Neuropathological substrates and structural changes in late-life depression: the impact of vascular burden

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

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The impact and measurement of social dysfunction in late‐life depression: an evaluation of current methods with a focus on wearable technology

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4632 ◽

2016 ◽

Vol 32 (3) ◽

pp. 247-255 ◽

Cited By ~ 3

Author(s):

Sophie Hodgetts ◽

Peter Gallagher ◽

Daniel Stow ◽

I. Nicol Ferrier ◽

John T. O'Brien

Keyword(s):

Late Life ◽

Wearable Technology ◽

Late Life Depression ◽

Social Dysfunction ◽

The Impact

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Preventing late-life depression: a clinical update

International Psychogeriatrics ◽

10.1017/s1041610210000864 ◽

2010 ◽

Vol 22 (8) ◽

pp. 1216-1224 ◽

Cited By ~ 25

Author(s):

Robert C. Baldwin

Keyword(s):

Risk Factors ◽

Primary Prevention ◽

Depressive Disorder ◽

Functional Limitation ◽

Late Life ◽

Current Evidence ◽

Secondary Outcome ◽

Late Life Depression ◽

Current Evidence Base ◽

The Impact

ABSTRACTBackground: Achieving remission in late-life depressive disorder is difficult; it is far better to prevent depression. In the last ten years there have been a number of clinical studies of the feasibility of prevention.Methods: A limited literature review was undertaken of studies from 2000 specifically concerning the primary prevention of late-life depressive disorder or where primary prevention is a relevant secondary outcome.Results: Selective primary prevention (targeting individuals at risk but not expressing depression) has been shown to be effective for stroke and macular degeneration but not hip fracture. It may also prove effective for the depression associated with caregiving in dementia. Emerging evidence finds effectiveness for indicated prevention (in those identified with subthreshold depression often with other risk factors such as functional limitation). Despite a number of promising risk factors (for example, diet, exercise, vascular risk factors, homocysteine and insomnia), universal prevention of late-life depression (acting to reduce the impact of risk factors at the population level) has no current evidence base, although a population approach might mitigate suicide.Conclusion: Interventions which work in preventing late-life depression include antidepressant medication in standard doses and Problem-Solving Treatment. When integrated into a care model, such as collaborative care, prevention is feasible but more economic studies are needed.

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