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Lao J, Zeng Y, Wu Z, Lin G, Wang Q, Yang M, Zhang S, Xu D, Zhang M, Yao K, Liang S, Liu Q, Li J, Zhong X, Ning Y. Abnormalities in Electroencephalographic Microstates in Patients with Late-Life Depression. Neuropsychiatr Dis Treat 2024; 20:1201-1210. [PMID: 38860214 PMCID: PMC11164213 DOI: 10.2147/ndt.s456486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
Background Late-life depression (LLD) is characterized by disrupted brain networks. Resting-state networks in the brain are composed of both stable and transient topological structures known as microstates, which reflect the dynamics of the neural activities. However, the specific pattern of EEG microstate in LLD remains unclear. Methods Resting-state EEG were recorded for 31 patients with episodic LLD (eLLD), 20 patients with remitted LLD (rLLD) and 32 healthy controls (HCs) using a 64-channel cap. The clinical data of the patients were collected and the 17-Item Hamilton Rating Scale for Depression (HAMD) was used for symptom assessment. Duration, occurrence, time coverage and syntax of the four microstate classes (A-D) were calculated. Group differences in EEG microstates and the relationship between microstates parameters and clinical features were analyzed. Results Compared with NC and patients with rLLD, patients with eLLD showed increased duration and time coverage of microstate class D. Besides, a decrease in occurrence of microstate C and transition probability between microstate B and C was observed. In addition, the time coverage of microstate D was positively correlated with the total score of HAMD, core symptoms, and miscellaneous items. Conclusion These findings suggest that disrupted EEG microstates may be associated with the pathophysiology of LLD and may serve as potential state markers for the monitoring of the disease.
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Affiliation(s)
- Jingyi Lao
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yijie Zeng
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Zhangying Wu
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Gaohong Lin
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Qiang Wang
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Mingfeng Yang
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Si Zhang
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Danyan Xu
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Min Zhang
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Kexin Yao
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Shuang Liang
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Qin Liu
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Jiafu Li
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Xiaomei Zhong
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yuping Ning
- Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, People’s Republic of China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, People’s Republic of China
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Nutley S, Nguyen BK, Mackin RS, Insel PS, Tosun D, Butters M, Aisen P, Raman R, Saykin AJ, Toga AW, Jack C, Weiner MW, Nelson C, Kassel M, Kryza-Lacombe M, Eichenbaum J, Nosheny RL, Mathews CA. Relationship of Hoarding and Depression Symptoms in Older Adults. Am J Geriatr Psychiatry 2024; 32:497-508. [PMID: 38092621 PMCID: PMC11055473 DOI: 10.1016/j.jagp.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
Hoarding disorder (HD) is a debilitating neuropsychiatric condition that affects 2%-6% of the population and increases in incidence with age. Major depressive disorder (MDD) co-occurs with HD in approximately 50% of cases and leads to increased functional impairment and disability. However, only one study to date has examined the rate and trajectory of hoarding symptoms in older individuals with a lifetime history of MDD, including those with current active depression (late-life depression; LLD). We therefore sought to characterize this potentially distinct phenotype. We determined the incidence of HD in two separate cohorts of participants with LLD (n = 73) or lifetime history of MDD (n = 580) and examined the reliability and stability of hoarding symptoms using the Saving Inventory-Revised (SI-R) and Hoarding Rating Scale-Self Report (HRS), as well as the co-variance of hoarding and depression scores over time. HD was present in 12% to 33% of participants with MDD, with higher rates found in those with active depressive symptoms. Hoarding severity was stable across timepoints in both samples (all correlations >0.75), and fewer than 30% of participants in each sample experienced significant changes in severity between any two timepoints. Change in depression symptoms over time did not co-vary with change in hoarding symptoms. These findings indicate that hoarding is a more common comorbidity in LLD than previously suggested, and should be considered in screening and management of LLD. Future studies should further characterize the interaction of these conditions and their impact on outcomes, particularly functional impairment in this vulnerable population.
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Affiliation(s)
- Sara Nutley
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL; Department of Epidemiology (SN), University of Florida, Gainesville, FL
| | - Binh K Nguyen
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL
| | - Robert Scott Mackin
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Duygu Tosun
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Meryl Butters
- Department of Psychiatry (MB), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Paul Aisen
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Rema Raman
- University of Southern California (PA, RR), San Diego, CA; Alzheimer's Therapeutic Research Institute (PA, RR), University of Southern California, San Diego, CA
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and Department of Radiology and Imaging Sciences (AS), Indiana University School of Medicine, Indianapolis, IN
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine (AT), University of Southern California, Los Angeles, CA
| | | | - Michael W Weiner
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA; Department of Neurology (MW), University of California, San Francisco, San Francisco, CA
| | - Craig Nelson
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA
| | - Michelle Kassel
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA
| | - Maria Kryza-Lacombe
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Mental Illness Research Education and Clinical Centers (MK-L), Veterans Administration Medical Center, San Francisco, CA
| | - Joseph Eichenbaum
- San Francisco Veterans Administration Medical Center (DT, MW, MK, JE), San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Rachel L Nosheny
- Department of Psychiatry and Behavioral Sciences (RM, PI, MW, CN, MK, MK-L, RN), University of California, San Francisco, San Francisco, CA; Department of Radiology (DT, MW, JE, RN), University of California, San Francisco, San Francisco, CA
| | - Carol A Mathews
- Department of Psychiatry (SN, BN, CAM), University of Florida College of Medicine, Gainesville, FL; Center for OCD, Anxiety, and Related Disorders (COARD) (SN, BN, CAM), University of Florida, Gainesville, FL.
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Krause-Sorio B, Siddarth P, Milillo MM, Kilpatrick L, Ercoli L, Narr KL, Lavretsky H. Grey matter volume predicts improvement in geriatric depression in response to Tai Chi compared to Health Education. Int Psychogeriatr 2023:1-9. [PMID: 38053398 DOI: 10.1017/s1041610223004386] [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: 12/07/2023]
Abstract
OBJECTIVES Geriatric depression (GD) is associated with cognitive impairment and brain atrophy. Tai-Chi-Chih (TCC) is a promising adjunct treatment to antidepressants. We previously found beneficial effects of TCC on resting state connectivity in GD. We now tested the effect of TCC on gray matter volume (GMV) change and the association between baseline GMV and clinical outcome. PARTICIPANTS Forty-nine participants with GD (>=60 y) underwent antidepressant treatment (38 women). INTERVENTION Participants completed 3 months of TCC (N = 26) or health and wellness education control (HEW; N = 23). MEASUREMENTS Depression and anxiety symptoms and MRI scans were acquired at baseline and 3-month follow-up. General linear models (GLMs) tested group-by-time interactions on clinical scores. Freesurfer 6.0 was used to process T1-weighted images and to perform voxel-wise whole-brain GLMs of group on symmetrized percent GMV change, and on the baseline GMV and symptom change association, controlling for baseline symptom severity. Age and sex served as covariates in all models. RESULTS There were no group differences in baseline demographics or clinical scores, symptom change from baseline to follow-up, or treatment-related GMV change. However, whole-brain analysis revealed that lower baseline GMV in several clusters in the TCC, but not the HEW group, was associated with larger improvements in anxiety. This was similar for right precuneus GMV and depressive symptoms. CONCLUSIONS While we observed no effect on GMV due to the interventions, baseline regional GMV predicted symptom improvements with TCC but not HEW. Longer trials are needed to investigate the long-term effects of TCC on clinical symptoms and neuroplasticity.
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Affiliation(s)
- Beatrix Krause-Sorio
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Prabha Siddarth
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michaela M Milillo
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Lisa Kilpatrick
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Linda Ercoli
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Krause-Sorio B, Siddarth P, Milillo MM, Kilpatrick LA, Narr KL, Lavretsky H. Regional gray matter volume correlates with anxiety, apathy, and resilience in geriatric depression. Int Psychogeriatr 2023; 35:698-706. [PMID: 37381880 DOI: 10.1017/s1041610223000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Geriatric depression (GD) is associated with significant medical comorbidity, cognitive impairment, brain atrophy, premature mortality, and suboptimal treatment response. While apathy and anxiety are common comorbidities, resilience is a protective factor. Understanding the relationships between brain morphometry, depression, and resilience in GD could inform clinical treatment. Only few studies have addressed gray matter volume (GMV) associations with mood and resilience. PARTICIPANTS Forty-nine adults aged >60 years (38 women) with major depressive disorder undergoing concurrent antidepressant treatment participated in the study. MEASUREMENTS Anatomical T1-weighted scans, apathy, anxiety, and resilience data were collected. Freesurfer 6.0 was used to preprocess T1-weighted images and qdec to perform voxel-wise whole-brain analyses. Partial Spearman correlations controlling for age and sex tested the associations between clinical scores, and general linear models identified clusters of associations between GMV and clinical scores, with age and sex as covariates. Cluster correction and Monte-Carlo simulations were applied (corrected alpha = 0.05). RESULTS Greater depression severity was associated with greater anxiety (r = 0.53, p = 0.0001), lower resilience (r = -0.33, p = 0.03), and greater apathy (r = 0.39, p = 0.01). Greater GMV in widespread, partially overlapping clusters across the brain was associated with reduced anxiety and apathy, as well as increased resilience. CONCLUSION Our results suggest that greater GMV in extended brain regions is a potential marker for resilience in GD, while GMV in more focal and overlapping regions may be markers for depression and anxiety. Interventions focused on improving symptoms in GD may seek to examine their effects on these brain regions.
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Affiliation(s)
- Beatrix Krause-Sorio
- Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Prabha Siddarth
- Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Michaela M Milillo
- Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Lisa A Kilpatrick
- Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry, Semel Institute for Neuroscience and Behavior, University of California Los Angeles, Los Angeles, CA, USA
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Bergua V, Blanchard C, Amieva H. Depression in Older Adults: Do Current DSM Diagnostic Criteria Really Fit? Clin Gerontol 2023:1-38. [PMID: 37902598 DOI: 10.1080/07317115.2023.2274053] [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: 10/31/2023]
Abstract
OBJECTIVES The great heterogeneity in symptoms and clinical signs of depression in older adults makes the current diagnostic criteria difficult to apply. This scoping review aims to provide an update on the relevance of each of the diagnostic criteria as defined in the DSM-5. METHODS In order to limit the risk of bias inherent in the study selection process, a priori inclusion and exclusion criteria were defined. Articles meeting these criteria were identified using a combination of search terms entered into PubMed, PsycINFO, PsycARTICLES and SocINDEX. RESULTS Of the 894 articles identified, 33 articles were selected. This review highlights a different presentation of depression in older adults. Beyond the first two DSM core criteria, some symptoms are more common in older adults: appetite change, sleep disturbance, psychomotor slowing, difficulty concentrating, indecisiveness, and fatigue. CONCLUSIONS This review provides an updated description of the clinical expression of depressive symptoms in the older population while highlighting current pending issues. CLINICAL IMPLICATIONS Somatic symptoms should be systematically considered in order to improve the diagnosis of depression in older adults, even if, in some cases, they may reflect symptoms of age-related illnesses.
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Affiliation(s)
- Valérie Bergua
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Cécile Blanchard
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
- Psychiatry, Centre Hospitalier Cadillac, Bordeaux, France
| | - Hélène Amieva
- Public health - Psychology, University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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Wu Z, Zhang J, Jiang M, Zhang J, Xiao YW. The longitudinal associations between perceived importance of the internet and depressive symptoms among a sample of Chinese adults. Front Public Health 2023; 11:1167740. [PMID: 37361143 PMCID: PMC10286239 DOI: 10.3389/fpubh.2023.1167740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 06/28/2023] Open
Abstract
Objective The aim of this study is to examine the extent to which individuals' cognitive evaluation of the importance of the Internet is associated with depressive symptoms, and in what ways. Methods This study utilized a sample of 4,100 participants from the fourth (2016), fifth (2018), and sixth (2020) waves of the China Family Panel Studies. Structural equation modeling was employed for data analysis. Result The findings of this study reveal that individuals' cognitive evaluation of the importance of the Internet in 2016 was positively linked with the frequency of Internet use and subjective socioeconomic status in 2018. Furthermore, the frequency of Internet use and subjective socioeconomic status in 2018 were found to be negatively associated with depressive symptoms in 2020. These results indicate that the perceived importance of the Internet has an indirect effect on depressive symptoms through the identified pathway. Conclusion The present findings contribute to the existing literature by highlighting the importance of individuals' perceived importance of the internet as a significant factor that influences depressive symptoms. The results suggest that policy makers should take actions to increase public awareness of the importance of the Internet in the digital era, and to ensure equitable access to the internet, thus facilitating convenient internet use and helping individuals adapt to the digital age.
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Affiliation(s)
- Zhengyu Wu
- 1School of Public Affairs, Xiamen University, Xiamen, China
| | - Jiabo Zhang
- School of Literature and Media, Lingnan Normal University, Zhanjiang, China
| | - Maomin Jiang
- 1School of Public Affairs, Xiamen University, Xiamen, China
| | - Jiawen Zhang
- School of Education, Silliman University, Dumaguete, Philippines
| | - Ye-Wei Xiao
- Department of Physiology, School of Basic Medical Science, Southwest Medical University, Luzhou, China
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Yang M, Chen B, Zhou H, Mai N, Zhang M, Wu Z, Peng Q, Wang Q, Liu M, Zhang S, Lin G, Lao J, Zeng Y, Zhong X, Ning Y. Relationships Among Short Self-Reported Sleep Duration, Cognitive Impairment, and Insular Functional Connectivity in Late-Life Depression. J Alzheimers Dis 2023:JAD220968. [PMID: 37182865 DOI: 10.3233/jad-220968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Both late-life depression (LLD) and short sleep duration increase the risk of cognitive impairment. Increased insular resting-state functional connectivity (FC) has been reported in individuals with short sleep duration and dementia. OBJECTIVE This study aimed to investigate whether short sleep duration is associated with impaired cognition and higher insular FC in patients with LLD. METHODS This case- control study recruited 186 patients with LLD and 83 normal controls (NC), and comprehensive psychometric assessments, sleep duration reports and resting-state functional MRI scans (81 LLD patients and 54 NC) were conducted. RESULTS Patients with LLD and short sleep duration (LLD-SS patients) exhibited more severe depressive symptoms and worse cognitive function than those with normal sleep duration (LLD-NS patients) and NC. LLD-SS patients exhibited higher FC between the bilateral insula and inferior frontal gyrus (IFG) pars triangularis than LLD-NS patients and NC, while LLD-NS patients exhibited lower FC than NC. Increased insular FC was correlated with short sleep duration, severe depressive symptoms, and slower information processing speeds. Furthermore, an additive effect was found between sleep duration and LLD on global cognition and insular FC. CONCLUSION LLD-SS patients exhibited impaired cognition and increased insular FC. Abnormal FC in LLD-SS patients may be a therapeutic target for neuromodulation to improve sleep and cognitive performance and thus decrease the risk of dementia.
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Affiliation(s)
- Mingfeng Yang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
- The first School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ben Chen
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Huarong Zhou
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Naikeng Mai
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Min Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhangying Wu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Qi Peng
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Qiang Wang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Meiling Liu
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Si Zhang
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Gaohong Lin
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jingyi Lao
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yijie Zeng
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xiaomei Zhong
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yuping Ning
- Department of Geriatric Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
- The first School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
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8
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Wu Z, Zhong X, Lin G, Peng Q, Zhang M, Zhou H, Wang Q, Chen B, Ning Y. Resting-state electroencephalography of neural oscillation and functional connectivity patterns in late-life depression. J Affect Disord 2022; 316:169-176. [PMID: 35931231 DOI: 10.1016/j.jad.2022.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The clinical manifestations of late-life depression (LLD) are highly heterogeneous. Currently, abnormal characteristics of resting-state electroencephalography (EEG) power and functional connectivity are considered trait markers of depressive symptoms in major depression. However, the relationship between EEG spectral features and functional connectivity in LLD remains unknown. METHODS Forty-one patients with LLD and 44 participants without depression underwent an eyes-closed resting-state EEG. EEG power spectra, alpha asymmetry, and functional connectivity were calculated and analyzed. RESULTS Although alpha frontal asymmetry and cortical functional connectivity between the two groups showed no significant differences, the LLD group exhibited abnormal neural oscillation patterns of higher beta frequency activity in the parietal, central, and occipital lobes while alpha activity was increased in the parietal central electrodes. LIMITATIONS The number of EEG electrodes used in this study was low, and the sample size was limited. CONCLUSIONS Increased alpha and beta frequency band powers were observed in patients with LLD. These abnormal patterns may be associated with a disturbed balance of cortical excitation, inhibition, and hyperactivity. In the future, a neurofeedback protocol based on the findings of neural oscillation patterns in certain types of LLD should be explored.
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Affiliation(s)
- Zhangying Wu
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Xiaomei Zhong
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Gaohong Lin
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Qi Peng
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Min Zhang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Huarong Zhou
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Qiang Wang
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Ben Chen
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Yuping Ning
- Department of Geriatric Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, China.
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9
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Ochi S, Mori T, Iga JI, Ueno SI. Prevalence of Comorbid Dementia in Late-life Depression and Bipolar Disorder: A Retrospective Inpatient Study. J Alzheimers Dis Rep 2022; 6:589-598. [PMID: 36275416 PMCID: PMC9535605 DOI: 10.3233/adr-220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Dementia in patients with late-life mood disorders is clinically important. Objective: We aimed to investigate the prevalence of dementia in patients with late-life major depressive disorder (MDD) or bipolar disorder (BD) and to clarify the clinical characteristics associated with the diagnosis of dementia. Methods: The prevalence of dementia at hospital discharge and the clinical characteristics at hospitalization who are diagnosed with MDD or BD over 65 years of age, from the medical records of 684 patients who had been admitted from 2015 to 2020 were investigated. Results: A total of 66 patients with MDD (n = 50) and BD (n = 16) were analyzed. The prevalence of dementia was significantly higher in MDD than in BD (24.0% versus 0%; p = 0.026). The mean age at onset of MDD was significantly older in the MDD with dementia group than in the MDD without (76.9±6.3 years versus 62.2±14.0 years; p < 0.001). The rate of first depressive episode at this admission was significantly higher in the MDD with dementia group (91.7% versus 30.3%; p < 0.001). The diagnosis of dementia was significantly associated with lower scores for “insomnia early” (p = 0.019) and higher scores for “insight” (p = 0.049) on the 17-item Hamilton Depression Rating (HAMD-17) subscales and lower scores for “recall” (p = 0.003) on the MMSE subscales. Conclusion: The older age of first onset of depression, “insomnia early”, “insight” and “recall” may be useful indicators for a diagnosis of dementia in late-life depression.
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Affiliation(s)
- Shinichiro Ochi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takaaki Mori
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Jun-ichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shu-ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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10
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Gunawan I, Huang XY. Prevalence of depression and its related factors among older adults in Indonesian nursing homes. BELITUNG NURSING JOURNAL 2022; 8:222-228. [PMID: 37547114 PMCID: PMC10401364 DOI: 10.33546/bnj.2075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 08/08/2023] Open
Abstract
Background Depression is one of the most severe mental disorders experienced by older adults worldwide. The prevalence of depression among older adults in nursing homes is three-time higher than in the community. Therefore, knowing the incident rates of depression and its related factors would help provide appropriate intervention and prevention programs in the future. Objectives The study aimed to determine the prevalence of depression and compare the difference in depression status according to the sociodemographic characteristic of the older adults in the Indonesian nursing homes. Methods A descriptive cross-sectional study design was used in this study, which involved 116 participants selected using convenience sampling from five different general nursing homes in Bandung City, Indonesia. The Short Form (SF) of the Geriatric Depression Scale (GDS) was used to evaluate depression among older adults in nursing homes. The t-test and one-way ANOVA were used for data analysis. Results Of the total participants, 56.9% had depression, which 7.8% with mild depression, 37.1% with moderate depression, and 12% with severe depression. In addition, there were significant differences in depression according to age, gender, marital status, educational background, ethnicity, disease history, duration of stay, and the visitor frequency among the older adults in nursing homes (p <.001). Conclusion A high rate of depression among older adults in Indonesian nursing homes was identified. Therefore, attention to caring for more specific needs, such as the psychosocial needs of older adults in nursing homes, is urgent.
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Affiliation(s)
- Indra Gunawan
- Faculty of Health and Science, Universitas Muhammadiyah Tasikmalaya, Indonesia
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Xuan-Yi Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taiwan
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11
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Zhang Y, Hou F, Cheng J, Chen G, Wang L, Jiang X, Chen R, Shen G. The association between leftover food consumption and depression among older adults: Findings from a cross-sectional study. J Affect Disord 2022; 307:157-162. [PMID: 35390351 DOI: 10.1016/j.jad.2022.03.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Leftover food consumption is very prevalent among the Chinese older adults, however, the potential effects of leftover eating consumption on depression have not yet been investigated. OBJECTIVES The study aims to determine the association between leftover consumption on depression among older adults. METHODS Data of leftover consumption frequency was collected in a cross-sectional study with a provincial representative sample of 5992 older adults (aged 60 or older) in 2019. Depression symptoms were assessed by the 9-item screener Patient Health Questionnaire (PHQ-9). Multiple logistic regression models were applied to analyze the association of the frequency of leftover eating consumption and the presence and the severity of depression. RESULTS After controlling for all the covariates, the participants who consume leftover food everyday had higher risk of having depression symptom comparing to those who had the lowest frequency of leftover eating (OR: 1.675, 95% CI: 1.435-1.956, p < 0.001). The participants who consume leftover food every day was also associated with more severe depression symptoms (OR: 1.621, 95% CI: 1.397-1.881, p < 0.001), when comparing to the reference group. The associations seemed stronger in men than women. LIMITATIONS The causal relationship between leftover consumption behavior and depression could not be determined due to the cross-sectional design. Moreover, the variety or handling method of the leftover food was not specified. CONCLUSION Leftovers eating frequency was associated with the presence and severity of depression symptoms among older adults.
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Affiliation(s)
- Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China
| | - Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China
| | - Guimei Chen
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China
| | - Li Wang
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China
| | - Xiaodong Jiang
- Department of Medical Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, PR China.
| | - Ren Chen
- School of Health Service Management, Anhui Medical University, Hefei 230032, Anhui, PR China; The Affiliated Suzhou Hospital of Anhui Medical University, Suzhou 234000, Anhui, PR China.
| | - Guodong Shen
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui Province, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui, PR China; Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei 230001, Anhui, PR China.
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12
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Baba H, Kito S, Nukariya K, Takeshima M, Fujise N, Iga J, Oshibuchi H, Kawano M, Kimura M, Mizukami K, Mimura M. Guidelines for diagnosis and treatment of depression in older adults: A report from the Japanese Society of mood disorders. Psychiatry Clin Neurosci 2022; 76:222-234. [PMID: 35274788 DOI: 10.1111/pcn.13349] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
The Committee for Treatment Guidelines of Mood Disorders, Japanese Society of Mood Disorders, published a Japanese guideline for the treatment of late-life depression in 2020. Based on that guideline, the present guideline was developed and revised to incorporate the suggestions of global experts and the latest published evidence. In the diagnosis of late-life depression, it is important to carefully differentiate it from bipolar disorders, depressive states caused by physical and organic brain disease, drug effects, and dementia, and to determine the comorbidity between late-life depression and dementia. It is necessary to fully understand the clinical characteristics and psychosocial background of late-life depression, evaluate the patient's condition, and provide basic interventions based on these factors. Problem-solving therapy, reminiscence therapy/life review therapy, and behavioral activation therapy, and other forms of psychotherapy can reduce depressive symptoms. In terms of pharmacotherapy, newer antidepressants or non-tricyclic antidepressants are recommended for late-life depression, and it is recommended that the efficacy of least the minimal effective dosage should first be determined. Switching antidepressants and aripiprazole augmentation can be used to treatment-resistant therapy. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have demonstrated usefulness for late-life depression. Exercise therapy, high-intensity light therapy, and diet therapy also show some effectiveness and are useful for late-life depression. Continuation therapy should be maintained for at least 1 year after remission.
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Affiliation(s)
- Hajime Baba
- Department of Psychiatry, Juntendo University Koshigaya Hospital, Saitama, Japan.,Department of Psychiatry & Behavioral Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| | - Kazutaka Nukariya
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Minoru Takeshima
- Department of Psychiatry, Meishin-kai Shibata Hospital, Toyama, Japan.,Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Noboru Fujise
- Health Care Center, Kumamoto University, Kumamoto, Japan
| | - Junichi Iga
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.,Department of Child Psychiatry, Kanagawa Children's Medical Center, Kanagawa, Japan
| | | | - Mahiko Kimura
- Department of Neuropsychiatry, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Katsuyoshi Mizukami
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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13
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Kilpatrick LA, Krause-Sorio B, Siddarth P, Narr KL, Lavretsky H. Default mode network connectivity and treatment response in geriatric depression. Brain Behav 2022; 12:e2475. [PMID: 35233974 PMCID: PMC9015007 DOI: 10.1002/brb3.2475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/09/2021] [Accepted: 12/08/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Default mode network (DMN) connectivity is altered in depression. We evaluated the relationship between changes in within-network DMN connectivity and improvement in depression in a subsample of our parent clinical trial comparing escitalopram/memantine (ESC/MEM) to escitalopram/placebo (ESC/PBO) in older depressed adults (NCT01902004). METHODS Twenty-six participants with major depression (age > 60 years) and subjective memory complaints underwent treatment with ESC/MEM (n = 13) or ESC/PBO (n = 13), and completed baseline and 3-month follow-up resting state magnetic resonance imaging scans. Multi-block partial least squares correlation analysis was used to evaluate the impact of treatment on within-network DMN connectivity changes and their relationship with symptom improvement at 3 months (controlling for age and sex). RESULTS A significant latent variable was identified, reflecting within-network DMN connectivity changes correlated with symptom improvement (p = .01). Specifically, although overall group differences in within-network DMN connectivity changes failed to reach significance, increased within-network connectivity of posterior/lateral DMN regions (precuneus, angular gyrus, superior/middle temporal cortex) was more strongly and positively correlated with symptom improvement in the ESC/MEM group (r = 0.97, 95% confidence interval: 0.86-0.98) than in the ESC/PBO group (r = 0.36, 95% confidence interval: 0.13-0.72). CONCLUSIONS Increased within-network connectivity of core DMN nodes was more strongly correlated with depressive symptom improvement with ESC/MEM than with ESC/PBO, supporting an improved engagement of brain circuitry implicated in the amelioration of depressive symptoms with combined ESC/MEM treatment in older adults with depression and subjective memory complaints.
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Affiliation(s)
- Lisa A Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Beatrix Krause-Sorio
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Prabha Siddarth
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Katherine L Narr
- Brain Mapping Center, Departments of Neurology, and Psychiatry and Biobehavioral Sciences, Los Angeles, California, USA
| | - Helen Lavretsky
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
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14
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Siafarikas N, Kirsebom BE, Srivastava DP, Eriksson CM, Auning E, Hessen E, Selbaek G, Blennow K, Aarsland D, Fladby T. Cerebrospinal fluid markers for synaptic function and Alzheimer type changes in late life depression. Sci Rep 2021; 11:20375. [PMID: 34645914 PMCID: PMC8514484 DOI: 10.1038/s41598-021-99794-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/28/2021] [Indexed: 01/11/2023] Open
Abstract
To explore markers for synaptic function and Alzheimer disease (AD) pathology in late life depression (LLD), predementia AD and normal controls (NC). A cross-sectional study to compare cerebrospinal fluid (CSF) levels of neurogranin (Ng), Beta-site amyloid-precursor-protein cleaving enzyme1 (BACE1), Ng/BACE1 ratio and Amyloid-β 42/40 ratio, phosphorylated-tau and total-tau in LLD with (LLD AD) or without (LLD NoAD) AD pathology, predementia AD and normal controls (NC). We included 145 participants (NC = 41; predementia AD = 66 and LLD = 38). LLD comprised LLD AD (n = 16), LLD NoAD (n = 19), LLD with non-AD typical changes (n = 3, excluded). LLD AD (pADJ < 0.05) and predementia AD (pADJ < 0.0001) showed significantly higher Ng than NC. BACE1 and Ng/BACE1 ratio were altered similarly. Compared to LLD NoAD, LLD AD showed significantly higher Ng (pADJ < 0.001), BACE1 (pADJ < 0.05) and Ng/BACE1 ratio (pADJ < 0.01). All groups had significantly lower Aβ 42/40 ratio than NC (predementia AD and LLD AD, p < 0.0001; LLD NoAD, p < 0.05). Both LLD groups performed similarly on tests of memory and executive function, but significantly poorer than NC. Synaptic function in LLD depended on AD pathology. LLD showed an association to Amyloid dysmetabolism. The LLD groups performed poorer cognitively than NC. LLD AD may be conceptualized as "predementia AD with depression".
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Affiliation(s)
- Nikias Siafarikas
- Department of Geriatric Psychiatry, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Bjørn-Eivind Kirsebom
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Deepak P Srivastava
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9NU, UK
| | - Cecilia M Eriksson
- Department of Geriatric Psychiatry, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | - Eirik Auning
- Department of Geriatric Psychiatry, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | - Erik Hessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Geir Selbaek
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit On Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway
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15
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Krause-Sorio B, Siddarth P, Laird KT, Ercoli L, Narr K, Barrio JR, Small G, Lavretsky H. [ 18F]FDDNP PET binding predicts change in executive function in a pilot clinical trial of geriatric depression. Int Psychogeriatr 2021; 33:149-156. [PMID: 31969201 PMCID: PMC7375908 DOI: 10.1017/s1041610219002047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Geriatric depression often presents with memory and cognitive complaints that are associated with increased risk for Alzheimer's disease (AD). In a parent clinical trial of escitalopram combined with memantine or placebo for geriatric depression and subjective memory complaints, we found that memantine improved executive function and delayed recall performance at 12 months (NCT01902004). In this report, we used positron emission tomography (PET) to assess the relationship between in-vivo amyloid and tau brain biomarkers and clinical and cognitive treatment response. DESIGN In a randomized double-blind placebo-controlled trial, we measured 2-(1-{6-[(2-[F18]fluoroethyl)(methyl)amino]-2-naphthyl}ethylidene) malononitrile ([18F]FDDNP) binding at baseline and assessed mood and cognitive performance at baseline, posttreatment (6 months), and naturalistic follow-up (12 months). PARTICIPANTS Twenty-two older adults with major depressive disorder and subjective memory complaints completed PET scans and were included in this report. RESULTS Across both treatment groups, higher frontal lobe [18F]FDDNP binding at baseline was associated with improvement in executive function at 6 months (corrected p = .045). This effect was no longer significant at 12 months (corrected p = .12). There was no association of regional [18F]FDDNP binding with change in mood symptoms (corrected p = .2). CONCLUSIONS [18F]FDDNP binding may predict cognitive response to antidepressant treatment. Larger trials are required to further test the value of [18F]FDDNP binding as a biomarker for cognitive improvement with antidepressant treatment in geriatric depression.
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Affiliation(s)
- Beatrix Krause-Sorio
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
| | - Prabha Siddarth
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
| | - Kelsey T. Laird
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
| | - Linda Ercoli
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
| | - Katherine Narr
- Brain Research Institute, 635 Charles E Young Drive South, Los Angeles, CA, 90095, USA
| | - Jorge R. Barrio
- Department of Molecular and Medical Pharmacology, The David Geffen UCLA School of Medicine, Los Angeles, CA 90095
| | - Gary Small
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
| | - Helen Lavretsky
- Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, 90095, USA
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16
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Cigiloglu A, Ozturk ZA, Efendioglu EM. How have older adults reacted to coronavirus disease 2019? Psychogeriatrics 2021; 21:112-117. [PMID: 33295036 DOI: 10.1111/psyg.12639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
AIM Outbreaks have a wide spectrum of psychosocial impact on individuals. This study aimed to investigate the psychosocial effects of measures to prevent the spread of the novel coronavirus disease on older adults in Turkey. METHODS A survey was conducted of 104 adults who had to stay at home during the pandemic. Participants' depressive symptoms, anxiety symptoms, nutritional status, health-related quality of life, and sleep quality were assessed. RESULTS The frequency of depressive and anxiety symptoms was 37.5% and 29.8%, respectively. The frequency of depressive symptoms was higher in women, individuals age ≥85 years, and those with less education and low monthly income. Anxiety symptom frequency was also higher in women and those with less education and low monthly income. Quality of life and sleep were worse in those with depressive symptoms and anxiety symptoms. CONCLUSION To our knowledge, this is the first published study to investigate the effect of a pandemic on the mood, anxiety symptoms, nutrition status, quality of life, and sleep of older adults during the pandemic period. Our findings indicate the importance of psychosocial support in older individuals during and after the pandemic period.
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Affiliation(s)
- Ahmet Cigiloglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Gaziantep, Turkey
| | - Zeynel Abidin Ozturk
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Gaziantep, Turkey
| | - Eyyup Murat Efendioglu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Gaziantep University, Gaziantep, Turkey
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17
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Bomfim AJDL, Chagas NMDS, Leal LR, Pessoa RMDP, Ferreira BLC, Chagas MHN. Cognitive performance of older adults with a low level of education with and without depression. Dement Neuropsychol 2021; 15:121-127. [PMID: 33907605 PMCID: PMC8049573 DOI: 10.1590/1980-57642021dn15-010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022] Open
Abstract
Major depression can develop in individuals aged 60 years or older and is commonly associated with cognitive decline in this population, especially the domains of working memory, attention, executive functions, and processing speed. Schooling is a protective factor with regard to cognitive decline. OBJECTIVE To compare the cognitive performance of community-dwelling older adults with a low level of schooling with and without major depression. METHODS A descriptive, analytical, cross-sectional study was conducted with 22 community-dwelling older adults with depression and 187 without depression. The following assessment tools were employed: Mini Mental Health Examination, Brief Cognitive Screening Battery, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Digit Span Test (forward and backward), and an object similarity test. RESULTS No statistically significant differences were found between the groups with and without depression on any of the tests. CONCLUSIONS This study demonstrated that there are no differences in the cognitive performance of older people with and without depression on neurocognitive tests commonly used in clinical practice. Future studies with different designs and methods as well as specific tests for older people with a low level of schooling could assist in the understanding of these relations and the mechanisms involved.
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Affiliation(s)
- Ana Julia de Lima Bomfim
- Department of Neurosciences and Behavioral Sciences,
Universidade de São Paulo – Ribeirão Preto, SP, Brazil
- Research Group on Mental Health, Cognition and Aging,
Universidade Federal de São Carlos – São Carlos, SP, Brazil
| | | | - Lívio Rodrigues Leal
- Department of Neurosciences and Behavioral Sciences,
Universidade de São Paulo – Ribeirão Preto, SP, Brazil
- Research Group on Mental Health, Cognition and Aging,
Universidade Federal de São Carlos – São Carlos, SP, Brazil
| | - Rebeca Mendes de Paula Pessoa
- Department of Neurosciences and Behavioral Sciences,
Universidade de São Paulo – Ribeirão Preto, SP, Brazil
- Research Group on Mental Health, Cognition and Aging,
Universidade Federal de São Carlos – São Carlos, SP, Brazil
| | - Bianca Letícia Cavalmoretti Ferreira
- Department of Neurosciences and Behavioral Sciences,
Universidade de São Paulo – Ribeirão Preto, SP, Brazil
- Research Group on Mental Health, Cognition and Aging,
Universidade Federal de São Carlos – São Carlos, SP, Brazil
| | - Marcos Hortes Nisihara Chagas
- Department of Neurosciences and Behavioral Sciences,
Universidade de São Paulo – Ribeirão Preto, SP, Brazil
- Research Group on Mental Health, Cognition and Aging,
Universidade Federal de São Carlos – São Carlos, SP, Brazil
- Bairral Institute of Psychiatry – Itapira, SP, Brazil
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18
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Combined treatment with escitalopram and memantine increases gray matter volume and cortical thickness compared to escitalopram and placebo in a pilot study of geriatric depression. J Affect Disord 2020; 274:464-470. [PMID: 32663977 PMCID: PMC7368564 DOI: 10.1016/j.jad.2020.05.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Geriatric depression with subjective cognitive complaints increases the risk of Alzheimer's Disease (AD). Memantine is a cognitive enhancer used to treat AD. In a 6-month double-blind randomized placebo-controlled trial of escitalopram and memantine (ESC/MEM), ESC/MEM improved cognition at 12 month in geriatric depression (NCT01902004). We now investigated structural neuroplastic changes at 3 months. METHODS Forty-one older depressed adults (mean age=70.43, SD=7.33, 26 female) were randomized to receive ESC/MEM or ESC/PBO. Mood scores (Hamilton Depression Rating Scale, HAMD) and high-resolution structural T1-weighted images were acquired at baseline and 3 months. Freesurfer 6.0 for image processing and General Linear Models was used to examine group differences in symmetrized percent change gray matter volume (GMV) and cortical thickness, controlling for age and intracranial volume. Nonparametric tests were used to investigate group differences in mood and subcortical volume change. RESULTS Among 27 completers (ESC/MEM n = 13; ESC/PBO n = 14), 62% achieved remission (HAMD≤6) with ESC/MEM and 43% with ESC/PBO (Fisher's exact p=.45). Change in HAMD did not differ between groups (F(1,23)=0.14, p=.7). GMV and thickness increased more with ESC/MEM than with ESC/PBO in the left middle and inferior temporal lobe, right medial, and lateral orbito-frontal cortex (OFC). LIMITATIONS included small sample size, dropout, and the lack of cognitive data at 3 months. CONCLUSIONS Although significant group differences in mood improvement were not observed, ESC/MEM resulted in increased GMV and cortical thickness in several brain regions compared to placebo. Larger longitudinal clinical trials can further examine the neuroprotective effect of memantine in geriatric depression.
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Agüera-Ortiz L, Claver-Martín MD, Franco-Fernández MD, López-Álvarez J, Martín-Carrasco M, Ramos-García MI, Sánchez-Pérez M. Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association. Front Psychiatry 2020; 11:380. [PMID: 32508684 PMCID: PMC7251154 DOI: 10.3389/fpsyt.2020.00380] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Present knowledge about depression in the elderly is still scarce and often controversial, despite its high frequency and impact. This article reports the results and most relevant conclusions of a Delphi-based consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. METHODS A 78-item questionnaire was developed by 7 highly specialized geriatric psychiatrists and was evaluated using the Modified Delphi technique in two rounds answered by 35 psychiatrists with an extensive expertise in geriatric depression. The topics and number of questions (in brackets) covered were: concepts, clinical aspects, and risk factors (12); screening and diagnosis (7); psychotic depression (17); depression and dementia (5); antidepressant drug treatment (18); non-pharmacological biological treatments (5); psychotherapeutic treatments (4); comorbidity and preventive aspects (6); professional training needed (4). In addition, the expert panel's opinion on the antidepressants of choice in 21 common comorbid conditions and on different strategies to approach treatment-resistant cases in terms of both efficacy and safety was assessed. RESULTS After the two rounds of the Delphi process, consensus was reached for 59 (75.6%) of the 78 items. Detailed recommendations are included in the text. Considering pharmacological treatments, agomelatine was the most widely mentioned drug to be recommended in terms of safety in comorbid conditions. Desvenlafaxine, sertraline, and vortioxetine, were the most frequently recommended antidepressants in comorbid conditions in general. Combining parameters of efficacy and safety, experts recommended the following steps to address cases of treatment resistance: 1. Escalation to the maximum tolerated dose; 2. Change of antidepressant; 3. Combination with another antidepressant; 4. Potentiation with an antipsychotic or with lamotrigine; 5. Potentiation with lithium; 6. Potentiation with dopamine agonists or methylphenidate. DISCUSSION AND CONCLUSIONS Consensus was reached for a high number of items as well as for the management of depression in the context of comorbid conditions and in resistant cases. In the current absence of sufficient evidence-based information, our results can be used to inform medical doctors about clinical recommendations that might reduce uncertainty in the diagnosis and treatment of elderly patients with depressive disorders.
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Affiliation(s)
- Luis Agüera-Ortiz
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | | | - Jorge López-Álvarez
- Servicio de Psiquiatría, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - María Isabel Ramos-García
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Sánchez-Pérez
- Unidad de Psiquiatría Geriátrica, Hospital Sagrat Cor. Martorell, Barcelona, Spain
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Xu H, Koszycki D. Interpersonal Psychotherapy for Late-life Depression and its Potential Application in China. Neuropsychiatr Dis Treat 2020; 16:1919-1928. [PMID: 32821108 PMCID: PMC7423351 DOI: 10.2147/ndt.s248027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
Interpersonal psychotherapy (IPT) is a time-limited, structured, interpersonally oriented psychotherapy, with demonstrated efficacy for the treatment of major depression across the lifespan. IPT uses a medical model of illness and links depressed mood to four research-informed interpersonal problem areas: complicated grief, role transitions, role disputes, and interpersonal deficits/sensitivity. The IPT model of vulnerability to depression nicely dovetails with interpersonal issues that are faced by older adults, and this article focuses on the application of IPT for late-life depression in China. The group format of IPT may be a practical and efficient method of improving access to an established depression-focused treatment for China's rapidly aging population and has the advantage of providing important social support for patients who feel lonely, isolated, and stigmatized. Short-term interventions like IPT are more cost-effective from a public health perspective and can easily be delivered in primary care facilities, where many elderly patients receive care. IPT is effective in different cultures, and possible cultural adaptations of IPT for older adults in China are discussed herein.
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Affiliation(s)
- Hua Xu
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Faculty of Education and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Koszycki
- Faculty of Education and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada
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21
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Parasympathetic predominance is a risk factor for future depression: A prospective cohort study. J Affect Disord 2020; 260:232-237. [PMID: 31521861 DOI: 10.1016/j.jad.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/27/2019] [Accepted: 09/02/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Changes in parasympathetic activity have been associated with depression; however, it is not well understood whether these changes are a result of depression, or represent a compensatory mechanism protecting against it. We examined the association of autonomic nervous system activity with the risk of depression in euthymic individuals and those with subsyndromal depression using heart rate variability (HRV) analysis. METHODS From a community-based longitudinal cohort, 464 subjects from the baseline assessment and 253 who completed the 5-year follow-up visit were included in the cross-sectional and prospective analyses, respectively. Linear regression analysis was used to investigate the association of HRV measures with the current and future GDS scores. Logistic regression analysis examined the effect of HRV on future risk of SSD. RESULTS Low-frequency power (LFN), high-frequency power (HFN), and the LFN/HFN ratio at the baseline assessment were associated with the GDS score at the 5-year follow-up assessment; however, they were not associated with the GDS score at the baseline assessment. High HFN indicated an increased risk of depression at the 5-year follow-up assessment in euthymic subjects (OR = 3.025, 95% CI = 1.184 - 7.726, p = 0.021). LIMITATIONS HRV was not measured at the follow-up assessment and the interval between the assessments was comparatively long. Five-minute ECG recordings were used, and all participants were 65 years old or older. CONCLUSIONS Parasympathetic predominance may precede the onset of depression in older adults.
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22
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Wong HL, Chan WC, Wong YL, Wong SN, Yung HY, Wong SMC, Cheng PWC. High-definition transcranial direct current stimulation-An open-label pilot intervention in alleviating depressive symptoms and cognitive deficits in late-life depression. CNS Neurosci Ther 2019; 25:1244-1253. [PMID: 31657152 PMCID: PMC6834921 DOI: 10.1111/cns.13253] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022] Open
Abstract
The efficacy of high-definition transcranial direct current stimulation (HD-tDCS) in late-life depression (LLD) remains unknown due to limited research on its therapeutic effects on the hallmarks of LLD-the depressive and cognitive symptoms. The present open-label pilot study aimed to examine the effectiveness of HD-tDCS as an augmentation therapy with antidepressants in improving the depressive and cognitive symptoms for LLD. Significant improvements were hypothesized in the depressive, cognitive, and daily functioning outcomes over time. A total of 15 subjects with LLD (13 females, mean age = 73.27 ± 6.25) received five consecutive daily sessions of 20-minute active HD-tDCS interventions weekly for 2 weeks, with a 2 mA anodal stimulation over F3 and cathodal stimulation over FC1, AF3, F7, and FC5. Depressive symptoms and cognitive and daily functioning were assessed across five assessment timepoints. The results revealed that the HD-tDCS was effective in reducing the depressive severity and the remission rates, with a sustained effect at both the 1-month and 3-month follow-up. Pre-post improvements were seen in the overall cognitive functioning and in verbal fluency, but not in executive functioning. Our pilot study provides a preliminary result of HD-tDCS in LLD, which was a safe and effective treatment in alleviating depressive symptoms, with mild cognitive improvements observed. Further larger scale randomized controlled trials are needed to confirm this result.
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Affiliation(s)
- Hau-Lam Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Yiu-Lung Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Sze-Nga Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - Hui-Yan Yung
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
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23
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Melrose S. Late life depression: nursing actions that can help. Perspect Psychiatr Care 2019; 55:453-458. [PMID: 30499598 DOI: 10.1111/ppc.12341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This article explains the symptoms of late life depression (LLD) and discusses evidence-informed actions that nurses can implement to provide older adults with the help they need. CONCLUSIONS Recognizing and addressing depression in older adults can enhance quality of life. PRACTICE IMPLICATIONS People with LLD may not appear sad or express feelings of depression. Instead, they demonstrate loss of interest, frailty, cognitive impairment, suicidal ideation, unexplained somatic complaints, and loneliness. Documenting symptoms, screening, and assessing suicidal ideation are essential. Positive outcomes are associated with antidepressant medications, cognitive behavioral therapy, electroconvulsive therapy, neuromodulation therapies, and exercise.
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Affiliation(s)
- Sherri Melrose
- Faculty of Health Disciplines, Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta
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24
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Kim YB, Lee SH. Social Support Network Types and Depressive Symptoms Among Community-Dwelling Older Adults in South Korea. Asia Pac J Public Health 2019; 31:367-375. [PMID: 30966800 DOI: 10.1177/1010539519841287] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purposes of this study were to derive empirical types of social support networks in a sample of 1000 community-dwelling, older Koreans 65 years of age or older and examine which types of social support network are associated with a lower risk of depressive symptoms. Depressive symptom was assessed using the Korean version of the Geriatric Depression Scale-Short Form. Using K-means cluster analysis, we identified 4 social support network types: friend, family, restricted, and diverse. Multivariate linear regression analysis revealed that diverse and family support networks were protective against depressive symptoms, whereas restricted support networks were least. Encouraging older people to develop a variety of social support networks with family and friends may help prevent depressive symptoms in the community-dwelling elderly. These findings extended prior studies and provided valuable information on how to prevent depressive symptoms of the community-dwelling elderly.
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25
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Bomfim AJDL, Ribeiro RADS, Chagas MHN. Recognition of dynamic and static facial expressions of emotion among older adults with major depression. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:159-166. [PMID: 30942267 DOI: 10.1590/2237-6089-2018-0054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The recognition of facial expressions of emotion is essential to living in society. However, individuals with major depression tend to interpret information considered imprecise in a negative light, which can exert a direct effect on their capacity to decode social stimuli. OBJECTIVE To compare basic facial expression recognition skills during tasks with static and dynamic stimuli in older adults with and without major depression. METHODS Older adults were selected through a screening process for psychiatric disorders at a primary care service. Psychiatric evaluations were performed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Twenty-three adults with a diagnosis of depression and 23 older adults without a psychiatric diagnosis were asked to perform two facial emotion recognition tasks using static and dynamic stimuli. RESULTS Individuals with major depression demonstrated greater accuracy in recognizing sadness (p=0.023) and anger (p=0.024) during the task with static stimuli and less accuracy in recognizing happiness during the task with dynamic stimuli (p=0.020). The impairment was mainly related to the recognition of emotions of lower intensity. CONCLUSIONS The performance of older adults with depression in facial expression recognition tasks with static and dynamic stimuli differs from that of older adults without depression, with greater accuracy regarding negative emotions (sadness and anger) and lower accuracy regarding the recognition of happiness.
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Affiliation(s)
| | | | - Marcos Hortes Nisihara Chagas
- Departamento de Psicologia, Universidade Federal de São Carlos, São Carlos, SP, Brazil.,Departamento de Gerontologia, Universidade Federal de São Carlos, São Carlos, SP, Brazil
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26
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Zhang QE, Ling S, Li P, Zhang S, Ng CH, Ungvari GS, Wang LJ, Lee SY, Wang G, Xiang YT. The association between urinary Alzheimer-associated neuronal thread protein and cognitive impairment in late-life depression: a controlled pilot study. Int J Biol Sci 2018; 14:1497-1502. [PMID: 30263001 PMCID: PMC6158723 DOI: 10.7150/ijbs.25000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/21/2018] [Indexed: 12/22/2022] Open
Abstract
Accumulation of tau protein is associated with both Alzheimer's disease (AD) and late-life depression (LLD). Alzheimer-associated neuronal thread protein (AD7c-NTP), which is closely linked with the tau protein, is elevated in the cerebrospinal fluid and urine of AD patients. This study examined the association between urinary AD7c-NTP and late-life depression with cognitive impairment. One hundred and thirty-eight subjects were recruited into late-life depression with cognitive impairment (LLD-CI, n=52), late-life depression without cognitive impairment (LLD-NCI, n=29), AD (n=27), and healthy control (HC, n=30) groups. The level of urinary AD7c-NTP was measured using the enzyme-linked immunosorbent assay method. The Montreal Cognitive Assessment scale (MoCA), Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HAMA) were used to assess cognitive functions and depressive and anxiety symptoms in the AD and LLD groups. Urinary levels of AD7c-NTP in the LLD-CI group (1.0±0.7ng/ml) were significantly higher than both the LLD-NCI (0.5±0.3ng/ml) and HC groups (0.5±0.3ng/ml), but lower than in the AD group (1.6±1.7 ng/ml). No significant associations were found in the level of urinary AD7c-NTP in relation to age, gender, education and MoCA in the LLD-CI group. The level of urinary AD7c-NTP appears to be associated with cognitive impairment in late-life depression and may be a potential biomarker for early identification of cognitive impairment in LLD.
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Affiliation(s)
- Qing-E Zhang
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Sihai Ling
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Peng Li
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Saina Zhang
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- The University of Notre Dame Australia / Graylands Hospital, Perth, Australia
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Gang Wang
- National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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Suicidal Ideation among the Chinese Elderly and Its Correlates: A Comparison between the Rural and Urban Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030422. [PMID: 29495615 PMCID: PMC5876967 DOI: 10.3390/ijerph15030422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/08/2018] [Accepted: 02/25/2018] [Indexed: 11/30/2022]
Abstract
Background: As China is going through a profound aging process, the mental health of the elderly is becoming an issue. As in many other societies, the elderly in China is a population at high risk of suicide; Methods: Data for the study were taken from the Sample Survey of the Aged Population in Urban/Rural China (SSAPUR) accomplished in 2010 by the China Ministry of Civil Affairs. The valid sample for this study was composed of 18,683 individuals, including 9416 urban residents and 9267 rural residents both aged 60 or more years; Results: Logistic regression analyses showed that household income and expenditure, the number of children, chronic diseases, disability of daily living, depression, the frequency of visiting neighbors and having friends or relatives who can help or not had remarkable effects on the suicidal ideation among urban and rural old people. Gender, education, political affiliation, marital status and self-rated health status did not work on the dependent variable. However, some risk factors for suicidal ideation among the Chinese elderly were different between rural and urban regions; Conclusions: We should take different measures when facing the different groups of the elderly.
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Stark A, Kaduszkiewicz H, Stein J, Maier W, Heser K, Weyerer S, Werle J, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG, Scherer M. A qualitative study on older primary care patients' perspectives on depression and its treatments - potential barriers to and opportunities for managing depression. BMC FAMILY PRACTICE 2018; 19:2. [PMID: 29295706 PMCID: PMC5751798 DOI: 10.1186/s12875-017-0684-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
Background Depression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare. Methods Qualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis. Results The study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression. Conclusions This study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder. Electronic supplementary material The online version of this article (10.1186/s12875-017-0684-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Stark
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Michaelisstr. 5, 24105, Kiel, Germany.
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Kathrin Heser
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Straße 25, 53105, Bonn, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J 5, 68159, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J 5, 68159, Mannheim, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Silke Mamone
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Martin Scherer
- Institute of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Haigh EAP, Bogucki OE, Sigmon ST, Blazer DG. Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions. Am J Geriatr Psychiatry 2018; 26:107-122. [PMID: 28735658 DOI: 10.1016/j.jagp.2017.06.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/16/2022]
Abstract
Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.
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30
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McCall WV, Lisanby SH, Rosenquist PB, Dooley M, Husain MM, Knapp RG, Petrides G, Rudorfer MV, Young RC, McClintock SM, Mueller M, Prudic J, Greenberg RM, Weiner RD, Bailine SH, Riley MA, McCloud L, Kellner CH. Effects of a Course of Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy Combined With Venlafaxine on Insomnia Symptoms in Elderly Depressed Patients. J Clin Psychiatry 2018; 79:16m11089. [PMID: 28742292 PMCID: PMC6704475 DOI: 10.4088/jcp.16m11089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Antidepressant medications have a variety of effects on sleep, apart from their antidepressant effects. It is unknown whether electroconvulsive therapy (ECT) has effects on perceived sleep in depressed patients. This secondary analysis examines the effects of ECT on perceived sleep, separate from its antidepressant effects. METHODS Elderly patients with major depressive disorder, as defined by DSM-IV, received open-label high-dose, right unilateral ultrabrief pulse ECT, combined with venlafaxine, as part of participating in phase 1 of the National Institute of Mental Health-supported study Prolonging Remission in Depressed Elderly (PRIDE). Phase 1 of PRIDE participant enrollment period extended from February 2009 to August 2014. Depression severity was measured with the Hamilton Depression Rating Scale-24 item (HDRS₂₄), and measures of insomnia severity were extracted from the HDRS₂₄. Participants were characterized at baseline as either "high-insomnia" or "low-insomnia" subtypes, based upon the sum of the 3 HDRS₂₄ sleep items as either 4-6 or 0-3, respectively. Insomnia scores were followed during ECT and were adjusted for the sum of all the HDRS₂₄ non-sleep items. Generalized linear models were used for longitudinal analysis of insomnia scores. RESULTS Two hundred forty patients participated, with 48.3% in the high-insomnia and 51.7% in the low-insomnia group. Although there was a reduction in the insomnia scores in the high-insomnia group, only 12.4% of them experienced remission of insomnia after a course of ECT, despite an increase in utilization of sleep aids across the course of ECT, from 8.6% to 23.2%. The degree of improvement in insomnia symptoms paralleled the degree of improvement in non-insomnia symptoms. A "low" amount of improvement on the sum of the HDRS non-insomnia items (HDRS-sleep) was accompanied by a "low" amount of improvement in insomnia scores (change of -1.6 ± 1.2, P < .0001), while a "high" amount of improvement on the sum of the HDRS non-insomnia items was accompanied by a "higher" amount of improvement in insomnia scores (change of -3.1 ± 1.6, P < .0001). After adjustment for non-insomnia symptoms, there was no change in insomnia in the low-insomnia group. CONCLUSIONS We found that ECT, combined with venlafaxine, has a modest anti-insomnia effect that is linked to its antidepressant effect. Most patients will have some degree of residual insomnia after ECT, and will require some consideration of whether additional, targeted assessment and treatment of insomnia is warranted. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01028508.
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Affiliation(s)
- W. Vaughn McCall
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Sarah H. Lisanby
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine, Durham, North Carolina
| | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Mary Dooley
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | - Mustafa M. Husain
- Department of Psychiatry; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca G. Knapp
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Robert C. Young
- Department of Psychiatry; Weill Cornell Medicine; New York, New York
| | - Shawn M. McClintock
- Department of Psychiatry; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Martina Mueller
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina, Charleston, South Carolina
| | - Joan Prudic
- Department of Psychiatry; Columbia University and New York State Psychiatric Institute, New York, New York
| | | | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences; Duke University School of Medicine, Durham, North Carolina
| | | | - Mary Anne Riley
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Laryssa McCloud
- Department of Psychiatry and Health Behavior; Augusta University/Medical College of Georgia, Augusta, Georgia
| | - Charles H. Kellner
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai, New York, New York
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31
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Lam RW, Ismail Z, MacQueen GM, Milev RV, Parikh SV, Ravindran AV, Kennedy SH. Response to Letter Regarding CANMAT Recommendations for the Pharmacological Treatment of Late-life Depression. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:353-354. [PMID: 28525728 PMCID: PMC5459233 DOI: 10.1177/0706743717700878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Glenda M MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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32
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Sun Y, Zhang D, Yang Y, Wu M, Xie H, Zhang J, Jia J, Su Y. Social Support Moderates the Effects of Self-esteem and Depression on Quality of Life Among Chinese Rural Elderly in Nursing Homes. Arch Psychiatr Nurs 2017; 31:197-204. [PMID: 28359433 DOI: 10.1016/j.apnu.2016.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Yaoyao Sun
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Dan Zhang
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Yang Yang
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Menglian Wu
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Hui Xie
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Jie Zhang
- School of Public Health, Shandong University, Jinan 250012, Shandong, China; Department of Sociology, State University of New York Buffalo State, Buffalo, NY 14222, USA
| | - Jihui Jia
- School of Nursing, Shandong University, Jinan 250012, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, Jinan 250012, Shandong, China; School of Nursing, Shandong University, Jinan 250012, Shandong, China.
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Hoell A, Weyerer S, Maier W, Wagner M, Scherer M, Stark A, Kaduszkiewicz H, Wiese B, König HH, Bock JO, Stein J, Riedel-Heller SG. The impact of depressive symptoms on utilization of home care by the elderly: Longitudinal results from the AgeMooDe study. J Affect Disord 2016; 204:247-54. [PMID: 27543722 DOI: 10.1016/j.jad.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/16/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization. METHODS Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM). RESULTS GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care. LIMITATIONS The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms. CONCLUSIONS Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.
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Affiliation(s)
- Andreas Hoell
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
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MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJV, Kennedy SH, Lam RW, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 6. Special Populations: Youth, Women, and the Elderly. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:588-603. [PMID: 27486149 PMCID: PMC4994788 DOI: 10.1177/0706743716659276] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section on "Special Populations" is the sixth of six guidelines articles. RESULTS Recent studies inform the treatment of MDD in children and adolescents, pregnant and breastfeeding women, women in perimenopause or menopause, and the elderly. Evidence for efficacy of treatments in these populations is more limited than for the general adult population, however, and risks of treatment in these groups are often poorly studied and reported. CONCLUSIONS Despite the limited evidence base, extant data and clinical experience suggest that each of these special populations can benefit from the systematic application of treatment guidelines for treatment of MDD.
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Affiliation(s)
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | | | - Meir Steiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Cunha RA. How does adenosine control neuronal dysfunction and neurodegeneration? J Neurochem 2016; 139:1019-1055. [PMID: 27365148 DOI: 10.1111/jnc.13724] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/23/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
The adenosine modulation system mostly operates through inhibitory A1 (A1 R) and facilitatory A2A receptors (A2A R) in the brain. The activity-dependent release of adenosine acts as a brake of excitatory transmission through A1 R, which are enriched in glutamatergic terminals. Adenosine sharpens salience of information encoding in neuronal circuits: high-frequency stimulation triggers ATP release in the 'activated' synapse, which is locally converted by ecto-nucleotidases into adenosine to selectively activate A2A R; A2A R switch off A1 R and CB1 receptors, bolster glutamate release and NMDA receptors to assist increasing synaptic plasticity in the 'activated' synapse; the parallel engagement of the astrocytic syncytium releases adenosine further inhibiting neighboring synapses, thus sharpening the encoded plastic change. Brain insults trigger a large outflow of adenosine and ATP, as a danger signal. A1 R are a hurdle for damage initiation, but they desensitize upon prolonged activation. However, if the insult is near-threshold and/or of short-duration, A1 R trigger preconditioning, which may limit the spread of damage. Brain insults also up-regulate A2A R, probably to bolster adaptive changes, but this heightens brain damage since A2A R blockade affords neuroprotection in models of epilepsy, depression, Alzheimer's, or Parkinson's disease. This initially involves a control of synaptotoxicity by neuronal A2A R, whereas astrocytic and microglia A2A R might control the spread of damage. The A2A R signaling mechanisms are largely unknown since A2A R are pleiotropic, coupling to different G proteins and non-canonical pathways to control the viability of glutamatergic synapses, neuroinflammation, mitochondria function, and cytoskeleton dynamics. Thus, simultaneously bolstering A1 R preconditioning and preventing excessive A2A R function might afford maximal neuroprotection. The main physiological role of the adenosine modulation system is to sharp the salience of information encoding through a combined action of adenosine A2A receptors (A2A R) in the synapse undergoing an alteration of synaptic efficiency with an increased inhibitory action of A1 R in all surrounding synapses. Brain insults trigger an up-regulation of A2A R in an attempt to bolster adaptive plasticity together with adenosine release and A1 R desensitization; this favors synaptotocity (increased A2A R) and decreases the hurdle to undergo degeneration (decreased A1 R). Maximal neuroprotection is expected to result from a combined A2A R blockade and increased A1 R activation. This article is part of a mini review series: "Synaptic Function and Dysfunction in Brain Diseases".
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Affiliation(s)
- Rodrigo A Cunha
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,FMUC-Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Fawale MB, Ibigbami O, Ismail I, Mustapha AF, Komolafe MA, Olamoyegun MA, Adedeji TA. Risk of obstructive sleep apnea, excessive daytime sleepiness and depressive symptoms in a Nigerian elderly population. ACTA ACUST UNITED AC 2016; 9:106-11. [PMID: 27656275 PMCID: PMC5021957 DOI: 10.1016/j.slsci.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/09/2016] [Accepted: 05/20/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the risk of obstructive sleep apnea (OSA) in a primary care population of elderly Nigerians and to determine its correlates. METHODS Clinical and demographic data of 414 elderly individuals in a primary care clinic were obtained. Their risk of OSA was estimated using Berlin questionnaire while Epworth sleepiness scale and the Center for Epidemiologic Studies Depression Scale (CESD-10) were also administered. RESULTS Of the 414 subjects, 96 (23.2%) met the criteria for a high risk for OSA with a male to female ratio of 1:1. Subjects at high OSA risk (high OSA risk group) were younger than those at low OSA risk (low OSA risk group) (71.4±6.8 vs 73.6±7.7, p=0.011). Mean body mass index (BMI, kg/m(2)) (27.3±5.8 vs 24.7±5.1, p<0.001) and waist circumference (WC, cm) (90.7±13.1 vs 86.5±13.9, p=0.011) were higher in the high OSA risk group compared with the low OSA risk group. A total of 215 (51.9%) and 62 (15.0%) subjects had clinically significant depressive symptoms (CESD-10 score≥10) and excessive daytime sleepiness (EDS), respectively. On regression, the odds of EDS, depressive symptoms, increased BMI and younger age were significantly higher in the high OSA risk group compared with the low OSA risk group. CONCLUSIONS High risk for OSA and depressive symptoms are common in our sample of elderly Nigerians. Depressive symptoms, EDS, BMI and age independently predict high OSA risk in the elderly.
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Affiliation(s)
- Michael B. Fawale
- Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Corresponding author.
| | | | - Ishaq Ismail
- Department of Family Medicine, State Hospital, Ilesa, Nigeria
| | - Adekunle F. Mustapha
- Neurology Unit, Department of Medicine, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Morenikeji A. Komolafe
- Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Michael A. Olamoyegun
- Endocrinology Unit, Department of Medicine, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Tewogbade A. Adedeji
- Department of Chemical Pathology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Stein J, Pabst A, Weyerer S, Werle J, Maier W, Heilmann K, Scherer M, Stark A, Kaduszkiewicz H, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG. The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study. J Affect Disord 2016; 193:309-17. [PMID: 26774519 DOI: 10.1016/j.jad.2015.12.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/03/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored. METHODS As part of the study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)", a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted. RESULTS This study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status. LIMITATIONS The conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design. CONCLUSIONS The study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Katharina Heilmann
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Silke Mamone
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
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Ghazavi Z, Feshangchi S, Alavi M, Keshvari M. Effect of a Family-Oriented Communication Skills Training Program on Depression, Anxiety, and Stress in Older Adults: A Randomized Clinical Trial. Nurs Midwifery Stud 2016; 5:e28550. [PMID: 27331053 PMCID: PMC4915212 DOI: 10.17795/nmsjournal28550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 10/18/2015] [Accepted: 10/19/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Older adults face several physical and psychological problems such as hearing loss, vision loss, and memory loss, which diminish the quality of their communication. Poor communication in turn affects their psychological wellbeing and induces substantial depression, anxiety, and stress. The family has an important role in the mental health of older adults. OBJECTIVES This study aimed to investigate the effect of a family-oriented communication skills training program on depression, anxiety, and stress in older adults. PATIENTS AND METHODS For this randomized controlled clinical trial, we enrolled 64 older adults from two healthcare centers affiliated to the Isfahan University of Medical Sciences. The subjects were randomly allocated to an experimental group (n = 32) and a control group (n = 32). In the experimental group, older adults along with their primary caregiver participated in six sessions of communication skill education. The control group participated in two training sessions on nutrition and exercise. All participants answered the DASS21 questionnaire three times-at the start of the study, at the end of the sixth week, and a month after the last educational session of the experimental group. Data were analyzed using chi-square, Fisher's exact and t tests and by repeated measures analysis of variance (ANOVA). RESULTS In the experimental group, the mean depression score significantly reduced from 10.56 ± 3.34 before intervention to 7.46 ± 2.80 and 6.30 ± 2.75 after intervention and at follow-up, respectively; the mean anxiety score significantly reduced from 8.46 ± 1.88 before intervention to 5.83 ± 1.93 and 5.80 ± 2.12 after intervention and at follow-up, respectively; and the mean stress score significantly decreased from 11.40 ± 4.53 before intervention to 8.90 ± 3.81 and 8.43 ± 3.31 after intervention and at follow-up, respectively (P < 0.05 for all three domains). In contrast, the control group did not show any significant change in the mean depression, anxiety, and stress scores. CONCLUSIONS Family-oriented education on communication skills could reduce depression, anxiety, and stress in the elderly. Therefore, such programs should be adopted as a non-pharmacological and cost-effective method for reducing depression, anxiety, and stress in older adults.
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Affiliation(s)
- Zahra Ghazavi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Simin Feshangchi
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mousa Alavi
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mahrokh Keshvari
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Affiliation(s)
- Heba El Bayoumi
- From the Department of Community Health Sciences, University of Calgary (El Bayoumi); and the Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary (Ismail), Calgary, Alta
| | - Zahinoor Ismail
- From the Department of Community Health Sciences, University of Calgary (El Bayoumi); and the Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary (Ismail), Calgary, Alta
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Gálvez V, Ho KA, Alonzo A, Martin D, George D, Loo CK. Neuromodulation therapies for geriatric depression. Curr Psychiatry Rep 2015; 17:59. [PMID: 25995098 DOI: 10.1007/s11920-015-0592-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is frequent in old age and its prognosis is poorer than in younger populations. The use of pharmacological treatments in geriatric depression is limited by specific pharmacodynamic age-related factors that can diminish tolerability and increase the risk of drug interactions. The possibility of modulating cerebral activity using brain stimulation techniques could result in treating geriatric depression more effectively while reducing systemic side effects and medication interactions. This may subsequently improve treatment adherence and overall prognosis in the older patient. Among clinically available neuromodulatory techniques, electroconvulsive therapy (ECT) remains the gold standard for the treatment of severe depression in the elderly. Studies have proven that ECT is more effective and has a faster onset of action than antidepressants in the treatment of severe, unipolar, geriatric depression and that older age is a predictor of rapid ECT response and remission. The application of novel and more tolerable forms of ECT for geriatric depression is currently being examined. Preliminary results suggest that right unilateral ultrabrief ECT (RUL-UB ECT) is a promising intervention, with similar efficacy to brief-pulse ECT and fewer adverse cognitive effects. Overall findings in repetitive transcranial magnetic stimulation (rTMS) suggest that it is a safe intervention in geriatric depression. Higher rTMS stimulation intensity and more treatments may need to be given in the elderly to achieve optimal results. There is no specific data on vagus nerve stimulation in the elderly. Transcranial direct current stimulation, magnetic seizure therapy and deep brain stimulation are currently experimental, and more data from geriatric samples is needed.
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Affiliation(s)
- Verònica Gálvez
- School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia
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Ismail Z, Malick A, Smith EE, Schweizer T, Fischer C. Depression versus dementia: is this construct still relevant? Neurodegener Dis Manag 2014; 4:119-26. [PMID: 24832029 DOI: 10.2217/nmt.14.5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Cognitive impairment has long been identified as a component of late-life depression (LLD), and depressive symptoms are common in neurodegeneration. Depression may confer a greater risk of cognitive decline in a cognitively intact population and further cognitive decline in a mild cognitive impairment population compared with those without depression. Exploration of the link between cognitive impairment in LLD and the depressive features of neurodegeneration is an essential part of a diagnostic algorithm. In this review, we will discuss these links; we will address depressive symptoms as a risk factor for dementia and as a prodrome to dementia. We will review clinical subtypes and imaging markers as predictors of development of dementia in depressed patients and explore vascular etiologies. We will also explore LLD and dementia as a spectrum, rather than mutually exclusive diagnostic entities.
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Affiliation(s)
- Zahinoor Ismail
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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