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Hird EJ, Slanina-Davies A, Lewis G, Hamer M, Roiser JP. From movement to motivation: a proposed framework to understand the antidepressant effect of exercise. Transl Psychiatry 2024; 14:273. [PMID: 38961071 PMCID: PMC11222551 DOI: 10.1038/s41398-024-02922-y] [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: 03/28/2024] [Accepted: 05/10/2024] [Indexed: 07/05/2024] Open
Abstract
Depression is the leading cause of disability worldwide, exerting a profound negative impact on quality of life in those who experience it. Depression is associated with disruptions to several closely related neural and cognitive processes, including dopamine transmission, fronto-striatal brain activity and connectivity, reward processing and motivation. Physical activity, especially aerobic exercise, reduces depressive symptoms, but the mechanisms driving its antidepressant effects are poorly understood. Here we propose a novel hypothesis for understanding the antidepressant effects of exercise, centred on motivation, across different levels of explanation. There is robust evidence that aerobic exercise decreases systemic inflammation. Inflammation is known to reduce dopamine transmission, which in turn is strongly implicated in effort-based decision making for reward. Drawing on a broad range of research in humans and animals, we propose that by reducing inflammation and boosting dopamine transmission, with consequent effects on effort-based decision making for reward, exercise initially specifically improves 'interest-activity' symptoms of depression-namely anhedonia, fatigue and subjective cognitive impairment - by increasing propensity to exert effort. Extending this framework to the topic of cognitive control, we explain how cognitive impairment in depression may also be conceptualised through an effort-based decision-making framework, which may help to explain the impact of exercise on cognitive impairment. Understanding the mechanisms underlying the antidepressant effects of exercise could inform the development of novel intervention strategies, in particular personalised interventions and boost social prescribing.
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Affiliation(s)
- E J Hird
- Institute of Cognitive Neuroscience, University College London, London, UK.
| | - A Slanina-Davies
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - M Hamer
- Institute of Sport, Exercise and Health, University College London, London, UK
| | - J P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
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Levy SA, Misiura MB, Grant JG, Adrien TV, Taiwo Z, Armstrong R, Dotson VM. Depression, Vascular Burden, and Dementia Prevalence in Late Middle-Aged and Older Black Adults. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae009. [PMID: 38374692 PMCID: PMC10926943 DOI: 10.1093/geronb/gbae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Late-life depression and white matter hyperintensities (WMH) have been linked to increased dementia risk. However, there is a dearth of literature examining these relationships in Black adults. We investigated whether depression or WMH volume are associated with a higher likelihood of dementia diagnosis in a sample of late middle-aged to older Black adults, and whether dementia prevalence is highest in individuals with both depression and higher WMH volume. METHODS Secondary data analysis involved 443 Black participants aged 55+ with brain imaging within 1 year of baseline visit in the National Alzheimer's Coordinating Center Uniform Data Set. Chi-square analyses and logistic regression models controlling for demographic variables examined whether active depression in the past 2 years, WMH volume, or their combination were associated with higher odds of all-cause dementia. RESULTS Depression and higher WMH volume were associated with a higher prevalence of dementia. These associations remained after controlling for demographic factors, as well as vascular disease burden. Dementia risk was highest in the depression/high WMH volume group compared to the depression-only group, high WMH volume-only group, and the no depression/low WMH volume group. Post hoc analyses comparing the Black sample to a demographically matched non-Hispanic White sample showed associations of depression and the combination of depression and higher WMH burden with dementia were greater in Black compared to non-Hispanic White individuals. DISCUSSION Results suggest late-life depression and WMH have independent and joint relationships with dementia and that Black individuals may be particularly at risk due to these factors.
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Affiliation(s)
- Shellie-Anne Levy
- Department of Clinical and Health Psychology, The Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida, USA
- The Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida, USA
| | - Maria B Misiura
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Jeremy G Grant
- Department of Clinical and Health Psychology, The Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida, USA
| | - Tamare V Adrien
- Department of Clinical and Health Psychology, The Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida, USA
| | - Zinat Taiwo
- Department of Rehabilitation Psychology and Neuropsychology, TIRR Memorial Hermann, Houston, Texas, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Rebecca Armstrong
- Department of Clinical and Health Psychology, The Center for Cognitive Aging and Memory, University of Florida, Gainesville, Florida, USA
| | - Vonetta M Dotson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
- Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
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Lugtenburg A, Zuidersma M, Rius Ottenheim N, Rhebergen D, Oude Voshaar RC. Age-related subtypes of late life depression and mortality: A prospective clinical cohort study. Int J Geriatr Psychiatry 2024; 39:e6064. [PMID: 38342779 DOI: 10.1002/gps.6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/27/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Late Life Depression (LLD) is associated with increased mortality rates, but it remains unclear which depressed patients are at increased risk. This study examined the mortality risk of previously identified subgroups of depressed older patients based on age-related clinical features (the presence of physical and cognitive frailty). METHODS A six-year follow-up of a clinical cohort study including 375 depressed older patients and 132 non-depressed persons (NESDO). Depressed patients were diagnosed with the Composite International Diagnostic Interview (CIDI) according to DSM-IV criteria and classified by latent profile analysis on depressive symptom severity, cognitive domains and physical frailty. We estimated the hazard rate of mortality for the four depressed subgroups compared to non-depressed persons by applying Cox-regression analyses. Models were adjusted for age, sex and education as confounders and for explanatory variables per pathway in separate models: somatic burden, lifestyle characteristics, vascular burden or inflammation markers. RESULTS A total of 61/375 (16.3%) depressed patients and 8/132 (6.1%) non-depressed persons died during the 6-year follow-up. Two of the four subgroups (n = 186/375 (50%) of the depressed sample) had a higher hazard rate (HR) for mortality compared to non-depressed participants, that is, frail-depressed patients (HR = 5.25, [95%-CI: 2.13-13.0]) and pure mild depressed patients (HR = 3.32 [95%-CI: 1.46-7.58]) adjusted for confounders. Adding possible underlying pathways did not explain these associations. CONCLUSIONS Age-related features (the presence of physical and cognitive frailty) contribute to the increased mortality risk in late-life depression. Future studies in depressed older patients should study the additional value of a clinical geriatric assessment and integrated treatment aimed to at reduce frailty and ameliorate their mortality risk.
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Affiliation(s)
- Astrid Lugtenburg
- Department Old Age Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Marij Zuidersma
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, Netherlands
| | | | - Didi Rhebergen
- Department of Psychiatry, Amsterdam UMC-Location VU University Medical Center & GGZ Centraal Specialized Mental Health Care, Amersfoort, The Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, Netherlands
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Choi NG, Choi BY, Marti CN. Mediation of the Association Between Physical Exercise and Depressive/Anxiety Symptoms by Pain and Sleep Problems Among Older Adults. Gerontol Geriatr Med 2024; 10:23337214241241397. [PMID: 38525486 PMCID: PMC10960979 DOI: 10.1177/23337214241241397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
In this study, based on the 2022 National Health and Aging Trend Study (N = 5,593, age 65+), we examined direct associations between moderate and vigorous physical exercise (PE) and depressive/anxiety symptoms as well as bothersome pain and sleep problems. We then examined if the association between PE and depressive/anxiety symptoms would be partially mediated by the effects of PE on bothersome pain and sleep problems. Results from a path model showed that controlling for sociodemographic and health statuses, PE was negatively associated with depressive/anxiety symptoms and bothersome pain, but it was not significantly associated with sleep problems. The mediation analysis showed that 10% of the total effects of PE on depressive/anxiety symptoms was indirect effects of PE on bothersome pain. This study is important as it examined the associations among PE, pain, sleep, and depression/anxiety in community-dwelling older adults in their natural environments. Healthcare and social service providers for older adults need to emphasize the importance and benefits of PE for older adults' physical and mental health. Easy access to venues for PE is also important.
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Affiliation(s)
| | - Bryan Y. Choi
- Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, USA
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Dotson VM. Can we promote cognitive resilience in late-life depression? Int Psychogeriatr 2023; 35:171-173. [PMID: 36192369 PMCID: PMC10461710 DOI: 10.1017/s1041610222000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vonetta M Dotson
- Department of Psychology and Gerontology Institute, Georgia State University, Atlanta, GA, USA
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Manning KJ, Wu R, McQuoid DR, Steffens DC, Potter GG. Reliable Cognitive Decline in Late-Life Major Depression. Arch Clin Neuropsychol 2023; 38:247-257. [PMID: 36302229 PMCID: PMC9940117 DOI: 10.1093/arclin/acac083] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Major depression in older adults increases the statistical likelihood of dementia. It is challenging to translate statistical evidence of cognitive decline at the group level into knowledge of individual cognitive outcomes. The objective of the current study is to investigate 2-year reliable cognitive change in late-life depression (LLD), which will enhance understanding of cognitive changes in LLD and provide a means to assess individual change. METHODS In a sample of non-depressed cognitively normal older adults or NDCN (n = 113), we used linear regression to predict tests of global cognition, processing speed-executive functioning, and memory administered 1 and 2 years later. Stepwise regression was used to select covariates among demographics and raw test scores (either baseline or year 1) and we cross-validated the final models using the predicted residual error sum of squares (PRESS). We then derived a z-change score from the difference between actual and predicted follow-up scores and investigated the proportion of LLD patients (n = 199) and NDCN adults who experienced reliable "decline" (a z-score < -1.645), "stability" (z-scores between + - 1.645), and "improvement" (z scores > +1.645). RESULTS A greater proportion LLD compared with NDCN experienced cognitive decline in processing speed/executive functioning and global cognition over 2 years. When compared to NDCN, a greater proportion of LLD also significantly improved on one test of processing speed over 2 years. CONCLUSIONS Older adults with LLD are at risk of meaningful cognitive decline over a relatively short period, particularly in the domain of executive functioning and processing speed. This study provides a series of reliable change equations for common neuropsychological tests that can be applied clinically.
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Affiliation(s)
- Kevin J Manning
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Rong Wu
- Biostatistics Center, University of Connecticut Health Center, Farmington, CT, USA
| | - Douglas R McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Guy G Potter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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An Exploratory Study to Assess the Impact of a Chair-Based Dance Intervention Among Older People With Depressive Symptoms in Residential Care. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Truly Cross-fit: The Association of Exercise and Clinical Outcomes: Introduction to a JINS Special Section. J Int Neuropsychol Soc 2021; 27:757-760. [PMID: 34548117 PMCID: PMC9448631 DOI: 10.1017/s1355617721001119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We introduce a JINS special section inspired by a symposium presented at INS 2020 in Denver. The symposium was entitled Truly Cross-fit: The Association of Exercise and Cognitive Reserve. The collection of papers herein spans diverse methods, a range of developmental and clinical conditions, and a variety of outcomes all reflecting on the association of exercise and cognition-related outcomes. Taken together, the studies in this Special Section direct us to the variety of dimensions to be considered in understanding this association including what mode, intensity, duration, and timing of physical activity and aspects of age, sex, genetics, baseline characteristics, and disease status moderate these findings. We hope this Special Section will not only provide a framing for important future research on exercise and clinical outcomes but also inspiration to pursue them.
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