Systematic Review: The Association between Late Life Depression and Hypotension

A scoping review of functional near-infrared spectroscopy biomarkers in late-life depression: Depressive symptoms, cognitive functioning, and social functioning

Late-life depression is one of the most damaging mental illnesses, disrupting the normal lives of older people by causing chronic illness and cognitive impairment. Patients with late-life depression, accompanied by changes in appetite, insomnia, fatigue and guilt, are more likely to experience irritability, anxiety and somatic symptoms. It increases the risk of suicide and dementia and is a major challenge for the public health systems. The current clinical assessment, identification and effectiveness assessment of late-life depression are primarily based on history taking, mental status examination and scale scoring, which lack subjectivity and precision. Functional near-infrared spectroscopy is a rapidly developing optical imaging technology that objectively reflects the oxygenation of hemoglobin in different cerebral regions during different tasks and assesses the functional status of the cerebral cortex. This article presents a comprehensive review of the assessment of functional near-infrared spectroscopy technology in assessing depressive symptoms, social functioning, and cognitive functioning in patients with late-life depression. The use of functional near-infrared spectroscopy provides greater insight into the neurobiological mechanisms underlying depression and helps to assess these three aspects of functionality in depressed patients. In addition, the study discusses the limitations of previous research and explores potential advances in the field.

Impact of cardiovascular evaluations and interventions on fall risk in older adults: a protocol for a scoping review and evidence map

INTRODUCTION

Cardiovascular disorders are increasingly recognised as important fall risk factors in older adults. Falls are a major public health problem in older adults, and therefore, effective interventions for reducing falls are essential for this population. Cardiovascular disease is a clinically relevant (but often overlooked) and potentially modifiable risk factor for falls. Literature describing the effects of cardiovascular assessments and treatments on fall prevention has generally focused on only one specific test or treatment. A comprehensive, comparative overview surrounding the effectiveness of available assessments and treatments on cardiovascular related fall risk is currently lacking.

METHODS AND ANALYSIS

A scoping review and evidence map will be conducted to summarise the available evidence regarding the (comparative) effectiveness of cardiovascular assessments and therapeutic interventions on reducing fall risk in older individuals. A systematic and comprehensive literature search will be performed in MEDLINE and Embase using the key components 'older adults', 'cardiovascular evaluation', 'cardiovascular intervention' and 'falls'. Furthermore, we will create an evidence map to summarise the quantity and quality of currently available evidence identified in the scoping review. The evidence map will consider, but will not be limited to, observational studies, randomised controlled trials and reviews evaluating cardiovascular tests and treatments (vs controls) on fall risk in older adults.

ETHICS AND DISSEMINATION

The scoping review and evidence map will only include data that are publicly available and, therefore, ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal and presented at scientific conferences.

The occurrence and risk factors associated with post-traumatic stress disorder among discharged COVID-19 patients in Tianjin, China

BACKGROUND

Post-traumatic stress disorder (PTSD) is a serious mental health condition that is triggered by a terrifying event. We aimed to investigate the occurrence and risk factors of PTSD among discharged COVID-19 patients.

METHODS

This study included 144 discharged COVID-19 patients. PTSD was assessed by using validated cut-offs of the impact of event scale-revised (IES-R, score ≥25). All patients completed a detailed questionnaire survey, and clinical parameters were routinely measured in the hospital. Binary logistic regression models were applied to identify factors associated with PTSD.

RESULTS

Of the 144 participants with laboratory-confirmed COVID-19, the occurrence of PTSD was 16.0%. In multivariable analyses, age above 40 years (adjusted OR [95% CI], 5.19 [2.17-12.32]), female sex (adjusted OR [95% CI], 7.82 [3.18-18.21]), current smoker (adjusted OR [95% CI], 6.72 [3.23-15.26]), and ≥3 involved pulmonary lobes (adjusted OR [95% CI], 5.76 [1.19-15.71]) were significantly associated with a higher risk of PTSD. Conversely, history of hypertension and serum hemoglobin levels were significantly associated with a lower risk of PTSD with adjusted ORs (95% CI) of 0.37 (0.12-0.87) and 0.91 (0.82-0.96), respectively.

CONCLUSION

Old age, gender (being female), current smoking, bacterial pneumonia, and ≥3 involved pulmonary lobes were associated with an increased occurrence of PTSD among discharged COVID-19 patients.

Orthostatic hypotension assessed by active standing is associated with worse cognition in geriatric rehabilitation inpatients, RESORT

PURPOSE

Geriatric rehabilitation inpatients who suffer from acute and chronic diseases that aggravate blood pressure (BP) dysregulation, may be particularly susceptible to orthostatic hypotension (OH). OH may increase the risk of cerebral small vessel disease and subsequent white matter hyperintensities inducing cognitive impairment (CI). This study investigates the association between OH and cognition in geriatric rehabilitation inpatients.

MATERIALS AND METHODS

Geriatric rehabilitation inpatients of the observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort in Melbourne, Australia, underwent intermittent BP measurements during active standing or partial postural change to sitting (when unable to stand). OH was defined as a systolic BP drop ≥20 mmHg and/or diastolic BP drop ≥10 mmHg within three minutes after postural change. CI included dementia diagnosis, Mini-Mental State Examination (MMSE) score <24 points (categorized as 18-23 (mild CI) and <18 points (severe CI)), Montreal Cognitive Assessment score <26 points or Rowland Universal Dementia Assessment Scale score <23 points.

RESULTS

In geriatric rehabilitation inpatients (n=1232, mean age 82.3 years (SD 8.2), 57.5% female), OH, CI and dementia prevalence was 20.0%, 61.0% and 20.4% respectively. MMSE was scored 18-23 in 32.6% and <18 points in 27.8% of patients (n=1033). In standing patients (51.7%), OH was associated with CI (p=0.045) and dementia (p=0.021), with a trend for MMSE scores <18 points (p=0.080), but not for MMSE scores 18-23 points (p=0.528). No association was found between seated OH and cognition.

CONCLUSION

OH assessed by active standing using intermittent BP measurements was associated with worse cognition in geriatric rehabilitation inpatients.

Development of hypotension in patients newly diagnosed with heart failure in UK general practice: retrospective cohort and nested case-control analyses

OBJECTIVES

Hypotension is of particular relevance for patients with heart failure (HF), since almost all HF drugs cause lowering of blood pressure (BP) and it is associated with a poor prognosis. We aimed to investigate hypotension incidence and risk factors in patients with incident HF in the UK.

DESIGN

Retrospective cohort study including nested case-control analyses.

SETTING

The Health Improvement Network UK primary care database.

PARTICIPANTS

18 677 adult patients with incident HF during 2000-2005 were followed and cases of hypotension (systolic BP ≤90 mm Hg) were identified. Controls were age-matched, sex-matched and date-matched to cases (1:2).

PRIMARY AND SECONDARY OUTCOME MEASURES

We estimated hypotension incidence in the full study population and relevant subgroups (eg, sex and age). Potential risk factors for hypotension overall and for multiple versus single hypotensive episodes were evaluated using conditional logistic regression and unconditional regression models, respectively.

RESULTS

During a mean follow-up of 3.31 years, 2565 patients (13.7%) developed hypotension. The incidence of hypotension was 3.17 cases per 100 patient years (95% confidence interval (CI): 3.05-3.30), and was markedly increased in women aged 18-39 years (n=32; 17.72 cases per 100 patient-years; 95% CI: 9.69-29.73). Hypotension risk factors included high healthcare utilisation (proxy measure for HF severity and general comorbidity; eg, ≥10 primary care physician visits versus none, odds ratio (OR): 2.29; 95% CI: 1.34-3.90), previous hypotensive episodes (OR: 2.32; 95% CI: 1.84-2.92), renal failure and use of aldosterone antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Risk factors identified for hypotension generally overlapped with those for multiple versus single hypotensive episodes.

CONCLUSIONS

Hypotension occurs frequently in patients with incident HF. Our findings may help identify patients most likely to benefit from close BP monitoring. The increased incidence of hypotension in young women with HF requires investigation.

Orthostatic hypotension in patients with late-life depression: Prevalence and validation of a new screening tool

OBJECTIVES

The objective of this study was to assess the prevalence of orthostatic hypotension (OH) in a sample of late life depression (LLD) patients and to determine the validity of a standardized questionnaire, the Orthostatic Hypotension Questionnaire (OHQ). Secondarily, we wished to assess variables associated with OH.

METHODS

We conducted a cross-sectional study on 82 consecutive geriatric outpatients presenting with LLD. OH was defined as a fall in systolic blood pressure of greater than 20 mm Hg and/or 10 mm Hg on diastolic blood pressure on an orthostatic stress test from sitting to standing. Logistic regressions were used to identify factors associated with OH.

RESULTS

The prevalence of OH as measured on the orthostatic stress test and on the OHQ was 28% and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the OHQ were 69.6% (95% CI 47%-87%), 47.5% (95%CI 34%-61%), 0.54 (95% CI: 0.43-0.64), 34% (95%CI 21%-49%), and 80% (95%CI 63%-92%), respectively. Females were more likely to have OH (OR: 3.96, 95%CI 1.06-14.89, P = .041), and those married or in a common-law relationship were less likely to have OH (OR: 0.25, 95% CI 0.08-0.72, P = .011).

CONCLUSIONS

OH is common in patients with LLD conferring them a risk of gait instability and falls. Females had a higher risk of having OH while participants who were married or in a common-law relationship were less likely to have OH. Although the OHQ is a quick to administer paper-based screening test, it did not show adequate diagnostic accuracy in patients with LLD seen in a routine psychiatry clinic.

Hospitalisation and surgery: Is exposure associated with increased subsequent depressive symptoms? Evidence from The Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

The dramatic shift in the global population demographic has led to increasing numbers of older people undergoing hospitalisation and surgical procedures. While necessary, these exposures may lead to an increase in depressive symptoms.

OBJECTIVES

To determine whether hospitalisation or hospitalisation with surgery under general anaesthesia is associated with an increase in depressive symptoms in adults over the age of 50.

METHODS

Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale in 8036 individuals at waves 1 and 2 of The Irish Longitudinal Study on Ageing (TILDA), 2 years apart. Mixed-effects models were used to investigate the hypothesis after adjustment for risk factors for depression and potential confounders.

RESULTS

During the 12 months preceding wave 1, a total of 459 participants were hospitalised (mean age, 67.0; 55.3% female), and a further 548 participants (mean age, 64.6; 51.8% female) were hospitalised and underwent surgery with general anaesthesia; 6891 (mean age, 63.5; 54.3% female) were not hospitalised. Analysis of waves 1 and 2 data using mixed-effects models demonstrated that there was a 7% increased adjusted incidence rate of depressive symptoms (IRR [95% CI] = 1.07 [1.02-1.11]) in the Center for Epidemiologic Studies Depression Scale in the hospitalisation group and a 4% increased adjusted incidence rate of depressive symptoms (IRR [95% CI] = 1.04 [1.00-1.08]) in the surgery group compared with those with no hospitalisation.

CONCLUSION

Hospitalisation and hospitalisation with surgery and general anaesthesia are associated with increased depressive symptoms. This is the first time a longitudinal population-representative study has demonstrated this relationship for both exposures simultaneously.

Orthostatic Hypotension in the Elderly: A Marker of Clinical Frailty?

BACKGROUND

Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its effect on mortality, disability, and hospitalization in frail older adults is poorly investigated. Thus, we assessed the relationship between the prevalence of OH and its effect on mortality, disability, and hospitalization in noninstitutionalized older adults stratified by frailty degree.

METHODS

Prospective, observational study of 510 older participants (≥65 years of age) consecutively admitted to a geriatric evaluation unit to perform a geriatric comprehensive assessment.

MEASUREMENTS

Clinical frailty was assessed using the Italian frailty index (40 items). Systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), and heart rate (bpm) were evaluated in clinostatic position and after 1, 3, and 5 minutes of orthostatic position. OH was defined with a decrease of 20 mm Hg in systolic blood pressure and/or a decrease of 10 mm Hg in diastolic blood pressure.

RESULTS

OH prevalence was 22%, and it increased from 9.0% to 66.0% according to frailty degree (P for trend <.001). When stratified by frailty degree, mortality, disability, and hospitalization increased from 1.0% to 24.5%, from 39.0% to 77.0% and from 14.0% to 32.0% in the absence, and from 0.0% to 35.5%, from 42.0% to 95.5% and from 19.0% to 65.5% in the presence of OH, respectively (P < .01 vs absence of OH). Multivariate analysis showed that the Italian frailty index is more predictive of mortality, disability, and hospitalization in the presence than in the absence of OH.

CONCLUSIONS

OH is a common condition in frail older adults, and it is strongly associated with mortality, disability, and hospitalization in the highest frailty degree. Thus, OH may represent a new marker of clinical frailty.

The association between antidepressant use and orthostatic hypotension in older people: a matched cohort study

Orthostatic hypotension (OH) is often reported as a significant potential adverse effect of antidepressant use but the association between phasic blood pressure (BP) and antidepressants has not yet been investigated. This cross-sectional study compares continuously measured phasic BP and prevalence of OH in a cohort of antidepressant users ≥50 years compared with an age- and sex-matched cohort not taking antidepressants. OH was defined as a drop in systolic BP ≥ 20 mm Hg or in diastolic BP ≥ 10 mm Hg at 30 seconds after standing, measured using continuous beat-to-beat finometry. Multilevel time × group interactions revealed significantly greater systolic and diastolic BP drop in antidepressant users than nonusers at 30 seconds after stand. The prevalence of OH among antidepressant users was 31% (63/206), compared with 17% in nonusers (X² = 9.7; P = .002). Unadjusted logistic regression models demonstrated that selective serotonin reuptake inhibitor use was associated with OH at an odds ratio of 2.11 (95% confidence interval: 1.25-3.57); P = .005, and this association was not attenuated when covariates including cardiac disease and depressive symptom burden were added. There was no statistically significant association between serotonin noradrenaline reuptake inhibitor or tricyclic antidepressant use and OH in unadjusted models although the study was not powered to detect changes within these subgroups. Older people taking antidepressants have a two-fold higher prevalence of OH than nonusers, highlighting the importance of screening the older antidepressant user for OH and dizziness and rationalizing medications to reduce the risk of falls within this vulnerable cohort.

Does baseline hypotension predict incident depression in a cohort of community-dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA)

Background

hypotension is now recognised as a risk factor for syncope, cardiovascular events and mortality, but it may also represent a risk factor for late life depression (LLD). The aim of this study was to clarify the longitudinal relationship between hypotension and incident LLD.

Methods

this is a longitudinal study involving community-dwelling participants aged ≥50 years, using data from The Irish Longitudinal Study on Ageing. The Centre for Epidemiological Studies Depression Scale (CES-D) was administered at baseline and at follow-up 2 years later. Blood pressure (BP) was measured at baseline. Participants with a CES-D score ≥16 at baseline and those taking antidepressants were excluded and considered to have a current diagnosis of depression. A score of ≥16 at follow-up was used to define incident depression.

Results

about 4,525 participants were included and 200 participants had diagnosis of incident LLD. The incident depression group had lower systolic BP at baseline than the non-depressed group (132.8 ± 1.43 mm Hg vs. 136.0 ± 0.30 mm HG, P = 0.025). Logistic regression showed those with systolic BP <130 mm HG had an unadjusted odds ratio of 1.31 (1.01-1.68) for incident depression. This persisted after adjustment for confounding factors.

Conclusion

systolic BP <130 mm Hg increased the likelihood of incident depression in a cohort of community-dwelling older adults. These findings are important because systolic hypotension may represent a potentially modifiable risk factor for LLD. They are also relevant in the context of BP treatment targets for older people.