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Huang YY, Gan YH, Yang L, Cheng W, Yu JT. Depression in Alzheimer's Disease: Epidemiology, Mechanisms, and Treatment. Biol Psychiatry 2024; 95:992-1005. [PMID: 37866486 DOI: 10.1016/j.biopsych.2023.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 10/07/2023] [Indexed: 10/24/2023]
Abstract
Depression and Alzheimer's disease (AD) are substantial public health concerns. In the past decades, a link between the 2 disease entities has received extensive acknowledgment, yet the complex nature of this relationship demands further clarification. Some evidence indicates that midlife depression may be an AD risk factor, while a chronic course of depression in late life may be a precursor to or symptom of dementia. Recently, multiple pathophysiological mechanisms have been proposed to underlie the bidirectional relationship between depression and AD, including genetic predisposition, immune dysregulation, accumulation of AD-related biomarkers (e.g., amyloid-β and tau), and alterations in brain structure. Accordingly, numerous therapeutic approaches, such as pharmacology treatments, psychotherapy, and lifestyle interventions, have been suggested as potential means of interfering with these pathways. However, the current literature on this topic remains fragmented and lacks a comprehensive review characterizing the association between depression and AD. In this review, we aim to address these gaps by providing an overview of the co-occurrence and temporal relationship between depression and AD, as well as exploring their underlying mechanisms. We also examine the current therapeutic regimens for depression and their implications for AD management and outline key challenges facing the field.
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Affiliation(s)
- Yu-Yuan Huang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Han Gan
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Liu Yang
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Cheng
- Institute of Science and Technology for Brain-Inspired Intelligence, Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jin-Tai Yu
- Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China.
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Ramos‐Cejudo J, Corrigan JK, Zheng C, Swinnerton KN, Jacobson SR, La J, Betensky RA, Osorio RS, Madanes S, Pomara N, Iosifescu D, Brophy M, Do NV, Fillmore NR. Antidepressant exposure and long-term dementia risk in a nationwide retrospective study on US veterans with midlife major depressive disorder. Alzheimers Dement 2024; 20:4106-4114. [PMID: 38717046 PMCID: PMC11180845 DOI: 10.1002/alz.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The use of antidepressants in major depressive disorder (MDD) has been reported to influence long-term risk of Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), but studies are conflicting. METHODS We used inverse probability weighted (IPW) Cox models with time-varying covariates in a retrospective cohort study among midlife veterans with MDD within the US Veterans Affairs healthcare system from January 1, 2000 to June 1, 2022. RESULTS A total of 35,200 patients with MDD were identified. No associations were seen regarding the effect of being exposed to any antidepressant versus no exposure on AD/ADRD risk (events = 1,056, hazard ratio = 0.94, 95% confidence interval: 0.81 to 1.09) or the exposure to specific antidepressant classes versus no exposure. A risk reduction was observed for female patients in a stratified analysis; however, the number of cases was small. DISCUSSION Our study suggests that antidepressant exposure has no effect on AD/ADRD risk. The association in female patients should be interpreted with caution and requires further attention. HIGHLIGHTS We studied whether antidepressant use was associated with future dementia risk. We specifically focused on patients after their first-ever diagnosis of depression. We used IPW Cox models with time-varying covariates and a large observation window. Our study did not identify an effect of antidepressant use on dementia risk. A risk reduction was observed in female patients, but the number of cases was small.
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Affiliation(s)
- Jaime Ramos‐Cejudo
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
| | - June K. Corrigan
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Chunlei Zheng
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Kaitlin N. Swinnerton
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Sean R. Jacobson
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
| | - Jennifer La
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
| | - Rebecca A. Betensky
- Department of BiostatisticsNYU School of Global Public HealthNew YorkNew YorkUSA
| | - Ricardo S. Osorio
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
- Nathan Kline InstituteOrangeburgNew YorkUSA
| | - Sharon Madanes
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
| | - Nunzio Pomara
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
- Nathan Kline InstituteOrangeburgNew YorkUSA
| | - Dan Iosifescu
- Department of PsychiatryNew York University (NYU) Grossman School of MedicineNew YorkNew YorkUSA
- Nathan Kline InstituteOrangeburgNew YorkUSA
| | - Mary Brophy
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Nhan V. Do
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of MedicineBoston University School of MedicineBostonMassachusettsUSA
| | - Nathanael R. Fillmore
- VA Boston Cooperative Studies Program, MAVERICVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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vom Hofe I, Stricker BH, Vernooij MW, Ikram MK, Ikram MA, Wolters FJ. Antidepressant use in relation to dementia risk, cognitive decline, and brain atrophy. Alzheimers Dement 2024; 20:3378-3387. [PMID: 38561253 PMCID: PMC11095425 DOI: 10.1002/alz.13807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION We aimed to assess the effect of antidepressant use on dementia risk, cognitive decline, and brain atrophy. METHODS In this prospective cohort study, we included 5511 dementia-free participants (Mini-Mental State Examination [MMSE] > 25) of the Rotterdam study (57.5% women, mean age 70.6 years). Antidepressant use was extracted from pharmacy records from 1991 until baseline (2002-2008). Incident dementia was monitored from baseline until 2018, with repeated cognitive assessment and magnetic resonance imaging (MRI) every 4 years. RESULTS Compared to never use, any antidepressant use was not associated with dementia risk (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.92-1.41), or with accelerated cognitive decline or atrophy of white and gray matter. Compared to never use, dementia risk was somewhat higher with tricyclic antidepressants (HR 1.36, 95% CI 1.01-1.83) than with selective serotonin reuptake inhibitors (HR 1.12, 95% CI 0.81-1.54), but without dose-response relationships, accelerated cognitive decline, or atrophy in either group. DISCUSSION Antidepressant medication in adults without indication of cognitive impairment was not consistently associated with long-term adverse cognitive effects. HIGHLIGHTS Antidepressant medications are frequently prescribed, especially among older adults. In this study, antidepressant use was not associated with long-term dementia risk. Antidepressant use was not associated with cognitive decline or brain atrophy. Our results support safe prescription in an older, cognitively healthy population.
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Affiliation(s)
- Ilse vom Hofe
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Bruno H. Stricker
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Meike W. Vernooij
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - M. Kamran Ikram
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of NeurologyErasmus University Medical CenterRotterdamThe Netherlands
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Frank J. Wolters
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MCErasmus University Medical CenterRotterdamThe Netherlands
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Santandreu J, Caballero FF, Gómez-Serranillos MP, González-Burgos E. Risk of dementia among antidepressant elderly users: A population-based cohort analysis in Spain. J Affect Disord 2024; 349:54-61. [PMID: 38195007 DOI: 10.1016/j.jad.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/21/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
The use of antidepressants with anticholinergic effects has been associated with an increased risk of dementia. However, the results published are contradictory. The aim of the study is to compare the risk of developing dementia in elderly who were prescribed tricyclic antidepressants (TCA) versus those who were prescribed selective serotonin reuptake inhibitors (SSRIs) and other antidepressants (OA). A prospective population-based cohort study was performed using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) data (from 2005 to 2018). The cohort study included 62,928 patients age ≥ 60 without dementia and with antidepressant long-term monotherapy. Patients were divided into exposure antidepressant groups based on ATC system [TCA, SSRIs users and OAs users]. The risk of dementia was calculated by Cox regression models, providing hazard ratios (HR) and 95 % confidence intervals. The Kaplan-Meier model was used for survival analysis. Chi2 test was used as association test. The results showed SSRI users had higher dementia risk than TCA users (HR = 1.864; 95%CI = 1.624-2.140). Moreover, OA users had also significant risk of dementia (HR = 2.103; 95%CI = 1.818-2.431). Several limitations are the variation of the trend in the prescription of antidepressants, the small number of patients that use some antidepressants, the lack of information related to the dose, or socioeconomic characteristics, the use of antidepressant drugs for other indications, or the therapeutic compliance. Our findings showed that older users of SSRI and OA have more risk of developing dementia than TCA elderly users. However, additional studies would be needed.
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Affiliation(s)
- Javier Santandreu
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Félix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - M Pilar Gómez-Serranillos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain.
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Wang GHM, Chen WH, Chang SH, Zhang T, Shao H, Guo J, Lo-Ciganic WH. Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study. BMC Geriatr 2023; 23:825. [PMID: 38066473 PMCID: PMC10709864 DOI: 10.1186/s12877-023-04475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Prior studies suggested that antidepressant use is associated with an increased risk of dementia compared to no use, which is subject to confounding by indication. We aimed to compare the dementia risk among older adults with depression receiving first-line antidepressants (i.e., SSRI/SNRI) versus psychotherapy, which is also considered the first-line therapy for depression. METHODS This retrospective cohort study was conducted using the US Medical Expenditure Panel Survey from 2010 to 2019. We included adults aged ≥ 50 years diagnosed with depression who initiated SSRI/SNRI or psychotherapy. We excluded patients with a dementia diagnosis before the first record of SSRI/SNRI use or psychotherapy. The exposure was the patient's receipt of SSRI/SNRI (identified from self-report questionnaires) or psychotherapy (identified from the Outpatient Visits or Office-Based Medical Provider Visits files). The outcome was a new diagnosis of dementia within 2 years (i.e., survey panel period) identified using ICD-9/ICD-10 codes from the Medical Conditions file. Using a multivariable logistic regression model, we reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We also conducted subgroup analyses by patient sex, age group, race/ethnicity, severity of depression, combined use of other non-SSRI/SNRI antidepressants, and presence of underlying cognitive impairment. RESULTS Among 2,710 eligible patients (mean age = 61 ± 8, female = 69%, White = 84%), 89% used SSRIs/SNRIs, and 11% received psychotherapy. The SSRI/SNRI users had a higher crude incidence of dementia than the psychotherapy group (16.4% vs. 11.8%), with an aOR of 1.36 (95% CI = 1.06-1.74). Subgroup analyses yielded similar findings as the main analyses, except no significant association for patients who were aged < 65 years (1.23, 95% CI = 0.93-1.62), male (1.34, 95% CI = 0.95-1.90), Black (0.76, 95% CI = 0.48-1.19), had a higher PHQ-2 (1.39, 95% CI = 0.90-2.15), and had underlying cognitive impairment (1.06, 95% CI = 0.80-1.42). CONCLUSIONS Our findings suggested that older adults with depression receiving SSRIs/SNRIs were associated with an increased dementia risk compared to those receiving psychotherapy.
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Affiliation(s)
- Grace Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP 3338, Gainesville, FL, 32610, USA
| | - Wei-Han Chen
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP 3338, Gainesville, FL, 32610, USA
| | - Shao-Hsuan Chang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP 3338, Gainesville, FL, 32610, USA
| | - Tianxiao Zhang
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP 3338, Gainesville, FL, 32610, USA
| | - Hui Shao
- Hubert Department of Global Health, Rollin School of Public Health, Emory University, Atlanta, GA, USA
| | - Jingchuan Guo
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, 1225 Center Drive, HPNP 3338, Gainesville, FL, 32610, USA
| | - Wei-Hsuan Lo-Ciganic
- Center for Pharmaceutical Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, USA.
- North Florida/South Georgia Veterans Health System, Geriatric Research Education and Clinical Center, Gainesville, FL, USA.
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Chandramouleeshwaran S, Khan WU, Inglis F, Rajji TK. Impact of psychotropic medications on cognition among older adults: a systematic review. Int Psychogeriatr 2023:1-18. [PMID: 37860872 DOI: 10.1017/s1041610223000844] [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] [Indexed: 10/21/2023]
Abstract
OBJECTIVES The aim of this systematic review is to examine the cognitive impact of psychotropic medications including benzodiazepines, antidepressants, mood stabilizers, antipsychotics, or a combination of these drugs on older adults. DESIGN Systematic review. SETTING We searched Medline, PsycINFO, and Embase through the Ovid platform, CINAHL through EBSCO, and Web of Science. PARTICIPANTS AND INTERVENTIONS Randomized control trials (RCTs) and cohort studies that used a validated scale to measure cognition with a follow-up period of at least six months were included. MEASUREMENT The primary outcome of interest was cognitive change associated with psychotropic medication use. RESULTS A total of 7551 articles were identified from the primary electronic literature search across the five databases after eliminating duplicates. Based on full-text analysis, 27 articles (two RCTs, 25 cohorts) met the inclusion criteria. Of these, nine each examined the impact of benzodiazepines and antidepressants, five examined psychotropic combinations, three on antipsychotic drugs, and one on the effects of mood stabilizers. CONCLUSIONS This is the first systematic review to examine the cognitive impact of multiple psychotropic drug classes in older adults over an extended follow-up period (six months or more) using robust sample sizes, drug-free control groups, and validated cognitive instruments. We found evidence to indicate cognitive decline with the cumulative use of benzodiazepines and the use of antidepressants, especially those with anticholinergic properties among older adults without cognitive impairment at baseline. Further, the use of antipsychotics and psychotropic combinations is also associated with cognitive decline in older adults.
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Affiliation(s)
- Susmita Chandramouleeshwaran
- Center for Addiction and Mental Health, Toronto, ON, Canada
- The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Waqas U Khan
- Center for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University Hospital Limerick, Limerick, Ireland
| | - Fiona Inglis
- Wilfrid Laurier University, Waterloo, ON, Canada
| | - Tarek K Rajji
- Center for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Levine SZ, Rotstein A, Kodesh A, Sandin S, Lee BK, Weinstein G, Schnaider Beeri M, Reichenberg A. Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia. JAMA Netw Open 2023; 6:e2338088. [PMID: 37847497 PMCID: PMC10582792 DOI: 10.1001/jamanetworkopen.2023.38088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/02/2023] [Indexed: 10/18/2023] Open
Abstract
Importance Evidence that adult attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk of dementia is scarce and inconsistent, and potential sources of bias are untested. Objective To examine the association between adult ADHD and the risk of dementia. Design, Setting, and Participants This prospective national cohort study consisted of 109 218 members of a nonprofit Israeli health maintenance organization born between 1933 and 1952 who entered the cohort on January 1, 2003, without an ADHD or dementia diagnosis and were followed up to February 28, 2020. Participants were aged 51 to 70 years in 2003. Statistical analysis was conducted from December 2022 to August 2023. Exposure Adult ADHD was a time-varying covariate, classified as present from the age of the first diagnosis (using the International Classification of Diseases, Ninth Revision, and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision); otherwise, absent. Main Outcome and Measures Cox regression models were fitted to quantify the association between adult ADHD and the risk of incident dementia with hazard ratios (HRs) and their 95% CIs unadjusted and in the primary analysis, using inverse probability weights, adjusted for 18 sources of potential confounding. In 14 complementary analyses, subgroup and sensitivity analyses were implemented. Results At the beginning of the follow-up, the sample of 109 218 participants had a mean (SD) age of 57.7 (5.5) years, 56 474 participants (51.7%) were female, and 52 744 (48.3%) were male. During follow-up, 730 participants (0.7%) received a diagnosis of adult ADHD, and 7726 (7.1%) received a diagnosis of dementia. Dementia occurred among 96 of 730 participants (13.2%) with adult ADHD and 7630 of 108 488 participants (7.0%) without adult ADHD. In the primary analysis, compared with the absence of adult ADHD, the presence of adult ADHD was statistically significantly (P < .001) associated with an increased dementia risk (unadjusted HR, 3.62 [95% CI, 2.92-4.49; P < .001]; adjusted HR, 2.77 [95% CI, 2.11-3.63; P < .001]). Twelve of the 14 complementary analyses did not attenuate the conclusions based on the results of the primary analysis. There was, however, no clear increase in the risk of dementia associated with adult ADHD among those who received psychostimulant medication, and evidence of reverse causation was mild. Conclusions and Relevance In this cohort study of individuals born between 1933 and 1952 and followed up in old age, adult ADHD was associated with an increased risk of dementia. Policy makers, caregivers, patients, and clinicians may wish to monitor reliably for ADHD in old age.
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Affiliation(s)
| | - Anat Rotstein
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Arad Kodesh
- Mental Health, Meuhedet Health Services, Tel Aviv, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian K. Lee
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Michal Schnaider Beeri
- The Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center, Brain Health Institute, Rutgers University, Piscataway, New Jersey
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Wang HMG, Chen WH, Chang SH, Zhang T, Shao H, Guo J, Lo-Ciganic WH. Association between first-line antidepressant use and risk of dementia in older adults: a retrospective cohort study. RESEARCH SQUARE 2023:rs.3.rs-3266805. [PMID: 37790299 PMCID: PMC10543301 DOI: 10.21203/rs.3.rs-3266805/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Prior studies suggested that antidepressant use is associated with an increased risk of dementia compared to no use, which is subject to confounding by indication. We aimed to compare the dementia risk among older adults with depression receiving first-line antidepressants (i.e., SSRI/SNRI) versus psychotherapy, which is also considered the first-line therapy for depression. Methods This retrospective cohort study was conducted using the US Medical Expenditure Panel Survey from 2010 to 2019. We included adults aged ≥50 years diagnosed with depression who initiated SSRI/SNRI or psychotherapy. We excluded patients with a dementia diagnosis before the first record of SSRI/SNRI use or psychotherapy. The exposure was the patient's receipt of SSRI/SNRI (identified from self-report questionnaires) or psychotherapy (identified from the Outpatient Visits or Office-Based Medical Provider Visits files). The outcome was a new diagnosis of dementia within 2 years (i.e., survey panel period) identified using ICD-9/ICD-10 codes from the Medical Conditions file. Using a multivariable logistic regression model, we reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). We also conducted subgroup analyses by patient sex, age group, race, severity of depression, combined use of other non-SSRI/SNRI antidepressants, and presence of underlying cognitive impairment. Results Among 2,710 eligible patients (mean age= 61±8, female=69%, white=84%), 89% used SSRIs/SNRIs, and 11% received psychotherapy. The SSRI/SNRI users had a higher crude incidence of dementia than the psychotherapy group (16.1% vs. 12.7%), with an aOR of 1.39 (95% CI=1.21-1.59). Subgroup analyses yielded similar findings as the main analyses, except no significant association for patients who were black (0.75, 95% CI=0.55-1.02), had a higher PHQ-2 (1.08, 95% CI=0.82-1.41), had concomitant non-SSRI/SNRI antidepressants (0.75, 95% CI=0.34-1.66), and had underlying cognitive impairment (0.84, 95% CI=0.66-1.05). Conclusions Our findings suggested that older adults with depression receiving SSRIs/SNRIs were associated with an increased dementia risk compared to those receiving psychotherapy.
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Buccianelli B, Marazziti D, Arone A, Palermo S, Simoncini M, Carbone MG, Massoni L, Violi M, Dell’Osso L. Depression and Pseudodementia: Decoding the Intricate Bonds in an Italian Outpatient Setting. Brain Sci 2023; 13:1200. [PMID: 37626556 PMCID: PMC10452733 DOI: 10.3390/brainsci13081200] [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: 06/21/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
In spite of the uncertainties of its diagnostic framework, pseudodementia may be conceptualized as a condition characterized by depressive symptoms and cognitive impairment in the absence of dementia. Given the controversies on this topic, the aim of the present study was to assess neurological and cognitive dysfunctions in a sample of elderly depressed subjects, and the eventual relationship between cognitive impairment and depressive symptoms. Fifty-seven elderly depressed outpatients of both sexes were included in the study. A series of rating scales were used to assess diagnoses, depressive and cognitive impairment. Comparisons for continuous variables were performed with the independent-sample Student's t-test. Comparisons for categorical variables were conducted by the χ2 test (or Fisher's exact test when appropriate). The correlations between between socio-demographic characteristics and clinical features, as well as between cognitive impairment and depressive symptoms were explored by Pearson's correlation coefficient or Spearman's rank correlation. Our data showed the presence of a mild-moderate depression and of a mild cognitive impairment that was only partially related to the severity of depression. These dysfunctions became more evident when analyzing behavioral responses, besides cognitive functions. A high educational qualification seemed to protect against cognitive decline, but not against depression. Single individuals were more prone to cognitive disturbance but were similar to married subjects in terms of the severity of depressive symptoms. Previous depressive episodes had no impact on the severity of depression or cognitive functioning. Although data are needed to draw firm conclusions, our findings strengthen the notion that pseudodementia represents a borderline condition between depression and cognitive decline that should be rapidly identified and adequately treated.
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Affiliation(s)
- Beatrice Buccianelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
- Saint Camillus International University of Health and Medical Sciences—UniCamillus, 00131 Rome, Italy
| | - Alessandro Arone
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Marly Simoncini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Manuel Glauco Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, 21100 Varese, Italy;
| | - Leonardo Massoni
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Miriam Violi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 56126 Pisa, Italy; (B.B.); (A.A.); (S.P.); (M.S.); (L.M.); (M.V.); (L.D.)
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Gómez-Gómez C, Moya-Molina MÁ, Tey-Aguilera MJ, Flores-Azofra J, González-Caballero JL. Baseline Profiles of Drug Prescriptions Prior to Diagnosis of Mild Cognitive Impairment (MCI) Obtained by Latent Class Analysis (LCA), and Assessment of Their Association with Conversion to Dementia. Healthcare (Basel) 2023; 11:2219. [PMID: 37570459 PMCID: PMC10419237 DOI: 10.3390/healthcare11152219] [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: 06/13/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Polypharmacy has been linked to cognitive decline. However, interventions targeting modifiable risk factors, some of which are targets of the most commonly used drugs, could reduce the prevalence of dementia. Our aim was to determine the drug prescription regimen at baseline, prior to the diagnosis of mild cognitive impairment (MCI), and its possible association with progression to dementia. Data were collected from the electronic medical records of 342 MCI outpatients diagnosed during 2006-2017 at their first neurology consultation. We followed the classical three-step method of statistical analysis, starting with a Latent Class Analysis (LCA) to discover subgroups of drug prescription probability. Half of the patients were under polypharmacy (≥5 drugs), 17.5% had no recorded medication, 33.3% progressed to dementia (94.7% in ≤5 years), and 84.1% of them to Alzheimer's disease (AD). According to the LCA and based on 20 therapeutic indicators obtained from 240 substances and regrouped according the Anatomical Therapeutic Chemical Classification, we identified a four-profile model: (1) low (35.7% of patients); (2) mixed (28.7%); (3) cardio-metabolic (19.3%); and (4) psychotropic (16.4%). The binomial regression logistic model showed that profiles 2 and 3 (and 4 for AD), with a higher drug prescription conditioned probability against classic risk factors, were protective than profile 1 (OR = 0.421, p = 0.004; OR = 0.278, p = 0.000; OR = 0.457, p = 0.040, respectively), despite polypharmacy being significant in profiles 2 and 3 (mean > 7 drugs) vs. profile 1 (1.4 ± 1.6) (p = 0.000). Patients in the latter group were not significantly older, although being aged 65-79 years old quadrupled (OR = 4.217, p = 000) and being >79 tripled (OR = 2.945, p = 0.010) the conversion risk compared to patients <65 years old. According to the proposed analytical model, profiling the heterogeneous association of risk factors, which were taken prior to diagnosis, could be explored as an indicator of prior care and a predictor of conversion to dementia.
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Affiliation(s)
- Carmen Gómez-Gómez
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Miguel Ángel Moya-Molina
- Department of Neurology, Hospital Universitario Puerta del Mar (HUPM), University of Cadiz, 11009 Cádiz, Spain
| | - Manuel Jesús Tey-Aguilera
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
| | - Jorge Flores-Azofra
- Department of Biochemistry and Molecular Biology, School of Medicine, University of Cadiz, 11002 Cádiz, Spain; (M.J.T.-A.); (J.F.-A.)
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11
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Tremblay C, Choudhury P, Belden CM, Goldfarb D, Lorenzini I, Beach TG, Serrano GE. The role of sex differences in depression in pathologically defined Alzheimer's disease. Front Aging Neurosci 2023; 15:1156764. [PMID: 37234269 PMCID: PMC10206015 DOI: 10.3389/fnagi.2023.1156764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Sex differences in Alzheimer's disease (AD) may contribute to disease heterogeneity and affect prevalence, risk factors, disease trajectories and outcomes. Depression impacts a large number of patients with AD and has been reported to be more prevalent in women. We aimed to better understand the interaction between sex, depression and AD neuropathology, which could have implications for detection of symptoms, earlier diagnosis, therapeutic management, and enhanced quality of life. Methods We compared 338 cases with clinicopathologically confirmed AD (46% women) to 258 control cases (50% women), without dementia, parkinsonism or a significant pathological diagnosis. Depression was assessed both, using the Hamilton Depression Scale (HAM-D), and as being reported in their medical history combined with treatment with antidepressant medication. Results In the control group, women showed a higher depression severity, and a higher proportion of women were found to meet the cut-off score for depression on the HAM-D (32 vs. 16%) and having an history of depression (33 vs. 21%), while these sex differences were not observed in AD. Further, in both groups, female sex independently predicted the presence of depression, with covariates for age and cognitive status. AD subjects had higher mean HAM-D scores, were more likely to meet cutoff scores for depression (41 vs. 24%) and have a history of depression than controls (47 vs. 27%). When comparing the increase in frequency of depression in controls versus AD, the difference was significantly greater in men (AD men - control men: 24%) than in women (AD women - control women: 9%). Although subjects with depression were more likely to have higher levels of AD neuropathology, these differences were not observed when investigating the control or AD group separately. Discussion Control women had a higher likelihood and severity of depression than control men, but this sex difference was not noted when considering only those with pathologically defined AD, emphasizing the importance of considering sex in aging studies. AD was associated with higher rates of depression and men may be more likely to report or be diagnosed with depression once they develop AD indicating the importance of more frequent depression screenings in men.
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Affiliation(s)
- Cécilia Tremblay
- Department of Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, United States
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12
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Romdhani A, Lehmann S, Schlatter J. Discontinuation of Antidepressants in Older Adults: A Literature Review. Ther Clin Risk Manag 2023; 19:291-299. [PMID: 37013196 PMCID: PMC10066696 DOI: 10.2147/tcrm.s395449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Polypharmacy increases the risk of unbearable side effects, drug-drug interactions, and hospitalizations in geriatric patients. The iatrogenic risk of inadequate management of antidepressants is very important in this population. Therefore, primary care physicians and geriatricians have the responsibility of the optimization of antidepressants prescriptions. Our work is a literature review of the European and the international guidelines regarding the management of antidepressants. We reviewed the PubMed database and Google scholar for articles and reviews from 2015. We also screened relevant articles for more references and searched the web for available European guidelines relevant to our topic. We divided our findings into four main inquiries that are Indication, effectiveness, tolerability, and iatrogenic risks. Poor or absence of effectiveness should lead to a readjustment of the treatment plan. In case of unbearable side effects, antidepressants should be stopped, and alternative non-pharmacological therapies should be proposed. Doctors should look out for drug-drug interaction risks in this population and constantly adjust the prescription. Prescription of antidepressants is not always evidence based which leads to heavy iatrogenic consequences. We suggest a simple 4-questions-algorithm that aims to remind doctors of the basics of good practice and helps in the process of deprescribing an antidepressant in older adults.
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Affiliation(s)
- Ahmed Romdhani
- Département Medico-Universitaire de Gériatrie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (AP-HP), Labruyère, France
- Correspondence: Ahmed Romdhani, Email
| | - Stephanie Lehmann
- Pôle d’hospitalisation et relation ville-hôpital, Centre Hospitalier de Saint Marcellin, Isére, France
| | - Joël Schlatter
- Pharmacie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (AP-HP), Labruyère, France
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Liu C, Li L, Pan W, Zhu D, Lian S, Liu Y, Ren L, Mao P, Ren Y, Ma X. Altered topological properties of functional brain networks in patients with first episode, late-life depression before and after antidepressant treatment. Front Aging Neurosci 2023; 15:1107320. [PMID: 36949772 PMCID: PMC10025486 DOI: 10.3389/fnagi.2023.1107320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Objectives To preliminarily explore the functional activity and information integration of the brains under resting state based on graph theory in patients with first-episode, late-life depression (LLD) before and after antidepressant treatment. Methods A total of 50 patients with first-episode LLD and 40 non-depressed controls (NCs) were recruited for the present research. Participants underwent the RBANS test, the 17-item Hamilton depression rating scale (HAMD-17) test, and resting-state functional MRI scans (rs-fMRI). The RBANS test consists of 12 sub-tests that contribute to a total score and index scores across the five domains: immediate memory, visuospatial/constructional, language, attention, and delayed memory. Escitalopram or sertraline was adopted for treating depression, and the dosage of the drug was adjusted by the experienced psychiatrists. Of the 50 LLD patients, 27 cases who completed 6-month follow-ups and 27 NCs matched with age, sex, and education level were included for the final statistical analysis. Results There were significant differences in RBANS total score, immediate memory, visuospatial/constructional, language, attention, and delayed memory between LLD baseline group and NCs group (P < 0.05). Considering the global attribute indicators, the clustering coefficient of global indicators was lower in the LLD baseline group than in the NCs group, and the small-world attribute of functional brain networks existed in all three groups. The degree centrality and node efficiency of some brains were lower in the LLD baseline group than in the NCs group. After 6 months of antidepressant therapy, the scores of HAMD-17, immediate memory, language, and delayed memory in the LLD follow-up group were higher than those in the LLD baseline group. Compared with the LLD baseline group, the degree centrality and node efficiency of some brains in the cognitive control network were decreased in the LLD follow-up group. Conclusions The ability to integrate and divide labor of functional brain networks declines in LLD patients and linked with the depression severity. After the relief of depressive symptoms, the small-world attribute of functional brain networks in LLD patients persists. However, the information transmission efficiency and centrality of some brain regions continue to decline over time, perhaps related to their progressive cognitive impairment.
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Affiliation(s)
- Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dandi Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Siyuan Lian
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Yanping Ren
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- *Correspondence: Xin Ma
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Wise EA, Adams RJ, Lyketsos CG, Leoutsakos J. Graphical methods for understanding changes in states: Understanding medication use pathways. Int J Methods Psychiatr Res 2022; 31:e1932. [PMID: 35894783 PMCID: PMC9720228 DOI: 10.1002/mpr.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES As epidemiological studies become longer and larger, the field needs novel graphical methods to visualize complex longitudinal data. The aim of this study was to present the Slinkyplot, a longitudinal crosstabulation, to illustrate patterns of antidepressant use in a large prospective cohort of older adults with mild cognitive impairment. METHODS Data from the National Alzheimer's Coordinating Center are used to track switches between different states and types of antidepressant use. A Slinkyplot is populated with rows representing the state of medication use at each timepoint and columns representing the state at each subsequent visit. RESULTS The constructed Slinkyplots display the common practice of switching on and off different antidepressants over time, with citalopram, sertraline, and bupropion most commonly used followed by switching to another SSRI or SNRI as second-line treatment. CONCLUSIONS Slinkyplots are an innovative graphical means of visualizing complex patterns of transitions between different states over time for large longitudinal studies.
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Affiliation(s)
- Elizabeth A. Wise
- Department of Psychiatry and Behavioral SciencesJohns Hopkins Bayview and Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Roy J. Adams
- Department of Psychiatry and Behavioral SciencesJohns Hopkins Bayview and Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral SciencesJohns Hopkins Bayview and Johns Hopkins UniversityBaltimoreMarylandUSA
| | - Jeannie‐Marie Leoutsakos
- Department of Psychiatry and Behavioral SciencesJohns Hopkins Bayview and Johns Hopkins UniversityBaltimoreMarylandUSA
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15
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Kim M, Park SJ, Choi S, Chang J, Kim SM, Jeong S, Park YJ, Lee G, Son JS, Ahn JC, Park SM. Association between antibiotics and dementia risk: A retrospective cohort study. Front Pharmacol 2022; 13:888333. [PMID: 36225572 PMCID: PMC9548656 DOI: 10.3389/fphar.2022.888333] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background: The possible relation between antibiotic exposure and the alteration of gut microbiota, which may affect dementia risk, has been revealed. However, the association between antibiotics and dementia incidence has rarely been studied. We aimed to determine the association between antibiotic exposure and the risk of dementia. Methods: This population-based retrospective cohort study used data from the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in South Korea. Exposure was the cumulative days of antibiotic prescription from 2002 to 2005. Newly diagnosed overall dementia, Alzheimer’s disease (AD), and vascular dementia (VD) were identified based on diagnostic codes and prescriptions for dementia-related drugs. The follow-up investigation was carried out from 1 January 2006 to 31 December 2013. The Cox proportional hazards regression was used to assess the association between cumulative antibiotic prescription days and dementia incidence. Results: A total of 313,161 participants were analyzed in this study. Compared to antibiotic non-users, the participants who used antibiotics for 91 or more days had an increased risk of overall dementia [adjusted hazard ratio (aHR), 1.44; 95% confidence interval (CI), 1.19–1.74], AD (aHR, 1.46; 95% CI, 1.17–1.81), and VD (aHR, 1.38; 95% CI, 0.83–2.30). Those who used five or more antibiotic classes had higher risks of overall dementia (aHR, 1.28; 95% CI, 1.00–1.66) and AD (aHR, 1.34; 95% CI, 1.00–1.78) than antibiotic non-users. Conclusion: Antibiotic exposure may increase the risk of dementia in a cumulative duration-dependent manner among adult participants. Future studies are needed to assess the causality between the long-term prescription of antibiotics and dementia risk.
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Affiliation(s)
- Minseo Kim
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- College of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Young Jun Park
- Medical Research Center, Genomic Medicine Institute, Seoul National University, Seoul, South Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Joseph C. Ahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, NY, United States
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Sang Min Park,
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Depression, Depression Treatments, and Risk of Incident Dementia: A Prospective Cohort Study of 354,313 Participants. Biol Psychiatry 2022; 93:802-809. [PMID: 36526487 DOI: 10.1016/j.biopsych.2022.08.026] [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: 05/05/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the associations between courses of depression, the application of depression treatment, and the risk of incident dementia. METHODS In this prospective cohort study, 354,313 participants ages 50-70 years were recruited from the UK Biobank between 2006 and 2010 and were followed until 2020, with a total of 4,212,929 person-years. We initially studied the effect of depression on dementia incidence across 4 subgroups characterized by courses of depressive symptoms. Then, 46,820 participants with a diagnosis of depression were further categorized into treated and untreated groups. We compared the risk of dementia among different depression treatment groups in all participants who were depressed as well as 4 courses of depressive symptoms by performing survival analyses. RESULTS Depression was associated with a 51% higher risk of dementia, among which the increasing, chronically high, and chronically low courses were associated with increased dementia risk, while no association was found in the decreasing course. Compared to those who were depressed but untreated, receiving depression treatments corresponded to a hazard ratio of 0.7 (95% CI, 0.62-0.77). Among the 3 detrimental courses, treatments for increasing and chronically low symptoms of depression were associated with a 32% and 28% lower risk of dementia, respectively, while the reduction effect for chronically high symptoms was insignificant. CONCLUSIONS The negative association between depression treatment and incident dementia was significant in the increasing and chronically low courses, highlighting the necessity of timely interventional strategies before depression progresses to a chronically severe state.
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Huang IC, Chang TS, Chen C, Sung JY. Effect of Vortioxetine on Cognitive Impairment in Patients With Major Depressive Disorder: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Neuropsychopharmacol 2022; 25:969-978. [PMID: 35981958 PMCID: PMC9743961 DOI: 10.1093/ijnp/pyac054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dementia and depression are increasingly common worldwide, and their effective control could ease the burden on economies, public health systems, and support networks. Vortioxetine is a new antidepressant with multipharmacologic actions that elevate the concentration of serotonin and modulate multiple neurotransmitter receptors in the brain. We conducted a meta-analysis to explore whether the cognitive function of patients with major depressive disorder (MDD) treated with vortioxetine would improve. METHODS We systematically reviewed randomized controlled trials (RCTs) in the PubMed, Embase, and Cochrane databases to assess the treatment effects of vortioxetine on the cognitive function of patients with MDD. The outcome measures included the Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire (PDQ), and Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Pooled results were calculated using a fixed-effects or random-effects model according to the heterogeneity of the included trials. RESULTS Six RCTs with a total of 1782 patients were included in the meta-analysis, which demonstrated that vortioxetine improved DSST, PDQ, and MADRS scores in patients with MDD. The results were consistent at the 10- and 20-mg doses. In the 20-mg group, the decrease in MADRS scores was more significant than that in the placebo group. CONCLUSIONS Both the 10- and 20-mg doses of vortioxetine can significantly increase DSST scores and decrease PDQ and MADRS scores in patients with MDD and cognitive dysfunction, but further studies with longer follow-up periods to assess mental function are required.
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Affiliation(s)
- I-Chen Huang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsui-San Chang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Jia-Ying Sung
- Correspondence: Jia-Ying Sung, MD, PhD, Department of Neurology, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd, Wenshan Dist, Taipei City 116, Taiwan ()
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18
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Chua AL, Mehla S, Orlova YY. Drug Safety in Episodic Migraine Management in Adults. Part 2: Preventive Treatments. Curr Pain Headache Rep 2022; 26:493-504. [PMID: 35587859 DOI: 10.1007/s11916-022-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to aid in decision-making when choosing safe and effective options for preventive migraine medications. RECENT FINDINGS In Part 2, we have compiled clinically relevant safety considerations for commonly used migraine prophylactic treatments. Preventive treatment of episodic migraine includes nonspecific and migraine-specific drugs. While medications from several pharmacological classes-such as anticonvulsants, beta-blockers, and antidepressants-have an established efficacy in migraine prevention, they are associated with a number of side effects. The safety of migraine-specific treatments such as anti-CGRP monoclonal antibodies and gepants are also discussed. This review highlights safety concerns of commonly used migraine prophylactic agents and offers suggestions on how to mitigate those risks.
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Affiliation(s)
- Abigail L Chua
- Geisinger Health Systems, Neurology, 1000 E. Mountain Boulevard, Wilkes-Barre, PA, 18711, USA.
| | - Sandhya Mehla
- Ayer Neurosciences Institute, Hartford HealthCare Medical Group, University of Connecticut School of Medicine, Norwich, CT, USA
| | - Yulia Y Orlova
- Neurology Department, University of Florida, Gainesville, USA
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19
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Rotstein A, Kodesh A, Goldberg Y, Reichenberg A, Levine SZ. Serum folate deficiency and the risks of dementia and all-cause mortality: a national study of old age. EVIDENCE-BASED MENTAL HEALTH 2022; 25:63-68. [PMID: 35292483 PMCID: PMC10231620 DOI: 10.1136/ebmental-2021-300309] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The association between serum folate deficiency and the risk of dementia in old age is unclear, perhaps owing to small sample sizes, the competing risk of mortality or reverse causation. OBJECTIVE To examine the associations between serum folate deficiency and the risks of incident dementia and all-cause mortality in a large national sample of older adults. METHODS A prospective cohort aged 60-75 years (n=27 188) without pre-existing dementia for at least 10 years, was tested for serum concentrations of folate and followed up for dementia or all-cause mortality. Serum folate deficiency was classified as present (<4.4 ng/mL), otherwise absent. HRs and 95% CIs from competing risks Cox models were fitted to quantify the associations between serum folate deficiency and the risks of dementia and all-cause mortality. To examine reverse causation, the analysis was stratified by duration of follow-up. FINDINGS The presence compared with the absence of serum folate deficiency was associated with higher risks of dementia (HR=1.68; 95% CI 1.32 to 2.13; p<0.001) and all-cause mortality (HR=2.98; 95% CI 2.52 to 3.52; p<0.001). Evidence for reverse causation were moderate for dementia and mild for all-cause mortality. CONCLUSIONS Serum concentrations of folate may function as a biomarker used to identify those at risk of dementia and mortality; however, reverse causation is likely. Further research is needed to examine the role of serum folate deficiency in dementia aetiology. CLINICAL IMPLICATIONS Serum folate deficiency in older adults requires monitoring and treatment for preventative measures and/or as part of implemented therapeutic strategies.
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Affiliation(s)
- Anat Rotstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arad Kodesh
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Department of Mental Health, Meuhedet Health Services, Tel Aviv, Israel
| | - Yair Goldberg
- The Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephen Z Levine
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Freudenberg-Hua Y, Makhnevich A, Li W, Liu Y, Qiu M, Marziliano A, Carney M, Greenwald B, Kane JM, Diefenbach M, Burns E, Koppel J, Sinvani L. Psychotropic Medication Use Is Associated With Greater 1-Year Incidence of Dementia After COVID-19 Hospitalization. Front Med (Lausanne) 2022; 9:841326. [PMID: 35372430 PMCID: PMC8972194 DOI: 10.3389/fmed.2022.841326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 has been associated with an increased risk of incident dementia (post-COVID dementia). Establishing additional risk markers may help identify at-risk individuals and guide clinical decision-making. Methods We investigated pre-COVID psychotropic medication use (exposure) and 1-year incidence of dementia (outcome) in 1,755 patients (≥65 years) hospitalized with COVID-19. Logistic regression models were used to examine the association, adjusting for demographic and clinical variables. For further confirmation, we applied the Least Absolute Shrinkage and Selection Operator (LASSO) regression and a machine learning (Random Forest) algorithm. Results One-year incidence rate of post-COVID dementia was 12.7% (N = 223). Pre-COVID psychotropic medications (OR = 2.7, 95% CI: 1.8-4.0, P < 0.001) and delirium (OR = 3.0, 95% CI: 1.9-4.6, P < 0.001) were significantly associated with greater 1-year incidence of post-COVID dementia. The association between psychotropic medications and incident dementia remained robust when the analysis was restricted to the 423 patients with at least one documented neurological or psychiatric diagnosis at the time of COVID-19 admission (OR = 3.09, 95% CI: 1.5-6.6, P = 0.002). Across different drug classes, antipsychotics (OR = 2.8, 95% CI: 1.7-4.4, P < 0.001) and mood stabilizers/anticonvulsants (OR = 2.4, 95% CI: 1.39-4.02, P = 0.001) displayed the greatest association with post-COVID dementia. The association of psychotropic medication with dementia was further confirmed with Random Forest and LASSO analysis. Conclusion Confirming prior studies we observed a high dementia incidence in older patients after COVID-19 hospitalization. Pre-COVID psychotropic medications were associated with higher risk of incident dementia. Psychotropic medications may be risk markers that signify neuropsychiatric symptoms during prodromal dementia, and not mutually exclusive, contribute to post-COVID dementia.
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Affiliation(s)
- Yun Freudenberg-Hua
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Alexander Makhnevich
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Wentian Li
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Yan Liu
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Michael Qiu
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Allison Marziliano
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Maria Carney
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Blaine Greenwald
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - John M. Kane
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Michael Diefenbach
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Edith Burns
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
| | - Jeremy Koppel
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Liron Sinvani
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, United States
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21
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Lin SK, Wang PH, Huang CH, Kuo YH, Lai JN, Cheng-Chung Wei J. Association between Traditional Chinese medicine and a lower risk of dementia in patients with major depression: A case-control study. JOURNAL OF ETHNOPHARMACOLOGY 2021; 278:114291. [PMID: 34089809 DOI: 10.1016/j.jep.2021.114291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Major depression is an important risk factor for dementia. Traditional Chinese medicine (TCM) can alleviate the symptoms of major depression. However, it is unclear whether TCM decreases the risk of dementia in patients with major depression. Therefore, in this nationwide case-control study, we aimed to evaluate the association between TCM and the risk of dementia. MATERIALS AND METHODS We included 31,981 major depression patients with dementia from the National Dementia Database as the case group, and 4391 major depression patients without dementia from a one-million random sample database as the control group. We matched age (plus or minus two years), sex, and year of depression diagnosis based on a 1:4 ratio. RESULT There were 11,724 and 2931 patients in the case and control groups, respectively. Based on a conditional logistic regression analysis, the TCM groups exhibited significantly lower odds ratios with a 95% confidence interval of 0.83 (0.74-0.91). TCM treatment for more than 90 days, dispersing Qi, and activating blood circulation resulted in lower dementia risk with the following odds ratios and 95% confidence intervals: 0.60 (0.56-0.68), 0.87 (0.74-1.08), and 0.66 (0.49-0.81). CONCLUSION The results suggest that TCM is associated with lower dementia risk in major depression patients.
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Affiliation(s)
- Shun-Ku Lin
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, Republic of China; General Education Center, University of Taipei, Taipei, Taiwan, Republic of China
| | - Pin-Hsuan Wang
- Department of Chinese Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan, Republic of China; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Ching-Hsuan Huang
- Department of Chinese Traumatology Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yu-Hsien Kuo
- Department of Chinese Traumatology Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Jung-Nien Lai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China; Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China.
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China; Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan, Republic of China; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan, Republic of China.
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22
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Pilot testing of Dual-task Zumba Gold (DTZ) for community-dwelling people with mild cognitive impairment: A mixed-methods study. Geriatr Nurs 2021; 42:1397-1407. [PMID: 34624697 DOI: 10.1016/j.gerinurse.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/09/2023]
Abstract
Dual-tasking (e.g., enrichment of physical activities with mental exercises) is an innovative strategy to enhance older adults' cognition. Meanwhile, Zumba is a popular dance program, but research is limited about its utility on older people or those with mild cognitive impairment (MCI). This study assessed the feasibility of a new intervention called dual-task Zumba Gold (DTZ) for people with MCI. A mixed-methods feasibility study involving ten people aged ≥55 years with MCI was conducted from December 2020 to March 2021. Nine participants completed the study (90%) with high intervention acceptability. Program adherence (90.3%) and implementation fidelity (92.2%) were high. Participants also expressed the program's benefits, challenges, and facilitators. Moreover, pilot test results suggested improvements in global cognition (Z=-2.680; p=0.007), quality of life (Z=-2.688; p=0.008), and mobility (Z=-2.333; p=0.020). Hence, DTZ is feasible and acceptable for people with MCI, offering potential multidomain effects. Future randomized controlled studies should confirm these outcomes.
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23
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Brender R, Mulsant BH, Blumberger DM. An update on antidepressant pharmacotherapy in late-life depression. Expert Opin Pharmacother 2021; 22:1909-1917. [PMID: 33910422 DOI: 10.1080/14656566.2021.1921736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction: Clinically important depressive symptoms that occur in adults over age 60 are often termed late-life depression (LLD). LLD poses challenges for treating clinicians in both detection and treatment. Antidepressants are the most common first-line treatment approach. Older adults are at an increased risk of adverse effects because of polypharmacy.Areas covered: This article summarizes the challenges and approaches when using pharmacotherapy in LLD with a focus on newer data that have become available during the last five years. While no new antidepressants have become available during this period, a review of the literature summarizes advances in the knowledge of the adverse effects associated with various antidepressants and on the potential contribution of pharmacogenetic tools when prescribing antidepressants to older patients.Expert opinion: During the past 5 years, most of the literature relevant to the pharmacotherapy of MDD in older patients has focused on adverse effects. In particular, the effects of antidepressants on cognition and bone are emerging as important areas for clinical attention and further investigation. There is also an emerging literature on the potential role of pharmacogenetic testing in patients with MDD, though recommendations for use in older adults await larger studies that demonstrate its efficacy and cost-effectiveness.
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Affiliation(s)
- Ram Brender
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Naß J, Abdelfatah S, Efferth T. Induction of stress resistance and extension of lifespan in Chaenorhabditis elegans serotonin-receptor knockout strains by withanolide A. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 84:153482. [PMID: 33611213 DOI: 10.1016/j.phymed.2021.153482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/17/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Approximately 300 million people worldwide suffer from depression. The COVID-19 crisis may dramatically increase these numbers. Severe side effects and resistance development limit the use of standard antidepressants. The steroidal lactone withanolide A (WA) from Withania somnifera may be a promising alternative. Caenorhabditis elegans was used as model to explore WA's anti-depressive and anti-stress potential. METHODS C. elegans wildtype (N2) and deficient strains (AQ866, DA1814, DA2100, DA2109 and MT9772) were used to assess oxidative, osmotic or heat stress as measured by generation of reactive oxygen species (ROS), determination of lifespan, and mRNA expression of serotonin receptor (ser-1, ser-4, ser-7) and serotonin transporter genes (mod-5). The protective effect of WA was compared to fluoxetine as clinically established antidepressant. Additionally, WA's effect on lifespan was determined. Furthermore, the binding affinities and pKi values of WA, fluoxetine and serotonin as natural ligand to Ser-1, Ser-4, Ser-7, Mod-5 and their human orthologues proteins were calculated by molecular docking. RESULTS Baseline oxidative stress was higher in deficient than wildtype worms. WA and fluoxetine reduced ROS levels in all strains except MT9772. WA and fluoxetine prolonged survival times in wildtype and mutants under osmotic stress. WA but not fluoxetine increased lifespan of all heat-stressed C. elegans strains except DA2100. Furthermore, WA but not fluoxetine extended lifespan in all non-stressed C. elegans strains. WA also induced mRNA expression of serotonin receptors and transporters in wildtype and mutants. WA bound with higher affinity and lower pKi values to all C. elegans and human serotonin receptors and transporters than serotonin, indicating that WA may competitively displaced serotonin from the binding pockets of these proteins. CONCLUSION WA reduced stress and increased lifespan by ROS scavenging and interference with the serotonin system. Hence, WA may serve as promising candidate to treat depression.
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Affiliation(s)
- Janine Naß
- Department of Pharmaceutical Biology, Institute of Biochemistry and Pharmacy, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Sara Abdelfatah
- Department of Pharmaceutical Biology, Institute of Biochemistry and Pharmacy, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Biochemistry and Pharmacy, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany.
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25
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Chen LF, Lin CE, Chung CH, Lai CH, Chien WC. Association between the use of antidepressants and the risk of preterm birth among pregnant women with depression: a retrospective cohort study in Taiwan. J Investig Med 2021; 69:999-1007. [PMID: 33648982 DOI: 10.1136/jim-2020-001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/04/2022]
Abstract
Our study was aimed to investigate the association between the use of antidepressants and the risk of preterm birth in pregnant women who have had perinatal depression. We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) and analyzed them using multivariate Cox proportional hazard regression models. Identified from the NHIRD, we matched 1789 women aged 18-55 years who were using antidepressants during pregnancy and 1789 women who were experiencing depression but who were not using antidepressants during pregnancy for age, index date, and medical comorbidities. We enrolled the women in our study, which we conducted using 12 years' worth of data between 2000 and 2012, and then followed up individually with them for up to 1 year to identify any occurrence of preterm birth. Results highlighted that, compared with the women with perinatal depression who were not using antidepressants during pregnancy, the women taking antidepressants had a 1.762-fold risk of preterm birth (adjusted HR=1.762, 95% CI 1.351 to 2.294, p<0.001). The use of antidepressants in women with perinatal depression may increase the risk of preterm birth. However, the decision to start, stop, or change the use of antidepressants during pregnancy requires evaluating the risks of treatment versus untreated depression for both mother and child.
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Affiliation(s)
- Li-Fen Chen
- Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
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26
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Gonzales MM, Samra J, O’Donnell A, Mackin RS, Salinas J, Jacob M, Satizabal CL, Aparicio HJ, Thibault EG, Sanchez JS, Finney R, Rubinstein ZB, Mayblyum DV, Killiany RJ, Decarli CS, Johnson KA, Beiser AS, Seshadri S. Association of Midlife Depressive Symptoms with Regional Amyloid-β and Tau in the Framingham Heart Study. J Alzheimers Dis 2021; 82:249-260. [PMID: 34024836 PMCID: PMC8900661 DOI: 10.3233/jad-210232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depressive symptoms predict increased risk for dementia decades before the emergence of cognitive symptoms. Studies in older adults provide preliminary evidence for an association between depressive symptoms and amyloid-β (Aβ) and tau accumulation. It is unknown if similar alterations are observed in midlife when preventive strategies may be most effective. OBJECTIVE The study aim was to evaluate the association between depressive symptoms and cerebral Aβ and tau in a predominately middle-aged cohort with examination of the apolipoprotein (APOE) ɛ4 allele as a moderator. METHODS Participants included 201 adults (mean age 53±8 years) who underwent 11C-Pittsburgh Compound B amyloid and 18F-Flortaucipir tau positron emission tomography (PET) imaging. Depressive symptoms were evaluated with the Center for Epidemiological Studies Depression Scale (CES-D) at the time of PET imaging, as well as eight years prior. Associations between depressive symptoms at both timepoints, as well as depression (CES-D≥16), with regional Aβ and tau PET retention were evaluated with linear regression adjusting for age and sex. Interactions with the APOE ɛ4 allele were explored. RESULTS Depressive symptoms and depression were not associated with PET outcomes in the overall sample. However, among APOE ɛ4 allele carriers, there was a significant cross-sectional association between depressive symptoms and increased tau PET uptake in the entorhinal cortex (β= 0.446, SE = 0.155, p = 0.006) and amygdala (β= 0.350, SE = 0.133, p = 0.012). CONCLUSION Although longitudinal studies are necessary, the results suggest that APOE ɛ4 carriers with depressive symptoms may present with higher susceptibility to early tau accumulation in regions integral to affective regulation and memory consolidation.
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Affiliation(s)
- Mitzi M. Gonzales
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jasmeet Samra
- The Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Adrienne O’Donnell
- The Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - R. Scott Mackin
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- Center for Imaging of Neurodegenerative Disease, Veteran Affairs Administration, San Francisco, CA, USA
| | - Joel Salinas
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Mini Jacob
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Hugo J. Aparicio
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Emma G. Thibault
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Justin S. Sanchez
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Zoe B. Rubinstein
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Danielle V. Mayblyum
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron J. Killiany
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Charlie S. Decarli
- Department of Neurology, University of California Davis, Davis, CA, USA
- Center for Neuroscience, University of California Davis, Davis, CA, USA
| | - Keith A. Johnson
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexa S. Beiser
- The Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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Lin CE, Lee MS, Kao SY, Chung CH, Chen LF, Chou PH, Lee JF, Chien WC. Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study. J Affect Disord 2020; 277:549-558. [PMID: 32891061 DOI: 10.1016/j.jad.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of dementia among subgroups of patients receiving concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone. METHODS Multivariate Cox proportional hazards regression models were used to determine the effects of antidepressants and hypnotics on dementia risk after adjusting for potential confounders. RESULTS Compared with the reference group, patients receiving concurrent antidepressant and hypnotic treatment had the highest adjusted hazard ratio (aHR: 2.390, 95% CI: 2.224-2.536; P < 0.001) for all-cause dementia, followed by those receiving antidepressants alone (aHR: 1.919, 95% CI: 1.811-2.012; P < 0.001) and hypnotics alone (aHR: 1.458, 95% CI: 1.397-1.527; P < 0.001). With regard to dementia subtypes, trends similar to those for all-cause dementia were observed for Alzheimer's dementia, vascular dementia and other types of dementia. The sensitivity analysis conducted also found the robustness of findings. Notably, inconsistent findings were observed in subgroup with depression, revealing a null association between concurrent antidepressant and hypnotic treatment (aHR: 0.496; 95% CI: 0.183-1.343; P = 0.175) or hypnotics alone (aHR: 2.750; 95% CI: 0.797-9.482; P = 0.102) and the risk of dementia, and a negative association between antidepressants alone (aHR: 0.351; 95% CI: 0.130-0.942; P = 0.032) and the risk of dementia. CONCLUSION A null or negative association was observed between concurrent antidepressant and hypnotic treatment, antidepressants alone, hypnotics alone, and the dementia risk in the subgroup of patients with depression, suggesting the absence of an association between dementia risk and antidepressants alone or hypnotics alone.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC)
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Centre, Taipei, Taiwan (ROC); Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan (ROC)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan (ROC)
| | - Jia-Fu Lee
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC).
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Risk of dementia and death in very-late-onset schizophrenia-like psychosis: A national cohort study. Schizophr Res 2020; 223:220-226. [PMID: 32807646 DOI: 10.1016/j.schres.2020.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 01/21/2023]
Abstract
Knowledge is limited regarding the risks of death and dementia in very-late onset schizophrenia-like psychosis (VLOS). This study aims to scrutinize the associations between VLOS with the risks of death and dementia. Based on a prospective Israeli cohort study with national coverage, 94,120 persons without dementia or schizophrenia diagnoses aged 60 to 90 in 2012 were followed-up for the risks of dementia or death from 2013 to 2017. VLOS was classified as present from the age of the first ICD-9 diagnosis during follow-up, otherwise as absent. Hazard ratios (HR) with confidence intervals (95% CI) were computed with survival models to quantify the associations between VLOS and the risks of death and dementia, without and with adjustment for confounding. Nine sensitivity analyses were computed to examine the robustness of the results. The group with VLOS, compared to the group without, had higher death (n = 61, 18.5% vs. n = 7028, 7.5%, respectively) and dementia (n = 64, 19.5% vs. n = 5962, 6.4%, respectively) rates. In the primary analysis, the group with VLOS compared to the group without had increased risks of death (unadjusted HR = 3.10, 95% CI = 2.36, 4.06, P < .001; adjusted HR = 2.89, 95% CI = 2.15, 3.89; P < .001) and dementia (unadjusted HR = 3.81, 95% CI = 2.90, 4.99, P < .001; adjusted HR = 2.67, 95% CI = 1.82, 3.91; P < .001). The results remained statistically significant (P < .05) in all sensitivity analyses, including among persons without antipsychotic medication. The results may support notions of increased dementia risk and accelerated aging in VLOS, or that VLOS is a prodromal state of dementia.
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Yeung A, Kiss A, Gallagher D. Intensive control of hypertension and risk of Alzheimer's dementia in older adults with depression. Int J Geriatr Psychiatry 2020; 35:888-896. [PMID: 32281159 PMCID: PMC7375011 DOI: 10.1002/gps.5309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Intensive control of hypertension has been reported to decrease risk of cognitive decline. However, the effect of this in older adults with hypertension and comorbid depression is not well understood. We aim to identify whether intensive control of systolic blood pressure (BP) is associated with reduced risk of Alzheimer's dementia (AD) in a clinical population. METHODS Using data from the National Alzheimer's Coordinating Center, we conducted survival analyses in older adults with normal cognition at baseline and treated hypertension. We also examined those with comorbid depression, to determine if intensive control of systolic BP (≤120 mmHg) was associated with reduced risk of AD. RESULTS In all older adults with treated hypertension (n = 4505), 298 (6.6%) developed AD during a median follow-up duration of 4.2 years. In the comorbid depression subgroup (n = 1327), 152 (11.5%) developed AD. Intensive control of systolic BP was not significantly associated with reduced risk of AD in the overall sample (HR 1.13, 95%, 0.79-1.64). However, in the comorbid depression subgroup, intensive control of systolic BP (≤120 mmHg) was associated with increased risk of AD (HR 1.49, 95%, 1.03-2.15) compared to standard control (121-139 mmHg). CONCLUSIONS In a clinical population of older adults with hypertension and comorbid depression, we found that an intensive systolic BP target of ≤120 mmHg was associated with increased risk of AD. While these findings are preliminary, they suggest that a more cautious approach to hypertension treatment may be warranted in this vulnerable subgroup.
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Affiliation(s)
- Anthony Yeung
- Department of Psychiatry, University of Toronto, Ontario
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute
| | - Damien Gallagher
- Department of Psychiatry, University of Toronto, Ontario
- Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Peakman G, Karunatilake N, Seynaeve M, Perera G, Aarsland D, Stewart R, Mueller C. Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care. BMJ Open 2020; 10:e035147. [PMID: 32448792 PMCID: PMC7252968 DOI: 10.1136/bmjopen-2019-035147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/06/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Depression can be a prodromal feature or a risk factor for dementia. We aimed to investigate which clinical factors in patients with late-life depression are associated with a higher risk of developing dementia and a more rapid conversion. DESIGN Retrospective cohort study. SETTING South London and Maudsley NHS Foundation Trust (SLaM) secondary mental healthcare services. PARTICIPANTS The SLaM Clinical Record Interactive Search was used to retrieve anonymised data on 3659 patients aged 65 years or older who had received a diagnosis of depression in mental health services and had been followed up for at least 3 months. OUTCOME MEASURES Predictors of development of incident dementia were investigated, including demographic factors, health status rated on the Health of the National Outcome scale for older people (HoNOS65+), depression recurrence and treatments including psychotropic drugs and cognitive behavioural therapy (CBT). RESULTS In total, 806 (22.0%) patients developed dementia over a mean follow-up time of 2.7 years. Significant predictors of receiving a dementia diagnosis in fully adjusted models and after accounting for multiple comparisons were older age (adjusted HR=1.04, 95% CI 1.03 to 1.06 per year difference from sample mean) and the HoNOS65+ subscale measuring cognitive problems (HR=4.72, 95% CI 3.67 to 6.06 for scores in the problematic range). Recurrent depressive disorder or past depression (HR=0.65, 95% CI 0.55 to 0.77) and the receipt of CBT (HR=0.73 95% CI 0.61 to 0.87) were associated with a lower dementia risk. Over time, hazards related to age increased and hazards related to cognitive problems decreased. CONCLUSIONS In older adults with depression, a higher risk of being subsequently diagnosed with dementia was predicted by higher age, new onset depression, severity of cognitive symptoms and not receiving CBT. Further exploration is needed to determine whether the latter risk factors are responsive to interventions.
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Affiliation(s)
- Georgia Peakman
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Mathieu Seynaeve
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Dag Aarsland
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Antidepressants, Indications of Prescribing, and Dementia Risk. Am J Geriatr Psychiatry 2020; 28:497-498. [PMID: 31839463 DOI: 10.1016/j.jagp.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/20/2022]
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Kodesh A, Sandin S, Reichenberg A, Rotstein A, Pedersen NL, Ericsson M, Karlsson IK, Davidson M, Levine SZ. Antidepressants and the Risk of Dementia: Appropriate Consideration of Confounding by Indication. Am J Geriatr Psychiatry 2020; 28:499-500. [PMID: 31899121 DOI: 10.1016/j.jagp.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Arad Kodesh
- Department of Community Mental Health, University of Haifa (AK, AR, SZL), Haifa, Israel; Meuhedet Health Services, Mental Health (AK), Tel Aviv, Israel
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (SS, NP, ME, IK), Stockholm, Sweden; The Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai (SS, AR), New York, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai (SS, AR), New York, NY
| | - Abraham Reichenberg
- The Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai (SS, AR), New York, NY; Department of Psychiatry, Icahn School of Medicine at Mount Sinai (SS, AR), New York, NY
| | - Anat Rotstein
- Department of Community Mental Health, University of Haifa (AK, AR, SZL), Haifa, Israel
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (SS, NP, ME, IK), Stockholm, Sweden
| | - Malin Ericsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (SS, NP, ME, IK), Stockholm, Sweden
| | - Ida K Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet (SS, NP, ME, IK), Stockholm, Sweden; Institute of Gerontology and Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University (IK), Jönköping, Sweden
| | - Michael Davidson
- Sackler Medical School, Tel Aviv University (MD), Tel Aviv, Israel; Nicosia Medical School (MD), Nicosia, Cyprus
| | - Stephen Z Levine
- Department of Community Mental Health, University of Haifa (AK, AR, SZL), Haifa, Israel.
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Neuropsychiatric symptoms in cognitively normal older persons, and the association with Alzheimer's and non-Alzheimer's dementia. ALZHEIMERS RESEARCH & THERAPY 2020; 12:35. [PMID: 32234066 PMCID: PMC7110750 DOI: 10.1186/s13195-020-00604-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/20/2020] [Indexed: 12/11/2022]
Abstract
Background Neuropsychiatric symptoms (NPS) have been reported to be useful in predicting incident dementia among cognitively normal older persons. However, the literature has not been conclusive on the differential utilities of the various NPS in predicting the subtypes of dementia. This study compared the risks of Alzheimer’s and non-Alzheimer’s dementia associated with the various NPS, among cognitively normal older persons. Methods This cohort study included 12,452 participants from the Alzheimer’s Disease Centers across USA, who were ≥ 60 years and had normal cognition at baseline. Participants completed the Neuropsychiatric Inventory-Questionnaire at baseline and were followed up almost annually for incident dementia (median follow-up = 4.7 years). Symptom clusters of NPS—as identified from exploratory and confirmatory factor-analyses—were included in the Cox regression to investigate their associations with incident dementia. Results The various NPS showed independent yet differential associations with incident dementia. Although psychotic symptoms were rarely endorsed by the participants, they predicted much higher risk of dementia (HR 3.6, 95% CI 2.0–6.4) than affective symptoms (HR 1.5, 95% CI 1.2–1.8) or agitation symptoms (HR 1.6, 95% CI 1.3–2.1). Psychotic symptoms predicted all dementia subtypes, while affective and agitation symptoms differentially predicted some subtypes. Across dementia subtypes, psychotic symptoms had relatively higher risk estimates than affective or agitation symptoms, with the risk estimates being particularly high in non-Alzheimer’s dementia. Conclusions Among cognitively normal individuals, the presence of NPS may warrant greater clinical vigilance as precursors to dementia and its subtypes. The findings highlight the need for further research to enrich our understanding on the neurobiological links between various NPS and dementia subtypes. They may also change the clinical approach in managing late-life psychotic symptoms, requiring a greater emphasis on dementia surveillance in the diagnostic criteria of late-life psychotic disorders.
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Han F, Bonnett T, Brenowitz WD, Teylan MA, Besser LM, Chen YC, Chan G, Cao KG, Gao Y, Zhou XH. Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression. PLoS One 2020; 15:e0227924. [PMID: 31951629 PMCID: PMC6968868 DOI: 10.1371/journal.pone.0227924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/02/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Previous studies have provided equivocal evidence of antidepressant use on subsequent cognitive impairment; this could be due to inconsistent modeling approaches. Our goals are methodological and clinical. We evaluate the impact of statistical modeling approaches on the associations between antidepressant use and risk of Mild Cognitive Impairment (MCI) in older adults with depression. METHODS 716 participants were enrolled. Our primary analysis employed a time-dependent Cox proportional hazards model. We also implemented two fixed-covariate proportional hazards models-one based on having ever used antidepressants during follow-up, and the other restricted to baseline use only. RESULTS Treating antidepressant use as a time-varying covariate, we found no significant association with incident MCI (HR = 0.92, 95% CI: 0.70, 1.20). In contrast, when antidepressant use was treated as a fixed covariate, we observed a significant association between having ever used antidepressants and lower risk of MCI (HR = 0.40, 95% CI: 0.28, 0.56). However, in the baseline-use only model, the association was non-significant (HR = 0.84, 95% CI: 0.60, 1.17). DISCUSSION Our results were dependent upon statistical models and suggest that antidepressant use should be modeled as a time-varying covariate. Using a robust time-dependent analysis, antidepressant use was not significantly associated with incident MCI among cognitively normal persons with depression.
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Affiliation(s)
- Fang Han
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Tyler Bonnett
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, United States of America
| | - Willa D. Brenowitz
- Department of Psychiatry, University of California, San Francisco, California, United States of America
| | - Merilee A. Teylan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Lilah M. Besser
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Yen-Chi Chen
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Gary Chan
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Ke-Gang Cao
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Hua Zhou
- Department of Biostatistics, Beijing International Center for Mathematical Research, Peking University, Beijing, China
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Solomonov N, Alexopoulos GS. Do Antidepressants Increase the Risk of Dementia? Am J Geriatr Psychiatry 2019; 27:1189-1191. [PMID: 31320244 PMCID: PMC7063578 DOI: 10.1016/j.jagp.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nili Solomonov
- Weill Cornell Medical College, Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY.
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