Depressive symptoms, depletion, or developmental change? Withdrawal, apathy, and lack of vigor in the Geriatric Depression Scale

3D built virtual arctic environment increase vigor through connectedness in older people

While the life expectancy of older people has increased significantly, this is often related to more long-term care in healthcare residences and nursing homes. Staying in these facilities can lead to a reduction in the sense of connection with others and the world around, as well as in vigor, with significant psychophysical repercussions in the long term. Although previous studies have shown that the virtual nature can benefit both, there are no significant studies that have tested its effect in generating these positive outcomes in the older population. Therefore, our study sought to investigate, in a sample of 53 older people in care at a nursing home or healthcare residence, the indirect effect of a 3D built virtual arctic environment (vs. a 3D built virtual urban environment) exposure in virtual reality on vigor through connectedness. Both the virtual scenarios were designed with a first-person view, with no translation around the environment and only in-situ rotation. Results highlighted that exposure to the 3D built virtual arctic environment leads to higher connectedness than the 3D built virtual urban environment, and this, in turn, leads to an increase in vigor. Findings were discussed based on the potential of adopting virtual nature in facilities to improve older people's sense of connectedness and, in turn, improve their well-being.

Feasibility of Deploying Home-Based Digital Technology, Environmental Sensors, and Web-Based Surveys for Assessing Behavioral Symptoms and Identifying Their Precipitants in Older Adults: Longitudinal, Observational Study

BACKGROUND

Apathy, depression, and anxiety are prevalent neuropsychiatric symptoms experienced by older adults. Early detection, prevention, and intervention may improve outcomes.

OBJECTIVE

We aim to demonstrate the feasibility of deploying web-based weekly questionnaires inquiring about the behavioral symptoms of older adults with normal cognition, mild cognitive impairment, or early-stage dementia and to demonstrate the feasibility of deploying an in-home technology platform for measuring participant behaviors and their environment.

METHODS

The target population of this study is older adults with normal cognition, mild cognitive impairment, or early-stage dementia. This is an observational, longitudinal study with a study period of up to 9 months. The severity of participant behavioral symptoms (apathy, depression, and anxiety) was self-reported weekly through web-based surveys. Participants' digital biomarkers were continuously collected at their personal residences and through wearables throughout the duration of the study. The indoor physical environment at each residence, such as light level, noise level, temperature, humidity, or air quality, was also measured using indoor environmental sensors. Feasibility was examined, and preliminary correlation analysis between the level of symptoms and the digital biomarkers and between the level of symptoms and the indoor environment was performed.

RESULTS

At 13 months after recruitment began, a total of 9 participants had enrolled into this study. The participants showed high adherence rates in completing the weekly questionnaires (response rate: 275/278, 98.9%), and data collection using the digital technology appeared feasible and acceptable to the participants with few exceptions. Participants' severity of behavioral symptoms fluctuated from week to week. Preliminary results show that the duration of sleep onset and noise level are positively correlated with the anxiety level in a subset of our participants.

CONCLUSIONS

This study is a step toward more frequent assessment of older adults' behavioral symptoms and holistic in situ monitoring of older adults' behaviors and their living environment. The goal of this study is to facilitate the development of objective digital biomarkers of neuropsychiatric symptoms and to identify in-home environmental factors that contribute to these symptoms.

Caudate volume and symptoms of apathy in older adults with multiple sclerosis

BACKGROUND

Apathy is common in multiple sclerosis (MS) and neurological disease, but its presence and underlying brain mechanisms in older adults with MS (OAMS) have not been evaluated.

OBJECTIVE

Examine apathy and its association with caudate nuclei volume in OAMS and controls. We hypothesized that compared to controls, OAMS would demonstrate: a) greater apathy; b) stronger associations between apathy and caudate nuclei volumes.

METHODS

OAMS (n = 67, mean age = 64.55 ± 3.89) and controls (n = 74, mean age = 69.04 ± 6.32) underwent brain MRI, cognitive assessment, psychological, and motoric testing. Apathy was assessed through the apathy subscale of the 30-item Geriatric Depression Scale.

RESULTS

OAMS reported greater apathy compared to controls (β = 0.281, p = 0.004). Adjusted moderation analyses revealed a significantly stronger association between caudate volume and apathy (left: B = -1.156, p = 0.039, right: B = -1.163, p = 0.040) among OAMS compared to controls. Conditional effects revealed that in adjusted models, lower volume of both the left (b = -0.882, p = 0.037) and right (b = -0.891, p = 0.038) caudate nuclei was significantly associated with greater apathy only among OAMS.

CONCLUSION

Caudate nuclei, which are susceptible to adverse MS effects and implicated in mediating cognitive and motor function, may influence the presence and severity of apathy in OAMS.

Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper

BACKGROUND

Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems.

METHODS

This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals.

DISCUSSION

Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life.

TRIAL REGISTRATION

Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.

The Influence of Environmental Enrichment on Affective and Neural Consequences of Social Isolation Across Development

Social stress is associated with depression and anxiety, physiological disruptions, and altered brain morphology in central stress circuitry across development. Environmental enrichment strategies may improve responses to social stress. Socially monogamous prairie voles exhibit analogous social and emotion-related behaviors to humans, with potential translational insight into interactions of social stress, age, and environmental enrichment. This study explored the effects of social isolation and environmental enrichment on behaviors related to depression and anxiety, physiological indicators of stress, and dendritic structural changes in amygdala and hippocampal subregions in young adult and aging prairie voles. Forty-nine male prairie voles were assigned to one of six groups divided by age (young adult vs. aging), social structure (paired vs. isolated), and housing environment (enriched vs. non-enriched). Following 4 weeks of these conditions, behaviors related to depression and anxiety were investigated in the forced swim test and elevated plus maze, body and adrenal weights were evaluated, and dendritic morphology analyses were conducted in hippocampus and amygdala subregions. Environmental enrichment decreased immobility duration in the forced swim test, increased open arm exploration in the elevated plus maze, and reduced adrenal/body weight ratio in aging and young adult prairie voles. Age and social isolation influenced dendritic morphology in the basolateral amygdala. Age, but not social isolation, influenced dendritic morphology in the hippocampal dentate gyrus. Environmental enrichment did not influence dendritic morphology in either brain region. These data may inform interventions to reduce the effects of social stressors and age-related central changes associated with affective behavioral consequences in humans.

The importance of a multidimensional approach to the preclinical study of major depressive disorder and apathy

Both the neuropsychiatric syndrome of apathy and major depressive disorder comprise a heterogenous cluster of symptoms which span multiple behavioural domains. Despite this heterogeneity, there is a tendency in the preclinical literature to conclude a MDD or apathy-like phenotype from a single dimensional behavioural task used in isolation, which may lead to inaccurate phenotypic interpretation. This is significant, as apathy and major depressive disorder are clinically distinct with different underlying mechanisms and treatment approaches. At the clinical level, apathy and major depressive disorder can be dissociated in the negative valence (loss) domain of the Research Domain Criteria. Symptoms of MDD in the negative valence (loss) domain can include an exaggerated response to emotionally salient stimuli and low mood, while in contrast apathy is characterised by an emotionally blunted state. In this article, we highlight how using a single dimensional approach can limit psychiatric model interpretation. We discuss how integrating behavioural findings from both the positive and negative (loss) valence domains of the Research Domain Criteria can benefit interpretation of findings. We focus particularly on behaviours relating to the negative valence (loss) domain, which may be used to distinguish between apathy and major depressive disorder at the preclinical level. Finally, we consider how future approaches using home cage monitoring may offer a new opportunity to detect distinct behavioural profiles and benefit the overall translatability of findings.

The 3-Item "Apathy" Subscale Within the GDS-15 Is Not Supported in De Novo Parkinson's Disease Patients: Analysis of the PPMI Cohort

This study examined individual components of the Geriatric Depression Scale-15 (GDS-15) to determine whether the 3-item Withdrawal-Apathy-Lack of Vigor (WAV) subscale, which has been validated in older adults and advanced Parkinson's disease (PD), was applicable to newly diagnosed patients with PD. Baseline Parkinson's Progression Markers Initiative (PPMI) data (n = 345), including GDS-15 and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) depression, apathy, and anxiety scores, were examined. Data reduction techniques (i.e., principal components, confirmatory factor analyses) were used. Model fit was poor for the previously identified GDS-15 factor structures. Via principal components analysis, 5 components were identified, none of which reflected the 3-item WAV subscale previously reported in the literature. Internal consistency of the GDS-15 was acceptable, as was the internal consistency for the largest component (labeled "Dysphoria"). All 5 components significantly correlated with the MDS-UPDRS depression, apathy, and anxiety items. Model fit was fair for the "Dysphoria" factor only. Overall, the 3-item WAV factor reported in previous literature was not supported in this sample of de novo PD patients.

Validation of EURO-D, a geriatric depression scale in South India: Findings from the Mysore study of Natal effects on Ageing and Health (MYNAH)

INTRODUCTION

Many of the assessment tools used to study depression amongst older people in low- and middle- income countries (LMICs) are adaptations of instruments developed in other cultural settings. There is a need to validate those instruments in LMICs.

METHODS

721 men and women aged 55-80 years from the Mysore Birth Records Cohort underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, cognitive function and mental health. Sensitivity, specificity and level of agreement of EURO-D diagnosis of depression with diagnosis of depression derived by the Geriatric Mental State (GMS) examination were calculated. To validate the EURO-D score against GMS depressive episode, we used maximum Youden's index as the criterion for each cut-off point. Concurrent validity was assessed by measuring correlations with the WHO Disability Assessment Schedule (WHO DAS II).

RESULTS

Of the 721 (408 men and 313 women) who participated in this study, 138 (54 men and 84 women) were diagnosed with depression. Women had higher depression scores on the EURO-D scale and disability on the WHO DAS II scale. A maximum Youden's Index of 0.60 was observed at a EURO-D cut-off of 6, which corresponded to 95% sensitivity, 64% specificity, kappa value of 0.6 and area under the curve (AUC) of 80%. There was significant and positive correlation between EURO-D and WHO DAS II scores.

LIMITATIONS

Future independent validation studies in other settings are required.

DISCUSSION

This study supports the use of the EURO-D scale for diagnosing depression amongst older adults in South India.

Acceptability and effects of tele-delivered behavioral activation for depression in low-income homebound older adults: in their own words

OBJECTIVES

To examine experiences and perspectives of low-income homebound older adults (N = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor's-level lay counselors.

METHODS

We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants' acceptability of Tele-BA. We used inductive thematic analysis to explore participants' Tele-BA session goals and activities and unsolicited and solicited comments about their Tele-BA experience.

RESULTS

Participant's TEI score averaged 70 out of maximum possible 77. The most frequently chosen Tele-BA goals were to improve self-care management of physical and mental health, engage in self-enrichment/self-enjoyment, improve living environment and daily routine, and to increase social connectedness. The themes that emerged from participants' comments about Tele-BA were: (1) benefits of psychoeducation; (2) importance of and gratitude for working with a counselor; (3) benefits of activity planning; (4) understanding of behavior and mood connection; (5) positive effects of increased activity on health and self-enjoyment; (6) sense of being productive and useful from accomplishing goals; (7) hope for the future; and (8) pride in tele-treatment.

CONCLUSION

Participants' comments show that Tele-BA aimed at reinforcing healthy behaviors that improve both physical functioning and mood is well aligned with these older adults' perception of what treatment should be. The findings also provide support for lay counselors' clinical capacity. Given geriatric mental health workforce shortages, lay counselors may be able to effectively supplement existing professional mental health service systems.

Apathy and executive functioning among non-demented community-dwelling elderly individuals in an everyday environment: the mediating effect of impulsivity

BACKGROUND

Apathy is common in normal ageing and widely recognized as a predictor of cognitive decline, especially in executive functions. Much less characterized than apathy in the elderly is impulsivity, which increases with ageing. It is also frequently described in comorbidity with apathy in various clinical populations, in whom it is associated with poorer executive functioning. In the present study, by capitalizing on a multidimensional approach, we explore the mediating role of facets of impulsivity on the bidirectional relationships between apathy dimensions and executive functioning in non-demented community-dwelling elderly individuals in daily life.

METHODS

A sample of non-demented community-dwelling older adults (n = 101) completed self-rated questionnaires. Apathy was measured by the Apathy Evaluation Scale; impulsivity was examined through the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency (UPPS-P) Impulsive Behaviour Scale; and executive functioning in daily life was assessed by the Behaviour Rating Inventory of Executive Function-Adult (BRIEF-A). Two models positing mediation were tested using conditional process modelling.

RESULTS

Hierarchical regressions controlling for depressive symptoms indicated that the cognitive apathy dimension was associated with the UPPS-P facets sensation seeking, lack of perseverance, and premeditation. Among the UPPS-P facets, lack of perseverance and negative urgency were found to contribute significantly to BRIEF-A Metacognitive index variance. Finally, in both models, lack of perseverance was found to totally mediate the relationship between cognitive apathy and the BRIEF-A Metacognitive index.

CONCLUSIONS

These preliminary findings suggest that, in normal ageing, apathy may share an overlap with impulsivity, contradicting the notion they represent opposite ends of a single behavioural spectrum. Our results argue for bidirectional relationship between a specific apathy dimension (i.e. cognitive apathy) and executive functioning. Moreover, they shed new light on the underlying psychological process implicated (i.e. lack of perseverance) among older adults without dementia and represent an interesting prospect for psychological interventions.

Is geriatric depression scale a valid instrument to screen depression in Chinese community-dwelling elderly?

BACKGROUND

The geriatric depression scale (GDS) is used widely as a screening instrument for depression worldwide. The present study aims to examine the reliability and validity of the GDS with 30 items (GDS-30) in Chinese cognitively normal elderly, and to preliminarily investigate the appropriateness of the GDS-30 among screened mild cognitive impairment (MCI) elderly and among the large-scale community-dwelling Chinese elderly.

METHODS

A total of 12,610 Chinese elderly completed GDS-30 in the project of Community-based Cohort Study on Nervous System Diseases. Of these, 5503 individuals with the ability to perform basic daily living activities were randomly sampled to further complete the Montreal Cognitive Assessment to screen for MCI. The cutoff value of screened depression was 11, and the cutoff values of MCI were education-dependent. Internal consistency was used to evaluate the reliability. Exploratory factor analysis (EFA) was used to determine the factor structure. Confirmatory factor analysis (CFA) was conducted to assess the construct validity in the elderly screened normal cognition, screened MCI, and the whole population, respectively.

RESULTS

The Kuder-Richardson coefficient (KR20) was 0.834, 0.821 and 0.840 for the cognitively normal elderly, screened MCI and the whole population, respectively. EFA showed that GDS-30 can be either a four-factor model (named positive mood, dysphoria, worry, and social withdrawal-cognitive impairment) or a two-factor model (named depression and positive mood). The latter was easier to interpret. CFA showed that the two-factor model fitted well in the elderly with normal cognition, with screened MCI, and the whole sample. The factors loaded from 0.900 to 0.588, 0.882 to 0.529, and 0.888 to 0.556 in these three populations respectively.

CONCLUSIONS

The GDS-30 has good reliability and validity and can be appropriately applied to screen depression in the large-scale community-dwelling Chinese elderly regardless of the presence of mild cognitive impairment.

Low dopamine transporter binding in the nucleus accumbens in geriatric patients with severe depression

AIM

Dysfunction of dopaminergic neurons in the central nervous system is considered to be related to major depressive disorder (MDD). Especially, MDD in geriatric patients is characterized by anhedonia, which is assumed to be associated with reduced dopamine neurotransmission in the reward system. Dopamine transporter (DAT) is considered to reflect the function of the dopamine nerve system. However, previous DAT imaging studies using single photon emission computed tomography or positron emission tomography (PET) have shown inconsistent results. The radioligand [¹⁸ F]FE-PE2I for PET enables more precise evaluation of DAT availability. Hence, we aimed to evaluate the DAT availability in geriatric patients with MDD using [¹⁸ F]FE-PE2I.

METHODS

Eleven geriatric patients with severe MDD and 27 healthy controls underwent PET with [¹⁸ F]FE-PE2I, which has high affinity and selectivity for DAT. Binding potentials (BP_ND ) in the striatum (caudate and putamen), nucleus accumbens (NAc), and substantia nigra were calculated. BP_ND values were compared between MDD patients and healthy controls.

RESULTS

MDD patients showed significantly lower DAT BP_ND in the NAc (P = 0.009), and there was a trend of lower BP_ND in the putamen (P = 0.032) compared to controls.

CONCLUSION

We found low DAT in the NAc and putamen in geriatric patients with severe MDD, which could be related to dysregulation of the reward system.

Depression, Anxiety, and Apathy in Mild Cognitive Impairment: Current Perspectives

Objective: Mild cognitive impairment (MCI) is an important risk state for dementia, particularly Alzheimer's disease (AD). Depression, anxiety, and apathy are commonly observed neuropsychiatric features in MCI, which have been linked to cognitive and functional decline in daily activities, as well as disease progression. Accordingly, the study's objective is to review the prevalence, neuropsychological characteristics, and conversion rates to dementia between MCI patients with and without depression, anxiety, and apathy. Methods: A PubMed search and critical review were performed relating to studies of MCI, depression, anxiety, and apathy. Results: MCI patients have a high prevalence of depression/anxiety/apathy; furthermore, patients with MCI and concomitant depression/anxiety/apathy have more pronounced cognitive deficits and progress more often to dementia than MCI patients without depression/anxiety/apathy. Conclusions and Implications: Depression, anxiety, and apathy are common in MCI and represent possible risk factors for cognitive decline and progression to dementia. Further studies are needed to better understand the role and neurobiology of depression, anxiety, and apathy in MCI.

The impact of apathy on cognitive performance in the elderly

OBJECTIVES

To examine the impact of apathy on cognitive performance in the elderly following the conceptual principles proposed by Marin1 and Stuss et al2 and to determine the role of the symptoms of apathy in different cognitive domains.

METHODS

Cross-sectional study with a cohort of healthy elderly subjects over 55 years old (n = 140). One hundred forty healthy-elderly subjects (aged 79.24 ± 8.6 years old) were recruited from 12 day centers in Northern Spain. Participants underwent a neuropsychological battery, which evaluated Mini Mental State Examination (MMSE), attention, processing speed, verbal fluency, visual and verbal memory, working memory, and executive functioning. Apathy was assessed by the Lille Apathy Rating Scale (LARS), which is composed of four factors: intellectual curiosity, emotion, action initiation, and self-awareness. Correlation and linear regression analyses were performed.

RESULTS

In the correlational analysis, the LARS total score correlated negatively with global cognition, verbal fluency, and visual and verbal memory. The intellectual curiosity factor correlated negatively with all cognitive domains except attention. The emotion factor correlated negatively with visual memory. No correlation was found between the action initiation and self-awareness factors or any of the cognitive variables. Multiple stepwise regression analysis showed that symptoms of apathy explained cognitive performance in attention, processing speed, verbal fluency, visual and verbal memory, working memory, executive functioning, and MMSE.

CONCLUSIONS

Apathy was significantly associated with cognitive performance, especially with the intellectual curiosity factor. Our results suggest that specific symptoms of apathy contribute differently to individual cognitive domains.

Examination of discrepancies between subjective and objective memory with latent factors of the geriatric depression scale

OBJECTIVE

The purpose of the present study was to examine whether multiple constructs of depressive symptoms explained discrepancies between subjective (SM) and objective memory (OM) in older adulthood.

METHOD

A sub-sample (Range: 65-98 years, N = 606) of the 2000 Wave Panel 3 of the Long Beach Longitudinal Study was used to explore underlying latent factors within the Geriatric Depression Scale (GDS).

RESULTS

Four GDS factors were identified (Dysphoria, Vigor/Withdrawal, Cognitive Concerns, and Agitation); the factor solution was tested in a confirmatory factor analysis. Mechanisms of the GDS factors on SM and OM were tested by using structural equation modeling. Dysphoria negatively predicted OM, but not SM, suggesting that people who scored high in Dysphoria might not sense their memory failures although they obviously performed poorly in OM. Cognitive concerns negatively predicted SM, but not OM, suggesting that cognitive concerns were not influential for OM, but negatively affected one's evaluation of SM.

CONCLUSION

The study results have clinical implications since such relationships can be concealed while assessing depressive symptoms as a single GDS factor. Thus, the patterns of the GDS factors, SM, and OM derived from this study can be very useful for clinicians who conduct assessments on depressive symptoms and memory failures.

Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes

OBJECTIVE

The aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults.

METHODS

Older adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints.

RESULTS

Significant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures.

CONCLUSIONS

A four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition.

CLINICAL TRIAL IDENTIFER

NCT02967185.

Apathy in early and late-life depression

BACKGROUND

Late-life depression is thought to differ in clinical presentation from early-life depression. Particularly, late-life depression is considered to be more characterized by apathy than is early-life depression. Lacking convincing evidence, this study examines the presence and associated socio-demographic/clinical characteristics of apathy in older compared to younger depressed persons.

METHODS

This cross-sectional study used data from two naturalistic cohort studies, i.e. the Netherlands Study of Depression in Older Persons (NESDO) and the Netherlands Study of Depression and Anxiety (NESDA). These studies included 605 persons (aged 18-93 years) with a major depressive disorder, divided into 217 early-life (< 60 years) and 388 late-life (≥ 60 years) depressed persons. Apathy was considered present if a score of ≥14 on the Apathy Scale.

RESULTS

Apathy was strongly associated with age: it was more frequently present in persons with late-life depression (74.5%) than in those with early-life depression (53.5%). Independent of age, the following characteristics were associated with the presence of apathy: male gender, low education, use of benzodiazepines, chronic diseases, and more severe depression. Of all potential risk factors, only former and current smoking was associated with the presence of apathy in older depressed persons but not in younger depressed persons (p-value for age interaction = 0.01).

LIMITATIONS

No causal relationships can be drawn due to the cross-sectional design of the study.

CONCLUSIONS

In depressed individuals, clinically relevant apathy was more frequently present in older compared to younger persons. Both age groups showed largely the same associated risk factors. Apathy was independently associated with older age, male gender and more severe depression.

Apathy and Executive Function in Healthy Elderly-Resting State fMRI Study

Apathy is a quantitative reduction in goal-directed behaviors, having three subtypes. Despite executive deterioration in healthy aging, researchers have not investigated the “cognitive-deficit” subtype of apathy in healthy populations, which would result from executive dysfunction. We hypothesized that a relationship between apathy and executive function (EF) would be found in healthy older adults, accompanied with neural deterioration with functional dysconnectivity between the striatum and frontal region as suggested by previous studies. A total of 100 healthy adults in a health examination system database were analyzed. The present study indicates that apathy is substantially associated with executive deterioration, which can be partially ascribed to decreased functional connectivity between the frontal and ventral striatum. Despite some limitations, our findings may contribute to research on healthy psychological aging.

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

OBJECTIVE

Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty, and disability among non-demented, community-dwelling older adults.

METHODS

We examined 2 independent prospective cohort studies-the LonGenity study (N = 625, 53% women, mean age = 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age = 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age- and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale.

RESULTS

The prevalence of apathy was 20% in the LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased the risk of developing incident slow gait (hazard ratio [HR] = 2.10; 95% CI, 1.36-3.24; P = .001), frailty (HR = 2.86; 95% CI, 1.96-4.16; P < .001), and disability (HR = 3.43; 95% CI, 1.73-6.79; P < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function.

CONCLUSIONS

Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened for as a potentially preventable cause of functional decline in clinical psychiatric settings.

Validity of the three apathy items of the Geriatric Depression Scale (GDS-3A) in measuring apathy in older persons

OBJECTIVE

The Geriatric Depression Scale (GDS)-3A, a three-item subset of the GDS-15, is increasingly used as a measure for apathy in research settings to assess factors associating with this neuropsychiatric syndrome. We aimed to assess how accurately the GDS-3A discriminates between presence and absence of apathy in two populations of community-dwelling older persons, using the Apathy Scale as reference standard.

METHODS

Baseline data were used from 427 participants of the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study Leiden and 1118 participants of the PROactive Management Of Depression in the Elderly (PROMODE) Study, all ≥75 years and with available GDS-3A and Apathy Scale measurements. A cut-off score of ≥14 was used for presence of apathy according to the Apathy Scale. Areas under the receiver operating characteristic curve (AUC) were calculated. Based on the likelihood ratios for GDS-3A scores, a cut-off of ≥2 was used for presence of apathy according to the GDS-3A to calculate test characteristics.

RESULTS

The AUC was 0.68 (95% confidence interval 0.62-0.73) in the DANTE Study and 0.72 (0.67-0.77) in the PROMODE Study. In the DANTE Study sensitivity was 29.3% (21.4-38.1) and specificity was 88.5% (84.4-91.8), whereas in the PROMODE Study sensitivity was 32.8% (24.5-41.1) and specificity 92.6% (90.9-94.2). Stratification on population characteristics did not yield more favourable test characteristics.

CONCLUSION

The GDS-3A has low sensitivity and high specificity as a measure of apathy in two populations of older persons. Using the GDS-3A in research might yield estimates biassed towards the null in case of non-differential misclassification. Copyright © 2016 John Wiley & Sons, Ltd.

The Parkinson's Active Living (PAL) Program

BACKGROUND

Apathy, one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), has been associated with reduced daily functioning, cognition, treatment compliance, quality of life, and increased caregiver burden and distress, among other outcomes.

OBJECTIVES

The purpose of the present study was to develop and gather pilot data on the feasibility, acceptability, and efficacy of the Parkinson's Active Living (PAL) program, to our knowledge, the first behavioral treatment specifically designed to target apathy in patients with PD. The Parkinson's Active Living is a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates external cueing to target disease-related self-generational deficits to reduce levels of apathy in nondemented, highly apathetic patients with PD.

METHODS

Participants aged 44 to 86 years (mean = 66, SD [standard deviation] = 10.7) ranging in disease duration from <1 to 23 years with elevated apathy (Apathy Evaluation Scale >35) were enrolled in a 1-arm trial and tested at 3 time points (baseline, posttest, and 1-month follow-up).

RESULTS

Feasibility aspects (ie, acceptability, demand, implementation, practicality, adaptation, integration, and expansion) and efficacy of PAL program are reported. Matched pairs t tests showed a medium to large effect of treatment on patient apathy (52% showing ≥1 SD improvement), depression (33% showing ≥1 SD improvement), and quality of life at posttest, with improvements in apathy and depression maintained at follow-up.

CONCLUSIONS

The program may hold promise as an effective nonpharmacological intervention for apathy in PD. Implications and future directions are discussed. Randomized controlled trials are needed.

Depression Moderates the Frailty-Subjective Health Link among Chinese Near Centenarians and Centenarians

OBJECTIVE

Very old adults may be physically frail, but they do not necessarily experience poor subjective health. The authors hypothesized that the relationship between frailty and subjective health is moderated by depression for very old people.

METHODS

In a cross-sectional study, a survey administered was by a face-to-face interview to 129 community-dwelling older adults aged 95-108. Measurements included the five-item FRAIL scale, the Geriatric Depression Scale Short-Form (GDS), and a subjective health rating. Hierarchical multiple regressions were conducted to test the moderation effects, adjusting for age, gender, living arrangement, perceived socioeconomic status, and cognition.

RESULTS

The interaction effect between frailty and depression was significant. Inspection of the simple slopes revealed that those who were more depressed had a more negative frailty-subjective health relationship. There was no significant moderation effect for a withdrawal-apathy-vigor dimension of the GDS.

CONCLUSION

Our findings suggest a protective psychological mechanism may enable very old adults to maintain an optimistic view of their health despite their increasing physical and functional limitations.

Latent class analysis of the Apathy Scale does not identify subtypes of apathy in general population-based older persons

OBJECTIVES

To identify clinically relevant subtypes of apathy in older persons using latent class analysis (LCA) and investigate the distribution of different characteristics across these subtypes.

MEASUREMENTS

Cross-sectional data of 122 older persons (mean age 84 years, 60% female) participating in the general population-based PROactive Management Of Depression in the Elderly study, with apathy according to a score of 14 or higher on the Apathy Scale, were included for LCA. All 14 items of the Apathy Scale were used as indicator variables. Several characteristics were examined including sociodemographics, depressive, and anxiety symptoms; global cognitive function; quality of life indicators; hazardous alcohol intake (drinking ≥ 14 consumptions per week); and perceived chronic pain.

RESULTS

Three distinct LCA classes were found classifying 17%, 7%, and 76% of the participants respectively. Individuals in the first class had a higher level of education and were less likely to live alone. Those in the second class had higher apathy and depression scores, lived more frequently alone and used more alcohol. Individuals in the third class showed a lower level of education and worse cognitive function. In multivariable multinomial analyses, only a lower educational level and higher scores on the Apathy Scale were significant predictors for class membership.

CONCLUSION

Differences between LCA-derived classes were minimal, suggesting that in a general population-based cohort the Apathy Scale measures a homogeneous construct. Copyright © 2016 John Wiley & Sons, Ltd.

The Effects of Donepezil on 15-Item Geriatric Depression Scale Structure in Patients with Alzheimer Disease

BACKGROUND/AIMS

In Alzheimer disease (AD), depression is among the most common accompanying neuropsychiatric symptoms and has different clinical manifestations when compared with early-life depression. In patients with drug-naïve AD, we tried to explore the structure of the 15-item Geriatric Depression Scale (GDS15) and the effect of donepezil on these substructures.

METHODS

GDS15, cognitive function, and activities of daily living function tests were administered to 412 patients with probable AD who had not been medicated before visiting the hospital. Using principal component analysis, three factors were identified. The patients with AD who received only donepezil were retrospectively analyzed and we compared the change of cognition and GDS15 subgroup after donepezil medication.

RESULTS

Our study identified three factors and revealed that the GDS15 may be comprised of a heterogeneous scale. The Barthel index was significantly correlated with factor 1 (positively) and factor 2 (negatively). The Korean version of the MMSE (K-MMSE) was significantly correlated with factor 2 and factor 3. Compared to the baseline state, K-MMSE and GDS15 showed significant improvement after taking donepezil. Among GDS15 subgroups, factor 2 and factor 3 showed significant improvement after donepezil treatment.

CONCLUSIONS

These results suggest that the GDS15 may be comprised of a heterogeneous scale and donepezil differentially affects the GDS15 subgroup in AD.

Alzheimer’s Caregiver Differences in Experience of Loss, Grief Reactions and Depressive Symptoms Across Stage of Disease

The self-reported losses, grief reactions, and depressive symptoms experienced by caregivers in the early, middle, and late stages of dementia were assessed using open-ended descriptive questions and scaled measures including the Meuser-Marwit Caregiver Grief Inventory (MM-CGI; Marwit & Meuser, 2002). Ninety-nine caregivers associated with an urban Alzheimer’s Association chapter were surveyed by post. While there were moderate levels of grief and depression reported across the entire sample, those caring for individuals in the late stage of dementia reported significantly more symptoms of grief and depression than those in the early or middle stages. Responses to open-ended questions regarding losses and grief also differed across the groups in the three disease stages. The late-stage group’s comments most resembled bereavement, in keeping with the higher grief and depression scores among members of this group. Findings suggest there are different emotional tasks faced by caregivers as the dementia progresses, and it is important to acknowledge the particular losses and facilitate grieving at each stage.

Changing Investment in Activities and Interests in Elders' Lives: Theory and Measurement

Socioemotional selectivity and gerotranscendence, newer theories with roots in the disengagement theory of aging, provided the theoretical framework for a new measure of perceived change in investment in a variety of pursuits. The 30-item Change in Activity and Interest Index (CAII) was given to a sample of 327 outpatients aged 65–94. Items with at least 30% decreased investment responses included Entertaining in my home, Concern with others' opinions, Shopping and buying things, and Attending social events with new people. Principal Components Analysis of the index with dichotomous recoding ( less vs. more or same investment) resulted in four factors: Active Instrumental (AI), Social Intellectual (SI), Spiritual Concerns (SC), and Transcendence (TR). Support for socioemotional selectivity and gerotranscendence is evident in the reported increase of importance of SI pursuits, with concurrent decrease in importance of AI activities among these respondents. Zero-order correlations of component scores with study variables suggest that AI and SI are more clearly related to older age, functional impairment, and negative affect than are SC and TR. The CAII appears to tap several dimensions of change in interests; the index gives geriatric mental health practitioners and researchers a tool to measure an aspect of social development that has been neglected in gerontology.

Neuroimaging correlates of neuropsychiatric symptoms in Alzheimer's disease: a review of 20 years of research

Assessing morphological, perfusion and metabolic brain changes preceding or associated with neuropsychiatric symptoms (NPSs) will help in the understanding of pathophysiological underlying processes in Alzheimer's disease (AD). This review aimed to highlight the main findings on significant associations between neuroimaging and NPSs, the pathophysiology to elucidate possible underlying mechanisms, and methodological issues to aid future research. Research papers published from January 1990 to October 2015 were identified in the databases PsycInfo, Embase, PubMed and Medline, using key words related to NPSs and imaging techniques. In addition to a semi-systematic search in the databases, we also performed hand searches based on reported citations identified to be of interest. Delusions, apathy and depression symptoms were particularly associated with brain changes in AD. The majority of studies disclosed an association between frontal lobe structural and/or metabolic changes and NPSs, implicating, interestingly, for all 12 NPSs studied, the anterior cingulate cortex although temporal, subcortical and parietal regions, and insula were also involved. Given the high degree of connectivity of these brain areas, frontal change correlates of NPSs may help in the understanding of neural network participation. This review also highlights crucial methodological issues that may reduce the heterogeneity of results to enable progress on the pathophysiological mechanisms and aid research on NPS treatments in AD. Based on a broad review of the current literature, a global brain pattern to support the huge heterogeneity of neuroimaging correlates of NPSs in AD and methodological strategies are suggested to help direct future research.

Comparing Patient-Reported Outcomes Measure Information System Depression Scale with Legacy Depression Measures in a Community Sample of Older Adults with Varying Levels of Cognitive Functioning

OBJECTIVE

This study evaluated the utility of Patient-Reported Outcomes Measure Information System Depression Scale (PROMIS-8a) compared with selected "Legacy" depression scales, including the Montgomery-Asberg Depression Rating Scale (MADRS), Geriatric Depression Scale (GDS), and GDS-Short Form (GDS-SF). Additionally, the measures' properties were assessed across levels of cognitive functioning.

METHODS

This cross-sectional analysis was extracted from a prospective cohort study. PROMIS-8a and Legacy depression measures were administered to individuals aged at least 70 years grouped by cognitive status based on the Saint Louis University Mental Status Examination. McNemar tests were run to determine if measures categorized the absence or presence of depression differently and item analysis evaluated classification discrepancies.

RESULTS

Sample mean age was 78, and most participants were women (71%), white (79%), with at least a high school education (89%). The percentage of individuals with at least mild depression was similar across measures (20.7% PROMIS-8a, 19.0% MADRS, 17.9% GDS, 13.9% GDS-SF). PROMIS-8a total score correlated moderately with MADRS (r = 0.56, df = 295, p <0.01), GDS (r = 0.68, df = 291, p <0.01), and GDS-SF (r = 0.60, df = 291, p <0.01), and predictive validity of the measures was similar. There were no significant mean differences on depression measures by cognitive status.

CONCLUSION

Although all measures identified a similar percent of depressed individuals, the classification differed by measure. Item analysis showed that PROMIS-8a was more likely to identify feelings of dysphoria while the MADRS and GDS were more likely to identify physiologic aspects of depression. Given the brevity and ease of administration of the PROMIS-8a, it appears to be a useful depression screen for community-dwelling older adults.

Differences in anxiety and depression symptoms: comparison between older and younger clinical samples

BACKGROUND

Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression.

METHODS

One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood.

RESULTS

The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous.

CONCLUSIONS

Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.

Dissociative contributions of the anterior cingulate cortex to apathy and depression: Topological evidence from resting-state functional MRI

Apathy is defined as a mental state characterized by a lack of goal-directed behavior. However, the underlying mechanisms of apathy remain to be fully understood. Apathy shares certain symptoms with depression and both these affective disorders are known to be associated with dysfunctions of the frontal cortex-basal ganglia circuits. It is expected that clarifying differences in neural mechanisms between the two conditions would lead to an improved understanding of apathy. The present study was designed to investigate whether apathy and depression depend on different network properties of the frontal cortex-basal ganglia circuits, by using resting state fMRI. Resting-state fMRI measurement and neuropsychological testing were conducted on middle-aged and older adults (N=392). Based on graph theory, we estimated nodal efficiency (functional integration), local efficiency (functional segregation), and betweenness centrality. We conducted multiple regression analyses for the network parameters using age, sex, apathy, and depression as predictors. Interestingly, results indicated that the anterior cingulate cortex showed lower nodal efficiency, local efficiency, and betweenness centrality in apathy, whereas in depression, it showed higher nodal efficiency and betweenness centrality. The anterior cingulate cortex constitutes the so-called "salience network", which detects salient experiences. Our results indicate that apathy is characterized by decreased salience-related processing in the anterior cingulate cortex, whereas depression is characterized by increased salience-related processing.

Gray Matter Volume Changes in the Apathetic Elderly

This study is to test the hypothesis that apathy in healthy participants is closely related to the prefrontal-basal-ganglia circuit and associated structural changes. We selected 36 healthy aged participants with (n = 18) or without apathy (n = 18) from our database. Participants underwent structural MRI scanning, providing data for voxel-based morphometric analysis to explore gray matter changes associated with apathy. Compared to the non-apathy group, the apathy group showed reduced gray matter volume of the right putamen, whereas volumes of the bilateral inferior frontal gyri and left inferior occipital gyrus showed increase. When depression scores were included in a regression model as a covariate, apathetic participants showed decreased gray matter volume in the right precentral gyrus compared to the non-apathetic participants. These findings suggest that apathy is associated with the gray matter volume in the prefrontal-basal-ganglia network, and may have a neuroanatomical basis distinct from depression in healthy elderly.

Apathy as a feature of prodromal Alzheimer's disease: an FDG-PET ADNI study

OBJECTIVE

The goal of this study is to evaluate brain metabolism in mild cognitive impairment (MCI) patients with and without apathy (as determined by the Neuropsychiatric Inventory Questionnaire).

METHODS

Baseline data from 65 MCI participants (11 with apathy and 54 without) from the Alzheimer's Disease (AD) Neuroimaging Initiative study were analyzed. All participants underwent a comprehensive cognitive and neuropsychiatric assessment, volumetric MRI and measures of cerebral glucose metabolism applying (18)F-fluorodeoxyglucose positron emission tomography at baseline. The presence of apathy at baseline was determined by the Neuropsychiatric Inventory Questionnaire.

RESULTS

There was no difference between apathy and apathy-free MCI patients regarding cognitive assessment and neuropsychiatric measures when apathy-specific items were removed. Cerebrovascular disease load and cerebral atrophy were equivalent in both groups. Compared with the apathy-free MCI patients, MCI patients with apathy had significantly decreased metabolism in the posterior cingulate cortex.

CONCLUSION

The presence of apathy in MCI patients is associated with AD-specific pattern of brain metabolic defect. These results could suggest that apathy belongs to the spectrum of prodromal AD symptoms.

Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study

BACKGROUND

Many of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC).

METHODS

A one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0.

RESULTS

17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. The most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.

CONCLUSIONS

There is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies.

Structural MRI correlates of apathy symptoms in older persons without dementia: AGES-Reykjavik Study

OBJECTIVE

We aimed to investigate the relation between apathy symptoms and structural brain changes on MRI, including white matter lesions (WMLs) and atrophy, in a large cohort of older persons.

METHODS

Cross-sectional analyses are based on 4,354 persons without dementia (aged 76 ± 5 years) participating in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study. Apathy symptoms were assessed with 3 items from the 15-item Geriatric Depression Scale. Brain volumes and total WML volume were estimated on 1.5-tesla MRI using an automated segmentation program; regional WML load was calculated using a semiquantitative scale. Regression analyses were adjusted for age, sex, education, intracranial volume, vascular risk factors, physical activity, brain infarcts, depressive symptoms, antidepressants, and cognitive status.

RESULTS

Compared to those with <2 apathy symptoms, participants with ≥ 2 apathy symptoms (49% of the cohort) had significantly smaller gray matter volumes (mean adjusted difference -3.6 mL, 95% confidence interval [CI] -6.2 to -1.0), particularly in the frontal and temporal lobes; smaller white matter volumes (mean adjusted difference -1.9 mL, 95% CI -3.6 to -0.3), mainly in the parietal lobe; and smaller thalamus volumes. They were also more likely to have WMLs in the frontal lobe (adjusted odds ratio = 1.08, 95% CI 0.9-1.3). Excluding participants with a depression diagnosis did not change the associations.

CONCLUSIONS

In this older population without dementia, apathy symptoms are associated with a more diffuse loss of both gray and white matter volumes, independent of depression.

Are self-efficacy beliefs and subjective task demand related to apathy in aging?

OBJECTIVE

Apathy, defined as a reduction in voluntary goal-directed behaviors (GDBs), is common in aging, but the processes underlying apathy are still unclear. Self-efficacy beliefs are likely to play a key role in GDBs, by influencing goal setting, perceived difficulty, and the necessary amount of effort to achieve goals. The aim of this study was to examine the relationships between apathy and perceived self-efficacy.

METHOD

Sixty-three healthy elderly participants worked on a memory task without fixed performance standard ('do your best') and indicated perceived difficulty and effort investment after performing the task. They also completed two short scales assessing general self-efficacy and negative mood. In addition, a close relative of each participant completed the Initiative Interest Scale, a new questionnaire assessing apathetic manifestations in aging.

RESULTS

The main results showed that subjective task demand (i.e., perceived difficulty and estimated effort) operated as a mediator between self-efficacy beliefs and apathy. These results suggest that elderly people with low self-efficacy beliefs who face a challenge judge the task to be highly difficult and effort demanding, which might result in GDB reduction.

CONCLUSION

These results shed new light on the processes related to apathy in aging and open up an interesting prospect for psychological interventions.

Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study

OBJECTIVE

Although depression is considered to be associated with cardiovascular disease (CVD), specifically symptoms of apathy have been strongly associated with a history of CVD in recent studies. In this study, we prospectively assess whether symptoms of apathy and depression are independent risk factors for incident CVD and stroke.

METHODS

We carried out a prospective cohort study of 1810 community-dwelling older individuals (70-78 years) without a history of CVD or stroke. Symptoms of apathy and depression were assessed with the 15-item Geriatric Depression Scale. Incident CVD and stroke were assessed after 2 years follow-up. The associations of symptoms of apathy and depression with incident CVD and stroke were analyzed separately using logistic regression analysis.

RESULTS

Symptoms of apathy and depression were present in 281 (15.5%) and 266 (14.7%) participants, respectively. Incident CVD occurred in 62 (3.5%) participants and stroke in 55 (3.1%) participants. Apathy was associated with incident CVD after adjustment for demographics and cardiovascular risk factors (odds ratio (OR) = 2.60, 95% CI = 1.46-4.65). Exclusion of subjects with depressive symptoms yielded a similar OR (2.94, 95% CI = 1.45-5.96, n = 1544). No association was found between depressive symptoms and incident CVD. Neither apathy symptoms nor depressive symptoms were associated with incident stroke.

CONCLUSIONS

Apathy, but not depression, is a strong, independent risk factor for incident CVD. It may be a marker of underlying vascular disease. By its nature, apathy may cause non-adherence to a healthy lifestyle, diminished activities, and possibly even withdrawal from clinical care aimed at improving vascular risk profiles.

Quality of life in community-dwelling older persons with apathy

OBJECTIVE

To investigate the relationship between apathy and perceived quality of life in groups both with and without depressive symptoms or cognitive impairment.

METHODS

We conducted a cross-sectional study comparing quality of life in older persons with and without apathy in 19 Dutch general practices. Participants were 1,118 older persons aged at least 75 years without current treatment for depression and a Mini-Mental State Examination score of at least 19. Perceived quality of life was determined using Cantril's Ladder for overall quality of life, EuroQol (EQ)-5D thermometer for subjective health quality, and De Jong-Gierveld Loneliness questionnaire for perceived loneliness. Apathy was assessed with the Apathy Scale.

RESULTS

Of the 1,118 older persons, apathy was present in 122 (11%) of them. Overall, apathy was associated with having no work, lower level of education, presence of depressive symptoms, cognitive impairment, and decreased scores on all quality of life measures. Among the 979 (88%) older persons without depressive symptoms and cognitive impairment, apathy was present in 73 (7.5%) of them, showing similar associations as in the total population. In the 77 (7%) persons with cognitive impairment only, apathy was correlated to a lower score on the EQ-5D thermometer. However, in the 51 (5%) depressed persons without cognitive impairment, presence of apathy did not contribute to their decreased quality of life.

CONCLUSION

Apathy frequently occurred in community-dwelling older persons, also in the absence of depressive symptoms and cognitive impairment. In them, apathy contributed to the perception of a diminished quality of life in various aspects of daily life.

Factor structure of the Geriatric Depression Scale and relationships with cognition and function in Alzheimer's disease

BACKGROUND/AIMS

No study to date has systematically explored whether the Geriatric Depression Scale (GDS) measures symptoms of apathy and dysphoria in patients with Alzheimer's disease (AD) or related these constructs to cognitive and functional status.

METHODS

Exploratory factor analysis (EFA) was used to identify factors of the GDS in a sample of 569 patients with probable AD. Two-way ANOVAs were used to determine the relationship of apathy and dysphoria to neuropsychological and functional measures.

RESULTS

The EFA yielded four factors associated with apathy, dysphoria, social withdrawal and cognitive impairment. Apathy was associated with greater impairments in verbal memory, motor speed, and functional abilities.

CONCLUSION

Apathy, but not dysphoria, was associated with some cognitive and functional variables. Results suggest that the GDS may be used as a screening measure for symptoms of apathy in AD.

Engineering the fitness of older patients for chemotherapy: An exploration of Comprehensive Geriatric Assessment in practice

Clinicians often report that currently available methods to assess older patients, including standard clinical consultations, do not elicit the information necessary to make an appropriate cancer treatment recommendation for older cancer patients. An increasingly popular way of assessing the potential of older patients to cope with chemotherapy is a Comprehensive Geriatric Assessment. What constitutes Comprehensive Geriatric Assessment, however, is open to interpretation and varies from one setting to another. Furthermore, Comprehensive Geriatric Assessment’s usefulness as a predictor of fitness for chemotherapy and as a determinant of actual treatment is not well understood. In this article, we analyse how Comprehensive Geriatric Assessment was developed for use in a large cancer service in an Australian capital city. Drawing upon Actor–Network Theory, our findings reveal how, during its development, Comprehensive Geriatric Assessment was made both a tool and a science. Furthermore, we briefly explore the tensions that we experienced as scholars who analyse medico-scientific practices and as practitioner–designers charged with improving the very tools we critique. Our study contributes towards geriatric oncology by scrutinising the medicalisation of ageing, unravelling the practices of standardisation and illuminating the multiplicity of ‘fitness for chemotherapy’.

The subscale structure of the Inventory of Depressive Symptomatology Self Report (IDS-SR) in older persons

BACKGROUND

Using symptom dimensions may be more effective than using categorical subtypes when investigating clinical outcome and underlying mechanisms of late-life depression. Therefore, this study aims to identify both the factor and subscale structure of late-life depression underlying the Inventory of Depressive Symptomatology Self Report (IDS-SR) in older persons.

METHOD

IDS-SR data of 423 participants in the Netherlands Study of Depression in Older Persons (NESDO) were analyzed by exploratory (EFA) and confirmatory factor analysis (CFA). The best-fitting factor solution in a group of older persons with a major depressive disorder diagnosis in the last month (n = 229) was replicated in a control group of older persons with no or less severe depression (n = 194). Multiple group (MG-CFA) was performed to evaluate generalizability of the best-fitting factor solution across subgroups, and internal consistency coefficients were calculated for each factor.

RESULTS

EFA and CFA show that a 3-factor model fits best to the data [comparative fit index (CFI) = 0.98; Tucker Lewis Index (TLI) = 0.99; and root mean square error of approximation (RMSEA) = 0.052], consisting of a 'mood', 'motivation' and 'somatic' factor with adequate internal consistencies (alpha coefficient 0.93, 0.83 and 0.70, respectively). MG-CFA shows a structurally similar factor model across subgroups.

CONCLUSION

The IDS-SR can be used to measure three homogeneous symptom dimensions that are specific to older people. Application of these dimensions that may serve as subscales of the IDS-SR may benefit both clinical practice and scientific research.

Geriatric depression in advanced cancer patients: the effect of cognitive and physical functioning

AIM

The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients.

METHODS

A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients.

RESULTS

The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99-10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%.

CONCLUSIONS

The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly.

Do centenarians have higher levels of depression? Findings from the Georgia Centenarian Study

OBJECTIVES

To examine age differences on specific items and subscales of the Geriatric Depression Scale (GDS).

DESIGN

Specific items, subscales, and total score on the GDS of three age groups were compared.

SETTING

Community-dwelling older adults.

PARTICIPANTS

One hundred thirty-nine centenarians were compared with 93 octogenarians and 91 sexagenarians.

MEASUREMENTS

GDS scores.

RESULTS

Results indicated age group differences in overall depression score and in withdrawal-apathy-vigor (WAV), cognitive impairment, and hopelessness subscale scores. Significant age group differences were also obtained for 12 of the 30 items. Centenarians rated higher on all subscales, but there was no difference in dysphoric mood and worry.

CONCLUSION

It is important to distinguish different dimensions of depression when assessing very old populations because some of the questions on the GDS are associated with fatigue, mild cognitive decline, and decline in physical functioning, which increase with aging. Future research should revisit the concept of depression in very late life.