1
|
Wang Q, Zhou S, Zhang J, Wang Q, Hou F, Han X, Shen G, Zhang Y. Risk assessment and stratification of mild cognitive impairment among the Chinese elderly: attention to modifiable risk factors. J Epidemiol Community Health 2023:jech-2022-219952. [PMID: 37321832 DOI: 10.1136/jech-2022-219952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The early identification of individuals at risk of mild cognitive impairment (MCI) has major public health implications for Alzheimer's disease prevention. OBJECTIVE This study aims to develop and validate a risk assessment tool for MCI with a focus on modifiable factors and a suggested risk stratification strategy. METHODS Modifiable risk factors were selected from recent reviews, and risk scores were obtained from the literature or calculated based on the Rothman-Keller model. Simulated data of 10 000 subjects with the exposure rates of the selected factors were generated, and the risk stratifications were determined by the theoretical incidences of MCI. The performance of the tool was verified using cross-sectional and longitudinal datasets from a population-based Chinese elderly cohort. RESULTS Nine modifiable risk factors (social isolation, less education, hypertension, hyperlipidaemia, diabetes, smoking, drinking, physical inactivity and depression) were selected for the predictive model. The area under the curve (AUC) was 0.71 in the training set and 0.72 in the validation set for the cross-sectional dataset. The AUCs were 0.70 and 0.64 in the training and validation sets, respectively, for the longitudinal dataset. A combined risk score of 0.95 and 1.86 was used as the threshold to categorise MCI risk as 'low', 'moderate' and 'high'. CONCLUSION A risk assessment tool for MCI with appropriate accuracy was developed in this study, and risk stratification thresholds were also suggested. The tool might have significant public health implications for the primary prevention of MCI in elderly individuals in China.
Collapse
Affiliation(s)
- Qiong Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Shuai Zhou
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Jingya Zhang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Qing Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Xiao Han
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Guodong Shen
- Department of Geriatrics, University of Science and Technology of China, Hefei, Anhui, China
| | - Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
2
|
Depression and bone loss as risk factors for cognitive decline: A systematic review and meta-analysis. Ageing Res Rev 2022; 76:101575. [PMID: 35093615 DOI: 10.1016/j.arr.2022.101575] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/24/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is linked to Alzheimer's disease (AD) but it is unclear whether depression is also associated with cognitive decline in the preclinical phase and mild cognitive impairment (MCI). Previous meta-analyses have only investigated AD as an outcome without accounting for individuals showing cognitive decline that does not meet the diagnostic criteria for AD. Other potentially modifiable risk factors such as bone loss have also been less explored and there remains uncertainty around their temporal relationship with cognitive decline. AIMS To conduct a systematic review and meta-analysis investigating depression and bone loss as risk factors for subsequent cognitive decline. METHODS A comprehensive search strategy was developed and applied using four databases; MEDLINE Complete, Embase, PsycINFO and CINAHL Complete. The pooled summary effects were estimated as odds ratios with 95% confidence intervals using a random-effects model. The study protocol was registered with PROSPERO (ID: CRD42020159369). RESULTS A total of 75 longitudinal cohort studies were identified for meta-analysis, of which 70 examined the impact of depression on cognitive decline and five examined the impact of bone loss. Prior exposure to depression was found to be associated with cognitive score reduction (OR 1.33 95% CI 1.17, 1.51), MCI incidence (OR 1.52 95% CI 1.28, 1.79) and AD incidence (OR 1.79 95% CI 1.46, 2.2). Bone loss was also associated with the incidence of AD (OR=1.81 95% CI 1.28, 2.55). CONCLUSIONS Overall, the results support the hypothesis that depression is associated with subsequent cognitive decline. Bone loss was also found to be associated with AD incidence; however, due to the small number of studies, the results should be viewed with caution.
Collapse
|
3
|
Abstract
OBJECTIVE Menopause is a natural phenomenon among women during their midlife, which is accompanied by unfavorable physical, physiological, and psychological consequences. Therefore, the major aim of the present cross-sectional study was to examine whether the cognitive performance of women is sensitive to the severity of menopausal symptoms. METHODS A total number of 404 rural women aged between 40 and 65 years were included in the present study. The menopausal symptoms and cognitive performance of the women were assessed using the Greene Climacteric Scale and Hindi Mini-Mental State Examination scale respectively. RESULTS The results of the present study demonstrated that women experiencing severe menopausal symptoms (higher Total Greene climacteric score) presented significantly lower mean values for orientation (8.11 vs 8.90, P < 0.001), registration (2.77 vs 2.91, P < 0.001), attention (4.31 vs 4.48, P < 0.01), recall (2.26 vs 2.53, P < 0.05), and language/visuo-spatial skills (7.13 vs 7.91, P < 0.001) as compared with their counterparts with mild menopausal symptoms. The multivariate linear regression model (after adjustment for age, marital status, and educational status) recorded severe depression and greater sexual dysfunction as the factors significantly associated with lower Mini-Mental State Examination scores. CONCLUSION Hence, the findings of the present study indicated that the cognitive performance of women was sensitive to severe depression and sexual dysfunction.
Collapse
Affiliation(s)
- Mankamal Kaur
- Department of Anthropology, Panjab University, Chandigarh, India
| | | |
Collapse
|
4
|
Hu M, Shu X, Wu X, Chen F, Hu H, Zhang J, Yan P, Feng H. Neuropsychiatric symptoms as prognostic makers for the elderly with mild cognitive impairment: a meta-analysis. J Affect Disord 2020; 271:185-192. [PMID: 32479315 DOI: 10.1016/j.jad.2020.03.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/11/2020] [Accepted: 03/22/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although several neuropsychiatric symptoms (NPSs) have been demonstrated to have value in the prediction of the progression of mild cognitive impairment (MCI) to dementia, these symptoms are less studied for the prediction of the transition from normal cognition (NC) to MCI. METHODS Prospective cohort studies were included if they reported on at least one NPS at baseline and had MCI as the outcome. RESULTS We obtained 13 cohort studies with a total population of 33,066. Depression was the most common neuropsychiatric symptom and could significantly predict transition to MCI (RR = 1.49, 95% CI: 1.13-1.86). However, depression was more capable of predicting amnestic MCI (RR=1.43, 95% CI: 1.04-1.83) than non-aMCI (RR= 0.96, 95% CI 95% CI: 0.60-1.33). Subgroup analysis suggested that the association between depression and MCI changed with depression severity, depression criteria, apolipoprotein-E-adjusted status, age, the percentage of females, and follow-up times, but some data were too sparse for a reliable estimate. Regarding other NPSs, there were insufficient data to assess their effect on the development of MCI. However, apathy, anxiety, sleep disturbances, irritability, and agitation might be risk factors for the prediction of NC-MCI transition with strong predictive value. CONCLUSIONS Depression was associated with an approximately 1.5-fold sincreased risk of the progression to MCI in the population with normal cognition. Other NPSs with underlying predictive value deserve more attention.
Collapse
Affiliation(s)
- Mingyue Hu
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China
| | - Xinhui Shu
- Department of Hematology, Tumor Hospital of Henan Province, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinyin Wu
- Department of Public Health, XiangYa School of Medicine, Central South University, Changsha, China
| | - Fenghui Chen
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China; Department of Nursing, Xinjiang Medical University, Xinjiang, China
| | - Hengyu Hu
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China
| | - Junmei Zhang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Ping Yan
- Department of Nursing, Xinjiang Medical University, Xinjiang, China
| | - Hui Feng
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China; Oceanwide Health management institute, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
5
|
Chan CK, Soldan A, Pettigrew C, Wang MC, Wang J, Albert MS, Rosenberg PB. Depressive symptoms in relation to clinical symptom onset of mild cognitive impairment. Int Psychogeriatr 2019; 31:561-569. [PMID: 30303065 PMCID: PMC6458104 DOI: 10.1017/s1041610218001138] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
ABSTRACTObjective:There is increasing evidence of an association between depressive symptoms and mild cognitive impairment (MCI) in cross-sectional studies, but the longitudinal association between depressive symptoms and risk of MCI onset is less clear. The authors investigated whether baseline symptom severity of depression was predictive of time to onset of symptoms of MCI. METHOD These analyses included 300 participants from the BIOCARD study, a cohort of individuals who were cognitively normal at baseline (mean age = 57.4 years) and followed for up to 20 years (mean follow-up = 2.5 years). Depression symptom severity was measured using the Hamilton Depression Scale (HAM-D). The authors assessed the association between dichotomous and continuous HAM-D and time to onset of MCI within 7 years versus after 7 years from baseline (reflecting the mean time from baseline to onset of clinical symptoms in the cohort) using Cox regression models adjusted for gender, age, and education. RESULTS At baseline, subjects had a mean HAM-D score of 2.2 (SD = 2.8). Higher baseline HAM-D scores were associated with an increased risk of progression from normal cognition to clinical symptom onset ≤ 7 years from baseline (p = 0.043), but not with progression > 7 years from baseline (p = 0.194). These findings remained significant after adjustment for baseline cognition. CONCLUSIONS These results suggest that low levels of depressive symptoms may be predictive of clinical symptom onset within approximately 7 years among cognitively normal individuals and may be useful in identifying persons at risk for MCI due to Alzheimer's disease.
Collapse
Affiliation(s)
- Carol K Chan
- Department of Psychiatry,Johns Hopkins University School of Medicine,Baltimore, MD,USA
| | - Anja Soldan
- Department of Neurology,Johns Hopkins University School of Medicine,Baltimore, MD,USA
| | - Corinne Pettigrew
- Department of Neurology,Johns Hopkins University School of Medicine,Baltimore, MD,USA
| | - Mei-Cheng Wang
- Department of Biostatistics,Johns Hopkins University School of Public Health,Baltimore, MD,USA
| | - Jiangxia Wang
- Department of Biostatistics,Johns Hopkins University School of Public Health,Baltimore, MD,USA
| | - Marilyn S Albert
- Department of Neurology,Johns Hopkins University School of Medicine,Baltimore, MD,USA
| | - Paul B Rosenberg
- Department of Psychiatry,Johns Hopkins University School of Medicine,Baltimore, MD,USA
| |
Collapse
|
6
|
Tan EY, Köhler S, Hamel RE, Muñoz-Sánchez JL, Verhey FR, Ramakers IH. Depressive Symptoms in Mild Cognitive Impairment and the Risk of Dementia: A Systematic Review and Comparative Meta-Analysis of Clinical and Community-Based Studies. J Alzheimers Dis 2019; 67:1319-1329. [DOI: 10.3233/jad-180513] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eva Y.L. Tan
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
- Geestelijk Gezondheidszorg Eindhoven en de Kempen (GGzE), The Netherlands
| | - Sebastian Köhler
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | | | | | - Frans R.J. Verhey
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| | - Inez H.G.B. Ramakers
- Alzheimer Centre Limburg, School for Mental Health and Neuroscience (MHeNS), Maastricht University, The Netherlands
| |
Collapse
|
7
|
Yu J, Lim HY, Abdullah FNDM, Chan HM, Mahendran R, Ho R, Kua EH, Power MJ, Feng L. Directional associations between memory impairment and depressive symptoms: data from a longitudinal sample and meta-analysis. Psychol Med 2018; 48:1664-1672. [PMID: 29113607 DOI: 10.1017/s0033291717003154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous cross-lagged studies on depression and memory impairment among the elderly have revealed conflicting findings relating to the direction of influence between depression and memory impairment. The current study aims to clarify this direction of influence by examining the cross-lagged relationships between memory impairment and depression in an Asian sample of elderly community dwellers, as well as synthesizing previous relevant cross-lagged findings via a meta-analysis. METHODS A total of 160 participants (Mage = 68.14, s.d. = 5.34) were assessed across two time points (average of 1.9 years apart) on measures of memory and depressive symptoms. The data were then fitted to a structural equation model to examine two cross-lagged effects (i.e. depressive symptoms→memory; memory→depressive symptoms). A total of 14 effect-sizes for each of the two cross-lagged directions were extracted from six studies (including the present; total N = 8324). These effects were then meta-analyzed using a three-level mixed effects model. RESULTS In the current sample, lower memory ability at baseline was associated with worse depressive symptoms levels at follow-up, after controlling for baseline depressive symptoms. However, the reverse effect was not significant; baseline depressive symptoms did not predict subsequent memory ability after controlling for baseline memory. The results of the meta-analysis revealed the same pattern of relationship between memory and depressive symptoms. CONCLUSIONS These results provide robust evidence that the relationship between memory impairment and depressive symptoms is unidirectional; memory impairment predicts subsequent depressive symptoms but not vice-versa. The implications of these findings are discussed.
Collapse
Affiliation(s)
- Junhong Yu
- Department of Psychological Medicine,National University Hospital,Singapore,Singapore
| | | | | | | | | | | | | | - Michael John Power
- Department of Psychology,National University of Singapore,Singapore,Singapore
| | - Lei Feng
- Department of Psychological Medicine,Yong Loo Lin School of Medicine,National University of Singapore,Singapore,Singapore
| |
Collapse
|
8
|
Lara E, Koyanagi A, Domènech-Abella J, Miret M, Ayuso-Mateos JL, Haro JM. The Impact of Depression on the Development of Mild Cognitive Impairment over 3 Years of Follow-Up: A Population-Based Study. Dement Geriatr Cogn Disord 2018; 43:155-169. [PMID: 28178703 DOI: 10.1159/000455227] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS In the absence of effective treatments for dementia, major efforts are being directed towards identifying the risk factors of the prodromal phase of the disease. We report the incidence rates of mild cognitive impairment (MCI) in a Spanish population sample and assess the effect of depression at baseline on incident MCI (or MCI subtypes) at a 3-year follow-up. METHODS A total of 1,642 participants (age ≥50 years) were examined as part of a Spanish nationally representative longitudinal study. MCI was defined as the presence of cognitive concerns, objective evidence of impairment in one or more cognitive domains, preservation of independence in functional abilities, and no dementia. Depression was assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). Binary and multinomial logistic regression analyses were carried out to assess the associations. RESULTS The overall MCI incidence rate was 33.19 (95% CI = 26.02, 43.04) per 1,000 person-years. Depression at baseline predicted the onset of MCI at follow-up after controlling for sociodemographics, cognitive functioning, and other physical health conditions (OR = 2.79; 95% CI = 1.70, 4.59). The effect of baseline depression on incident MCI subtypes was as follows: amnestic MCI, OR = 3.81 (95% CI = 1.96, 7.43); nonamnestic MCI, OR = 2.03 (95% CI = 0.98, 4.21). CONCLUSION Depression significantly increases the risk for MCI. Targeting depression among those at risk for dementia may help delay or even prevent the onset of dementia.
Collapse
Affiliation(s)
- Elvira Lara
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | | | | | | | | |
Collapse
|
9
|
Lam Nogueira BOC, Li L, Meng LR, Ungvari GS, Ng CH, Chiu HFK, Kuok KCF, Tran L, Xiang YT. Clinical characteristics and quality of life of older adults with cognitive impairment in Macao. Psychogeriatrics 2018; 18:182-189. [PMID: 29409163 DOI: 10.1111/psyg.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/22/2017] [Accepted: 10/22/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about the characteristics of older adults with cognitive impairment in Macao. This study aimed to determine the prevalence of cognitive impairment and the quality of life (QOL) of older adults living in the community and nursing homes. METHODS A consecutive sample of 413 subjects (199 from the community; 214 from nursing homes) was recruited and interviewed using standardized instruments. Cognition was measured with the Repeatable Battery for the Assessment of Neuropsychological Status and QOL with the brief version of the World Health Organization Quality of Life instrument. RESULTS Altogether 87 subjects (21.0%) had cognitive impairment. On multivariate analyses, advanced age (P < 0.001, OR = 1.06, 95%CI: 1.03-1.1) and depressive symptoms (P = 0.03, OR = 1.07, 95%CI: 0.005-1.1) were positively associated with cognitive impairment. Married marital status (P = 0.01, OR = 0.3, 95%CI: 0.1-0.7) and higher education level (P < 0.001, OR = 0.1, 95%CI: 0.06-0.3) were negatively associated with cognitive impairment. After the confounders were controlled for, cognitive impairment was significantly associated with the lower psychological (F (11,412) = 6.3, P = 0.01) and social relationship domains of QOL (F (11,412) = 4.0, P = 0.04). CONCLUSION Cognitive impairment was found to be common in community-dwelling and nursing home resident older adults in Macao. Given cognitive impairment's negative impact on QOL, appropriate strategies should be implemented to improve access to treatment in this population.
Collapse
Affiliation(s)
- Bernice O C Lam Nogueira
- School of Health Sciences, Macao Polytechnic Institute, Macao, China.,Macao Sino-Portuguese Nurses Association, Macao, China
| | - Lu Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, China
| | - Li-Rong Meng
- School of Health Sciences, Macao Polytechnic Institute, Macao, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Marian Centre, Perth, Western Australia, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Kenny C F Kuok
- School of Health Sciences, Macao Polytechnic Institute, Macao, China
| | - Linda Tran
- Macao Sino-Portuguese Nurses Association, Macao, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao, China
| |
Collapse
|
10
|
Yates JA, Clare L, Woods RT. "You've got a friend in me": can social networks mediate the relationship between mood and MCI? BMC Geriatr 2017; 17:144. [PMID: 28705185 PMCID: PMC5508771 DOI: 10.1186/s12877-017-0542-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 07/09/2017] [Indexed: 12/01/2022] Open
Abstract
Background Social networks can change with age, for reasons that are adaptive or unwanted. Social engagement is beneficial to both mental health and cognition, and represents a potentially modifiable factor. Consequently this study explored this association and assessed whether the relationship between mild cognitive impairment (MCI) and mood problems was mediated by social networks. Methods This study includes an analysis of data from the Cognitive Function and Ageing Study Wales (CFAS Wales). CFAS Wales Phase 1 data were collected from 2010 to 2013 by conducting structured interviews with older people aged over 65 years of age living in urban and rural areas of Wales, and included questions that assessed cognitive functioning, mood, and social networks. Regression analyses were used to investigate the associations between individual variables and the mediating role of social networks. Results Having richer social networks was beneficial to both mood and cognition. Participants in the MCI category had weaker social networks than participants without cognitive impairment, whereas stronger social networks were associated with a decrease in the odds of experiencing mood problems, suggesting that they may offer a protective effect against anxiety and depression. Regression analyses revealed that social networks are a significant mediator of the relationship between MCI and mood problems. Conclusions These findings are important, as mood problems are a risk factor for progression from MCI to dementia, so interventions that increase and strengthen social networks may have beneficial effects on slowing the progression of cognitive decline.
Collapse
Affiliation(s)
- Jennifer A Yates
- Institute of Mental Health, University of Nottingham, Nottingham, UK.
| | - Linda Clare
- Department of Psychology and PenCLAHRC, University of Exeter, Exeter, UK
| | - Robert T Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | | |
Collapse
|
11
|
Feng L, Lim WS, Chong MS, Lee TS, Gao Q, Nyunt MSZ, Feng L, Kua EH, Ng TP. Depressive Symptoms Increase the Risk of Mild Neurocognitive Disorders among Elderly Chinese. J Nutr Health Aging 2017; 21:161-164. [PMID: 28112770 DOI: 10.1007/s12603-016-0765-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Depression is prevalent among patients with late life neurocognitive disorders but its role as an independent risk factor is not established. We aimed to examine the longitudinal relationship between depression and the incidence of mild neurocognitive disorders (NCD) in a Chinese population. METHODS We analyzed data from 889 community-living Chinese elderly in the Singapore Longitudinal Aging Study (SLAS) cohort. All subjects were cognitively normal at baseline based on their performance on the Mini-Mental State Examination (MMSE). Depression was defined as total score of 5 or more on the 15-item Geriatric Depression Scale. Incident cases of mild NCD were ascertained at follow up after an average of 45 moths (range: 10-62). Odds ratios (OR) of associations were calculated in logistic regression models that adjusted for potential confounders. RESULTS A total of 59 mild NCD cases were identified. Increased risk of mild NCD was observed for subjects who had depressive symptom at baseline (OR=2.56, 95%CI 1.17-5.60) after controlling for age, gender, education, hypertension, diabetes mellitus, heart disease, APOE genotype and length of follow-up. The interaction between depression and APOE genotype was not statistically significant. CONCLUSION Depressive symptom was independently associated with increased risk of mild NCD among Chinese elderly. Effective management of late life depression may potentially reduce incident cases of NCD in the population.
Collapse
Affiliation(s)
- L Feng
- Dr. Lei Feng, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, Jellinger KA, Kruglov LS, Meshandin IA, Mijajlovic MD, Niklewski G, Pospos S, Raju K, Richter K, Steffens DC, Taylor WD, Tene O. Vascular depression consensus report - a critical update. BMC Med 2016; 14:161. [PMID: 27806704 PMCID: PMC5093970 DOI: 10.1186/s12916-016-0720-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression". DISCUSSION This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed. CONCLUSION The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.
Collapse
Affiliation(s)
- Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrius Baskys
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Maura Boldrini
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Breno S Diniz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manoj Kumar Jaiswal
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| | - Lev S Kruglov
- Department of Geriatric Psychiatry of the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev, Medical Faculty of St. Petersburg University, St. Petersburg, Russia
| | - Ivan A Meshandin
- Clinical Department, Scientific and Practical Center of Psychoneurology named after V. M. Soloviev, St. Petersburg, Russia
| | - Milija D Mijajlovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Belgrade, Serbia
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany
| | - Sarah Pospos
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Keerthy Raju
- Consultant in Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.,Faculty for Social Sciences, Technical University of Nuremberg Georg Simon Ohm, Nuremberg, Germany
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Warren D Taylor
- Department of Psychiatry, The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Veterans Affairs Medical Center, The Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Oren Tene
- Departments of Neurology and Psychiatry, Tel Aviv Medical Center, Tel Aviv, Israel.,Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
13
|
Bai J, Wei P, Zhao N, Xiao Y, Yang C, Zhong J, Cai Y, Li Y, Zhu Q, Cao X, Sun L, Wang B, Teng K, Ling S, Ni H, Xie M, Tan J, Wang L, Sun XM, Zhang W. A study of mild cognitive impairment in veterans: role of hypertension and other confounding factors. AGING NEUROPSYCHOLOGY AND COGNITION 2016; 23:703-15. [PMID: 26999624 DOI: 10.1080/13825585.2016.1161000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hypertension has shown to be an important risk factor for the decline in cognitive function. Aim of our study is to investigate the presence of cognitive impairment of the elders with hypertension and other confounding factors. METHODS This study was conducted on 400 veterans who were matched one-to-one with the confounding factors for assessing the presence of mild cognitive impairment using both MMSE and Montreal Cognitive Assessment (MoCA). The 13 related factors of patient data were studied. RESULTS The prevalence rate of cognitive impairment was 29.25%. Age (OR 2.679, 95%CI 1.663-6.875), sleep impairment (OR 1.117, 95%CI 1.754-7.422), uncontrolled hypertension (OR 1.522, 95%CI 1.968-4.454), type 2 diabetes (OR 2.464, 95%CI 1.232-4.931), and hyperlipidaemia (OR 1.411, 95%CI 1.221-8.988) are the risk factors for the cognitive deterioration, while the protective factors are high level of education (OR 0.032, 95%CI 0.007-0.149) and regular exercise (OR 0.307, 95%CI 0.115-0.818). DISCUSSION Because some vascular disease risk factors, such as hypertension, can be treated effectively, cognitive decline related to these risk factors, and vascular disease per se, may be prevented or its course modified through more aggressive treatment and improved compliance.
Collapse
Affiliation(s)
- Jie Bai
- a Department of Geriatrics, Changhai hospital , Second Military Medical University , Shanghai , China
| | - Peng Wei
- b Department of Cardiology , Xuzhou Central Hospital , Xuzhou , China
| | - Ning Zhao
- a Department of Geriatrics, Changhai hospital , Second Military Medical University , Shanghai , China
| | - Ying Xiao
- a Department of Geriatrics, Changhai hospital , Second Military Medical University , Shanghai , China
| | - Chunhui Yang
- c Department of Pathology, Rush Alzheimer's disease Center , Rush University Medical Center , Chicago , IL , USA
| | - Jun Zhong
- d St. Elizabeths Hospital , Washington , DC , USA
| | - Yong Cai
- e PLA 62403 Troops, Shanghai General Logistics Department Retired Cadre's Sanatorium , Shanghai , China
| | - Yongchao Li
- f Shuidian Retired cadre's Sanatorium , Shanghai , China
| | - Qin Zhu
- g Xingyin Retired Cadre's Sanatorium , Shanghai , China
| | - Xian Cao
- h Xiang'an Retired Cadre's Sanatorium , Shanghai , China
| | - Li Sun
- i Air Force Command College Retired Cadre's Sanatorium , Shanghai , China
| | - Bing Wang
- j Navy Tiyuhui Retired Cadre's Sanatorium , Shanghai , China
| | - Keqin Teng
- k Xinhua Retired Cadre's Sanatorium , Shanghai , China
| | - Shifeng Ling
- l Navy Liangchen Retired Cadre's Sanatorium , Shanghai , China
| | - Hailai Ni
- a Department of Geriatrics, Changhai hospital , Second Military Medical University , Shanghai , China
| | - Minghui Xie
- m Department of intervention, Changhai hospital , Second Military Medical University , Shanghai , China
| | - Jiping Tan
- n Department of Geriatrics , Chinese PLA General Hospital , Beijing , China
| | - Luning Wang
- n Department of Geriatrics , Chinese PLA General Hospital , Beijing , China
| | - Xiao-Mao Sun
- o Joint Logistics, Department of the Nanjing Military Command , Retired Cadres Health Center , Shanghai , China
| | - Wenjun Zhang
- a Department of Geriatrics, Changhai hospital , Second Military Medical University , Shanghai , China
| |
Collapse
|
14
|
Eryomina OV, Petrova MM, Prokopenko SV, Mozheyko EY, Kaskaeva DS, Gavrilyuk OA. The effectiveness of the correction of cognitive impairment using computer-based stimulation programs for patients with coronary heart disease after coronary bypass surgery. J Neurol Sci 2015; 358:188-92. [PMID: 26386717 DOI: 10.1016/j.jns.2015.08.1535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 08/25/2015] [Indexed: 12/17/2022]
Abstract
We evaluated effectiveness of using copyrighted computer-based stimulation programs in the correction of cognitive function in patients with coronary heart disease after coronary bypass surgery.A total of 74 patients were examined, all the patients underwent a course of drug therapy, 37 patients underwent a course of rehabilitation in addition to medical therapy using computer-based stimulation programs (1 time per day for 20 min within 10 days). A course of rehabilitation using computer-based stimulation programs in patients with coronary heart disease after coronary bypass surgery was proved to be an effective way of correcting cognitive function.
Collapse
Affiliation(s)
- Oksana Vasilyevna Eryomina
- Department of Polyclinic Therapy and Family Medicine, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| | - Marina Mikhaylovna Petrova
- Department of Polyclinic Therapy and Family Medicine, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| | - Semyon Vladimirovich Prokopenko
- Department of Neurological Diseases with the course of medical rehabilitation, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| | - Elena Yuryevna Mozheyko
- Department of Neurological Diseases with the course of medical rehabilitation, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia; Department of Neurological Diseases with the course of medical rehabilitation, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| | - Darya Sergeevna Kaskaeva
- Department of Polyclinic Therapy and Family Medicine, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| | - Oksana Alexandrovna Gavrilyuk
- Department of Latin and Foreign Languages, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetsky, Ministry of Health of the Russian Federation, 1, Partizan Zheleznyak Str., Krasnoyarsk 660022, Russia.
| |
Collapse
|
15
|
Bae JB, Kim YJ, Han JW, Kim TH, Park JH, Lee SB, Lee JJ, Jeong HG, Kim JL, Jhoo JH, Yoon JC, Kim KW. Incidence of and risk factors for Alzheimer's disease and mild cognitive impairment in Korean elderly. Dement Geriatr Cogn Disord 2015; 39:105-15. [PMID: 25401488 DOI: 10.1159/000366555] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Knowledge of incidence rates and risk factors is essential for the development of strategies to treat patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS A subpopulation of the Nationwide Survey on Dementia Epidemiology (460 Korean subjects aged ≥65 years from 2 rural and 2 urban districts) was followed up for 3.5 years. The age-specific incidence was estimated and risk factors were identified. RESULTS The age-standardized incidence of AD and MCI was 7.9 and 28.1 cases per 1,000 person-years, respectively. MCI was associated with a 6-fold increased risk of AD. Depression was a risk factor for AD with MCI. Age, lack of formal education, illiteracy, rural residence, and marital status were associated with the risk of AD. CONCLUSION Strategies to control modifiable risk factors should be implemented to decrease the incidence of AD.
Collapse
Affiliation(s)
- Jong Bin Bae
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Beydoun MA, Fanelli Kuczmarski M, Kitner-Triolo MH, Beydoun HA, Kaufman JS, Mason MA, Evans MK, Zonderman AB. Dietary antioxidant intake and its association with cognitive function in an ethnically diverse sample of US adults. Psychosom Med 2015; 77:68-82. [PMID: 25478706 PMCID: PMC4597309 DOI: 10.1097/psy.0000000000000129] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dietary antioxidants can inhibit reactions accompanying neurodegeneration and thus prevent cognitive impairment. We describe associations of dietary antioxidants with cognitive function in a large biracial population, while testing moderation by sex, race, and age and mediation by depressive symptoms. METHODS This was a cross-sectional analysis of 1274 adults (541 men and 733 women) aged 30 to 64 years at baseline (mean [standard deviation] = 47.5 [9.3]) in the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study, Baltimore city, MD. Cognitive performance in the domains of memory, language/verbal, attention, spatial, psychomotor speed, executive function, and global mental status were assessed. The 20-item Center for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Dietary intake was assessed with two 24-hour recalls, estimating daily consumption of total carotenoids and vitamins A, C, and E per 1000 kcal. RESULTS Among key findings, 1 standard deviation (∼ 2.02 mg/1000 kcal) higher vitamin E was associated with a higher score on verbal memory, immediate recall (β = +0.64 [0.19], p = .001), and better language/verbal fluency performance (β = +0.53 [0.16], p = .001), particularly among the younger age group. Women with higher vitamin E intake (β = +0.68 [0.21], p = .001) had better performance on a psychomotor speed test. The vitamin E-verbal memory association was partially mediated by depressive symptoms (proportion mediated = 13%-16%). CONCLUSIONS In sum, future cohort studies and dietary interventions should focus on associations of dietary vitamin E with cognitive decline, specifically for domains of verbal memory, verbal fluency, and psychomotor speed.
Collapse
Affiliation(s)
- M. A. Beydoun
- National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | | | | | - H. A. Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA
| | - J. S. Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - M. A. Mason
- Statistical Information Systems, MedStar Research Institute, Baltimore, MD
| | - M. K. Evans
- National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | | |
Collapse
|
17
|
Dean K, Oulhaj A, Zamboni G, deJager CA, Wilcock GK. Role of depression in predicting time to conversion to mild cognitive impairment. Am J Geriatr Psychiatry 2014; 22:727-34. [PMID: 23611364 DOI: 10.1016/j.jagp.2012.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/29/2012] [Accepted: 12/18/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To establish whether, in a cohort with normal cognition, severity of depressive symptoms at baseline was related to the time taken for conversion to mild cognitive impairment (MCI) and whether this interacted with other potential risk factors, including APOE ε4 status and demographic and cognitive variables. METHODS In a population-based cohort study, 126 cognitively normal subjects were assessed for depressive symptoms at baseline using the Geriatric Depression Scale (GDS) and were then followed over 20 years with regular cognitive assessments. The interval-censored accelerated failure time model was used to establish whether GDS and other factors, including APOE ε4 status, predicted the median time to development of MCI. RESULTS Fifty subjects developed MCI. In APOE ε4 noncarriers, the degree of depressive symptoms at baseline predicted the time to development of MCI: An increase in GDS of 1 standard deviation (3.85) was associated with shortening of the median time to conversion to MCI by 25.4% (p = 0.0024, z = -5.6). This relationship remained statistically significant after controlling for cognitive and other confounding variables. The relationship was not significant in APOE ε4 carriers. CONCLUSION Depressive symptoms (measured by GDS) predict time to conversion to MCI in cognitively normal people who do not carry the APOE ε4 allele. This may explain conflicting results of previous studies where APOE ε4 status was not taken into account when exploring the relationship between depression and MCI. It may also have a clinical application in helping to identify people at greater risk of developing MCI.
Collapse
Affiliation(s)
- Katherine Dean
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
| | - Abderrahim Oulhaj
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Giovanna Zamboni
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; FMRIB Centre, University of Oxford, Oxford, United Kingdom
| | - Celeste A deJager
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gordon K Wilcock
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
18
|
Abstract
Although mild cognitive impairment (MCI) is a widely accepted construct both clinically and in the research literature, it remains a heterogeneous condition that varies in presentation and prognosis. This article first reviews the evolution of the diagnosis of MCI, followed by examination of pros and cons of cognitive assessments commonly used to assess for MCI. Emotional changes commonly seen in MCI are also reviewed. Finally, the relation between cognitive and emotional dysfunction is examined, including a discussion of specific psychological symptoms seen in subtypes of MCI, and how the presence of neuropsychiatric symptoms may affect the risk for progression to dementia.
Collapse
Affiliation(s)
- Suzanne Penna
- Atlanta Veteran's Affairs Medical Center, 1670 Clairmont Road, Atlanta, GA 30033, USA; Department of Rehabilitation Medicine, Emory University School of Medicine, Center for Rehabilitation Medicine, 1441 Clifton Road NE, Suite 150, Atlanta, GA 30022, USA.
| |
Collapse
|
19
|
Locke DEC, Dueck AC, Stonnington CM, Knopman DS, Geda YE, Caselli RJ. Depressive symptoms in healthy apolipoprotein E ε4 carriers and noncarriers: a longitudinal study. J Clin Psychiatry 2013; 74:1256-61. [PMID: 24434095 PMCID: PMC4097601 DOI: 10.4088/jcp.13m08564] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/14/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine if symptoms of depression accelerate in cognitively normal apolipoprotein E (APOE) ε4 carriers as compared to noncarriers. METHOD Six hundred thirty-three cognitively and functionally normal members of the Arizona APOE Cohort aged 21-86 years underwent neuropsychological testing every 1 to 2 years that included the Hamilton Depression Rating Scale, the Beck Depression Inventory, the Geriatric Depression Scale, and the Personality Assessment Inventory. We estimated the longitudinal change on these measures using mixed models that simultaneously modeled cross-sectional and longitudinal effects of age on depression scores by APOE status and the interaction between the two. We also estimated incident depression on the basis of accepted clinical cut-scores on depression measures and use of depression medications. RESULTS The mean length of follow-up was 7.7 years. Comparing APOE ε4 carriers with noncarriers revealed no significant longitudinal difference in the rate of change or slope of change on any depression scale or subscale. There was also no difference in incident depression or antidepressant drug use between the carrier and noncarrier groups. CONCLUSIONS These data fail to support a relationship between APOE genotype and longitudinal change in depression symptoms, suggesting that depression symptoms may not be intrinsic to the early preclinical phase of Alzheimer's disease.
Collapse
|
20
|
Abstract
SummaryThis systematic review, with meta-analyses conducted where data were available, aimed to investigate the prevalence of symptoms of depression and anxiety in mild cognitive impairment (MCI), and to establish how symptoms of depression and anxiety relate to the progression from no cognitive impairment to MCI, and from MCI to dementia. Sixty studies were included in the review. Meta-analyses indicated that symptoms of depression and anxiety were more prevalent in people with MCI than in people with normal cognitive function, and increased the risk of progression from no cognitive impairment to MCI. There were mixed results regarding the effect of such symptoms on progression from MCI to dementia. The findings highlight the need for more research in this area, which can inform attempts to slow or halt the progression of cognitive impairment in later life, with resulting benefits for quality of life.
Collapse
|
21
|
Steenland K, Karnes C, Seals R, Carnevale C, Hermida A, Levey A. Late-life depression as a risk factor for mild cognitive impairment or Alzheimer's disease in 30 US Alzheimer's disease centers. J Alzheimers Dis 2013; 31:265-75. [PMID: 22543846 DOI: 10.3233/jad-2012-111922] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Identification of potentially modifiable risk factors for cognitive deterioration is important. We conducted a prospective study of 5,607 subjects with normal cognition and 2,500 subjects with mild cognitive impairment (MCI) at 30 Alzheimer's Disease Centers in the Unites States between 2005 and 2011. Cox regression was used to determine whether depression predicted transition from normal to MCI, or MCI to Alzheimer's disease (AD). Over an average of 3.3 visits, 15% of normal subjects transitioned to MCI (62/1000 per year), while 38% of MCI subjects transitioned to AD (146/1000 per year). At baseline, 22% of participants had recent (within the last two years) depression defined by clinician judgment; 9% and 17% were depressed using the Geriatric Depression Scale (GDS score ≥5) and the Neuropsychiatric Inventory Questionnaire (NPI-Q), respectively. At baseline, depressed subjects performed significantly worse on cognitive tests. Those always depressed throughout follow-up had an increased risk for progression from normal to MCI (RR = 2.35; 95% CI 1.93-3.08) versus never depressed. Normal subjects, identified as depressed at first visit but subsequently improved, were found to have lower risk of progression (RR 1.40 (1.01-1.95)). The 'always depressed' had only a modest increased risk of progression from MCI to AD (RR = 1.21 (1.00-1.46). Results were similar using time-dependent variables for depression or when defining depression via the GDS or NPI-Q. We found no effect of earlier depression (>2 years past). The effect of recent depression did not differ by antidepressant treatment, APOE4 allele status, or type of MCI. In conclusion, late-life depression is a strong risk factor for normal subjects progressing to MCI.
Collapse
Affiliation(s)
- Kyle Steenland
- Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
OBJECTIVES Increasing evidence suggests that depression is a risk factor for cognitive impairment, but it is unclear if this is true among the oldest old. We determined whether elevated depressive symptoms predicted 5-year incident mild cognitive impairment (MCI) or dementia, and neuropsychological test performance among oldest-old women. DESIGN Prospective. SETTING Three study sites. PARTICIPANTS 302 women ≥85 years (mean, 87 ± 2). MEASUREMENTS Depressive symptoms were measured with the 15-item Geriatric Depression Scale (GDS); scores of 6 or more indicated elevated symptoms. Five years later, participants completed neuropsychological testing and clinical cognitive status was adjudicated. RESULTS In analyses of MCI versus normal cognition, 70% of women with GDS score 6 or more at baseline developed MCI versus 37% with GDS score less than 6. After adjustment for age, education, alcohol, and benzodiazepine use, and study site, GDS score 6 or more remained independently associated with much greater likelihood of developing MCI (multivariable odds ratio [MOR] = 3.71, 95% confidence interval (CI): 1.30-10.59). In analyses of dementia versus normal cognition, 65% of women with GDS score 6 or more developed dementia compared with 37% of those with GDS score less than 6 (MOR = 3.15, 95% CI: 1.03-9.65). Only 19% of women with GDS score 6 or more had normal cognitive status 5 years later, compared with 46% of those with GDS score less than 6 (MOR = 0.28, 95% CI: 0.11-0.73). Women with elevated depressive symptoms had worse scores on tests of global cognition and working memory. CONCLUSION Elevated depressive symptoms are an important risk factor for cognitive disorders and lower cognitive performance among women living to their ninth and tenth decades.
Collapse
|
23
|
Shin KR, Kang Y, Kim M, Jung D, Kim M. Comparative study between depression in Korean elderly with mild cognitive impairment and normal cognitive function. Nurs Health Sci 2012; 14:81-6. [PMID: 22288784 DOI: 10.1111/j.1442-2018.2011.00666.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kyung-Rim Shin
- Division of Nursing Science, College of Health Sciences, Ewha Womans University, Seodaemun-gu, Seoul, Korea.
| | | | | | | | | |
Collapse
|
24
|
Lack of association between prior depressive episodes and cerebral [11C]PiB binding. Neurobiol Aging 2011; 33:2334-42. [PMID: 22192243 DOI: 10.1016/j.neurobiolaging.2011.11.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/26/2011] [Accepted: 11/15/2011] [Indexed: 10/14/2022]
Abstract
Depressive symptoms are frequent in Alzheimer's disease (AD), but it is controversial whether depression is a risk factor for AD. This study measured for the first time cortical amyloid-β (Aβ) levels using [(11)C] Pittsburgh Compound B (PiB) positron emission tomography (PET) in a group of nondemented patients with prior depressive episodes. Twenty-eight elderly patients (mean age 61 years, range 51-75, 18 women) with onset of first depressive episode more than 6 years ago but now remitted from depression and 18 healthy subjects (mean age 61 years, range 50-76, 12 women) were included. All subjects were investigated with cognitive testing, 3T magnetic resonance imaging (MRI) and [(11)C]PiB high resolution research tomography (HRRT) positron emission tomography scan. There was no between-groups difference in [(11)C]PiB binding (p = 0.5) and no associations to number of depressive episodes, cognitive performance, or antidepressant treatment. Patients with late onset of depression had increased severity of white matter lesions (p = 0.04). In this study depressive episodes were not associated with increased levels of [(11)C]PiB. Thus, our results do not support the notion that depressive episodes previously in life are a risk factor for developing AD.
Collapse
|
25
|
Depression, strokes and dementia: new biological insights into an unfortunate pathway. Cardiovasc Psychiatry Neurol 2011; 2011:649629. [PMID: 22216404 PMCID: PMC3246693 DOI: 10.1155/2011/649629] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 01/12/2023] Open
Abstract
The literature emphasizes the risk of depression after a stroke. Less well known is the fact that depression may be as big a risk factor for strokes as hypertension, particularly in the older age group. This article reviews the risk for stroke and cognitive impairment consequent to depression, and describes the cardiovascular and immunological mechanisms that would appear to link depression to its cerebrovascular consequences. As well, the article refers to the brain imaging signatures that may allow prediction of impending brain injury. Finally, some questions that might be explored by future research are suggested, and some practical means to identify and help those at risk for the development of depression-associated vascular disease of the brain are suggested.
Collapse
|
26
|
Prevalence of gender disparities and predictors affecting the occurrence of mild cognitive impairment (MCI). Arch Gerontol Geriatr 2011; 54:185-91. [PMID: 21546098 DOI: 10.1016/j.archger.2011.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/28/2011] [Accepted: 03/29/2011] [Indexed: 01/22/2023]
Abstract
The aims were to investigate the prevalence of mild cognitive impairment (MCI) within gender disparities in Malaysian older adults, and to determine the predictors of MCI according to gender disparities. A community-based sample of urban, multiethnic dwelling elderly aged 60 years of age and above from Cheras, Kuala Lumpur was recruited. Prevalence of all-type MCI, amnestic-type MCI (am-MCI) and non-amnestic-type MCI (nam-MCI) was assessed using comprehensive neuropsychological batteries. The association between demography, socioeconomic status, lifestyle practices, and nutritional status and health risk factors with MCI were examined. Predictors of MCI occurrence between gender disparities were determined. The prevalence of all-type MCI, am-MCI and nam-MCI was 21.1%, 15.4% and 5.7%, respectively. Binary logistic regression indicated that hypercholesterolemia is the significant predictor for MCI in men after adjustment for age, ethnicity and total years of education. While, in women, MCI was best predicted by married status, without exercise practice, overweight and obesity. These results suggest that approximately one-fifth of the studied elderly people had MCI. Predictors for MCI are totally different between men and women. It is critical to identify those at higher risk for MCI in order to implement preventative measures to delay or reverse this abnormal condition.
Collapse
|
27
|
Abstract
OBJECTIVE Late-life depression has been associated with memory loss and is frequently assumed to be a risk factor for continued cognitive decline. This study examined cognition in patients with late-life depression with a focus on the assessment of the extent and type of memory loss among elderly depressed patients. METHODS Two-year cross-sectional study of elderly depressed (N = 112) and nondepressed (N = 138) individuals at or older than 60 years in an urban area surrounding a major medical center in southern California. Participants had little to moderate stroke risk. Volunteers were screened with the Hamilton Depression Rating Scale and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders. Patients were diagnosed for major depression by a geriatric psychiatrist using DSM-IV criteria. Volunteers completed neuropsychological testing, a standard battery of laboratory tests, and a neurologic and psychiatric evaluation to rule out a medical burden that might contribute to depression or early dementia. RESULTS Depressed patients showed deficits in attention and processing, executive function, and immediate explicit recall. Implicit learning and episodic recall of the testing procedure, semantic and phonetic fluency, and retention of newly acquired verbal material after a delay period were comparable with controls. CONCLUSION Moderately depressed patients demonstrate a pattern of cognitive deficits suggestive of mild frontal dysfunction during recall tasks. Their retention of material over a delay period and their intact language skills indicate medial hippocampal function similar to controls. Subcortically mediated implicit memory is also at normal levels. These findings support current efforts to identify pathways of frontal and/or striatal compromise during depressive episodes.
Collapse
|
28
|
Goveas JS, Espeland MA, Woods NF, Wassertheil-Smoller S, Kotchen JM. Depressive symptoms and incidence of mild cognitive impairment and probable dementia in elderly women: the Women's Health Initiative Memory Study. J Am Geriatr Soc 2011; 59:57-66. [PMID: 21226676 DOI: 10.1111/j.1532-5415.2010.03233.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine whether significant depressive symptoms in postmenopausal women increases the risk of subsequent mild cognitive impairment (MCI) and dementia. DESIGN Prospective cohort study. SETTING Thirty nine of the 40 Women's Health Initiative (WHI) clinical centers that participated in a randomized clinical trial of hormone therapy. PARTICIPANTS Six thousand three hundred seventy-six postmenopausal women without cognitive impairment aged 65 to 79 at baseline. MEASUREMENTS Depressive disorders were assessed using an eight-item Burnam algorithm and followed annually for a mean period of 5.4 years. A central adjudication committee classified the presence of MCI and probable dementia based on an extensive neuropsychiatric examination. RESULTS Eight percent of postmenopausal women in this sample reported depressive symptoms above a 0.06 cut point on the Burnam algorithm. Depressive disorder at baseline was associated with greater risk of incident MCI (hazard ratio (HR)=1.98, 95% confidence interval (CI)=1.33-2.94), probable dementia (HR=2.03, 95% CI=1.15-3.60), and MCI or probable dementia (HR=1.92, 95% CI=1.35-2.73) after controlling for sociodemographic characteristics, lifestyle and vascular risk factors, cardiovascular and cerebrovascular disease, antidepressant use, and current and past hormone therapy status. Assignment to hormone therapy and baseline cognitive function did not affect these relationships. Women without depression who endorsed a remote history of depression had a higher risk of developing dementia. CONCLUSION Clinically significant depressive symptoms in women aged 65 and older are independently associated with greater incidence of MCI and probable dementia.
Collapse
Affiliation(s)
- Joseph S Goveas
- From the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | | | | | | | | |
Collapse
|
29
|
Panza F, Frisardi V, Capurso C, D'Introno A, Colacicco AM, Chiloiro R, Dellegrazie F, Di Palo A, Capurso A, Solfrizzi V. Effect of donepezil on the continuum of depressive symptoms, mild cognitive impairment, and progression to dementia. J Am Geriatr Soc 2010; 58:389-90. [PMID: 20370868 DOI: 10.1111/j.1532-5415.2009.02702.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Abstract
Clinical and epidemiologic research has focused on the identification of risk factors that may be modified in predementia syndromes, at a preclinical and early clinical stage of dementing disorders, with specific attention to the role of depression. Our goal was to provide an overview of these studies and more specifically to describe the prevalence and incidence of depression in individuals with mild cognitive impairment (MCI), the possible impact of depressive symptoms on incident MCI, or its progression to dementia and the possible mechanisms behind the observed associations. Prevalence and incidence of depressive symptoms or syndromes in MCI vary as a result of different diagnostic criteria and different sampling and assessment procedures. The prevalence of depression in individuals with MCI was higher in hospital-based studies (median: 44.3%, range: 9%-83%) than in population-based studies (median: 15.7%, range: 3%-63%), reflecting different referral patterns and selection criteria. Incidence of depressive symptoms varied from 11.7 to 26.6/100 person-years in hospital-based and population-based studies. For depressed normal subjects and depressed patients with MCI, the findings on increased risk of incident MCI or its progression to dementia were conflicting. These contrasting findings suggested that the length of the follow-up period, the study design, the sample population, and methodological differences may be central for detecting an association between baseline depression and subsequent development of MCI or its progression to dementia. Assuming that MCI may be the earliest identifiable clinical stage of dementia, depressive symptoms may be an early manifestation rather than a risk factor for dementia and Alzheimer disease, arguing that the underlying neuropathological condition that causes MCI or dementia also causes depressive symptoms. In this scenario, at least in certain subsets of elderly patients, late-life depression, MCI, and dementia could represent a possible clinical continuum.
Collapse
|
31
|
|
32
|
Abstract
The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals' mental abilities, but it has recently been suggested that neuropsychiatric symptoms should also be considered important factors in age-related neurodegeneration. Psychological distress, defined as a reaction of an individual to external and internal stresses, is characterized by a mixture of psychological symptoms. It also may be considered a neuropsychiatric symptom encompassing depression, anxiety, and apathy. This paper reviews and summarizes recent evidence and relevant issues regarding the presence of psychological distress in healthy older adults and MCI patients and its relationship to risk for developing dementia. Results presented in this review show that psychological distress and depressive, anxious, and apathetic symptoms can be present in MCI and may predict progression to dementia. This article also provides suggestions for future research.
Collapse
Affiliation(s)
- Martine Simard
- School of Psychology, Pav. Félix-Antoine Savard, Laval University, Québec City, Québec G1V 0A6, Canada.
| | | | | |
Collapse
|
33
|
Panza F, Capurso C, D'Introno A, Colacicco AM, Zenzola A, Menga R, Pistoia G, Santamato A, Scafato E, Gandin C, Capurso A, Solfrizzi V. Impact of depressive symptoms on the rate of progression to dementia in patients affected by mild cognitive impairment. The Italian Longitudinal Study on Aging. Int J Geriatr Psychiatry 2008; 23:726-34. [PMID: 18188869 DOI: 10.1002/gps.1967] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is often a prodromal of dementia and depressive symptoms have been suggested as risk factor for dementing disorders. We evaluated the possible impact of depressive symptoms on the rate of progression to dementia in MCI patients after a 3.5-year follow-up; and the interaction between depressive symptoms and vascular risk factors for conversion to dementia. METHODS A total of 2,963 individuals from a sample of 5,632 65-84 year old subjects were evaluated at the first (1992-1993), and second survey (1995-1996) of the Italian Longitudinal Study on Aging (ILSA), a prospective cohort study. MCI and dementia were classified using current clinical criteria. Depressive symptoms were measured with the Geriatric Depression Scale. RESULTS Among the 2,963 participants, 139 prevalent MCI patients were diagnosed at the first survey. During the 3.5-year follow-up, 14 MCI patients progressed to dementia, and we did not find any significant relationship between depressive symptoms and rate of progression to dementia (RR 1.42, 95% CI, 0.48-4.23, chi2 0.40, p < 0.53). No socio-demographic variables or vascular risk factors modified the association between depressive symptoms and conversion to dementia. CONCLUSIONS In our population, depressive symptoms were not associated with the rate of progression to dementia in MCI patients. Our findings did not support a role of socio-demographic variables or vascular risk factors in the association of depressive symptoms and conversion to dementia.
Collapse
Affiliation(s)
- Francesco Panza
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|