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Heisey HD, Qualls C, Villareal DT, Segoviano-Escobar MB, Nava MLD, Gatchel JR, Kunik ME. Depressive Symptoms are Associated With C-Reactive Protein in Older Adults With Obesity. J Geriatr Psychiatry Neurol 2024; 37:332-338. [PMID: 37950647 PMCID: PMC11087374 DOI: 10.1177/08919887231215041] [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: 04/05/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVES To test the hypothesis that depressive symptoms vary with high-sensitivity C-reactive protein (hs-CRP), among older adults with obesity. METHODS This was a cross-sectional, secondary analysis of baseline data from two related lifestyle intervention trials. The study sample comprises 148 consecutively recruited, community-dwelling older adults (age >=65 years) without severe psychiatric illness and with body mass index >=30 kg/m2. Logarithmically transformed GDS was analyzed as the dependent variable. Independent variables included log-transformed hs-CRP and covariates: sex, age, and concurrent use of antidepressant medication at baseline. An additional analysis was performed using binary conversion of the GDS scores, wherein a cutoff score of 5 was considered positive for depressive symptoms. RESULTS Sample mean GDS score was 2.7 (SD 3.0, range 0 - 14). A significant multivariate model of GDS scores (R2 = .089, F = 3.5, P = .010) revealed log-transformed hs-CRP (P = .017) and male sex (P = .012) as associated with depressive symptoms. Supplemental analysis demonstrated associations between depressive symptoms and log-transformed hs-CRP (OR 2.17, P = .001) and between depressive symptoms and male sex (OR 3.78, P = .013). Univariate logistic regression found hs-CRP to be associated with depressive symptoms. CONCLUSIONS In older adults with obese BMI, male sex and higher hs-CRP are associated with depression, even in a group with relatively minimal depressive symptoms. Hs-CRP may offer clinical utility as a biomarker for depression among older adults with obese BMI, even among those with non-severe psychiatric symptomatology.
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Affiliation(s)
- Henry D. Heisey
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Clifford Qualls
- Department of Mathematics and Statistics, University of New Mexico School of Medicine, Albuquerque, NM, United States
- The School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Dennis T. Villareal
- Michael E. DeBakey Veterans Affairs Medical Center, Center for Translational Research on Inflammatory Diseases, Houston, TX, United States
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX, United States
| | - Martha Belen Segoviano-Escobar
- Michael E. DeBakey Veterans Affairs Medical Center, Center for Translational Research on Inflammatory Diseases, Houston, TX, United States
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX, United States
| | - Maria Liza Duremdes Nava
- Michael E. DeBakey Veterans Affairs Medical Center, Center for Translational Research on Inflammatory Diseases, Houston, TX, United States
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX, United States
| | - Jennifer R. Gatchel
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, McLean Hospital, Belmont, MA, United States
| | - Mark E. Kunik
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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2
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Zhao H, Li H, Ding Y, Li Z, Huang Y. The relationship between apathy and nonparametric variables of rest activity rhythm in older adults with cerebral small vessel disease. Chronobiol Int 2023; 40:1574-1581. [PMID: 37990547 DOI: 10.1080/07420528.2023.2282467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
The goal of the current study was to demonstrate if the rest-activity rhythm (RAR) was altered in apathetic older adults with cerebral small vessel disease (CSVD) and find out the relationship between apathy/depression severity and RAR features in CSVD patients. This is a cross-sectional observational investigation including 53 CSVD cases (54.74% men), aged 70.70 ± 6.18 years old. The participants were assessed by neuropsychiatric inventory (NPI) subscale of apathy (NPI-apathy) and depression (NPI-depression) in succession, according to updated diagnostic criteria for apathy (DCA). Each subject wore an actigraph device (ActiGraph GT3X) in their nondominant hand for 7 days to collect raw data. Using a non-parametric methodological analysis, this study determined RAR variables such as interdaily stability (IS), intraday variability (IV) and relative amplitude (RA). Patients in the apathy-positive group had a higher Fazekas score than those in the apathy-negative group. IS, but not IV, RA, or objective sleep variables, differed between elderly patients with varying degrees of CSVD burden. Furthermore, apathy severity was statistically correlated with RA after adjusting for age, gender and education level, whereas depression severity was not associated with RAR variables. Finally, we discovered that the severity of apathy had no significant relationship with the severity of depression. All these findings indicated that the RAR altered in apathetic older adults with CSVD, and apathy was associated with decreased RAR amplitude.
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Affiliation(s)
- Hongyi Zhao
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Hong Li
- Department of Medical prevention and military operatiions, Center for Disease Control and Prevention of Central Theater Command, Beijing, China
| | - Yu Ding
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
| | - Zhiyi Li
- Department of Neurology, NO 984 Hospital of PLA, Beijing, China
| | - Yonghua Huang
- Department of Neurology, The Seventh-Medical Center of PLA General Hospital, Beijing, China
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3
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Bugge E, Wynn R, Mollnes TE, Reitan SK, Lapid M, Grønli OK. C-reactive protein levels and depression in older and younger adults - A study of 19,947 individuals. The Tromsø study. Brain Behav Immun Health 2022; 27:100571. [PMID: 36583067 PMCID: PMC9793216 DOI: 10.1016/j.bbih.2022.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Erlend Bugge
- University Hospital of North Norway, Regional Centre for Research and Education in Forensic Psychiatry and Psychology, University Hospital of North-Norway, Tromsoe, Norway,Corresponding author.
| | - Rolf Wynn
- UiT the Arctic University of Norway, Department of Clinical Medicine, Tromsoe, Norway
| | - Tom Eirik Mollnes
- Oslo University Hospital, Institute of Clinical Medicine, Department of Immunology, Oslo, Norway
| | - Solveig Klæbo Reitan
- Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Department of Mental Health, Trondheim, Norway
| | - Maria Lapid
- Mayo Clinic, Division of Consultation, Department of Psychiatry & Psychology, Rochester MN, USA
| | - Ole Kristian Grønli
- University Hospital of North Norway, Department of Geriatric Psychiatry, University Hospital of North-Norway, Tromsoe, Norway
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4
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Maruta M, Shimokihara S, Makizako H, Ikeda Y, Han G, Akasaki Y, Hidaka Y, Kamasaki T, Kubozono T, Ohishi M, Tabira T. Associations between apathy and comprehensive frailty as assessed by the Kihon Checklist among community-dwelling Japanese older adults. Psychogeriatrics 2022; 22:651-658. [PMID: 35753049 DOI: 10.1111/psyg.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment. METHODS We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders. RESULTS Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22-2.64; frailty: OR 3.24, 95% CI 1.63-6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001). CONCLUSIONS Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health.
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Affiliation(s)
- Michio Maruta
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, Kagoshima, Japan.,Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Suguru Shimokihara
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuriko Ikeda
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Gwanghee Han
- Visiting Researcher, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yoshihiko Akasaki
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Yuma Hidaka
- Department of Rehabilitation, Medical Corporation, Sanshukai, Okatsu Hospital, Kagoshima, Japan.,Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Taishiro Kamasaki
- Graduate School of Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takayuki Tabira
- Department of Occupational Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
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Subbanna M, Shivakumar V, Bhalerao G, Varambally S, Venkatasubramanian G, Debnath M. Variants of Th17 pathway-related genes influence brain morphometric changes and the risk of schizophrenia through epistatic interactions. Psychiatr Genet 2022; 32:146-155. [PMID: 35353801 DOI: 10.1097/ypg.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE T helper 17 (Th17) pathway has been reported to be abnormal in schizophrenia; however, it is not known whether variation within genes of this pathway has any impact on schizophrenia. Herein, the impact of genetic variations and gene-gene interactions of Th17 pathway-related genes on the risk, psychopathology, and brain volume was examined in schizophrenia patients. METHODS Functional polymorphisms within interleukin 6 ( IL6 )(rs1800795 and rs1800797), IL10 (rs1800872 and rs1800896), IL17A (rs2275913 and rs8193036), IL22 (rs2227484 and rs2227485), IL23R (rs1884444), and IL27 (rs153109 and rs181206) genes were studied in 224 schizophrenia patients and 226 healthy controls. These variants were correlated with the brain morphometry, analyzed using MRI in a subset of patients ( n = 117) and controls ( n = 137). RESULTS Patients carrying CC genotype of rs2227484 of IL22 gene had significantly higher apathy total score [ F (1,183) = 5.60; P = 0.019; partial ɳ 2 = 0.030]. Significant epistatic interactions between IL6 (rs1800797) and IL17A (rs2275913) genes were observed in schizophrenia patients. GG genotype of rs2275913 of IL17A gene was associated with reduced right middle occipital gyrus volume in schizophrenia patients ( T = 4.56; P < 0.001). CONCLUSION Interactions between genes of Th17 pathway impact the risk for schizophrenia. The variants of Th17 pathway-related genes seem to have a determining effect on psychopathology and brain morphometric changes in schizophrenia.
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Affiliation(s)
- Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences
| | - Venkataram Shivakumar
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
- Integrative Medicine
| | - Gaurav Bhalerao
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
| | - Shivarama Varambally
- Integrative Medicine
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, and Departments of
- Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences
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6
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Ceïde ME, Eguchi D, Ayers EI, Lounsbury DW, Verghese J. Mediation Analyses of the Role of Apathy on Motoric Cognitive Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127376. [PMID: 35742625 PMCID: PMC9224534 DOI: 10.3390/ijerph19127376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
Recent literature indicates that apathy is associated with poor cognitive and functional outcomes in older adults, including motoric cognitive risk syndrome (MCR), a predementia syndrome. However, the underlying biological pathway is unknown. The objectives of this study were to (1) examine the cross-sectional associations between inflammatory cytokines (Interleukin 6 (IL-6) and C-Reactive Protein (CRP)) and apathy and (2) explore the direct and indirect relationships of apathy and motoric cognitive outcomes as it relates to important cognitive risk factors. N = 347 older adults (≥65 years old) enrolled in the Central Control of Mobility in Aging Study (CCMA). Linear and logic regression models showed that IL-6, but not CRP was significantly associated with apathy adjusted for age, gender, and years of education (β = 0.037, 95% CI: 0.002-0.072, p = 0.04). Apathy was associated with a slower gait velocity (β = -14.45, 95% CI: -24.89-4.01, p = 0.01). Mediation analyses demonstrated that IL-6 modestly mediates the relationship between apathy and gait velocity, while apathy mediated the relationships between dysphoria and multimorbidity and gait velocity. Overall, our findings indicate that apathy may be an early predictor of motoric cognitive decline. Inflammation plays a modest role, but the underlying biology of apathy warrants further investigation.
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Affiliation(s)
- Mirnova E. Ceïde
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
- Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Correspondence: ; Tel.: +1-347-920-0112; Fax: +1-718-430-3829
| | - Daniel Eguchi
- Medical Program, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Emmeline I. Ayers
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
| | - David W. Lounsbury
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
| | - Joe Verghese
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, NY 10461, USA; (E.I.A.); (J.V.)
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7
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Zhang T, Zhang Y, Lv Z, Xiang J. Sarcopenia and motoric cognitive risk syndrome: a moderated mediation model. BMC Geriatr 2022; 22:141. [PMID: 35183116 PMCID: PMC8857782 DOI: 10.1186/s12877-022-02802-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/27/2022] [Indexed: 02/07/2023] Open
Abstract
Background Sarcopenia has been identified as a risk factor for cognitive impairment, and motoric cognitive risk syndrome (MCR) is a recently defined pre-dementia syndrome. It is not known whether they are related. We aimed to investigate the association and potential pathways between sarcopenia and MCR in the community elderly by establishing a moderated mediation model. Methods 846 community residents aged ≥ 60 years were recruited from May 2021 to September 2021 and had a comprehensive geriatric evaluation. The diagnosis of sarcopenia followed the criteria issued by the Asian Working Group for Sarcopenia in 2019. MCR was defined as subjective cognitive decline and slow gait. Apathy symptoms and physical activity were assessed by the Apathy Evaluation Scale (AES) and the International Physical Activity Questionnaire (IPAQ). Logistic regression and moderated mediation analyses were conducted to explore the association between the four. Results 60 (7.1%) had MCR among 846 participants. After full adjustment, sarcopenia (odds ratio [OR] = 3.81, 95% confidence interval [CI] = 1.69–8.60, P = 0.001), AES score (OR = 1.09, 95% CI = 1.04–1.14, P < 0.001), and IPAQ level (OR = 0.43, 95% CI = 0.28–0.66, P < 0.001) were associated with MCR. Apathy partially mediated the relationship between sarcopenia and MCR. Physical activity played a moderation role in the indirect pathway of the mediation model. The increase in physical activity can alleviate the indirect effect of sarcopenia on MCR. Conclusion We established a moderated mediation model to uncover the underlying association mechanism of sarcopenia and MCR preliminarily. These findings suggest that attention should be paid to the management of apathy and physical activity in the context of sarcopenia to prevent early dementia actively. Further validation is needed in future longitudinal studies.
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Teixeira AL, Salem H, Martins LB, Gonzales MM, Seshadri S, Suchting R. Factors Associated with Apathy in Alzheimer’s Disease: A Cross-Sectional Analysis of the Texas Alzheimer’s Research and Care Consortium (TARCC) Study. J Alzheimers Dis 2022; 86:403-411. [DOI: 10.3233/jad-215314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Apathy is among the most frequent neuropsychiatric syndromes in Alzheimer’s disease (AD). Objective: To determine the prevalence of apathy and the associated clinical and laboratorial parameters (focus on inflammatory biomarkers) in patients with dementia enrolled at the Texas Alzheimer’s Research and Care Consortium (TARCC) study. Methods: This is a cross-sectional analysis of TARCC baseline. Participants were evaluated through different clinical tools, including the Mini-Mental State Examination (MMSE) and the Lawton-Brody Instrumental Activities of Daily Life (IADL)/Physical Self-Maintenance Scale (PSMS). Apathy was defined by a positive response to the respective item in the Neuropsychiatric Inventory–Questionnaire applied to caregivers. Serum levels of 16 biomarkers were determined by HumanMap multiplex immunoassay. Comparisons between apathy versus non-apathy groups were carried out with non-parametric tests. Logistic regression and the least absolute shrinkage and selection operator (LASSO) were used to separately model apathy as a function of each biomarker, adjusted for the potential confounders. Results: From 1,319 patients with AD (M/F: 579/740, mean age ± SD: 75.3 ± 8.4), 373 (28.3%) exhibited apathy. When categorized according to the presence of apathy, the groups had significant differences in sex, diabetes diagnosis, and tobacco use. The apathy group also had worse cognitive performance and daily functioning than the non-apathy group as assessed, respectively, by MMSE and IADL/PSMS. Higher levels of interleukin-6, interleukin-10, and leptin were associated with higher odds of apathy. Conclusion: Apathy is associated with cognitive and functional status in AD. The association between apathy and peripheral inflammatory mediators deserves further investigation.
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Affiliation(s)
- Antonio L. Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Haitham Salem
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Lais B. Martins
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
| | - Mitzi M. Gonzales
- Biggs Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | - Sudha Seshadri
- Biggs Institute, University of Texas Health Science Center, San Antonio, TX, USA
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA
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9
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Revisiting Apathy in Alzheimer's Disease: From Conceptualization to Therapeutic Approaches. Behav Neurol 2021; 2021:6319826. [PMID: 34394772 PMCID: PMC8356015 DOI: 10.1155/2021/6319826] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022] Open
Abstract
Apathy is a neurobehavioral syndrome characterized by impaired motivation for goal-directed behaviors and cognitive activity, alongside blunted affect. Apathy is a common neuropsychiatric syndrome in Alzheimer's disease (AD), with a 5-year prevalence over 70%. Apathy also serves as a prognostic indicator, correlating with the progression of AD. Despite advances in its conceptualization and understanding of its neural basis, there is very limited empirical evidence to support the available strategies for the treatment of apathy in AD. Given its complex pathophysiology, including distinct substrates for different apathy dimensions (affective, cognitive, and behavioral), it is unlikely that a single pharmacological or nonpharmacological strategy will be effective for all cases of apathy in AD. High-quality evidence research is needed to better understand the role of specific strategies aiming at a personalized approach.
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10
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Ceïde ME, Warhit A, Ayers EI, Kennedy G, Verghese J. Apathy and the Risk of Predementia Syndromes in Community-Dwelling Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 75:1443-1450. [PMID: 32374839 PMCID: PMC7424283 DOI: 10.1093/geronb/gbaa063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives Apathy is a potential predictor of dementia in older adults, but this investigation has been limited to older adults with a preexisting neurological illness like mild cognitive impairment (MCI), stroke or Parkinson’s disease. The objective of this study was to investigate the association between apathy at baseline and incident predementia syndromes, including MCI and motoric cognitive risk syndrome (MCR), subjective cognitive complaints and slow gait, in community-dwelling older adults. Method We prospectively studied the association between apathy (using the 3-item subscale of the Geriatric Depression Scale [GDS3A]) and incident cognitive disorders in 542 community-dwelling older adults enrolled in the Central Control of Mobility in Aging study using Cox proportional hazard models. Associations were reported as hazard ratio (HR) with 95% confidence intervals (CIs), adjusting for age, education, baseline cognitive performance, and depressive symptoms. Results Apathy was associated with incident MCR (HR 2.39, 95% CI: 1.10–5.20), but not predementia syndromes overall nor MCI. In sensitivity analyses of MCI subtypes, apathy was associated with nonamnestic MCI (HR 2.44, 95% CI: 1.14–5.22), but not amnestic MCI. Our study was limited by a short follow-up time (median 13.6 months; interquartile range 29.8) and a brief subscale measurement of apathy, GDS3A. Discussion In our study, apathy predicted MCR but not MCI in community-dwelling older adults. These results and the current literature suggest that apathy is an early risk factor for dementia. Additionally, apathy may be a novel treatment target that could forestall the disability of dementia.
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Affiliation(s)
- Mirnova E Ceïde
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York.,Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, New York
| | - Alana Warhit
- Department of Psychiatry, Weill Cornell Medicine, New York City, New York
| | - Emmeline I Ayers
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York
| | - Gary Kennedy
- Department of Psychiatry and Behavioral Sciences and Medicine, Montefiore Medical Center, Bronx, New York
| | - Joe Verghese
- Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Bronx, New York
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11
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Zhào H, Liu Y, Xia Z, Xie H, Huang Y. Diagnosis and Assessment of Apathy in Elderly Chinese Patients With Cerebral Small Vessel Disease. Front Psychiatry 2021; 12:688685. [PMID: 34413797 PMCID: PMC8368720 DOI: 10.3389/fpsyt.2021.688685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The study aimed to estimate the frequency of apathy in Chinese patients with cerebral small vessel disease (CSVD) and investigate the relationship between apathy and neuroimaging markers of CSVD. Methods: A total of 150 CSVD aged patients were recruited for a cross-sectional observational study. Following the new revised version of diagnostic criteria for apathy (DCA), each patient was evaluated successively by the neuropsychiatric inventory (NPI-apathy), geriatric depression scale (GDS), and caregiver burden scale (CBS). The MRI presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces were rated independently. Furthermore, presence of all these MRI markers were summed in a score of 0-4 representing all CSVD features combined. Results: According to the DCA, we found that the frequency of apathy in Chinese Alzheimer's disease patients reached 37.33%, with lack of and diminished goal-directed activities in the dimension of behavior/cognition. We did not find a close relationship between apathy and depression. Caregiver burden was positively correlated with apathy severity. Apathy, but not depression, was positively associated with total CSVD burden, rather than a separate MRI marker of CSVD. Conclusion: As a key component of neuropsychiatric symptoms, apathy was common in Chinese elderly with CSVD, more attention should be paid to apathy in clinical practice of CSVD.
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Affiliation(s)
- Hóngyi Zhào
- Department of Neurology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Psychiatry, NO 984 Hospital of People's Liberation Army, Beijing, China
| | - Yu Liu
- Department of Neurology, NO 984 Hospital of People's Liberation Army, Beijing, China
| | - Zhenxi Xia
- Department of Neurology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongyang Xie
- Department of Neurology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yonghua Huang
- Department of Neurology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
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12
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Minocycline augmentation in older adults with persistent depression: an open label proof of concept study. Int Psychogeriatr 2020; 32:881-884. [PMID: 32690123 PMCID: PMC8350752 DOI: 10.1017/s1041610220001313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Less than 40% of depressed older adults treated with an antidepressant achieve remission. Incomplete response to treatment is common. Current augmentation strategies have limited efficacy, and many have side effects that restrict their utilization in older adults. We conducted the first open pilot trial of minocycline augmentation in older adults who had failed to achieve remission after adequate psychopharmacologic treatment. Subjects older than 55 years of age with major depression and failure to achieve substantial improvement of depressive symptoms after at least 6 weeks of antidepressant treatment were given augmentation with minocycline 100 mg twice daily over an 8-week period. At the end of 8 weeks of augmentation with minocycline, 31% (4/13) patients achieved remission. Remitters had higher baseline ratings of hopelessness and apathy. Minocycline was well tolerated with no reported adverse events or discontinuation due to intolerance. Larger placebo-controlled studies are needed to evaluate the effects of minocycline augmentation in older adults who had failed to achieve remission after adequate treatment with antidepressants.
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13
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Werneck AO, Christofaro DGD, Ritti-Dias RM, Cucato GG, Stubbs B, Oyeyemi AL, Conceição RDO, Santos RD, Bittencourt MS. Does physical activity influence the association between depressive symptoms and low-grade inflammation in adults? A study of 8,048 adults. Physiol Behav 2020; 223:112967. [PMID: 32479805 DOI: 10.1016/j.physbeh.2020.112967] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
This study investigated whether physical activity (PA) influences the association between depression risk and low-grade inflammation. This was a cross-sectional study including 8,048 adults (18-59y). Depression symptoms were evaluated with the Beck depression inventory (BDI) and physical activity through the international physical activity questionnaire. Adults with infectious and inflammatory diseases were excluded. Blood samples were collected, including high sensitivity C-reactive protein (CRP), a marker of low-grade inflammation when ≥3mg/L. Additional measures of LDL-C, HDL-C, triglycerides and fasting glucose were also determined. Sex, chronological age, tobacco smoking, alcohol drinking, body mass index, dyslipidemia, high blood pressure and fasting glucose were used as covariates. Mediation models were conducted using the procedures of Karlson Holm Breen. Adults with elevated CRP (≥3mg/L) compared to those with low CRP (<3mg/L) presented with higher BDI scores [8.5%(95%CI:7.2%-10.1%) vs. 5.8%(95%CI:5.2-6.4)] as well as higher prevalence of physical inactivity 67.4% (95%CI:64.9-69.9) vs. 59.7% (95%CI:58.4-60.9). The prevalence of elevated CRP was highest in physically inactive adults with greater depression risk. Models revealed that physical activity risk explained 13% of the association between depression risk and elevated CRP (p=0.035), independently of potential confounders. Physical activity may reduce the association between depression symptoms and elevated CRP. Future longitudinal research is required to determine the directionality of the relationships observed.
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Affiliation(s)
- André O Werneck
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo; Brazil.
| | - Diego G D Christofaro
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo; Brazil
| | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom and South London and Maudsley NHS Foundation Trust, London, UK
| | - Adewale L Oyeyemi
- Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria
| | | | - Raul D Santos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Lipid Clinic Heart Institute (InCor), University of São Paulo, Sao Paulo, Brazil
| | - Márcio S Bittencourt
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil.; Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil
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14
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Tay J, Lisiecka-Ford DM, Hollocks MJ, Tuladhar AM, Barrick TR, Forster A, O'Sullivan MJ, Husain M, de Leeuw FE, Morris RG, Markus HS. Network neuroscience of apathy in cerebrovascular disease. Prog Neurobiol 2020; 188:101785. [PMID: 32151533 DOI: 10.1016/j.pneurobio.2020.101785] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
Apathy is a reduction in motivated goal-directed behavior (GDB) that is prevalent in cerebrovascular disease, providing an important opportunity to study the mechanistic underpinnings of motivation in humans. Focal lesions, such as those seen in stroke, have been crucial in developing models of brain regions underlying motivated behavior, while studies of cerebral small vessel disease (SVD) have helped define the connections between brain regions supporting such behavior. However, current lesion-based models cannot fully explain the neurobiology of apathy in stroke and SVD. To address this, we propose a network-based model which conceptualizes apathy as the result of damage to GDB-related networks. A review of the current evidence suggests that cerebrovascular disease-related pathology can lead to network changes outside of initially damaged territories, which may propagate to regions that share structural or functional connections. The presentation and longitudinal trajectory of apathy in stroke and SVD may be the result of these network changes. Distinct subnetworks might support cognitive components of GDB, the disruption of which results in specific symptoms of apathy. This network-based model of apathy may open new approaches for investigating its underlying neurobiology, and presents novel opportunities for its diagnosis and treatment.
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Affiliation(s)
- Jonathan Tay
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | - Matthew J Hollocks
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Thomas R Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Michael J O'Sullivan
- University of Queensland Centre for Clinical Research, University of Queensland Australia, Brisbane, Australia
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences & Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Robin G Morris
- Department of Psychology, King's College London, London, UK
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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15
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Ehrenberg AJ, Suemoto CK, França Resende EDP, Petersen C, Leite REP, Rodriguez RD, Ferretti-Rebustini REDL, You M, Oh J, Nitrini R, Pasqualucci CA, Jacob-Filho W, Kramer JH, Gatchel JR, Grinberg LT. Neuropathologic Correlates of Psychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2019; 66:115-126. [PMID: 30223398 DOI: 10.3233/jad-180688] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Clarifying the relationships between neuropsychiatric symptoms and Alzheimer's disease (AD)-related pathology may open avenues for effective treatments. Here, we investigate the odds of developing neuropsychiatric symptoms across increasing burdens of neurofibrillary tangle and amyloid-β pathology. Participants who passed away between 2004 and 2014 underwent comprehensive neuropathologic evaluation at the Biobank for Aging Studies from the Faculty of Medicine at the University of São Paulo. Postmortem interviews with reliable informants were used to collect information regarding neuropsychiatric and cognitive status. Of 1,092 cases collected, those with any non-Alzheimer pathology were excluded, bringing the cohort to 455 cases. Braak staging was used to evaluate neurofibrillary tangle burden, and the CERAD neuropathology score was used to evaluate amyloid-β burden. The 12-item neuropsychiatric inventory was used to evaluate neuropsychiatric symptoms and CDR-SOB score was used to evaluate dementia status. In Braak I/II, significantly increased odds were detected for agitation, anxiety, appetite changes, depression, and sleep disturbances, compared to controls. Increased odds of agitation continue into Braak III/IV. Braak V/VI is associated with higher odds for delusions. No increased odds for neuropsychiatric symptoms were found to correlate with amyloid-β pathology. Increased odds of neuropsychiatric symptoms are associated with early neurofibrillary tangle pathology, suggesting that subcortical neurofibrillary tangle accumulation with minimal cortical pathology is sufficient to impact quality of life and that neuropsychiatric symptoms are a manifestation of AD biological processes.
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Affiliation(s)
- Alexander J Ehrenberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | | | - Elisa de Paula França Resende
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Cathrine Petersen
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Michelle You
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jun Oh
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Joel H Kramer
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Lea T Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.,University of São Paulo Medical School, São Paulo, Brazil.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
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16
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Bakeer MS, Youssef MI, Elshazly HM, Abdel-Samiee M, El-Gendy AA, Abouzed M, Othman W, Abdelkareem M, Abozeid M, Awad SM, Khalil FO, Bedair HM, Diab KA, Seif AS, Youssef MF, Sakr AA, Abdelsameea E. On-treatment improvement of an emerging psychosomatic depressive disorder among salmonella carriers: a multicenter experience from Egypt. Infect Drug Resist 2019; 12:2573-2582. [PMID: 31686865 PMCID: PMC6709802 DOI: 10.2147/idr.s206642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background As physicians in a referral hospital, we observed the association between history of enteric fever and somatic disorders associated with low mood. At the Al-Hussein University Hospital, Cairo and the National Liver Institute Hospital, Menoufia, we receive patients from all over Egypt, including rural areas where enteric fever is endemic. Aim Here in, 60 Egyptian patients referred to us for evaluation of different somatic disorders are reported. Methods After extensive evaluations, the patients' symptoms were function-related. Also, their typhoid carrier states were documented, and the severity of depression using Hamilton-D (HAM-D) questionnaire was evaluated and recorded. All patients were treated with ceftriaxone, 2 gm, IV, daily for 15 days. The clinical evaluation and Hamilton score were reassessed at the end of the treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the Salmonella species, and not by serology, isolated from stool culture along with febrile condition, plus the absence of fever in the past 3 weeks. The Widal test was not accepted as a criterion for enrollment. Results Patients showed clinically significant improvement in the somatic complaints, and their HAM-D score immediately post-treatment that was consolidated for 6 weeks post-treatment completion. Conclusion In this study, the typhoid carrier was associated with the psychosomatic depression that improved by antibiotic therapy.
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Affiliation(s)
| | | | - Helmy M Elshazly
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdel-Samiee
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - M Abouzed
- Psychiatry Department, Al-Azhar University, Cairo, Egypt
| | - Warda Othman
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mervat Abdelkareem
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mai Abozeid
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Samah Mohammed Awad
- Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Fatma O Khalil
- Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Hanan M Bedair
- Clinical Pathology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Karema A Diab
- Clinical Pathology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - A S Seif
- Tropical Medicine Hepatology and Gastroenterology Department, Shebin Elkom Teaching Hospital, Menoufia, Egypt
| | - Marwa F Youssef
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ayman Ahmed Sakr
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
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17
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Yao H, Mizoguchi Y, Monji A, Yakushiji Y, Takashima Y, Uchino A, Yuzuriha T, Hashimoto M. Low-Grade Inflammation Is Associated with Apathy Indirectly via Deep White Matter Lesions in Community-Dwelling Older Adults: The Sefuri Study. Int J Mol Sci 2019; 20:ijms20081905. [PMID: 30999680 PMCID: PMC6514652 DOI: 10.3390/ijms20081905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023] Open
Abstract
Low-grade inflammation is implicated in the pathogenesis of atherosclerosis, metabolic syndrome, and apathy as a form of vascular depression. We analyzed the brain magnetic resonance imaging findings in 259 community-dwelling older adults (122 men and 137 women, with a mean age of 68.4 years). The serum concentrations of high-sensitivity C-reactive protein (hsCRP) were measured by a quantitative enzyme-linked immunosorbent assay. Logistic regression analysis revealed that the log10 hsCRP value and the presence of a metabolic syndrome were independently associated with confluent but not punctate deep white matter lesions (DWMLs). Path analysis based on structural equation modeling (SEM) indicated that the direct path from the log10 hsCRP to the DWMLs was significant (β = 0.119, p = 0.039). The direct paths from the metabolic syndrome to the log10 hsCRP and to the DWMLs were also significant. The direct path from the DWMLs to apathy (β = −0.165, p = 0.007) was significant, but the direct path from the log10 hsCRP to apathy was not significant. Inflammation (i.e., elevated serum hsCRP levels) was associated with DWMLs independent of common vascular risk factors, while DWMLs were associated with apathy. The present analysis with SEM revealed the more realistic scheme that low-grade inflammation was associated with apathy indirectly via DWMLs in community-dwelling older adults.
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Affiliation(s)
- Hiroshi Yao
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Yoshito Mizoguchi
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Akira Monji
- Department of Psychiatry, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
| | - Yuki Takashima
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Akira Uchino
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
| | - Takefumi Yuzuriha
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
| | - Manabu Hashimoto
- Division of Clinical Research, National Hospital Organization Hizen Psychiatric Center, Saga 842-0192, Japan.
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18
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Subbanna M, Shivakumar V, Talukdar PM, Narayanaswamy JC, Venugopal D, Berk M, Varambally S, Venkatasubramanian G, Debnath M. Role of IL-6/RORC/IL-22 axis in driving Th17 pathway mediated immunopathogenesis of schizophrenia. Cytokine 2018; 111:112-118. [PMID: 30138899 DOI: 10.1016/j.cyto.2018.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
Abstract
The immuno-inflammatory origin of schizophrenia in a subset of patients is viewed as a key element of an overarching etiological construct. Despite substantial research, the immune components exerting major effect are yet to be fully clarified. Disrupted T cell networks have consistently been linked to the pathogenesis of schizophrenia. Amongst the Th cell subsets, the Th17 cells have emerged as a paradigmatic lineage with significant functional implications in a vast number of immune mediated diseases including brain disorders such as schizophrenia. The present study was aimed at examining the functional role of the Th17 pathway in schizophrenia. To address this, genotyping of IL17A (rs2275913; G197A) Single Nucleotide Polymorphism was carried out by the PCR-RFLP method in 221 schizophrenia patients and 223 healthy control subjects. Gene expression of two transcription factors STAT3 and RORC was quantified in a subset of drug naïve schizophrenia patients (n = 56) and healthy controls (n = 52) by TaqMan assay. The plasma levels of fifteen cytokines belonging to Th17 pathway were estimated in a subset of drug naïve schizophrenia patients (n = 61) and healthy controls (n = 50) by using Bio-Plex Pro Human Th17 cytokine assays. The AA genotype was associated with higher total score of bizarre behaviour and apathy in female schizophrenia patients. A high gene expression level of RORC was observed in drug naïve schizophrenia patients. In addition, significantly elevated plasma levels of IL-6 and IL-22, and reduced levels of IL-1β and IL-17F were noted in schizophrenia patients. Taken together, these findings indicate a dysregulated Th17 pathway in schizophrenia patients.
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Affiliation(s)
- Manjula Subbanna
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Venkataram Shivakumar
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pinku Mani Talukdar
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Deepthi Venugopal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, Geelong, Victoria, Australia; Orygen, The Centre of Excellence in Youth Mental Health, The Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Australia
| | - Shivarama Varambally
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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19
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Horn SR, Long MM, Nelson BW, Allen NB, Fisher PA, Byrne ML. Replication and reproducibility issues in the relationship between C-reactive protein and depression: A systematic review and focused meta-analysis. Brain Behav Immun 2018; 73:85-114. [PMID: 29928963 PMCID: PMC6800199 DOI: 10.1016/j.bbi.2018.06.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022] Open
Abstract
One of the most common inflammatory markers examined in depression is C-reactive protein (CRP). However, the magnitude of the association between CRP and depression when controlling for potentially confounding factors such as age, sex, socio-economic status, body mass index, medication and other substance use, and medical illness, is unclear. Inconsistencies in other methodological practices, such as sample collection, assaying, and data cleaning and transformation, may contribute to variations in results. We aggregate studies that examined the association between CRP and depression in two ways. First, a systematic review summarizes how studies of CRP and depression have reported on methodological issues. Second, a tiered meta-analysis aggregates studies that have adhered to various levels of methodological rigor. Findings from the systematic review indicate a lack of protocol detail provided. The effect between depression and CRP was small, but highly significant across all stages of the meta-analysis (p < 0.01). The effect size in the most methodologically rigorous stage of the meta-analysis, which included studies controlling for age, sex, obesity, medical conditions and substance, medication, or psychosocial factors, was small (r = 0.05). There were also only 26 articles in this stage (13% of studies from the systematic review), suggesting that more studies that consistently account for these confounding factors are needed. Additionally, an a priori quality score of methodological rigor was a significant moderator in this stage of the meta-analysis. The effect size was strikingly attenuated (r = 0.005) and non-significant in studies with higher quality scores. We describe a set of recommended guidelines for future research to consider, including sample collection and assaying procedures, data cleaning and statistical methods, and control variables to assess.
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Affiliation(s)
- Sarah R Horn
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States.
| | - Madison M Long
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States; Leiden University, Faculty of Social and Behavioral Sciences, Pieter de la Court Building, P.O. Box 9555, 2300 RB Leiden, The Netherlands
| | - Benjamin W Nelson
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States
| | - Nicholas B Allen
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States
| | - Philip A Fisher
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States
| | - Michelle L Byrne
- University of Oregon, Department of Psychology, 1227 University of Oregon, Eugene, OR 97402, United States
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20
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Carlier A, van Exel E, Dols A, Bouckaert F, Sienaert P, Ten Kate M, Wattjes MP, Vandenbulcke M, Stek ML, Rhebergen D. The course of apathy in late-life depression treated with electroconvulsive therapy; a prospective cohort study. Int J Geriatr Psychiatry 2018; 33:1253-1259. [PMID: 29851173 DOI: 10.1002/gps.4917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Apathy, a lack of motivation, is frequently seen in older individuals, with and without depression, with substantial impact on quality of life. This prospective cohort study of patients with severe late-life depression treated with electroconvulsive therapy (ECT) aims to study the course of apathy and the predictive value of vascular burden and in particular white matter hyperintensities on apathy course. METHODS Information on apathy (defined by a score of >13 on the Apathy Scale), depression severity, vascular burden, and other putative confounders was collected in at 2 psychiatric hospitals on patients with late-life depression (aged 55 to 87 years, N = 73). MRI data on white matter hyperintensities were available in 52 patients. Possible risk factors for apathy post-ECT were determined using regression analyses. RESULTS After treatment with ECT, 52.0% (26/50) of the depression remitters still suffered from clinically relevant apathy symptoms. In the entire cohort, more patients remained apathetic (58.9%) than depressed (31.5%). Presence of apathy post-ECT was not associated with higher age, use of benzodiazepines, or severity of apathy and depression at baseline. Less response in depressive symptomatology after ECT predicted post-treatment apathy. The presence of vascular disease, diabetes mellitus and smoking, and white matter hyperintensities in the brain was not associated with post-treatment apathy. CONCLUSIONS Apathy may perpetuate in individual patients, despite remission of depressive symptoms. In this cohort of patients with late-life depression, post-ECT apathy is not associated with white matter hyperintensities.
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Affiliation(s)
- A Carlier
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - E van Exel
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - A Dols
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - F Bouckaert
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - P Sienaert
- Academic Center for ECT and Neuromodulation, KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - M Ten Kate
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M P Wattjes
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Vandenbulcke
- Old-age Psychiatry, KU Leuven, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium
| | - M L Stek
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - D Rhebergen
- Department of Old Age Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health research institute and NCA Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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21
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Eurelings LS, van Dalen JW, Ter Riet G, Moll van Charante EP, Richard E, van Gool WA, Almeida OP, Alexandre TS, Baune BT, Bickel H, Cacciatore F, Cooper C, de Craen TA, Degryse JM, Di Bari M, Duarte YA, Feng L, Ferrara N, Flicker L, Gallucci M, Guaita A, Harrison SL, Katz MJ, Lebrão ML, Leung J, Lipton RB, Mengoni M, Ng TP, Østbye T, Panza F, Polito L, Sander D, Solfrizzi V, Syddall HE, van der Mast RC, Vaes B, Woo J, Yaffe K. Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data. Clin Epidemiol 2018; 10:363-379. [PMID: 29670402 PMCID: PMC5894652 DOI: 10.2147/clep.s150915] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Previous findings suggest that apathy symptoms independently of depressive symptoms measured using the Geriatric Depression Scale (GDS) are associated with cardiovascular disease (CVD) in older individuals. Aims To study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis. Methods Medline, Embase, and PsycInfo databases up to September 3, 2013, were systematically searched without language restrictions. We sought prospective studies with older (mean age ≥65 years) community-dwelling populations in which the GDS was employed and subsequent stroke and/or CVD were recorded to provide individual participant data. Apathy symptoms were defined as the three apathy-related subitems of the GDS, with depressive symptoms the remaining items. We used myocardial infarction (MI), stroke, and all-cause mortality as main outcomes. Analyses were adjusted for age, sex, and MI/stroke history. An adaptation of the Newcastle–Ottawa scale was used to evaluate bias. Hazard ratios were calculated using one-stage random-effect Cox regression models. Results Of the 52 eligible studies, 21 (40.4%) were included, comprising 47,625 older people (mean age [standard deviation] 74 [7.4] years), over a median follow-up of 8.8 years. Participants with apathy symptoms had a 21% higher risk of MI (95% confidence interval [CI] 1.08–1.36), a 37% higher risk of stroke (95% CI 1.18–1.59), and a 47% higher risk of all-cause mortality (95% CI 1.38–1.56). Participants with depressive symptoms had a comparably higher risk of stroke (HR 1.36, 95% CI 1.18–1.56) and all-cause mortality (HR 1.44, 95% CI 1.35–1.53), but not of MI (HR 1.08, 95% CI 0.91–1.29). Associations for isolated apathy and isolated depressive symptoms were comparable. Sensitivity analyses according to risk of bias yielded similar results. Conclusion Our findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease.
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Affiliation(s)
- Lisa Sm Eurelings
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan Willem van Dalen
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands .,Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem A van Gool
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Osvaldo P Almeida
- Department of Psychiatry and Clinical Neurosciences, Royal Perth Hospital, University of Western Australia, Perth, Australia.,Harry Perkins Institute for Medical Research, Western Australian Centre for Health & Ageing, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Tiago S Alexandre
- Department of Gerontology, Center for Biological and Health Sciences, Federal University of São Carlos, São Carlos, Brazil
| | - Bernhard T Baune
- Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia
| | - Horst Bickel
- Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Salvatore Maugeri Foundation, Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Ton Ajm de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Marie Degryse
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Mauro Di Bari
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence, Florence, Italy.,Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Yeda A Duarte
- Department of Medical-Surgical Nursing, University of São Paulo, São Paulo, Brazil
| | - Liang Feng
- Department of Health Sciences and System Research, Duke NUS Medical School, National University of Singapore, Singapore.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Salvatore Maugeri Foundation, Scientific Institute of Telese Terme, Telese Terme, Italy
| | - Leon Flicker
- Centre Medical Research, Western Australian Centre for Health & Ageing, University of Western Australia, Perth, Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Maurizio Gallucci
- Cognitive Impairment Center, Health District of Treviso, Local Health Authority 9 of Treviso, Treviso, Italy.,Interdisciplinary Geriatric Research Foundation, Treviso, Italy
| | | | - Stephanie L Harrison
- Department of Epidemiology and Biostatistics, California Pacific Medical Center Research Institute, University of California, San Francisco, CA, USA
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Maria L Lebrão
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Jason Leung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Marta Mengoni
- Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence, Florence, Italy
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Truls Østbye
- Center for Aging Research and Education, Duke NUS Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Francesco Panza
- Department of Basic Medicine, Neuroscience, and Sense Organs, Neurodegenerative Disease Unit, Pia Fondazione Cardinale G Panico, University of Bari Aldo Moro, Tricase, Italy
| | | | - Dirk Sander
- Department of Neurology, Benedictus Krankenhaus Tutzing, Technische Universität München, Tutzing, Germany
| | - Vincenzo Solfrizzi
- Interdisciplinary Department of Medicine, Geriatric Medicine and Memory Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, University of Bari Aldo Moro, Bari, Italy
| | - Holly E Syddall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Roos C van der Mast
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Bert Vaes
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.,Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Woo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Kristine Yaffe
- Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil.,Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA
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Narendran G, Tomfohr L, Schulte F. Inflammatory cytokines and depression in children with cancer: A review of the literature. Pediatr Hematol Oncol 2018; 35:11-19. [PMID: 29648904 DOI: 10.1080/08880018.2018.1440335] [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: 10/17/2022]
Abstract
Compared to the general pediatric population, pediatric cancer patients are at increased risk of experiencing depressive symptoms during and after their treatment. Clinically, there exist few resources to guide health care professionals in the care of children with cancer who report depressive symptomatology. Pediatric cancer patients experience unique inflammatory changes secondary to their disease and accompanying treatments. It has been reported that inflammatory changes in the context of illness are related to cytokine dysregulation which in turn may influence the expression of depressive symptoms. In this review of current literature, we summarize the existing knowledge, relevant models and studies in progress with respect to this concept.
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Affiliation(s)
- Gaya Narendran
- a Division of Pediatric Oncology, Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Lianne Tomfohr
- b Department of Psychology , Faculty of Arts, University of Calgary , Calgary , Alberta , Canada
| | - Fiona Schulte
- a Division of Pediatric Oncology, Alberta Children's Hospital , Calgary , Alberta , Canada
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23
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Heeres RHM, Hoogeveen EK, Geleijnse JM, de Goede J, Kromhout D, Giltay EJ. Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients. BMC Psychol 2017; 5:1. [PMID: 28081723 PMCID: PMC5228176 DOI: 10.1186/s40359-016-0170-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/20/2016] [Indexed: 01/01/2023] Open
Abstract
Background The aim was to investigate whether mild kidney dysfunction and low-grade inflammation in post-myocardial infarction patients are independently associated with markers of mental well-being (i.e. depressive and apathy symptoms, and dispositional optimism). Methods In post-myocardial infarction patients, kidney function was assessed by estimated glomerular filtration rate (eGFR) calculated from the combined CKD-EPI formula based on serum levels of both creatinine and cystatine C. Systemic inflammation was assessed using high sensitivity C-reactive protein (hs-CRP) levels. The 15-item Geriatric Depression Scale (GDS-15), the 3-item apathy subscale and the 4-item optimism questionnaire (4Q) were used to measure mental well-being and were analyzed using linear multivariable regression analysis. Results Of the 2355 patients, mean age was 72.3 (range 63–84) years and 80.1% were men. After multivariable adjustment, a poorer kidney function was associated with more depressive symptoms (β = -0.084, p < 0.001), more apathy symptoms (β = -0.101, p < 0.001), and less dispositional optimism (β = 0.072, p = 0.002). Moreover, higher levels of hs-CRP were associated with more depressive symptoms (β = 0.051, p = 0.013), more apathy symptoms (β = 0.083, p < 0.001) and less dispositional optimism (β = -0.047 p = 0.024). Apathy showed the strongest independent relation with both low eGFR and high hs-CRP. Conclusions In post-myocardial infarction patients, impaired kidney function and systemic inflammation showed a stronger association with apathy than with depressive symptoms and dispositional optimism.
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Affiliation(s)
- Rick H M Heeres
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300, RC, Leiden, Netherlands.
| | - Ellen K Hoogeveen
- Departments of Internal Medicine and Nephrology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | | | - Janette de Goede
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300, RC, Leiden, Netherlands
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24
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Yasuno F, Kazui H, Morita N, Kajimoto K, Ihara M, Taguchi A, Yamamoto A, Matsuoka K, Kosaka J, Kudo T, Iida H, Kishimoto T, Nagatsuka K. High amyloid-β deposition related to depressive symptoms in older individuals with normal cognition: a pilot study. Int J Geriatr Psychiatry 2016; 31:920-8. [PMID: 26766490 DOI: 10.1002/gps.4409] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/03/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Previous studies have reported depressive symptoms in the preclinical stages of Alzheimer's disease (AD). The objective of this study was to determine whether depressive symptoms are associated with cortical amyloid burden. In order to do this, we measured cortical amyloid via (11) C-labeled Pittsburgh Compound B ([(11) C]PIB) uptake using positron emission tomography (PET) in cognitively normal subjects. METHODS We performed [(11) C]PIB-PET in 29 cognitively normal, older participants. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS). Aβ deposition was quantified by binding potential (BPND ), and the association between cortical mean BPND values and GDS scores was evaluated. Analysis of parametric BPND images was performed to examine the relationship between regional BPND and GDS scores. RESULTS We found a positive correlation between depressive symptoms and mean cortical PIB-BPND in groups of subjects with middle to high PIB-BPND . There was little change in GDS-depression score between subjects with low and middle PIB-BPND levels, while an increase in GDS was shown in the high PIB-BPND group. The main BPND increase was localized to the precuneus/posterior cingulate cortex (PCu/PCC) in subjects with high PIB-BPND , and we found a significant positive relationship between PIB-BPND in this area and depressive symptoms. CONCLUSIONS Emotional dysregulation because of Aβ neuropathology in the PCu/PCC may relate to depressive symptoms. More specifically, we found that older, cognitively normal patients with depressive episodes were more likely to have underlying AD pathology. Thus, depressive symptoms may increase the predictive ability of the identification of future AD cases. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, Kashihara, Japan.,Department of Investigative Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Osaka University Medical School, Suita, Japan
| | - Naomi Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Katsufumi Kajimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akihiko Taguchi
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Regenerative Medicine Research, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Akihide Yamamoto
- Department of Investigative Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Jun Kosaka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Takashi Kudo
- Department of Psychiatry, Osaka University Health Care Center, Toyonaka, Japan
| | - Hidehiro Iida
- Department of Investigative Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Kazuyuki Nagatsuka
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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25
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Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol 2016; 16:22-34. [PMID: 26711676 DOI: 10.1038/nri.2015.5] [Citation(s) in RCA: 2121] [Impact Index Per Article: 265.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Crosstalk between inflammatory pathways and neurocircuits in the brain can lead to behavioural responses, such as avoidance and alarm, that are likely to have provided early humans with an evolutionary advantage in their interactions with pathogens and predators. However, in modern times, such interactions between inflammation and the brain appear to drive the development of depression and may contribute to non-responsiveness to current antidepressant therapies. Recent data have elucidated the mechanisms by which the innate and adaptive immune systems interact with neurotransmitters and neurocircuits to influence the risk for depression. Here, we detail our current understanding of these pathways and discuss the therapeutic potential of targeting the immune system to treat depression.
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Affiliation(s)
- Andrew H Miller
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, 30322 Georgia, USA
| | - Charles L Raison
- School of Human Ecology, University of Wisconsin-Madison, Madison, 53706 Wisconsin, USA
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26
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The mediating role of cardiovascular risk factors in the relationship between symptoms of apathy and incident cardiovascular disease in community-dwelling older individuals. Int Psychogeriatr 2016; 28:669-79. [PMID: 26542880 DOI: 10.1017/s1041610215001751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND In old age, both apathy and depression have been associated with an increased cardiovascular disease (CVD) risk. This study evaluated the mediating role of cardiovascular risk factors in the relationship of apathy and mood symptoms with incident CVD. METHODS Prospective cohort study of 1,790 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. At baseline, apathy and mood symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), of which three items represent apathy symptoms. The mediational risk factors included were diabetes mellitus (DM), body mass index (BMI), current smoking, physical inactivity, systolic blood pressure, and total cholesterol. Incident CVD was evaluated after two years of follow-up. Data were analyzed using structural equation modeling (SEM). RESULTS Incident CVD occurred in 59 (3.3%) participants. Apathy symptoms had a significant estimated total effect on incident CVD, with increases of 2.2% for each unit increase in apathy score. Of this total effect, 22.7% was due to the mediational effects of physical inactivity (13.6%), current smoking (4.5%), and DM (4.5%). The remaining 77.3% was due to direct effects reflecting other mediational dynamics. No significant (in)direct effects of mood symptoms on incident CVD were found. CONCLUSIONS Physical inactivity, smoking, and DM account for nearly one-fourth of the variation reflecting the link between apathy symptoms and incident CVD. This illustrates the relevance of unfavorable health behaviors and assessment of DM in older individuals with apathy. The majority of the effect of apathy symptoms on incident CVD is caused by other, yet unknown, factors.
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