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Veronese N, Smith L, Koyanagi A, Soysal P, Mueller C, Errera CM, Vassallo G, Vernuccio L, Catanese G, Solmi M, Dominguez LJ, Barbagallo M. Association between depression and incident dementia: Longitudinal findings from the share study. Int J Geriatr Psychiatry 2024; 39:e6121. [PMID: 38970170 DOI: 10.1002/gps.6121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow-up in the SHARE (Survey of Health, Aging and Retirement in Europe) study. METHODS Depressive symptoms were defined using the EURO-D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self-reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated. RESULTS In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow-up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54-1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06-1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42-3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14-1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO-D, loss of concentration was the strongest individual variable predicting the onset of dementia. CONCLUSIONS Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening.
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Affiliation(s)
- Nicola Veronese
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Christopher Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chiara Maria Errera
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy
| | - Giusy Vassallo
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy
| | - Laura Vernuccio
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Giuseppina Catanese
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, Regional Centre for the Treatment of Eating Disorders and on Track: The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario, Ottawa, Ontario, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | | | - Mario Barbagallo
- Department of Internal Medicine and Geriatrics, Geriatric Unit, University of Palermo, Palermo, Italy
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Breneman CB, Valmas MM, Skalina LM, Cypel Y, Spiro A, Frayne SM, Magruder KM, Kilbourne AM, Kimerling R, Reinhard MJ. Mental Health and Cognition in Women Veterans Enrolled in the Health of Vietnam Era Veteran Women's Study (HealthViEWS). J Womens Health (Larchmt) 2024. [PMID: 38913339 DOI: 10.1089/jwh.2023.0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Objective: This analysis explored relationships between mental health symptoms and conditions and cognitive function in a cohort of Vietnam-era women veterans from the Health of Vietnam Era Veteran Women's Study (HealthViEWS). Methods: Vietnam-era women veterans completed a mail survey assessing self-reported symptom severity of posttraumatic stress disorder (PTSD) and depression. A telephone-based structured interview assessed mental health conditions and cognitive function (telephone interview for cognitive status [TICS]). Participants were categorized using a TICS threshold of ≤29 to designate possible cognitive impairment versus nonimpaired. Separate logistic regression models were used to determine associations between possible cognitive impairment and each self-reported and interviewer-rated assessment of PTSD and depression while adjusting for age, education, race, marital status, and wartime service location. Results: The sample consisted of 4,077 women veterans who were ≥60 years old and completed the TICS. Of these women, 7.20% were categorized with possible cognitive impairment. Logistic regression models indicated that self-reported PTSD and depression symptom severity were each significantly associated with higher odds of possible cognitive impairment (adjusted odds ratios [aOR]: 1.03 [95% confidence interval [CI]: 1.02-1.04] and 1.07 [95% CI: 1.04-1.09], respectively). Women veterans with a probable diagnosis of depression had higher odds of possible cognitive impairment compared to those without depression (aOR: 1.61 [95% CI: 1.07-2.42]). No association was found for probable diagnosis of PTSD. Conclusions: Although further examination remains necessary, results suggest that Vietnam-era women veterans with self-reported PTSD and depression symptom severity or a probable diagnosis of depression may benefit from screening of cognitive function to inform clinical care.
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Affiliation(s)
- Charity B Breneman
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
| | - Mary M Valmas
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Lauren M Skalina
- Department of Veterans Affairs, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Yasmin Cypel
- Department of Veterans Affairs, Health Outcomes Military Exposures, Veterans Health Administration, Washington, District of Columbia, USA
| | - Avron Spiro
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, Massachusetts, USA
| | - Susan M Frayne
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kathryn M Magruder
- Departments of Psychiatry and Behavioral Sciences and Public Health, Medical University of SC, Charleston, South Carolina, USA
| | - Amy M Kilbourne
- US Department of Veterans Affairs, Quality Enhancement Research Initiative (QUERI), Washington, District of Columbia, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rachel Kimerling
- National Center for PTSD and VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Matthew J Reinhard
- Department of Veterans Affairs, War Related Illness and Injury Study Center (WRIISC), Washington, District of Columbia, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
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Gibson CJ, Bahorik A, Xia F, Peltz C, Yaffe K. Intimate Partner Violence, Mental Health, and Aging-Related Health Among Men and Women Veterans Across the Lifespan. J Gen Intern Med 2024; 39:931-939. [PMID: 37962725 DOI: 10.1007/s11606-023-08466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A growing body of evidence suggests adverse health outcomes related to intimate partner violence (IPV), including traumatic brain injury (TBI). However, most research in this area has focused on reproductive-aged women. OBJECTIVE To examine relationships between IPV (with and without TBI), mental health, and aging-related health outcomes among men and women Veterans across the lifespan. DESIGN Cross-sectional analysis of Department of Veterans Affairs (VA) administrative data from fiscal years 2000-2019. Descriptive statistics and chi-square analyses were used to compare key comorbidities in matched samples of Veterans with and without IPV (gender-stratified and matched 1:3 based on demographics and index date). Comparisons between those with IPV and TBI relative to IPV alone were also examined. SUBJECTS Veterans aged 18 + with and without documented IPV in Department of Veterans Affairs (VA) electronic health records (n = 4108 men, 2824 women). MAIN MEASURES ICD codes were used to identify IPV, TBI, and aging-related medical (sleep disorder, hypertension, diabetes, dementia) and common psychiatric (depression, posttraumatic stress disorder, alcohol use disorder, and substance use disorder) diagnoses. KEY RESULTS Demographic characteristics were reflective of VA-enrolled Veterans (men: mean age 66, SD 16; 72% non-Hispanic White; women: mean age 47, SD 13; 64% non-Hispanic White). Relative to Veterans without IPV, both men and women with IPV had higher rates of all examined medical (e.g., sleep disorders, men: 33% vs. 52%; women: 45% vs. 63%) and psychiatric diagnoses (e.g., depression, men 32% vs. 74%; women 59% vs. 91%; all ps < .001), with evidence of an additive effect of TBI on some psychiatric outcomes. CONCLUSIONS IPV is broadly associated with aging-related and mental health, and TBI is a common correlate that may further contribute to psychiatric outcomes. Findings highlight the importance of trauma-informed care and recognizing the potential role of these exposures on men and women Veterans' health across the lifespan.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, CA, USA.
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Amber Bahorik
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Feng Xia
- NCIRE-The Veterans' Health Research Institute, San Francisco, CA, USA
| | - Carrie Peltz
- NCIRE-The Veterans' Health Research Institute, San Francisco, CA, USA
| | - Kristine Yaffe
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA
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Chen CYA, Chiu CC, Huang CY, Cheng YC, Huang MC, Kuo PH, Chen WY. Cluster analysis dissecting cognitive deficits in older adults with major depressive disorder and the association with neurofilament light chain. BMC Geriatr 2024; 24:344. [PMID: 38627748 PMCID: PMC11020442 DOI: 10.1186/s12877-024-04960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Cognitive impairment is a growing problem with increasing burden in global aging. Older adults with major depressive disorder (MDD) have higher risk of dementia. Neurofilament light chain (NfL) has been proven as a potential biomarker in neurodegenerative disease, including dementia. We aimed to investigate the association between cognitive deficits and NfL levels in older adults with MDD. METHODS In this cross-sectional study, we enrolled 39 MDD patients and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer's type, as controls, from a tertiary psychiatric hospital. Both groups were over age 65 and with matched Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and each cognitive domain. RESULTS In the MDD group, participants had higher rate of family psychiatry history and current alcohol use habit compared with controls. Control group of neurocognitive disorders showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits clustered with that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster. CONCLUSIONS We noted the negative correlation between NfL levels and cognition in MDD patients clustered with neurodegenerative disorder, Alzheimer's type. NfL could be a promising candidate as a biomarker to predict subtype of patients in MDD to develop cognitive decline. Further longitudinal studies and within MDD cluster analysis are required to validate our findings for clinical implications.
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Affiliation(s)
- Cynthia Yi-An Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cho-Yin Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
| | - Ying-Chih Cheng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wen-Yin Chen
- Department of Psychiatry, Taipei City Psychiatric Center, Songde branch, Taipei City Hospital, Taipei, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
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Wang T, Sun R, Sindelar JL, Chen X. Occupational differences in the effects of retirement on hospitalizations for mental illness among female workers: Evidence from administrative data in China. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101367. [PMID: 38340649 PMCID: PMC11060846 DOI: 10.1016/j.ehb.2024.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Retirement, a major transition in the life course, may affect many aspects of retirees' well-being, including health and health care utilization. Leveraging differential statutory retirement age (SRA) by occupation for China's urban female workers, we provide some of the first evidence on the causal effect of retirement on hospitalizations attributable to mental illness and its heterogeneity. To address endogeneity in retirement decisions, we take advantage of exogeneity of the differing SRA cut-offs for blue-collar (age 50) and white-collar (age 55) female urban employees. We apply a Fuzzy Regression Discontinuity Design (RDD) around the SRA cut-offs using nationally representative hospital inpatient claims data that cover these workers. We show that blue-collar females incur more hospitalizations for mental illness after retirement, while no similar change is found for white-collar females. Conditional on blue-collar females being hospitalized, probabilities of overall and ER admissions due to mental illness increase by 2.3 and 1.2 percentage points upon retirement, respectively. The effects are primarily driven by patients within the categories of schizophrenia, schizotypal and delusional disorders; and neurotic, stress-related and somatoform disorders. Moreover, the 'Donut' RDD estimates suggest that pent-up demand at retirement unlikely dominates our findings for blue-collar females. Rather, our results lend support to their worsening mental health at retirement. These findings suggest that occupational differences in mental illness and related health care utilization at retirement should be considered when optimizing retirement policy schemes.
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Affiliation(s)
- Tianyu Wang
- School of Labor and Human Resources, Renmin University of China, China
| | - Ruochen Sun
- Wharton School of Business, University of Pennsylvania, USA
| | | | - Xi Chen
- Yale School of Public Health, Yale University, USA.
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Thomas KR, Clark AL, Weigand AJ, Edwards L, Durazo AA, Membreno R, Luu B, Rantins P, Ly MT, Rotblatt LJ, Bangen KJ, Jak AJ. Cognition and Amyloid-β in Older Veterans: Characterization and Longitudinal Outcomes of Data-Derived Phenotypes. J Alzheimers Dis 2024; 99:417-427. [PMID: 38669550 DOI: 10.3233/jad-240077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Background Within older Veterans, multiple factors may contribute to cognitive difficulties. Beyond Alzheimer's disease (AD), psychiatric (e.g., PTSD) and health comorbidities (e.g., TBI) may also impact cognition. Objective This study aimed to derive subgroups based on objective cognition, subjective cognitive decline (SCD), and amyloid burden, and then compare subgroups on clinical characteristics, biomarkers, and longitudinal change in functioning and global cognition. Methods Cluster analysis of neuropsychological measures, SCD, and amyloid PET was conducted on 228 predominately male Vietnam-Era Veterans from the Department of Defense-Alzheimer's Disease Neuroimaging Initiative. Cluster-derived subgroups were compared on baseline characteristics as well as 1-year changes in everyday functioning and global cognition. Results The cluster analysis identified 3 groups. Group 1 (n = 128) had average-to-above average cognition with low amyloid burden. Group 2 (n = 72) had the lowest memory and language, highest SCD, and average amyloid burden; they also had the most severe PTSD, pain, and worst sleep quality. Group 3 (n = 28) had the lowest attention/executive functioning, slightly low memory and language, elevated amyloid and the worst AD biomarkers, and the fastest rate of everyday functioning and cognitive decline. CONCLUSIONS Psychiatric and health factors likely contributed to Group 2's low memory and language performance. Group 3 was most consistent with biological AD, yet attention/executive function was the lowest score. The complexity of older Veterans' co-morbid conditions may interact with AD pathology to show attention/executive dysfunction (rather than memory) as a prominent early symptom. These results could have important implications for the implementation of AD-modifying drugs in older Veterans.
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Affiliation(s)
- Kelsey R Thomas
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Alexandra L Clark
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Alexandra J Weigand
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Lauren Edwards
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Alin Alshaheri Durazo
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Rachel Membreno
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Britney Luu
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Peter Rantins
- VA San Diego Healthcare System, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Monica T Ly
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Lindsay J Rotblatt
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Katherine J Bangen
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amy J Jak
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Weaver DF. Thirty Risk Factors for Alzheimer's Disease Unified by a Common Neuroimmune-Neuroinflammation Mechanism. Brain Sci 2023; 14:41. [PMID: 38248256 PMCID: PMC10813027 DOI: 10.3390/brainsci14010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
One of the major obstacles confronting the formulation of a mechanistic understanding for Alzheimer's disease (AD) is its immense complexity-a complexity that traverses the full structural and phenomenological spectrum, including molecular, macromolecular, cellular, neurological and behavioural processes. This complexity is reflected by the equally complex diversity of risk factors associated with AD. However, more than merely mirroring disease complexity, risk factors also provide fundamental insights into the aetiology and pathogenesis of AD as a neurodegenerative disorder since they are central to disease initiation and subsequent propagation. Based on a systematic literature assessment, this review identified 30 risk factors for AD and then extended the analysis to further identify neuroinflammation as a unifying mechanism present in all 30 risk factors. Although other mechanisms (e.g., vasculopathy, proteopathy) were present in multiple risk factors, dysfunction of the neuroimmune-neuroinflammation axis was uniquely central to all 30 identified risk factors. Though the nature of the neuroinflammatory involvement varied, the activation of microglia and the release of pro-inflammatory cytokines were a common pathway shared by all risk factors. This observation provides further evidence for the importance of immunopathic mechanisms in the aetiopathogenesis of AD.
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Affiliation(s)
- Donald F Weaver
- Krembil Research Institute, University Health Network, Departments of Medicine, Chemistry, Pharmaceutical Sciences, University of Toronto, Toronto, ON M5T 0S8, Canada
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Chiu YM, Lan JL, Huang WL, Wu CS. Estimation of life expectancy and healthcare cost in rheumatoid arthritis patients with and without depression: a population-based retrospective cohort study. Front Med (Lausanne) 2023; 10:1221393. [PMID: 38020149 PMCID: PMC10657652 DOI: 10.3389/fmed.2023.1221393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose This study aimed to estimate the lifetime healthcare costs and loss of life expectancy (loss-of-LE) among patients with incident rheumatoid arthritis (RA) with and without depression. Methods This 18 years longitudinal cohort study used data from Taiwan's National Health Insurance Research Database. In total, 43,311 patients with RA were included. Among them, 1,663 patients had depressive disorders in the year preceding the RA diagnosis. The survival function for patients with RA with or without depression was estimated and extrapolated over a lifetime using the rolling extrapolation algorithm. The loss-of-LE was calculated by comparing the sex, age, and calendar year-matched referents from vital statistics. The average monthly cost was calculated as the sum of the monthly costs for all patients divided by the number of surviving patients. Lifetime healthcare costs were estimated by multiplying the monthly average cost by the monthly survival probability. Results The loss-of-LE for RA patients with and without depression was 5.60 years and 4.76 years, respectively. The lifetime costs of RA patients with and without depression were USD$ 90,346 and USD$ 92,239, respectively. However, the annual healthcare costs were USD$ 4,123 for RA patients with depression and USD$ 3,812 for RA patients without depression. Regardless of sex or age, RA patients with depression had higher annual healthcare costs than those without depression. Conclusion Patients with RA and depression have a high loss-of-LE and high annual healthcare costs. Whether treating depression prolongs life expectancy and reduces healthcare costs warrants further investigation.
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Affiliation(s)
- Ying-Ming Chiu
- Department of Allergy, Immunology, and Rheumatology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Nursing, Jen Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
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Liu CC, Lin CY, Liu CH, Chang KC, Wang SK, Wang JY. Bidirectional association between major depressive disorder and dementia: Two population-based cohort studies in Taiwan. Compr Psychiatry 2023; 127:152411. [PMID: 37722203 DOI: 10.1016/j.comppsych.2023.152411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) and dementia are both major contributors to the global burden of disease. Despite existing literature on the association between MDD and dementia, there is a lack of a nationwide longitudinal cohort study that considers the competing risk of death. Therefore, this study assessed the bidirectional associations between MDD and dementia over an 11-year period in population-based settings, accounting for death as a competing risk. METHODS We conducted two population-based retrospective cohort studies in Taiwan. We identified 80,742 patients diagnosed with MDD in 2009-2010 and matched them with patients without MDD by sex, age, and year of diagnosis to assess the relative risk of dementia. We also identified 80,108 patients diagnosed with dementia in 2009-2010 and matched them with patients without dementia by sex, age, and year of diagnosis to assess the relative risk of MDD. All patients were followed until they received a diagnosis of new onset MDD or new onset dementia, their death, or the end of 2019. Cause-specific hazards models were used to estimate adjusted hazard ratios (aHRs). RESULTS The incidence density (ID) of dementia was higher in patients with MDD than in patients without MDD (7.63 vs. 2.99 per 1000 person-years), with an aHR of 2.71 (95% confidence interval [CI]: 2.55-2.88). The ID of MDD was higher in patients with dementia than in patients without dementia (12.77 vs. 4.69 per 1000 person-years), with an aHR of 2.47 (95% CI: 2.35-2.59). CONCLUSIONS This population-based study found a bidirectional association between MDD and dementia. Our findings suggest the need to identify dementia in patients with MDD and vice versa.
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Affiliation(s)
- Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan.
| | - Chih-Yuan Lin
- Department of Neurology, Taipei City Hospital, Linsen Chinese Medicine Branch, Taipei, Taiwan; Institute of Health and Welfare Policy, School of Medicine, National Yang Ming Chiao Tung University, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taiwan; Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei City, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Taiwan; Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Kai Wang
- Department of Pediatrics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taiwan.
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Elser H, Horváth-Puhó E, Gradus JL, Smith ML, Lash TL, Glymour MM, Sørensen HT, Henderson VW. Association of Early-, Middle-, and Late-Life Depression With Incident Dementia in a Danish Cohort. JAMA Neurol 2023; 80:949-958. [PMID: 37486689 PMCID: PMC10366950 DOI: 10.1001/jamaneurol.2023.2309] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/15/2023] [Indexed: 07/25/2023]
Abstract
Importance Late-life depressive symptoms are associated with subsequent dementia diagnosis and may be an early symptom or response to preclinical disease. Evaluating associations with early- and middle-life depression will help clarify whether depression influences dementia risk. Objective To examine associations of early-, middle-, and late-life depression with incident dementia. Design, Setting, and Participants This was a nationwide, population-based, cohort study conducted from April 2020 to March 2023. Participants included Danish citizens from the general population with depression diagnoses who were matched by sex and birth year to individuals with no depression diagnosis. Participants were followed up from 1977 to 2018. Excluded from analyses were individuals followed for less than 1 year, those younger than 18 years, or those with baseline dementia. Exposure Depression was defined using diagnostic codes from the International Classification of Diseases (ICD) within the Danish National Patient Registry (DNPR) and Danish Psychiatric Central Research Register (DPCRR). Main Outcomes and Measure Incident dementia was defined using ICD diagnostic codes within the DPCRR and DNPR. Cox proportional hazards regression was used to examine associations between depression and dementia adjusting for education, income, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, anxiety disorders, stress disorders, substance use disorders, and bipolar disorder. Analyses were stratified by age at depression diagnosis, years since index date, and sex. Results There were 246 499 individuals (median [IQR] age, 50.8 [34.7-70.7] years; 159 421 women [64.7%]) with diagnosed depression and 1 190 302 individuals (median [IQR] age, 50.4 [34.6-70.0] years; 768 876 women [64.6%]) without depression. Approximately two-thirds of those diagnosed with depression were diagnosed before the age of 60 years (684 974 [67.7%]). The hazard of dementia among those diagnosed with depression was 2.41 times that of the comparison cohort (95% CI, 2.35-2.47). This association persisted when the time elapsed from the index date was longer than 20 to 39 years (hazard ratio [HR], 1.79; 95% CI, 1.58-2.04) and among those diagnosed with depression in early, middle, or late life (18-44 years: HR, 3.08; 95% CI, 2.64-3.58; 45-59 years: HR, 2.95; 95% CI, 2.75-3.17; ≥60 years: HR, 2.31; 95% CI, 2.25-2.38). The overall HR was greater for men (HR, 2.98; 95% CI, 2.84-3.12) than for women (HR, 2.21; 95% CI, 2.15-2.27). Conclusions and Relevance Results suggest that the risk of dementia was more than doubled for both men and women with diagnosed depression. The persistent association between dementia and depression diagnosed in early and middle life suggests that depression may increase dementia risk.
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Affiliation(s)
- Holly Elser
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Meghan L. Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Clinical Excellence Research Center, Stanford University, Palo Alto, California
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
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11
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Li Q, Smith JP, Zhao Y. Understanding the Effects of Widowhood on Health in China: Mechanisms and Heterogeneity. JOURNAL OF THE ECONOMICS OF AGEING 2023; 25:100458. [PMID: 37389325 PMCID: PMC10306321 DOI: 10.1016/j.jeoa.2023.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This paper analyzes the impact of widowhood on the health of mid-aged and older individuals in China using data from the China Health and Retirement Longitudinal Study (CHARLS) data. Our results show that widowhood significantly increases the risk of depression, chronic diseases, and body pain while reducing cognitive function, sleeping time, and daily activity functions. The effects on depression and daily functions are immediate, that on chronic diseases is lagged, and the effects on cognitive function and sleeping hours persist over time. We find that rural widows are particularly vulnerable to negative health outcomes due to their weaker economic positions, for whom widowhood leads to more grandchild care responsibility and corresponding workforce and social withdrawals. Moreover, rural widows' income loss is not compensated by children, either by co-residence or financial transfers, leading to reduced living standards. Overall, our findings suggest that China needs to strengthen economic security for older people, especially among rural women, in order to avoid significant negative consequences of widowhood.
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Affiliation(s)
- Qin Li
- South China Agricultural University, Guangzhou, China
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12
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Bergman BP, Mackay DF, Pell JP. Dementia in Scottish military veterans: early evidence from a retrospective cohort study. Psychol Med 2023; 53:1015-1020. [PMID: 34165055 PMCID: PMC9975994 DOI: 10.1017/s0033291721002440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/19/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have examined whether UK military veterans are at an increased risk of dementia. We explored the risk of dementia in Scottish military veterans aged up to 73 years in comparison with people who have never served. METHODS Retrospective cohort study of 78 000 veterans and 253 000 people with no record of service, matched for age, sex and area of residence, with up to 37 years follow-up, using Cox proportional hazard analysis to compare risk of dementia in veterans and non-veterans, overall and by subgroup. RESULTS Dementia was recorded in 0.2% of both veterans and non-veterans overall, Cox proportional hazard ratio 0.98, 95% confidence interval (CI) 0.82-1.19, p = 0.879 (landmark age: 50 years), with no difference for men but increased risk in veteran women and Early Service Leavers. Post-traumatic stress disorder (PTSD) was associated with a higher risk of dementia in both veterans and non-veterans, although possibly to a lesser degree in veterans. A history of mood disorder was strongly associated with developing dementia, greater in veterans than in non-veterans, odds ratio 1.54, 95% CI 1.01-2.35, p = 0.045. CONCLUSIONS There was no evidence to suggest that military service increased the risk of dementia, although this may change as the cohort ages. The well-documented association with PTSD shows no evidence of being stronger in veterans; by contrast, the association of mood disorder with dementia is much stronger in veterans. Healthcare providers should carefully assess the cognitive status of older veterans presenting with depressive illness in order to identify early dementia and ensure optimum management.
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Affiliation(s)
- B. P. Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - D. F. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - J. P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
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13
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Kim H, Yoo J, Han K, Lee DY, Fava M, Mischoulon D, Jeon HJ. Hormone therapy and the decreased risk of dementia in women with depression: a population-based cohort study. Alzheimers Res Ther 2022; 14:83. [PMID: 35710453 PMCID: PMC9202170 DOI: 10.1186/s13195-022-01026-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/29/2022] [Indexed: 12/27/2022]
Abstract
Abstract
Background
The literature has shown depression to be associated with an increased risk of dementia. In addition, hormone therapy can be a responsive treatment option for a certain type of depression. In this study, we examined the association between hormone therapy, including lifetime oral contraceptive (OC) use, and hormone replacement therapy (HRT) after menopause with the occurrence of dementia among female patients with depression.
Methods
The South Korean national claims data from January 1, 2005, to December 31, 2018, was used. Female subjects aged 40 years or older with depression were included in the analyses. Information on hormone therapy was identified from health examination data and followed up for the occurrence of dementia during the average follow-up period of 7.72 years.
Results
Among 209,588 subjects, 23,555 were diagnosed with Alzheimer’s disease (AD) and 3023 with vascular dementia (VD). Lifetime OC usage was associated with a decreased risk of AD (OC use for < 1 year: HR, 0.92 [95% CI, 0.88–0.97]; OC use for ≥ 1 year: HR, 0.89 [95% CI, 0.84–0.94]), and HRT after menopause was associated with a decreased risk of AD (HRT for < 2 years: HR, 0.84 [95% CI, 0.79–0.89]; HRT for 2–5 years: HR, 0.80 [95% CI, 0.74–0.88]; and HRT for ≥ 5 years : HR, 0.78 [95% CI, 0.71–0.85]) and VD (HRT < 2 years: HR, 0.82 [95% CI, 0.71–0.96]; HRT for 2–5 years: HR, 0.81 [95% CI, 0.64–1.02]; and HRT for ≥ 5 years: HR, 0.61 [95% CI, 0.47–0.79]).
Conclusions
In this nationwide cohort study, lifetime OC use was associated with a decreased risk of AD, and HRT after menopause was associated with a decreased risk of AD and VD among female patients with depression. However, further studies are needed to establish causality.
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14
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Chen C, Lu Z, Zhao J, Wang X, Zhang J, Zhang D, Li S. Combined association of depressive symptoms and sugar-sweetened beverages consumption with low cognitive performance. J Affect Disord 2022; 313:15-20. [PMID: 35772623 DOI: 10.1016/j.jad.2022.06.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The combined association of depressive symptoms and sugar-sweetened beverages (SSB) consumption with low cognitive performance is poorly understood so far. METHODS Data from the National Health and Nutrition Examination Survey 2011-2014 and Food Patterns Equivalents Database was used. Depressive symptoms were identified using the Patient Health Questionnaire-9. The combinations of depressive symptoms/SSB were defined as a categorical variable comprising no depressive symptoms/low SSB, no depressive symptoms/high SSB, mild-to-severe depressive symptoms/low SSB and mild-to-severe depressive symptoms/high SSB. Cognitive function was measured by three tests. People whose score were lower than the gender group stratified lowest quartile were defined as low cognitive performance. Logistic regression model was applied to examine the combined association with low cognitive performance. Interaction analysis was conducted to verify the interaction with gender. RESULTS The combined associations of depressive symptoms and SSB consumption with low cognitive performance were significant. For the Consortium to Establish a Registry for Alzheimer's Disease test, the combinations of mild-to-severe depressive symptoms/low SSB (ORs (95 % CI): 1.59 (1.01, 2.52)), no depressive symptoms/high SSB (ORs (95 % CI): 1.48 (0.96, 2.26)) and mild-to-severe depressive symptoms/high SSB (ORs (95 % CI): 1.74 (1.21, 2.53)) had significant or marginally significant associations with low cognitive performance to those with no depressive symptoms and low SSB consumption. LIMITATION This is a cross-sectional study. CONCLUSIONS The combination of depressive symptoms and SSB consumption might be associated with low cognitive performance, which had gender differences. These evidences could help guide interventions that focus on dietary nutrition patterns or mood for low cognitive performance.
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Affiliation(s)
- Chen Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China
| | - Zhonghai Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China
| | - Jiwei Zhao
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Xueyan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China
| | - Jiesong Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China
| | - Suyun Li
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, China.
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15
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Đapić B, Schernhammer E, Haslacher H, Stögmann E, Lehrner J. No effect of thyroid hormones on 5-year mortality in patients with subjective cognitive decline, mild cognitive disorder, and Alzheimer's disease. J Neuroendocrinol 2022; 34:e13107. [PMID: 35213057 PMCID: PMC9286816 DOI: 10.1111/jne.13107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
The present study aimed to investigate differences in circulating thyroid hormone levels, gender, education, depressive symptoms, and cognitive performance among patients with cognitive impairment, and also to examine their associations, as well as that of cognitive decline, with 5-year mortality. Between 1998 and 2017, a hospital-based, single-centre (Neurology Department of the General Hospital in Vienna, Austria), retrospective follow-up study enrolled 2102 patients with mild to severe cognitive impairment (grouped into subjective cognitive decline, mild cognitive impairment, and Alzheimer's disease). Cox proportional hazards models were used to calculate hazard ratios (HRs), with 95% confidence intervals (CIs), as well as to calculate stepwise adjustments for demographic variables (age, gender, and education), depressive symptoms (Geriatric Depression Scale, GDS-15), and neuropsychological abilities (four domains of a neuropsychological test battery of Vienna, NTVB). In univariate analyses, total triiodothyronine (TT3) levels differed significantly between Alzheimer's disease and mild cognitive impairment patients (pdiff = .001). No other differences in cognitive impairment subgroups with any of the measured thyroid hormones were observed. Furthermore, in multivariate models, circulating TT3 was not associated with mortality (multivariable-adjusted HR per unit increase in TT3 = 0.56; 95% CI = 0.29-1.07). In multivariate models, we observed significantly lower 5-year mortality among women (HR = 0.56; 95% CI = 0.43-0.73) and those who scored higher on any of the four domains of the NBTV (e.g., attention and perceptual speed, HR = 0.63; 95% CI = 0.54-0.72); we also observed significantly higher 5-year mortality among patients with depressive symptoms (HR per one point score increase in GDS-15 = 1.06; 95% CI = 1.02-1.10), regardless of cognitive impairment subgroup. Among patients with various degrees of cognitive impairment, we found no associations of thyroid hormone levels with 5-year mortality. Gender, neuropsychological abilities, and depressive symptoms were each significant predictors of 5-year mortality. These results suggest that a neurocognitive test performance could serve as an important predictor of 5-year mortality among patients with cognitive impairment, although further studies with a more complete adjustment for comorbidities are needed to confirm these findings.
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Affiliation(s)
- Blaž Đapić
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Eva Schernhammer
- Department of EpidemiologyCenter for Public HealthMedical University of ViennaViennaAustria
| | - Helmuth Haslacher
- Department of Laboratory MedicineMedical University of ViennaViennaAustria
| | | | - Johann Lehrner
- Department of NeurologyMedical University of ViennaViennaAustria
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16
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Larsen EN, Sloth MM, Osler M, Wium-Andersen IK, Jørgensen TSH. Depression in adulthood and risk of dementia later in life: A Danish register-based cohort study of 595,828 men. J Affect Disord 2022; 302:25-32. [PMID: 35066008 DOI: 10.1016/j.jad.2022.01.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Associations between depression and dementia could express a causal relationship, reverse causality or be explained by health-related factors. This study explores the association of depression and indicators of depression severity with subsequent risk of dementia while ensuring temporality and adjusting for important health-related factors. METHOD 595,828 men from the Danish Conscription Database born in 1939-59 with register-based information on lifetime depression and covariates at age 55 years were followed in nationwide registers to identify dementia cases until 2016. Associations were analyzed using Cox proportional hazard regression models with adjustment for intelligence, education level, body mass index, and comorbidities. RESULTS The dementia incidence per 1000 person-years was 1.2 cases for men without prior depression and 2.1 and 3.6 cases for men who had depression identified by antidepressants and hospitalization, respectively. Compared to no prior depression, depression identified by antidepressant medication was associated with 1.94 times [95% confidence interval (CI) 1.81;2.07] higher hazard of dementia and depression identified by hospitalization with depression was associated with 2.18 [95% CI: 1.95;2.45] higher hazard of dementia. Long-term course of depression identified by antidepressant prescriptions (>20 prescriptions), was associated with 40% 95% CI: 1.23;1.59 higher hazard of dementia compared to having ≤10 prescriptions. LIMITATIONS This study is restricted to men and dementia cases until age 57-77 years. CONCLUSION Men with depression before late midlife are subject to a higher risk of dementia later in life. Clinicians should be aware of dementia symptoms in patients with a long history of depression to initiate early treatment.
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Affiliation(s)
- Emma Neble Larsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark.
| | - Mathilde Marie Sloth
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ida Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark; Psychiatric Center Copenhagen, department O, Denmark
| | - Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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17
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Astorga-Aliaga A, Díaz-Arroyo F, Carreazo NY, Caballero KC, Rodríguez-Cuba MA, Runzer-Colmenares F, Parodi-García J. Depression Symptoms and Mortality in Elderly Peruvian Navy Veterans: A Retrospective Cohort Study. ADVANCES IN GERONTOLOGY 2022. [PMCID: PMC8966854 DOI: 10.1134/s2079057022010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Our study was design to determine the association between depressive symptoms and mortality in adults over 60 years old Navy Peruvian Veterans. We performed a retrospective cohort study based on a previous cohort study. A total of 1681 patients over 60 years old were included between 2010–2015. Demographic information, self-reported information about falls, physical frailty assessment, tobacco consumption, hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease and was collected. Depression was assessed by the short form of the Geriatric Depression Scale. We found that depressive symptoms were present in 24.9% of the participants and 40.5% of them died. Mortality risk in patients with depressive symptoms, physical frailty, and male sex was: RR of 23.1 (95% CI: 11.7–45.7), 3.84 (95% CI: 2.16–6.82), and 1.37 (95% CI: 1.07–1.75) respectively. We concluded that depressive symptoms in Peruvian retired military personnel and their immediate relatives are high and are significatively associated with mortality. Also, being male and frail was associated with an increased risk of death. This reinforces that early detection and assessment of depressive symptoms could be an opportunity to improve the health status of older adults.
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Affiliation(s)
| | | | | | - K. C. Caballero
- Universidad Científica del Sur, Lima, Perú
- CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Científica del Sur, EL Salvador, Perú
| | - M. A. Rodríguez-Cuba
- Universidad Científica del Sur, Lima, Perú
- CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Científica del Sur, EL Salvador, Perú
| | - F. Runzer-Colmenares
- Universidad Científica del Sur, Lima, Perú
- CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Científica del Sur, EL Salvador, Perú
- Universidad de San Martín de Porres, Centro de Investigación del Envejecimiento (CIEN), Lima, Perú
| | - J. Parodi-García
- Universidad de San Martín de Porres, Centro de Investigación del Envejecimiento (CIEN), Lima, Perú
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18
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Karel MJ, Wray LO, Adler G, Hannum AOR, Luci K, Brady LA, McGuire MH. Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations. Clin Gerontol 2022; 45:252-271. [PMID: 31971092 DOI: 10.1080/07317115.2020.1716910] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.
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Affiliation(s)
- Michele J Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, VA Western New York Health Care System, Buffalo, New York, United States.,Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Geri Adler
- VA South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
| | - Alisa O' Riley Hannum
- Mental Health Service, VA Eastern Colorado Healthcare System, Colorado Springs, Colorado, United States
| | - Katherine Luci
- Center for Aging and Neurocognitive Services, Salem VA Medical Center, Salem, Virginia, United States.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Blacksburg, Virginia, United States
| | - Laura A Brady
- Jacobs School of Medicine and Biomedical Sciences, SUNY University at Buffalo, Buffalo, New York, United States
| | - Marsden H McGuire
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs (VA) Central Office, Washington, DC, United States
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19
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Eastman J, Bahorik A, Kornblith E, Xia F, Yaffe K. Sex Differences in the Risk of Dementia in Older Veterans. J Gerontol A Biol Sci Med Sci 2022; 77:1250-1253. [PMID: 35134198 PMCID: PMC9391887 DOI: 10.1093/gerona/glac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies have demonstrated women to have a higher prevalence of dementia compared to men. However, sex differences in dementia incidence are controversial with conflicting reports showing women with higher, lower, or similar incidence. Source of difference may be due to clinical setting and lack of consideration of competing risk of death. We examined dementia incidence in a sample of the national Veteran population to determine differences by sex. METHODS We examined data from the Veterans Health Administration (VHA), the largest integrated health care system in the United States. We studied 947 797 Veterans aged ≥55 years (mean age: 69.9 ± 8.4, 3% female) evaluated in the VHA from October 1, 1999 to September 30, 2019. We estimated age-adjusted incidence rates of dementia (International Classification of Diseases, 9th and 10th Edition codes) by sex, and used Fine-Gray proportional hazards models with age as time scale to examine time to diagnosis, accounting for competing risk of death. RESULTS During the follow-up (mean 8.4 years), 11.3% (n = 106 977, 11.4% men and 8.0% women) of Veterans developed dementia. Age-adjusted incidence was 12.6/1 000 person-years for men and 12.7/1 000 person-years for women. Compared to male Veterans, risk dementia was slightly higher among females (hazard ratio = 1.15; 95% confidence interval: 1.10-1.20), and on average, female Veterans developed dementia 0.2 years earlier than male Veterans. After additional adjustment for race, education, medical, and psychiatric conditions, results were similar. CONCLUSIONS Among older Veterans in a national cohort, women had a slightly increased risk for developing dementia compared to men after accounting for competing risk of death.
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Affiliation(s)
- Jennifer Eastman
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Amber Bahorik
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Erica Kornblith
- San Francisco Veterans Affairs Health Care System, San Francisco, California, USA,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Feng Xia
- Northern California Institute for Research and Education, San Francisco, California, USA
| | - Kristine Yaffe
- Address correspondence to: Kristine Yaffe, MD, University of California, San Francisco, San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA. E-mail:
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20
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Koutsimani P, Montgomery A. Cognitive functioning in non-clinical burnout: Using cognitive tasks to disentangle the relationship in a three-wave longitudinal study. Front Psychiatry 2022; 13:978566. [PMID: 36061283 PMCID: PMC9428402 DOI: 10.3389/fpsyt.2022.978566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Burnout is often characterized by cognitive deficits and it has been associated with depression and anxiety. However, it is not clear whether cognitive impairment is a burnout consequence or employees with poor cognitive skills are more prone in developing burnout. Moreover, the exact nature of the association between burnout and depression, and burnout and anxiety is still unknown. Depression and anxiety are also related to cognitive impairments but their prospective associations are not fully understood. The aim of the present three-wave longitudinal study was to investigate the causality between cognitive functioning, burnout, depression, and anxiety among non-clinical burnout employees. The cause-effect associations of burnout with depression and anxiety were also explored. Perceived family support as a protective factor against cognitive decline, burnout, depression and anxiety was examined as well. A wide range of cognitive tasks tapping different cognitive domains were administered to employees of the general working population. Burnout, depression, anxiety, and perceived family support were assessed with self-reported questionnaires. Present results suggest that visuospatial functioning deficits are a burnout consequence and they indicate the role of automatic processing skills and executive functions in burnout onset. Additionally, current findings support that burnout is differentiated from depression and anxiety but it is reciprocally associated with the two psychological phenomena. Lastly, current results support the inclusion of perceived family support as an intervention to help individuals who suffer from mental health and cognitive difficulties.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational and Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Anthony Montgomery
- Department of Psychology, Northumbria University Newcastle, Newcastle upon Tyne, United Kingdom
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21
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Hayley S, Hakim AM, Albert PR. Depression, dementia and immune dysregulation. Brain 2021; 144:746-760. [PMID: 33279966 DOI: 10.1093/brain/awaa405] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/26/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
Major depression is a prevalent illness that increases the risk of several neurological conditions. These include stroke, cardiovascular disease, and dementia including Alzheimer's disease. In this review we ask whether certain types of depression and associated loneliness may be a harbinger of cognitive decline and possibly even dementia. We propose that chronic stress and inflammation combine to compromise vascular and brain function. The resulting increases in proinflammatory cytokines and microglial activation drive brain pathology leading to depression and mild cognitive impairment, which may progress to dementia. We present evidence that by treating the inflammatory changes, depression can be reversed in many cases. Importantly, there is evidence that anti-inflammatory and antidepressant treatments may reduce or prevent dementia in people with depression. Thus, we propose a model in which chronic stress and inflammation combine to increase brain permeability and cytokine production. This leads to microglial activation, white matter damage, neuronal and glial cell loss. This is first manifest as depression and mild cognitive impairment, but can eventually evolve into dementia. Further research may identify clinical subgroups with inflammatory depression at risk for dementia. It would then be possible to address in clinical trials whether effective treatment of the depression can delay the onset of dementia.
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Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Antoine M Hakim
- Ottawa Hospital Research Institute (Neuroscience), uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Paul R Albert
- Ottawa Hospital Research Institute (Neuroscience), uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada
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22
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Depressive symptoms with cognitive dysfunction increase the risk of cognitive impairment: analysis of the Korean Longitudinal Study of Aging (KLoSA), 2006-2018. Int Psychogeriatr 2021; 33:791-801. [PMID: 33190670 DOI: 10.1017/s1041610220003622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Geriatric depression complicates cognitive health in older adults. This study aims to investigate the impact of depressive symptoms on cognitive impairment in community-dwelling older adults, depending on whether cognitive dysfunction accompanied. DESIGN A community-based longitudinal cohort study. SETTING This study analyzed data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2018. PARTICIPANTS Among 10,254 individuals who were registered in the KLoSA study, a total of 9119 subjects met the criteria, and 4547 subjects were included in the final analysis. The subjects were grouped into 4 categories based on depressive symptoms and cognitive dysfunction at baseline assessment: "normal control" (NC, n = 3341), "depression only" (Dep-only, n = 652), "cognitive dysfunction only" (CD-only, n = 393), and "depression with cognitive dysfunction" (Dep-CD, n = 161). MEASUREMENTS Cognitive impairment 10 years later was defined as K-MMSE scores below two percentile on demographically adjusted norms. RESULTS Ten-year survival, that is, not experiencing cognitive impairment, was 80 $$ \pm \,$$1% in NC group, 72 $$ \pm $$ 2% in Dep-only group, 52 $$ \pm $$ 3% in CD-only group, and 44 $$ \pm $$ 5% in Dep-CD group. The hazard ratio (HR) of the Dep-only group (HR = 1.18, 95% CI, 0.97-1.43, n.s.) did not differ from that of the NC group, but the HR of the Dep-CD group was significantly higher (HR = 2.85, 95% CI, 2.23-3.66, p < 0.001) than the NC group. When the Dep-CD group was compared to the CD-only group, the HR was 1.13 (95% CI, 0.85-1.49, n.s.), which indicates that it did not significantly differ from the CD-only group. CONCLUSIONS Our findings suggest that depressive symptoms with cognitive dysfunction are associated with a higher risk of cognitive impairment. Furthermore, cognitive dysfunction occurring with depressive symptoms is as much a risk for cognitive impairment as is pure cognitive dysfunction. Thus, healthcare providers should pay close attention to the community-dwelling elderly when depressive symptoms occur with cognitive dysfunction.
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Chen J, Shu H, Wang Z, Zhan Y, Liu D, Liu Y, Zhang Z. Intrinsic connectivity identifies the sensory-motor network as a main cross-network between remitted late-life depression- and amnestic mild cognitive impairment-targeted networks. Brain Imaging Behav 2021; 14:1130-1142. [PMID: 31011952 DOI: 10.1007/s11682-019-00098-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Remitted late-life depression (rLLD) and amnestic mild cognitive impairment (aMCI) are both associated with a high risk of developing Alzheimer's disease (AD). Neurodegeneration is considered to spread within pre-existing networks. To investigate whether, in the healthy brain, there was a pre-existing cross-network between the intrinsic networks that are vulnerable to rLLD and aMCI. We performed functional connectivity analyses based on brain areas with the greatest brain neuronal activity differences in 55 rLLD, 87 aMCI, and 114 healthy controls. Intrinsic networks that were differentially vulnerable to rLLD and aMCI converged onto the sensory-motor network (SMN) in the healthy brain. These regions in the SMN within the aMCI- and rLLD-vulnerable networks played different roles in the cognitive functions. This study identifies the SMN as a cross-network between rLLD- and aMCI-vulnerable networks. The common susceptibility of these diseases to AD is likely due to the breakdown of the cross-network. The results further suggest that interventions targeting the amelioration of sensory-motor deficits in the early course of disease in individuals with AD risk may enhance patient function as AD pathology progresses.
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Affiliation(s)
- Jiu Chen
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China.,Institute of neuropsychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Hao Shu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yafeng Zhan
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Duan Liu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yong Liu
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, 210009, Jiangsu, China. .,Department of Psychology, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
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24
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Chosy EJ, Gross N, Meyer M, Liu CY, Edland SD, Launer LJ, White LR. Brain Injury and Later-Life Cognitive Impairment and Neuropathology: The Honolulu-Asia Aging Study. J Alzheimers Dis 2021; 73:317-325. [PMID: 31771050 DOI: 10.3233/jad-190053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Findings are inconsistent regarding the role of traumatic head injury in the subsequent development of neurologic outcomes. OBJECTIVE Examine the relationship between head injury and later cognitive impairment. METHODS A sample of 3,123 Japanese-American men was assessed for history of head injury and evaluated for cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). For a subsample of 676 respondents, neuropathologic results from those with and without head injury were compared. RESULTS Although the crude model showed an association between history of head injury and later severe cognitive impairment, the relationship lost significance in the adjusted model (OR = 1.320, CI: 0.90-1.93), regardless of time between injury and impairment. Similar to cognitive impairment, hippocampal sclerosis was observed significantly more in the brains of respondents with a history of head injury in the crude model, but the relationship weakened in the adjusted model (OR = 1.462, CI: 0.68-3.12). After adjustment, decedents with a head injury demonstrated marginally higher brain weight (OR = 1.003, CI: 1.00-1.01). CONCLUSION We did not find a relationship between head injury and subsequent cognitive decline in this cohort. The neuropathology results also displayed no strong association between history of head injury and specific brain lesions and characteristics. These results support other findings in prospective cohorts. However, they could be influenced by the demographic make-up of the sample (male Japanese-Americans) or by the observation that the majority reported only a single head injury.
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Affiliation(s)
- E Julia Chosy
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Noele Gross
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Marnie Meyer
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | - Catherine Y Liu
- Pacific Health Research and Education Institute, Honolulu, HI, USA
| | | | - Lenore J Launer
- National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lon R White
- Pacific Health Research and Education Institute, Honolulu, HI, USA
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25
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Wang F, Zheng H. Do Public Pensions Improve Mental Wellbeing? Evidence from the New Rural Society Pension Insurance Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052391. [PMID: 33804508 PMCID: PMC7967743 DOI: 10.3390/ijerph18052391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
The causal effect of public pensions on the mental wellbeing of the elderly in lower and middle-income countries deserves further investigation. This paper first constructed a theoretical framework for the impact of New Rural Society Pension Insurance pensions in China on the mental wellbeing of the rural elderly, and described potential channels through which pension income may affect mental wellbeing. We then used the fixed effect model and the instrument variable approach to estimate the casual effects of pension income on the mental wellbeing of the rural elderly. The results reveal that pension income improves mental wellbeing by relieving depression of the rural elderly; however, the beneficial effects of pension income are very limited. Pension income has no beneficial effects on the mental health of the rural elderly in the east region, whereas it slightly relieves depression of those in the middle and west regions. We also found that pension income produces small improvements in the mental health of older females, elderly persons living independently, and those with relatively poor economic conditions.
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26
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Hagen JM, Sutterland AL, Liefers T, Schirmbeck F, Cohn DM, Lok A, Tan HL, Zwinderman AH, de Haan L. Skin autofluorescence of advanced glycation end products and mortality in affective disorders in the lifelines cohort study: A mediation analysis. J Affect Disord 2021; 282:1082-1089. [PMID: 33601681 DOI: 10.1016/j.jad.2020.12.202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Life expectancy in patients suffering from affective disorders is considerably diminished. We investigated whether skin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, mediates the association between affective disorders and excess mortality. METHODS Included were 81,041 participants of the Lifelines cohort study. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed with the Mini-International Neuropsychiatric Interview. SAF was assessed as mediator in Cox proportional hazards models for all-cause or natural-cause mortality. RESULTS Mortality was increased in cases with major depression compared to controls (36.4 vs. 22.5 per 100,000 person years). Partial mediation by SAF of the association between affective disorders and mortality was shown (9.0-10.5%, P<.001-.002), although attenuated by cardiometabolic parameters and history of physical illness. For major depressive disorder, partial mediation by 5.5-10.3% was shown (crude model: P<.001; fully adjusted model: P=.03). LIMITATIONS The relatively short duration of follow-up and the relatively young cohort resulted in a lack of power to detect an association between mortality and dysthymia, social phobia and two or more comorbid disorders. CONCLUSION Evidence of partial mediation by SAF of the association between affective disorders and all-cause and natural-cause mortality was demonstrated, although attenuated by health factors. For major depression, mediation by SAF was largest and remained significant after adjustment for sociodemographic and health factors, identifying oxidative stress as possible determinant of premature death.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands.
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Tessa Liefers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands
| | - Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hanno L Tan
- The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
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27
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Koutsimani P, Montgomery A, Masoura E, Panagopoulou E. Burnout and Cognitive Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042145. [PMID: 33671754 PMCID: PMC7926785 DOI: 10.3390/ijerph18042145] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/16/2023]
Abstract
The aim of this study was to investigate the relationship between burnout and cognitive functioning. The associations of depression, anxiety and family support with burnout and cognitive functioning were also examined both independently and as potential moderators of the burnout–cognitive functioning relationship. Seven different cognitive tasks were administered to employees of the general working population and five cognitive domains were assessed; i.e., executive functions, working memory, memory (episodic, visuospatial, prospective), attention/speed of processing and visuospatial abilities. Burnout, depression, anxiety and family support were assessed with the Maslach Burnout Inventory-General Survey, the Hospital Anxiety and Depression Scale and the Family Support Scale respectively. In congruence with the first and fourth (partially) Hypotheses, burnout and perceived family support are significantly associated with some aspects of cognitive functioning. Moreover, in line with the third Hypothesis, perceived family support is inversely related to burnout. However, in contrast to the second and fourth Hypotheses, depression, anxiety and perceived family support do not moderate the burnout–cognitive functioning relationship. Additional results reveal positive associations between burnout depression and anxiety. Overall findings suggest that cognitive deficits, depression and anxiety appear to be common in burnout while they underpin the role of perceived family support in both mental health and cognitive functioning. Implications for practice are discussed.
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Affiliation(s)
- Panagiota Koutsimani
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Egnatia 156, 54636 Thessaloniki, Greece;
- Correspondence: ; Tel.: +30-2310-891-308
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Egnatia 156, 54636 Thessaloniki, Greece;
| | - Elvira Masoura
- Department of Experimental Cognitive Psychology, School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efharis Panagopoulou
- Laboratory of Hygiene, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Obbels J, Vansteelandt K, Bouckaert F, Dols A, Stek M, Verwijk E, Sienaert P. Neurocognitive functioning after electroconvulsive therapy in late-life depression: A 4-year prospective study. Acta Psychiatr Scand 2021; 143:141-150. [PMID: 33150605 DOI: 10.1111/acps.13252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression (LLD) from before the start until 4 years after the index ECT course. METHODS Fourty one patients aged 55 years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years, and 4 years after the last ECT session. RESULTS We did not find any statistically significant cognitive changes from before the start to 4 years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. CONCLUSION Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4 years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long-term cognitive side effects.
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Affiliation(s)
- Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Filip Bouckaert
- Old-age Psychiatry, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
| | - Annemiek Dols
- Department of Old Age Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, GGZ inGeest/Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Max Stek
- Department of Old Age Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, GGZ inGeest/Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Department of Medical Psychology, Neuropsychology Department, Academic Medical Center, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands.,ECT Department, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT, University Psychiatric Center KU Leuven, KU Leuven - University of Leuven, Kortenberg, Belgium
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29
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Kim S, Lee HJ, Jeong W, Jang SI, Park EC. Effects of spouse's employment status on depression. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:554-560. [PMID: 33377434 DOI: 10.1080/19338244.2020.1860876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Whether the spouse's employment status would be associated with individual's mental health condition is uncertain. Therefore, the aim of this study was to investigate the effects of spouse's employment status on depression. METHODS Data included the second to sixth wave of the Korean Longitudinal Study of Ageing (KLoSA). Depression was measured based on the CES-D10. Spouse's employment status was divided into 4 categories based on their employment changes. RESULTS Participants with still unemployed spouse were more likely to have high scores of depression (male: β = 0.32, female: β = 0.42). Participants who are employed and have unemployed spouse have higher depression scores (male: β = 0.45, female: β = 0.77). CONCLUSION This study identified the effect of spouse's employment status on depression by gender, and the results were significant. We should consider the possibility of conducting interventions with people who are remained unemployed.
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Affiliation(s)
- Selin Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Wonjeong Jeong
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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30
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Lin CE, Lee MS, Kao SY, Chung CH, Chen LF, Chou PH, Lee JF, Chien WC. Association between concurrent antidepressant and hypnotic treatment and the risk of dementia: A nationwide cohort study. J Affect Disord 2020; 277:549-558. [PMID: 32891061 DOI: 10.1016/j.jad.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of dementia among subgroups of patients receiving concurrent antidepressant and hypnotic treatment, antidepressants alone, and hypnotics alone. METHODS Multivariate Cox proportional hazards regression models were used to determine the effects of antidepressants and hypnotics on dementia risk after adjusting for potential confounders. RESULTS Compared with the reference group, patients receiving concurrent antidepressant and hypnotic treatment had the highest adjusted hazard ratio (aHR: 2.390, 95% CI: 2.224-2.536; P < 0.001) for all-cause dementia, followed by those receiving antidepressants alone (aHR: 1.919, 95% CI: 1.811-2.012; P < 0.001) and hypnotics alone (aHR: 1.458, 95% CI: 1.397-1.527; P < 0.001). With regard to dementia subtypes, trends similar to those for all-cause dementia were observed for Alzheimer's dementia, vascular dementia and other types of dementia. The sensitivity analysis conducted also found the robustness of findings. Notably, inconsistent findings were observed in subgroup with depression, revealing a null association between concurrent antidepressant and hypnotic treatment (aHR: 0.496; 95% CI: 0.183-1.343; P = 0.175) or hypnotics alone (aHR: 2.750; 95% CI: 0.797-9.482; P = 0.102) and the risk of dementia, and a negative association between antidepressants alone (aHR: 0.351; 95% CI: 0.130-0.942; P = 0.032) and the risk of dementia. CONCLUSION A null or negative association was observed between concurrent antidepressant and hypnotic treatment, antidepressants alone, hypnotics alone, and the dementia risk in the subgroup of patients with depression, suggesting the absence of an association between dementia risk and antidepressants alone or hypnotics alone.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC)
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Centre, Taipei, Taiwan (ROC); Department of Psychiatry, Hualien Armed Forces General Hospital, Hualien, Taiwan (ROC)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan (ROC); Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan (ROC)
| | - Jia-Fu Lee
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan (ROC); School of Medicine, Tzu Chi University, Hualien, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Number 325, Section 2, Chenggong Road, Neihu District, Taipei 11490, Taiwan (ROC); School of Public Health, National Defense Medical Centre, Taipei, Taiwan (ROC); Graduate Institute of Life Science, National Defense Medical center, Taipei, Taiwan (ROC).
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31
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Bock MA, Bahorik A, Brenowitz WD, Yaffe K. Apathy and risk of probable incident dementia among community-dwelling older adults. Neurology 2020; 95:e3280-e3287. [PMID: 33055276 DOI: 10.1212/wnl.0000000000010951] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the association between baseline apathy and probable incident dementia in a population-based sample of community-dwelling older adults. METHODS We studied 2,018 white and black community-dwelling older adults from the Health, Aging, and Body Composition (Health ABC) study. We measured apathy at year 6 (our study baseline) with the modified Apathy Evaluation Scale and divided participants into tertiles based on low, moderate, or severe apathy symptoms. Incident dementia was ascertained over 9 years by dementia medication use, hospital records, or clinically relevant cognitive decline on global cognition. We examined the association between apathy and probable incident dementia using a Cox proportional hazards model adjusting for demographics, cardiovascular risk factors, APOE4 status, and depressed mood. We also evaluated the association between the apathy group and cognitive change (as measured by the modified Mini-Mental State Examination and Digit Symbol Substitution Test over 5 years) using linear mixed effects models. RESULTS Over 9 years of follow-up, 381 participants developed probable dementia. Severe apathy was associated with an increased risk of dementia compared to low apathy (25% vs 14%) in unadjusted (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.5-2.5) and adjusted models (HR 1.7, 95% CI 1.3-2.2). Greater apathy was associated with worse cognitive score at baseline, but not rate of change over time. CONCLUSION In a diverse cohort of community-dwelling adults, apathy was associated with increased risk of developing probable dementia. This study provides novel evidence for apathy as a prodrome of dementia.
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Affiliation(s)
- Meredith A Bock
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA.
| | - Amber Bahorik
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Willa D Brenowitz
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Neurology (M.A.B., K.Y.), Psychiatry (A.B., W.D.B., K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; and San Francisco Veterans Affairs Medical Center (K.Y.), CA
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Alper HE, Tuly RA, Seil K, Brite J. Post-9/11 Mental Health Comorbidity Predicts Self-Reported Confusion or Memory Loss in World Trade Center Health Registry Enrollees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197330. [PMID: 33049920 PMCID: PMC7579594 DOI: 10.3390/ijerph17197330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Numerous studies report elevated levels of chronic mental health conditions in those exposed to the World Trade Center attacks of 11 September 2001 (9/11), but few studies have examined the incidence of confusion or memory loss (CML) or its association with mental health in 9/11 attack survivors. We investigated the incidence of CML and its association with the number of post-9/11 mental health conditions (PTSD, depression, and anxiety) in 10,766 World Trade Center Health Registry (Registry) enrollees aged 35–64 at the time of the wave 4 survey (2015–2016) that completed all four-wave surveys and met the study inclusion criteria. We employed log-binomial regression to evaluate the associations between CML and the number of mental health conditions. A total of 20.2% of enrollees in the sample reported CML, and there was a dose-response relationship between CML and the number of mental health conditions (one condition: RR = 1.85, 95% CI (1.65, 2.09); two conditions: RR = 2.13, 95% CI (1.85, 2.45); three conditions: RR = 2.51, 95% CI (2.17, 2.91)). Survivors may be experiencing confusion or memory loss partly due to the mental health consequences of the 9/11 attacks. Clinicians treating patients with mental health conditions should be aware of potential cognitive impairment.
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Affiliation(s)
- Howard E. Alper
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
- Correspondence: ; Tel.: +1-718-786-4387; Fax: +1-718-786-4006
| | - Rifat A. Tuly
- School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Kacie Seil
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
| | - Jennifer Brite
- New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (K.S.); (J.B.)
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Su JA, Chang CC, Yang YH, Chen KJ, Li YP, Lin CY. Risk of incident dementia in late-life depression treated with antidepressants: A nationwide population cohort study. J Psychopharmacol 2020; 34:1134-1142. [PMID: 32847467 DOI: 10.1177/0269881120944152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied. METHODS Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998-2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval. RESULTS Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91-1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95-1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results. CONCLUSION Antidepressants did not increase the risk of incident dementia in patients with late-life depression.
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Affiliation(s)
- Jian-An Su
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital at Chiayi, Taiwan.,Department of Nursing, Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan.,Department of Health Psychology, Chang Jung Christian University, Tainan, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yueh-Ping Li
- Department of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.,Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
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Kuring JK, Mathias JL, Ward L. Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. J Affect Disord 2020; 274:247-261. [PMID: 32469813 DOI: 10.1016/j.jad.2020.05.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/16/2020] [Accepted: 05/10/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be linked to dementia, but it is unclear whether they are risk factors (causal or prodromal) for, comorbid with, or sequelae to (secondary effect of) dementia. Existing meta-analyses have examined depression or anxiety in all-cause dementia, Alzheimer's disease (AD) and vascular dementia (VaD), but have not considered post-traumatic stress disorder (PTSD), dementia with Lewy bodies (DLB), or frontotemporal dementia (FTD). The current meta-analysis examined the risk of developing dementia (AD, VaD, DLB, FTD, all-cause) in people with and without a history of clinically-significant depression, anxiety or PTSD in order to better understand the link between mental illness and dementia (PROSPERO number: CRD42018099872). METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 36 eligible studies. RESULTS There is a higher risk of developing all-cause dementia and AD in people with previous depression, and a higher risk of all-cause dementia in people with prior anxiety, than in persons without this history. Prior PTSD was not associated with a higher risk of later being diagnosed with dementia. LIMITATIONS The data for anxiety, PTSD, DLB and FTD were limited. CONCLUSIONS Depression and anxiety appear to be risk factors for dementia, but longitudinal studies across adulthood (young adult/mid-life/older adult) are needed to evaluate the likely causal or prodromal nature of this risk. The link between PTSD and dementia remains unclear. Regular screening for new onset mental illness and for cognitive changes in older adults with a history of mental illness may assist with earlier identification of dementia.
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Affiliation(s)
- J K Kuring
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- School of Psychology, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
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Wu JJ, Wang HX, Yao W, Yan Z, Pei JJ. Late-life depression and the risk of dementia in 14 countries: a 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe. J Affect Disord 2020; 274:671-677. [PMID: 32664001 DOI: 10.1016/j.jad.2020.05.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depression is the most common mental health problem and often co-occurs with dementia in old age. This study investigates the influence of late-life depression on risk of dementia. METHODS A total of 16210 dementia-free participants aged 60+ from the Survey of Health, Aging, and Retirement in Europe were followed up for 10 years to detect incident dementia. Depression was assessed by a 12-item Europe-depression scale, dementia was determined by physician diagnosis reported by the participants and their informants. Fine and Gray model was performed to explore the association between depression and incident dementia taking into account competing risk of death. RESULTS During an average of 8 years follow-up, 1030 (6.35%) incident dementia were identified. Late-life depression was related to higher subdistribution hazard ratio (sHR) of dementia (sHR=1.52, 95%CI: 1.32-1.75) after adjusting for age, gender, country, education, smoking, drinking, living arrangement, BMI, chronic disease, and physical activity. Further, the risk was only existed in those below age of 80 (sHR=1.75, 95%CI: 1.47-2.07). In addition, a dose-response association was observed between the severity of depression and dementia risk (p for trend<0.001). LIMITATION The ascertainment of depression and dementia was based on information reported by the participants and/or their informants, which might result in information bias. The causal relationship could not be determined because limited follow-up time. CONCLUSIONS Late-life depression is associated with higher incidence of dementia in a dose-response fashion. Interventions targeting depression patients aged 60-79 years and those with severe depression may be effective strategies to prevent dementia.
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Affiliation(s)
- Jia-Jia Wu
- College of Public health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hui-Xin Wang
- College of Public health, Zhengzhou University, Zhengzhou, Henan, China; Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.
| | - Wu Yao
- College of Public health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Zhen Yan
- College of Public Health, Hainan Medical University, Haikou, China
| | - Jin-Jing Pei
- Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
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Pitts BL, Wen V, Whealin JM, Fogle BM, Southwick SM, Esterlis I, Pietrzak RH. Depression and Cognitive Dysfunction in Older U.S. Military Veterans: Moderating Effects of BDNF Val66Met Polymorphism and Physical Exercise. Am J Geriatr Psychiatry 2020; 28:959-967. [PMID: 32122804 DOI: 10.1016/j.jagp.2020.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/14/2020] [Accepted: 02/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Depression is associated with increased risk for cognitive dysfunction, yet little is known about genetic and behavioral factors that may moderate this association. Using data from a nationally representative sample of older U.S. military veterans, we examined the direct and interactive effects of depression, brain-derived neurotropic factor (BDNF) Val66Met genotype, and physical exercise on cognitive functioning. METHODS One thousand three hundred eighty-six older European-American U.S. military veterans (mean age = 63) completed a web-based survey and cognitive assessment. Analyses of covariance were conducted to evaluate the effects of depression, BDNF Met allele carrier status, and physical exercise on these measures. RESULTS Depressed veterans scored worse than nondepressed veterans on subjective measures of cognitive functioning (Cohen d's = 0.34-0.57) and objective measures of visual learning (d = 0.39) and working memory (d = 0.28). Among depressed veterans, those who were Met allele carriers scored worse than Val/Val homozygotes on subjective cognitive measures (d's = 0.52-0.97) and an objective measure of visual learning (d = 0.36). Engagement in physical exercise moderated the association between depression and cognitive function, with depressed exercisers scoring better than depressed nonexercisers on a subjective measure of reasoning, and objective measures of processing speed, attention, and visual learning (d = 0.58-0.99): further, in depressed Met allele carriers, exercisers scored better than nonexercisers on subjective cognitive (d's = 0.80-1.92), and objective measures of visual learning (d = 0.8-1.31) and working memory (d = 0.67). CONCLUSION Depression is associated with moderate decrements in cognitive functioning in older U.S. military veterans, and this association is moderated by BDNF Val66Met genotype and physical exercise. Prevention and treatment efforts designed to promote physical exercise may help preserve cognitive functioning in at-risk veterans.
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Affiliation(s)
- Barbara L Pitts
- Department of Psychological Sciences (BLP), Kansas State University, Manhattan, KS
| | - Vivian Wen
- Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT
| | - Julia M Whealin
- U.S. Department of Veterans Affairs, VA Pacific Islands Healthcare System (JMW), Honolulu, HI; University of Hawaii School of Medicine (JMW), Manoa, HI
| | - Brienna M Fogle
- Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT; U.S. Department of Veterans Affairs, Clinical Neurosciences Division (BMF, SMS, RHP), National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT
| | - Steven M Southwick
- Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT; U.S. Department of Veterans Affairs, Clinical Neurosciences Division (BMF, SMS, RHP), National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT
| | - Irina Esterlis
- Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT
| | - Robert H Pietrzak
- Department of Psychiatry (VW, BMF, SMS, IE, RHP), Yale University School of Medicine, New Haven, CT; U.S. Department of Veterans Affairs, Clinical Neurosciences Division (BMF, SMS, RHP), National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT.
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Kim YK, Kim OY, Song J. Alleviation of Depression by Glucagon-Like Peptide 1 Through the Regulation of Neuroinflammation, Neurotransmitters, Neurogenesis, and Synaptic Function. Front Pharmacol 2020; 11:1270. [PMID: 32922295 PMCID: PMC7456867 DOI: 10.3389/fphar.2020.01270] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022] Open
Abstract
Depression has emerged as a major cause of mortality globally. Many studies have reported risk factors and mechanisms associated with depression, but it is as yet unclear how these findings can be applied to the treatment and prevention of this disorder. The onset and recurrence of depression have been linked to diverse metabolic factors, including hyperglycemia, dyslipidemia, and insulin resistance. Recent studies have suggested that depression is accompanied by memory loss as well as depressive mood. Thus, many researchers have highlighted the relationship between depressive behavior and metabolic alterations from various perspectives. Glucagon-like peptide-1 (GLP-1), which is secreted from gut cells and hindbrain areas, has been studied in metabolic diseases such as obesity and diabetes, and was shown to control glucose metabolism and insulin resistance. Recently, GLP-1 was highlighted as a regulator of diverse pathways, but its potential as the therapeutic target of depressive disorder was not described comprehensively. Therefore, in this review, we focused on the potential of GLP-1 modulation in depression.
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Affiliation(s)
- Young-Kook Kim
- Department of Biochemistry, Chonnam National University Medical School, Hwasun, South Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan, South Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Graduate School, Dong-A University, Busan, South Korea
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun, South Korea
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Trifu SC, Trifu AC, Aluaş E, Tătaru MA, Costea RV. Brain changes in depression. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:361-370. [PMID: 33544788 PMCID: PMC7864313 DOI: 10.47162/rjme.61.2.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present review addresses major depressive disorder (MDD) and the implications of antidepressant treatment in the field of brain neuroplasticity, an effect initially considered adjacent but currently passed as central in the process of remission of MDD. Both in experimental animal studies and in human studies in subjects with mood disorders, neuroplasticity is considered the fundamental mechanism of neural defense against stress. Stress is the mediator between neurofunctional, neuroendocrine, neurobiological and neuroimmune disorders and depressive pathology of various intensities. Neurons have a high potential to adapt to the influences of internal and external factors. We are talking about neuroplasticity at different levels: structural neuroplasticity involving adult neurogenesis (such as plastic changes, dendritic reconstruction, when the morphology of the spine is affected); synaptic functional neuroplasticity and molecular and cellular mechanisms involved. These two major dimensions explain the pathophysiology of depression, as well as the convergence of the mechanisms involved in stress, major depressive decompensations, and the concept of neuroplasticity as the present target for new effective and potent antidepressant treatments.
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Affiliation(s)
- Simona Corina Trifu
- Department of General Medicine, Medical Military Institute, Bucharest, Romania;
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Military Sexual Trauma in Older Women Veterans: Prevalence and Comorbidities. J Gen Intern Med 2020; 35:207-213. [PMID: 31713042 PMCID: PMC6957619 DOI: 10.1007/s11606-019-05342-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent attention has highlighted the common occurrence and health consequences of military sexual trauma (MST) in younger women veterans. However, almost nothing is known about MST in older veterans. OBJECTIVE To describe MST among older women veterans, including prevalence and common comorbidities. DESIGN Cross-sectional observational study, using data from national Department of Veterans Affairs medical records. PARTICIPANTS Population-based sample of women Veterans aged 55+ with at least one documented MST screen response and at least one clinical encounter in fiscal years 2005-2015. MAIN MEASURES MST screen: medical diagnoses (diabetes, hypertension, hyperlipidemia, myocardial infarction, cerebrovascular disease, congestive heart failure, obesity, chronic pain conditions, back pain, dementia, insomnia, sleep apnea, menopause symptoms) and mental health diagnoses (anxiety, depression, posttraumatic stress disorder, tobacco use, alcohol use disorder, substance use disorder, opioid use disorder, suicidal ideation) from International Classification of Diseases, Ninth Revision Clinical Modification codes in the medical record. KEY RESULTS In this cohort of older women veterans (n = 70,864, mean age 65.8 ± 10.4 years), 13% had a positive MST screen. In multivariable regression analyses adjusted for age, race/ethnicity, and marital status, MST was strongly associated with most mental health diagnoses, particularly posttraumatic stress disorder (OR 7.25, 95% CI 6.84-7.68), depression (OR 2.39, 95% CI 2.28-2.50), and suicidal ideation (OR 2.42, 95% CI 2.08-2.82). MST was also associated with multiple medical conditions, particularly sleep disorders (insomnia OR 1.61, 95% CI 1.43-1.82; sleep apnea OR 1.48, 95% CI 1.37-1.61) and pain (chronic pain OR 1.58, 95% CI 1.50-1.67; back pain OR 1.40, 95% CI 1.34-1.47). CONCLUSIONS A history of MST is common among older women veterans and associated with a range of medical and mental health diagnoses. These findings call attention to the need for additional research in this understudied population, and the importance of trauma-informed care approaches for women across the lifespan.
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Marceaux JC, Soble JR, O'Rourke JJF, Swan AA, Wells M, Amuan M, Sagiraju HKR, Eapen BC, Pugh MJ. Validity of early-onset dementia diagnoses in VA electronic medical record administrative data. Clin Neuropsychol 2019; 34:1175-1189. [PMID: 31645200 DOI: 10.1080/13854046.2019.1679889] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the validity of diagnoses indicative of early-onset dementia (EOD) obtained from an algorithm using administrative data, we examined Veterans Health Administration (VHA) electronic medical records (EMRs). METHOD A previously used method of identifying cases of dementia using administrative data was applied to a random sample of 176 cases of Post-9/11 deployed veterans under 65 years of age. Retrospective, cross-sectional examination of EMRs was conducted, using a combination of administrative data, chart abstraction, and review/consensus by board-certified neuropsychologists. RESULTS Approximately 73% of EOD diagnoses identified using existing algorithms were identified as false positives in the overall sample. This increased to approximately 76% among those with mental health conditions and approximately 85% among those with mild traumatic brain injury (TBI; i.e. concussion). Factors related to improved diagnostic accuracy included more severe TBI, diagnosing clinician type, presence of neuroimaging data, absence of a comorbid mental health condition diagnosis, and older age at time of diagnosis. CONCLUSIONS A previously used algorithm for detecting dementia using VHA administrative data was not supported for use in the younger adult samples and resulted in an unacceptably high number of false positives. Based on these findings, there is concern for possible misclassification in population studies using similar algorithms to identify rates of EOD among veterans. Further, we provide suggestions to develop an enhanced algorithm for more accurate dementia surveillance among younger populations.
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Affiliation(s)
- Janice C Marceaux
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Department of Neurology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jason R Soble
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA.,Psychiatry & Neurology, Neuropsychiatric Institute, University of Illinois College of Medicine, Chicago, IL, USA
| | - Justin J F O'Rourke
- Psychology Service, South Texas Veterans Health Care System San Antonio, TX, USA
| | - Alicia A Swan
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Margaret Wells
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Megan Amuan
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
| | - Hari Krishna Raju Sagiraju
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Bhattarai JJ, Oehlert ME, Multon KD, Sumerall SW. Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race. J Aging Health 2019; 31:1398-1422. [PMID: 29900802 DOI: 10.1177/0898264318781131] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to examine major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosed at age < 55 as predictors, and sex and race as potential moderators, of dementia and other forms of cognitive impairment. Method: Veterans (N = 4,800) aged ⩾ 56 years were grouped by psychiatric history, sex, and race. Hierarchical and stepwise regression were employed to determine significant predictors. Results: MDD and PTSD were associated with almost double the risk for developing dementia or cognitive impairment at age ⩾ 56. Sex, as a moderator, had small effects whereas race increased the risk almost twofold for Black veterans, given the presence of MDD history. Discussion: MDD and PTSD act as significant risk factors for dementia and other forms of cognitive impairment, and Black veterans, given a history of MDD, may be at an increased risk. An important endeavor for future research is to examine how this risk may vary across dementia subtypes and related conditions.
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Affiliation(s)
| | - Mary E Oehlert
- 2 VA Eastern Kansas Health Care System, Leavenworth, KS, USA
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Helvik AS, Barca ML, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Borza T. The course of depressive symptoms with decline in cognitive function - a longitudinal study of older adults receiving in-home care at baseline. BMC Geriatr 2019; 19:231. [PMID: 31443638 PMCID: PMC6708209 DOI: 10.1186/s12877-019-1226-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė-Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tom Borza
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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Carta MG, Paribello P, Nardi AE, Preti A. Current pharmacotherapeutic approaches for dysthymic disorder and persistent depressive disorder. Expert Opin Pharmacother 2019; 20:1743-1754. [DOI: 10.1080/14656566.2019.1637419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Mauro Giovanni Carta
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Egidio Nardi
- Medical School - Institute of Psychiatry, Federal University of Rio de Janeiro National Academy of Medicine, Rio de Janeiro, Brazil
| | - Antonio Preti
- Department of Health Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Ou MJ, Huang CC, Wang YC, Chen YL, Ho CH, Wu MP, Huang YT, Wu CY, Chen PJ. Depression is a major risk factor for the development of dementia in people with lower urinary tract symptoms: A nationwide population-based study. PLoS One 2019; 14:e0217984. [PMID: 31173611 PMCID: PMC6555508 DOI: 10.1371/journal.pone.0217984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background/Objectives Studies have shown a strong relationship between depression and dementia. Lower urinary tract symptoms (LUTS) were reported to be independently associated with depression and dementia. However, the relationship between depression and cognitive dysfunction in patients with LUTS is not well characterized. Method We conducted a matched cohort study by using a one-million population-based dataset in Taiwan. A total of 15,944 patients with LUTS aged 50 or older were included from 2001 to 2005 and followed up until their death or the end of 2012. During the follow-up period, 1958 cases developed depression subsequently and were defined as the study group. 7832 patients without depression were then identified as control group, matching by age, gender, insurance premium, status of catastrophic illness certificate, and the index year in a 1:4 ratio. The primary outcome was the onset of dementia. LUTS, depression, dementia, and other comorbidities were defined by the International Classification of Disease, 9th Revision, Clinical Modification coding system. Cox hazards models and Aalen Johansen curves were applied to measure the influence of depression on the risk of dementia in patients with LUTS. Results The crude incidence of depression among people with LUTS was 12.3%. The incidence of dementia in the depression group was significantly higher than that in the control group (12.2% versus 8.9%; P < 0.001). Depression was associated with a significantly greater risk of subsequent dementia after adjusted for socioeconomic status, number of outpatient visits and multiple comorbidities (adjusted hazard ratio: 1.32; 95% confidence interval: 1.13–1.54). Conclusions Depression is a major risk factor for the onset of subsequent dementia in patients with LUTS. Early screening and interventions for depression in patients with LUTS may be important to maintain cognitive function.
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Affiliation(s)
- Ming-Jung Ou
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Che Huang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yi-Chi Wang
- Department of Family Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yung-Liang Chen
- Department of Family Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan City, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, Fu-Jan Catholic University, New Taipei City, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- Palliative Care Center, Chi-Mei Medical Center, Tainan City, Taiwan
- * E-mail:
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Klimova B, Maresova P, Kuca K. Combat Military Personnel and Selective Risk Factors for the Development of Dementias - A Review. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190114155451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
:
Due to the growth of life expectancies and the increasing number of elderly population all
over the world, there is a risk of growth of aging diseases such as dementia. Recent research studies
also indicate that there will be a growing number of military veterans who will be affected by dementia,
already at the age of 55+ years. In the case of combat military personnel, the most common
dementias are Alzheimer’s disease and vascular dementia. These two dementias are very similar
because their main symptoms are the same. The purpose of this review is to explore two main risk
factors influencing the development of the dementias. These include posttraumatic stress disorder
(PTSD) and traumatic brain injury (TBI). Furthermore, the authors of this study focus on the exploration
of the treatment of PTSD and TBI in order to delay the development of dementias among
combat military personnel.
:
For the purpose of this study, a method of literature review of available sources exploring these two
main risk factors of dementia among combat military personnel was used. Based on the evaluation
of these literature sources, possibilities of pharmacological and non-pharmacological approaches to
the treatment and care of these people were described.
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Affiliation(s)
- Blanka Klimova
- Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petra Maresova
- Faculty of Informatics and Management, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
| | - Kamil Kuca
- Philosophical Faculty, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic
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Lwi SJ, Barnes DE, Xia F, Peltz C, Hoang T, Yaffe K. Ten-Year Prevalence of Cognitive Impairment Diagnoses and Associated Medical and Psychiatric Conditions in a National Cohort of Older Female Veterans. Am J Geriatr Psychiatry 2019; 27:417-425. [PMID: 30704839 DOI: 10.1016/j.jagp.2018.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/08/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Veterans are at risk for dementia because of elevated general risk factors and exposure to military risk factors; however, few studies have focused on female veterans despite their growing numbers. We sought to characterize the 10-year prevalence of cognitive impairment (i.e., mild cognitive impairment and dementia) and associated conditions in older female veterans. METHODS Data were extracted from Veterans Health Administration medical records of 168,111 female veterans aged 65 and older. Cognitive impairment (CI) diagnoses were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes or dementia medication prescriptions. Medical comorbidities and psychiatric conditions were determined using ICD-9 codes occurring within 2years of CI diagnosis or the last recorded medical encounter for veterans without CI. RESULTS Ten-year prevalence was 1.8% (3,075) for mild cognitive impairment (MCI) diagnoses and 8.1% (13,653) for dementia diagnoses. Prevalence increased with age (MCI age 65: 1.4%; age 85+: 2.7%; dementia age 65: 2.5%; age 85+: 17.7%); 37.3% had dementia subtype diagnoses, with Alzheimer's disease being the most prevalent (72.7%). 47.7% of veterans with CI had at least one medical comorbidity, whereas 22.5% had at least one psychiatric condition. CONCLUSION Few studies have characterized the prevalence of cognitive impairment in female veterans despite the expected increases in CI and impending demographic shifts in the military. The high prevalence of medical and psychiatric conditions in female veterans with CI highlights their healthcare burden and emphasizes the need for further investigations into the prevention, treatment, and care of cognitive impairment in this understudied population.
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Affiliation(s)
- Sandy J Lwi
- the San Francisco VA Medical Center (SJL, DEB, KY), San Francisco
| | - Deborah E Barnes
- the San Francisco VA Medical Center (SJL, DEB, KY), San Francisco; Departments of Psychiatry, Neurology, Epidemiology, and Biostatistics (DEB, KY), University of California, San Francisco, San Francisco
| | - Feng Xia
- the Northern California Institute for Research and Education-The Veterans Health Research Institute (FX, CP, TH), San Francisco
| | - Carrie Peltz
- the Northern California Institute for Research and Education-The Veterans Health Research Institute (FX, CP, TH), San Francisco
| | - Tina Hoang
- the Northern California Institute for Research and Education-The Veterans Health Research Institute (FX, CP, TH), San Francisco
| | - Kristine Yaffe
- the San Francisco VA Medical Center (SJL, DEB, KY), San Francisco; Departments of Psychiatry, Neurology, Epidemiology, and Biostatistics (DEB, KY), University of California, San Francisco, San Francisco.
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Yaffe K, Lwi SJ, Hoang TD, Xia F, Barnes DE, Maguen S, Peltz CB. Military-related risk factors in female veterans and risk of dementia. Neurology 2019; 92:e205-e211. [PMID: 30541865 PMCID: PMC6340384 DOI: 10.1212/wnl.0000000000006778] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/31/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans. METHODS This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death. RESULTS During follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01-2.20; PTSD adjusted sHR 1.78, 95% CI 1.34-2.36; and depression-adjusted sHR 1.67, 95% CI 1.55-1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84-2.51). CONCLUSIONS We found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.
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Affiliation(s)
- Kristine Yaffe
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco.
| | - Sandy J Lwi
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Tina D Hoang
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Feng Xia
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Deborah E Barnes
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Shira Maguen
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
| | - Carrie B Peltz
- From the San Francisco Veterans Affairs Health Care System (K.Y., S.J.L., T.D.H., F.X., D.E.B., S.M., C.B.P.); and Departments of Psychiatry (K.Y., D.E.B., S.M.), Neurology (K.Y.), and Epidemiology & Biostatistics (K.Y.), University of California, San Francisco
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Chen X, Wang T, Busch SH. Does money relieve depression? Evidence from social pension expansions in China. Soc Sci Med 2018; 220:411-420. [PMID: 30530234 DOI: 10.1016/j.socscimed.2018.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 10/22/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
We estimate the impact of pension enrollment on mental well-being using China's New Rural Pension Scheme (NRPS), the largest existing pension program in the world. Since its launch in 2009, more than 400 million Chinese have enrolled in the NRPS. We first describe plausible pathways through which pension may affect mental health. We then use the national sample of China Family Panel Studies (CFPS) to examine the effect of pension enrollment on mental health, as measured by CES-D and self-reported depressive symptoms. To overcome the endogeneity of pension enrollment or of income change on mental health, we exploit geographic variation in pension program implementation. Results indicate modest to large reductions in depressive symptoms due to pension enrollment; this effect is more pronounced among individuals eligible to claim pension income, among populations with more financial constraints, and among those with worse baseline mental health. Our findings hold for a rich set of robustness checks and falsification tests.
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Affiliation(s)
- Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, USA; Department of Economics, Yale University, USA.
| | - Tianyu Wang
- School of Labor and Human Resources, Renmin University of China, China.
| | - Susan H Busch
- Department of Health Policy and Management, Yale School of Public Health, USA; Institution for Social and Policy Studies, Yale University, USA.
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Gender Differences in Cardiovascular Risk Related to Diabetes and Posttraumatic Stress Disorder. Am J Geriatr Psychiatry 2018; 26:1268-1272. [PMID: 30314941 DOI: 10.1016/j.jagp.2018.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/28/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine relationships between posttraumatic stress disorder (PTSD), diabetes, and cardiovascular disease (CVD) among older men and women. METHODS In a national retrospective cohort study of Veterans aged ≥55 (n=2,789,264, 6% female), associations between PTSD and diabetes (2008-2011) and incident CVD (2012-2015) were assessed with gender-stratified Fine-Gray proportional hazard models, adjusted for demographics and medical comorbidities. RESULTS Incident CVD was observed in 22% of men and 12% of women, and related to PTSD (men HR=1.05, 95% CI=1.04-1.06, Wald χ2=80.46, df=1, p<.001; women HR=1.47, 95% CI=1.38-1.57, Wald χ2=148.60, df=1, p<.001), diabetes (men HR=1.34, 95% CI=1.34-1.35, Wald χ2=9177.64, df=1, p<.001; women HR=1.49, 95% CI=1.44-1.55, Wald χ2=419.02, df=1, p<.001), and comorbid PTSD-diabetes (men HR=1.50, 95% CI=1.48-1.52, Wald χ2=4180.92, df=1, p<.001; women HR=1.96, 95% CI=1.80-2.12, Wald χ2=257.28, df=1, p<.001). CONCLUSIONS CVD risk was increased with PTSD and diabetes, and strongly increased with comorbid PTSD-diabetes. Among women, PTSD and diabetes conferred equivalent CVD risk.
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50
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Snyder HM, Carare RO, DeKosky ST, de Leon MJ, Dykxhoorn D, Gan L, Gardner R, Hinds SR, Jaffee M, Lamb BT, Landau S, Manley G, McKee A, Perl D, Schneider JA, Weiner M, Wellington C, Yaffe K, Bain L, Pacifico AM, Carrillo MC. Military-related risk factors for dementia. Alzheimers Dement 2018; 14:1651-1662. [PMID: 30415806 PMCID: PMC6281800 DOI: 10.1016/j.jalz.2018.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In recent years, there has been growing discussion to better understand the pathophysiological mechanisms of traumatic brain injury and post-traumatic stress disorder and how they may be linked to an increased risk of neurodegenerative diseases including Alzheimer's disease in veterans. METHODS Building on that discussion, and subsequent to a special issue of Alzheimer's & Dementia published in June 2014, which focused on military risk factors, the Alzheimer's Association convened a continued discussion of the scientific community on December 1, 2016. RESULTS During this meeting, participants presented and evaluated progress made since 2012 and identified outstanding knowledge gaps regarding factors that may impact veterans' risk for later life dementia. DISCUSSION The following is a summary of the invited presentations and moderated discussions of both the review of scientific understanding and identification of gaps to inform further investigations.
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Affiliation(s)
- Heather M Snyder
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA.
| | - Roxana O Carare
- Clinical Neuroanatomy, Equality and Diversity Lead, University of Southampton, Southampton, United Kingdom
| | - Steven T DeKosky
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Mony J de Leon
- Department of Psychiatry, New York University Medical Center, New York City, NY, USA
| | - Derek Dykxhoorn
- Department of Microbiology and Immunology, Miami University, Miami, FL, USA
| | - Li Gan
- Gladstone Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Raquel Gardner
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sidney R Hinds
- Blast Injury Research Program Coordinating Office, United States Army Medical Research and Material Command, Frederick, MD, USA
| | - Michael Jaffee
- Department of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
| | - Bruce T Lamb
- Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA
| | - Susan Landau
- Helen Willis Neuroscience Institute, University of California, Berkley, Berkley, CA, USA
| | - Geoff Manley
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Ann McKee
- Department of Neurology and Pathology, Boston University, Boston, MA, USA
| | - Daniel Perl
- Department of Pathology, Uniformed Services University, Bethesda, MD, USA
| | - Julie A Schneider
- Neurology Department, Rush University Medical Center, Chicago, IL, USA
| | - Michael Weiner
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kristine Yaffe
- Department of Psychiatry, Neurology & Epidemiology, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa Bain
- Independent Science Writer, Philadelphia, PA, USA
| | | | - Maria C Carrillo
- Medical & Scientific Relations, Alzheimer's Association, Chicago, IL, USA
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