The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition

BACKGROUND

Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.

METHODS

Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions.

RESULTS

Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations.

DISCUSSION

Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression.

Physical Exercise for Late-Life Major Depression

(Reprinted with permission from Br J Psychiatry 2005; 207: 235-242).

Physical Exercise for Late-Life Depression: Customizing an Intervention for Primary Care

OBJECTIVES

To identify which individual- and context-related factors influence the translation into clinical practice of interventions based on physical exercise (PE) as an adjunct to antidepressants (AD) for the treatment of late-life major depression (LLMD).

DESIGN

Secondary analysis of a randomized controlled trial.

SETTING

Primary care with psychiatric consultation-liaison programs (PCLPs)-organizational protocols that regulate the clinical management of individuals with psychiatric disorders.

PARTICIPANTS

Individuals aged 65 and older with major depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (N = 121).

INTERVENTION

Participants with LLMD were randomized to AD (sertraline) or AD plus PE (AD + PE).

MEASUREMENTS

Participant characteristics that were associated with greater effectiveness of AD + PE (moderators) were identified, and effect sizes were calculated from success rate differences. Whether the characteristics of the study setting influenced participant flow and attendance at exercise sessions was then explored, and primary care physicians (PCPs) were surveyed regarding their opinions on PE as a treatment for LLMD.

RESULTS

The following participant characteristics were associated with greater likelihood of achieving remission from depression with AD + PE than with AD alone: aged 75 and older (effect size 0.32), polypharmacy (0.35), greater aerobic capacity (0.48), displaying psychomotor slowing (0.49), and less-severe anxiety (0.30). The longer the PCLP had been established at a particular center, the more individuals were recruited at that center. After participating in the study, PCPs expressed positive views on AD + PE as a treatment for LLMD and were more likely to use this as a therapeutic strategy.

CONCLUSIONS

The combination of PE and sertraline could improve the management of LLMD, especially when customized for individuals with specific clinical features. Liaison programs might influence the implementation of similar interventions in primary care, and PCPs viewed them positively.

Physical Exercise for Late-Life Depression: Effects on Heart Rate Variability

OBJECTIVES

Late-life major depression is associated with increased cardiovascular risk and impaired autonomic control of the heart, as evident from reduced heart rate variability (HRV). Moreover, antidepressant drug therapy also might be associated with further reductions of HRV. In the SEEDS study, we investigated whether sertraline associated with physical exercise protocols led to improvements of HRV, compared with antidepressant drug therapy alone.

DESIGN

Single-blind randomized controlled trial.

SETTING

Psychiatric consultation-liaison program for primary care.

PARTICIPANTS

Patients aged 65-85 years with major depression, recruited from primary care.

INTERVENTIONS

Sertraline plus structured, tailored group physical exercise (S + EX) versus sertraline alone (S) for 24 weeks.

MEASUREMENTS

HRV indices (RR, percentage of NN intervals greater than 50 msec [pNN50], square root of the mean squared differences of successive NN intervals [RMSSD], standard deviation of heart rate [SDHR], standard deviation of the NN interval [SDNN], high-frequency band [HF], low-frequency band [LF], and their ratio [LF/HF]) were measured at baseline, week 12, and week 24. Psychiatric and medical assessments.

RESULTS

Participants displayed significant improvements of most HRV indices over time, irrespective of the group assignment (pNN50, RMSSD, SDHR, SDNN, HF, LF, and LF/HF). Moreover, patients in the S + EX group displayed greater increases of different HRV indices(RR, pNN50, RMSSD, SDHR, SDNN, HF, and LF) compared with those in the S group.

CONCLUSIONS

The combination of structured physical exercise and sertraline might exert positive effects on the autonomic control of the heart among older patients with major depression.

A new vinyl selenone-based domino approach to spirocyclopropyl oxindoles endowed with anti-HIV RT activity

Herein, we disclose a general and flexible access to spirocyclopropyl oxindoles by a domino Michael/intramolecular nucleophilic substitution pathway with variously substituted vinyl selenones and enolizable oxindoles in aqueous sodium hydroxide solution. The spirocyclopropyl oxindole being a privileged scaffold, some of the synthesized compounds were selected for biological evaluation. Compound showed selective anti-HIV-1 activity thanks to its ability to inhibit the reverse transcriptase.

Educational needs for palliative care of Italian undergraduate students

This article was migrated. The article was not marked as recommended. Background. Since most of the clinical training is carried out within the academic departments, the future physicians may not feel prepared to deal with clinical situations typical of primary care.Aim of the study was to evaluate how students of the last year of course of the School of Medicine assess their level of professional autonomy with respect to different clinical situations of primary care. Methods. Anonymous questionnaire about ten primary care clinical cases. The students were required to self-assess the degree of preparation for an autonomous treatment for each clinical case on a scale of four levels. Results. In 124 questionnaires the percentage of students who claim to be able to manage the various clinical situations in full autonomy or with a limited specialist integration varies from 54% and 90% with the exception of the scenario "palliative care" (14%). Conclusions. Students, who are at the end of their course of study feel poorly adequate to deal with the settings of palliative care, a problem that has not been considered sufficiently during their training experience. Direct experience in various setting represents an essential component for an all-round training.

Physical exercise for late-life major depression

BACKGROUND

Interventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available.

AIMS

To investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression.

METHOD

Primary care patients (465 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of ≤10 on the Hamilton Rating Scale for Depression).

RESULTS

A total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group.

CONCLUSIONS

Physical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.

Human heart rate variability and sleep stages

With the aim of better understanding the dynamic changes in sympatho-vagal tone occurring during the night, human heart rate variability (HRV) during the various sleep stages was evaluated by means of autoregressive spectral analysis. Each recording consisted of an electroencephalogram, an electrooculogram, and electromyogram, and electrocardiogram, and a spirometry trace. All of the data were sampled and stored in digital form. Sleep was analysed visually, but HRV was analysed off-line by means of original software using Burg's algorithm to calculate the LF/HF ratio (LF: 0.04-0.12 Hz; HF: 0.15-0.35 Hz) for each sleep stage. Seven healthy subjects (four males; mean age 35 years) were enrolled in the study. Our findings show a progressive and significant reduction in the LF/HF ratio through sleep stages S1-S4, as a result of an increase in the HF component; this indicates the prevalence of parasympathetic activity during slow-wave sleep. During wakefulness, S1 and REM, the LF/HF values were similar and close to 1.

[The risk factors of atherosclerotic disease. Life style and primary prevention]

Atherosclerosis brings about cardiovascular diseases and is the world's largest cause of death. Risk factors are to be considered in their incidence and correlation to various pathologies. Cholesterolaemia, smoking, physical inactivity, alcohol are held to be the most important risk factors. Hypercholesterolaemia involves a greater incidence of coronary heart disease; studies on cholesterol reduction however did not give evidence of any reduction in overall mortality. Alcohol displays an u-shaped relation between levels of assumption and associated mortality, depending on the fact that moderate drinkers show decreasing mortality scores and even a decreasing incidence of cardiovascular diseases (while the curve inflects upwards for serious drinkers). A direct correlation appears instead between both smoking and sedentary life on the one hand and both cardiovascular pathologies and mortality on the other. In order to reduce the risk factors' influence, on the ground of available studies and published trials do the authors offer practical indications. Fats in diet should be less than 30% of total calories (where of 10% saturated, 10% monounsaturated, 10% polyunsaturated); abstention from smoking must be absolute; alcohol should not exceed 15 g/die; some physical activity should be practised for 40-60 minutes, twice a week.