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Al-Sharif NB, Zavaliangos-Petropulu A, Narr KL. A review of diffusion MRI in mood disorders: mechanisms and predictors of treatment response. Neuropsychopharmacology 2024:10.1038/s41386-024-01894-3. [PMID: 38902355 DOI: 10.1038/s41386-024-01894-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
By measuring the molecular diffusion of water molecules in brain tissue, diffusion MRI (dMRI) provides unique insight into the microstructure and structural connections of the brain in living subjects. Since its inception, the application of dMRI in clinical research has expanded our understanding of the possible biological bases of psychiatric disorders and successful responses to different therapeutic interventions. Here, we review the past decade of diffusion imaging-based investigations with a specific focus on studies examining the mechanisms and predictors of therapeutic response in people with mood disorders. We present a brief overview of the general application of dMRI and key methodological developments in the field that afford increasingly detailed information concerning the macro- and micro-structural properties and connectivity patterns of white matter (WM) pathways and their perturbation over time in patients followed prospectively while undergoing treatment. This is followed by a more in-depth summary of particular studies using dMRI approaches to examine mechanisms and predictors of clinical outcomes in patients with unipolar or bipolar depression receiving pharmacological, neurostimulation, or behavioral treatments. Limitations associated with dMRI research in general and with treatment studies in mood disorders specifically are discussed, as are directions for future research. Despite limitations and the associated discrepancies in findings across individual studies, evolving research strongly indicates that the field is on the precipice of identifying and validating dMRI biomarkers that could lead to more successful personalized treatment approaches and could serve as targets for evaluating the neural effects of novel treatments.
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Affiliation(s)
- Noor B Al-Sharif
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Artemis Zavaliangos-Petropulu
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Departments of Neurology and Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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2
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Xu EP, Nguyen L, Leibenluft E, Stange JP, Linke JO. A meta-analysis on the uncinate fasciculus in depression. Psychol Med 2023; 53:2721-2731. [PMID: 37051913 PMCID: PMC10235669 DOI: 10.1017/s0033291723000107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 04/14/2023]
Abstract
Aberrant microstructure of the uncinate fasciculus (UNC), a white matter (WM) tract implicated in emotion regulation, has been hypothesized as a neurobiological mechanism of depression. However, studies testing this hypothesis have yielded inconsistent results. The present meta-analysis consolidates evidence from 44 studies comparing fractional anisotropy (FA) and radial diffusivity (RD), two metrics characterizing WM microstructure, of the UNC in individuals with depression (n = 5016) to healthy individuals (n = 18 425). We conduct meta-regressions to identify demographic and clinical characteristics that contribute to cross-study heterogeneity in UNC findings. UNC FA was reduced in individuals with depression compared to healthy individuals. UNC RD was comparable between individuals with depression and healthy individuals. Comorbid anxiety explained inter-study heterogeneity in UNC findings. Depression is associated with perturbations in UNC microstructure, specifically with respect to UNC FA and not UNC RD. The association between depression and UNC microstructure appears to be moderated by anxiety. Future work should unravel the cellular mechanisms contributing to aberrant UNC microstructure in depression; clarify the relationship between UNC microstructure, depression, and anxiety; and link UNC microstructure to psychological processes, such as emotion regulation.
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Affiliation(s)
- Ellie P. Xu
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Lynn Nguyen
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Leibenluft
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan P. Stange
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Julia O. Linke
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
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3
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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4
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Batail JM, Corouge I, Combès B, Conan C, Guillery-Sollier M, Vérin M, Sauleau P, Le Jeune F, Gauvrit JY, Robert G, Barillot C, Ferre JC, Drapier D. Apathy in depression: An arterial spin labeling perfusion MRI study. J Psychiatr Res 2023; 157:7-16. [PMID: 36427413 DOI: 10.1016/j.jpsychires.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/28/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Apathy, as defined as a deficit in goal-directed behaviors, is a critical clinical dimension in depression associated with chronic impairment. Little is known about its cerebral perfusion specificities in depression. To explore neurovascular mechanisms underpinning apathy in depression by pseudo-continuous arterial spin labeling (pCASL) magnetic resonance imaging (MRI). METHODS Perfusion imaging analysis was performed on 90 depressed patients included in a prospective study between November 2014 and February 2017. Imaging data included anatomical 3D T1-weighted and perfusion pCASL sequences. A multiple regression analysis relating the quantified cerebral blood flow (CBF) in different regions of interest defined from the FreeSurfer atlas, to the Apathy Evaluation Scale (AES) total score was conducted. RESULTS After confound adjustment (demographics, disease and clinical characteristics) and correction for multiple comparisons, we observed a strong negative relationship between the CBF in the left anterior cingulate cortex (ACC) and the AES score (standardized beta = -0.74, corrected p value = 0.0008). CONCLUSION Our results emphasized the left ACC as a key region involved in apathy severity in a population of depressed participants. Perfusion correlates of apathy in depression evidenced in this study may contribute to characterize different phenotypes of depression.
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Affiliation(s)
- J M Batail
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France.
| | - I Corouge
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - B Combès
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - C Conan
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France
| | - M Guillery-Sollier
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; Univ Rennes, LP3C (Laboratoire de Psychologie: Cognition, Comportement, Communication) - EA 1285, CC5000, Rennes, France
| | - M Vérin
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; CHU Rennes, Department of Neurology, F-35033, Rennes, France
| | - P Sauleau
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; CHU Rennes, Department of Neurophysiology, F-35033, Rennes, France
| | - F Le Jeune
- Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France; Centre Eugène Marquis, Department of Nuclear Medicine, F-35062, Rennes, France
| | - J Y Gauvrit
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; CHU Rennes, Department of Radiology, F-35033, Rennes, France
| | - G Robert
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France
| | - C Barillot
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France
| | - J C Ferre
- Univ Rennes, Inria, CNRS, IRISA, INSERM, Empenn U1228 ERL, F-35042, Rennes, France; CHU Rennes, Department of Radiology, F-35033, Rennes, France
| | - D Drapier
- Centre Hospitalier Guillaume Régnier, Pôle Hospitalo-Universitaire de Psychiatrie Adulte, F-35703, Rennes, France; Univ Rennes, "Comportement et noyaux gris centraux" Research Unit (EA 4712), F-35000, Rennes, France
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Steffens DC, Fahed M, Manning KJ, Wang L. The neurobiology of apathy in depression and neurocognitive impairment in older adults: a review of epidemiological, clinical, neuropsychological and biological research. Transl Psychiatry 2022; 12:525. [PMID: 36572691 PMCID: PMC9792580 DOI: 10.1038/s41398-022-02292-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
Apathy is a common condition that involves diminished initiative, diminished interest and diminished emotional expression or responsiveness. It is highly prevalent in the context of a variety of neuropsychiatric disorders and is related to poor health outcomes. Presence of apathy is associated with cognitive and functional decline in dementia. Despite its negative impact on health, there is no definitive treatment for apathy, a clinical reality that may be due in part to lack of knowledge about assessment, neuropsychological features and neurobiological underpinnings. Here, we review and synthesize evidence from clinical, epidemiological, neuropsychological, peripheral biomarker and neuroimaging research. Apathy is a common feature of depression and cognitive disorders and is associated with impairment in executive function. Neuropsychological and neuroimaging studies point to dysfunction of brain circuitry involving the prefrontal cortex, especially the dorsolateral prefrontal cortex circuit, the dorsomedial prefrontal cortex circuit, and the ventromedial prefrontal cortex circuit. However, inconsistent findings, particularly in neuroimaging may be due to heterogeneity of apathy symptoms (with a need to better elucidate subtypes), neuropsychiatric comorbidities, the severity of cognitive impairment and other factors. These factors need to be accounted for in future studies so that biomarker research can make progress. On the whole, the literature on apathy has identified likely neurocognitive, peripheral biomarker and neuroimaging targets for understanding apathy, but also points to the need to address methodological issues that will better inform future studies. In turn, as we learn more about the underpinning of apathy and its subtypes, subsequent research can focus on new neurally based interventions that will strengthen the clinical management of apathy in the context of its comorbidities.
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Affiliation(s)
- David C. Steffens
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Mario Fahed
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Kevin J. Manning
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
| | - Lihong Wang
- grid.208078.50000000419370394Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT USA
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Li Y, Wang J, Yan X, Li H. Combined fractional anisotropy and subcortical volumetric deficits in patients with mild-to-moderate depression: Evidence from the treatment of antidepressant traditional Chinese medicine. Front Neurosci 2022; 16:959960. [PMID: 36081664 PMCID: PMC9448251 DOI: 10.3389/fnins.2022.959960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Numerous neuroimaging studies have demonstrated that diverse brain structural plasticity could occur in a human brain during a depressive episode. However, there is a lack of knowledge regarding the underlying mechanisms of mild-to-moderate depression (MMD), especially the changes of brain structural characteristics after treatment with the Shuganjieyu capsule (SG), a kind of traditional Chinese medicine that has been recommended for the specialized treatment of MMD. In this study, we investigated the structural brain plasticity in MMD that have been undergoing 8 weeks of SG treatment compared with age- and sex-matched healthy controls (HCs) and assessed the relationship between these brain structural alternations and clinical symptoms in MMD. At the baseline, we found that: (1) fractional anisotropy (FA) values in patients with MMD were found to be significantly increased in the regions of anterior limb of internal capsule (ALIC) [MNI coordinates: Peak (x/y/z) = 102, 126, 77; MMD FApeak (Mean ± SD) = 0.621 ± 0.043; HCs FApeak (Mean ± SD) = 0.524 ± 0.052; MMD > HCs, t = 9.625, p < 0.001] and posterior limb of internal capsule (PLIC) [MNI coordinates: Peak (x/y/z) = 109, 117, 87; MMD FApeak (Mean ± SD) = 0.694 ± 0.042; HCs FApeak (Mean ± SD) = 0.581 ± 0.041; MMD > HCs, t = 12.90, p < 0.001], and FA values were significantly positively correlated with HAMD scores in patients with MMD. (2) Patients with MMD showed smaller gray matter volume (GMV) of the dorsolateral prefrontal cortex (DLPFC), frontal cortex, occipital cortex, and precuneus, and the GMV of DLPFC was negatively correlated with HAMD scores. After SG treatment, we found that (1) the HAMD scores decreased; (2) FA values were significantly decreased in the regions of the ALIC and PLIC compared to those at baseline and TBSS revealed no significant differences in FA values between patients with MMD and HCs. (3) The structural characteristics of DLPFC in patients with MMD obtained at the 8th week were improved, e.g., no significant differences in GMV of DLPFC between the two groups. Taken together, our results provided neuroimaging evidence suggesting that SG is an effective treatment for patients with MMD. Moreover, alterations of GMV after 8 weeks of SG treatment indicated a potential modulation mechanism in brain structural plasticity within the DLPFC in patients with MMD.
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Affiliation(s)
- Yuan Li
- Department of Radiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Junjie Wang
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xu Yan
- Department of Medical Imaging, Changzhi Medical College, Changzhi, China
| | - Hong Li
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Department of Mental Health, Shanxi Medical University, Taiyuan, China
- *Correspondence: Hong Li
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Gerlach AR, Karim HT, Peciña M, Ajilore O, Taylor WD, Butters MA, Andreescu C. MRI predictors of pharmacotherapy response in major depressive disorder. Neuroimage Clin 2022; 36:103157. [PMID: 36027717 PMCID: PMC9420953 DOI: 10.1016/j.nicl.2022.103157] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
Major depressive disorder is among the most prevalent psychiatric disorders, exacting a substantial personal, social, and economic toll. Antidepressant treatment typically involves an individualized trial and error approach with an inconsistent success rate. Despite a pressing need, no reliable biomarkers for predicting treatment outcome have yet been discovered. Brain MRI measures hold promise in this regard, though clinical translation remains elusive. In this review, we summarize structural MRI and functional MRI (fMRI) measures that have been investigated as predictors of treatment outcome. We broadly divide these into five categories including three structural measures: volumetric, white matter burden, and white matter integrity; and two functional measures: resting state fMRI and task fMRI. Currently, larger hippocampal volume is the most widely replicated predictor of successful treatment. Lower white matter hyperintensity burden has shown robustness in late life depression. However, both have modest discriminative power. Higher fractional anisotropy of the cingulum bundle and frontal white matter, amygdala hypoactivation and anterior cingulate cortex hyperactivation in response to negative emotional stimuli, and hyperconnectivity within the default mode network (DMN) and between the DMN and executive control network also show promise as predictors of successful treatment. Such network-focused measures may ultimately provide a higher-dimensional measure of treatment response with closer ties to the underlying neurobiology.
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Affiliation(s)
- Andrew R Gerlach
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marta Peciña
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL, USA
| | - Warren D Taylor
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Health System, Nashville, TN, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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8
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Apathy in Parkinson’s Disease: Defining the Park Apathy Subtype. Brain Sci 2022; 12:brainsci12070923. [PMID: 35884730 PMCID: PMC9313138 DOI: 10.3390/brainsci12070923] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023] Open
Abstract
Apathy is a neurobehavioural symptom affecting Parkinson’s disease patients of all disease stages. Apathy seems to be associated with a specific underlying non-motor disease subtype and reflects dysfunction of separate neural networks with distinct neurotransmitter systems. Due to the complicated neuropsychiatric aetiology of apathy, clinical assessment of this invalidating non-motor symptom remains challenging. We aim to summarize the current findings on apathy in Parkinson’s disease and highlight knowledge gaps. We will discuss the prevalence rates across the different disease stages and suggest screening tools for clinically relevant apathetic symptoms. We will approach the fundamental knowledge on the neural networks implicated in apathy in a practical manner and formulate recommendations on patient-tailored treatment. We will discuss the Park apathy phenotype in detail, shedding light on different clinical manifestations and implications for prognosis. With this review, we strive to distil the vast available theoretical knowledge into a clinical and patient-oriented perspective.
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Soleimani L, Schnaider Beeri M, Grossman H, Sano M, Zhu CW. Specific depression dimensions are associated with a faster rate of cognitive decline in older adults. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12268. [PMID: 35317432 PMCID: PMC8923346 DOI: 10.1002/dad2.12268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/02/2022] [Accepted: 10/22/2021] [Indexed: 06/14/2023]
Abstract
Introduction Understanding the relationship between different depression presentations and cognitive outcome may elucidate high-risk sub-groups for cognitive decline. Methods In this study we utilized longitudinal data from the National Alzheimer's Coordinating Center (NACC) on 16,743 initially not demented older adults followed every 12 months for an average of 5 years. Depression dimensions were defined based on the 15-item Geriatric Depression Scale (GDS-15), that is, dysphoric mood, Withdrawal-Apathy-Vigor (WAV), anxiety, hopelessness, and subjective memory complaint (SMC). Results After adjustment for sociodemographic and clinical covariates, SMC and hopelessness were associated with faster decline in global cognition and all cognitive domains and WAV with decline executive function. Dysphoric mood and anxiety were not associated with a faster cognitive decline in any of the cognitive domains. Discussion Different depression dimensions had different associations with the rate of cognitive decline, suggesting distinct pathophysiology and the need for more targeted interventions.
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Affiliation(s)
- Laili Soleimani
- Department of PsychiatryThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Michal Schnaider Beeri
- Department of PsychiatryThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- The Joseph Sagol Neuroscience CenterSheba Medical CenterTel‐HashomerIsrael
| | - Hillel Grossman
- Department of PsychiatryThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- James J Peters VAMCBronxNew YorkUSA
| | - Mary Sano
- Department of PsychiatryThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- James J Peters VAMCBronxNew YorkUSA
| | - Carolyn W. Zhu
- Department of PsychiatryThe Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- James J Peters VAMCBronxNew YorkUSA
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10
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Altered resting-state functional connectivity of the frontal-striatal circuit in elderly with apathy. PLoS One 2021; 16:e0261334. [PMID: 34898646 PMCID: PMC8668136 DOI: 10.1371/journal.pone.0261334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Apathy is defined as reduction of goal-directed behaviors and a common nuisance syndrome of neurodegenerative and psychiatric disease. The underlying mechanism of apathy implicates changes of the front-striatal circuit, but its precise alteration is unclear for apathy in healthy aged people. The aim of our study is to investigate how the frontal-striatal circuit is changed in elderly with apathy using resting-state functional MRI. Eighteen subjects with apathy (7 female, 63.7 ± 3.0 years) and eighteen subjects without apathy (10 female, 64.8 ± 3.0 years) who underwent neuropsychological assessment and MRI measurement were recruited. We compared functional connectivity with/within the striatum between the apathy and non-apathy groups. The seed-to-voxel group analysis for functional connectivity between the striatum and other brain regions showed that the connectivity was decreased between the ventral rostral putamen and the right dorsal anterior cingulate cortex/supplementary motor area in the apathy group compared to the non-apathy group while the connectivity was increased between the dorsal caudate and the left sensorimotor area. Moreover, the ROI-to-ROI analysis within the striatum indicated reduction of functional connectivity between the ventral regions and dorsal regions of the striatum in the apathy group. Our findings suggest that the changes in functional connectivity balance among different frontal-striatum circuits contribute to apathy in elderly.
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Fahed M, Steffens DC. Apathy: Neurobiology, Assessment and Treatment. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:181-189. [PMID: 33888648 PMCID: PMC8077060 DOI: 10.9758/cpn.2021.19.2.181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/22/2022]
Abstract
Apathy is a highly prevalent, disabling and treatment resistant syndrome. It is defined as a quantitative reduction of goal- directed activity in comparison to the patient’s previous level of in multiple dimensions including behavior/cognition, emotion and social interaction. It has been described in major depressive disorder, Alzheimer’s disease, frontotemporal dementia, Parkinson’s Disease, cerebrovascular disease, and vascular dementia, among others. This review will address the neuropsychology and associated neurobiological underpinnings of apathy in the above conditions, identify specific methods to assess apathy clinically, and review the literature on managing apathy across these various disorders.
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Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut, School of Medicine, Farmington, CT, USA
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12
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Pimontel MA, Solomonov N, Oberlin L, Kanellopoulos T, Bress JN, Hoptman MJ, Alexopoulos GS, Gunning FM. Cortical Thickness of the Salience Network and Change in Apathy Following Antidepressant Treatment for Late-Life Depression. Am J Geriatr Psychiatry 2021; 29:241-248. [PMID: 32680763 PMCID: PMC7738363 DOI: 10.1016/j.jagp.2020.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Apathy is common in late-life depression and is associated with poor response to antidepressant drugs. In depressed older adults, apathy may be characterized by neuroanatomical abnormalities of the salience network. The current study examined whether cortical thickness of select salience network structures predicted change in apathy following a 12-week treatment with escitalopram. METHODS A sample of 46 older adults with major depressive disorder received 12 weeks of escitalopram treatment at a daily target dose of 20 mg. All participants underwent a structural brain MRI scan at baseline, and cortical thickness was estimated in key cortical nodes of the salience network: the caudal anterior cingulate cortex and the insula. We measured baseline and post-treatment symptoms using the Apathy Evaluation Scale and the Hamilton Depression Rating Scale. RESULTS A thicker insula at baseline predicted reduction in apathy symptoms following 12 weeks of treatment with escitalopram, even when controlling for age, baseline depression severity and change in depressive symptoms. CONCLUSION Reduced insular thickness predicted residual apathetic symptoms following escitalopram treatment. These results converge with our previous findings of abnormal functional connectivity of the insular cortex in older depressed individuals with apathy. Older depressed adults with apathy may benefit from alternative treatment approaches or augmentative interventions that target abnormalities of the salience network.
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Affiliation(s)
- Monique A Pimontel
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Lauren Oberlin
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Theodora Kanellopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Jennifer N Bress
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Matthew J Hoptman
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY; New York University School of Medicine, New York, NY
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY
| | - Faith M Gunning
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (MAP, NS, LO, TK, JNB, GSA, FMG), White Plains, NY.
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13
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Jurek L, Dorey JM, Nourredine M, Galvao F, Brunelin J. Impact of vascular risk factors on clinical outcome in elderly patients with depression receiving electroconvulsive therapy. J Affect Disord 2021; 279:308-315. [PMID: 33096329 DOI: 10.1016/j.jad.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/29/2020] [Accepted: 10/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although electroconvulsive therapy (ECT) is a highly effective, safe, and well-tolerated antidepressant treatment for late-life depression (LLD), there is large variability in response rates across individuals. We hypothesized that these variations would be in part explained by the level of vascular risk in this population. We therefore compared response rates to ECT in patients with LLD presenting with or without vascular risk factors (VRF). METHODS 52 patients with LLD (age > 55) who received a course of ECT were separated into 2 groups according to the presence of VRF (n = 20) or not (n = 32). Framingham score (10-year risk for developing a coronary heart disease) was calculated for each patient. Our primary outcome was the number of responders to ECT in each group (defined as at least 50% decrease of the Montgomery-Åsberg Depression Rating Scale score following ECT course). Scores at the self-rated Beck Depression Inventory are also reported. RESULTS Patients with VRF presented significant lower response rates to ECT (12 out of 20; 60%) than patients without VRF (30 out of 32; 94%; p = 0.004). A negative correlation was found between Framingham score and changes in depression scores pre/post ECT (r = -0.42; p = 0.0039). LIMITATIONS Our study was limited by sample size and retrospective design. CONCLUSION Patients with LLD and VRF showed lower response rates to ECT than those without VRF. The more the VRF increased, the less the antidepressant effect of ECT was observed. Results are discussed in light of the role of apathy in clinical response to ECT.
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Affiliation(s)
- Lucie Jurek
- University Lyon 1, Villeurbanne F-69000, France; Centre Hospitalier Le Vinatier, Bron, France.
| | - Jean-Michel Dorey
- Centre Hospitalier Le Vinatier, Bron, France; Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Mikaïl Nourredine
- University Lyon 1, Villeurbanne F-69000, France; INSERM, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, U1028; CNRS, UMR5292, PSYR2 Team, Lyon F-69000, France
| | - Filipe Galvao
- University Lyon 1, Villeurbanne F-69000, France; INSERM, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, U1028; CNRS, UMR5292, PSYR2 Team, Lyon F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
| | - Jérome Brunelin
- University Lyon 1, Villeurbanne F-69000, France; INSERM, Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response, U1028; CNRS, UMR5292, PSYR2 Team, Lyon F-69000, France; Centre Hospitalier Le Vinatier, Bron, France
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14
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Kim YK, Han KM. Neural substrates for late-life depression: A selective review of structural neuroimaging studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110010. [PMID: 32544600 DOI: 10.1016/j.pnpbp.2020.110010] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
Recent neuroimaging studies have characterized the pathophysiology of late-life depression (LLD) as a dysfunction of the brain networks involved in the regulation of emotion, motivational behavior, cognitive control, executive function, and self-referential thinking. In this article, we reviewed LLD-associated structural neuroimaging markers such as white matter hyperintensity (WMH), white matter integrity measured by diffusion tensor imaging, cortical and subcortical volumes, and cortical thickness, which may provide a structural basis for brain network dysfunction in LLD. LLD was associated with greater severity or volumes of deep, periventricular, or overall WMH and with decreased white matter integrity in the brain regions belonging to the fronto-striatal-limbic circuits and reduced white matter tract integrity which connects these circuits, such as the cingulum, corpus callosum, or uncinate fasciculus. Decreased volumes or cortical thickness in the prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate cortex, several temporal and parietal regions, hippocampus, amygdala, striatum, thalamus, and the insula were associated with LLD. These structural neuroimaging findings were also associated with cognitive dysfunction, which is a prominent clinical feature in LLD. Several structural neuroimaging markers including the WMH burden, white matter integrity, and cortical and subcortical volumes predicted antidepressant response in LLD. These structural neuroimaging findings support the hypothesis that disruption of the brain networks involved in emotion regulation and cognitive processing by impaired structural connectivity is strongly associated with the pathophysiology of LLD.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
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15
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Neurobiological Targets of Apathy Can Guide Treatment Development. Am J Geriatr Psychiatry 2021; 29:63-65. [PMID: 32713752 DOI: 10.1016/j.jagp.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022]
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16
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Wiels WA, Wittens MMJ, Zeeuws D, Baeken C, Engelborghs S. Neuropsychiatric Symptoms in Mild Cognitive Impairment and Dementia Due to AD: Relation With Disease Stage and Cognitive Deficits. Front Psychiatry 2021; 12:707580. [PMID: 34483998 PMCID: PMC8415837 DOI: 10.3389/fpsyt.2021.707580] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The interaction between neuropsychiatric symptoms, mild cognitive impairment (MCI), and dementia is complex and remains to be elucidated. An additive or multiplicative effect of neuropsychiatric symptoms such as apathy or depression on cognitive decline has been suggested. Unraveling these interactions may allow the development of better prevention and treatment strategies. In the absence of available treatments for neurodegeneration, a timely and adequate identification of neuropsychiatric symptom changes in cognitive decline is highly relevant and can help identify treatment targets. Methods: An existing memory clinic-based research database of 476 individuals with MCI and 978 individuals with dementia due to Alzheimer's disease (AD) was reanalyzed. Neuropsychiatric symptoms were assessed in a prospective fashion using a battery of neuropsychiatric assessment scales: Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia (CSDD), and Geriatric Depression Scale (30 items). We subtyped subjects suffering from dementia as mild, moderate, or severe according to their Mini-Mental State Examination (MMSE) score and compared neuropsychiatric scores across these groups. A group of 126 subjects suffering from AD with a significant cerebrovascular component was examined separately as well. We compared the prevalence, nature, and severity of neuropsychiatric symptoms between subgroups of patients with MCI and dementia due to AD in a cross-sectional analysis. Results: Affective and sleep-related symptoms are common in MCI and remain constant in prevalence and severity across dementia groups. Depressive symptoms as assessed by the CSDD further increase in severe dementia. Most other neuropsychiatric symptoms (such as agitation and activity disturbances) progress in parallel with severity of cognitive decline. There are no significant differences in neuropsychiatric symptoms when comparing "pure" AD to AD with a significant vascular component. Conclusion: Neuropsychiatric symptoms such as frontal lobe symptoms, psychosis, agitation, aggression, and activity disturbances increase as dementia progresses. Affective symptoms such as anxiety and depressive symptoms, however, are more frequent in MCI than mild dementia but otherwise remain stable throughout the cognitive spectrum, except for an increase in CSDD score in severe dementia. There is no difference in neuropsychiatric symptoms when comparing mixed dementia (defined here as AD + significant cerebrovascular disease) to pure AD.
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Affiliation(s)
- Wietse A Wiels
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Mandy M J Wittens
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Dieter Zeeuws
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Chris Baeken
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Psychiatry, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Department of Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
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17
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Krause-Sorio B, Siddarth P, Milillo MM, Vlasova R, Ercoli L, Narr KL, Lavretsky H. Regional White Matter Integrity Predicts Treatment Response to Escitalopram and Memantine in Geriatric Depression: A Pilot Study. Front Psychiatry 2020; 11:548904. [PMID: 33329088 PMCID: PMC7718009 DOI: 10.3389/fpsyt.2020.548904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Geriatric depression with subjective memory complaints increases the risk for Alzheimer's Disease. Memantine, a neuroprotective drug, can improve depression and help prevent cognitive decline. In our 6-months clinical trial, escitalopram/memantine (ESC/MEM) improved mood and cognition compared to escitalopram/placebo treatment (ESC/PBO; NCT01902004). In this report, we investigated whether baseline brain white matter integrity in fronto-limbic-striatal tracts can predict clinical outcomes using fractional anisotropy (FA). Methods: Thirty-eight older depressed adults (mean age = 70.6, SD = 7.2) were randomized to ESC/MEM or ESC/PBO and underwent diffusion-weighted imaging (DWI) at 3 Tesla at baseline. Mood was assessed using the Hamilton Depression Rating Scale (HAMD), apathy using the Apathy Evaluation Scale (AES) and anxiety using the Hamilton Anxiety Scale (HAMA) at baseline and 6-months follow-up. FA was extracted from seven tracts of interest (six in each hemisphere and one commissural tract) associated with geriatric depression. Non-parametric General Linear Models were used to examine group differences in the association between FA and symptom improvement, controlling for age, sex, baseline symptom scores and scanner model, correcting for false discovery rate (FDR). Post-hoc tests further investigated group differences in axial, mean and radial diffusivity (AD, MD, and RD, respectively). Lastly, we performed an exploratory whole-brain model to test whether FA might be related to treatment response with memantine. Results: There were no differences in remission rates or HAMD change between groups. In bilateral anterior and posterior internal capsule tracts and bilateral inferior and right superior fronto-occipital (IFO and SFO) fasciculus, higher FA was associated with larger improvements in depressive symptoms for ESC/MEM, but not ESC/PBO, correcting for FDR. Lower MD in the left IFO and RD in the right anterior internal capsule were associated with improved treatment responses. We found no significant associations in the whole-brain analysis. Limitations: Included small sample size and high dropout. Conclusions: Higher baseline FA and lower RD and MD in hypothesized fronto-limbic-striatal tracts predicted greater improvement in mood and anxiety with ESC/MEM compared to ESC/PBO in geriatric depression. FA as a biomarker for white matter integrity may serve as a predictor of treatment response but requires confirmation in larger future studies.
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Affiliation(s)
- Beatrix Krause-Sorio
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Prabha Siddarth
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michaela M. Milillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roza Vlasova
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Linda Ercoli
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine L. Narr
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Helen Lavretsky
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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18
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Pimontel MA, Kanellopoulos D, Gunning FM. Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review. J Geriatr Psychiatry Neurol 2020; 33:289-303. [PMID: 31635522 DOI: 10.1177/0891988719882100] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. METHOD Systematic literature review. RESULTS The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. CONCLUSIONS Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.
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Affiliation(s)
- Monique A Pimontel
- Graduate Center, City University of New York, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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19
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Kanellopoulos D, Wilkins V, Avari J, Oberlin L, Arader L, Chaplin M, Banerjee S, Alexopoulos GS. Dimensions of Poststroke Depression and Neuropsychological Deficits in Older Adults. Am J Geriatr Psychiatry 2020; 28:764-771. [PMID: 32081532 PMCID: PMC7354891 DOI: 10.1016/j.jagp.2020.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Poststroke depression (PSD) has a heterogeneous presentation and is often accompanied by cognitive impairment. This study aimed to identify distinct dimensions of depressive symptoms in older adults with PSD and to evaluate their relationship to cognitive functioning. DESIGN Cross-sectional factor and correlational analyses of patients with poststroke depression. SETTING Patients were recruited from the community and from acute inpatient stroke rehabilitation hospitals. PARTICIPANTS Participants had suffered a stroke and met DSM-IV criteria for major depression (≥18 Montgomery Åsberg Depression Scale; MADRS). INTERVENTION None. MEASUREMENTS MADRS was used to quantify depression severity at study entry. Neuropsychological assessment at the time of study entry consisted of measures of Global Cognition, Attention, Executive Function, Processing Speed, Immediate Memory, Delayed Memory, and Language. RESULTS There were 135 (age ≥50) older adult participants with PSD and varying degrees of cognitive impairment (MMSE Total ≥20). Factor analysis of the MADRS identified three factors, that is sadness, distress, and apathy. Items comprising each factor were totaled and correlated with neuropsychological domain z-score averages. Symptoms of the apathy factor (lassitude, inability to feel) were significantly associated with greater impairment in executive function, memory, and global cognition. Symptoms of the sadness and distress factors had no relationship to cognitive impairment. CONCLUSION PSD consists of three correlated dimensions of depressive symptoms. Apathy symptoms are associated with cognitive impairment across several neuropsychological domains. PSD patients with prominent apathy may benefit from careful attention to cognitive functions and by interventions that address both psychopathology and behavioral deficits resulting from cognitive impairment.
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Affiliation(s)
- Dora Kanellopoulos
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Victoria Wilkins
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Jimmy Avari
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Lauren Oberlin
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Lindsay Arader
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Merete Chaplin
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - Samprit Banerjee
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY
| | - George S Alexopoulos
- Weill Cornell Medicine, Weill Cornell Institute of Geriatric Psychiatry (DK, VW, JA, LO, LA, MC, SB, GSA), White Plains, NY.
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20
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Guessoum SB, Le Strat Y, Dubertret C, Mallet J. A transnosographic approach of negative symptoms pathophysiology in schizophrenia and depressive disorders. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109862. [PMID: 31927053 DOI: 10.1016/j.pnpbp.2020.109862] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Negative Symptoms (blunted affect, alogia, anhedonia, avolition and asociality) are observed in schizophrenia but also in depressive disorders. OBJECTIVE To gather cognitive, neuroanatomical, neurofunctional and neurobiological knowledge of negative symptoms in studies on schizophrenia, depressive disorder, and transnosographic studies. RESULTS Blunted affect in schizophrenia is characterized by amygdala hyperactivation and frontal hypoactivation, also found in depressive disorder. Mirror neurons, may be related to blunted affect in schizophrenia. Alogia may be related to cognitive dysfunction and basal ganglia area impairments in schizophrenia. Data surrounding alogia in depressive disorder is scarce; wider speech deficits are often studied instead. Consummatory Anhedonia may be less affected than Anticipatory Anhedonia in schizophrenia. Anhedonia is associated with reward impairments and altered striatal functions in both diagnostics. Amotivation is associated with Corticostriatal Hypoactivation in both disorders. Anhedonia and amotivation are transnosographically associated with dopamine dysregulation. Asociality may be related to oxytocin. CONCLUSION Pathophysiological hypotheses are specific to each dimension of negative symptoms and overlap across diagnostic boundaries, possibly underpinning the observed clinical continuum.
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Affiliation(s)
- Sélim Benjamin Guessoum
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France
| | - Yann Le Strat
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
| | - Caroline Dubertret
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
| | - Jasmina Mallet
- AP-HP; Psychiatry Department, University Hospital Louis Mourier; University of Paris, 178 rue des Renouillers, 92700 Colombes, France; INSERM UMR1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), 102-108 rue de la Santé, 75014 Paris, France.
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21
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Petrova NN, Markin AV. [Apathy syndrome in depressed patients previously treated with selective serotonin reuptake inhibitors]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:111-117. [PMID: 32105278 DOI: 10.17116/jnevro2020120011111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review of literature considers apathy syndrome induced by selective serotonin reuptake inhibitors (SSRI). Epidemiology and etiology of this phenomenon are not clear. Clinical features, diagnosis of apathy, differentiating and correlations between apathy and depression are presented. The possible mechanisms of onset and strategies of therapy of SSRI-induced apathy are discussed. It has been concluded that, despite the clinical evidence of the relationship between apathy and SSRI treatment, evidence-based research is needed.
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Affiliation(s)
- N N Petrova
- Saint-Petersburg State University, St. Petersburg, Russia
| | - A V Markin
- Saint-Petersburg State University, St. Petersburg, Russia
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22
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Lavretsky H, Laird KT, Krause-Sorio B, Heimberg BF, Yeargin J, Grzenda A, Wu P, Thana-Udom K, Ercoli LM, Siddarth P. A Randomized Double-Blind Placebo-Controlled Trial of Combined Escitalopram and Memantine for Older Adults With Major Depression and Subjective Memory Complaints. Am J Geriatr Psychiatry 2020; 28:178-190. [PMID: 31519517 PMCID: PMC6997044 DOI: 10.1016/j.jagp.2019.08.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Geriatric depression is difficult to treat and frequently accompanied by cognitive complaints that increase risk for dementia. New treatment strategies targeting both depression and cognition are urgently needed. METHODS We conducted a 6-month double-blind placebo-controlled trial to assess the efficacy and tolerability of escitalopram + memantine (ESC/MEM) compared to escitalopram + placebo (ESC/PBO) for improving mood and cognitive functioning in depressed older adults with subjective memory complaints (NCT01902004). Primary outcome was change in depression as assessed by the HAM-D post-treatment (at 6 months). Remission was defined as HAM-D ≤6; naturalistic follow-up continued until 12 months. RESULTS Of the 95 randomized participants, 62 completed the 6-month assessment. Dropout and tolerability did not differ between groups. Mean daily escitalopram dose was 11.1 mg (SD = 3.7; range: 5-20 mg). Mean daily memantine dose was 19.3 mg (SD = 2.6; range 10-20 mg). Remission rate within ESC/MEM was 45.8% and 47.9%, compared to 38.3% and 31.9% in ESC/PBO, at 3 and 6 months, respectively (χ2(1) = 2.0, p = 0.15). Both groups improved significantly on the HAM-D at 3, 6, and 12 months, with no observed between-group differences. ESC/MEM demonstrated greater improvement in delayed recall (F(2,82) = 4.3, p = 0.02) and executive functioning (F(2,82) = 5.1, p = 0.01) at 12 months compared to ESC/PBO. CONCLUSIONS The combination of memantine with escitalopram was well tolerated and as effective as escitalopram and placebo in improving depression using HAM-D. Combination memantine and escitalopram was significantly more effective than escitalopram and placebo in improving cognitive outcomes at 12 months. Future reports will address the role of biomarkers of aging in treatment response.
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Affiliation(s)
- Helen Lavretsky
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA.
| | - Kelsey T Laird
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Beatrix Krause-Sorio
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Brandon F Heimberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Jillian Yeargin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Adrienne Grzenda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Pauline Wu
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Kitikan Thana-Udom
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA; Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University (KT-U), Bangkok, Thailand
| | - Linda M Ercoli
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
| | - Prabha Siddarth
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (HL, KTL, BK-S, BFH, JY, AG, PW, KT-U, LME, PS), Los Angeles, CA
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Abstract
Background:
Apathy is defined as diminished motivation free from altered consciousness,
cognitive impairment or emotional distress. It is a prevalent syndrome in different disorders,
which share brain system alterations despite very different underlying pathologies. However, to
date, little research has be en devoted to the subject.
Aim:
To review the concept of apathy and clarify its aetiology, structural and functional neural
bases and treatment options.
Methods:
Literature search and review, with “apathy” as a term, using all main databases (Medline,
Psychinfo, Cochrane) included in our organization’s (RSMB; Osakidetza/Basque Health Service)
Ovid search engine, together with a manual search of relevant papers.
Results:
The literature reviewed shows that apathy is a multi-dimensional clinical construct with a
current definition and validated diagnostic criteria. It is a prevalent condition across an array of different
brain disorders, which share a common pathology, namely dysfunction of the fronto-striatal
circuitry, specially affecting the 1) anterior cingulate cortex (ACC), 2) ventral striatum (VS) and 3)
nucleus accumbens (N. Acc.). Different theories have emerged regarding the role of the ACC in the
genesis of apathy. The neuromodulator dopamine is heavily implicated in 1- ACC, 2- VS, 3- in particulat
the N. Acc., and 4- the genesis of apathy, although other neurotransmitters could also be
involved to a lesser degree. There is a patent lack of RCTs on the efficiency of current therapeutic options.
Conclusion:
Further research is needed to help understand the functional neuroanatomy, neuromodulators
involved and possible treatment options of this clinical construct.
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Updating Apathy: Using Research Domain Criteria to Inform Clinical Assessment and Diagnosis of Disorders of Motivation. J Nerv Ment Dis 2019; 207:707-714. [PMID: 30256334 DOI: 10.1097/nmd.0000000000000860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term "apathy" and "related phenomena" in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.
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Predictive Value of Fissured Tongue in Functional Dyspepsia Combined with Depression. Gastroenterol Res Pract 2019; 2019:4596560. [PMID: 31316559 PMCID: PMC6604341 DOI: 10.1155/2019/4596560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/22/2019] [Accepted: 05/09/2019] [Indexed: 01/25/2023] Open
Abstract
Anxiety and depression are common in functional dyspepsia (FD) patients. Although fissured tongue (FT) is often observed in FD, its clinical value in such patients is rarely reported. We analyzed clinical data of FD patients with FT with the aim of elucidating the clinical value of FT in FD. This study suggests FD patients with different types of FT with the course of disease and the 9-item Patient Health Questionnaire (PHQ9) showed a significant difference. The PHQ9, course of disease, and self-rated dyspepsia symptoms (SRDS) correlated positively with the types of FT by the Spearman rank analysis. Epigastric pain, bloating, nausea, and SRDS showed a significant difference between FT-FD and nonfissured tongue- (NFT-) FD as well as between FD patients with and without symptoms of depression. Many FD patients also have FT, which may be associated with depressive symptoms. The longer the course of disease, the more serious the fissured tongue; thus, it may provide a predictive value for the diagnosis of depressive symptoms in FD patients.
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Nugent AC, Farmer C, Evans JW, Snider SL, Banerjee D, Zarate CA. Multimodal imaging reveals a complex pattern of dysfunction in corticolimbic pathways in major depressive disorder. Hum Brain Mapp 2019; 40:3940-3950. [PMID: 31179620 DOI: 10.1002/hbm.24679] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 05/21/2019] [Indexed: 11/08/2022] Open
Abstract
Major depressive disorder (MDD) is highly prevalent and associated with considerable morbidity, yet its pathophysiology remains only partially understood. While numerous studies have investigated the neurobiological correlates of MDD, most have used only a single neuroimaging modality. In particular, diffusion tensor imaging (DTI) studies have failed to yield uniform results. In this context, examining key tracts and using information from multiple neuroimaging modalities may better characterize potential abnormalities in the MDD brain. This study analyzed data from 30 participants with MDD and 26 healthy participants who underwent DTI, magnetic resonance spectroscopy (MRS), resting-state functional magnetic resonance imaging (fMRI), and magnetoencephalography (MEG). Tracts connecting the subgenual anterior cingulate cortex (sgACC) and the left and right amygdala, as well as connections to the left and right hippocampus and thalamus, were examined as target areas. Reduced fractional anisotropy (FA) was observed in the studied tracts. Significant differences in the correlation between medial prefrontal glutamate concentrations and FA were also observed between MDD and healthy participants along tracts connecting the sgACC and right amygdala; healthy participants exhibited a strong correlation but MDD participants showed no such relationship. In the same tract, a correlation was observed between FA and subsequent antidepressant response to ketamine infusion in MDD participants. Exploratory models also suggested group differences in the relationship between DTI, fMRI, and MEG measures. This study is the first to combine MRS, DTI, fMRI, and MEG data to obtain multimodal indices of MDD and antidepressant response and may lay the foundation for similar future analyses.
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Affiliation(s)
- Allison C Nugent
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.,Magnetoencephalography Core Facility, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Cristan Farmer
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Jennifer W Evans
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Sam L Snider
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Dipavo Banerjee
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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Sözeri-Varma G, Bingöl C, Topak OZ, Enli Y, Özdel O. Relationship of Apathy with Depressive Symptom Severity and Cognitive Functions in Geriatric Depression. Noro Psikiyatr Ars 2019; 56:133-138. [PMID: 31223247 PMCID: PMC6563860 DOI: 10.29399/npa.22931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 09/07/2018] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Apathy which is known as loss of primary motivation is observed more frequently in elderly depression in comparison with younger adults. It is put forth that apathy is related with depressive symptom severity and cognitive functions, that the existence of apathy may be a predictor of neurocognitive impairment. The objective of this study was to examine the apathy levels in elderly patients with major depression as well as the relationship between depressive symptom severity and cognitive functions. METHODS The study was carried out with 40 major depressive disorder patients (MDD) aged 60 and above, 40 healthy controls aged 60 and above. Sociodemographic data form, structured psychiatric interview (SCID-I), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Montgomery-Asberg Depression Rating Scale (MADRS), Standardized Mini Mental State Examination (SMMSE), Montreal Cognitive Assessment Scale (MoCA), Apathy Evaluation Scale (AES) and Sheehan Disability Scale (SDS) were applied to the participants. RESULTS In our study, HAM-D, HAM-A and MADRS scale scores of MDD group was determined to be higher in comparison with those of the healthy control group. A positive correlation was determined in the MDD groups between the AES scores and depressive symptom severity, whereas a negative correlation was determined between the AES scores and cognitive functions. The SMMSE and MoCA scores of the geriatric MDD group were determined to be lower in comparison with healthy control group. Low performance was observed in the geriatric MDD group especially in the fields of orientation, visual/spatial functions, memory and language. Functionality was found to be lower in MDB group than in the control group, and functionality decreased as the level of apathy increased. CONCLUSION Our results indicate that the apathy levels in geriatric depression are higher in comparison with the control group. Cognitive functions are affected adversely in geriatric patients in major depressive disorder, depressive symptom severity, impairment in cognitive functions and functionality are observed to be related with apathy level.
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Affiliation(s)
- Gülfizar Sözeri-Varma
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ceren Bingöl
- Department of Psychiatry, Akşehir State Hospital, Konya, Turkey
| | - Osman Zülkif Topak
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Yaşar Enli
- Department of Biochemistry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Osman Özdel
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Chakraborty S, Lennon JC, Malkaram SA, Zeng Y, Fisher DW, Dong H. Serotonergic system, cognition, and BPSD in Alzheimer's disease. Neurosci Lett 2019; 704:36-44. [PMID: 30946928 DOI: 10.1016/j.neulet.2019.03.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022]
Abstract
Behavioral and Psychological Symptoms of Dementia (BPSD), present in almost 90% of patients with Alzheimer's Disease (AD), cause extensive impairment leading to reduced independence and inability to complete activities of daily living. Though BPSD includes a wide range of symptoms, such as agitation, aggression, disinhibition, anxiety, depression, apathy, delusions, and hallucinations. Certain BPSD in AD co-present and can be clustered into distinct domains based on their frequency of co-occurrence. As these BPSD are so pervasive in any stages of AD, the disease may be better characterized as a disorder of heterogeneous degenerative symptoms across a number of symptom domains, with the most prominent domain comprising memory and cognitive deficits. Importantly, there are no FDA-approved drugs to treat these BPSD, and new approaches must be considered to develop effective treatments for AD patients. The biogenic monoamine 5-hydroxytryptamine (5-HT), or serotonin, works as both a neurotransmitter and neuromodulator, which has been tied to cognitive decline and multiple BPSD domains. This review summarizes the evidence for specific serotonergic system alterations across some of the well-studied cognitive, behavioral, and psychiatric domains. Though differences in overall serotonergic transmission occur in AD, circuit-specific alterations in individual 5-HT receptors (5-HTRs) are likely linked to the heterogeneous presentation of BPSD in AD.
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Affiliation(s)
- Saikat Chakraborty
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Jack C Lennon
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Sridhar A Malkaram
- Department of Biology, West Virginia State University Institute, WV-25112, USA
| | - Yan Zeng
- Brain and Cognition Research Institute, Wuhan University of Science and Technology, China
| | - Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
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Laird KT, Krause B, Funes C, Lavretsky H. Psychobiological factors of resilience and depression in late life. Transl Psychiatry 2019; 9:88. [PMID: 30765686 PMCID: PMC6375932 DOI: 10.1038/s41398-019-0424-7] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/28/2018] [Accepted: 01/26/2019] [Indexed: 12/18/2022] Open
Abstract
In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD.
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Affiliation(s)
- Kelsey T Laird
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Beatrix Krause
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Cynthia Funes
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA.
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Motter JN, Pelton GH, D’Antonio K, Rushia SN, Pimontel MA, Petrella JR, Garcon E, Ciovacco MW, Sneed JR, Doraiswamy PM, Devanand DP. Clinical and radiological characteristics of early versus late mild cognitive impairment in patients with comorbid depressive disorder. Int J Geriatr Psychiatry 2018; 33:1604-1612. [PMID: 30035339 PMCID: PMC6246783 DOI: 10.1002/gps.4955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 06/17/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The classification of mild cognitive impairment (MCI) continues to be debated though it has recently been subtyped into late (LMCI) versus early (EMCI) stages. Older adults presenting with both a depressive disorder (DEP) and cognitive impairment (CI) represent a unique, understudied population. Our aim was to examine baseline characteristics of DEP-CI patients in the DOTCODE trial, a randomized controlled trial of open antidepressant treatment for 16 weeks followed by add-on donepezil or placebo for 62 weeks. METHODS/DESIGN Key inclusion criteria were diagnosis of major depression or dysthymic disorder with Hamilton Depression Rating Scale (HAM-D) score >14, and cognitive impairment defined by MMSE score ≥21 and impaired performance on the WMS-R Logical Memory II test. Patients were classified as EMCI or LMCI based on the 1.5 SD cutoff on tests of verbal memory, and compared on baseline clinical, neuropsychological, and anatomical characteristics. RESULTS Seventy-nine DEP-CI patients were recruited of whom 39 met criteria for EMCI and 40 for LMCI. The mean age was 68.9, and mean HAM-D was 23.0. Late mild cognitive impairment patients had significantly worse ADAS-Cog (P < .001), MMSE (P = .004), Block Design (P = .024), Visual Rep II (P = .006), CFL Animal (P = .006), UPSIT (P = .051), as well as smaller right hippocampal volume (P = .037) compared to EMCI patients. MRI indices of cerebrovascular disease did not differ between EMCI and LMCI patients. CONCLUSIONS Cognitive and neuronal loss markers differed between EMCI and LMCI among patients with DEP-CI, with LMCI being more likely to have the clinical and neuronal loss markers known to be associated with Alzheimer's disease.
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Affiliation(s)
- Jeffrey N. Motter
- The Graduate Center, City University of New York,Queens College, City University of New York
| | | | | | - Sara N. Rushia
- The Graduate Center, City University of New York,Queens College, City University of New York
| | - Monique A. Pimontel
- The Graduate Center, City University of New York,Queens College, City University of New York
| | | | - Ernst Garcon
- Columbia University and the New York State Psychiatric Institute
| | | | - Joel R. Sneed
- The Graduate Center, City University of New York,Queens College, City University of New York,Columbia University and the New York State Psychiatric Institute
| | | | - Davangere P. Devanand
- Columbia University and the New York State Psychiatric Institute,Correspondence: D. P. Devanand, MD, Department of Psychiatry, Division of Geriatric Psychiatry, 1051 Riverside Drive, Unit 98, New York, NY 10032,
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Henstra MJ, Houbolt CM, Seppala LJ, de Rooij SE, Rhebergen D, Stek ML, van der Velde N. Age modifies the association between apathy and recurrent falling in Dutch ambulant older persons with a high fall risk: Recurrent falling in Dutch outpatients, does apathy play a role? Exp Gerontol 2018; 112:54-62. [PMID: 30217662 DOI: 10.1016/j.exger.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022]
Abstract
Apathy, a common and disabling behavioural syndrome in older persons, has been associated with impaired physical performance and executive dysfunction. Both are fall risk factors and they share pathophysiological pathway. We cross-sectionally examined the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls in the past 12 months in 243 outpatients aged ≥65 years with ≥3 fall risk-factors visiting a fall-clinic after a fall. We calculated Odds Ratio's (ORs), Incidence Rate Ratio's (IRRs) and their 95% Confidential Intervals (CI95) using multivariable regression and negative binomial regression analyses. We adjusted for cognitive functioning, depression, the use of fall risk increasing drugs, visual impairment, urine incontinence, comorbidity, smoking, use of alcohol, body mass index (BMI), and the number of months between assessment of fall risk and of apathy. We assessed effect modification by age and gender. In our study, apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.0-7.7). Overall, patients with apathy experienced 1.46 times as many falls in the past 12 months compared to patients without apathy (IRR 1.46 (CI95 1.0-2.1). To conclude, in high fall-risk older outpatients, apathy was cross-sectionally associated with recurrent falling in patients aged 65-75 years and the number of falls. Apathy appeared to be especially relevant in relation to falling in this age group. Whether apathy predicts recurrent falling is yet to be determined.
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Affiliation(s)
- M J Henstra
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - C M Houbolt
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - L J Seppala
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - S E de Rooij
- UMCG Department of Internal Medicine, Geriatrics, University Medical Centre Groningen, Groningen, the Netherlands; AMC Department of Internal Medicine, Geriatrics, Academic Medical Center, University of Amsterdam, the Netherlands
| | - D Rhebergen
- Department of Psychiatry, GGZ inGeest, Amsterdam, the Netherlands; EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - M L Stek
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; GGZ inGeest/Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, the Netherlands
| | - N van der Velde
- Department of Internal Medicine, Geriatrics, Academic Medical Centre Amsterdam, the Netherlands; Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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32
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Carlier A, van Exel E, Dols A, Bouckaert F, Sienaert P, Ten Kate M, Wattjes MP, Vandenbulcke M, Stek ML, Rhebergen D. The course of apathy in late-life depression treated with electroconvulsive therapy; a prospective cohort study. Int J Geriatr Psychiatry 2018; 33:1253-1259. [PMID: 29851173 DOI: 10.1002/gps.4917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Apathy, a lack of motivation, is frequently seen in older individuals, with and without depression, with substantial impact on quality of life. This prospective cohort study of patients with severe late-life depression treated with electroconvulsive therapy (ECT) aims to study the course of apathy and the predictive value of vascular burden and in particular white matter hyperintensities on apathy course. METHODS Information on apathy (defined by a score of >13 on the Apathy Scale), depression severity, vascular burden, and other putative confounders was collected in at 2 psychiatric hospitals on patients with late-life depression (aged 55 to 87 years, N = 73). MRI data on white matter hyperintensities were available in 52 patients. Possible risk factors for apathy post-ECT were determined using regression analyses. RESULTS After treatment with ECT, 52.0% (26/50) of the depression remitters still suffered from clinically relevant apathy symptoms. In the entire cohort, more patients remained apathetic (58.9%) than depressed (31.5%). Presence of apathy post-ECT was not associated with higher age, use of benzodiazepines, or severity of apathy and depression at baseline. Less response in depressive symptomatology after ECT predicted post-treatment apathy. The presence of vascular disease, diabetes mellitus and smoking, and white matter hyperintensities in the brain was not associated with post-treatment apathy. CONCLUSIONS Apathy may perpetuate in individual patients, despite remission of depressive symptoms. In this cohort of patients with late-life depression, post-ECT apathy is not associated with white matter hyperintensities.
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Affiliation(s)
- A Carlier
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - E van Exel
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A Dols
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - M Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Vandenbulcke
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - M L Stek
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Ly M, Andreescu C. Advances and Barriers for Clinical Neuroimaging in Late-Life Mood and Anxiety Disorders. Curr Psychiatry Rep 2018; 20:7. [PMID: 29492705 DOI: 10.1007/s11920-018-0870-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Mood and anxiety disorders are very commonly experienced by older adults and are becoming a growing concern due to the rapidly aging global population. Recent advances in neuroimaging may help in improving outcomes in late-life mood and anxiety disorders. The elucidation of mechanisms contributing to late-life mental health disorders may ultimately lead to the identification of novel therapeutic interventions. Alternatively, clinically validated imaging biomarkers may allow for the prediction of treatment response and identification of better therapeutic approaches in late-life mood and anxiety disorders. RECENT FINDINGS In community samples, late-life depression and late-life generalized anxiety disorder occur up to 38 and 15%, respectively, while late-life bipolar disorder is less common and occur in approximately 0.5% of the population. There are significant challenges in treating and improving outcome in late-life mood and anxiety disorders. Time to treatment response and treatment resistance are increased in older adults. Novel neuroimaging techniques have the potential to improve diagnostic and therapeutic outcome in late-life mood and anxiety disorders either through "personalized pharmacotherapy" or through identifying dysfunction regions/networks to be subsequently used for direct interventions such as transcranial magnetic stimulation. This review will provide an overview of recent literature that substantiates the potential role of neuroimaging in clinical practice, as well as the barriers that must be overcome prior to clinical translation.
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Affiliation(s)
- Maria Ly
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA.
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Funes CM, Lavretsky H, Ercoli L, St Cyr N, Siddarth P. Apathy Mediates Cognitive Difficulties in Geriatric Depression. Am J Geriatr Psychiatry 2018; 26:100-106. [PMID: 28755989 PMCID: PMC5725249 DOI: 10.1016/j.jagp.2017.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 06/09/2017] [Accepted: 06/14/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cognitive impairment associated with late-life depression can persist after remission of mood symptoms. Apathy, a common symptom of late-life depression, often leads to worse clinical outcomes. We examined if severity of apathy mediates cognitive difficulties in a cohort of older adults with major depression. METHODS One hundred thirty-eight older adults with depression (54.4% female; mean [SD] age: 69.7 [7.4] years; mean [SD] education:15.6 [2.7] years) were recruited to participate in a treatment study, and only baseline data were analyzed. All participants received a comprehensive evaluation of depression, apathy, and cognition. We examined whether apathy mediated the relationship between depression and cognition, focusing our attention on memory and cognitive control. We then explored whether the mediation effects differed across women and men. RESULTS Increased apathy was significantly associated with worse depression and lower performance in the cognitive control domain but not in memory. Higher depressive scores were significantly associated with worse cognitive control but not memory. Mediation analyses revealed a significant indirect effect on cognitive control by depression through increased apathy scores with the mediator accounting for 21% of the total effect. Stratifying by sex, we found that women exhibited a significant indirect effect, with the mediator accounting for 47% of the total effect, whereas there was no mediation by apathy in men. CONCLUSIONS The findings imply that increased apathy mediates the relationship between cognition and depression. The identification of mediating effects may inform future treatment strategies and preventive interventions that can focus on decreasing apathy to improve cognition in late-life depression.
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Affiliation(s)
- Cynthia M Funes
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Linda Ercoli
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Natalie St Cyr
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Prabha Siddarth
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Tully PJ, Debette S, Mazoyer B, Tzourio C. White Matter Lesions are Associated with Specific Depressive Symptom Trajectories among Incident Depression and Dementia Populations: Three-City Dijon MRI Study. Am J Geriatr Psychiatry 2017; 25:1311-1321. [PMID: 28688824 DOI: 10.1016/j.jagp.2017.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/27/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evidence is mixed as to whether periventricular or deep white matter hyperintensities (WMHs) increase the risk for depressive symptoms, partly because of heterogeneity in depression measurement, short follow-up, and confounding by prodromal dementia. The study objective was to evaluate WMH volume in relation to discrete depressive symptoms over 10 years, stratifying by incident depression and dementia. METHODS In this prospective longitudinal cohort study of a representative population sample from Dijon, France, 1,440 participants aged 65-80 years (median age: 72 years; 59.5% women) without depression, dementia, or stroke at baseline were studied. Baseline T2-weighted images were obtained in a 1.5-T scanner to quantify WMHs (log cm3). Clinic visits were performed up to five times in a 10-year period to assess incident neurologic diseases and comorbidities. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale and converted to factor z scores, representing somatic symptoms, depressed affect, low positive affect, and interpersonal problems. RESULTS Periventricular WMH volume was uniquely associated with low positive affect among incident depression cases (β = 0.15; 95% confidence interval [CI]: 0.02-0.29; p = 0.026). Deep WMH volume was uniquely associated with depressed affect among incident dementia cases (β = 0.36; 95% CI: 0.05-0.68; p = 0.025). WMH volume (periventricular, deep, and total) was associated with interpersonal problems among persons who developed dementia with depression. CONCLUSION The findings highlight that regional WMH volumes and specific depressive symptoms have clinical and prognostic relevance to help differentiate between persons at risk for depression and dementia.
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Affiliation(s)
- Phillip J Tully
- Bordeaux Population Health, University of Bordeaux, INSERM U1219, Bordeaux, France; Department of Neuroepidemiology, University of Bordeaux, INSERM U1219, Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia.
| | - Stephanie Debette
- Bordeaux Population Health, University of Bordeaux, INSERM U1219, Bordeaux, France; Department of Neuroepidemiology, University of Bordeaux, INSERM U1219, Bordeaux, France; Department of Neurology, Bordeaux University Hospital, Bordeaux, France; Department of Neurology, Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, Bordeaux, France
| | - Christophe Tzourio
- Bordeaux Population Health, University of Bordeaux, INSERM U1219, Bordeaux, France; Department of Neuroepidemiology, University of Bordeaux, INSERM U1219, Bordeaux, France
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Abstract
Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making.
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Affiliation(s)
- Patricia A Areàn
- Professor in Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kien Hoa Ly
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden ; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Avedisova AS, Zakharova KV, Gaskin VV, Samotaeva IS, Arkusha IA. [Clinical and neurovisualization characteristics of apathetic depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:11-17. [PMID: 28884712 DOI: 10.17116/jnevro20171178111-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIM To study apathetic depression first diagnosed at late age and identify its relation to cognitive and social dysfunction as well as to morphological and functional changes in the brain. MATERIAL AND METHODS Thirty-two patients at the age above 60 years with newly diagnosed depressive episode and 15 healthy age-matched volunteers were included in the study. All patients were divided into two groups by the score on the Apathy scale (AS): >14 - depression with apathy (n=21), <14 - depression without apathy (n=11). Patients were examined using psychometric methods (HAMD, GDS, AS, SHAPS, SF-36, MoCA-test), neuroimaging (MRI scanner with a magnetic field strength of 1.5 Tesla - EXCEL ART Vantage Atlas-X, Toshiba, Japan) and statistical data analysis. RESULTS AND CONCLUSION Apathy component in clinical depression reflects a tendency towards the increase in depression severity and cognitive deterioration that results in the substantial lowering of quality of life and correlates with cerebrovascular changes, decrease in gray and white matter volume and mean cortical thickness of large hemispheres.
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Affiliation(s)
- A S Avedisova
- Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia; Soloview Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - K V Zakharova
- Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia; Soloview Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - V V Gaskin
- Soloview Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - I S Samotaeva
- Soloview Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - I A Arkusha
- Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia
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Quality of Life, Integrative Community Therapy, Family Support, and Satisfaction with Health Services Among Elderly Adults with and without Symptoms of Depression. Psychiatr Q 2017; 88:359-369. [PMID: 27377928 DOI: 10.1007/s11126-016-9453-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this cross-sectional study was to analyse quality of life, socio-demographic characteristics, family support, satisfaction with health services, and effect of integrative community therapy among non-institutionalised elderly adults with and without symptoms of depression in the state of Rio Grande do Norte, Brazil. Data from elderly adults with (n = 59) and without (n = 61) depressive symptoms were compared. The instruments used were the Mini-Mental State Examination, the short version of the Geriatric Depression Scale, a clinical socio-demographic questionnaire, the abbreviated version of the World Health Organisation Quality of Life questionnaire, the Family Assessment Device, and the Patient Satisfaction with Mental Health Services Rating Scale. Elderly adults with depressive symptoms had lower quality of life in the social relations domain than did those without depressive symptoms (p = 0.003). In addition, compared with those without depression, fewer elderly adults with depressive symptoms attended integrative community therapy (p = 0.04); they also reported a low degree of family involvement in problem solving (p = 0.04) and showed apathy regarding their satisfaction with health services (p = 0.007). These results have important implications in the decision-making process with regard to strategies for improving the health status of elderly adults with depressive symptoms.
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Eyre HA, Siddarth P, van Dyk K, St Cyr N, Baune BT, Barrio JR, Small GW, Lavretsky H. Neural correlates of apathy in late-life depression: a pilot [ 18 F]FDDNP positron emission tomography study. Psychogeriatrics 2017; 17:186-193. [PMID: 28130887 PMCID: PMC5540328 DOI: 10.1111/psyg.12213] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/19/2016] [Accepted: 06/15/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neurotoxicity associated with amyloid and tau protein aggregation could represent a pathophysiological cascade that, along with vascular compromise, may predispose individuals to late-life depression (LLD). In LLD, apathy is common, leads to worsening of functioning, and responds poorly to antidepressant treatment. Better understanding of the pathophysiological mechanisms of apathy in LLD would facilitate development of more effective diagnostic and treatment approaches. In this cross-sectional pilot study, we performed positron emission tomography scans after injection of 2-(1-{6-[(2-[18 F]fluoroethyl)(methyl)-amino]-2-naphthyl}ethylidene) malononitrile ([18 F]FDDNP), an in vivo amyloid and tau neuroimaging study, in patients with LLD to explore neural correlates of apathy. METHODS Sixteen depressed elderly volunteers received clinical assessments and [18 F]FDDNP positron emission tomography scans. The cross-sectional relationship of [18 F]FDDNP binding levels with depression (Hamilton Depression Rating Scale) and apathy (Apathy Evaluation Scale) were studied using Spearman's correlation analyses because of the relatively small sample size. Age, sex, and years of education were partialed out. Significance levels were set at P ≤ 0.05. RESULTS [18 F]FDDNP binding in the anterior cingulate cortex was negatively associated with the Apathy Evaluation Scale total (r = -0.62, P = 0.02; where low Apathy Evaluation Scale score equals greater severity of apathy). This suggests that apathy in LLD is associated with higher amyloid and/or tau levels in the anterior cingulate cortex. None of the regional [18 F]FDDNP binding levels was significantly associated with the Hamilton Depression Rating Scale total. CONCLUSION This pilot study suggests that increased apathy in subjects with LLD may be associated with greater amyloid and/or tau burden in certain brain regions. Future studies in larger samples would elucidate the generalizability of these results, which eventually could lead to improved diagnostic and treatment methods in LLD.
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Affiliation(s)
- Harris A Eyre
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia.,Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Kathleen van Dyk
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Natalie St Cyr
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
| | - Jorge R Barrio
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary W Small
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
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Meyniel F, Goodwin GM, Deakin JW, Klinge C, MacFadyen C, Milligan H, Mullings E, Pessiglione M, Gaillard R. A specific role for serotonin in overcoming effort cost. eLife 2016; 5. [PMID: 27824554 PMCID: PMC5100997 DOI: 10.7554/elife.17282] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
Serotonin is implicated in many aspects of behavioral regulation. Theoretical attempts to unify the multiple roles assigned to serotonin proposed that it regulates the impact of costs, such as delay or punishment, on action selection. Here, we show that serotonin also regulates other types of action costs such as effort. We compared behavioral performance in 58 healthy humans treated during 8 weeks with either placebo or the selective serotonin reuptake inhibitor escitalopram. The task involved trading handgrip force production against monetary benefits. Participants in the escitalopram group produced more effort and thereby achieved a higher payoff. Crucially, our computational analysis showed that this effect was underpinned by a specific reduction of effort cost, and not by any change in the weight of monetary incentives. This specific computational effect sheds new light on the physiological role of serotonin in behavioral regulation and on the clinical effect of drugs for depression. CLINICAL TRIAL REGISTRATION ISRCTN75872983.
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Affiliation(s)
- Florent Meyniel
- Motivation, Brain and Behavior team, Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,INSERM UMRS 1127, CNRS UMR 7225, Université Pierre et Marie Curie (UPMC-P6), Paris, France.,Cognitive Neuroimaging Unit, NeuroSpin Center, INSERM U992, Institut d'Imagerie Biomédicale, Direction de la recherche fondamentale, Commissariat à l'énergie atomique et aux énergies alternatives, Gif-sur-Yvette, France
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Jf William Deakin
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Corinna Klinge
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Christine MacFadyen
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Holly Milligan
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Emma Mullings
- Neuroscience and Psychiatry Unit, The University of Manchester, Manchester, United Kingdom
| | - Mathias Pessiglione
- Motivation, Brain and Behavior team, Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,INSERM UMRS 1127, CNRS UMR 7225, Université Pierre et Marie Curie (UPMC-P6), Paris, France
| | - Raphaël Gaillard
- Centre Hospitalier Sainte-Anne, Service de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Laboratoire de Physiopathologie des maladies Psychiatriques, Centre de Psychiatrie et Neurosciences, INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Human Histopathology and Animal Models, Department of Infection and Epidemiology, Institut Pasteur, Paris, France
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Harada K, Matsuo K, Nakashima M, Hobara T, Higuchi N, Higuchi F, Nakano M, Otsuki K, Shibata T, Watanuki T, Matsubara T, Fujita Y, Shimoji K, Yamagata H, Watanabe Y. Disrupted orbitomedial prefrontal limbic network in individuals with later-life depression. J Affect Disord 2016; 204:112-9. [PMID: 27344619 DOI: 10.1016/j.jad.2016.06.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/09/2016] [Accepted: 06/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression in old age is an increasing contributor to poor health and accompanying health care costs. Although there is an abundance of literature on later-life depression (LLD), the neural correlates have not been clarified. The aim of this study was to determine whether patients with LLD show abnormal gray matter volume (GMV) and white matter integrity by using multiple image analysis methods. METHODS The study included 45 patients with LLD and 61 healthy participants who were matched for age, sex, years of education, and vascular risk factors. GMV was examined using voxel-based morphometry, while the white matter integrity was determined by tract-based spatial statistics and tract-specific analysis, which were obtained from high-resolution magnetic resonance images. RESULTS Patients with LLD showed significantly less GMV in the orbitofrontal cortex, anterior cingulate, insula, amygdala, and temporal regions, as well as higher fractional anisotropy in the uncinate fasciculus, compared with healthy participants. Patients with LLD who had reduced orbitofrontal and insular GMV had more severe clinical variables. The reduced orbitofrontal GMV was associated with higher fractional anisotropy in the uncinate fasciculus. LIMITATION The effects of medication should also be considered when interpreting the results of this study. CONCLUSION Our results suggest that regional GMV is linked to white matter integrity of the uncinate fasciculus in the orbitomedial prefrontal limbic network, and the disruption of this network may be involved in the pathophysiology of LLD.
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Affiliation(s)
- Kenichiro Harada
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Koji Matsuo
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Mami Nakashima
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Nagato-ichinomiya Hospital, Shimonoseki, Yamaguchi, Japan
| | - Teruyuki Hobara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Department of Psychiatry, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, Japan
| | - Naoko Higuchi
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Fumihiro Higuchi
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Masayuki Nakano
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Katakura Hospital, Ube, Yamaguchi, Japan
| | - Koji Otsuki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Konan Hospital, Matsue, Shimane, Japan
| | - Tomohiko Shibata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Shinwaen Hospital, Onoda, Yamaguchi, Japan
| | - Toshio Watanuki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; Health Administration Center, Yamaguchi University Organization for University Education, Yamaguchi, Yamaguchi, Japan
| | - Yusuke Fujita
- Department of Biomolecular Engineering Applied Molecular Bioscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Keigo Shimoji
- Department of Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hirotaka Yamagata
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshifumi Watanabe
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Di Domenico A, Palumbo R, Fairfield B, Mammarella N. Fighting apathy in Alzheimer's dementia: A brief emotional-based intervention. Psychiatry Res 2016; 242:331-335. [PMID: 27336799 DOI: 10.1016/j.psychres.2016.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/31/2016] [Accepted: 06/10/2016] [Indexed: 12/14/2022]
Abstract
Lack of motivation, or apathy, is a clinically significant feature among dementia patients. The current study aimed to assess the effectiveness of a brief emotional shaping intervention developed to reduce apathy and increase willingness-to-do in Alzheimer's Dementia patients. To this end, 26 Alzheimer patients diagnosed with apathy according to the Apathy Evaluation Scale (AES, Marin et al.,1991) and 26 healthy older controls performed an emotional shaping task intended to unconsciously foster willingness-to-do. Participants were randomly assigned to either a positive or a neutral conditioning situation. Results showed how the positively conditioned group was associated with improved willingness-to-do in both patients and controls compared to the neutrally conditioned group. Our findings suggest that unconscious emotional processing can be used to treat apathy symptoms and increase willingness-to-do in Alzheimer's Dementia.
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Affiliation(s)
| | - Rocco Palumbo
- Department of Psychological Science, University of Chieti, Italy; Schepens Eye Research Institute, Harvard Medical School, 20 Staniford St, Boston, 02114 MA, USA.
| | - Beth Fairfield
- Department of Psychological Science, University of Chieti, Italy
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Groeneweg-Koolhoven I, Comijs HC, Naarding P, de Waal MWM, van der Mast RC. Apathy in Older Persons With Depression: Course and Predictors: The NESDO Study. J Geriatr Psychiatry Neurol 2016; 29:178-86. [PMID: 26917555 DOI: 10.1177/0891988716632914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Apathy is a common behavioral syndrome, influencing different areas of daily functioning and often seen in depression. Little is known about the course of apathy in depression. In this study, we examine the course and predicting factors of apathy in older persons with depression. METHOD Data of 266 older persons with depression participating in the Netherlands Study of Depression in Older Persons, all aged at least 60 years with complete Apathy Scale scores at baseline and 2-year follow-up, were included in this study. Associations between several baseline variables and severity, incidence, and persistence of apathy were examined using regression analyses. RESULTS At 2-year follow-up, the severity of apathy was predicted by the severity of apathy at baseline, and incidence rate of apathy was 36%, with a lower baseline Mini-Mental State Examination score being an independent predictor. Older persons with incident apathy did not differ in remission rate of depression compared to those without apathy at follow-up. Persistence rate of apathy was 80% and was independently predicted by a higher baseline Apathy Scale score and, surprisingly, by less use of benzodiazepines. Persons with persistent apathy were less likely to recover from depression than those who remitted from apathy. CONCLUSION Severity of apathy at baseline, but not depression, predicted apathy at follow-up. Incident apathy was predicted by poorer cognitive function, whereas severe apathy at baseline predicted its persistence. Remarkably, new apathy was not associated with worse outcome of depression whereas persistent apathy was.
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Affiliation(s)
- Isis Groeneweg-Koolhoven
- Old-Age Psychiatry, Hospital Parnassia Group, Rotterdam, the Netherlands Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Hannie C Comijs
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands VU University Medical Center and GGZ inGeest, Amsterdam, the Netherlands
| | - Paul Naarding
- Department of Old-Age Psychiatry, GGNet Mental Health, Apeldoorn, the Netherlands Department of Psychiatry, University Medical Center St Radboud, Nijmegen, the Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands Department of Psychiatry, CAPRI, University of Antwerp, Antwerp, Belgium
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Buoli M, Caldiroli A, Altamura AC. Psychiatric Conditions in Parkinson Disease: A Comparison With Classical Psychiatric Disorders. J Geriatr Psychiatry Neurol 2016; 29:72-91. [PMID: 26377851 DOI: 10.1177/0891988715606233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Psychiatric conditions often complicate the outcome of patients affected by Parkinson disease (PD), but they differ from classical psychiatric disorders in terms of underlying biological mechanisms, clinical presentation, and treatment response. The purpose of the present review is to illustrate the biological and clinical aspects of psychiatric conditions associated with PD, with particular reference to the differences with respect to classical psychiatric disorders. A careful search of articles on main databases was performed in order to obtain a comprehensive review about the main psychiatric conditions associated with PD. A manual selection of the articles was then performed in order to consider only those articles that concerned with the topic of the review. Psychiatric conditions in patients with PD present substantial differences with respect to classical psychiatric disorders. Their clinical presentation does not align with the symptom profiles represented by Diagnostic and Statistical Manual for Mental Disorders and International Classification of Diseases. Furthermore, psychiatry treatment guidelines are of poor help in managing psychiatric symptoms of patients with PD. Specific diagnostic tools and treatment guidelines are needed to allow early diagnosis and adequate treatment of psychiatric conditions in comorbidity with PD.
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Affiliation(s)
- Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfredo Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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Depressionen im höheren Lebensalter, Teil 1. Z Gerontol Geriatr 2016; 49:335-48. [DOI: 10.1007/s00391-015-1019-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/11/2015] [Accepted: 12/22/2015] [Indexed: 12/29/2022]
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Hollocks MJ, Lawrence AJ, Brookes RL, Barrick TR, Morris RG, Husain M, Markus HS. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain 2015; 138:3803-15. [PMID: 26490330 PMCID: PMC4655344 DOI: 10.1093/brain/awv304] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/26/2015] [Indexed: 01/30/2023] Open
Abstract
Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and apathy, depression and cognitive impairment; and (ii) if apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with apathy but not directly with depressive symptoms. These results suggest that apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
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Affiliation(s)
- Matthew J Hollocks
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew J Lawrence
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Rebecca L Brookes
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- 2 St. Georges, University of London, Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, London, UK
| | - Robin G Morris
- 3 King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Masud Husain
- 4 University of Oxford, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Hugh S Markus
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
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Neuropathological sequelae of Human Immunodeficiency Virus and apathy: A review of neuropsychological and neuroimaging studies. Neurosci Biobehav Rev 2015; 55:147-64. [PMID: 25944459 DOI: 10.1016/j.neubiorev.2015.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023]
Abstract
Apathy remains a common neuropsychiatric disturbance in the Human Immunodeficiency Virus (HIV-1) despite advances in anti-retroviral treatment (ART). The goal of the current review is to recapitulate findings relating apathy to the deleterious biobehavioral effects of HIV-1 in the post-ART era. Available literatures demonstrate that the emergence of apathy with other neurocognitive and neuropsychiatric symptoms may be attributed to neurotoxic effects of viral proliferation, e.g., aggregative effect of Tat and gp120 on apoptosis, transport and other enzymatic reactions amongst dopaminergic neurons and neuroglia. An assortment of neuroimaging modalities converge on the severity of apathy symptoms associated with the propensity of the virus to replicate within frontal-striatal brain circuits that facilitate emotional processing. Burgeoning research into functional brain connectivity also supports the effects of microvascular and neuro-inflammatory injury linked to aging with HIV-1 on the presentation of neuropsychiatric symptoms. Summarizing these findings, we review domains of HIV-associated neurocognitive and neuropsychiatric impairment linked to apathy in HIV. Taken together, these lines of research suggest that loss of affective, cognitive and behavioral inertia is commensurate with the neuropathology of HIV-1.
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Apathy in late-life depression: common, persistent, and disabling. Am J Geriatr Psychiatry 2015; 23:488-94. [PMID: 25047306 PMCID: PMC4277500 DOI: 10.1016/j.jagp.2014.06.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aims of this study were to examine: (1) the relationship between apathy and disability in late-life depression, and (2) the functional significance of improvement in apathy following escitalopram treatment in terms of its relationship to disability. METHODS Subjects were 71 non-demented elderly with non-psychotic major depression. After a 2-week single-blind placebo period, subjects who had Hamilton Depression Rating Scale (HDRS) ≥ 18 received escitalopram 10 mg daily for 12 weeks. Apathy and disability were assessed with the Apathy Evaluation Scale (AES) and the World Health Organization Disability Assessment Scale II (WHODAS), respectively. These measures and the HDRS were administered at baseline and again following 12 weeks of treatment. RESULTS At baseline, 38% of depressed subjects had significant apathy (AES ≥ 36.5). Severity of apathy at baseline significantly correlated with severity of disability. In a multivariate regression model, baseline severity of apathy, but not the overall depressive syndrome (HDRS), significantly correlated with baseline disability. Following escitalopram treatment, improvement in apathy significantly correlated with improvement in disability measures, while change in the rest of the depressive syndrome did not. The overall change in apathy and disability in response to escitalopram treatment was significant but small. CONCLUSION Apathy is common in late-life depression and is associated with disability above and beyond the influence of other depressive symptoms. Given the strong relationship between apathy and disability, understanding the neurobiology of apathy and developing treatments for apathy may improve the functional outcomes of late-life depression.
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Guekht AB, Avedisova AS, Zaharova KV, Luzin RV, Gaskin VV, Rozovskaya RI. [Neuroanatomical age-related changes in apathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:117-123. [PMID: 27030831 DOI: 10.17116/jnevro2015115111117-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The introduction of new instrumental methods, in particular neuroimaging techniques, in academic studies and clinical practice allowed to identify neuroanatomical and functional correlates of different clinical syndromes. Authors summarized the results of magnetic-resonance tomography (MRI) and one-photon emission computed tomography (OPECT) studies of apathy of old-age developed in the structure of different neurological and mental diseases. The literature over that last two decades was reviewed
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Affiliation(s)
- A B Guekht
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - A S Avedisova
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - K V Zaharova
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - R V Luzin
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - V V Gaskin
- Research-Practical Psychoneurological Center, Moscow, Russia
| | - R I Rozovskaya
- Research-Practical Psychoneurological Center, Moscow, Russia
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McGovern AR, Alexopoulos GS, Yuen GS, Morimoto SS, Gunning FM. Reward-related decision making in older adults: relationship to clinical presentation of depression. Int J Geriatr Psychiatry 2014; 29:1125-31. [PMID: 25306937 PMCID: PMC4353615 DOI: 10.1002/gps.4200] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/24/2014] [Accepted: 07/31/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Impairment in reward processes has been found in individuals with depression and in the aging population. The purpose of this study was twofold: (1) to use an affective neuroscience probe to identify abnormalities in reward-related decision making in late-life depression; and (2) to examine the relationship of reward-related decision making abnormalities in depressed, older adults to the clinical expression of apathy in depression. We hypothesized that relative to older, healthy subjects, depressed, older patients would exhibit impaired decision making and that apathetic, depressed patients would show greater impairment in decision making than non-apathetic, depressed patients. METHODS We used the Iowa Gambling Task to examine reward-related decision making in 60 non-demented, older patients with non-psychotic major depression and 36 older, psychiatrically healthy participants. Apathy was quantified using the Apathy Evaluation Scale. Of those with major depression, 18 individuals reported clinically significant apathy, whereas 42 participants did not have apathy. RESULTS Older adults with depression and healthy comparison participants did not differ in their performance on the Iowa Gambling Task. However, apathetic, depressed older adults adopted an advantageous strategy and selected cards from the conservative decks compared with non-apathetic, depressed older adults. Non-apathetic, depressed patients showed a failure to adopt a conservative strategy and persisted in making risky decisions throughout the task. CONCLUSIONS This study indicates that apathy in older, depressed adults is associated with a conservative response style on a behavioral probe of the systems involved in reward-related decision making. This conservative response style may be the result of reduced sensitivity to rewards in apathetic individuals.
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Affiliation(s)
- Amanda R. McGovern
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - George S. Alexopoulos
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Genevieve S. Yuen
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Sarah Shizuko Morimoto
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
| | - Faith M. Gunning
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY
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