cortisol bioavailability and attenuated glucocorticoid responsiveness due to decreased expression and sensitivity of GR may lead to insufficient glucocorticoid signaling and thus elevation of inflammation in these patients.

Association analysis of the catechol-O-methyltransferase /methylenetetrahydrofolate reductase genes and cognition in late-onset depression

AIMS

Increasing evidence suggests that the catechol-O-methyltransferase (COMT) gene might be associated with cognition in patients with mental disorders and healthy people. The metabolic pathways of COMT and methylenetetrahydrofolate reductase (MTHFR) are closely interconnected. In this study, we aimed to examine whether the COMT-MTHFR genotype interacted with cognitive function in late-onset depression (LOD) patients and COMT Val/Val homozygous individuals who also carried the MTHFR T allele and had poor neuropsychological test performance.

METHODS

Ninety-seven unrelated LOD patients who met DSM-IV criteria for major depressive disorder were recruited for the study and 103 normal controls were recruited from the local community. All of these patients and 44 normal controls completed a series of neuropsychological tests. Patients and normal controls were genotyped for COMT (rs4680) and MTHFR (rs1801133) variants using polymerase chain reaction-restriction fragment length polymorphism.

RESULTS

There were no significant differences in the frequencies of the single alleles and genotypes of two polymorphisms between LOD patients and normal controls. No main effects of COMT or MTHFR genotype on any neuropsychological test performance were observed. There was a significant interactive effect of COMT Val158Met and MTHFR C677T polymorphisms on the Symbol Digit Modalities Test independent of diagnosis (P < 0.05). After controlling for covariates, the subjects with COMT Met/ Met and MTHFR C/C genotype had better Symbol Digit Modalities Test performance.

CONCLUSIONS

The results suggest no major effect of COMT or MTHFR on cognitive function alone. However, an interaction of COMT Val158Met and MTHFR C677T polymorphisms may be associated with cognitive function. Further studies in a large sample are needed to replicate the genetic role in the LOD patients.

Natural course of depressive symptoms in late life. An 8-year population-based prospective study

AIMS

The aim of the study was to follow the natural course of late-life depressive symptoms within a German population-based study.

METHODS

Within the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative sample of 1265 individuals aged 75 years and older were interviewed every 1.5 years over 8 years. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D, German-specific cut-off score ≥23).

RESULTS

The incidence of depressive symptoms was 34 per 1000 person-years (95% confidence interval 31-37). In a multivariate regression model, female gender, poor self-rated health status, stroke, risky alcohol consumption, a poor social network, higher number of specialist visits, functional impairment, and CES-D score at baseline were significant risk factors of future depressive symptoms. We observed remission in 60%, an intermittent course in 17% and a chronic course in 23% of the participants. No baseline characteristic distinguished the remission group from the persistently depressed.

CONCLUSION

Depressive symptoms in late life are common and highly persistent. In the present study encountered risk factors entailed potentialities for secondary prevention.

Longitudinal changes in hippocampal volumes and cognition in remitted geriatric depressive disorder

Growing evidences suggest that the abnormality of hippocampal volume may occur in the process of depression. In this longitudinal study, we calculated the hippocampal volume of 14 remitted geriatric depressed (RGD) patients and 19 healthy participants at baseline and follow-up. We found significant improvement of performance in Trail Making Test-A (P=0.038) and Test-B (P=0.032), and the right hippocampal volume increased mildly in RGD. However, in RGD patients, positive correlations were seen between the changes in right hippocampal volumes and Symbol Digit Modality Test scores (r=0.675, P=0.008), and changes in left hippocampal volumes and Mini-Mental State Examination scores (r=0.743, P=0.002). Our findings suggest that hippocampus related cognitive impairment and previously addressed decreased hippocampal volume might represent a state rather than a permanent trait of the depressive disorder. The results suggest that hippocampal volume may be a useful risk marker for conversion to Alzheimer's disease in RGD patients. Additionally, our study indicates that effective antidepressants treatment might postpone and even revise the deterioration of hippocampus to some degree.

Eyes Wide Open or Not

Depression is significant among older Americans in the United States. A literature review found only five studies on the interrelationship between individual and neighborhood effects in predicting depression among older Americans. This article presents the results of exploring this interrelationship using data from the Brookdale Demonstration Project Initiative on Healthy Urban Aging (BDI). The BDI database is from a sample of 1,870 enrollees in New York City senior centers in 2008. The BDI analysis finds the association with depression is highest with visual impairment ( p = .000); frequent falling ( p = .000); lower income ( p = .000); little leisure-time physical activity ( p = .000); low neighborhood satisfaction ( p = .000); trouble hearing ( p = .000); arthritis/rheumatoid arthritis ( p = .001); and being disabled ( p = .005). Implications for senior center and home care provider collaboration on early preventive interventions relating to sensory impairment, depression, and conditions related to falls and the built environment are discussed.

Association study between plasma GDNF and cognitive function in late-onset depression

OBJECTIVE

Improving evidence suggest that neurotrophic growth factor systems might be involved in the pathophysiology of major depressive disorder (MDD). The glial cell line-derived neurotrophic factor (GDNF) is a neurotrophic factor from the transforming growth factor-β-family, which plays a role in the development and function of hippocampal cells. This study was aimed to test whether GDNF in plasma was abnormal in late-onset depression (LOD), and whether it was associated with the cognitive impairment of LOD.

METHODS

The plasma GDNF levels in LOD patients (n=27) before antidepressant treatment and normal control subjects (n=28) were measured with the ELISA method. All subjects were assessed by neuropsychological tests and Hamilton Depression Rating Scale (HDRS).

RESULTS

The performance of neuropsychological tests of the LOD group except TMT-B was significantly poorer than those of the control group. The plasma GDNF levels in LOD patients were significantly increased compared to control subjects (P<0.05). Furthermore, the increase of plasma GDNF level was significantly positively correlated with Digit Span Test backward score in LOD patients, and negatively associated with TMT-B performance.

CONCLUSIONS

The findings suggest that LOD patients in acute phase have extensive impairments of cognitive function, and higher plasma GDNF might be involved in the pathogenesis of LOD, which may be associated with the cognitive dysfunction in LOD.

Clinic visits and prescribing patterns among Veterans Affairs Maryland Health Care System dementia patients

OBJECTIVE

Our objective was to determine how patient demographics and outpatient referrals to specialized dementia (DEM) or mental health (MH) clinics influence receipt of anti-dementia (AD), antidepressant (ADEP), antipsychotic (APSY) and sedative-hypnotic (SEDH) medications among veterans with dementia.

DESIGN

Retrospective, cross-sectional observational study.

SETTING

Veterans Affairs Maryland Health Care System (VAMHCS).

PARTICIPANTS

Veterans aged ≥ 60 years with Alzheimer's or related dementia diagnosis after 1999 with minimum of one-year follow-up or death were included.

MEASUREMENTS

Retrospective analysis of VAMHCS electronic medical records were used to determine predictors of AD, ADEP, APSY, and SEDH prescribing using logistic regression models that examined visits to DEM or MH clinics, patient age, follow-up time, race/ethnicity and marital status.

RESULTS

Among 1209 veterans with average follow-up of 3.2 (SD 1.9) years, 36% percent had MH visits, 38% had DEM visits and 19% visited both clinics. DEM visits were associated with AD and ADEP but not APSY medication receipt (OR(AD:DEM) = 1.47, 95% CI = (1.052, 2.051); OR(ADEP:DEM) = 1.66, 95% CI = (1.193, 2.302); OR(APSY:DEM) = 1.35, 95% CI = (0.941, 1.929)). MH visit was associated with ADEP and APSY medication receipt (OR(AD:MH)\ = 1.16, 95% CI = (0.821, 1.631); OR(ADEP:MH) = 2.83, 95% CI = (2.005, 4.005); OR (APSY:MH) = 4.41, 95% CI = (3.109, 6.255)).

CONCLUSION

In the VAMHCS dementia population, visits to DEM or MH specialty clinics increase the odds of receiving AD, ADEP, and APSY medications.

The D-allele of ACE insertion/deletion polymorphism is associated with regional white matter volume changes and cognitive impairment in remitted geriatric depression

Prior studies suggested that angiotensin-converting enzyme (ACE) affected vascular homeostasis and degradation of amyloid beta (Abeta ). It is associated with the therapeutic outcome in major depression. The aim of this study was to investigate the association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and structural abnormalities in remitted geriatric depression (RGD), and test the relationship of neuropsychological performances and regional white matter volumes. 31 RGD patients were recruited and neuropsychological tests, magnetic resonance imaging (MRI) and genotype of ACE I/D were examined for each subject. The differences in regional white matter volume were tested between I homozygotes and D-allele carriers (I/D or D/D genotype) by optimized VBM. D-allele carriers exhibited significantly smaller white matter volumes of right superior frontal gyrus (SFG) and right anterior cingulated gyrus (ACG), but had larger volumes of left middle temporal gyrus (MTG) and right middle occipital gyrus (MOG) than I homozygotes (P < 0.001). Meanwhile, there was a significant positive correlation between white matter volume enlargement of left MTG and Symbol Digit Modalities Test (SDMT) (r = 0.456, P = 0.043), and the reduction of right ACG was negatively related to Clock Drawing Test (CDT) performance (r = -0.445, P = 0.050) in D-allele carriers. The finding suggests that ACE can modulates the pathology of RGD, the left MTG and right ACG might be involved in the pathophysiology of cognitive dysfunction in RGD patients.

A prospective study of outcome and predictors of subclinical and clinical depression in an older biracial sample of psychiatric outpatients

OBJECTIVES

There continues to be a debate about the long-term prognosis of psychiatric treatment of depression in later life. There have been no long-term naturalistic studies of psychiatric outpatient treatment of older adults in the United States. This study examines outcome and predictors of various levels of depression among a biracial sample of geropsychiatric outpatients in Brooklyn, NY.

METHODS

We conducted a naturalistic study (median: 33 months) of 143 persons aged 55 and over with diagnoses of depression drawn from 15 psychiatry outpatient clinics and 2 geriatric day programs. Their mean age was 68 years, 87% were female, and 43% were white and 57% were black, among whom 37% were African Caribbeans. Using George's Social Antecedent Model of Depression, we examined the impact of 15 predictor variables on two outcome measures: presence of any either subclinical or clinical depression (CES-D score > or = 8) and presence of clinical depression (CES-D score > or = 16).

RESULTS

On follow-up, 84% and 90% of subclinically and clinically depressed persons at baseline, respectively, were depressed (CES-D > or = 8); 62% of those in remission at baseline were depressed. In logistic regression, 3 variables were significant predictors of any level of depression on follow-up: baseline depression, baseline anxiety, greater increase in anxiety symptoms during the follow-up period. These 3 variables along with financial strain were significant predictors of clinical depression on follow-up. There were no inter- or intra-racial differences in outcome.

CONCLUSIONS

The bleak outcome findings among older psychiatric outpatients in Brooklyn were consistent with unfavorable results reported in European studies. Because there were only a few predictors of outcome, strategies that target high risk persons - e.g., such as those with subclinical depression, anxiety, or in more economic distress - may prevent transition to severe and persistent depressive states.

Genetic variation in apolipoprotein E alters regional gray matter volumes in remitted late-onset depression

BACKGROUND

The apolipoprotein E (ApoE) gene has been confirmed as the major genetic risk factor for late-onset Alzheimer's disease (AD). The effect of ApoE polymorphism on brain morphology still remains unclear in remitted late-onset depression (RLOD).

METHODS

A total of 37 patients with remitted geriatric depression were investigated with optimized voxel-based morphometry. We tested for differences in gray matter volume between ApoE epsilon4 allele noncarriers (n=25) and ApoE epsilon4 allele carriers (n=12) in RLOD patients.

RESULTS

The volumes of right medial frontal gyrus, left middle frontal gyrus and left inferior occipital gyrus were significantly smaller in RLOD patients with ApoE epsilon4 allele carriers as compared to ApoE epsilon4 allele noncarriers. There was a significant positive correlation between gray matter volume of right medial frontal gyrus and Digit Span Test score in RLOD patients with ApoE epsilon4 allele carriers.

LIMITATIONS

This study is cross-sectional, therefore it cannot determine whether abnormal gray matter volume is a state marker or trait marker of RLOD with ApoE epsilon4 allele carriers.

CONCLUSION

Our findings support the hypothesis that the ApoE genotype might be associated with structural changes in RLOD.

Larger regional white matter volume is associated with executive function deficit in remitted geriatric depression: an optimized voxel-based morphometry study

OBJECTIVE

We aimed to investigate structural abnormalities in first-episode remitted geriatric depression (RGD) using optimized voxel-based morphometry (VBM) in closely matched patients and healthy controls, and examining the relationship of performances on neuropsychological tests with regional white matter volumes.

METHODS

Forty subjects with first-episode RGD and 36 well-matched healthy controls were recruited for this study and neuropsychological tests and magnetic resonance imaging (MRI) were conducted on the subjects. The differences in regional white matter volume were determined between these two groups by optimized VBM.

RESULTS

The white matter volumes of left inferior parietal lobule and right inferior frontal gyrus were significantly larger in patients with RGD relative to healthy controls. RGD patients performed significantly worse in the delayed recall of RAVLT, Trail Making Test A and B (seconds), and Symbol Digit Modalities Test when compared with the control group (all P<0.01). And there was a significant positive correlation between white matter volume of right inferior frontal gyrus and Trail Making Test A (r=0.319, P=0.045) in patients with RGD.

LIMITATIONS

This study is cross-sectional, therefore it cannot determine whether increased white matter volume is a state marker or trait marker of RGD.

CONCLUSION

These results reveal that RGD is associated with larger white matter volumes of left inferior parietal lobule and right inferior frontal gyrus, and the right inferior frontal gyrus may thus be involved in the pathophysiology of executive function in RGD.

Regional gray matter changes are associated with cognitive deficits in remitted geriatric depression: an optimized voxel-based morphometry study

BACKGROUND

We aimed to investigate structural abnormalities in first-episode remitted geriatric depression (RGD) with optimized voxel-based morphometry (VBM) in closely matched patients and healthy control subjects and examine the relationship of performances on neuropsychological tests with regional gray matter volumes.

METHODS

Nineteen subjects with first-episode RGD and 16 well-matched healthy control subjects were recruited for this study, and neuropsychological tests and magnetic resonance imaging were conducted on the subjects. The differences in regional gray matter volume were determined between these two groups by optimized VBM.

RESULTS

The volumes of right superior frontal cortex, left postcentral cortex, and right middle temporal gyrus were significantly smaller in patients with RGD relative to healthy control subjects. However, patients with RGD had larger left cingulate gyrus volume compared with healthy control subjects. There was a significant negative correlation between left cingulate gyrus volume and Rey Auditory Verbal Learning Test delayed recall raw score in patients with RGD.

CONCLUSION

These results reveal that RGD is associated with gray matter changes of certain brain regions hypothesized to influence cognition and might thus be involved in the psychopathology and pathophysiology of cognitive impairment in RGD.

Cerebrovascular risk factors and incident depression in community-dwelling elderly

OBJECTIVE

The 'vascular depression' hypothesis suggests that late-life depression results from vascular brain damage. We studied the longitudinal association between cerebrovascular risk factors and incident depression in a large population-based study.

METHOD

Two thousand nine hundred and thirty-one persons with the age of > or =61 years were followed up. Data on a comprehensive set of cerebrovascular risk factors were collected at baseline. Participants received a psychiatric assessment 5 years later to establish DSM-IV diagnoses.

RESULTS

Only current smoking and antihypertensive drug use were independently associated with incident depressive symptoms. Diabetes mellitus and the Framingham stroke risk score were related to incident depressive disorder. No relation with depression was observed for cholesterol, diastolic and systolic blood pressure, history of cardiovascular disease, atrial fibrillation, left ventricular hypertrophy or the use of statins and anticoagulants.

CONCLUSION

These results moderately support the 'vascular depression' hypothesis.

Protective Association Between Neighborhood Walkability and Depression in Older Men

OBJECTIVES

To evaluate the association between neighborhood walkability and depression in older adults.

DESIGN

Cross-sectional analysis using data from Adult Changes in Thought (ACT), a prospective, longitudinal cohort study.

SETTING

King County, Washington.

PARTICIPANTS

Seven hundred forty randomly selected men and women aged 65 and older, cognitively intact, living in the same home for at least 2 years.

MEASUREMENTS

Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale. The Walkable and Bikable Communities Project provided objective data predicting the probability of walking at least 150 minutes per week in a particular neighborhood. ACT data were linked at the individual level via a geographic information system to this walkability score using buffer radii of 100, 500, and 1,000 meters around the subject's home. Multiple regression analysis tests were conducted for associations between the buffer-specific neighborhood walkability score and depressive symptoms.

RESULTS

There was a significant association between neighborhood walkability and depressive symptoms in men when adjusted for individual-level factors of income, physical activity, education, smoking status, living alone, age, ethnicity, and chronic disease. The odds ratio for the interquartile range (25th to 75th percentile) of walkability score was 0.31 to 0.33 for the buffer radii (P=.02), indicating a protective association with neighborhood walkability. This association was not significant in women.

CONCLUSION

This study demonstrates a significant association between neighborhood walkability and depressive symptoms in older men. Further research on the effects of neighborhood walkability may inform community-level mental health treatment and focus depression screening in less-walkable areas.