Cerebrovascular risk factors and subsequent depression in older general practice patients

Vascular risk factors, depression, and cognitive change among African American older adults

OBJECTIVE

Vascular burden has been linked to future depression and cognitive change in predominately European American samples. This study investigated these relationships in older African Americans.

METHODS

To examine the connection between vascular risk factors, depression, and cognitive change, this study utilized data from 435 older African Americans. Specifically, the study examined the link between vascular risk at baseline with depression and cognitive functioning at a 2.5-year follow-up visit.

RESULTS

High baseline vascular risk was associated with increased odds of future depression while controlling for age and current depression. A series of path analyses demonstrated links between baseline vascular risk, increases in depression, and decreases in processing speed.

CONCLUSIONS

These findings suggest that African Americans with greater vascular burden are at greater risk for depression and cognitive change.

Vascular risk factors and depression in later life: a systematic review and meta-analysis

Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years; 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27-1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99-1.57), hypertension (OR: 1.14; 95% CI: .94-1.40), or dyslipidemia (OR: 1.08; 95% CI: .91-1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00-1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30-1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52-2.04), and stroke (OR: 2.11; 95% CI: 1.61-2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.

The interaction between cerebrovascular disease and neuroticism in late-life depression: a cross-sectional study

OBJECTIVE

Vascular disease and neuroticism are both risk factors for late-life depression. In this study we examined the interaction between vascular disease and neuroticism as determinants of clinically relevant depressive symptoms (CRDS) in late-life.

METHODS

Multivariate logistic regression in a survey of 1396 population-dwelling people aged ≥70 years. CRDS were defined as scoring ≥16 on the CES-D. Vascular disease was categorised into four levels: none, ≥2 vascular risk factors, cardiac disease or stroke.

RESULTS

Neuroticism was strongly associated with CRDS in women (OR: 1.6, 95% CI: 1.4-1.8). In men vascular disease interacted negatively but significantly with neuroticism (cardiac disease by neuroticism: OR: 0.8, 95% CI: 0.6-0.9; stroke by neuroticism: OR: 0.8, 95% CI: 0.6-0.96) when predicting CRDS.

CONCLUSIONS

In men vascular disease attenuates the predictive value of neuroticism in CRDS, which might be mediated by apathy caused by cerebrovascular disease.

Does extracranial arterial pathology play a role in late-onset psychiatric disorders?

INTRODUCTION

Carotid interventions are commonly performed to reduce the risk of disabling stroke and stroke-related death. Carotid interventions may also have an effect on cognitive functions. Mental disorders in the elderly have been related to structural brain pathology. This review of literature was performed to test the hypothesis that atherosclerotic lesions in the carotid and vertebral arteries may have an impact on the development and treatment of late-onset psychiatric disorders.

METHODS

A literature search identified articles focusing on the key issues using the Pubmed and Cochrane databases.

RESULTS

Cardiovascular risk factors seem to be increased in patients with late-onset mania, depression, and schizophrenia. Cerebral infarctions, especially right-sided, have repeatedly been associated with various psychiatric disorders. Several case reports suggest that chronic cerebral hypoperfusion may also induce psychiatric disease and that these disorders might disappear after reconstruction.

CONCLUSIONS

There seems to be an association between occlusive carotid and vertebral disease and the late-onset of various psychiatric disorders. Both thromboembolic and chronic cerebral hypoperfusion might contribute to its pathophysiology. This group of patients might benefit from an intervention.

Depression among centenarians and the oldest old: contributions of cognition and personality

BACKGROUND

An estimated 20% of adults over the age of 55 experience clinical mental disorders such as depression and anxiety. For older adults, mental health concerns are often undetected, concomitant with physical challenges, and ultimately go untreated. These realities have significant implications for older adults' day-to-day functioning, particularly among the oldest old.

OBJECTIVE

The present study examined the ability of cognition and personality in explaining depression within a sample of octogenarians and centenarians.

METHODS

Participants were assessed during the most recent cross-sectional data collection of the Georgia Centenarian Study. The final eligible sample included 76 octogenarians (mean: 84.25 years, SD: 2.82; range: 81-90) and 158 centenarians and near centenarians (mean: 99.82 years, SD: 1.72; range: 98-109).

RESULTS

Hierarchical regression analyses were conducted to examine the relation between key variables and depressive symptoms in the two age groups. Blocks entered into the analyses included: demographics (i.e. age group, residential status, sex, and ethnicity) and functioning, memory and problem-solving ability, and personality (i.e. extraversion and neuroticism). Models differed for octogenarians and centenarians. Decreased problem-solving ability was related to greater depressive symptoms among octogenarians. For centenarians, institutional residence and increased neurotic tendencies were related to greater depressive symptoms.

CONCLUSION

Study findings demonstrate the need to examine a variety of factors which influence mental health in later life and to consider the unique contexts and differential experiences of octogenarians and centenarians.

Efficacy evaluation for depression with somatic symptoms treated by electroacupuncture combined with Fluoxetine

OBJECTIVE

This study is to investigate the clinical therapeutic effects and safety of treating mild or moderate depression with somatic symptoms with electroacupuncture combined with Fluoxetine.

METHODS

95 cases of mild or moderate depression with somatic symptoms were randomly divided into a Fluoxetine group, and an electroacupuncture plus Fluoxetine group. Hamilton Depression Scale (HAMD) was used for the assessment of clinical therapeutic effects and Treatment Emergent Symptom Scale (TESS) was used for assessment of adverse reactions.

RESULTS

The total effective rate was 77.27% in the Fluoxetine group and 78.26% in the electroacupuncture plus Fluoxetine group, showing no statistically significant difference between these two groups (P > 0.05). However, the treatment took effect after two weeks in the electroacupuncture plus Fluoxetine group but after four weeks in Fluoxetine group. During this time, a better therapeutic effect on depression with mild or moderate somatic symptoms was found in the electroacupuncture plus Fluoxetine group, which also had fewer adverse reactions than the Fluoxetine group.

CONCLUSION

Electroacupuncture combined with Fluoxetine takes effect faster for relieving the somatic symptoms with fewer adverse reactions. It is worth popularizing clinically.

A systematic review of community-based health interventions on depression for older adults with heart disease

PURPOSE

This systematic review examined the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease.

DESIGN AND METHODS

A comprehensive literature search and meta analysis was performed to evaluate randomized controlled trials examining outpatient or home-based interventions. Methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative.

RESULTS

Fifteen studies met our inclusion criteria and all measured depression outcomes. Studies differed in scope and methodological rigor and sample sizes varied widely. Problems in treatment fidelity and masking of group assignment were noted. Great variability was found in depression outcomes due to the differences in methodology and intervention. Five studies reported significant treatment effect on depression; three of those employed home-based interventions and two were outpatient-clinic interventions. Ten studies were included in the meta analysis and the effect sizes (ESs) ranged from -0.39 (in favor of control group) to 0.65 (in favor of treatment group). The mean weighted ES was 0.11 and six studies showed positive ESs.

IMPLICATIONS

Mixed evidence for community-based heart disease interventions on depression outcomes was found. Future research should include sub-analysis of ESs of interventions on depression outcomes by different demographic characteristics of the study sample, common depression outcome measures, and different follow-up periods.