Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life

Mediation analysis of cognitive function in the relationship between pulmonary function and depression among middle-aged and older adults

AIM

This study aims to explore the association between declining lung function and depression in middle-aged and older adults, with a special focus on the mediating role of cognitive function.

METHODS

This study utilizes self-reported and physical examination data from 5345 individuals participating in the 2015 cycle of the China Health and Retirement Longitudinal Study (CHARLS) to explore the role of cognitive function changes in mediating the effects of diminished lung function on depression among middle-aged and older adults.

RESULTS

Multivariate linear regression analysis revealed a positive correlation between pulmonary and cognitive functions (β = 0.003, 95% CI: 0.002∼0.003, P < 0.01) and a negative correlation between cognitive function and depression (β = -0.279, 95% CI: -0.330-0.228, P < 0.01). Cognitive function plays a mediating role in linking pulmonary function with depression, exhibiting a mediation effect of -0.0007 and a total effect of -0.0046, wherein the mediation effect contributes to 15.22% of the total effect. For females, the mediating effect of cognitive function was stronger (β = -0.0013, 95% CI: -0.0018∼-0.0008, P < 0.01) than it was for males (β = -0.0006, 95% CI: -0.0009∼-0.0003, P < 0.01).

CONCLUSIONS

The study underscores the importance of monitoring lung and cognitive functions as interconnected factors contributing to the mental health of middle-aged and older adults. It suggests that interventions aimed at improving pulmonary health and cognitive function may help mitigate depressive symptoms among middle-aged and older adults. Further research is warranted to validate these findings across diverse cultural and demographic settings. Geriatr Gerontol Int 2024; ••: ••-••.

Does Baseline Cognitive Function Predict the Reduction Rate in HDRS-17 Total Scores in First-Episode, Drug-Naïve Patients with Major Depressive Disorder?

Purpose

Major depressive disorder (MDD) is associated with worse cognitive functioning. We aim to examine the association between baseline cognitive functioning and the reduction rate in HDRS-17 total scores and to highlight the predictors of the reduction rate in HDRS-17 total scores in MDD with first-episode, drug-naïve (FED) patients.

Patients and Methods

Ninety FED patients were recruited consecutively and evaluated using the 17-item Hamilton Depression Rating Scale (HDRS-17), the 14-item Hamilton Anxiety Scale (HAMA-14), the Functioning Assessment Short Test (FAST) and the MATRICS Consensus Cognitive Battery (MCCB) at baseline and again at week 8.

Results

Eighty-four FED patients completed the study. Comparison showed that response group had significantly higher T scores in TMT-A, BACS-SC, WMS-III, BVMT-R, MSCEI and CPT-IP, but showed significantly lower scores in FAST total scores including autonomy, occupational functioning, cognitive functioning, interpersonal relationship than non- response group (all p's< 0.05). Partial correlation analysis also found that the reduction rate in HDRS-17 total scores could be negatively associated with autonomy, cognitive functioning and interpersonal relationship domains as well as total FAST scores, also was further positively associated with T-scores of BACS-SC, CPT-IP and MSCEI in MCCB, even when accounting for potential confounders. Furthermore, the levels of cognitive function domain, autonomy domain in FAST, and BACS-SC, CPT-IP in MCCB may predict the reduction rate in HDRS-17 total scores in FED patients (all p's< 0.05).

Conclusion

Our findings underscore significant correlations between baseline functioning and the reduction rate in HDRS-17 total scores in FED patients. Moreover, better baseline cognitive function, autonomy, speed of processing and attention/vigilance are more likely to predict patients' response to antidepressant treatment, indicating pre-treatment better cognitive functioning may be predictors to treatment response in FED.

Do community-related traumatic events affect academic outcomes among adolescents? Quasi-experimental evidence from the Sewol disaster in South Korea

The sinking of the South Korean ferry Sewol in April 2014 claimed a total of 304 lives. Among the victims were 250 students from Dan-won High School in the city of Ansan and 11 of their teachers. For the residents of Ansan, the tragedy marked the beginning of widespread psychological distress and overwhelming grief. Exploiting the disaster's quasi-experimental nature, we employ a difference-in-differences (DID) strategy to measure its impact on the academic performance of Ansan's high school students in 5 major subjects. Using peers from Ansan's neighboring cities as the control group, our results reveal that the disaster impaired performances particularly in mathematics and natural science, a finding that is more pronounced for female students. Our results highlight that it is of uttermost importance to provide comprehensive psychological support and interventions to traumatized students but also to the communities they live in to minimize adverse effects on educational attainment.

Do psychological distress and digital sports influence the willingness to take the vaccine and precautionary saving? Empirical evidence from Shanghai

Aim

The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings.

Subject and methods

We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16-60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest.

Results

Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save.

Conclusions

This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications.

Psychiatric rehabilitation and cognitive deficit for treatment-resistant depression

Patients with TRD often experience persistent impairment of affective, psychosocial, and cognitive function, which impedes their recovery. The continuation of pharmacotherapy for patients with TRD remains the cornerstone of functional recovery. Cognitive dysfunction is prevalent in patients with MDD and may make patients' depressive symptoms and psychosocial functioning worse, even in the remitted stage of illness. Deficits can manifest not only in specific cognitive domains but also in global cognitive function, which may reflect underlying persistent pathophysiological changes. Compared with nontreatment-resistant patients with MDD, patients with TRD exhibit greater subjective and objective cognitive impairment, which possibly contributes to a greater adverse impact on daily functioning. Cognitive and psychosocial remission should be a goal in treating MDD. How to appropriately and individualized perform pharmacological intervention, psychotherapy, neuromodulation, cognitive remediation or other rehabilitation treatment programs is a critical step to achieve our goal. Integrating multiple interventions that engage multiple physiological systems with a multidisciplinary team warrants increased attention, and personalized therapeutic programs may facilitate the complete restoration of patients' everyday functioning.

Longitudinal Predictors of Informant-Rated Everyday Function in Mild Cognitive Impairment

OBJECTIVE

To examine predictors of informant-reported everyday functioning in mild cognitive impairment (MCI) and relations between everyday function and conversion to dementia.

METHODS

Informants of participants (n = 2614) with mild cognitive impairment (MCI) were administered the Functional Activities Questionnaire (FAQ). Changes in dimensions of functional ability as determined by an exploratory factor analysis (EFA) were examined over 3 years and participant predictors of change were examined using multilevel modeling (MLM).

RESULTS

The FAQ consisted of 3 factors, multistep, finance, and memory/orientation daily tasks. Impairment in memory/orientation tasks was significantly higher than impairment in multistep tasks. Worse functioning was associated with greater depression, worse memory, worse speed/EF, higher years of education and identifying as White. There was variability in some of these associations with different FAQ factors. Impairments in financial and memory/orientation daily tasks predicted follow-up conversion to dementia.

CONCLUSIONS

Depression, speed/EF, and memory are consistently associated with domains of everyday functioning. Race, education, and age may be more variability associated with everyday functioning. Specific attention should be paid to subtle declines in the financial and memory/orientation domains as they may uniquely predict future dementia development. Depression may be a modifiable risk factor associated with functional impairment over time.

Longitudinal Association Between Depressive Symptoms and Cognitive Function Among Older Adults: A Latent Growth Curve Modeling Approach

Objectives: Although the evidence from numerous longitudinal studies has indicated a remarkable change in cognitive function (CF) and depressive symptoms (DS) over time, the parallel latent growth curve model (LGCM) has seldom been used to simultaneously investigate the relationship between their change trajectories. This study aimed to examine whether a change in DS was associated with CF over time using an LGCM. Methods: Data were collected from the Chinese Longitudinal Healthy Longevity Survey's 2011, 2014, and 2018 waves. A parallel LGCM examined the association between CF and DS. Results: The multivariate conditioned model's goodness of fit supported the validity of the longitudinal model (Tucker-Lewis index [TLI] = 0.90, comparative fit index [CFI] = 0.96, root mean square error of approximation [RMSEA] = 0.04). The results showed that the CF intercept was positively to the DS slope (β = 0.42, p = 0.004). The CF and DS slopes were significantly linked (β = -0.65, p = 0.002). Conclusion: The findings expand the knowledge about CF's effect on DS in older adults.

A Pilot Study Assessing the Effects of Goal Management Training on Cognitive Functions among Individuals with Major Depressive Disorder and the Effect of Post-Traumatic Symptoms on Response to Intervention

Recent meta-analyses highlight alterations in cognitive functioning among individuals with major depressive disorder (MDD), with performance deficits observed across multiple cognitive domains including executive functioning, memory, and attention. Moreover, impaired concentration is a formal diagnostic criterion for a major depressive episode. Notably, cognitive impairment is reported frequently in MDD and is associated with poor treatment response. Despite this knowledge, research examining the effectiveness of top-down, adjunctive treatments for cognitive dysfunction in MDD remains in its infancy. The primary aim of the present study was to perform a pilot investigation of the implementation of a standardized cognitive remediation program, Goal Management Training (GMT), among individuals with a primary diagnosis of MDD. A secondary aim was to explore how comorbid symptoms of post-traumatic stress disorder (PTSD) among those MDD patients exposed to trauma may affect treatment response. A final sample of thirty individuals were randomized to either participate in the nine-week GMT program (active group; n = 16) or to complete a nine-week waiting period (waitlist control; n = 14). One participant was excluded from the GMT group analysis following study completion due to meeting an exclusion criteria. In total, 60% of the individuals allocated to the GMT program were trauma exposed (n = 9). Groups were assessed at baseline, post-treatment, and at three-month follow-up. The assessment comprised neuropsychological tasks assessing a variety of cognitive domains, subjective measures of functioning and symptom severity, as well as a clinical interview to establish a primary diagnosis of MDD. Significant gains in processing speed, attention/concentration, and response inhibition were observed for the participants in the GMT condition relative to participants in the waitlist control condition. Individuals in the GMT condition also reported improvements in subjective cognitive functioning from baseline to post-treatment. Heightened PTSD symptom severity was associated with reduced response to treatment with respect to the domain of processing speed. The results of this pilot investigation highlight not only the potential utility of GMT as an augmentative treatment in MDD, but also highlight the contribution of comorbid symptoms of PTSD to diminished treatment response among trauma-exposed individuals with MDD. The study is limited primarily by its small pilot sample and the absence of a program evaluation component to gauge participant opinions and feedback of the treatment protocol.

A Multi-Center Study for the Development of the Taiwan Cognition Questionnaire (TCQ) in Major Depressive Disorder

Cognitive dysfunction is associated with functional impairment of patients with Major Depressive Disorder (MDD). The goals were to explore the associated factors of cognitive impairment in MDD and to develop and validate a brief and culture-relevant questionnaire, the Taiwan Cognition Questionnaire (TCQ), among patients with MDD. This was a cross-sectional, multi-center observational study of MDD patients in Taiwan. Participants of Group 1 from 10 centers contributed to the validation of the TCQ by their response and sociodemographics. The participants of Group 2 from one center received an objective cognitive assessment for clarification of the relationship between the TCQ score and its associated factors. In Group 1, 493 participants were recruited. As for Group 2, an extra 100 participants were recruited. The global Cronbach’s alpha for the TCQ was 0.908. According to the coordinates of the ROC curve, 9/10 was the ideal cut-off point. With the criteria, the sensitivity/specificity of the TCQ was 0.610/0.689. The TCQ score was positively associated with a history of being admitted to acute psychiatric care and the severity of depression and negatively associated with objective cognitive measures. The TCQ provides a reliable, valid, and convenient measure of subjective cognitive dysfunction in patients with MDD.

Depression and episodic memory across the adult lifespan: A meta-analytic review

Episodic memory deficits have increasingly been recognized as a cognitive feature of depression. To quantify these deficits and determine how they are moderated by various tasks (e.g., stimulus valence) and participant (e.g., age, depression diagnosis) variables, we conducted a three-level meta-analysis on 995 effect sizes derived from 205 studies with 236 unique comparisons between depressive and control groups on episodic memory measures. Overall, depression was associated with small to moderate deficits in episodic memory, Hedges' g = -0.36, 95% CI [-0.41 to -0.31]. Effects were larger in older age, in diagnosed compared to subthreshold depression, and in those taking medication for depression; effects did not differ between those with current and remitted symptoms. Stimulus valence moderated the effects, such that depression-related deficits were particularly pronounced for positive and neutral stimuli, but not for negative stimuli. Educational attainment served as a sort of protective factor, in that at higher levels of education, depressed group performance was more similar to that of controls. These findings confirm the episodic memory deficits in depression but highlight the important differences in the size of these deficits across a number of task- and participant-related variables. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study

BACKGROUND

Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions.

AIMS

This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics.

METHODS

Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups.

RESULTS

Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety.

CONCLUSIONS

Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.

The reciprocal relationship between depression and disability in low-income homebound older adults following tele-depression treatment

OBJECTIVES

Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low-income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality.

METHODS

In a 3-arm randomized clinical trial, 277 low-income homebound individuals aged 50+ participated in behavioral activation tele-delivered by bachelor's-level lay counselors (Tele-BA), problem-solving therapy tele-delivered by licensed clinicians (Tele-PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24-item Hamilton Rating Scale for Depression and disability with the 12-item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects.

RESULTS

Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross-lagged model, in which autoregressive and contemporaneous effects were included, only the depression-to-disability path exhibited mediation. There was no evidence of difference between Tele-BA and Tele-PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement.

CONCLUSIONS

Brief depression treatments for low-income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele-BA and Tele-PST. Lay-counselor model is a promising alternative to clinician-delivered psychotherapy for growing numbers of homebound older adults.

Performance on the Wechsler Adult Intelligence Scale (WAIS) in Japanese patients with bipolar and major depressive disorders in euthymic and depressed states

AIM

This study aimed to examine the cognitive performance of patients with bipolar disorder (BD) stratified by illness phase compared to that of patients with major depressive disorder (MDD) and healthy controls.

METHODS

Participants were 139 patients with BD (55 euthymic and 84 depressed), 311 patients with MDD (88 euthymic and 223 depressed), and 386 healthy controls who underwent the Wechsler Adult Intelligence Scale-Revised or the Third Edition. They were non-elderly Japanese individuals with normal estimated premorbid intelligence quotient (IQ; >90), group-matched for age, sex, and premorbid IQ.

RESULTS

The depressed BD group showed significantly lower scores on verbal IQ, performance IQ, full-scale IQ, and three group indexes of perceptual organization, working memory, and processing speed when compared with healthy controls (all P < 0.001). All IQs and working memory index were also significantly lower than those of the depressed MDD group. The depressed MDD group scored significantly lower than controls in performance IQ (P < 0.001), full-scale IQ, and only in the index of processing speed (P < 0.001). The euthymic BD group scored significantly lower than controls in performance IQ (P = 0.004), whereas the euthymic MDD group scored significantly lower than controls only in processing speed (P = 0.030).

CONCLUSION

Patients with BD appear to have global and more intense cognitive impairments in depressed states compared with those with MDD whose impairments seem to be apparent only in processing speed in the Wechsler Adult Intelligence Scale. Attenuated impairments appear to exist in euthymic states of both patients.

Critical thinking disposition of undergraduate students in relation to emotional intelligence: Gender as a moderator

Undergraduate student, especially first-year students face challenges in the new found academic environment. Critical thinking (CT) has been found to be effective in managing negative experiences. Earlier literature found Emotional intelligence (EI) is accounted for variance in critical thinking (CT) skill irrespective of the gender. However, there is scarcity of research on the relationship between EI and CT disposition with respect to gender. The present research intended to study the effect of EI on CT disposition of students in the transition phase with gender as a moderator. 500 first-year undergraduate students from West Bengal (eastern part of India) were selected to fill up assessment tools; the Profile of Emotional Competence (Brasseur et al., 2013) and Critical Thinking Disposition Assessment (Ricketts & Rudd, 2005). Structural Equation Model (SEM) was followed using AMOS adopting maximum likelihood approach. Path analysis revealed an accepted model fit establishing EI to have significant effect on CT disposition. However, this effect was not moderated by gender. The present research might be helpful in generating awareness regarding the importance of EI and training for developing disposition of CT among college fresher's well-being and emotional health. The study has highlighted the non-significant moderating role of gender in relation to EI and CT disposition that was missing in the existing literature.

Measurement of Social Communication, Emotion and Cognitive Development from 6 Months to 8 Years Old: In a Taiwan Birth Cohort Study

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

The Longitudinal Associations between Physical Health and Mental Health among Older Adults

OBJECTIVES

This study examines the lead-lag relationship between physical and mental health among older adults.

METHOD

Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated.

RESULTS

Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health.

CONCLUSION

This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.

Rumination in major depressive and bipolar disorder - a meta-analysis

BACKGROUND

rumination, defined as repetitive thoughts about emotionally relevant experiences, has been linked extensively with mood disorders, especially major depressive disorder (MDD).¹ However, there is a growing body of evidence suggesting the importance of rumination in bipolar disorder (BD)² as well.

METHODS

we searched for studies that investigated rumination in both BD and MDD in four databases. Our systematic search identified 12 studies with an overall sample size of 2071 clinical patients.

RESULTS

results demonstrated no significant difference in the ruminative tendencies of the two patient groups when all rumination measures were included. We tested for the effect of rumination subtype, BD subgroups, and the current mood state of BD and MDD patients. There were no significant differences in terms of depressive rumination, however, BD patients reported more rumination on positive affect. This difference remained significant when examining in BD-I³ and BD-II⁴ patient groups, with similar effect sizes.

LIMITATIONS

due to the lack of sufficient data in the literature, only a few self-report studies qualified to be included in our analysis. Thus additional moderating factors, such as the current mood state of the two patient groups could not be analyzed.

CONCLUSIONS

this review demonstrates that rumination is a significant process in both MDD and BD, highlighting the importance of interventions to reduce rumination in mood disorders. The two patient groups share several commonalities in terms of rumination, however, rumination subtype was found to be an important moderating variable underlining a difference in rumination on positive affect.

Depression, social support, executive functioning, functionality, and quality of life in institutionalized elderly people

Aim

Our aim was to study the executive functioning, functionality, and quality of life of institutionalized old aged persons and to determine the potential roles of self-reported depression and satisfaction with social support on these domains.

Method

The sample comprised 36 volunteers (13 males and 23 females) aged between 71 and 94 years. The measures used consisted of well-established battery of neuropsychological tests. A comparative study was performed.

Results

Participants with depressive symptoms shown impaired executive functioning. Cognitive flexibility, functionality in instrumental activities of daily living, and quality of life are more affected in participants with higher levels of depression that also report higher levels of satisfaction with social support.

Conclusion

This result is intriguing and may highlight the relevance of considering not only depression, but also factors related to social isolation and loneliness in the explanation of cognitive performance, functionality, and quality of life.

Association of renal function and depressive symptoms: Evidence from the China health and retirement longitudinal study

AIM

We examined the association between kidney function and risks of depression in a nationally representative sample of community-dwelling older adults.

METHODS

Participants were a subset selected from the China Health and Retirement Longitudinal Study. Estimated glomerular filtration rate (eGFR) was calculated using chronic kidney disease epidemiology collaboration equations. Incident depression was defined by a score of 10 or higher on the 10-item Center for Epidemiologic Studies Depression Scale, use of antidepressant medications, or both, at the 2015 follow-up visit. Multiple linear regression analyses were used to examine the baseline eGFR and CESD-10 score during follow up. The associations between level of renal function at baseline and incident depression were assessed using multivariate logistic regression analysis.

RESULTS

Over a four-year follow-up period, 22.8% (N = 773) of the participants reported incident depression. After multivariate analysis, baseline eGFRcr and eGFRcr-cys were significantly associated with higher depression score during follow up. Coefficients and 95%CI for eGFRcr and eGFRcr-cys were - 0.041(-0.066 to -0.016) and - 0.028(-0.051 to -0.005), respectively. Using eGFRcr-cys, the crude odds ratio (OR) for incident depression in the 4th quartile group was 1.60 (95%CI 1.23-2.06) than that in the 1st quartile group, (p for trend <0.001). Fully adjustment for confounding factors did not attenuate but strengthened the association (OR 2.46, 95%CI 1.61-3.76).

CONCLUSIONS

Among community-dwelling older adults over most of the range in renal function, eGFR was significantly, independently, and associated with incident depression.

Predictors of mortality in people with late-life depression: A retrospective cohort study

OBJECTIVES

Late-life depression (LLD) is associated with an increased mortality risk in the general older population. It remains however unclear which signs or symptoms are predictive of mortality in those suffering from LLD.

SETTING AND PARTICIPANTS

Patients aged 65 years or older with depressive disorder diagnosed in Southeast London between January 2008 and December 2017.

METHODS

We assembled patients diagnosed with late-life depression from the Maudsley Biomedical Research Centre Case Register, which is linked to national mortality data. Using depression diagnosis as index date, we followed patients until death or censoring point. Sociodemographic data, scores of Health of the Nation Outcome Scales (HoNOS65+), which include a physical illness scale, profiles of depressive symptoms, and psychotropic medications were extracted and modeled in multivariable survival analyses to determine predictors of mortality.

RESULTS

Of 4,243 patients with LLD (mean age 77.0 years; 61.2% female), 2,327 (54.8%) died over a median follow-up time of 3.5 years. In multivariable Cox regression models, an increased risk of all-cause mortality was associated with older age, cognitive problems, physical illness/disability, impaired activities of daily living, apathy, lack of appetite and mirtazapine prescription; conversely, female gender, non-white ethnicity, guilt feelings, tearfulness, impaired concentration, disturbed sleep and delusions were associated with lower mortality risk.

CONCLUSIONS

Besides demographic factors, physical health, functioning and cognition, different depressive symptoms were significantly associated with the prognosis of LLD. Elderly patients presenting with depressive symptoms predicting higher mortality risk should be examined and followed more closely.

Comparative Study of Cognitive Function Between Treatment-Resistant Depressive Patients and First-Episode Depressive Patients

OBJECTIVE

Despite reports of cognitive dysfunction during the acute phase of depression, there is a lack of studies in patients with treatment-resistant depression (TRD). The aim of this study was to investigate the cognitive function profile of TRD and compare cognitive dysfunction between subjects with TRD and first-episode depression.

PATIENTS AND METHODS

The study included 31 patients with TRD and 53 with first-episode depression. Cognitive function was assessed by a series of neuropsychological tools such as the verbal fluency test, Modified Wisconsin Card Sorting Test (M-WCST), Tower of Hanoi test, Chinese-revision of the Wechsler Adult Intelligence Scale (WAIS-RC), and Trail Making Test A and B.

RESULTS

There were no significant demographic differences between the TRD, first-episode depression, and normal control groups (gender, age, years of education). The full-scale, verbal, and performance intelligence quotients measured with the WAIS-RC were also not significantly different (p>0.05). The normal group scores were all significantly better than TRD and first-episode depression, and the TRD group performed significantly worse than subjects with first-episode depression on Trail Making Test B, two WCST subscales, and the profile score of the Tower of Hanoi test (all p<0.05).

CONCLUSION

Patients with depression exhibited global impairments in cognitive function, and these were more common in TRD. Poor executive function may play an important role in TRD.

Correlates of physical activity among depressed older people in six low-income and middle-income countries: A community-based cross-sectional study

OBJECTIVE

Despite the benefits of physical activity (PA) in older people with depression, many do not comply with the International PA guidelines. Thus, we investigated what factors influence PA participation among 915 community-dwelling older adults (aged ≥65 years) with depression in 6 low-income and middle-income countries (LMICs).

METHODS

Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. The sample was restricted to those with DSM-IV depression or receiving depression treatment in the last 12 months. PA was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (ie, not meeting 150 minutes of moderate PA per week) and moderate-to-high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions.

RESULTS

The prevalence of low PA was 40.4% (95%CI = 34.8%-46.1%). After adjusting for age, sex, and country, larger household size and unemployment were significant sociodemographic correlates of low PA. Former smoking (vs never), anxiety, mild cognitive impairment (MCI), lower body mass index, bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, slow gait, poor self-rated health, higher levels of disability, and lower levels of social cohesion were identified as significant negative correlates of PA.

CONCLUSIONS

The current data provide guidance for future interventions across LMICs to assist older people with depression engage in regular PA. The promotion of social cohesion may increase the efficacy of future public health initiatives, while from a clinical perspective, somatic co-morbidities, MCI, pain, and slow gait need to be considered.

The ACTIVE conceptual framework as a structural equation model

Background/Study Context: Conceptual frameworks are analytic models at a high level of abstraction. Their operationalization can inform randomized trial design and sample size considerations.

METHODS

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) conceptual framework was empirically tested using structural equation modeling (N=2,802). ACTIVE was guided by a conceptual framework for cognitive training in which proximal cognitive abilities (memory, inductive reasoning, speed of processing) mediate treatment-related improvement in primary outcomes (everyday problem-solving, difficulty with activities of daily living, everyday speed, driving difficulty), which in turn lead to improved secondary outcomes (health-related quality of life, health service utilization, mobility). Measurement models for each proximal, primary, and secondary outcome were developed and tested using baseline data. Each construct was then combined in one model to evaluate fit (RMSEA, CFI, normalized residuals of each indicator). To expand the conceptual model and potentially inform future trials, evidence of modification of structural model parameters was evaluated by age, years of education, sex, race, and self-rated health status.

RESULTS

Preconceived measurement models for memory, reasoning, speed of processing, everyday problem-solving, instrumental activities of daily living (IADL) difficulty, everyday speed, driving difficulty, and health-related quality of life each fit well to the data (all RMSEA < .05; all CFI > .95). Fit of the full model was excellent (RMSEA = .038; CFI = .924). In contrast with previous findings from ACTIVE regarding who benefits from training, interaction testing revealed associations between proximal abilities and primary outcomes are stronger on average by nonwhite race, worse health, older age, and less education (p < .005).

CONCLUSIONS

Empirical data confirm the hypothesized ACTIVE conceptual model. Findings suggest that the types of people who show intervention effects on cognitive performance potentially may be different from those with the greatest chance of transfer to real-world activities.

Cognitive performance of community-dwelling oldest-old individuals with major depression: the Pietà study

BACKGROUND

Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education.

METHODS

We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ).

RESULTS

Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = -0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD.

CONCLUSION

Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.

Analysis of life quality and prevalence of cognitive impairment, anxiety, and depressive symptoms in older adults

Abstract The development of anxiety, depressive symptoms, and a decrease in cognitive performance can affect older adults’ quality of life. The objective of this cross-sectional study was to analyze quality of life and determine the prevalence of cognitive impairment, anxiety, and depression symptoms in senior center participants. A total of 120 older adults living in the city of Passo Fundo, RS, Brazil, participated in this study. The convenience sampling technique was used. All participants answered questions relative to socio-demographic variables, quality of life (World Health Organization Quality of Life-Bref), cognitive performance (Addenbrooke’ Cognitive Examination), and emotional state (Geriatric Depression Scale and Beck Anxiety Inventory). The prevalence of anxiety, depressive symptoms, and cognitive impairment were low indicating satisfactory quality of life of the older adults investigated.

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

BACKGROUND

Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL.

METHODS AND FINDINGS

The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65-93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840-.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805-.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978-1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759-.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study.

CONCLUSIONS

This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.

Neuropsychological profiles of major depressive disorder and bipolar disorder during euthymia. A systematic literature review of comparative studies

Bipolar disorder and major depressive disorder have been shown to be associated with neurocognitive abnormalities during periods of clinical remission. However, at present, there is no consensus on whether these disorders have distinctive cognitive profiles. The aim of this study was to provide an updated systematic review of studies comparing neuropsychological functioning between bipolar disorder and major depressive disorder during remission. Main findings included the following: 1) no differences regarding performances in measures of attention and processing speed, executive functions and theory of mind were found between both patient groups and 2) regarding verbal memory, preliminary evidence points towards a more defective performance in patients with bipolar disorder than those with major depressive disorder. However, several variables with negative impact on cognition (medication status, age at onset, premorbid IQ, bipolar subtype, among others) were not adequately controlled in most studies. In conclusion, evidence from studies exploring neuropsychological profiles in bipolar disorder and major depressive disorder could not provide clues to differentiate these mood disorders. Larger studies with adequate control of confounding variables would be necessary to elucidate if the finding of more defective verbal memory performance in bipolar disorder is truly explained by distinct underlying mechanisms.

Are major depression and bipolar disorder neuropsychologically distinct? A meta-analysis of comparative studies

BACKGROUND

Neuropsychological deficits are present in both major depression and bipolar disorder. So far, however, reports directly comparing these mood disorders with regard to cognitive outcomes have been scant and yielded inconsistent results. This work aims to combine the findings of comparative studies of cognition in major depression and bipolar disorder in order to explore whether these neuropsychiatric conditions present with distinct cognitive features.

METHODS

The main online databases were extensively searched to retrieve reports assessing neurocognitive functioning in two groups of mood disorder patients, one with major depressive disorder and another with bipolar disorder, both in the same phase of illness. Between-group effect sizes for cognitive variables were obtained from selected studies and pooled by means of meta-analytic procedures.

RESULTS

During euthymia, a significant overall effect size (Hedges'g=0.64, P<0.001) favoring major depressive disorder was found for verbal memory as assessed with list learning tests, whereas no significant between-group differences were found for the remaining variables analyzed. During depressive episodes, similar cognitive outcomes were observed between groups.

CONCLUSION

At present, it is not possible to postulate specific neuropsychological profiles for major depression and bipolar disorder in light of available evidence. It remains to be ascertained whether the differences found for verbal memory constitute an expression of distinct underlying mechanisms or whether they are best explained by sample characteristics or differential exposure to variables with a negative impact on cognition.

Positive affect predicts everyday problem-solving ability in older adults

OBJECTIVES

Increased symptom endorsement on the short form of the Centre for Epidemiologic Studies Depression (CES-D) Scale has been previously associated with lower everyday problem-solving (EPS) ability in older adults. However, given the multifactorial and complex nature of depressive symptoms, it remains unclear whether certain symptoms/aspects of depression account for this relationship. We examined established factor scores on the full version of the CES-D to assess their utility as predictors of EPS in an older adult cohort.

METHODS

Community-dwelling older adults (n = 103; age: 51-91) were administered the CES-D along with a measure of EPS ability assessing both social and practical EPS. Regression analyses were used to determine the relationships between variables.

RESULTS

Analyses revealed that increased CES-D scores predicted worse EPS ability in older adults (β = -.17, p < .05) beyond the effects of age, gender, and education. Regression analyses examining each CES-D factor score revealed that decreased positive affect (loss of hope/enjoyment in life; β = -.21, p < .01) remained the only significant predictor of decreased overall EPS scores beyond demographic variables, while depressed affect, interpersonal, and somatic factors were not significant predictors. Positive affect predicted both practical, as well as social EPS scores.

CONCLUSIONS

Current results extend previous findings by showing that the relationship between increased depressive symptoms and decreased EPS ability in older age may be primarily driven by anhedonia as opposed to other depressive symptoms.

Depressive Symptoms, Cognition, and Everyday Function Among Community-Residing Older Adults

OBJECTIVE

The aim of this study was to understand the relationships among depressive symptoms, cognition, and functional performance in a community-based sample of older adults.

METHOD

Older adults ( N = 885) from the Staying Keen in Later Life study completed tests of executive function, speed of processing, and memory. The Center for Epidemiologic Depression Scale assessed depressive symptoms. The Timed Instrumental Activities of Daily Living Test assessed participants' everyday functional performance.

RESULTS

Depressive symptoms had significant associations with measures of executive function, speed of processing, memory, and everyday functional performance. Cognitive performance completely mediated the association between depressive symptoms and everyday function.

DISCUSSION

Among community-dwelling older adults, depressive symptoms were associated with impaired cognition across multiple domains, which detrimentally affected everyday function. Health care providers should be aware of these associations to monitor and manage changes in depressive symptoms and cognitive performance and thereby potentially mitigate functional decline.

Reproductive Steroid Regulation of Mood and Behavior

In this article, we examine evidence supporting the role of reproductive steroids in the regulation of mood and behavior in women and the nature of that role. In the first half of the article, we review evidence for the following: (i) the reproductive system is designed to regulate behavior; (ii) from the subcellular to cellular to circuit to behavior, reproductive steroids are powerful neuroregulators; (iii) affective disorders are disorders of behavioral state; and (iv) reproductive steroids affect virtually every system implicated in the pathophysiology of depression. In the second half of the article, we discuss the diagnosis of the three reproductive endocrine-related mood disorders (premenstrual dysphoric disorder, postpartum depression, and perimenopausal depression) and present evidence supporting the relevance of reproductive steroids to these conditions. Existing evidence suggests that changes in reproductive steroid levels during specific reproductive states (i.e., the premenstrual phase of the menstrual cycle, pregnancy, parturition, and the menopause transition) trigger affective dysregulation in susceptible women, thus suggesting the etiopathogenic relevance of these hormonal changes in reproductive mood disorders. Understanding the source of individual susceptibility is critical to both preventing the onset of illness and developing novel, individualized treatments for reproductive-related affective dysregulation. © 2016 American Physiological Society. Compr Physiol 6:1135-1160, 2016e.

Discrepancies between cognition and decision making in older adults

BACKGROUND AND AIMS

There is increasing clinical and legal interest in discrepancies between decision-making ability and cognition in old age, a stage of life when decisions have major ramifications. We investigated the frequency and correlates of such discrepancies in non-demented older adults participating in a large community-based cohort study of aging, the Rush Memory and Aging Project.

METHODS

Participants [n = 689, mean age 81.8 (SD 7.6), mean education 15.2 (SD 3.1), 76.8 % female and 93.3 % white] completed a measure of financial and healthcare decision making (DM) and a battery of 19 neuropsychological tests from which a composite measure of global cognition (COG) was derived.

RESULTS

Results indicated that 23.9 % of the sample showed a significant discrepancy between DM and COG abilities. Of these, 12.9 % showed DM < COG, while 11.0 % showed DM > COG. Logistic regression models showed older age, being non-white, greater temporal discounting, and greater risk aversion were associated with higher odds of being in the DM < COG group. Being male was associated with higher odds of being in the DM > COG group. Education, income, depressive symptoms, and impulsivity were not associated with a discrepancy. Only demographic associations (age, sex, and race) remained significant in a fully adjusted model with terms included for all factors.

CONCLUSION

These results support the consideration of decision making and cognition as potentially separate constructs.

How does cognitive reserve impact on the relationships between mood, rumination, and cognitive function in later life?

OBJECTIVES

Higher levels of cognitive reserve (CR) are associated with better cognitive function in later life. In contrast, depressive symptoms, anxiety, and rumination are associated with diminished cognitive function. There has been limited research to date examining the influence of CR on the relationship between mood and cognitive function, and results are inconsistent. The aim of this study was to investigate the role CR plays in the relationships between mood, rumination, and cognitive function in later life.

METHOD

Two hundred and thirty-six healthy people aged 60+ completed measures of CR, depression, anxiety, rumination, recall, and verbal fluency. Participants were dichotomised at the median into those with lower and higher levels of CR.

RESULTS

CR, mood, and rumination together accounted for between 13% and 15.6% of the variance in scores on the cognitive tasks in the sample as a whole. Mood and rumination explained a significant amount of variance in cognitive test scores in those with lower levels of CR, but not in those with higher levels of CR.

CONCLUSION

The way in which mood and rumination are related to cognitive function differs depending on the individual's level of CR. These results support the view that it is important to continue to build on CR as people move into later life in order to maintain cognitive health.

Cognitive Deficits as a Mediator of Poor Occupational Function in Remitted Major Depressive Disorder Patients

Cognitive deficits in major depressive disorder (MDD) patients have been described in numerous studies. However, few reports have aimed to describe cognitive deficits in the remitted state of MDD and the mediational effect of cognitive deficits on occupational outcome. The aim of the current review is to synthesize the literature on the mediating and moderating effects of specific domains of cognition on occupational impairment among people with remitted MDD. In addition, predictors of cognitive deficits found to be vocationally important will be examined. Upon examination of the extant literature, attention, executive function and verbal memory are areas of consistent impairment in remitted MDD patients. Cognitive domains shown to have considerable impact on vocational functioning include deficits in memory, attention, learning and executive function. Factors that adversely affect cognitive function related to occupational accommodation include higher age, late age at onset, residual depressive symptoms, history of melancholic/psychotic depression, and physical/psychiatric comorbidity, whereas higher levels of education showed a protective effect against cognitive deficit. Cognitive deficits are a principal mediator of occupational impairment in remitted MDD patients. Therapeutic interventions specifically targeting cognitive deficits in MDD are needed, even in the remitted state, to improve functional recovery, especially in patients who have a higher risk of cognitive deficit.

Is cognitive lifestyle associated with depressive thoughts and self-reported depressive symptoms in later life?

Key components of cognitive lifestyle are educational attainment, occupational complexity and engagement in cognitively stimulating leisure activities. Each of these factors is associated with experiencing fewer depressive symptoms in later life, but no study to date has examined the relationship between overall cognitive lifestyle and depressive symptoms. This task is made more complex because relatively few older participants in cross-sectional studies will be currently experiencing depression. However, many more will show evidence of a depressive thinking style that predisposes them towards depression. This study aimed to investigate the extent to which cognitive lifestyle and its individual components are associated with depressive thoughts and symptoms. Two hundred and six community-dwelling participants aged 65+ completed the depressive cognitions scale, the geriatric depression scale and the lifetime of experiences questionnaire, which assesses cognitive lifestyle. Correlational analysis indicated that each of the individual lifestyle factors—education, occupational complexity and activities in young adulthood, mid-life and later life—and the combined cognitive lifestyle score was positively associated with each other and negatively with depressive symptoms, while all except education were negatively associated with depressive thoughts. Depressive thoughts and symptoms were strongly correlated. Cognitive lifestyle score explained 4.6 % of the variance in depressive thoughts and 10.2 % of the variance in depressive symptoms. The association of greater participation in cognitive activities, especially in later life, with fewer depressive symptoms and thoughts suggests that preventive interventions aimed at increasing participation in cognitively stimulating leisure activity could be beneficial in decreasing the risk of experiencing depressive thoughts and symptoms in later life.

Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study

Caring for a spouse with dementia is a chronic stressor that may compromise caregivers' own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.

Impact of Education on Memory Deficits in Subclinical Depression

Elevated depressive symptoms are associated with cognitive deficits, while higher education protects against cognitive decline. This study was conducted to test if education level moderates the relationship between depressive symptoms and cognitive function. Seventy-three healthy, dementia-free adults aged 18-81 completed neuropsychological tests, as well as depression and anxiety questionnaires. Controlling for age, sex, and state anxiety, we found a significant interaction of depressive symptoms and education for immediate and delayed verbal memory, such that those with a higher education level performed well regardless of depressive symptomatology, whereas those with lower education and high depressive symptoms had worse performance. No effects were found for executive functioning or processing speed. Results suggest that education protects against verbal memory deficits in individuals with elevated depressive symptoms. Further research on cognitive reserve in depression-related cognitive deficits and decline is needed to understand the mechanisms behind this phenomenon.

Major depressive disorder in older adults: benefits and hazards of prolonged treatment

Antidepressants have been shown to reduce the risk of depression recurrence in adults, justifying prolonged antidepressant maintenance therapy for most if not all patients. However, older depressed adults may be at increased risk for antidepressant adverse effects. This article discusses the benefits and hazards of continued treatment in elderly depressed patients, and indicates which patients should and should not receive maintenance phase antidepressants. Most clinical trials conducted so far suggest that prolonged antidepressant use in older adults is efficacious to reduce recurrence rates. The benefits of prolonged antidepressant use may not be restricted to preventing recurrence but also include preservation of overall well-being, social functioning, reduced mortality risk from medical disorders, and reduced risk of dementia. Although generally safe, the prolonged use of antidepressants has been associated with higher risk of osteopenia/osteoporosis (in particular the selective serotonin reuptake inhibitors) and cardiovascular toxicity (tricyclic antidepressants). Fewer data are available for special populations, like those with multiple medical comorbidities or those with dementia; thus, the benefits of prolonged antidepressant use are not clear in these individuals.

Differential prefrontal and subcortical circuitry engagement during encoding of semantically related words in patients with late-life depression

OBJECTIVE

Verbal memory difficulties are common among individuals with late-life depression (LLD), though there is limited knowledge about disruptions to underlying cerebral circuitry. The purpose of this study is to examine aberrations to cerebral networks implicated in encoding novel verbal semantic material among older adults with LLD.

METHODS

Twenty-four older adults with early-onset LLD and 23 non-depressed comparisons participated in the study. Participants completed a word list-learning task while undergoing functional magnetic resonance imaging.

RESULTS

In the context of equivalent recall and recognition of words following scanning and similar hippocampal volumes, patients with LLD exhibited less activation in structures known to be relevant for new learning and memory, including hippocampus, parahippocampal gyrus, insula, and cingulate, relative to non-ill comparisons. An important region in which the LLD group displayed greater activation than the non-depressed comparison group was in left inferior frontal gyrus, an area involved in cognitive control and controlled semantic/phonological retrieval and analysis; this region may be critical for LLD patients to consolidate encoded words into memory.

CONCLUSIONS

Functional irregularities found in LLD patients may reflect different modes of processing to-be-remembered information and/or early changes predictive of incipient cognitive decline. Future studies might consider mechanisms that could contribute to these functional differences, including hypothalamic-pituitary-adrenal axis functioning and vascular integrity, and utilize longitudinal designs in order to understand whether functional changes are predictive of incipient cognitive decline.

The effect of gender, age, and symptom severity in late-life depression on the risk of all-cause mortality: the Bambuí Cohort Study of Aging

BACKGROUND

Increased mortality risk and its moderators is an important, but still under recognized, negative outcome of late-life depression (LLD). Therefore, we aimed to evaluate whether LLD is a risk factor for all-cause mortality in a population-based study with over 10 years of follow-up, and addressed the moderating effect of gender and symptom severity on mortality risk.

METHODS

This analysis used data from the Bambuí Cohort Study of Aging. The study population comprised 1.508 (86.5%) of all eligible 1.742 elderly residents. Depressive symptoms were annually evaluated by the GHQ-12, with scores of five or higher indicating clinically significant depression. From 1997 to 2007, 441 participants died during 10,648 person-years of follow-up. We estimated the hazard ratio for mortality risk by Cox regression analyses.

RESULTS

Depressive symptoms were a risk factor for all-cause mortality after adjusting for confounding lifestyle and clinical factors (adjusted HR = 1.24 CI95% [1.00-1.55], P = .05). Mortality risk was significantly elevated in men (adjusted HR = 1.45 CI95% [1.01-2.07], P = 0.04), but not in women (adjusted HR = 1.13 CI95% [0.84-1.48], P = 0.15). We observed a significant interaction between gender and depressive symptoms on mortality risk ((HR = 1.72 CI95% [1.18-2.49], P = 0.004).

CONCLUSION

The present study provides evidence that LLD is a risk factor for all-cause mortality in the elderly, especially in men. The prevention and adequate treatment of LLD may help to reduce premature disability and death among elders with depressive symptoms.

Cognitive impairment in euthymic major depressive disorder: a meta-analysis

BACKGROUND

There is evidence to suggest that cognitive deficits might persist beyond the acute stages of illness in major depressive disorder (MDD). However, the findings are somewhat inconsistent across the individual studies conducted to date. Our aim was to conduct a systematic review and meta-analysis of existing studies that have examined cognition in euthymic MDD patients.

METHOD

Following a systematic search across several publication databases, meta-analyses were conducted for 27 empirical studies that compared euthymic adult MDD patients (895 participants) and healthy controls (997 participants) across a range of cognitive domains. The influence of demographic variables and confounding factors, including age of onset and recurrent episodes, was examined.

RESULTS

Compared with healthy controls, euthymic MDD patients were characterized by significantly poorer cognitive functions. However, the magnitude of observed deficits, with the exception of inhibitory control, were generally modest when late-onset cases were excuded. Late-onset cases demonstrated significantly more pronounced deficits in verbal memory, speed of information processing and some executive functions.

CONCLUSIONS

Cognitive deficits, especially poor response inhibition, are likely to be persistent features, at least of some forms, of adult-onset MDD. More studies are necessary to examine cognitive dysfunction in remitted psychotic, melancholic and bipolar spectrum MDD. Cognitive deficits overall appear to be more common among patients with late-onset depression, supporting the theories suggesting that possible vascular and neurodegenerative factors play a role in a substantial number of these patients.

Speed of processing and depression affect function in older adults with mild cognitive impairment

OBJECTIVES

To evaluate the effect of depression and cognition on function in older adults with amnestic and nonamnestic mild cognitive impairment (aMCI and nonaMCI).

DESIGN

The study uses baseline data from the National Alzheimer's Coordinating Center.

SETTING

Data were collected at multiple Alzheimer's Disease Centers in the United States.

PARTICIPANTS

The sample included a total of 3,117 individuals with MCI, mean age = 74.37 years, SD: 9.37 (aMCI, n = 2,488; non-aMCI, n = 629).

MEASUREMENTS

The 10-item Pfeffer Functional Activities Questionnaire assessed function.

RESULTS

Depressive symptoms (Geriatric Depression Scale), memory impairment (Logical Memory II), and processing speed decrements (Digit Symbol Substitution Test) were significantly associated with functional impairment (p <0.001). Processing speed partially mediated the effect of depression on function and fully mediated the effect of executive dysfunction on function (p <0.001) in the total MCI and aMCI subsample, while in the non-aMCI subsample, processing speed mediated the effect of executive function but not the effect of depression (p = 0.20) on function.

CONCLUSIONS

The findings show that processing speed is central to the effect that depression and executive dysfunction have on functional impairment in cognitively impaired older adults. Future studies are needed to better understand the physiologic underpinnings in age-related and disease-specific decrements in processing speed, and to address the problems in the assessment of processing speed in clinical samples.

Neural correlates of successful response inhibition in unmedicated patients with late-life depression

OBJECTIVE

Accumulating evidence implicates a strong association between abnormal frontostriatal-limbic brain circuits, executive dysfunction, and late-life depression (LLD). The stop signal task (SST) was designed by Rubia et al. for use with functional magnetic resonance imaging (fMRI) to identify the neural correlates of motor response inhibition, a well-characterized executive function. In this study, we compared brain activation between a group of unmedicated participants with LLD and an unmedicated healthy cohort during SST performance.

METHODS

Participants 55-85 years of age were screened, clinically evaluated, and entered into either the LLD (n = 15) or healthy comparison group (n = 13). Both groups underwent neuroimaging while performing the SST under similar conditions. The brain circuitry of successful motor inhibition was evaluated by contrasting the condition of correctly inhibiting responses with the condition of correctly responding to Go signals. Differential areas of brain activation between the LLD and comparison groups were determined with FMRIB Software Library.

RESULTS

Despite comparable SST performance measures, LLD participants demonstrated greater blood oxygen level dependent activation relative to the comparison group in predominantly left-lateralized frontostriatal-limbic circuitry that included the bilateral superior frontal cortices and left-hemispheric orbitofrontal gyri, insular cortex, cingulate cortex, caudate, and putamen. Conversely, the healthy comparison group did not exhibit any areas of greater activation than the LLD group.

CONCLUSION

Unmedicated participants with LLD activate additional areas within frontostriatal-limbic brain circuitry when performing the SST at a level comparable to a healthy cohort.

Differences in depression severity in family caregivers of hospitalized individuals with dementia and family caregivers of outpatients with dementia

OBJECTIVES

To determine if family caregivers of hospitalized individuals with dementia exhibit greater depression severity than caregivers of outpatients.

METHODS

Caregivers were recruited during care recipient treatment. Measures assessed depression, stress, burden, and grief.

RESULTS

Forty-one caregivers of a hospitalized patient and 44 caregivers of an outpatient (total N = 85) were recruited. The groups did not differ except caregivers of hospitalized patients were younger and less likely to reside with the care recipient. Regarding depression, 63.4% of caregivers of a hospitalized patient and 43.2% of caregivers of an outpatient scored within the clinical depressive symptoms range. Independent sample t-tests showed that caregivers of a hospitalized patient had greater severity of depression, burden, and grief. Caregiving for a hospitalized person remained a significant predictor of greater depression severity in regression models.

CONCLUSIONS

Family caregiving for a person hospitalized for psychiatric treatment of dementia is a risk factor for depression.

Depression and cognitive impairment in older adults

Late life depression (LLD) is a heterogeneous illness with high rates of treatment resistance. Cognitive impairment is common in the context of LLD, and LLD may be a prodromal symptom and/or potentially a risk factor for dementia. This manuscript reviews the most recent research into the cognitive deficits associated with LLD and risk of conversion to dementia in the context of LLD. We discuss potential moderators and mediators of cognitive deficits in LLD, including demographic and clinical variables, in addition to brain structure and function. Potential interventions for cognitive symptoms of LLD are reviewed. We conclude with a discussion of the broader implications of what is now known about LLD, and how this might be applied toward improved prognosis and models for effective treatment.

Cognitive and noncognitive determinants of everyday activities in a racially diverse population of older persons receiving health services

We examined the relationship of cognitive, medical, psychological, and behavioral factors with everyday functioning in a racially diverse older community population recruited from health service agencies. Everyday functioning was characterized as a latent variable composed of 15 instrumental activities of daily living (IADL). The mean (SD) age of the participants (N = 237) was 78.3 (8.1) years; 67% were women, 34% were African-American, 18 (7.6%) met criteria for a depressive disorder, and 61 (27.0%) met criteria for dementia. Worse verbal memory, older age, depression, and number of medical conditions were independently associated with worse IADL ability. The final model explained 60% of the variability. As the population ages and the prevalence of impaired cognition and disability rises, identifying cognitive and noncognitive determinants of disability becomes increasingly important. Interventions to optimize episodic memory, medical status, and treatment of depression may slow down the pathway to disability in older persons.

Mild depressive symptoms, self-reported disability, and slowing across multiple functional domains

BACKGROUND

Subthreshold depressive symptoms are common in older adults. The threshold for the clinical significance of such symptoms is unclear. Mechanisms linking depressed mood to increased risk of disability need further investigation.

METHODS

Among older adults who did not meet criteria for depression, respondents reporting no anhedonia and dysphoria over the past two weeks were compared to respondents reporting occasional symptoms with respect to self-reported disability and cognitive, psychomotor, and physical performance tests.

RESULTS

Of 312 community-resident participants without dementia, 35.3% (n = 110) reported one or both of the two depressive symptoms at mild severity (no more than "several days" in the past two weeks). Older adults with mild depressive symptoms reported more physician-diagnosed medical conditions (2.2 vs. 1.8, p < 0.01) and mobility problems (3.0 vs. 1.8, 0-7 scale, p < 0.001), and were slower in gait (0.80 vs. 0.73 m/sec, p < 0.01) and speed of cognitive processing (Trail B, 166.1 vs. 184.7 sec, p < 0.001). In regression models that adjusted for sociodemographic and medical status, subthreshold symptoms were not a significant correlate of slowing in gait speed or cognitive performance. However, subthreshold depressive symptoms were associated with self-reported mobility limitation in models that adjusted for observed performance.

CONCLUSIONS

Mild depressive symptoms in this sample were not an independent correlate of slowed performance. However, the presence of mild depressive symptoms was associated with poorer appraisal of mobility after adjustment for objective measures of mobility.