Psychiatric disorders and cognitive dysfunction among older, postmenopausal women: results from the Women's Health Initiative Memory Study

Neuropsychological performance in women at risk of postpartum depression and postpartum psychosis

PURPOSE

While neuropsychological deficits are commonly observed in affective and psychotic disorders, this remains unexplored in these disorders when they occur during pregnancy and the postpartum period.

METHODS

A neuropsychological test battery was administered to women defined at risk of postpartum depression (PD, N = 53) because having either a current or past diagnosis of major depressive disorder, women at risk of postpartum psychosis (PP, N = 43) because of a diagnosis of bipolar disorder or schizoaffective disorder and/or a previous episode of PP and women not at risk (NR, N = 48) in the third trimester of pregnancy. Generalized and specific cognitive abilities were compared between groups.

RESULTS

Women at risk of PP presented worse executive functions and processing speed compared to NR and worse performance compared to women at risk of PD across all cognitive domains. In addition, women at risk of PP who developed a psychiatric relapse in the first four weeks post-partum showed worse verbal learning and memory, visual memory, executive functions and processing speed in pregnancy compared to NR, whereas women at risk of PP who remained well presented neuropsychological performance that was intermediate between that of the women NR and those at risk of PP who developed symptoms. There were no differences in performance between women at risk of PD and the NR women, even if 31 women at risk of PD presented depressive symptoms at the time of cognitive assessment.

CONCLUSIONS

Our findings in women at risk of PP align with neuropsychological findings in individuals with, or at risk of psychosis unrelated to pregnancy. In addition, initial evidence that women at risk of PP who develop a psychiatric relapse in the postpartum show a particularly poor neuropsychological performance in pregnancy suggests that this could be considered part of a phenotype for the disease and help guiding future preventive strategies in this clinical population. In women at risk of PD, the presence of depressive symptoms did not influence cognitive performance.

Effect of alcohol intake on the development of mild cognitive impairment into dementia: A protocol for systematic review and dose-response meta-analysis

OBJECTIVE

To assess the dose-response relationship between alcohol consumption and the progression of MCI to dementia.

METHOD

This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta analysis for Protocols. Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, EMBASE will be searched for all relevant published articles, with no restrictions on the year of publication or language. Case-control and cohort studies explored the relationship between alcohol exposure and the incidence of dementia in patients with MCI will be included. Study selection, data collection and assessment of study bias will be conducted independently at each level by a pair of independent reviewers. The Newcastle-Ottawa Scale (NOS) tool will be used for the risk of bias assessment. The methodological quality of systematic review will be based on A measurement Tool to Assess Systematic Review (AMSTAR 2). The Grading of Recommendations Assessment Development and Evaluation (GRADE) system will be used to assess the quality of evidence. Stata 15.0 will be used for general meta-analysis and exploring the dose-response relationship. Piecewise linear regression model and the restricted cubic spline model will be used for nonlinear trend estimation, and the generalized least-square method will be used to estimate the parameters.

DISCUSSION

This dose-response meta-analysis is the first to investigate the dose-effect relationship between alcohol exposure and the incidence of dementia in patients with MCI, providing a comprehensive understanding of the prevention of alcohol-related cognitive impairment.

REGISTRATION

The dose-response meta-analysis is registered in the PROSPERO (CRD42019127226) international prospective register of systematic review.

[Multidisciplinary approach to the rehabilitation of patients with osteoporosis]

The article outlines the modern concept of rehabilitation of patients with osteoporosis (OP), the cornerstone of which is the use of a multidisciplinary approach. This approach involves not only the participation of specialists of various specializations and levels in the process of rehabilitation treatment, but the formation of a new functional unit - a multidisciplinary team, whose members actively interact with each other from the first days to the completion of the rehabilitation course at every stage of the course; they together make a rehabilitation diagnosis based on the International Classification of Functioning, Disability and Health (ICF); they formulate rehabilitation goals, evaluate rehabilitation potential, discuss and develop a rehabilitation program and evaluate its effectiveness by using modern scales, tests and questionnaires to assess the change in the condition of the patient"s life at all levels and the quality of life in general. Taking into account the principle of multidisciplinarity, approaches to preparation of rehabilitation programs for patients with OP are described using various methods: those of therapeutic gymnastics, mechanotherapy, physiotherapy, balneotherapy, occupational therapy, psychotherapy, drug treatment and orthosis. Particular attention in the process of rehabilitation of patients with OP is given to physical therapy and orthosis, which are aimed at reducing pain, improving coordination, posture, as well as reducing the risk of falls and fractures. The literature review presented in the article allows us to conclude that the use of a multidisciplinary approach in the rehabilitation of patients with OP makes it possible to significantly improve the quality of life of patients even with severe forms of the disease.

Prevalence of anxiety in patients with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND

Prevalence rates of anxiety in patients with mild cognitive impairment (MCI) varied widely across studies and may confer a higher likelihood of progression to dementia. Our aim was to estimate the prevalence of anxiety in MCI and identify reasons for heterogeneity in the reported results.

METHODS

A computerized search in PubMed, EMBASE, and Psyc INFO for studies on anxiety in MCI was performed up to March 2017. The overall prevalence of anxiety in patients with MCI was pooled using a random-effects model. Heterogeneity was explored using stratification (recruitment resource; method of anxiety diagnosis; method of MCI diagnosis; and region) and random-effects meta-regression.

RESULTS

Of 2494 unique abstracts, 290 were selected for full-text review, and 39 studies, representing 10,587 patients, met all inclusion criteria. The overall pooled prevalence of depression in patients with MCI was 21.0% (95% CI, 16.2-26.7) with significant heterogeneity present (I² = 97.2%, p < 0.001). When stratified by source, the prevalence of anxiety in patients with MCI in community-based samples was 14.3% (95% CI, 9.7-20.5) and was 31.2% (95% CI, 23.6-40.0) in clinic-based samples, which was significantly different (p < 0.01). The prevalence of anxiety estimates also differed significantly, when stratification by the method of anxiety diagnosis (p < 0.01). However, the criteria used for MCI diagnosis and geographical region did not significantly influence the prevalence estimate.

LIMITATIONS

We did not consider the usage of anti-anxiety drugs and language bias.

CONCLUSIONS

The prevalence of anxiety in patients with MCI was common and variability in prevalence of anxiety across studies can be attributed partly to the source of the sample and method of anxiety diagnosis. Further research is needed to identify sources of heterogeneity.

Predisposing, enabling, and need factors of service utilization in the elderly with mental health problems

ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly.

METHODS

As part of the MentDis_ICF65+ study, N = 3,142 people aged 65-84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses.

RESULTS

Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. "I can deal with my problem on my own" (90%).

CONCLUSION

Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.

Psychological Outcomes of Living Liver Donors From a Multicenter Prospective Study: Results From the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2)

Although single-center and cross-sectional studies have suggested a modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multicenter studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2) consortium. In total, 271 (91%) of 297 eligible donors were interviewed at least once before donation and at 3, 6, 12, and 24 mo after donation using validated measures. We found that living liver donors reported low rates of major depressive (0-3%), alcohol abuse (2-5%), and anxiety syndromes (2-3%) at any given assessment in their first 2 years after donation. Between 4.7% and 9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors' perceptions of being better people and experiencing psychological growth following donation, including age, sex, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation would make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27); some of those donors experienced guilt and concerns about responsibility. Careful screening and targeted, data-driven follow-up hold promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.

Prolonged ovarian hormone deprivation alters the effects of 17β-estradiol on microRNA expression in the aged female rat hypothalamus

Administration of 17β-estradiol (E₂) has beneficial effects on cognitive function in peri- but not post-menopausal women, yet the molecular mechanisms underlying age-related changes in E₂ action remain unclear. We propose that there is a biological switch in E₂ action that occurs coincident with age and length of time after ovarian hormone depletion, and we hypothesized that age-dependent regulation of microRNAs (miRNAs) could be the molecular basis for that switch. Previously we showed that miRNAs are regulated by E₂ in young compared to aged female rats. Here we tested whether increasing lengths of ovarian hormone deprivation in aged females altered E₂ regulation of these mature miRNAs. In addition, we determined where along the miRNA biogenesis pathway E₂ exerted its effects. Our results showed that age and increased lengths of ovarian hormone deprivation abolished the ability of E₂ to regulate mature miRNA expression in the brain. Further, we show that E₂ acted at specific points along the miRNA biogenesis pathway.

Validation of a Computerized Use of Time Recall for Activity Measurement in Advanced-Age Adults

Background:

The Multimedia Activity Recall for Children and Adults (MARCA) is a computerized recall instrument that records use of time during 24 hr the previous day and has been developed to address limitations of current self-report physical activity measures for those in advanced age.

Methods:

Test–retest reliability and convergent validity of the adult MARCA were assessed in a sample of 45 advanced-age adults (age 84.9SD ±1.62 yr) as a subsample of the Life and Living in Advanced-Age Cohort Study New Zealand (LiLACS NZ). Test–retest methods required participants to recall the previous day’s activity using the MARCA twice within the same day. Convergent validity was assessed against accelerometry.

Results:

Test–retest reliability was high, with ICCs greater than .99 for moderate to vigorous physical activity (MVPA) and physical activity level (PAL). Compared with accelerometry, the MARCA demonstrated validity comparable to other self-report instruments with Spearman’s coefficients of .34 and .59 for time spent in nonsedentary physical activity and PAL.

Conclusion:

The MARCA is a valid and reliable self-report tool for physical activity behaviors in advanced-age adults.

Depression and cognitive impairment in patients with mild parkinsonian signs

OBJECTIVES

Mild parkinsonian signs (MPS) are reported to be associated with increased risk of dementia, Parkinson's disease, parkinsonism, and vascular lesions of white matter and are also a significant predictor of mortality. Although more than 20% of subjects aged 60 years and older suffer from MPS in Japan, it is often unrecognized and underestimated by patients and medical physicians. We used neuropsychological methods to examine cognitive function and depressive symptoms in subjects with MPS.

METHODS

We performed a population-based study in Ama-cho, a rural island town in western Japan. Participants included 951 subjects aged 65 years and older, 613 of whom completed all questionnaires, neurological examinations, and neuropsychological assessments and were included in the data analysis. Subjects were assessed for depression and subjective cognitive impairment using the Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and modified Unified Parkinson's Disease Rating Scale (mUPDRS).

RESULTS

Of the 613 participants, 143 were diagnosed with MPS. GDS scores were significantly higher in the MPS group compared with the motor control group, while MMSE scores were significantly lower.

CONCLUSIONS

We demonstrated that MPS correlate with both depressive symptoms and cognitive impairment.

Advances in tryptophan hydroxylase-2 gene expression regulation: new insights into serotonin-stress interaction and clinical implications

Serotonin (5-HT) modulates the stress response by interacting with the hormonal hypothalamic-pituitary-adrenal (HPA) axis and neuronal sympathetic nervous system (SNS). Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in 5-HT biosynthesis, and the recent identification of a second, neuron-specific TPH isoform (TPH2) opened up a new area of research. While TPH2 genetic variance has been linked to numerous behavioral traits and disorders, findings on TPH2 gene expression have not only reinforced, but also provided new insights into, the long-recognized but not yet fully understood 5-HT-stress interaction. In this review, we summarize advances in TPH2 expression regulation and its relevance to the stress response and clinical implications. Particularly, based on findings on rhesus monkey TPH2 genetics and other relevant literature, we propose that: (i) upon activation of adrenal cortisol secretion, the cortisol surge induces TPH2 expression and de novo 5-HT synthesis; (ii) the induced 5-HT in turn inhibits cortisol secretion by modulating the adrenal sensitivity to ACTH via the suprachiasmatic nuclei (SCN)-SNS-adrenal system, such that it contributes to the feedback inhibition of cortisol production; (iii) basal TPH2 expression or 5-HT synthesis, as well as early-life experience, influence basal cortisol primarily via the hormonal HPA axis; and (iv) 5'- and 3'-regulatory polymorphisms of TPH2 may differentially influence the stress response, presumably due to their differential roles in gene expression regulation. Our increasing knowledge of TPH2 expression regulation not only helps us better understand the 5-HT-stress interaction and the pathophysiology of neuropsychiatric disorders, but also provides new strategies for the treatment of stress-associated diseases.

The symptomatology of climacteric syndrome: whether associated with the physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder

PURPOSE

To explore whether the symptoms of climacteric syndrome associated with its physical factors or psychological disorder in perimenopausal/postmenopausal patients with anxiety-depression disorder.

METHODS

We recruited 78 climacteric patients with anxiety-depression disorder and 72 control participants in perimenopausal/postmenopausal without anxiety-depression disorder for this study. We measured symptoms using the Greene Climacteric Symptom Scale in all cases. We also collected demographic data and tested sexual hormone, blood pressure, bone density, cognitive, estrogen receptor-alpha (ERα) gene polymorphism as physiological factors, using HARS-14 and CHDS assessed psychological disorder degree.

RESULTS

C-MMSE scores as well as Estradiol and progesterone levels in the anxiety-depression disorder group were significantly lower compared to the control group (P < 0.01). In addition, the anxiety-depression disorder group had significantly higher Greene Climacteric Scale scores, as well as somatic symptoms compared to controls (P < 0.01). Moreover, the anxiety, depression and somatic symptoms of the Greene Climacteric Scale were positively correlated with HARS-14 and CHDS scores (P < 0.001) and negatively with estrogen level and C-MMSE scores (P < 0.05) in the anxiety-depression disorder group. Greene Climacteric Scale Symptoms were not significantly correlated with blood pressure, bone density or other factors (P > 0.05). There was no significant change in the allele frequency or the estrogen receptor-alpha gene polymorphisms, between the two groups (P > 0.05); however, the Pp genotype was negatively associated with C-MMSE scores (r = appraises, P = 0.033).

LIMITATIONS

The sample size was relatively small.

CONCLUSIONS

The symptoms of somatic symptoms in patients with climacteric syndrome and anxiety-depression disorder are associated with the emotional disorder but not with a physical disease. The Pp ERα polymorphism Pvu II is associated with a cognitive decrease.

Memory dysfunction in panic disorder: an investigation of the role of chronic benzodiazepine use

BACKGROUND

Studies of the neurocognitive effects of long-term benzodiazepine use have been confounded by the presence of neurocognitive deficits characterizing the clinical conditions for which these medications are taken. Similarly, studies of the neurocognitive effects of anxiety disorders have been confounded by the inclusion of chronically benzodiazepine-medicated patients. This study was designed to tease apart the potentially confounding effects of long-term benzodiazepine use and panic disorder (PD) on memory and visuoconstructive abilities.

METHODS

Twenty chronically benzodiazepine-medicated and 20 benzodiazepine-free patients with PD with agoraphobia were compared with a group of 20 normal control participants, group-matched for age, education, and gender on a battery of neuropsychological tests assessing short-term, episodic long-term, and semantic memory, as well as visuoconstructive abilities.

RESULTS

Results indicated that benzodiazepine-free panic patients were relatively impaired in nonverbal short-term and nonverbal episodic long-term memory and visuoconstructive abilities, whereas verbal short-term and verbal episodic memory and semantic memory were preserved. Only limited evidence was found for more pronounced impairments in chronically benzodiazepine-medicated PD patients.

CONCLUSIONS

This study provides evidence that patients with PD are characterized by relative impairments in nonverbal memory and visuoconstructive abilities, independent of benzodiazepine use. Nonetheless, we found evidence that chronic treatment with benzodiazepines is associated with intensification of select relative impairments in this realm. Documentation of these deficits raises questions about the broader etiology of neurocognitive impairment in PD as well as its impact on daily functioning.

Anxiety-like behaviors and expression of SERT and TPH in the dorsal raphé of estrogen- and fluoxetine-treated ovariectomized rats

The anxiolytic effect of fluoxetine (Flx) was often ineffective in postmenopausal and estrogen-deficient patients, but such effect had not been experimentally demonstrated, particularly in the female rat model of estrogen deficiency. Here we determined the anxiety-like behaviors in ovariectomized (Ovx) rats treated for 4weeks with 10μg/kg 17β-estradiol s.c. (Ovx+E2), 10mg/kg Flx p.o. (Ovx+Flx) or a combination of both (Ovx+E2+Flx). Since Flx is known to induce anxiolysis in males, we first evaluated the Flx regimen in male rats. The results showed that anxiety-like behaviors were reduced in Flx-treated male rats. In contrast, Ovx+Flx rats still exhibited the same anxiety-like behaviors as in Ovx rats. Both Ovx+E2 and Ovx+E2+Flx rats, however, showed comparable reductions in anxiety-like behaviors, suggesting that Flx had no anxiolytic-like effect. Furthermore, E2 and E2+Flx similarly upregulated the mRNA expression of serotonin reuptake transporter (SERT) and tryptophan hydroxylase-2 in the dorsal raphé of Ovx rats, while having no effect on SERT expression in the frontal cortex, hippocampus, septum, amygdala and periaqueductal gray. In conclusion, Flx induced anxiolytic-like action in male rats. In Ovx rats, it was E2 and not Flx that exerted the anxiolytic-like action, which was mediated, in part, by altering serotonin metabolism in the dorsal raphé.

Mild parkinsonian signs in a community-dwelling elderly population sample in Japan

Mild parkinsonian signs (MPS) may represent the mild end of a disease spectrum that spans from normal aging to neurodegenerative diseases. We conducted a population-based study in a rural island town in western Japan, Ama-cho. Participants included 1129 subjects, aged 60 years and older, residing in the town. Participants were classified according to a modified Unified Parkinson's Disease Rating Scale (mUPDRS) score. MPS was determined to be present if any of the following conditions were met: (1) two or more mUPDRS ratings=1 [MPS-mild]; (2) one mUPDRS rating≥2; or (3) mUPDRS rest tremor rating≥1; [(2) and (3): MPS-severe]. Subjects wore a uniaxial accelerometer (Actiwatch), resulting in the measurement of actigraphic activity counts (AC). Of the 804 participants with complete data, 178 subjects (22.1%) were classified as demonstrating MPS. AC was significantly lower in the MPS-severe group compared with both the CTL and the MPS-mild groups. Diagnostic sensitivity for MPS-severe became 100% when we adopted a cutoff point of low physical activity, as measured by actigraphy, combined with the presence of subjective depression. We established the prevalence of MPS in a community-dwelling elderly population sample in Japan. Actigraphy may be a useful objective tool for screening MPS-severe.