Depression and metabolic syndrome in the older population: A review of evidence.
Repousi Nikolena,Masana Maria F,Sanchez-Niubo Albert,Haro Josep Maria,Tyrovolas Stefanos
Journal of affective disorders
BACKGROUND:Metabolic syndrome (MetS) has been shown to be associated with depression in older adults but the results are mixed. We summarized and evaluated the association between depression and MetS in people aged 60 years or over. METHODS:Relevant published studies from January 1997 to July 2017 were identified by searching two electronic databases: PubMed/Medline and EMBASE. Observational studies were considered. RESULTS:Twelve studies were included in the systematic review. Depression seemed to be related with MetS in the majority of the studies (10/12 = 83.3%). As far as the longitudinal studies are concerned, the onset of depression was related to MetS in 2 out of 3 studies (66.6%), while a relation between chronicity of depression and MetS was reported (1 study). Regarding cross-sectional studies, 7 out of 9 (77.7%) concluded that there was a positive association between depression and MetS. Mixed evidence was found among studies concerning the association between depression and the individual components of MetS. Four out of ten studies (40%) reported that depression was significantly associated with the waist circumference, a component of MetS. LIMITATIONS:There was a high degree of heterogeneity between studies regarding their design. Only studies written in English, from peer-reviewed journals were included. CONCLUSIONS:Depression seemed to be significantly associated with MetS in people aged 60 years or over. Among the components of MetS, abdominal obesity seemed to be associated more strongly and consistently with depression. The direction of the causality and mechanisms underlying the relationship are still largely unknown.
10.1016/j.jad.2018.04.102
Does the presence of anxiety affect the validity of a screening test for depression in the elderly?
Sinoff Gary,Ore Liora,Zlotogorsky David,Tamir Ada
International journal of geriatric psychiatry
INTRODUCTION:Depression in the elderly is frequently detected by screening instruments and often accompanied by anxiety. We set out to study if anxiety will affect the ability to detect depression by a screening instrument. OBJECTIVE:To validate the short Zung depression rating scale in Israeli elderly and to study the affect of anxiety on its validity. DESIGN:The short Zung was validated against a psychiatric evaluation, in a geriatric inpatient and outpatient service. The overall validity was determined, as well as for subgroups of sufferers and non-sufferers of anxiety. SETTING:An urban geriatric service in Israel. PATIENTS:150 medical inpatients and outpatients, aged 70 years and older. MEASURES:Psychiatric evaluation of modified Anxiety Disorders Interview Schedule for DSM-IV as criterion standard for anxiety and depression and short Zung instrument for depression. RESULTS:By criterion validity, 60% suffered from depression. The overall validity of the short Zung was high (sensitivity 71.1%, specificity 88.3%, PPV 90.1%, NPV 67.1%). The validity for those not suffering from anxiety was good (sensitivity 71.1%, specificity 90.2%, PPV 84.4%, NPV 80.7%). In those with anxiety, sensitivity, specificity and PPV were high (71.2%, 77.8%, 94.9% respectively), although the specificity was less than in non-suffers. However major difference was in the NPV rate being much lower (31.8%). CONCLUSION:The short Zung, an easily administered instrument for detecting depression, is also valid in the Israeli elderly. However, anxiety limits the usefulness of this instrument in correctly ruling out depression. The clinician must be aware, therefore, that those suffering from anxiety may score negatively for depression on a screening instrument, such as the short Zung.
10.1002/gps.594
Epigenetics and the glucocorticoid receptor: A review of the implications in depression.
Farrell Chloe,O'Keane Veronica
Psychiatry research
Depression is a serious psychiatric disorder that effects at least 350 million people worldwide today. Dysregulation of the hypothalamic-pituitary-adrenal axis (HPAA) is a robust finding in the pathophysiology of depression. This dysregulation is hypothesized to result from altered central glucocorticoid receptor (GR) levels and/or function as a consequence of chronic glucocorticoid (GC) release, leading to receptor resistance. Pivotal animal and human research to date has identified that early life exposure to prolonged levels of GCs, stress and/or depression, can induce epigenetic modifications at key regions on the GR gene that lead to alterations in GR expression and function. Epigenetics provides an attractive mechanism to explain how ones' genes and environment can interact to produce different disease phenotypes. This review aims to compile the information that has been collected to date and to identify key areas for further investigation.
10.1016/j.psychres.2016.06.022
Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies.
Long J,Duan G,Tian W,Wang L,Su P,Zhang W,Lan J,Zhang H
Journal of human hypertension
The objective of the study was to assess the relationship between hypertension and risk of depression. The relationship between hypertension and depression has been discussed for a long time, but the results are controversial. Studies were searched from PubMed and Cochrane up to 24 March 2014. Any prospective cohort study, which possibly reported the relationship between hypertension and depression, was included. The random effect model was used to calculate the pooled relative risk (RR). Finally, five prospective cohort studies were included for analysis, with a total of 9647 participants involved. Our meta-analysis does not support that hypertension is probably a risk factor of depression. The pooled RR was 1.16 (95% confidence interval: 0.91, 1.42) when those exposed to hypertension were compared with those who were not. Subgroup analysis, sensitivity analysis and publication bias test suggested that the overall result of this analysis was robust. Further studies are needed to exclude the effects of other confounding factors.
10.1038/jhh.2014.112
A study of the relationship between depression symptom and physical performance in elderly women.
Lee Yang Chool
Journal of exercise rehabilitation
Depression is a general public health problem; there is an association between regular exercise or vigorous physical activity and depression. Physical activity has positive physical, mental, and emotional effects. The purpose of this study was to examine the relationship between depression symptom and physical performance in elderly women. A total of 173 elderly women aged 65 to 80 participated in this study. We evaluated elderly women using the 6-min walk, grip-strength, 30-sec arm curl, 30-sec chair stand, 8-foot up and go, back scratch, and chair sit and reach, and unipedal stance, measured the body mass index (BMI), and depression symptom assessed using Korean version of the Geriatric Depression Scale (GDS-K). The collected data were analyzed using descriptive statistics, correlation analysis, paired t-tests, and simple linear regression using IBM SPSS Statistics ver. 21.0. There were significant correlations between GDS-K and the 6-min walk, 30-sec chair stand, 30-sec arm curl, chair sit and reach, 8-foot up and go, and grip strength tests (P<0.05), but not BMI, back strength, and unipedal stance. When divided into two groups (GDS-K score≥14 and GDS-K score<14), there was a difference between the two groups in the 6-min walk, 30-sec chair stand, 30-sec arm curl test, chair sit and reach, 8-foot up and go test, and grip strength test performances. Physical performance factors were strongly associated with depression symptom, suggesting that physical performance improvements may play an important role in preventing depression.
10.12965/jer.150257
[The origin of depression in Alzheimer disease: a systematic review].
Quattropani Maria Catena,Lenzo Vittorio,Armieri Vanessa,Filastro Antonella
Rivista di psichiatria
AIM:Depression was associated to Alzheimer's disease (AD), even if its role as predictive symptom, risk factor or reactive factor remains unclear. The aim of this review was to investigate the relation between depression and AD. More specifically, we aimed to examine if depression may be a prodrome of AD or an early reaction to cognitive decline. METHODS:A systematic review based on the electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, Web of Knowledge) was carried out on the scientific literature from 2010 to 2016. Observational studies and literature reviews were included, searched for predefined inclusion criteria. RESULTS:A total of 29 studies were included. Most of the reviews reported that depression may be a risk factor for dementia. Moreover, frequency and severity of depressive episodes may increase the risk for dementia. However, the results are contradictory to a possible risk difference between early or late depression in determining the occurrence of AD. CONCLUSIONS:Depression may be a prodrome of dementia and a risk factor of AD. However, the hypothesis of depression as risk factor is the most accredited one. Finally, there is one evidence suggesting that depression is a reaction to cognitive decline of AD.
10.1708/2866.28920
Brain choline in major depression: A review of the literature.
Riley Colin A,Renshaw Perry F
Psychiatry research. Neuroimaging
The focus of this review is to provide a synthesis of the current literature on the role of brain choline, as measured by proton magnetic resonance spectroscopy (1H-MRS), in major depressive disorder (MDD). The most recent H-MRS literature review took place over 10 years ago and, reflecting the high level of research on this topic, much has been learned since then. Higher brain choline levels have been linked to an increase in depression, and a cholinergic model for MDD development has been postulated. However, current H-MRS studies have been inconclusive regarding the role of choline in depression. Data from eighty-six peer-reviewed studies were analyzed for a random-effects model meta-analysis. Two significant findings are reported. Papers that did not report segmentation had a significant, moderate effect size. Higher choline concentrations in the frontal lobe were found in depressed patients, both in those who responded to treatment and those who did not, after treatment with psychiatric medication, repetitive transcranial magnetic stimulation, or electroconvulsive therapy. Findings from this review may add to existing information regarding the role of brain choline in MDD. This may provide a future target for treatment and drug development. It also may serve as a biomarker for treatment progress.
10.1016/j.pscychresns.2017.11.009
Proportion of depression among the elderly population in a rural health care setting.
Sathyanath M Shreyaswi,Kundapur Rashmi,Bhat U Shrinivasa,Kiran N Udaya
Journal of clinical and diagnostic research : JCDR
INTRODUCTION:Depression among elderly has serious public health implications. Integration of mental health into primary care may help in reaching the elderly population better and in identifying depression among them. OBJECTIVES:This study was done to determine the proportion and the correlates of depression among the elderly population which attended the rural psychiatry services and to compare the proportion with that of the middle aged population. MATERIAL AND METHODS:The outpatient data of the past one year in the rural psychiatry centre was analysed. Correlates of depression among the elderly were studied by Chi square test and the proportion in elderly was compared with that of the middle aged population using Z-test. RESULTS AND CONCLUSION:Depression among the elderly attendees was significantly higher than that in the middle aged group. Depression was more common among the young old and females and co-morbidities were more commonly seen in males and the young old compared to those who were aged 80 years and above.
10.7860/JCDR/2014/5619.3905
Prevalence of depression among the elderly (60 years and above) population in India, 1997-2016: a systematic review and meta-analysis.
BMC public health
BACKGROUND:There is lack of information on the magnitude of depression among elderly population in India. This systematic review and meta-analysis aimed to estimate the prevalence of depression among elderly population in India. METHODS:PubMed, Scopus, Web of Science, Embase, PsycINFO, IndMed, and Google Scholar were searched to identify articles reported community-based prevalence of depression among elderly population using screening tools. This study included the articles published during the years 1997 to 2016. Studies conducted in the special population groups, hospitals, reported only a subcategory of depression, and not specified the screening tool were excluded. Data were extracted from published reports and any missing information was requested from authors. Estimates were pooled using random-effects meta-analyses. Subgroup and sensitivity analysis were performed. The publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS:Fifty-one studies from 16 States of India were included as 56 datasets, which estimated the prevalence of depression among Indian elderly population as 34.4% (95% CI: 29.3-39.7). In sub-group analysis, the pooled prevalence was higher among females, rural populations, and in the eastern part of the country. Studies using non-probability sampling, and GDS and CES-D screening tool showed higher prevalence. Exclusion of the studies with sample size less than 100 and low-quality studies (score < 5/8) had no effect on the estimate of the prevalence. The studies that excluded dementia before assessment of depression had lower prevalence. CONCLUSION:About one third elderly population of India suffered from depression with female preponderance. The estimates varied with type of study tool, geographic region, sampling methods, and presence of dementia. The pooled estimate should be interpreted with caution as the studies included in this review had varied methodological approach and screening tools.
10.1186/s12889-019-7136-z
The epidemiology of affective disorders in the elderly: a review.
Palsson S,Skoog I
International clinical psychopharmacology
It has been suggested that elderly people are predisposed to depression by age-related structural and biochemical changes that may increase their vulnerability to depression and by the fact that risk factors such as bereavement and other psychological losses, somatic diseases and institutionalization become more common with increasing age. The elderly also have a disproportionately high rate of suicide. Whether the prevalence of depression increases or decreases with age is, however, debatable. There may be a peak in the prevalence during the years before retirement, a low prevalence during the first 10-15 years thereafter, and an increase after the age of 75 years. Among the consequences of depression are social deprivation, loneliness, poor quality of life, increased use of health and home-care services, cognitive decline, impairments in activities of daily living, chronicity, suicide and increased non-suicide mortality. However, most studies report that few depressives in the community are treated with antidepressants. During recent years new antidepressants have been introduced, which are better tolerated by the elderly. At the same time, the prescription of anti-depressants has increased in the community. It remains to be seen whether these changes have led to a higher rate of treatment of depression in the elderly.
10.1097/00004850-199712007-00002
Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews.
Journal of affective disorders
BACKGROUND:Depression has been identified as one of the leading causes of the disease burden worldwide. Identification of the potential factors that increased or decreased the risk of depression could be important to provide prevention strategies. We aimed to conduct an umbrella review of risk factors for depression in the elderly and assessed the credibility of evidence of the association between each factor and depression. METHODS:We searched PubMed and Web of Science from 1990 to April 11, 2021 for articles investigating associations between potential factors and depression. For each association, we recalculated the summary effect size and 95% confidence intervals using random effects models. The 95% prediction interval and between-heterogeneity were also reported. For publication bias, small-study effect and excess of significance bias were assessed. RESULTS:Twenty-five publications met the inclusion criteria, including twenty-two meta-analyses and three qualitative systematic reviews. Approximately 1,199,927 participants and 82 unique factors were reported. Two factors were rated as convincing evidence and four factors showed highly suggestive evidence. These risk factors were aspirin use, individuals aged 80 years and above, sleep disturbances and persistent sleep disturbances, hearing problem, poor vision, and cardiac disease. LIMITATIONS:Most studies that we included were of low quality. CONCLUSIONS:We found several risk factors for depression with different levels of evidence, in which aspirin use and individuals aged 80 years and above presented the strongest evidence. Further research is warranted to support other findings from this umbrella review using a large, well-designed cohort study.
10.1016/j.jad.2022.03.062
Insomnia as a risk factor for onset of depression in the elderly.
Perlis Michael L,Smith Leisha J,Lyness Jeffrey M,Matteson Sara R,Pigeon Wil R,Jungquist Carla R,Tu Xin
Behavioral sleep medicine
There are at least 9 studies that provide evidence that insomnia is a significant risk factor for recurrent and new onset major depressive disorder (MDD), two of which suggest that this association also exists specifically for the elderly. In this study, archival data from a community sample of healthy elderly participants were used to assess the extent to which insomnia predicts future illness in this age cohort. Out of the 147 participants with no prior history of mental illness, 66 participants were classified as having no insomnia, 47 had indeterminate insomnia, and 34 had persistent insomnia. Twelve participants developed MDD during the 1-year follow-up period. Two had no insomnia, 4 had indeterminate insomnia, and 6 had persistent insomnia. Persistent insomnia with onset of depression occurred only in female participants and was significantly associated with middle insomnia. These data suggest that elderly participants with persistent insomnia are at greater risk for the development of new onset depression.
10.1207/s15402010bsm0402_3
Reduced plasma Fetuin-A is a promising biomarker of depression in the elderly.
Fanelli Giuseppe,Benedetti Francesco,Wang Sheng-Min,Lee Soo-Jung,Jun Tae-Youn,Masand Prakash S,Patkar Ashwin A,Han Changsu,Serretti Alessandro,Pae Chi-Un,Fabbri Chiara
European archives of psychiatry and clinical neuroscience
Depression affects 7% of the elderly population, and it often remains misdiagnosed or untreated. Peripheral biomarkers might aid clinicians by allowing more accurate and well-timed recognition of the disease. We sought to determine if plasma protein levels predict the severity of depressive symptomatology or distinguish patients from healthy individuals. The severity of depressive symptoms and global cognitive functioning were assessed by the Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) in 152 elderly subjects, 76 of which with major depressive disorder (MDD). Plasma levels of 24 proteins were measured by multiplexing and analyzed as continuous predictors or dichotomized using the median value. The association between individual plasma proteins and MDD risk or depressive symptoms severity was investigated using multiple logistic and linear regressions including relevant covariates. Sensitivity analyses were performed excluding cognitively impaired individuals or non-acute patients with MDD. After adjusting for possible confounders and false discovery rate (FDR) correction, we found lower Fetuin-A levels in MDD patients vs. controls (p = 1.95 × 10). This result was confirmed by the sensitivity and dichotomized analyses. Lower prolactin (PRL) levels predicted more severe depressive symptoms in acute MDD patients (p = 0.024). Fetuin-A is a promising biomarker of MDD in the elderly as this protein was negatively associated with the disorder in our sample, regardless of the global cognitive functioning. Lower PRL levels may be a peripheral signature of impaired neuroprotective processes and serotoninergic neurotransmission in more severely depressed patients.
10.1007/s00406-019-01090-1
Estimation of the prevalence of depression using diagnostic instruments in the elderly population in India, 2000-2019: a systematic review protocol.
BMJ open
INTRODUCTION:Depression is a common mental disorder in the elderly population, which significantly impacts their quality of life. However, correct estimates of its magnitude are not available in the elderly in India. The present systematic review and meta-analysis would attempt to estimate the prevalence of depression using diagnostic instruments among elderly persons aged 60 years and above. METHODS AND ANALYSIS:Searches will be performed in PubMed, Scopus, Embase, Web of Science, CINAHL and PsycINFO. Community-based cross-sectional and cohort studies (2001 to September 2019) reporting the prevalence of depression in the elderly, using diagnostic instruments will be included. Studies conducted among chronic disease patients, in-hospital patients and special groups such as with disaster-stricken populations, and studies reporting the only one or two subcategories of depression, will be excluded. Disagreements in study selection and data abstraction will be resolved by consensus and arbitration by a third reviewer. AXIS critical appraisal tool will be used for quality assessment of individual studies. Findings of eligible studies will be pooled using fixed-effects or random-effects meta-analysis whichever is appropriate. Heterogeneity between studies will be examined by Cochran's Q test and quantified by I² statistic. A cumulative meta-analysis will be used to detect temporal trends in the prevalence of depression and the effect of poor-quality studies on the pooled estimate. Publication bias will be assessed by visual inspection of funnel plots and the Egger test. ETHICS AND DISSEMINATION:No ethical approval will be needed because it will be a systematic review. Data from previously published studies will be retrieved and analysed. Findings will be disseminated through a peer-reviewed publication in a scientific journal and conferences. PROSPERO REGISTRATION NUMBER:CRD42019138453.
10.1136/bmjopen-2019-034330
Treatment of depression in the elderly: a review of the recent literature on the efficacy of single- versus dual-action antidepressants.
Mukai Yuki,Tampi Rajesh R
Clinical therapeutics
BACKGROUND:Despite the prevalence of depression in the elderly, there is a shortage of randomized controlled studies comparing the efficacy of various antidepressant classes in this population. OBJECTIVES:This review of recent data on the treatment of depression in the elderly examined the relative efficacy of the selective serotonin reuptake inhibitors (SSRIs) and 2 antidepressant classes having broader neuroreceptor activity-the tricyclic antidepressants (TCAs) and the serotonin-norepinephrine reuptake inhibitors (SNRIs). Tolerability was examined as a secondary objective. METHODS:A systematic review of MEDLINE, PsycINFO, and PubMed (January 2003-January 2009) was performed using the terms antidepressant, SSRI, SNRI, TCA, depression, randomized controlled trials, human trials, and individual antidepressant names. The criteria for inclusion in the review were a doubleblind design, a placebo control or active comparator group, a population exclusively aged > or = 59 years, and enrollment of patients with a diagnosis of major depressive disorder. RESULTS:The literature search identified 18 trials of the treatment of depression in the elderly: 10 compared SSRIs either head to head or versus placebo, 2 compared TCAs with SSRIs, and 6 examined SNRIs (2 vs placebo, 1 vs a TCA, and 3 vs SSRIs). In 2 head-to-head trials, one of which measured efficacy in terms of change in Hamilton Depression Rating Scale (HAM-D) scores and response rates, and the other in terms of a preset 90% CI, TCAs and SSRIs had comparable efficacy. The data from 5 studies using various measures (including changes in Montgomery-Asberg Depression Rating Scale, HAM-D, or Geriatric Depression Scale [GDS] scores; response rates; and remission rates) suggested no additional efficacy benefit for the SNRI venlafaxine compared with SSRIs or TCAs. In a single trial, duloxetine was significantly more effective than placebo in terms of reductions in HAM-D and GDS scores (both, P < 0.001). CONCLUSION:The available data, although limited, suggest that the dual-action agents (TCAs and SNRIs) do not appear to confer any additional benefits in efficacy over single-action agents (SSRIs) in the treatment of depression in the elderly.
10.1016/j.clinthera.2009.05.016
The prevalence of depression in a cohort of the very elderly.
Girling D M,Barkley C,Paykel E S,Gehlhaar E,Brayne C,Gill C,Mathewson D,Huppert F A
Journal of affective disorders
In a community study of 1173 very elderly (> or = 77 years) subjects, a screening interview was followed by a CAMDEX diagnostic interview in a subsample of 461. The estimated prevalence of DSM-III-R major depressive disorder in the community sampled was 2.4% (95% CI 0.9%, 4.0%). Using CAMDEX criteria, the prevalence of depressive illness was 3.0% (95% CI 0.7%, 5.3%). 10% of those who had a diagnostic interview were rated as having depressive symptoms of mild or moderate severity. Of these, approximately 1/3 met diagnostic criteria for major depressive disorder. The significance of these findings and the possible need for wider criteria for depression in the elderly are discussed.
Treatment of depression in the elderly: a Canadian view.
Ancill R J,Holliday S G
Progress in neuro-psychopharmacology & biological psychiatry
1. Between 10 and 15% of people over the age of 65 have a potentially treatable depression. 2. The commonest antidepressants used in Canada, the tertiary-amine tricyclics, are potentially problematic when used with geriatric patients. 3. It is current practice in geriatric psychiatry to use secondary-amine tricyclics as "first choice" drugs for elderly depressed patients. 4. Electroconvulsive therapy can be effectively used to deal with severely depressed elderly patients, particularly if there are also features of dementia. 5. Although "better drugs" are needed for the elderly, people over the age of 65 are typically excluded from treatment outcome research.
[Depression in the elderly: a review].
de Almeida O P,Lafer B,Miguel Filho E C
Revista paulista de medicina
With the increase in life expectancy during recent years, the elderly population and its medical problems are increasing considerably. Depression in the elderly is an important example of this situation. In this article, the authors discuss special aspects of depression in the elderly, its clinical presentation, prevalence, course, etiologic factors, diagnosis, and treatment. They draw attention to the risk of not correctly identifying and treating those patients.
Depression overview.
American health & drug benefits
Depression is a common condition that often remains undiagnosed and untreated; however, symptoms are more likely to be recognized today than in past decades. Survey data suggest that female, nonwhite patients are more likely to report depressive symptoms, especially those who are less educated, poor, and covered by Medicaid. Depression may be a finding suggestive of dysthymic disorder, minor or major depressive disorder, seasonal affective disorder, episodic depression, or a sign of an associated mood disorder, such as bipolar disorder. Many effective treatments are available that are well tolerated. This article outlines the diagnostic approach used in primary care, as well as the different treatment options available for this condition. Depression can have serious consequences and must be treated appropriately.
[Psychotic depression in older adults: an overview].
Vermeulen Tom,Diermen Linda van,Madani Yamina,Sabbe Bernard C G,Mast Roos C van der
Tijdschrift voor gerontologie en geriatrie
Psychotic depression is a frequent, severe psychiatric condition in older depressive inpatients aged 60 years and older. Older adults with a psychotic depression exhibit specific symptoms that are different from those in younger adults with psychotic depression. Moreover, the symptoms are also different from those in older adults with a major depression without psychotic features. The recommended treatment consists of a tricyclic antidepressant, with or without addition of an antipsychotic, or electroconvulsive therapy. These treatments may however produce significant side effects that require intensive monitoring. In this article we present an overview of clinical topics regarding the diagnosis and treatment of older people with a psychotic depression.
10.36613/tgg.1875-6832/2019.01.01
Sleep Disturbances and Risk of Depression in Older Men.
Paudel Misti,Taylor Brent C,Ancoli-Israel Sonia,Blackwell Terri,Maglione Jeanne E,Stone Katie,Redline Susan,Ensrud Kristine E
Sleep
INTRODUCTION:Self-reported sleep disturbances are associated with an increased risk of depression in younger and older adults, but associations between objective assessments of sleep/wake disturbances via wrist actigraphy and risk of depression are unknown. METHODS:Depressive symptoms (Geriatric Depression Scale [GDS]), self-reported (questionnaires), and objective (actigraphy) sleep parameters were measured at baseline in 2,510 nondepressed men 67 y or older. Depressive symptoms were reassessed an average of 3.4 ± 0.5 y later. RESULTS:Of the 2,510 men without evidence of depression at baseline, 116 (4.6%) were depressed (GDS ≥ 6) at the follow-up examination. After adjusting for multiple potential confounders, including baseline depressive symptoms (GDS 0-5), there was evidence of an association between poor self-reported sleep quality and higher odds of being depressed at follow-up (multivariable odds ratio [MOR] = 1.53, 95% confidence interval (CI) 1.00-2.33). In age- and site-adjusted models, objectively measured reduced sleep efficiency (odds ratio [OR] = 1.88, 95% CI 1.13-3.13), prolonged sleep latency (OR = 1.77, 95% CI 1.04-3.00), greater nighttime wakefulness (OR = 1.48, 95% CI 1.01-2.18) and multiple long-wake episodes (OR = 1.69, 95% CI 1.15-2.47) were associated with increased odds of depression at follow-up, but these associations were attenuated and no longer significant after further adjustment for number of depressive symptoms at baseline. Self-reported excessive daytime sleepiness and objectively measured total sleep time were not associated with depression status at follow-up. Excluding baseline antidepressant users from the analyses did not alter the results. CONCLUSIONS:Among nondepressed older men, poor self-reported sleep quality was associated with increased odds of depression several years later. Associations between objectively measured sleep disturbances (e.g., reduced sleep efficiency, prolonged sleep latency, greater nighttime wakefulness, and greater long-wake episodes) and depression several years later were largely explained by a greater burden of depressive symptoms at baseline. CITATION:Paudel M; Taylor BC; Ancoli-Israel S; Blackwell T; Maglione JE; Stone K; Redline S; Ensrud KE; for the Osteoporotic Fractures in Men Study Group. Sleep disturbances and risk of depression in older men. 2013;36(7):1033-1040.
10.5665/sleep.2804
[Sleep and depression in elderly people].
Nicolas Alain,Dorey Jean-Michel,Charles Eric,Clement Jean-Pierre
Psychologie & neuropsychiatrie du vieillissement
Mood disorders and sleep disturbances are closely related. In elderly people, the prevalence of insomnia and depressive symptoms is increased. Moreover, somatic co-morbidities associated with aging are known to be risk factors for both insomnia and depression. Assessment of the origin of sleep complaints must consider primary and secondary insomnia, and the existence of associated depression. Causal treatment of insomnia is necessary keeping in consideration that depressive dimension can, afterward, evolve on its own. In presence of intense sleep complaints in inadequacy with somatic examination, and not documented by sleep recordings, depression must be evoked. In patients with a diagnosis of depression, treatment and monitoring of the evolution of insomnia is necessary, because persistent disturbances of sleep are associated with poor prognosis. Concerning the therapeutics, beyond antidepressant treatment and psychotherapy, chronotherapy is a promising, but still not yet evaluated, approach, which presents the advantage to limit the use of psychotropics drugs.
10.1684/pnv.2010.0224
Sleep, insomnia, and depression.
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
10.1038/s41386-019-0411-y
Depression and Sleep.
Steiger Axel,Pawlowski Marcel
International journal of molecular sciences
Impaired sleep is both a risk factor and a symptom of depression. Objective sleep is assessed using the sleep electroencephalogram (EEG). Characteristic sleep-EEG changes in patients with depression include disinhibition of rapid eye movement (REM) sleep, changes of sleep continuity, and impaired non-REM sleep. Most antidepressants suppress REM sleep both in healthy volunteers and depressed patients. Various sleep-EEG variables may be suitable as biomarkers for diagnosis, prognosis, and prediction of therapy response in depression. In family studies of depression, enhanced REM density, a measure for frequency of rapid eye movements, is characteristic for an endophenotype. Cordance is an EEG measure distinctly correlated with regional brain perfusion. Prefrontal theta cordance, derived from REM sleep, appears to be a biomarker of antidepressant treatment response. Some predictive sleep-EEG markers of depression appear to be related to hypothalamo-pituitary-adrenocortical system activity.
10.3390/ijms20030607
Hippocampal volume in geriatric depression.
Steffens D C,Byrum C E,McQuoid D R,Greenberg D L,Payne M E,Blitchington T F,MacFall J R,Krishnan K R
Biological psychiatry
BACKGROUND:There is a growing literature on the importance of hippocampal volume in geriatric depression. METHODS:We examined hippocampal volume in a group of elderly depressed patients and a group of elderly control subjects (N = 66 geriatric depressed patients and 18 elderly nondepressed control subjects) recruited through Duke's Mental Health Clinical Research Center for the Study of Depression in the Elderly. The subjects received a standardized evaluation, including a magnetic resonance imaging scan of the brain. Patients had unipolar major depression and were free of comorbid major psychiatric illness and neurologic illness. Differences were assessed using t tests and linear regression modeling. RESULTS:Accounting for the effects of age, gender, and total brain volume, depressed patients tended to have smaller right hippocampal volume (p =.014) and left hippocampal volume (p =.073). Among depressed patients, age of onset was negatively but not significantly related to right hippocampal volume (p =.052) and to left hippocampal volume (p =.062). We noted that among subjects with either right or left hippocampal volume of 3 mL or less, the vast majority were patients rather than control subjects. CONCLUSIONS:These results support a role for hippocampal dysfunction in depression, particularly in late-age onset depression. Longitudinal studies examining both depressive and cognitive outcomes are needed to clarify the relationships between the hippocampus, depression, and dementia.
The relationship between Comprehensive Geriatric Assessment parameters and depression in elderly patients.
Frontiers in aging neuroscience
Background:Depression is common and serious among elderly patients. The treatment of elderly depression is often delayed owing to insufficient diagnosis, which eventually leads to adverse consequences. Aims:To explore the association between the parameters of the Comprehensive Geriatric Assessment and depression in elderly patients. Methods:A cross-sectional study of 211 outpatients and inpatients aged ≥ 65 years from the Comprehensive Geriatric Assessment database was conducted. A Comprehensive Geriatric Assessment inventory was prepared by compiling and screening general characteristics, chronic diseases (cardiovascular disease, diabetes, and peptic ulcer disease), nutritional status, daily living ability, anthropometric measurements (body mass index (BMI), upper arm circumference, and calf circumference), and blood biochemical indicators (hemoglobin, albumin, prealbumin, triglycerides, and low-density lipoprotein cholesterol). The Geriatric Depression Scale was also conducted for each elderly patient to screen for depression. A multivariable logistic regression analysis was used to determine the association between the parameters of the Comprehensive Geriatric Assessment and geriatric depression. Results:There were 63 patients in the depression group with a median age of 84.00 years, and 148 patients in the non-depression group with a median age of 78.50 years. After controlling for confounders, the risk of depression in elderly patients with cardiovascular diseases was 6.011 times higher than that in those without cardiovascular diseases ( < 0.001); and the risk of depression in elderly patients with peptic ulcer diseases was 4.352 times higher than that in those without peptic ulcer diseases ( < 0.001); the risk of depression in elderly patients decreased by 22.6% for each 1-point increase in the Mini Nutritional Assessment ( < 0.001). The risk of depression in elderly patients decreased by 19.9% for each 1-point increase in calf circumference ( = 0.002), and by 13.0% for each 1-point increase in albumin ( = 0.014). Conclusion:Our findings suggest that Comprehensive Geriatric Assessment parameters, such as cardiovascular disease, peptic ulcer disease, Mini Nutritional Assessment score, calf circumference, and albumin, were associated with depression. The Comprehensive Geriatric Assessment can assist in the early identification of depression in the elderly population.
10.3389/fnagi.2022.936024
Executive dysfunction in geriatric depression.
Lockwood Kathryn A,Alexopoulos George S,van Gorp Wilfred G
The American journal of psychiatry
OBJECTIVE:The purpose of this study was to characterize the neuropsychological presentation of geriatric depression and to determine whether depression-related executive dysfunction is more pronounced during advanced age. METHOD:The attention and executive functioning of 40 adults with major depression were compared with those of 40 healthy comparison subjects; 20 subjects were 20-60 years old, and 20 were > or =61 years. It was hypothesized that depressed subjects, regardless of age, would perform more poorly than comparison subjects on both attention and executive tasks but that the older depressed adults would evidence significantly greater impairment on executive measures. RESULTS:A significant interaction between age and depressive status was noted for tasks of executive functioning, while no age-depression interaction was found for tasks of selective or sustained attention. Older depressed adults demonstrated the slowest psychomotor speed and the poorest performance on tasks requiring set shifting, problem solving, and initiation of novel responses. CONCLUSIONS:Patients with late-life depression have significant impairment in executive functioning. These findings can guide the development of stimulated functional neuroimaging paradigms that may clarify the pathophysiology of geriatric depression. Timely identification of attentional and executive processes fundamental to the daily functioning of depressed older adults may lead to compensatory strategies that will improve the outcomes of late-life depression.
10.1176/appi.ajp.159.7.1119
Peculiarities of geriatric psychiatry: a focus on aging and depression.
Laks Jerson,Engelhardt Eliasz
CNS neuroscience & therapeutics
There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late-onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.
10.1111/j.1755-5949.2010.00196.x
The functional neuroanatomy of geriatric depression.
International journal of geriatric psychiatry
OBJECTIVE:Positron Emission Tomography (PET) studies of cerebral glucose metabolism have demonstrated sensitivity in evaluating the functional neuroanatomy of treatment response variability in depression, as well as in the early detection of functional changes associated with incipient cognitive decline. The evaluation of cerebral glucose metabolism in late life depression may have implications for understanding treatment response variability, as well as evaluating the neurobiological basis of depression in late life as a risk factor for dementia. METHODS:Sixteen patients with geriatric depression and 13 comparison subjects underwent resting PET studies of cerebral glucose metabolism, as well as magnetic resonance (MR) imaging scans to evaluate brain structure. RESULTS:Cerebral glucose metabolism was elevated in geriatric depressed patients relative to comparison subjects in anterior (right and left superior frontal gyrus) and posterior (precuneus, inferior parietal lobule) cortical regions. Cerebral atrophy (increased cerebrospinal fluid [CSF] and decreased grey and white matter volumes) were observed in some of these regions, as well. Regional cerebral metabolism was positively correlated with severity of depression and anxiety symptoms. CONCLUSIONS:In contrast to decreased metabolism observed in normal aging and neurodegenerative conditions such as Alzheimer's disease, cortical glucose metabolism was increased in geriatric depressed patients relative to demographically matched controls, particularly in brain regions in which cerebral atrophy was observed, which may represent a compensatory response.
10.1002/gps.2185
Geriatric Depression and Cognitive Impairment-An Update.
Indian journal of psychological medicine
BACKGROUND:Depression and cognitive impairment often coexist in older adults. The relation between depression and cognitive impairment is complex. The objective of this article is to review recent literature on cognitive impairment in older adults with depression and provide clinicians an update. METHODS:We searched PubMed, Google Scholar, Science Direct, and Psych Info for the articles published in the English language related to late-life depression (LLD)/geriatric depression and cognitive impairment. We considered original research articles, relevant systematic reviews, chapters, and important conceptual articles published in the last 9 years (2011-2019). We selected relevant articles for this narrative review. CONCLUSION:The concept pseudodementia, indicating depression with cognitive impairment mimicking dementia, is now seen only as a historical concept. The current literature strongly agrees with fact that cognitive deficits often exist in LLD. The cognitive deficits in depression were initially seen as trait marker; however, some recent studies suggest that cognitive deficits persist even in the remission phase. There is heterogeneity among the studies in terms of the nature of the cognitive deficits, but higher number of studies reported impairment in attention and executive function. LLD with cognitive deficits is at a higher risk of progression to dementia. In older adults, depression with cognitive impairments requires a comprehensive evaluation. Electroencephalography, event-related potentials, fluorodeoxyglucose-positron emission tomography, amyloid positron emission tomography, and CSF amyloid will supplement clinical evaluation in differentiating functional depressive disorder with cognitive impairment from depression with an underlying degenerative condition.
10.1177/0253717620981556
The inflammation hypothesis in geriatric depression.
Alexopoulos George S,Morimoto Sarah Shizuko
International journal of geriatric psychiatry
BACKGROUND:A large body of research has focused on "mediating mechanisms" and predisposing brain abnormalities to geriatric depression, but little is known about its etiology. This paper examines whether age-related and comorbid disease-related immune deregulation is an etiologic contributor to geriatric depression. METHODS:This article reviews findings on neuroinflammation during the aging process and depression as well as studies of anti-inflammatory actions of classical antidepressants and antidepressant actions of anti-inflammatory agents. RESULTS:Aging results in increased peripheral immune responses, impaired peripheral-CNS immune communication, and a shift of the CNS into a pro-inflammatory state. These exaggerated and prolonged immune responses may lead to changes in the function of emotional and cognitive networks pertinent to geriatric depression and to behavioral changes reminiscent of the depressive and cognitive symptoms of geriatric depression. Some antidepressants may reduce the expression of inflammation markers. Limited data suggest that some anti-inflammatory agents may have antidepressant properties. CONCLUSIONS:A synthesis of available findings suggests that aging-related and comorbid disease-related inflammatory processes may promote changes in the neural systems predisposing to geriatric depression or facilitating metabolic changes that mediate depressive syndromes. The "inflammation hypothesis" in geriatric depression cannot be tested in its entirety, but it can lead to testable hypotheses and data on mechanisms by which inflammatory processes promote geriatric depression. The significance of such an effort is that it may lead to a novel treatment development model bringing to bear recent advances of anti-inflammatory pharmacology to the treatment of depressed elderly patients.
10.1002/gps.2672
Socio-demographic Factors of Geriatric Depression.
Barua Ankur,Ghosh M K,Kar N,Basilio M A
Indian journal of psychological medicine
BACKGROUND:Depression is a common mental health problem in geriatric population and the overall prevalence rate of depression in this age group varies between 10 and 20%. OBJECTIVE:To study the socio-demographic factors associated with depression in geriatric population. MATERIALS AND METHODS:A systematic review was done on 74 community-based mental health surveys on depression in geriatric population, which were conducted in the continents of Asia, Europe, Australia, North America, and South America. All the studies were conducted between 1955 and 2005. The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of geriatric population in the world, who were selected by simple random sampling technique. A qualitative analysis was conducted to study the socio-demographic factors of depression. RESULTS AND CONCLUSION:The two non-modifiable risk factors found to be significantly associated with depression in geriatric population were "older age group" and "female gender". However, the potentially modifiable risk factors for depression in the geriatric population were identified as low socioeconomic status, loss of spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL).
10.4103/0253-7176.78503
Immunity, aging, and geriatric depression.
Morimoto Sarah Shizuko,Alexopoulos George S
The Psychiatric clinics of North America
Inflammatory processes are likely to play a causal role in geriatric depression. Geriatric depression occurs in the context of illnesses in which inflammatory processes are part of the pathogenesis. Both aging and depression are associated with immune responses, and the connectivity among mood-regulating structures may be modulated by inflammatory responses. Geriatric depression exacerbates the symptoms of comorbid disorders. Geriatric depression often occurs in persons exposed to chronic stress, a state precipitating geriatric depression and triggering proinflammatory responses. The successful treatment of comorbid conditions that increase central nervous system inflammatory responses has general health benefits and should be part of clinical practice.
10.1016/j.psc.2011.02.006
Research advances in geriatric depression.
Alexopoulos George S,Kelly Robert E
World psychiatry : official journal of the World Psychiatric Association (WPA)
Technical advances have facilitated the exploration of factors related to geriatric depression and have helped generate novel biological and psychosocial treatment approaches. This review summarizes the main advancements in epidemiology, clinical presentation and course, genetics, and other areas of biological research. Treatment interventions outlined in this paper include electroconvulsive therapy, repetitive transcranial magnetic stimulation, magnetic seizure therapy, vagus nerve stimulation, deep brain stimulatn, depression prophylaxis, multidisciplinary approaches to depression treatment, and psychotherapy. Forms of psychotherapy for geriatric depression summarized include interpersonal psychotherapy, supportive psychotherapy, cognitive-behavioral therapy, problem-solving therapy, and ecosystem-focused therapy. Neuroimaging techniques based on magnetic resonance imaging are discussed briefly, including volumetric brain studies, diffusion tensor imaging, fractional anisotropy, fiber tractography, magnetization transfer imaging, and blood-oxygenation-level-dependent functional magnetic resonance imaging. Finally, treatment effectiveness is addressed in a discussion of new models to improve access to and quality of care offered in the community.
10.1002/j.2051-5545.2009.tb00234.x
Research Review: Developmental origins of depression - a systematic review and meta-analysis.
Journal of child psychology and psychiatry, and allied disciplines
BACKGROUND:Many observational studies have found a direct association between adverse in utero, perinatal and postnatal exposures and offspring's depression. These findings are consistent with the 'developmental origins of disease hypothesis'. But no review has comprehensively summarized the roles of these exposures. This review aims to systematically scrutinize the strength of associations between individual prenatal, perinatal, and postnatal exposures and subsequent depression in offspring. METHODS:We conducted a systematic review and meta-analysis to synthesize the literature from the EMBASE, HealthStar, PsychoInfo, and Medline databases since their inception to September 1, 2019. English language articles on population-based prospective cohort studies examining the associations between in utero, perinatal, and postnatal exposures and offspring's depression were searched. Random-effects models were used to calculate pooled estimates, and heterogeneity and sensitivity tests were conducted to explore potential confounders in the relationships of depression and early-life factors. Qualitative analysis was also conducted. RESULTS:Sixty-four prospective cohort studies with 28 exposures studied in the relationships to offspring's depression met inclusion criteria. The meta-analysis found 12 prenatal, perinatal, and postnatal characteristics were associated with an increased risk of depression in offspring: low birth weight, premature birth, small gestational age, maternal education, socioeconomic status, having younger parents (<20 years), having older parents (≥35 years), maternal smoking, paternal smoking, maternal stress, maternal anxiety, and prenatal depression. Heterogeneity and sensitivity tests supported the findings. By and large, study characteristics had no effects on conclusions. Qualitative analyses generally supported the findings of meta-analysis and reported on additional risk factors. CONCLUSIONS:This review provides a robust and comprehensive overview of the lasting psychopathological effects of in utero, perinatal, and postnatal exposures. The findings highlight the need for clinical and public health interventions focusing on the identified risk factors. Large prospective cohort studies are warranted to investigate the combined effects of multiple co-existing early-life exposures.
10.1111/jcpp.13358
The neuroanatomy of depression: A review.
Oakes Peter,Loukas Marios,Oskouian Rod J,Tubbs R Shane
Clinical anatomy (New York, N.Y.)
Depression is the most common psychiatric disorder, the number one cause of disability and affects up to 15% of the population. The aim of this review is to present a brief synopsis of the various biochemical imbalances thought to contribute to depression, aspects of anatomy possibly implicated in depression, and treatments related to targeting these specific locales. Multiple neurotransmitters and parts of the brain are involved with the disorder of depression. Although an exact etiology for depression has not been found in most cases, various treatments, medicinal, psychiatric and surgical, exist for this disabling disease. An improved knowledge of anatomical sites involved in patients with depression will help in future treatment modalities. Clin. Anat. 30:44-49, 2017. © 2016 Wiley Periodicals, Inc.
10.1002/ca.22781
Hypothyroidism and Depression: A Narrative Review.
Cureus
There has been an established relationship between hypothyroidism and depression. Studies have demonstrated that somatostatin and serotonin influence the hypothalamus-pituitary-thyroid axis, which links hypothyroidism to depression. Multiple studies concluded that undiagnosed, untreated, undertreated patients with hypothyroidism are at increased risk of developing depression. Autoimmune thyroiditis is also associated with an increased risk of depression. Elevated thyroid-stimulating hormone (TSH), antithyroglobulin (TgAb), and thyroid peroxidase antibodies (TPOAb) levels have all been linked to depression and an increased risk of suicide. Moreover, hypothyroidism is known to be one of the leading causes of treatment-resistant depression. Treating underlying hypothyroidism with thyroid replacement therapy could significantly improve mood disorders such as depression. Levothyroxine therapy is also used as adjunctive therapy to antidepressants in the management of depression, and it is known to improve the symptoms of depression rapidly when compared to antidepressants alone. This review strengthens the link between hypothyroidism and depression, and it also demonstrates how treating the underlying hypothyroidism in people who have been diagnosed with depression will be very beneficial.
10.7759/cureus.28201
[Incidence of senile dementia and depression in elderly population in Xicheng District, Beijing, an epidemiologic study].
Yan Fang,Li Shuran,Liu Jin,Zhang Weii,Chen Changhui,Liu Mian,Xu Liang,Li Shuo,Shao Jun,Wu Hong,Wang Yulan,Liang Kouhua,Zhao Changqi,Lei Xiaxing
Zhonghua yi xue za zhi
OBJECTIVE:To investigate the incidence of senile dementia and depression in the elderly and the factors correlative with these disorders. METHODS:All the non-case subjects investigated in a survey of prevalence of senile dementia and depression conducted among the elderly population in Xicheng District, Beijing in 1997 were followed up in 1999. The investigation procedure, instruments and diagnostic criteria were identical with those used in 1997 survey. RESULTS:The annual incidence rates of senile dementia was 0.89% in those aged 60 and over. The incidence rate of old males and that of the old females were not significantly different. The annual incidence rate of senile dementia in groups aged 60 approximately 64, 64 approximately 69, 70 approximately 74 75 approximately 79 80 approximately 84 85 approximately 89, and 90 and over were 0.15% 0.68 % 0.44% 1.32% 2.41% 5.72% and 5.13% respectively. The incidence rate in the elderly over 90 was lower than that in the group aged 85 approximately 89. The minimum annual incidence rate of depression in the elderly aged 60 and over was 1.28%. The incidence rate of depression was higher in the group with poorer health than in the group with better health. The incidence rates of moderate and severe dementia were not significantly different from those in 1989. CONCLUSION:The incidence rate of senile dementia in the elderly remains rather stable during this period of 10 years in Beijing city. The incidence rate of senile dementia is closely correlated with age. The incidence rate of depression in the elderly is remarkably correlated with health status. Senile dementia and depression may coexist in the same person.
Towards an understanding of the pathological basis of senile depression and incident dementia: Implications for treatment.
Psychiatry and clinical neurosciences
Senile depression (SD) is a heterogeneous syndrome. Several clinical profiles are more likely to appear in SD than in early-life depression, but it remains unclear whether the pathophysiology is different. The prevalence of dementia increases with aging, and the underlying pathophysiological processes in the preclinical phase begin even before cognitive deficits or neurological signs appear. SD may be either a risk factor for developing dementia or a prodromal stage of dementia. The inconsistent findings regarding the association between SD and incident dementia may be attributable to the neuropathological heterogeneity underlying SD. Most studies have focused on patients with the clinical diagnosis of Alzheimer disease (AD) as an outcome, but several clinicopathological studies suggest that primary age-related tauopathy and argyrophilic grain disease may account for a proportion of cases clinically misdiagnosed as AD in the elderly population. Furthermore, most AD cases have additional neuropathologic changes such as cerebrovascular disease and Lewy body disease. Here, we review the neuropathological findings linking SD to incident dementia, focusing on common age-related neuropathologies. In particular, the roles of disturbance of neural circuity, imbalance of monoaminergic systems, dysregulation of the hypothalamic-pituitary-adrenal axis, and elevated neuroinflammatory status are discussed. Finally, we review the current treatment of SD in the context of age-related neuropathological changes.
10.1111/pcn.13485
Obstructive sleep apnea and risk for late-life depression.
Bajpai Siddharth,Im Kyoung Bin,Dyken Mark Eric,Sodhi Simrit K,Fiedorowicz Jess G
Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists
BACKGROUND:Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by repetitive pharyngeal collapse. Because of the association between OSA, ischemia, and late-life depression, we hypothesized that older patients with OSA would have a higher prevalence of depression relative to their younger counterparts. METHODS:We retrospectively reviewed charts of patients evaluated at the Sleep Disorders Center (SDC) at University of Iowa Hospitals and Clinics. A total of 617 patients age≥18 seen at SDC for diagnostic and therapeutic sleep studies were identified. Patients with a chart diagnosis of depressive disorder or treatment with antidepressants were identified as having a depressive disorder. Patients with an Apnea/Hypopnea Index≥5 were identified as having OSA. RESULTS:No evidence of an escalating prevalence of depression with age was found in patients with OSA relative to those without the disorder. Prevalence of depression was similar in the OSA and the nonapnea groups (40.9% vs 40.3%, respectively; χ2=0.02; df=1; P=.89). Individuals with OSA had a significantly higher body mass index and greater number of chart diagnoses of hypertension, diabetes mellitus, and coronary artery disease compared with the nonapnea group. CONCLUSIONS:The prevalence of depression among individuals with OSA does not appear to be moderated by age. Similarly high rates of depression were observed across the population of individuals referred for sleep studies, whether or not they were diagnosed with OSA.
Depression as a Manifestation of Obstructive Sleep Apnea.
Journal of neurosciences in rural practice
BACKGROUND:Obstructive sleep apnea (OSA) often results in a wide range of comorbid conditions, predominantly of the cardiovascular/respiratory, endocrine/metabolic, and neuropsychiatric symptoms. In view of the ambiguity of literature regarding the association between OSA and depression, we conducted this study to show any association between the two disorders. OBJECTIVE:The aim of the study was to see the association between OSA and depression and to study the prevalence of OSA in patients suffering from depression. METHODS:We performed polysomnography (PSG) studies of patients that were referred from various subspecialty clinics from July 2011 to August 2013. Psychiatric diagnosis was done using mini international neuropsychiatric interview plus scale. This was followed by application of Hamilton Depression Rating Scale (HAM-D). Standard methods of statistical analysis were used for data analysis. RESULTS:Out of 182 patients who underwent PSG, 47 were suffering from depression with a mean age significantly more ( < 0.001) than that of other population (58.60 years vs. 53.60 years). In our 47 depressed patients, 44 (93.6%) had abnormal PSG. Based on apnea-hypopnea index score, 3 (6.8%) patients had mild, 18 (40.9%) had moderate, and 23 (52.3%) had severe OSA. The mean HAM-D score was significantly more in depression patients, (17. 35 ± 5.45) as compared to non depressive patents (8.64 ± 6.24) ( = 0.0001). CONCLUSION:This study demonstrates significant overlap between the sleep apnea and depression. Health specialists need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition. Most of the clinicians do not suspect this important comorbidity of depression in the beginning resulting in delayed diagnosis.
10.4103/jnrp.jnrp_462_16
Nightmares in obstructive sleep apnoea.
Neuro endocrinology letters
OBJECTIVE:Obstructive events in patients with obstructive sleep apnoea (OSA) cause recurrent sleep fragmentation and occasional desaturation, which can cause various parasomnias, including nightmares. Several lines of evidence suggest that OSA may be potentially associated with a higher frequency of nightmares. METHOD:We searched for studies published from January 2000 until November 2020 in PubMed, the Cochrane Library, Web of Science and Google Scholar. The keywords Obstructive Sleep Apnoea / OSA / Nightmares / CPAP / PTSD / Sleep Quality / Dream / were used in various combinations. The literature search identified 1361 articles which were eligible to more careful examination. Secondary texts were also examined, evaluated for suitability, and added to the primary document list. Finally, a total of 168 articles were included in the review. RESULTS:According to current findings, OSA could affect emotional regulation via activation of limbic system during sympathetic activation and suppression of REM sleep essential to emotional regulation. The reviews also found an increased prevalence of nightmares in OSA patients. OSA is significantly associated with psychiatric morbidity, as was proved in several studies. There seems to be a strong link between nightmares, OSA, PTSD symptoms and other disorder such as unipolar depression. CONCLUSIONS:It is clear that therapy of OSA patients, especially those with psychiatric comorbidity, must be complex. In the case of nightmares, we should not forget to use psychotherapy as a first choice, particularly in patients with poor compliance to continuous positive airway pressure (CPAP) and poor sleep and overall life quality. In the same time, we should emphasise the healthy lifestyle and sleep hygiene.
Predictors of symptoms of anxiety and depression in obstructive sleep apnea.
Kjelsberg Frank N,Ruud Espen A,Stavem Knut
Sleep medicine
BACKGROUND AND PURPOSE:To assess factors associated with anxiety and depression in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS:The study was comprised of a postal survey with a hospital chart review. Questionnaires were mailed to 242 previously hospitalised patients with OSAS. We assessed anxiety and depression with the Hospital Anxiety and Depression scale (HAD). Scores on the two HAD scales (0-21 scale, higher scores represent poor health) were categorized as normal/borderline (< or =10), and corresponding to a clinical diagnosis of anxiety or depression (> or =11). In logistic regression analysis, we assessed the association with HAD scores > or =11, using variables from the chart review and self-reported data on demographics, disease history, smoking status, CPAP/BiPAP use, and daytime sleepiness as assessed with the Epworth Sleepiness Scale (ESS), as potential predictors. RESULTS:One hundred and seventy-eight patients (74%) with mean (SD) age 55 (11) years and body mass index (BMI) of 31 (5) kgm(-2) responded to the questionnaire. In multivariate logistic regression analysis, only low compliance with CPAP therapy (odds ratio (OR) 5.60, P=0.005) predicted high level of anxiety, and low compliance with CPAP therapy (OR 3.59, P=0.03) and daytime sleepiness (OR 1.14 per unit increase in ESS score, P=0.02) were the only predictors of high level of depression. CONCLUSIONS:High anxiety score was associated with non-compliance with CPAP therapy. High depression score was associated with daytime sleepiness and non-compliance with CPAP therapy.
10.1016/j.sleep.2005.02.004
Obstructive sleep apnoea and depression--diagnostic and treatment implications.
Kaplan R
The Australian and New Zealand journal of psychiatry
Sleep apnoea (OSA), a common sleep disorder, is well recognised as a cause of morbidity including psychiatric disorders. There is increasing recognition of the link between OSA and depression. Sleep changes are intrinsic to depressive disorders, most notably disturbances of REM sleep; OSA causes predominantly REM sleep disturbances. The neuro-vegetative features of depression are similar or identical to the symptoms of OSA-an issue which has not achieved wide clinical recognition. A growing number of studies confirm the statistical link between the two conditions. The implications are twofold: OSA needs to be excluded in cases of chronic or resistant depression and treatment of OSA will make it easier to treat the primary depressive disorder. A new method of treatment for OSA, the Sullivan continuous positive airway pump (CPAP), raises the theoretical possibility of treating depression by this means as well.
10.3109/00048679209072093
[Sleep psychiatry].
Chiba Shigeru
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
Sleep disorders are serious issues in modern society. There has been marked scientific interest in sleep for a century, with the discoveries of the electrical activity of the brain (EEG), sleep-wake system, rapid eye movement (REM) sleep, and circadian rhythm system. Additionally, the advent of video-polysomnography in clinical research has revealed some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. Decades of clinical research have demonstrated that sleep disorders are intimately tied to not only physical disease (e. g., lifestyle-related disease) but psychiatric illness. According to The International Classification of Sleep Disorders (2005), sleep disorders are classified into 8 major categories: 1) insomnia, 2) sleep-related breathing disorders, 3) hypersomnias of central origin, 4) circadian rhythm sleep disorders, 5) parasomnias, 6) sleep-related movement disorders, 7) isolated symptoms, and 8) other sleep disorders. Several sleep disorders, including obstructive sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder, sleepwalking, REM sleep behavior disorder, and narcolepsy, may be comorbid or possibly mimic numerous psychiatric disorders, and can even occur due to psychiatric pharmacotherapy. Moreover, sleep disorders may exacerbate underlying psychiatric disorders when left untreated. Therefore, psychiatrists should pay attention to the intimate relationship between sleep disorders and psychiatric symptoms. Sleep psychiatry is an academic field focusing on interrelations between sleep medicine and psychiatry. This mini-review summarizes recent findings in sleep psychiatry. Future research on the bidirectional relation between sleep disturbance and psychiatric symptoms will shed light on the pathophysiological view of psychiatric disorders and sleep disorders.
Optimal treatment of obstructive sleep apnea and excessive sleepiness.
Rosenberg Russell,Doghramji Paul
Advances in therapy
INTRODUCTION:Collapsibility of the upper airway in obstructive sleep apnea (OSA) causes repeated arousals from sleep, decreased oxygen saturation of the blood, and excessive sleepiness (ES). Patients with OSA are at increased risk of cardiovascular and cerebrovascular disease, and experience occupational and vehicular accidents more frequently than the general population. Furthermore, the life expectancy of patients with untreated OSA is significantly reduced. METHODS:A MEDLINE search of articles published between 2003 and 2008 was conducted using the search terms: obstructive sleep apnea [ti/ab] AND treatment; obstructive sleep apnoea [ti/ab] AND treatment; and excessive sleepiness [ti/ab] AND treatment. Searches were limited to articles in English; clinical trials; meta-analyses; practice guidelines; randomized, controlled trials; and reviews. RESULTS:Continuous positive airway pressure (CPAP) is the reference-standard treatment for patients with OSA. CPAP addresses the symptoms of OSA and reduces the risk of heart disease and depression associated with this sleep disorder. However, the efficacy of CPAP is contingent on patient adherence, and >or=4 hours of therapy per night are required for patients with OSA to experience significant clinical benefits. However, reports of nonadherence to CPAP therapy range from 29% to 83%. Other therapies are available for patients who refuse or cannot adhere to CPAP treatment, including dental devices and surgery, but these treatments are generally considered to be less efficacious. A significant number of patients continue to experience residual ES despite CPAP treatment. Pharmacologic therapies, eg, modafinil and armodafinil, may be of use in patients with OSA to improve tolerance with CPAP or to address residual ES. CONCLUSION:There are a variety of treatments available for patients with OSA. Successful treatment involves encouraging patient compliance with CPAP or oral appliances. Primary-care physicians play a crucial role in recognizing this disorder and ensuring the best possible outcome through support and education.
10.1007/s12325-009-0016-7
The roles of depression and anxiety in the understanding and treatment of Obstructive Sleep Apnea Syndrome.
Andrews Jonathan G,Oei Tian P S
Clinical psychology review
Obstructive Sleep Apnea Syndrome (OSAS) is a debilitating condition stemming from disruption to the respiratory system during sleep. At present, the nature of the relationship between OSAS and mood, specifically depression and anxiety, is still unclear. The purpose of this paper is to shed some light on this relationship. PsycINFO was used to locate relevant papers on this topic. This literature search formed the basis of our investigation. Results showed that the anxiety and depression methodology is weak. It is now clear that there is an urgent need to better understand the roles of anxiety and depression in OSAS. For example, the research literature suggests that depression and anxiety covary with OSAS. However, because of methodological issues, such as difficulties involved in diagnosis and the use of inappropriate instruments, this conclusion remains tenuous. Future directions are discussed.
10.1016/j.cpr.2004.08.002
[Sleepiness, continuous positive airway pressure and the obstructive sleep apnea hypopnea syndrome].
Lerousseau L
Revue des maladies respiratoires
Excessive daytime sleepiness is a major symptom in cases of the obstructive sleep apnea-hypopnea syndrome. Most often, it is vastly improved by treatment with continuous positive airway pressure (CPAP). The most effective way to confirm its disappearance is through wakefulness maintenance testing. If residual sleepiness remains, despite CPAP, further diagnostic investigation must be carried out. Firstly, it must be assessed whether the treatment is fully effective (apnea hypopnea index<10/h) by examining flow limitations under treatment (polysomnography) and whether it is sufficiently used (>6h/night). If this is the case, the possibility of other situations responsible for excessive daytime sleepiness must be reviewed and eliminated, whether they are depression, sleep insufficiency, use of intoxicants, obesity, restless legs syndrome, or circadian sleep-wake cycle disorder. If not, the multiple sleep latency tests make it possible to assess sleepiness (latency<8min) and can lead to a diagnosis of central hypersomnia (narcolepsy, idiopathic hypersomnia, hypersomnia due to a medical pathology). In some rare cases (about 6% of patients) investigations will reveal central hypersomnia due to the obstructive sleep apnea-hypopnea syndrome or "lesional" hypersomnia due to intermittent hypoxia. Since 2011, medications treating excessive sleepiness have had marketing authorization only for narcolepsy in France. However, they can be administered by way of derogation to other neurological hypersomnias on prescription by a reference centre or a centre with expertise in hypersomnia.
10.1016/j.rmr.2017.04.005
2018 Year in Review: Sleep.
Carlin Brian W
Respiratory care
Sleep-disordered breathing affects a significant portion of the population worldwide. It is associated with many comorbid conditions, including heart failure and depression. Advances in the field regarding the diagnosis and treatment of sleep-disordered breathing are occurring on an increasing basis. This review will discuss the latest findings in the field with an emphasis on people who have obstructive sleep apnea.
10.4187/respcare.07063
Depression and Obstructive Sleep Apnea (OSA).
Schröder Carmen M,O'Hara Ruth
Annals of general psychiatry
For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea (OSA). Recently, Ohayon underscored the evidence for a link between these two disorders in the general population, showing that 800 out of 100,000 individuals had both, a breathing-related sleep disorder and a major depressive disorder, with up to 20% of the subjects presenting with one of these disorders also having the other. In some populations, depending on age, gender and other demographic and health characteristics, the prevalence of both disorders may be even higher: OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults. In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment. Furthermore, an undiagnosed OSA might be exacerbated by adjunct treatments to antidepressant medications, such as benzodiazepines. Increased awareness of the relationship between depression and OSA might significantly improve diagnostic accuracy as well as treatment outcome for both disorders. In this review, we will summarize important findings in the current literature regarding the association between depression and OSA, and the possible mechanisms by which both disorders interact. Implications for clinical practice will be discussed.
10.1186/1744-859X-4-13
Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI.
Khazaie Habibolah,Veronese Mattia,Noori Khadijeh,Emamian Farnoosh,Zarei Mojtaba,Ashkan Keyoumars,Leschziner Guy D,Eickhoff Claudia R,Eickhoff Simon B,Morrell Mary J,Osorio Ricardo S,Spiegelhalder Kai,Tahmasian Masoud,Rosenzweig Ivana
Neuroscience and biobehavioral reviews
Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.
10.1016/j.neubiorev.2017.03.013
Obstructive sleep apnea, inflammation, and cardiopulmonary disease.
Arter Jim L,Chi David S,M Girish,Fitzgerald S Matthew,Guha Bhuvana,Krishnaswamy Guha
Frontiers in bioscience : a journal and virtual library
Obstructive sleep apnea (OSA) occurs commonly in the U.S. population and is seen in both obese as well as non-obese individuals. OSA is a disease characterized by periodic upper airway collapse during sleep, which then results in either apnea, hypopnea, or both. The disorder leads to a variety of medical complications. Neuropsychiatric complications include daytime somnolence, cognitive dysfunction, and depression. Increased incidence of motor vehicle accidents has been documented in these patients and probably reflects disordered reflex mechanisms or excessive somnolence. More importantly, vascular disorders such as hypertension, stroke, congestive cardiac failure, arrhythmias, and atherosclerosis occur frequently in these patients. The lungs may be affected by pulmonary hypertension and worsening of asthma. Recent data from several laboratories demonstrate that obstructive sleep apnea is characterized by an inflammatory response. Cytokines are elaborated during the hypoxemic episodes leading to inflammatory responses as marked clinically by elevated C-reactive protein (CRP). As elevated CRP levels are considered markers of the acute phase response and characterize progression of vascular injury in coronary artery disease, it is likely that obstructive sleep apnea could lead to worsening of vasculopathy. Moreover, as inflammatory mechanisms regulate bronchial asthma, it is also likely that cytokines and superoxide radicals generated during hypoxemic episodes could exacerbate reactive airway disease. Patients with Cough, Obstructive sleep apnea, Rhinosinusitis, and Esophageal reflux clustered together can be categorized by the acronym, "CORE", syndrome. The purpose of this manuscript is to review the inflammatory responses that occur in patients with obstructive sleep apnea and relate them to the occurrence of cardiopulmonary disease.
Update on Research and Practices in Major Sleep Disorders: Part I. Obstructive Sleep Apnea Syndrome.
Chaiard Jindarat,Weaver Terri E
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing
PURPOSE:The purpose of this first of two review articles providing an update on sleep disorders was to examine the pathophysiology, epidemiology, and treatment of obstructive sleep apnea (OSA). OSA is a common sleep disorder whose prevalence is similar to asthma. As with other sleep disorders, OSA has a broad impact on individuals, affecting their daily behaviors, cognitive abilities, and performance, and putting them at increased risk for accidents, mood disorders, cancer, cardiovascular disease, and hypertension. Thus, early recognition and management, much of which can be implemented by nurses, can reduce health and accident risks and improve daily functioning. METHODS:This narrative review utilized medical databases such as PubMed to identify relevant English language original and systematic review articles predominantly from peer-reviewed journals from 2012 to 2018. However, as background, findings from classic articles prior to 2012 were also included. CLINICAL RELEVANCE:OSA is a common condition with considerable impact on daily functioning and potential for accidents and serious comorbidities such as hypertension, cardiovascular disease, diabetes, and depressed mood. The impairments and comorbidities associated with OSA can be reduced through early detection, encouraging treatment, providing education about sleep and OSA, and, importantly, promoting adherence to the predominant therapy, positive airway pressure.
10.1111/jnu.12489
Beyond heart health: Consequences of obstructive sleep apnea.
Walia Harneet K
Cleveland Clinic journal of medicine
Obstructive sleep apnea (OSA) is a serious condition associated with impaired quality of life, depression, drowsy driving and motor vehicle accidents, metabolic disease, and cognitive decline. The mechanisms accounting for OSA and metabolic disease include hypoxia, sleep fragmentation, and systemic inflammation. OSA appears to advance cognitive decline, and the relationship between the 2 conditions may be bidirectional. Treatment of patients with continuous positive air pressure therapy improves many of the impaired outcomes associated with OSA. Greater awareness, screening, and treatment of patients with OSA can reduce the negative consequences associated with OSA.
10.3949/ccjm.86.s1.04
Pathogenesis of central and complex sleep apnoea.
Orr Jeremy E,Malhotra Atul,Sands Scott A
Respirology (Carlton, Vic.)
Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.
10.1111/resp.12927
Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis.
Povitz Marcus,Bolo Carmelle E,Heitman Steven J,Tsai Willis H,Wang JianLi,James Matthew T
PLoS medicine
BACKGROUND:Obstructive sleep apnea (OSA) is associated with increased morbidity and mortality, and decreased quality of life. Treatment with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is effective for many symptoms of OSA. However, it remains controversial whether treatment with CPAP or MAD also improves depressive symptoms. METHODS AND FINDINGS:We performed a systematic review and meta-analysis of randomized controlled trials that examined the effect of CPAP or MADs on depressive symptoms in patients with OSA. We searched Medline, EMBASE, the Cochrane Central Registry of Controlled Trials, and PsycINFO from the inception of the databases until August 15, 2014, for relevant articles. In a random effects meta-analysis of 19 identified trials, CPAP treatment resulted in an improvement in depressive symptoms compared to control, but with significant heterogeneity between trials (Q statistic, p<0.001; I(2) = 71.3%, 95% CI: 54%, 82%). CPAP treatment resulted in significantly greater improvement in depressive symptoms in the two trials with a higher burden of depression at baseline (meta-regression, p<0.001). The pooled standardized mean difference (SMD) in depressive symptoms with CPAP treatment in these two trial populations with baseline depression was 2.004 (95% CI: 1.387, 2.621), compared to 0.197 (95% CI: 0.059, 0.334) for 15 trials of populations without depression at baseline. Pooled estimates of the treatment effect of CPAP were greater in parallel arm trials than in crossover trials (meta-regression, p = 0.076). Random effects meta-analysis of five trials of MADs showed a significant improvement in depressive symptoms with MADs versus controls: SMD = 0.214 (95% CI: 0.026, 0.401) without significant heterogeneity (I(2) = 0%, 95% CI: 0%, 79%). Studies were limited by the use of depressive symptom scales that have not been validated specifically in people with OSA. CONCLUSIONS:CPAP and MADs may be useful components of treatment of depressive symptoms in individuals with OSA and depression. The efficacy of CPAP and MADs compared to standard therapies for depression is unknown. Please see later in the article for the Editors' Summary.
10.1371/journal.pmed.1001762
Obstructive sleep apnea: personal, societal, public health, and legal implications.
Morsy Nesreen E,Farrag Nesrine S,Zaki Nevin F W,Badawy Ahmad Y,Abdelhafez Sayed A,El-Gilany Abdel-Hady,El Shafey Mohsen Mohammed,Pandi-Perumal Seithikurippu R,Spence David Warren,BaHammam Ahmed S
Reviews on environmental health
Introduction Obstructive sleep apnea (OSA) is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA is reported to be associated with cognitive dysfunction, impaired productivity at the workplace and in an increased risk of motor vehicle accidents (MVAs) resulting in injury and fatality. Other consequences of OSA include, but are not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world. Many driving license regulations have been developed to reduce MVAs among OSA patients. Methods Studies of the personal, societal, public health, and legal aspects of OSA are reviewed. Data were collected through the following databases: MEDLINE, Google Scholar, Scopus, SAGE Research Methods, and ScienceDirect. Conclusion OSA leads to worsening of patients' personal relationships, decreasing work productivity, and increasing occupational accidents as well as MVAs. The costs of undiagnosed and untreated OSA to healthcare organizations are excessive. Thus, proper management of OSA will benefit not only the patient but will also provide widespread benefits to the society as a whole.
10.1515/reveh-2018-0068
Obstructive sleep apnea and other sleep-related syndromes.
Paiva Teresa,Attarian Hrayr
Handbook of clinical neurology
Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity.
10.1016/B978-0-7020-4086-3.00018-7
Untreated obstructive sleep apnea and the risk for serious long-term adverse outcomes: a systematic review.
Kendzerska Tetyana,Mollayeva Tatyana,Gershon Andrea S,Leung Richard S,Hawker Gillian,Tomlinson George
Sleep medicine reviews
BACKGROUND:Reports on the association between obstructive sleep apnea (OSA) and risk of death, cardiovascular (CV) events, diabetes and depression have been inconsistent. METHODS:We conducted a systematic review of the prognostic value of clinical and polysomnographic (PSG) characteristics of OSA for adverse long-term outcomes of untreated OSA in adult patients. A comprehensive search strategy for prognosis studies, OSA, CV events, mortality, depression and diabetes was developed in collaboration with a medical information specialist. All English language studies, from Jan 1999 to Dec 2011, with longitudinal design in adults with OSA diagnosed by PSG recording, found through Medline, Embase and bibliographies of identified articles, were considered eligible. Quality was assessed using published guidelines. RESULTS:Among 26 articles, ten evaluated the association of OSA with mortality, 9 with a composite CV outcome, 4 with stroke, 2 with diabetes and 1 with depression. Significant relationships between the apnea-hypopnea index (AHI) and outcomes of interest were reported in 18 studies: seven for all-cause mortality, six for composite CV events, three for stroke, one for diabetes and one for depression. The effect of AHI was attenuated by female gender, older age, absence of daytime sleepiness and higher body mass index. Due to clinical heterogeneity between studies, meta-analyses were not performed. CONCLUSION:Evidence exists in men for a relationship between OSA and all-cause mortality and a composite CV outcome. Associations between OSA and other outcomes remain uncertain. Among OSA-specific markers, only AHI was a consistent predictor. Other consistent predictors were traditional CV risk factors. Research is required to identify effect modifiers and the predictive ability of various AHI threshold values and hypopnea definitions. An enhanced set of OSA-specific predictors will allow better risk stratification to guide OSA treatment.
10.1016/j.smrv.2013.01.003
An Updated Review on the Relationship of Depressive Symptoms in Obstructive Sleep Apnea and Continuous Positive Airway Pressure.
Aftab Zarmeena,Anthony Adarsh Thomas,Rahmat Shermeen,Sangle Prerna,Khan Safeera
Cureus
Obstructive sleep apnea (OSA) is a common sleep disorder occurring across all age groups, gender, and is multifactorial. The episodic decrease in airflow during sleep results in hypoxia and hypercapnia over time, resulting in morning headache, systemic and pulmonary hypertension, and polycythemia. Fragmentation of sleep at night-time cause daytime somnolence, fatigue, memory problems, and mood symptoms such as depression and anxiety. These secondary mood symptoms could be easily missed by healthcare providers as the primary disorder resulting in unnecessary anti-depressants' prescription. This study investigates the effect of continuous airway pressure (CPAP) on depressive symptoms of OSA. We used PubMed, PubMed Central (PMC), and MEDLINE for data collection. We used OSA, depression, anxiety, mood symptoms, psychological symptoms, and CPAP as the keywords, both alone and in combination. The search ended on November 5, 2020, and it was limited to the year 2010 until the day of the search. However, a few of the papers published earlier than 2010 were also included to have better insight into some aspects of the topic. We included articles measuring the impact of CPAP on mood symptoms using any one of the validated scales, such as the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS), or Hamilton Depression Scale (HAM-D). Our initial searches yielded 131 articles. Twenty-one of the 131 papers satisfied the review's criteria. Four studies out of 21 revealed no improvement in OSA-related mood symptoms with CPAP therapy, whereas the others reported beneficial effects on mood, daytime sleepiness, cognition, and patient quality of life.
10.7759/cureus.15907
Obstructive sleep apnea and depression.
Baran Alp Sinan,Richert Allen C
CNS spectrums
Is there an association between obstructive sleep apnea (OSA) and depression? OSA is a common breathing-related sleep disorder. There have been reports that depressive symptoms can be associated with this sleep disorder. A number of investigations have addressed this issue. Although some have found no correlation, most studies have concluded that there is an association between OSA and depressive symptoms. Other investigations have shown that depressive symptoms improve with treatment of OSA, and that untreated OSA may contribute to treatment resistance in some cases of mood disorders. Within the framework of current psychiatric diagnostic criteria, the depressive symptoms associated with OSA can be viewed as a combination of a mood disorder secondary to a primary medical condition and an adjustment disorder with depressed mood. The question of whether OSA causes depressive symptoms can perhaps be best answered by viewing OSA and depression as having certain symptoms that are common to both disorders.
Obstructive sleep apnea.
Wiegand L,Zwillich C W
Disease-a-month : DM
The high prevalence of obstructive sleep apnea (OSA) has only recently been appreciated, in part because the symptoms and signs of chronic sleep disruption are often overlooked in spite of their debilitating consequences. They typically develop insidiously during a period of years. We now know that the lives of millions of people each year are significantly impaired by the sequelae of OSA. Many of these patients go unrecognized, with tremendous medical and economic consequences for individual patients and for society. Evidence indicates that chronic, heavy snoring may be associated with increased long-term cardiovascular and neurophysiologic morbidity. Therefore considerable interest lies in the study of the epidemiology and the natural history of these related disorders. The fundamental problem in OSA is the periodic collapse of the pharyngeal airway during sleep. The pathophysiology of this phenomenon is reviewed in some detail. During apneas caused by obstruction, airflow is impeded by the collapsed pharynx in spite of continued effort to breathe. This causes progressive asphyxia, which increasingly stimulates breathing efforts against the collapsed airway, typically until the person is awakened. Hypopneas predominate in some patients and are caused by partial pharyngeal collapse. The clinical sequelae of OSA relate to the cumulative effects of exposure to periodic asphyxia and to sleep fragmentation caused by apneas and hypopneas. Some patients with frequent, brief apneas and hypopneas and normal underlying cardiopulmonary function may have considerable sleep disruption without much exposure to nocturnal hypoxia. Patients with sleep apnea often have excessive daytime sleepiness. As the disorder progresses, sleepiness becomes increasingly irresistible and dangerous, and patients develop cognitive dysfunction, inability to concentrate, memory and judgment impairment, irritability, and depression. These problems may lead to family and social problems and job loss. Cardiac and vascular morbidity in OSA may include systemic hypertension, cardiac arrhythmias, pulmonary hypertension, cor pulmonale, left ventricular dysfunction, stroke, and sudden death. The challenge for the clinician is to routinely consider the diagnosis and to incorporate several basic questions in the historical review of systems regarding daytime or inappropriate sleepiness. The diagnosis of OSA is made with polysomnography, and the decision to treat is based on an overall assessment of the severity of sleep-disordered breathing, sleep fragmentation, and associated clinical sequelae. The therapeutic options for the management of OSA are reviewed. Recognition and appropriate treatment of OSA and related disorders will often significantly enhance the patient's quality of life, overall health, productivity, and safety on the highways.
10.1016/0011-5029(94)90013-2
Obstructive sleep apnea.
Qureshi Asher,Ballard Robert D
The Journal of allergy and clinical immunology
Obstructive sleep apnea is an increasingly well-recognized disease characterized by periodic collapse of the upper airway during sleep. This leads to either complete or partial obstruction of the airway, resulting in apneas, hypopneas, or both. This disorder causes daytime somnolence, neurocognitive defects, and depression. It affects almost every system in the body, resulting in an increased incidence of hypertension, cardiovascular disease, stroke, pulmonary hypertension, cardiac arrhythmias, and altered immune function. It also increases the risk of having an accident, presumably as a result of associated somnolence. The gold standard for the diagnosis of sleep apnea is an overnight polysomnogram. Split-night studies are becoming increasingly common and allow for quicker implementation of therapy at a reduced cost. Treatment options for sleep apnea include weight loss, positional therapy, oral devices, continuous positive airway pressure (CPAP), and upper airway surgery. CPAP is the most efficacious and widely used therapy. Its complications include nasal congestion or dryness, mask discomfort, and claustrophobia. Heated humidifiers, newer types of masks, and nasal steroids have improved tolerance of this therapy. Bilevel positive-pressure therapy can be considered for patients who find it difficult to exhale against the consistently increased pressure of CPAP. The disease requires aggressive treatment to improve quality of life and prevent its complications.
10.1016/j.jaci.2003.08.031
Obstructive sleep apnea and depression: a review.
Ejaz Shakir M,Khawaja Imran S,Bhatia Subhash,Hurwitz Thomas D
Innovations in clinical neuroscience
Obstructive sleep apnea is a common sleep disorder associated with several medical conditions, increased risk of motor vehicle accidents, and overall healthcare expenditure. There is higher prevalence of depression in people with obstructive sleep apnea in both clinical and community samples. Many symptoms of depression and obstructive sleep apnea overlap causing under-diagnosis of obstructive sleep apnea in depressed patients. Sleep problems, including obstructive sleep apnea, are rarely assessed on a regular basis in patients with depressive disorders, but they may be responsible for antidepressant treatment failure. The mechanism of the relationship between obstructive sleep apnea and depression is complex and remains unclear. Though some studies suggest a mutual relationship, the relationship remains unclear. Several possible pathophysiological mechanisms could explain how obstructive sleep apnea can cause or worsen depression. Increased knowledge of the relationship between obstructive sleep apnea and depression might significantly improve diagnostic accuracy as well as treatment outcomes for both obstructive sleep apnea and depression.
Depressive Symptoms in Comorbid Obstructive Sleep Apnea and Insomnia: An Integrative Review.
Western journal of nursing research
The purpose of this integrative review was to synthesize evidence concerning the relationship between comorbid obstructive sleep apnea and insomnia (OSA+I), and depressive symptoms. OSA and insomnia are common sleep disorders, recently comorbid OSA+I has been recognized as prevalent in adults. Although each sleep disorder increases the risk and severity of depressive symptoms, the effect of comorbid OSA+I on depressive symptoms remains unclear. A systematic search of PubMed, CINAHL, and PsycINFO identified 15 data-based studies. All the studies were observational with either a cross-sectional (n = 14) or a case-control design (n = 1). Study quality was assessed. Most of the studies (n = 14) indicated that comorbid OSA+I had an additive role on depressive symptoms. Insomnia appeared to have a more important role than OSA in increasing the severity of depressive symptoms in persons with comorbid OSA+I.
10.1177/0193945921989656
Obstructive sleep apnea and depression.
Harris Melanie,Glozier Nick,Ratnavadivel Rajeev,Grunstein Ronald R
Sleep medicine reviews
There are high rates of depression in people with obstructive sleep apnea (OSA) in both community and clinical populations. A large community study reported a rate of 17% and reports for sleep clinic samples range between 21% and 41%. A large cohort study found OSA to be a risk factor for depression, but we are unaware of any longitudinal study of the reverse association. However correlations have not generally been found in smaller studies. Well-designed longitudinal studies are needed to examine temporal relationships between the two conditions and further research is needed to establish the role of confounders, and effect modifiers such as gender, in any apparent relationship. Symptoms common to OSA and depression, such as sleepiness and fatigue, are obstacles to determining the presence and severity of one condition in the presence of the other, in research and clinically. Sleep clinicians are advised to consider depression as a likely cause of sleepiness and fatigue. Several possible causal mechanisms linking OSA and depression have been proposed but not established. Patients who have depression as well as OSA appear worse off than those with OSA only, and depressive symptoms persist in at least some patients in short term studies of treatment for OSA. Direct treatment of depression in OSA might improve acceptance of therapy, reduce sleepiness and fatigue and improve quality of life, but intervention trials are required to answer this question.
10.1016/j.smrv.2009.04.001
Comorbid depression in obstructive sleep apnea: an under-recognized association.
BaHammam Ahmed S,Kendzerska Tetyana,Gupta Ravi,Ramasubramanian Chellamuthu,Neubauer David N,Narasimhan Meera,Pandi-Perumal Seithikurippu R,Moscovitch Adam
Sleep & breathing = Schlaf & Atmung
BACKGROUND:Obstructive sleep apnea (OSA) and depression may coexist in the same patient. This article aims to review the link between OSA and comorbid depression and critically evaluate the results of studies that assessed the correlation between OSA and depression, the impact of OSA treatment on comorbid depression, and the impact of comorbid depression on continuous positive airway pressure (CPAP) adherence. METHODS:An integrative review was conducted on English language studies and reports that assessed the relationship between OSA and depression. Studies were identified by searching PubMed, Web of Science and Google Scholar databases, and reference lists of included studies. RESULTS:Generally, cross-sectional studies show a higher prevalence of depression among OSA patients with both community and sleep disorder clinic samples. Nevertheless, the relationship between OSA and depression is complicated by the fact that the disorders have overlapping symptoms. Longitudinal studies demonstrate an increased risk of developing depression among people with OSA, as well as an association between OSA severity and the likelihood of developing depression. On the other hand, studies assessing the impact of CPAP therapy on depression among OSA patients report conflicting results. Therefore, it is essential to consider how the disorders affect one another and to understand the clinical consequences of treating each disorder in isolation. CONCLUSION:Depression is prevalent among patients with OSA both in the community and in sleep disorder clinics. Clinicians in general should be aware of this significant association and should aim to treat both disorders.
10.1007/s11325-015-1223-x
Depression and anxiety in obstructive sleep apnea syndrome: a review.
Saunamäki T,Jehkonen M
Acta neurologica Scandinavica
OBJECTIVE - To provide an update on recent research on depression and anxiety in obstructive sleep apnea syndrome (OSAS). METHODS - A review was carried out on reports drawn from MEDLINE and PSYCHLIT (January 1995-June 2006) and identified from their list of references. The selection criteria were met by 55 articles. RESULTS - Sample sizes in the reviewed studies varied widely and consisted mainly of working age men. Depression and anxiety were mostly evaluated with commonly used mood scales; only a few studies provided a psychiatric diagnosis. Prevalence figures fluctuated considerably for both depression (7-63%) and anxiety (11-70%). The effect of the continuous positive airway pressure (CPAP) on mood was inconsistent. CONCLUSIONS - Variations in the prevalence of depression and anxiety are affected by patient characteristics, mood assessment methods, and overlap between mood alterations and OSAS-related symptoms. CPAP might improve mood alterations but more long-term follow-up studies are needed to verify the effectiveness.
10.1111/j.1600-0404.2007.00901.x
Sleep disorders in geriatric patients.
Wooten V
Clinics in geriatric medicine
The elderly have more organic sleep problems disturbing sleep and contributing to insomnia than younger individuals. The most common disorders afflicting the elderly are obstructive sleep apnea, restless legs syndrome, and nocturnal myoclonus. Poor sleep habits often aggravate or contribute to the ongoing difficulty with sleeping. In the depressed elderly, characteristic EEG changes occur that may help distinguish major depression from pseudodementia; however, it should be considered that pseudodementia may be a harbinger of primary dementia. A careful sleep history and often evaluation by polysomnography are central to the management of sleep problems in the elderly. In conjunction with treatment of any underlying organic sleep disorders, brief administration of short-acting benzodiazepine sedatives for sleep onset insomnia or rapid-acting intermediate half-life benzodiazepines for sleep maintenance insomnia can be quite helpful in the elderly, especially if behavioral techniques also are employed. Elimination of medications, alcohol, and caffeine, which disturb sleep, is also an important part of the treatment approach.
Sleep disorders and non-sleep circadian disorders predict depression: A systematic review and meta-analysis of longitudinal studies.
Zhang Mi-Mi,Ma Yan,Du Lan-Ting,Wang Ke,Li Zhe,Zhu Weili,Sun Yu-Hui,Lu Lin,Bao Yan-Ping,Li Su-Xia
Neuroscience and biobehavioral reviews
Patients with depression often suffer from sleep disorders and non-sleep circadian disorders. However, whether they precede and predict subsequent depression is unclear. We conducted a meta-analysis of studies on sleep disorders and non-sleep circadian disorders. We found insomnia, hypersomnia, short and long sleep duration, obstructive sleep apnea, restless legs syndrome and eveningness orientation at baseline all led to subsequent depression. Those with propensity to late meal patterns, heightened levels of cortisol in awakening response and low robustness of rest-activity rhythm at baseline had higher risks for later depression. Among insomnia subtypes, difficulty initiating sleep and difficulty maintaining sleep predicted future depression. Notably, persistent insomnia at baseline contributed to more than two-fold risk of incident depression compared to insomnia. Moreover, insomnia symptom numbers showed dose-dependent relationship with the incident depression. In conclusion, different types of sleep disorders and non-sleep circadian disorders were proven to be risk factors of subsequent depression, and mechanisms underlying the relationship between sleep disorders, non-sleep circadian disorders and subsequent depression should be further elucidated in the future.
10.1016/j.neubiorev.2022.104532
Obstructive sleep apnea and depression: A systematic review and meta-analysis.
Edwards Cass,Almeida Osvaldo P,Ford Andrew H
Maturitas
INTRODUCTION:The present study aimed to review the association between obstructive sleep apnea (OSA) and depression and compare the prevalence of depression among people with and without OSA. METHODS:Systematic review and meta-analysis following PRISMA guidelines. We searched for papers published between 1 January 2010 and 20 October 2019 listed on the following databases: Embase, Ovid MEDLINER(R) and PsychINFO. The search terms included a combination of keywords related to sleep apnea and depression. We also completed a manual search of the references listed in the articles retrieved and grouped them according to study design: cross-sectional, case-control and longitudinal. Scale scores were standardised for comparison. RESULTS:Our search strategy yielded 1158 papers, of which 34 were considered suitable of review and 11 reported data that could be used for meta-analysis. Data from the 6 cross-sectional studies found no compelling evidence of an association between OSA and depression (odds ratio = 1.12, 95 % confidence interval, 95 %CI = 0.78, 1.47), but the meta-analysis of 5 longitudinal studies indicated that people with OSA were at greater risk of developing depression during follow-up than those without OSA (non-specific risk ratio (RR) = 2.18, 95 %CI = 1.47, 2.88), although there was evidence of high study heterogeneity (I = 72.8 %). DISCUSSION:The results of this systematic review and meta-analysis of observational studies is consistent with the hypothesis that OSA may increase the risk of depression. Sample characteristics and various methodological issues create uncertainty about the validity and generalizability of these associations.
10.1016/j.maturitas.2020.06.002
Obstructive sleep apnea and psychiatric disorders: a systematic review.
Gupta Madhulika A,Simpson Fiona C
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES:Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. METHODS:A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. RESULTS:The search retrieved 47 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insufficient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. CONCLUSIONS:OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes.
10.5664/jcsm.4466
Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms.
Kerner Nancy A,Roose Steven P
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Obstructive sleep apnea (OSA) is highly prevalent but very frequently undiagnosed. OSA is an independent risk factor for depression and cognitive impairment/dementia. Herein the authors review studies in the literature pertinent to the effects of OSA on the cerebral microvascular and neurovascular systems and present a model to describe the key pathophysiologic mechanisms that may underlie the associations, including hypoperfusion, endothelial dysfunction, and neuroinflammation. Intermittent hypoxia plays a critical role in initiating and amplifying these pathologic processes. Hypoperfusion and impaired cerebral vasomotor reactivity lead to the development or progression of cerebral small vessel disease (C-SVD). Hypoxemia exacerbates these processes, resulting in white matter lesions, white matter integrity abnormalities, and gray matter loss. Blood-brain barrier (BBB) hyperpermeability and neuroinflammation lead to altered synaptic plasticity, neuronal damage, and worsening C-SVD. Thus, OSA may initiate or amplify the pathologic processes of C-SVD and BBB dysfunction, resulting in the development or exacerbation of depressive symptoms and cognitive deficits. Given the evidence that adequate treatment of OSA with continuous positive airway pressure improves depression and neurocognitive functions, it is important to identify OSA when assessing patients with depression or cognitive impairment. Whether treatment of OSA changes the deteriorating trajectory of elderly patients with already-diagnosed vascular depression and cognitive impairment/dementia remains to be determined in randomized controlled trials.
10.1016/j.jagp.2016.01.134
Obstructive sleep apnea, depression and cognitive impairment.
Vanek Jakub,Prasko Jan,Genzor Samuel,Ociskova Marie,Kantor Krystof,Holubova Michaela,Slepecky Milos,Nesnidal Vlastimil,Kolek Antonin,Sova Milan
Sleep medicine
OBJECTIVE:Obstructive sleep apnea (OSA) is a severe disorder with a high prevalence. Psychiatric comorbidities, especially depressive symptoms and cognitive dysfunction, are often described in OSA patients. This narrative review aims to examine: (1) the relationship between obstructive sleep apnea syndrome (OSAS) and depressive and cognitive symptoms, and (2) the effect of OSAS treatment on psychiatric symptoms. METHOD:Articles that were published between January 1990 and August 2018 were searched and extracted via PubMed, and Web of Science databases. Authors analyzed the papers and its references using the following keywords: obstructive sleep apnea, depression, cognitive dysfunction, anxiety disorders, and continuous positive airway pressure (CPAP). A total of 632 articles were nominated. After the selection according to the inclusion and exclusion criteria, 172 articles were chosen. After complete inspection of the full texts, finally, 58 papers were selected. Secondary papers from the reference lists of the primarily designated papers were also searched, assessed for suitability, and added to the first list of the papers (n = 67). In total, 125 papers were included in this review. RESULTS:There is a significant overlap in depressive, anxious and OSA symptoms. Studies also show that attention, working memory, episodic memory, and executive functions are decreased in OSA. Conversely, most of verbal functions remain intact and variable results are found in psychomotor speed. Several studies implicated that in some fields of cognitive functions (eg, attention) deficit caused by untreated OSA can be irreversible and shows only partial recovery after a period of treatment with CPAP. CONCLUSIONS:Untreated OSA impacts affective disorders, and often leads to decline of cognitive functions or even leads to permanent brain damage. Further studies are needed to analyze the connection between OSA and affective disorders, anxiety disorders and its effect on cognitive functions more thoroughly, especially in the context of CPAP treatment.
10.1016/j.sleep.2020.03.017
Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis.
Garbarino Sergio,Bardwell Wayne A,Guglielmi Ottavia,Chiorri Carlo,Bonanni Enrica,Magnavita Nicola
Behavioral sleep medicine
: Obstructive sleep apnea (OSA) has been associated with mental disorders, but the strength of this association is unknown. The aim of our study was to investigate the association among OSA, depression, and anxiety in adults and to quantitatively summarize the results. : A literature search in Medline, PubMed, PsycInfo, Scopus, and Web of Science was conducted. Seventy-three articles were selected for study. : The pooled prevalence of depressive and anxious symptoms in OSA patients was 35% (95% CI, 28-41%) and 32% (95% CI, 22-42%), respectively. : The association between OSA, anxiety, and depression indicates the value of an early diagnosis and personalized treatment of OSA to improve mental disorders conditioning compliance to therapy. These conditions share a probably bidirectional relationship.
10.1080/15402002.2018.1545649
Depression and obstructive sleep apnea.
Hobzova Milada,Prasko Jan,Vanek Jakub,Ociskova Marie,Genzor Samuel,Holubova Michaela,Grambal Ales,Latalova Klara
Neuro endocrinology letters
OBJECTIVE:Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses. METHOD:The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life". RESULTS:After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms. CONCLUSIONS:It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.
Clarifying the role of sleep in depression: A narrative review.
Pandi-Perumal Seithikurippu R,Monti Jaime M,Burman Deepa,Karthikeyan Ramanujam,BaHammam Ahmed S,Spence David Warren,Brown Gregory M,Narashimhan Meera
Psychiatry research
It has been established that 4.4 to 20% of the general population suffers from a major depressive disorder (MDD), which is frequently associated with a dysregulation of normal sleep-wake mechanisms. Disturbances of circadian rhythms are a cardinal feature of psychiatric dysfunctions, including MDD, which tends to indicate that biological clocks may play a role in their pathophysiology. Thus, episodes of depression and mania or hypomania can arise as a consequence of the disruption of zeitgebers (time cues). In addition, the habit of sleeping at a time that is out of phase with the body's other biological rhythms is a common finding in depressed patients. In this review, we have covered a vast area, emerging from human and animal studies, which supports the link between sleep and depression. In doing so, this paper covers a broad range of distinct mechanisms that may underlie the link between sleep and depression. This review further highlights the mechanisms that may underlie such link (e.g. circadian rhythm alterations, melatonin, and neuroinflammatory dysregulation), as well as evidence for a link between sleep and depression (e.g. objective findings of sleep during depressive episodes, effects of pharmacotherapy, chronotherapy, comorbidity of obstructive sleep apnea and depression), are presented.
10.1016/j.psychres.2020.113239
Association study between plasma GDNF and cognitive function in late-onset depression.
Wang Xiaoquan,Hou Zhenghua,Yuan Yonggui,Hou Gang,Liu Yang,Li Hailin,Zhang Zhijun
Journal of affective disorders
OBJECTIVE:Improving evidence suggest that neurotrophic growth factor systems might be involved in the pathophysiology of major depressive disorder (MDD). The glial cell line-derived neurotrophic factor (GDNF) is a neurotrophic factor from the transforming growth factor-β-family, which plays a role in the development and function of hippocampal cells. This study was aimed to test whether GDNF in plasma was abnormal in late-onset depression (LOD), and whether it was associated with the cognitive impairment of LOD. METHODS:The plasma GDNF levels in LOD patients (n=27) before antidepressant treatment and normal control subjects (n=28) were measured with the ELISA method. All subjects were assessed by neuropsychological tests and Hamilton Depression Rating Scale (HDRS). RESULTS:The performance of neuropsychological tests of the LOD group except TMT-B was significantly poorer than those of the control group. The plasma GDNF levels in LOD patients were significantly increased compared to control subjects (P<0.05). Furthermore, the increase of plasma GDNF level was significantly positively correlated with Digit Span Test backward score in LOD patients, and negatively associated with TMT-B performance. CONCLUSIONS:The findings suggest that LOD patients in acute phase have extensive impairments of cognitive function, and higher plasma GDNF might be involved in the pathogenesis of LOD, which may be associated with the cognitive dysfunction in LOD.
10.1016/j.jad.2011.03.043
A systematic review comparing clinical features in early age at onset and late age at onset late-life depression.
Grayson Louise,Thomas Alan
Journal of affective disorders
BACKGROUND:Although evidence suggests that there are neurobiological differences between unipolar depression in younger versus older adults, conflicting evidence exists about whether these manifest as clinically identifiable differences. METHOD:We conducted a systematic review of aetiological, phenomenological and outcome studies to examine the evidence for a distinction between early onset (EOD) and late onset (LOD) depression. A literature search was completed using the computer databases MEDLINE, EMBASE, PSYCHINFO and PUBMED for papers published between January 1982 and December 2012 which compared groups with EOD and LOD. Studies were included if they were of older people and compared symptoms, aetiological factors or outcomes. We conducted a quality assessment of included articles. RESULTS:We identified 23 articles which met entry criteria. The only clinical feature which was different between the groups was a higher frequency of a family history of mood disorders in EOD. LIMITATIONS:The number of studies identified was low and their quality was generally poor. CONCLUSIONS:Although neurobiological studies have reported differences between EOD and LOD, generally these do not appear to translate into identifiable distinguishing clinical features.
10.1016/j.jad.2013.03.021
Aromatase (CYP19A1) gene variants, sex steroid levels, and late-life depression.
Ancelin Marie-Laure,Norton Joanna,Canonico Marianne,Scarabin Pierre-Yves,Ritchie Karen,Ryan Joanne
Depression and anxiety
BACKGROUND:Sex differences in psychiatric disorders are common and could involve sex steroids. Aromatase, the product of the CYP19A1 gene, is the key enzyme in the conversion of androgen to estrogen. Whether CYP19A1 variants could be associated with depression differently in men and women has not been examined. METHODS:This population-based study included 405 men and 602 women aged ≥65 years. A clinical level of depression (DEP) was defined as having a score ≥16 on the Center for Epidemiology Studies Depression scale or a diagnosis of current major depression based on the Mini-International Neuropsychiatric Interview and according to DSM-IV criteria. Seven single-nucleotide polymorphisms (SNPs) spanning the CYP19A1 gene were genotyped and circulating levels of estradiol and testosterone were determined. Multivariable analyses were adjusted for age, body mass index, ischemic pathologies, cognitive impairment, and anxiety. RESULTS:Five SNPs were associated with DEP in women specifically and this varied according to a history of major depression (p-values .01 to .0005). Three SNPs were associated with an increased risk of late-life DEP in women without a history of major depression, while two SNPs were associated with a decreased DEP risk in women with a history of major depression and were also associated with higher estradiol levels. CONCLUSIONS:Variants of the CYP19A1 gene appear to be susceptibility factors for late-life depression in a sex-specific manner. The polymorphisms decreasing the risk of recurrent depression in postmenopausal women also influence estradiol levels.
10.1002/da.22974
Brain pathology and cognitive scores prior to onset of late-life depression.
International journal of geriatric psychiatry
OBJECTIVES:Understanding the biological changes that occur prior to onset of late-life depression (LLD) is key to its prevention. To investigate potential predictors of LLD, we assessed cognitive scores and neurodegenerative and vascular biomarkers in healthy older adults who later developed depression. METHODS:Longitudinal data from the Alzheimer's Disease Neuroimaging Initiative of 241 cognitively unimpaired and non-depressed older adults aged 56-90 at baseline with at least 4 years of follow-up were included. Participants were classified based on whether they developed an incident depression (n = 96) or not (n = 145). Cognitive measures of memory, executive functioning, and language, and biomarkers proposed to be related to LLD: hippocampal volume, white matter hyperintensity volume (WMH), and cortical and cerebrospinal fluid (CSF) amyloid beta levels, were compared between the incident depression and the never-depressed groups at four time points: at baseline, the visit prior to onset, at onset, and after the onset of depression. RESULTS:In the incident depression group, there was a mild decline in cognitive scores from baseline to the visit before depression onset compared with the never-depressed group. The cognitive differences between the groups became more marked after depression onset. Baseline cortical amyloid burden, CSF amyloid beta levels, and WMH were significant predictors of incident depression. Compared to the non-depressed group, hippocampal volume was not reduced before onset, but was reduced following depression. CONCLUSIONS:Amyloid pathology and WMH can predict future development of LLD in cognitively unimpaired individuals and may be involved in precipitating vulnerability for depression in older adults.
10.1002/gps.5686
Early-onset late-life depression: Association with body mass index, obesity, and treatment response.
Comprehensive psychoneuroendocrinology
Early-onset (EOD) and late-onset (LOD) late-life depression might differ in etiology, clinical features, and treatment response. While EOD is more frequently associated with a family history of affective disorders and personality aspects, LOD is thought to be more strongly driven by acquired cerebrovascular risk factors associated with vascular pathology, executive dysfunction, and poor treatment response. However, in a systematic review, EOD and LOD only differed in the frequency of affective disorders in the family history. We compared EOD versus LOD using medical records. In this retrospective chart review, elderly depressed patients (N = 108; mean age: 69.0 ± 7.2 years) were characterized by sociodemographic, psychiatric, and somatic variables and divided according to age-at-onset (cut-off: 60 years): EOD (N = 67, mean age-at-onset: 40.2 ± 13.6 years) and LOD (N = 41, 67.5 ± 6.3 years). A family history of affective disorders was more common in EOD than LOD patients (49.2% vs. 19.5%). EOD patients had a higher body mass index (mean: 27.0 kg/m vs. 23.1 kg/m) and were more often obese compared with LOD patients (20% vs. 0%). There were fewer treatment responders in the EOD group than in the LOD group on trend level significance (46.3% vs. 63.4%). Higher frequency of affective disorders in the family history is compatible with a greater genetic risk of EOD. The larger metabolic burden of EOD might stem from the longer duration of depressive illness.
10.1016/j.cpnec.2021.100096
Clinical remission of late-onset depression in elderly Chinese: a short-term outcome study.
Tam C W C,Lam L C W
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
OBJECTIVE:Better understanding of the relationship between executive and memory functions and treatment response in late-onset depression may improve our ability to identify those individuals who are less likely to benefit from traditional pharmacological interventions. This study aimed to investigate the remission rate in elderly Chinese people with late-onset depression, and to examine the predictors of outcomes. METHODS:Patients aged 60 years or older with late-onset depression without dementia were recruited into the study. Mood symptoms were assessed by the 24-item Hamilton Rating Scale for Depression and Neuropsychiatric Inventory at 12 and 24 weeks. Cognitive domains assessed included global cognitive function, episodic memory, executive functions, and processing speed. The clinical characteristics and cognitive scores were compared among the early remitters, late remitters, and non-remitters. RESULTS:Of the 105 subjects, 42 (40%) had remission at 12 weeks and were categorised as early remitters, 41 (39%) who did not remit at 12 weeks achieved remission at 24 weeks (late remitters), and 22 (21%) had not achieved remission at 24 weeks (non-remitters). Executive function, processing speed, episodic memory, apathy and depression severity were related to remission outcomes. Regression analyses found that severity of baseline apathy and depression were predictors of remission at 12 and 24 weeks, respectively. CONCLUSIONS:This study identified 2 subgroups of patients according to outcomes. One group with clinical characteristics similar to vascular depression achieved a late response to treatment. The other group were non-remitters who had features of depression-executive dysfunction syndrome, which might have underlying degenerative process and presented with the co-occurrence of depression and mild cognitive impairment.
Cognitive and functional impairment in Chinese elderly with late-onset depression.
Tam C W C,Lam L C W
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
OBJECTIVES. To investigate cognitive and functional impairment in Chinese elderly subjects with late-onset depression. METHODS. Subjects with late-onset depression and who were clinically non-demented were recruited. Their cognitive and functional scores were compared with those of cognitively normal elderly controls and elderly persons with mild cognitive impairment. Functional ability was assessed by the Disability Assessment for Dementia score. Various cognitive domains were assessed including global cognitive function, delayed episodic memory, working memory, and categorical verbal fluency test. RESULTS. A total of 105 depressed subjects and 324 non-depressed controls (149 normal elderly controls and 175 with mild cognitive impairment) were recruited. The depression group had significantly poorer performance in all cognitive assessments compared to the normal elderly control group. The depression group had a similar cognitive profile to those with mild cognitive impairment, except that its subjects had slightly better performance in the Categorical Verbal Fluency Test, delayed recall testing, and the Chinese version of the Alzheimer's Disease Assessment Scale-Cognitive subscale test. Depressed subjects had significantly lower functional scores in instrumental activities of daily living than the non-depressed, normal elderly controls, and those with mild cognitive impairment. CONCLUSIONS. Our results demonstrate that Chinese elderly with late-onset depression had cognitive impairments in multiple domains similar to those encountered in the age- and sex-matched non-depressed controls with mild cognitive impairment. However, their functional performance was significantly poorer than that in these controls. This study provided extensive characterisation of the range and depth of cognitive and functional impairments in elderly patients with late-onset depression.
Predictors of recurrence in remitted late-life depression.
Deng Yi,McQuoid Douglas R,Potter Guy G,Steffens David C,Albert Kimberly,Riddle Meghan,Beyer John L,Taylor Warren D
Depression and anxiety
BACKGROUND:Late-life depression (LLD) is associated with a fragile antidepressant response and high recurrence risk. This study examined what measures predict recurrence in remitted LLD. METHODS:Individuals of age 60 years or older with a Diagnostic and Statistical Manual - IV (DSM-IV) diagnosis of major depressive disorder were enrolled in the neurocognitive outcomes of depression in the elderly study. Participants received manualized antidepressant treatment and were followed longitudinally for an average of 5 years. Study analyses included participants who remitted. Measures included demographic and clinical measures, medical comorbidity, disability, life stress, social support, and neuropsychological testing. A subset underwent structural magnetic resonance imaging (MRI). RESULTS:Of 241 remitted elders, approximately over 4 years, 137 (56.8%) experienced recurrence and 104 (43.2%) maintained remission. In the final model, greater recurrence risk was associated with female sex (hazard ratio [HR] = 1.536; confidence interval [CI] = 1.027-2.297), younger age of onset (HR = 0.990; CI = 0.981-0.999), higher perceived stress (HR = 1.121; CI = 1.022-1.229), disability (HR = 1.060; CI = 1.005-1.119), and less support with activities (HR = 0.885; CI = 0.812-0.963). Recurrence risk was also associated with higher Montgomery-Asberg Depression Rating Scale (MADRS) scores prior to censoring (HR = 1.081; CI = 1.033-1.131) and baseline symptoms of suicidal thoughts by MADRS (HR = 1.175; CI = 1.002-1.377) and sadness by Center for Epidemiologic Studies-Depression (HR = 1.302; CI, 1.080-1.569). Sex, age of onset, and suicidal thoughts were no longer associated with recurrence in a model incorporating report of multiple prior episodes (HR = 2.107; CI = 1.252-3.548). Neither neuropsychological test performance nor MRI measures of aging pathology were associated with recurrence. CONCLUSIONS:Over half of the depressed elders who remitted experienced recurrence, mostly within 2 years. Multiple clinical and environmental measures predict recurrence risk. Work is needed to develop instruments that stratify risk.
10.1002/da.22772
Cognitive function, functional performance and severity of depression in Chinese older persons with late-onset depression.
Tam C W C,Lam L C W
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
OBJECTIVES. The relationship between cognitive status and depressive symptoms and their liability to cause functional decline are of clinical and public health importance as it appears to be common, frequently coexists, and may be treatable. This study examined the relationship of depression severity and cognitive performance and the impact of such an interaction on functional ability in Chinese elderly subjects with late-onset depression. METHODS. A total of 105 non-demented elderly patients with late-onset depression were recruited. Impairment in instrumental activities of daily living and severity of depression were respectively assessed with the Disability Assessment for Dementia scale and the 24-item Hamilton Depression Rating Scale. Various cognitive domains were assessed including global cognitive function, delayed episodic memory, and executive functions. The relationship between specific cognitive impairment and mood symptom severity was assessed. The clinical correlates of functional performance were also examined. RESULTS. Increasingly severe depression was associated with lower scores in the Mini-Mental State Examination, delayed recall, and poorer performance in the Trail Making Test-Part A (after adjusting for the effect of age and education). The severity of apathy correlated negatively with the Mini-Mental State Examination scores only. Among the depressed subjects, greater levels of depression and apathy, poorer performance in Trail Making Test-Part B, and mild parkinsonian signs were associated with lower functional scores. CONCLUSIONS. Lack of interest and motivation, depressive mood, compounded by behavioural abnormalities resulting from executive dysfunction, accounted for functional disability in elderly subjects with late-onset depression. These relationships may provide the background for developing interventions targeting functional deficits associated with specific cognitive dysfunctions and depression.
Age at onset and vascular pathology in late-life depression.
Paranthaman Raghupathy,Burns Alistair S,Cruickshank J Kennedy,Jackson Alan,Scott Marietta L J,Baldwin Robert C
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:There is considerable evidence to suggest that late-onset depression may be etiologically distinct from early-onset depression. The aim of this study was to compare vascular function and magnetic resonance imaging-defined brain ischemic changes between early-onset depressed (EOD) and late-onset depressed (LOD) subjects. DESIGN:Case-control study. PARTICIPANTS:Twenty-five subjects with late-life depression recruited from secondary care were divided into groups with EOD (<60 years, 11 subjects) and LOD (>60 years, 14 subjects). MEASURES:All subjects underwent a variety of vascular assessments including pulse wave analysis, pulse wave velocity, carotid intima media thickness (IMT), and magnetic resonance imaging of the brain to assess white matter hyperintensities. RESULTS:The mean age of LOD subjects was 71.3 ± 4.0 years and EOD was 73.6 ± 4.7 years (p = NS). There were no baseline differences in vascular risk or sociodemographic variables. LOD subjects had significantly higher common carotid IMT (EOD: 0.06 [0.01]; LOD: 0.09 [0.02], p = 0.02), carotid plaques (EOD: 2.1 [1.1]; LOD: 5.4 [3.9], p = 0.02), and peripheral augmentation index (EOD: 81.7 [7.9]; LOD: 96.2 [21.6], p = 0.04) when compared with early-onset subjects, indicating more vascular pathology. There were no group differences in white matter hyperintensities. Age at onset of depression was positively correlated with peripheral augmentation index, common carotid IMT, and plaque index. CONCLUSION:This study suggests that elderly subjects with LOD have greater vascular impairment than those with an early-onset illness. Whether preventing vascular disease at an earlier age may decrease the risk of last onset depression is a potential area for future research.
10.1097/JGP.0b013e318227f85c
Longitudinal Cognitive Outcomes of Clinical Phenotypes of Late-Life Depression.
Riddle Meghan,Potter Guy G,McQuoid Douglas R,Steffens David C,Beyer John L,Taylor Warren D
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:Late-life depression is associated with cognitive deficits and increased risk for cognitive decline. The purpose of the study was to determine whether clinical characteristics could serve as phenotypes informative of subsequent cognitive decline. Age at depression onset and antidepressant remission at 3 months (acute response) and 12 months (chronic response) were examined. METHODS:In a longitudinal study of late-life depression in an academic center, 273 depressed and 164 never-depressed community-dwelling elders aged 60 years or older were followed on average for over 5 years. Participants completed annual neuropsychological testing. Neuropsychological measures were converted to z-scores derived from the baseline performance of all participants. Cognitive domain scores at each time were then created by averaging z-scores across tests, grouped into domains of episodic memory, attention-working memory, verbal fluency, and executive function. RESULTS:Depressed participants exhibited poorer performance at baseline and greater subsequent decline in all domains. Early-onset depressed individuals exhibited a greater decline in all domains than late-onset or nondepressed groups. For remission, remitters and nonremitters at both 3 and 12 month exhibited greater decline in episodic memory and attention-working memory than nondepressed subjects. Three-month remitters also exhibited a greater decline in verbal fluency and executive function, whereas 12-month nonremitters exhibited greater decline in executive function than other groups. CONCLUSION:Consistent with past studies, depressed elders exhibit greater cognitive decline than nondepressed subjects, particularly individuals with early depression onset, supporting the theory that repeated depressive episodes may contribute to decline. Clinical remission is not associated with less cognitive decline.
10.1016/j.jagp.2017.03.016
C-reactive protein level in late-onset depression: A case-control study.
Mishra Dheerendra,Sardesai Ujwal,Razdan Ramghulam
Indian journal of psychiatry
BACKGROUND:Late-onset depression (LOD) is less responsive to standard antidepressant medication compared to early-onset depressive disorder. A group of early-onset depressive episode is less responsive to antidepressant medication, and immune dysregulation is critically involved in it. LOD has been associated with increased vascular risk factor and atherosclerosis and immune dysregulation is critically involved in vascular disease. We hypothesized that increased inflammatory activity may be associated with late-onset depressive disorders. AIM:The aim of this study is to study the C-reactive protein (CRP) levels in LOD compared with age-matched controls and association between CRP levels and severity of depressive episode. SETTINGS AND DESIGN:This was a case-control study at tertiary care psychiatry department. MATERIALS AND METHODS:Depressed patients (as per International Classification of Disease 10 Diagnostic and Research Criteria) of age >55 years were recruited and age-matched control participant were recruited after informed consent. A complete clinical assessment, assessment of vascular risk factors, blood sample for the evaluation of serum CRP was obtained, and baseline depression severity was measured on Hamilton Depression Rating Scale (HDRS). STATISTICAL ANALYSIS:The quantitative and qualitative variables were described as means, standard deviation, and value. The student's -test for parametric data and the mann-whitney test for nonparametric data spearman correlation coefficient method were used. RESULTS:The mean age of cases ( = 25) was 64.7 ± 5.8 years, and mean age of controls ( = 25) was 64.2 ± 3.7 years. Patients with current depressive disorders had 40% times higher levels of CRP than control. Baseline HDRS of cases was 18 ± 3. CRP level and depression severity shows strong positive ( = 0.935, = <0.001) correlation between CRP level and depression severity. CONCLUSION:LOD was associated with higher level of CRP compared to age-matched nondepressed patients. Raised CRP was associated with severity of depressive episode of LOD.
10.4103/psychiatry.IndianJPsychiatry_127_17
A comparative study of caregiver burden in late-onset depression and Alzheimer's disease.
Kazhungil Firoz,Velayudhan Rajmohan,Kumar Manoj,Thazhe Mangool Raghuram
Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society
BACKGROUND:Alzheimer's disease (AD) and major depressive disorder are the two most common psychogeriatric disorders. Late-onset depression (LOD) is the most common cause of emotional suffering in the elderly and is associated with a poor quality of life in caregivers. Although the burden on caregivers of individuals suffering from AD has been well studied, there is a paucity of comparative studies on caregiver burden between AD and LOD. The objectives of this study were to compare the caregiver burden in LOD and AD and to identify factors associated with caregiver burden in LOD. METHODS:The study included two groups of 25 patients and their caregivers. Group 1 consisted of LOD patients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, with onset after age 60, and their caregivers. Group 2 consisted of AD patients and their caregivers. Caregiver burden was assessed by the Zarit Caregiver Burden Interview. Sociodemographic and clinical correlates of caregiver burden in LOD and AD were analyzed. RESULTS:There was no significant difference in caregiver burden between LOD and AD (P = 0.27). In LOD, the factors positively associated with caregiver burden included the patient's education and the caregiver being a woman, married, unmarried, and a student. Factors negatively associated with caregiver burden included being the son of the patient and high income status. Multivariate stepwise regression analysis showed that caregiver burden in AD is predicted by the Behavioural Pathology in Alzheimer's Disease Scale score, income, presence of diabetes, and in-laws as caregivers (adjusted R(2) = 0.847, P < 0.001). In LOD, caregiver burden is predicted by income, the patient's education, and whether the caregiver is a student or spouse (adjusted R(2) = 0.388, P < 0.001). CONCLUSION:This study highlights the finding that caregiver burden in LOD is comparable to that in AD and requires interventions to reduce the caregiver strain.
10.1111/psyg.12141
A Comparative Study of Regional Homogeneity of Resting-State fMRI Between the Early-Onset and Late-Onset Recurrent Depression in Adults.
Frontiers in psychology
Background:Neurobiological mechanisms underlying the recurrence of major depressive disorder (MDD) at different ages are unclear, and this study used the regional homogeneity (ReHo) index to compare whether there are differences between early onset recurrent depression (EORD) and late onset recurrent depression (LORD). Methods:Eighteen EORD patients, 18 LORD patients, 18 young healthy controls (HCs), and 18 older HCs were included in the rs-fMRI scans. ReHo observational metrics were used for image analysis and further correlation of differential brain regions with clinical symptoms was analyzed. Results:ANOVA analysis revealed significant differences between the four groups in ReHo values in the prefrontal, parietal, temporal lobes, and insula. Compared with EORD, the LORD had higher ReHo in the right fusiform gyrus/right middle temporal gyrus, left middle temporal gyrus/left angular gyrus, and right middle temporal gyrus/right angular gyrus, and lower ReHo in the right inferior frontal gyrus/right insula and left superior temporal gyrus/left insula. Compared with young HCs, the EORD had higher ReHo in the right inferior frontal gyrus/right insula, left superior temporal gyrus/left insula, and left rolandic operculum gyrus/left superior temporal gyrus, and lower ReHo in the left inferior parietal lobule, right inferior parietal lobule, and left middle temporal gyrus/left angular gyrus. Compared with old HCs, the LORD had higher ReHo in the right fusiform gyrus/right middle temporal gyrus, right middle temporal gyrus/right angular gyrus, and left rolandic operculum gyrus/left superior temporal gyrus, and lower ReHo in the right inferior frontal gyrus/right insula. ReHo in the right inferior frontal gyrus/right insula of patients with LORD was negatively correlated with the severity of 17-item Hamilton Rating Scale for Depression (HAMD-17) scores ( = -0.5778, = 0.0120). Conclusion:Adult EORD and LORD patients of different ages have abnormal neuronal functional activity in some brain regions, with differences closely related to the default mode network (DMN) and the salience network (SN), and patients of each age group exhibit ReHo abnormalities relative to matched HCs. Clinical Trial Registration:[http://www.chictr.org.cn/], [ChiCTR1800014277].
10.3389/fpsyg.2022.849847
Six-month Follow-up of Cognitive Impairment and Depressive Symptoms in Late-onset Depression.
Wong M M C,Chan C F,Li S W,Lau Y M
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
OBJECTIVE:To assess cognitive performance in elderly depressed patients following treatment for 6 months. Remission rate of depression after 6 months of treatment was calculated. METHODS:The study was performed in a consecutive group of patients aged ≥ 65 years with late-onset depression. Severity of depression was assessed by the Hamilton Depression Scale, cognitive performance by the Hong Kong Montreal Cognitive Assessment, and functional level by the Instrumental Activities of Daily Living Scale. RESULTS:A total of 52 patients were recruited. In all, 28 (53.8%) were found to have cognitive impairment at baseline and 8 (28.6%) of them had improvement after 6 months. This cognitively impaired group was older and had a lower Instrumental Activities of Daily Living Scale score. The remission rate of depression was 61.5%. CONCLUSIONS:Cognitive impairment constituted a stable feature in a considerable number of elderly patients with depression. About two-thirds of patients achieved remission of depression after 6 months of treatment.
Melancholia in later life: late and early onset differences in presentation, course, and dementia risk.
Sachs-Ericsson Natalie,Moxley Jerad H,Corsentino Elizabeth,Rushing Nicole Collins,Sheffler Julia,Selby Edward A,Gotlib Ian,Steffens David C
International journal of geriatric psychiatry
OBJECTIVES:Depression is a risk factor for cognitive decline and dementia. This risk may vary with age of onset and depression subtype. Late onset depression (LOD, 60 years and older) is associated with more cognitive decline, whereas early onset depression (EOD, before 60 years) is associated with more residual depressive symptoms. Potential differences may reflect divergent etiologies. These onset differences, however, have not been examined in the melancholic subtype of depression in older adults. METHODS:Data were obtained from the Neurocognitive Outcomes of Depression in the Elderly study. Participants (N = 284, 73% EOD-melancholic (EOD-M) and 27% LOD-melancholic (LOD-M)) were followed up over 3 years. Factor analyses examined differences in baseline depressive symptoms. Hierarchical linear growth curve models examined changes in depressive symptoms (Montgomery-Asberg Depression Rating Scale) and cognition (mini mental state examination). An annual clinical review panel assigned diagnoses of dementia. RESULTS:The LOD-M participants had more vegetative symptoms at baseline. LOD-M exhibited greater cognitive decline but fewer residual depressive symptoms than EOD-M. Among participants who remained in the study for at least 1 year, in uncontrolled analyses, a greater percentage of LOD-M compared with EOD-M developed dementia (23.0% vs. 7.8%). Whereas in logistic analyses, controlling for baseline demographics, age at onset remained a predictor of dementia, the odds ratio suggested that the effect was relatively small. CONCLUSIONS:The EOD-M and LOD-M participants have a different presentation and course. LOD-M may represent a syndrome of neuropsychiatric deterioration with expression of both depressive symptoms and cognitive decline.
10.1002/gps.4083
The ACE Gene Is Associated with Late-Life Major Depression and Age at Dementia Onset in a Population-Based Cohort.
Zettergren Anna,Kern Silke,Gustafson Deborah,Gudmundsson Pia,Sigström Robert,Östling Svante,Eriksson Elias,Zetterberg Henrik,Blennow Kaj,Skoog Ingmar
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:Depression and dementia in the elderly have been suggested to share similar risk factors and pathogenetic background, and recently the authors reported that the APOEɛ4 allele is a risk factor for both disorders in the general population. The aim of the present study was to examine the influence of the well-known polymorphisms rs1799752 in the angiotensin-converting enzyme (ACE) and rs5186 in the angiotensin receptor II type 1 (AGTR1) on late-life depression and dementia in a population-based Swedish cohort of older individuals followed over 12 years. METHODS:In 2000-2001, 900 individuals underwent neuropsychiatric and neuropsychological examinations. Follow-up evaluations were performed in 2005-2006 and 2009-2010, and register data on dementia to 2012 were included. Cross-sectional associations between genotypes/alleles and depression and dementia at baseline and between genotypes/alleles and depression on at least one occasion during the study period and dementia onset to 2012 were investigated. RESULTS:As previously found for rs1799752 in ACE, rs5186 in AGTR1 was associated with dementia at baseline (OR: 3.25 [CI: 1.42-7.06], z = 2.90, p = 0.004). These associations became substantially weaker, or disappeared, when dementia onset to 2012 was included. For rs1799752 this could be explained by a significant association with age at onset (mean: 79.5 [SD: 6.45] years for risk-genotype carriers and 81.7 [SD: 7.12] years for carriers of other genotypes, b = -2.43, t = -2.38, df = 192, p = 0.02). When individuals with major depression on at least one occasion were analyzed, a significant association (OR: 2.14 [95% CI: 1.13-4.20], z = 2.28, p = 0.02), remaining after exclusion of dementia, with rs1799752 in ACE was found. CONCLUSION:In this population-based sample of older individuals, genetic variations in ACE seem to be important both for late-life major depression and dementia.
10.1016/j.jagp.2016.06.009
Influence of gender and age on cognitive inhibition in late-onset depression: a case-control study.
Richard-Devantoy S,Deguigne F,Annweiler C,Letourneau G,Beauchet O
International journal of geriatric psychiatry
OBJECTIVE:To compare cognitive inhibition performance between people with early-onset (EOD) or late-onset depression (LOD) and controls, and between women and men with LOD. METHODS:On the basis of a case-control design, global executive performance (Frontal Assessment Battery); verbal (Hayling), attention (Stroop), and motor (Go/No-Go) components of cognitive inhibition; mental shifting (Trail Making Test parts A and B); and updating in working memory (Wechsler Adult Intelligence Scale) were assessed in 40 participants (10 depressed women with LOD (i.e., ≥60 years old), 10 depressed women with EOD (i.e., <60 years old), 10 healthy women and 10 depressed men with LOD (i.e., ≥60 years old)). RESULTS:Older depressed women, irrespective of age of depression onset, had greater cognitive inhibition impairments (attention and verbal component) compared with healthy women. LOD was significantly associated with the attention component of cognitive inhibition impairment, unlike EOD (p = 0.026). No executive differences were found regarding age of first-onset depression in older depressed women, and between women and men with LOD. CONCLUSION:Cognitive inhibition impairment, and more specifically its attention component, was the main characteristic of depression in the studied sample of older adults, independently of gender and age of depression onset. It is essential to perform similar studies in both genders in view of future tailor-made therapeutic modalities.
10.1002/gps.3929
Early and late onset depression in young and middle aged adults: differential symptomatology, characteristics and risk factors?
Korten Nicole C M,Comijs Hannie C,Lamers Femke,Penninx Brenda W J H
Journal of affective disorders
BACKGROUND:Early onset depression (EOD) and late onset depression (LOD) may be different phenomena. In this study, differences between EOD and LOD in symptomatology, psychiatric characteristics and psychosocial/somatic factors were examined. METHODS:Baseline data were from 1104 participants with a current major depressive disorder participating in the Netherlands Study of Depression and Anxiety (age range 18-65 years). DSM-IV diagnoses, depressive symptoms and age of onset were assessed with the Composite International Diagnostic Interview. Analyses were performed by using a continuous as well as a dichotomous (cut-off 40 years) age of onset indicator. RESULTS:Differences between EOD and LOD were observed: longer duration of symptoms (p<.001), a personal history of depressive episodes (p<.001), a serious suicide attempt (p<.001), childhood events (p<.001), a family history of depression (p=.03), and high neuroticism (p<.001) were more often present in EOD than in LOD. Also differences in symptomatology were observed: feelings of sadness (p<.001), diminished concentration (p=.02) and suicidal thoughts (p=.001) were significantly less prevalent at a higher age of onset, whereas decreased appetite/weight loss (p=.01) was more prominent at a higher age of onset. LIMITATIONS:The age of first depression onset was asked retrospectively and might be biased by selective recall. However, participants can likely recall whether symptoms started earlier or later in life. CONCLUSIONS:Despite similarities, our observed differential findings in symptoms, psychiatric characteristics, and psychosocial factors between EOD and LOD further support that EOD is associated with more frequent occurrence of some clinical features of depression. These differential findings are important factors to keep in mind for diagnostics, treatment, and prevention.
10.1016/j.jad.2012.01.042
Comparison of brain structural variables, neuropsychological factors, and treatment outcome in early-onset versus late-onset late-life depression.
Disabato Brianne M,Morris Carrie,Hranilovich Jennifer,D'Angelo Gina M,Zhou Gongfu,Wu Ningying,Doraiswamy P Murali,Sheline Yvette I
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:To compare differences in gray matter volumes, white matter and subcortical gray matter hyperintensities, neuropsychological factors, and treatment outcome between early- and late-onset late-life depressed (LLD) subjects. METHODS:We conducted a prospective, nonrandomized, controlled trial at the outpatient clinics at Washington University and Duke University on 126 subjects, aged 60 years or older, who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression, scored 20 or more on the Montgomery-Asberg Depression Rating Scale (MADRS), and received neuropsychological testing and magnetic resonance imaging. Subjects were excluded for cognitive impairment or severe medical disorders. After 12 weeks of sertraline treatment, subjects' MADRS scores over time and neuropsychological factors were studied. RESULTS:Left anterior cingulate thickness was significantly smaller in the late-onset depressed group than in the early-onset LLD subjects. The late-onset group also had more hyperintensities than the early-onset LLD subjects. No differences were found in neuropsychological factor scores or treatment outcome between early-onset and late-onset LLD subjects. CONCLUSION:Age at onset of depressive symptoms in LLD subjects are associated with differences in cortical thickness and white matter and subcortical gray matter hyperintensities, but age at onset did not affect neuropsychological factors or treatment outcome.
10.1016/j.jagp.2013.02.005
Amygdala volume in late-life depression: relationship with age of onset.
Burke Julie,McQuoid Douglas R,Payne Martha E,Steffens David C,Krishnan Ranga R,Taylor Warren D
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVES:Depression is common in the elderly population. Although numerous neuroimaging studies have examined depressed elders, there is limited research examining how amygdala volume may be related to depression. DESIGN:A cross-sectional examination of amygdala volume comparing elders with and without a diagnosis of major depressive disorder, and between depressed subjects with early and later initial depression onset. SETTING:An academic medical center. PARTICIPANTS:Ninety-one elderly patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression (54 early-onset depressed and 37 late-onset depressed) and 31 elderly subjects without any psychiatric diagnoses. MEASUREMENTS:Amygdala and cerebral volumes were measured using reliable manual tracing methods. RESULTS:In models controlling for age, sex, and cerebral volume, there was a significant difference between diagnostic cohorts in amygdala volume bilaterally (left: F[2, 116] = 16.28, p < 0.0001; right: F[2, 116] = 16.28, p < 0.0001). Using least squares mean group analyses, both early- and late-onset depressed subjects exhibited smaller bilateral amygdala volumes than did the nondepressed cohort (all comparisons p < 0.0001), but the two depressed cohorts did not exhibit a statistically significant difference. LIMITATIONS:Limitations include missing antidepressant treatment data, recall bias, inability to establish a causal relationship between amygdala size and depression given the cross-sectional nature of the design. CONCLUSIONS:Depression in later life is associated with smaller amygdala volumes, regardless of age of initial onset of depression.
10.1097/JGP.0b013e318211069a
Association of age at depression onset with cognitive functioning in individuals with late-life depression and executive dysfunction.
Mackin R Scott,Nelson J Craig,Delucchi Kevin L,Raue Patrick J,Satre Derek D,Kiosses Dimitris N,Alexopoulos George S,Arean Patricia A
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:To compare patterns of cognitive performance in older adults with late-onset depression (LOD; ≥65 years of age) with that of older adults with early-onset depression (EOD; <65 years). METHODS:Participants were 171 adults aged 60 years or older with major depression and executive dysfunction who were participating in a randomized psychotherapy trial. Participants included 72 LOD and 99 EOD individuals. Cognitive performance on measures of verbal learning, memory, and executive functioning were evaluated. Demographic and clinical characteristics, severity of cerebrovascular risk factors, and disability ratings were also compared between groups. RESULTS:The LOD group was older and had fewer previous episodes of depression and lower severity of depression compared with EOD participants. The LOD group demonstrated poorer performance on measures of verbal learning (F(1,161) = 4.28, p = 0.04) and memory (F(1,160) = 4.65, p = 0.03) than the EOD group. Linear regression analysis demonstrated that LOD and fewer years of education were significant predictors of poorer verbal learning (F(7,114) = 6.25, p <0.001) and memory (F(7,113)=7.24, p <0.001). Performance on measures of executive functioning, severity of vascular risk factors, and disability ratings did not differ between the two groups. CONCLUSION:In older adults with depression and executive dysfunction, LOD was associated with poorer performance on measures of verbal learning and memory. Aging-related brain changes associated with LOD may play a more important role, leading to dysfunction in these cognitive domains than a history of recurrent depressive episodes in older adults with a dysexecutive syndrome.
10.1016/j.jagp.2014.02.006
Amyloid imaging with [(18)F]florbetapir in geriatric depression: early-onset versus late-onset.
Tateno Amane,Sakayori Takeshi,Higuchi Makoto,Suhara Tetsuya,Ishihara Keiichi,Kumita Shinichiro,Suzuki Hidenori,Okubo Yoshiro
International journal of geriatric psychiatry
BACKGROUND:We examined patients with mild cognitive impairment (MCI) with a history of geriatric depression (GD) and healthy controls (HC) to evaluate the effect of beta-amyloid (Aβ) pathology on the pathology of GD by using [(18)F]florbetapir PET. METHODS:Thirty-three elderly patients (76.7 ± 4.2 years) and 22 healthy controls (HC; 72.0 ± 4.5 years, average ± SD) were examined by [(18)F]florbetapir positron emission tomography (PET) to quantify the standard uptake value ratio (SUVR) as the degree of amyloid accumulation, by MRI to determine the degree of atrophy, by Mini-Mental State Examination for cognitive functions, and by Geriatric Depression Scale for the severity of depression, and by Clinical Dementia Rating for activity of daily living (ADL). The cut-off value of 1.08 for SUVR was defined as Aβ-positive. RESULTS:Of the patients and HC, 39.4% and 27.3%, respectively, were beta-amyloid-positive. The onset age of GD was significantly correlated with SUVR (r = 0.44, p < 0.01). Compared to patients without Aβ (GD-Aβ), patients with Aβ (GD + Aβ) did not differ in terms of age, cognitive function, severity of depression and ADL, and brain atrophy. GD + Aβ had significantly older average ± SD age at onset of GD (73.6 ± 7.1 versus 58.7 ± 17.8, p < 0.01) and significantly shorter average ± SD time between onset of GD and PET scan day (3.1 ± 5.2 years versus 18.1 ± 18.6 years, p < 0.001) than GD-Aβ. CONCLUSIONS:Our results showed that the rate of Aβ positivity was higher in late-onset GD and that onset-age was associated with SUVR, suggesting that the later the onset of GD, the more Aβ pathology affected its onset.
10.1002/gps.4215
Neuroticism in Remitted Major Depression: Elevated with Early Onset but Not Late Onset of Depression.
Gade Anders,Kristoffersen Marius,Kessing Lars Vedel
Psychopathology
BACKGROUND:The personality trait of neuroticism is strongly related to depression, but depression is etiologically heterogeneous. Late-onset depression (LOD) may be more closely related to vascular factors, and previous studies of neuroticism in LOD versus early-onset depression (EOD) have not been consistent. METHOD:We examined neuroticism, extraversion and perceived stress in 88 fully remitted depressed patients with a mean age of 60 years and with a history of hospitalization for major depressive disorder. Patients were divided into those with onset after and those with onset before 50 years of age (LOD and EOD, respectively), and the two groups were compared both with each other and with matched control groups of healthy subjects. RESULTS:EOD patients showed increased levels of neuroticism in comparison with both LOD and matched controls, who did not differ. The association between age of onset and neuroticism was confirmed in analyses based on age of depression onset as a continuous variable. CONCLUSION:Neuroticism may be an etiological factor in EOD but not or less so in LOD. This finding contributes to the growing evidence for etiological differences between early- and late-onset late-life depression.
10.1159/000440813
Childhood abuse and late-life depression: Mediating effects of psychosocial factors for early- and late-onset depression.
Wielaard Ilse,Hoyer Mathijs,Rhebergen Didi,Stek Max L,Comijs Hannie C
International journal of geriatric psychiatry
OBJECTIVE:Childhood abuse makes people vulnerable to developing depression, even in late life. Psychosocial factors that are common in late life, such as loneliness or lack of a partner, may explain this association. Our aim was to investigate whether the association between childhood abuse and depression in older adults can be explained by psychosocial factors. METHODS:Cross-sectional data were derived from the Netherlands Study of Depression in Older Persons (aged 60-93), including 132 without lifetime depression, 242 persons with an early-onset depression (<60 years), and 125 with a late-onset (≥60 years) depression. Childhood abuse (yes/no) and a frequency-based childhood abuse index were included. Multinomial regression and multivariable mediation analyses were used to examine the association between childhood abuse and the onset of depression, and the influence of loneliness, social network, and partner status. RESULTS:Multinomial regression analyses showed a significant association between childhood abuse and the childhood abuse index with early- and late-onset depression. Multivariable mediation analyses showed that the association between childhood abuse and early-onset depression was partly mediated by social network size and loneliness. This was particularly present for emotional neglect and psychological abuse, but not for physical and sexual abuse. No psychosocial mediators were found for the association between childhood abuse and late-onset depression. CONCLUSIONS:A smaller social network and feelings of loneliness mediate the association between childhood abuse and early-onset depression in older adults. Our findings show the importance of detecting childhood abuse as well as the age at depression onset and mapping of relevant psychosocial factors in the treatment of late-life depression.
10.1002/gps.4828
Are Apathy and Depressive Symptoms Related to Vascular White Matter Hyperintensities in Severe Late Life Depression?
Oudega Mardien Leoniek,Siddiqui Amna,Wattjes Mike P,Barkhof Frederik,Kate Mara Ten,Muller Majon,Bouckaert Filip,Vandenbulcke Mathieu,De Winter François-Laurent,Sienaert Pascal,Stek Max L,Comijs Hannie C,Korten Nicole C M,Emsell Louise,Eikelenboom Piet,Rhebergen Didi,van Exel Eric,Dols Annemieke
Journal of geriatric psychiatry and neurology
OBJECTIVE:Apathy symptoms are defined as a lack of interest and motivation. Patients with late-life depression (LLD) also suffer from lack of interest and motivation and previous studies have linked apathy to vascular white matter hyperintensities (WMH) of the brain in depressed and nondepressed patients. The aim of this study was to investigate the relationship between apathy symptoms, depressive symptoms, and WMH in LLD. We hypothesize that late-onset depression (LOD; first episode of depression after 55 years of age) is associated with WMH and apathy symptoms. METHODS:Apathy scores were collected for 87 inpatients diagnosed with LLD. Eighty patients underwent brain magnetic resonance imaging. Associations between depressive and apathy symptoms and WMH were analyzed using linear regression. RESULTS:All 3 subdomains of the 10-item Montgomery-Åsberg Depression Rating Scale correlated significantly with the apathy scale score (all < .05). In the total sample, apathy nor depressive symptoms were related to specific WMH. In LOD only, periventricular WMH were associated with depression severity (β = 5.21, = .04), while WMH in the left infratentorial region were associated with apathy symptoms (β coefficient = 5.89, = .03). CONCLUSION:Apathy and depressive symptoms are highly overlapping in the current cohort of older patients with severe LLD, leading to the hypothesis that apathy symptoms are part of depressive symptoms in the symptom profile of older patients with severe LLD. Neither apathy nor depressive symptoms were related to WMH, suggesting that radiological markers of cerebrovascular disease, such as WMH, may not be useful in predicting these symptoms in severe LLD.
10.1177/0891988720901783
A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning.
Sachs-Ericsson Natalie,Corsentino Elizabeth,Moxley Jerad,Hames Jennifer L,Rushing Nicole C,Sawyer Kathryn,Joiner Thomas,Selby Edward A,Zarit Steven,Gotlib Ian H,Steffens David C
Aging & mental health
OBJECTIVES:Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. METHOD:At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery-Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. RESULTS:Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. CONCLUSIONS:EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.
10.1080/13607863.2012.717253
Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults.
Gallagher Damien,Mhaolain Aine Ni,Greene Elaine,Walsh Cathal,Denihan Aisling,Bruce Irene,Golden Jeannette,Conroy Ronan M,Kirby Michael,Lawlor Brian A
International journal of geriatric psychiatry
BACKGROUND:It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults. METHODS:89 subjects with GMS-AGECAT depression were identified from a sample of 1231 community dwelling adults aged 65 years and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode. RESULTS:Subjects with late onset depression (≥ 60) were significantly less likely to report a family history of depression, were less likely to report previous hospitalisation for depression and had greater cognitive impairment. Late onset subjects were also less likely to report feelings of guilt or thoughts that life was not worth living in the previous month. CONCLUSION:While we found that patients with late onset depression differed from early onset patients according to certain aetiological risk factors, we did not find a distinctive profile of depressive symptomatology which might be considered clinically useful at an individual level. These findings are consistent with studies based in hospital populations.
10.1002/gps.2438
Late-onset major depression is associated with age-related white matter lesions in the brainstem.
Schwichtenberg Johannes,Al-Zghloul Mansour,Kerl Hans U,Wenz Holger,Hausner Lucrezia,Frölich Lutz,Groden Christoph,Förster Alex
International journal of geriatric psychiatry
OBJECTIVE:Age-related white matter lesions (ARWMLs) have been identified in various clinical conditions such as reduced gait speed, cognitive impairment, urogenital dysfunction, and mood disturbances. Previous studies indicated an association between ARWML and late-onset major depression. However, most of these focused on the extent of supratentorial ARWML and neglected presence and degree of infratentorial lesions. METHODS:In 45 patients (mean age 73.7 ± 6.3 years, 17 (37.8%) men, 28 (62.2%) women) with late-onset major depression, MRI findings (3.0-T MR system, Magnetom Trio, Siemens Medical Systems, Erlangen, Germany) were analyzed with emphasis on the extent of supratentorial and infratentorial, as well as brainstem ARWMLs, and compared with control subjects. ARWMLs were determined by semiquantitative rating scales (modified Fazekas rating scale, Scheltens' rating scale), as well as a semiautomatic volumetric assessment, using a specific software (MRIcron). Supratentorial and infratentorial, as well as brainstem ARWMLs, were assessed both on fluid attenuated inversion recovery and T2-weighted images. RESULTS:Patients with late-onset major depression had significantly higher infratentorial ARWML rating scores (5 (5-7) vs 4.5 (3-6), p = 0.003) on T2-weighted images and volumes (1.58 ± 1.35 mL vs 1.05 ± 0.81 mL, p = 0.03) on T2-weighted images, as well as fluid attenuated inversion recovery images (2.07 ± 1.35 mL vs 1.52 ± 1.10 mL, p = 0.04), than normal controls. In more detail, in particular, the pontine ARWML rating subscore was significantly higher in patients with late-onset major depression (1 (1-2) vs 1 (1-1), p = 0.004). CONCLUSIONS:The extent and localization of brainstem ARWML might be of importance for the pathophysiology of late-onset major depression. In particular, this may hold true for pontine ARWML. Copyright © 2016 John Wiley & Sons, Ltd.
10.1002/gps.4487
Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy.
Dols Annemiek,Bouckaert Filip,Sienaert Pascal,Rhebergen Didi,Vansteelandt Kristof,Ten Kate Mara,de Winter Francois-Laurent,Comijs Hannie C,Emsell Louise,Oudega Mardien L,van Exel Eric,Schouws Sigfried,Obbels Jasmien,Wattjes Mike,Barkhof Frederik,Eikelenboom Piet,Vandenbulcke Mathieu,Stek Max L
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
OBJECTIVE:The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years). METHODS:Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated. RESULTS:Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode. CONCLUSION:The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients.
10.1016/j.jagp.2016.09.005
Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe).
Heser K,Tebarth F,Wiese B,Eisele M,Bickel H,Köhler M,Mösch E,Weyerer S,Werle J,König H-H,Leicht H,Pentzek M,Fuchs A,Riedel-Heller S G,Luppa M,Prokein J,Scherer M,Maier W,Wagner M,
Psychological medicine
BACKGROUND:Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years). METHOD:Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment. RESULTS:An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ≥ 70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41-12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries. CONCLUSIONS:Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.
10.1017/S0033291712002449
Late versus Early Onset Depression in Elderly Patients: Vascular Risk and Cognitive Impairment.
Hashem Abdelhamid H,M Nasreldin,Gomaa Maged A,Khalaf Ola O
Current aging science
BACKGROUND:Three-quarters of patients with major depressive disorder have late-onset depression. Late-onset depression is more often associated with cognitive impairment than earlyonset depression and evidences showed a relationship between vascular factors and late-life depression. OBJECTIVES:To compare cognitive functions between late-onset (&ge;60 years) and early-onset (<60 years) depression in elderly patients and to highlight the effect of vascular risk factors in elderly patients with late and early onset depression. METHODS:This was a cross sectional, case control study with consecutive referral done on eighty elderly patients with depression who were recruited from Geriatric Outpatient Clinic of Psychiatry and Addiction Prevention Hospital, Al Kasr Al-Ainy, Cairo University. They were divided into two groups according to the age of onset of depression: Late Onset Depression (LOD) group and Early Onset Depression (EOD) group. They were cognitively assessed using ACE III, Framingham risk score for vascular risk assessment. RESULTS:Late onset group had worse performance than early onset group regarding memory, verbal fluency, language, visuospatial abilities and had more vascular risk. CONCLUSION:Elderly patients with late onset depression had higher severity of depression as well as they were more cognitively affected regarding memory, verbal fluency, language, and visuospatial abilities. Vascular risk factors especially hypertension and diabetes mellitus were higher elderly patients with late onset depression and affects the severity of depression and degree of cognitive impairment.
10.2174/1874609810666170404105634
Clinical and radiological characteristics of early versus late mild cognitive impairment in patients with comorbid depressive disorder.
Motter Jeffrey N,Pelton Gregory H,D'Antonio Kristina,Rushia Sara N,Pimontel Monique A,Petrella Jeffrey R,Garcon Ernst,Ciovacco Michaela W,Sneed Joel R,Doraiswamy P Murali,Devanand Davangere P
International journal of geriatric psychiatry
OBJECTIVE:The classification of mild cognitive impairment (MCI) continues to be debated though it has recently been subtyped into late (LMCI) versus early (EMCI) stages. Older adults presenting with both a depressive disorder (DEP) and cognitive impairment (CI) represent a unique, understudied population. Our aim was to examine baseline characteristics of DEP-CI patients in the DOTCODE trial, a randomized controlled trial of open antidepressant treatment for 16 weeks followed by add-on donepezil or placebo for 62 weeks. METHODS/DESIGN:Key inclusion criteria were diagnosis of major depression or dysthymic disorder with Hamilton Depression Rating Scale (HAM-D) score >14, and cognitive impairment defined by MMSE score ≥21 and impaired performance on the WMS-R Logical Memory II test. Patients were classified as EMCI or LMCI based on the 1.5 SD cutoff on tests of verbal memory, and compared on baseline clinical, neuropsychological, and anatomical characteristics. RESULTS:Seventy-nine DEP-CI patients were recruited of whom 39 met criteria for EMCI and 40 for LMCI. The mean age was 68.9, and mean HAM-D was 23.0. Late mild cognitive impairment patients had significantly worse ADAS-Cog (P < .001), MMSE (P = .004), Block Design (P = .024), Visual Rep II (P = .006), CFL Animal (P = .006), UPSIT (P = .051), as well as smaller right hippocampal volume (P = .037) compared to EMCI patients. MRI indices of cerebrovascular disease did not differ between EMCI and LMCI patients. CONCLUSIONS:Cognitive and neuronal loss markers differed between EMCI and LMCI among patients with DEP-CI, with LMCI being more likely to have the clinical and neuronal loss markers known to be associated with Alzheimer's disease.
10.1002/gps.4955
Blood Transcriptomic Markers in Patients with Late-Onset Major Depressive Disorder.
Miyata Shigeo,Kurachi Masashi,Okano Yoshiko,Sakurai Noriko,Kobayashi Ayumi,Harada Kenichiro,Yamagata Hirotaka,Matsuo Koji,Takahashi Keisuke,Narita Kosuke,Fukuda Masato,Ishizaki Yasuki,Mikuni Masahiko
PloS one
We investigated transcriptomic markers of late-onset major depressive disorder (LOD; onset age of first depressive episode ≥ 50 years) from the genes expressed in blood cells and identified state-dependent transcriptomic markers in these patients. We assessed the genes expressed in blood cells by microarray and found that the expression levels of 3,066 probes were state-dependently changed in the blood cells of patients with LOD. To select potential candidates from those probes, we assessed the genes expressed in the blood of an animal model of depression, ovariectomized female mice exposed to chronic ultra-mild stress, by microarray and cross-matched the differentially expressed genes between the patients and the model mice. We identified 14 differentially expressed genes that were similarly changed in both patients and the model mice. By assessing statistical significance using real-time quantitative PCR (RT-qPCR), the following 4 genes were selected as candidates: cell death-inducing DFFA-like effector c (CIDEC), ribonuclease 1 (RNASE1), solute carrier family 36 member-1 (SLC36A1), and serine/threonine/tyrosine interacting-like 1 (STYXL1). The discriminating ability of these 4 candidate genes was evaluated in an independent cohort that was validated. Among them, CIDEC showed the greatest discriminant validity (sensitivity 91.3% and specificity 87.5%). Thus, these 4 biomarkers should be helpful for properly diagnosing LOD.
10.1371/journal.pone.0150262
Depressive symptoms in early- and late-onset older bipolar patients compared with younger ones.
García-López Aurelio,Ezquiaga Elena,De Dios Consuelo,Agud Jose Luis
International journal of geriatric psychiatry
OBJECTIVES:The aim of this study was to determine clinical and outcome differences between older bipolar patients with early onset (EO) and late onset (LO) of the illness and between younger and EO older patients with a bipolar disorder under long-term treatment in an outpatient clinical setting. METHODS:Three hundred ninety-five bipolar I and II outpatients were followed up for up to 7.7 years. Of these, 213 younger (<50 years) and 88 older (>60 years) patients were included. In the older subsample, 50 EO patients (onset <50 years) versus 38 LO patients (≥50 years) were analyzed. Likewise, younger versus EO older patients were compared. RESULTS:The likelihood of LO older patients of being bipolar II was higher than for EO older patients. They were also diagnosed earlier than EO older patients. No other clinical differences at baseline and at the prospective follow-up were found. Compared with younger patients, EO older patients had more frequent depressive symptoms at baseline, suffered more major depressive episodes in the previous year and in the prospective follow-up, received more antidepressants at baseline, had higher rates of medical comorbid conditions and were less likely to be tobacco smokers. CONCLUSIONS:Older patients constitute a meaningful proportion of bipolar patients under treatment. EO older patients suffered significantly from more frequent depressive symptoms than younger ones. LO older patients were predominantly bipolar II. So as bipolar illness progressed, depressive symptomatology became more frequent and manic episodes were less severe. Copyright © 2016 John Wiley & Sons, Ltd.
10.1002/gps.4465
Cerebral hemodynamics and capillary dysfunction in late-onset major depressive disorder.
Dalby Rikke B,Eskildsen Simon F,Videbech Poul,Rosenberg Raben,Østergaard Leif
Psychiatry research. Neuroimaging
In major depressive disorder (MDD), perfusion changes in cortico-limbic pathways are interpreted as altered neuronal activity, but they could also signify changes in neurovascular coupling due to altered capillary function. To examine capillary function in late-onset MDD, 22 patients and 22 age- and gender-matched controls underwent perfusion MRI. We measured normalized cerebral blood flow (nCBF), cerebral blood volume (nCBV), and relative transit-time heterogeneity (RTH). Resulting brain oxygenation was estimated in terms of oxygen tension and normalized metabolic rate of oxygen (nCMRO). Patients revealed signs of capillary dysfunction (elevated RTH) in the anterior prefrontal cortex and ventral anterior cingulate cortex bilaterally and in the left insulate cortex compared to controls, bilateral hypometabolism (parallel reductions of nCBV, nCBF, and CMRO) but preserved capillary function in the subthalamic nucleus and globus pallidus bilaterally, and hyperactivity with preserved capillary function (increased nCBF) in the cerebellum and brainstem. Our data support that perfusion changes in deep nuclei and cerebellum reflect abnormally low and high activity, respectively, in MDD patients, but suggest that microvascular pathology affects neurovascular coupling in ventral circuits. We speculate that microvascular pathology is important for our understanding of etiology of late-onset MDD as well as infererences about resulting brain activity changes.
10.1016/j.pscychresns.2021.111383
Inflammation in older subjects with early- and late-onset depression in the NESDO study: a cross-sectional and longitudinal case-only design.
Rozing M P,Veerhuis R,Westendorp R G J,Eikelenboom P,Stek M,Marijnissen R M,Oude Voshaar R C,Comijs H C,van Exel E
Psychoneuroendocrinology
OBJECTIVE:Different biological mechanisms may underlie depression beginning in early life (early-onset) and depression beginning later in life (late-onset). Although the relation between inflammation and depression has been studied extensively, the distinct role of inflammation in early and late-onset depression in older patients has not been addressed before. In the cross-sectional part of this study, we explored differences in levels of circulating inflammatory markers and cytokine levels in lipopolysaccharide (LPS) stimulated whole blood between older subjects with a late-life onset depression (≥60 years) and older subjects with an early-onset depression (<60 years). Secondly, in a 2-year follow-up study, we examined if circulating and stimulated inflammatory markers influenced the change in Inventory of Depressive Symptomatology (IDS) scores, and if this relation was different for early- and late-onset depression. METHODS:The study was part of the Netherlands Study of Depression in Older Persons (NESDO). We included 350 patients, all aged 60 and older, with a depressive episode in the previous 6 months: 119 with a late-onset depression and 231 with an early-onset depression. Blood samples were collected and CRP, IL-6, NGAL, GDF15, and, LPS plasma levels were determined and whole blood was LPS stimulated and cytokine levels IL-1β, IL-6, TNFα, IFNγ, IL-10, and IL-1 receptor antagonist (IL-1ra) were determined. RESULTS:After adjustment for demographics, health indicators, and medication use, increased plasma CRP levels were more strongly associated with late-onset depression than early-onset depression (OR [95% CI]: 1.43 [1.05-1.94]). In the longitudinal analyses, higher circulating IL-6 levels were associated with a significantly slower decline in IDS scores in the crude and the adjusted models (p ≤ 0.027). This relation was not different between late- and early-onset depression. Other circulating and stimulated inflammatory markers were not associated with late- and/or early-onset depression. CONCLUSIONS:This study provides preliminary evidence that low-grade inflammation is more strongly associated with late-onset than early-onset depression in older adults, suggesting a distinct inflammatory etiology for late-onset depression. Cytokine production capacity did not distinguish between early- and late-onset depression.
10.1016/j.psyneuen.2018.08.029
Late-onset depression is associated to age-related central auditory processing disorder in an older population in Southern Italy.
GeroScience
The association between late-life depression (LLD) and age-related hearing loss (ARHL) was suggested by preliminary studies, but reliance on LLD subtypes may introduce significant bias. We examined the association between ARHL and LLD according to the age of onset (early-onset depression (EOD) and late-onset depression (LOD)). We investigated the association between ARHL and LLD diagnosed according to the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR in 1749 Italian community-dwelling older subjects from the population-based GreatAGE Study, Southern Italy. Peripheral ARHL was assessed as a pure tone average (PTA) threshold > 40 dB hearing level in the better ear- and age-related CAPD as a score of < 50% to the Synthetic Sentences Identification with Ipsilateral Competitive Message (SSI-ICM) test. LLD amounted at 10.29% of the sample, subdivided in LOD (6.21%) and EOD (4.08%). Age-related CAPD tended to be higher in LOD (28.91%) than in EOD (19.05%). After accounting for covariates, LOD was tendentially associated to age-related CAPD, but not to peripheral ARHL. This trend was confirmed by the linear models in which LOD was significantly associated to worsen SSI-ICM percentages (odds ratio 2.38, 95% confidence interval 1.32-4.30, p = 0.004), but not to PTA values. In a fully adjusted model of LOD, the effect of the association between CAPD and LOD was explained by social dysfunction. LLD was not associated to peripheral ARHL. Age-related CAPD was associated to LOD, a form of depression with cognitive dysfunction hallmark. The ARHL assessment may be an important opportunity to prevent depressive disorders in later life, particularly for LOD.
10.1007/s11357-020-00290-1
Preliminary analysis of age of illness onset effects on symptom profiles in major depressive disorder.
Charlton Rebecca A,Lamar Melissa,Ajilore Olusola,Kumar Anand
International journal of geriatric psychiatry
OBJECTIVE:Major depressive disorder (MDD) is prevalent across the lifespan, but relatively little is known about how age of illness onset impacts the cognitive and affective presentation of MDD. METHOD:We explore depressive symptoms and cognition in 70 adults (30-89 years old) with MDD. Participants were divided into three groups on the basis of age of MDD onset: early (<30 years), midlife (30-49.9 years), and late (>50 years). Symptoms were assessed using the Hamilton Depression Rating Scale; principal component analysis was used to create symptom component scores. Cognitive functions were measured. RESULTS:The late-onset group were significantly older than the early-onset and midlife-onset groups. Analysis controlled for age and hemoglobin A1c levels, as some participants had diabetes. The late-onset group demonstrated greater weight loss and gastrointestinal symptoms compared with the early-onset group. Suicidal thoughts and sleep disturbance were higher in both the early-onset and late-onset groups compared with the midlife-onset group. Correlations between symptom components and cognitive domains varied by age-of-onset group. DISCUSSION:This preliminary analysis demonstrates cognitive and affective profiles that are both unique to age of onset and common across MDD. Symptom profiles may assist in identifying factors influencing depression and enhance the clinical evaluation and care of individuals struggling with the effects of depression across the lifespan.
10.1002/gps.3939
Association of cortical thickness with age of onset in first-episode, drug-naïve major depression.
Shen Zonglin,Jiang Hongyan,Cheng Yuqi,Ye Jing,Lu Yi,Zhou Cong,Li Na,Dai Nan,He Mengxin,Xu Xiufeng
Neuroreport
OBJECTIVE:We previously showed differences in brain grey matter volume changes between patients with early-onset adult depression (EOD) and late-onset adult depression (LOD). Here, we aim to identify whether cortical thickness (CT) is affected by the age of onset in patients with depression. METHODS:High-resolution MRI images were obtained for 54 major depressive disorder (MDD) patients with EOD, 58 patients with LOD, 57 young healthy controls (HCs), and 58 aged HCs. Depression severity was assessed using the Hamilton Depression Rating Scale 17-item (HDRS17). Associations between CT of patients and clinical scores were analyzed. RESULTS:There was a significant main effect of diagnosis for the left rostal anterior cingulate (rACC), right inferior temporal, right lateral orbitofrontal cortex (lOFC), and bilateral pericalcarine. A remarkable onset age-group effect on CT was observed in the rACC and bilateral caudal anterior cingulate (cACC). The diagnosis-by-onset age interaction effect was found in bilateral rACC and right lOFC. Thinning CT in bilateral rACC was observed in EOD patients compared to young HCs. Compared to older HCs, thicker CT in lOFC was seen in the LOD patient group. Compared with the LOD group, the EOD group showed cortical thinning of the right cACC and posterior cingulate cortex (PCC). There were no significant associations between CT in right cACC or PCC with symptom severity or illness duration. CONCLUSIONS:MDD patients with different age at onset show distinct CT alterations, suggesting potentially divergent pathological mechanisms of EOD and LOD.
10.1097/WNR.0000000000001314
Comparison of cognitive function between early- and late-onset late-life depression in remission.
Cheng Ying-Chih,Liu Shen-Ing,Chen Chun-Hsin,Liu Hsing-Cheng,Lu Mong-Liang,Chang Ching-Jui,Chiu Wei-Che,Sun I-Wen,Yao Lin-Sheng,Chiu Chih-Chiang,Robert Stewart
Psychiatry research
Differences in cognitive function have been suggested in people with late-life depression between those with early- (EOD) and late-onset (LOD), possibly reflecting different etiologies. The cutoff point for EOD and LOD was the first depressive episode before age 60 or later. However, depressive symptoms at the time of disorder are important confounders. The study aimed to compare cognitive function in older people with EOD and LOD in the euthymic state. A sample of 135 participants aged 60+ with a history of major depressive disorder in remission, received neuropsychological evaluation including tests of memory, attention, processing speed, visuospatial function, language, and executive function. Individual test scores and a derived composite score were investigated as dependent variables against age of onset using multiple linear regressions adjusted for potential confounders, including residual depressive symptoms. We found EOD (N = 67) and LOD (N = 68) groups did not differ significantly in overall composite cognitive scores after adjustment. Of individual test scores, only those for immediate recall were significantly lower in participants with EOD compared to LOD. In conclusion, the study found no associations between cognitive function and age of onset in this sample of people with depressive disorder in remission. Active or residual depressive symptoms might have confounded this relationship in previous research.
10.1016/j.psychres.2020.113051
Investigating the relationship between age of onset of depressive disorder and cognitive function.
Eraydin Irem Ece,Mueller Christoph,Corbett Anne,Ballard Clive,Brooker Helen,Wesnes Keith,Aarsland Dag,Huntley Jonathan
International journal of geriatric psychiatry
OBJECTIVES:Depressive disorder is commonly associated with impaired cognitive function; however, it is unclear whether the age of onset of the first episode of depression, current depression severity, or historical severity of depressive episodes are associated with cognitive performance. METHODS:This study examined baseline cross-sectional data from the ongoing online PROTECT study. A total of 7344 participants, 50 years or older, with a history of depression and no diagnosis of dementia were divided into three groups according to age of onset of their first depressive episode: early-onset, midlife-onset, and late-onset. Performance on measures of visuospatial episodic memory, executive function, verbal working, and visual working memory were evaluated. Demographic and clinical characteristics such as age, education, and severity of symptoms during their worst previous depressive episode and current depression severity were included in multivariate regression models. RESULTS:The late-onset depression group scored significantly lower on the verbal reasoning task than the early-onset group while there were no significant differences found on the other tasks. Midlife-onset depression participants performed better in the visual episodic memory task, but worse on the verbal reasoning task, than early-onset depression participants. Current depression severity was negatively correlated with all four cognitive domains, while historical severity score was found to be significantly associated with cognitive performance on the verbal reasoning and spatial working memory tasks. CONCLUSIONS:The most important indicator of cognitive performance in depression appears to be current, rather than historic depression severity; however, late-onset depression may be associated with more executive impairment than an early-onset depression.
10.1002/gps.4979