Association between physical frailty and cognition in late-life depression

IntroductionCognitive frailty has recently been defined as the co-occurrence of physical frailty and cognitive impairment. Late-life depression is associated with both physical frailty and cognitive impairment, especially processing speed and executive functioning.Aim and objectivesIn this study, we investigated the association between physical frailty and cognitive functioning in depressed older persons.MethodsIn a total of 378 patients (> 60 years) with depression according to DSM-IV criteria and a MMSE score of 24 points or higher, the physical frailty phenotype as well as its individual criteria (weight loss, weakness, exhaustion, slowness, low activity) was studied. Cognitive functioning was examined in 4 domains: verbal memory, working memory, interference control, and processing speed.ResultsOf the 378 depressed patients (range 60–90 years; 66.1% women), 61 were classified as robust (no frailty criteria present), 214 as prefrail (1 or 2 frailty criteria present), and 103 as frail (> 3 criteria). Linear regression analyses, adjusted for confounders, showed that the severity of physical frailty was associated with poorer verbal memory, slower processing speed, and decreased working memory, but not with changes in interference control.ConclusionIn late-life depression, physical frailty is associated with poorer cognitive functioning, although not consistently for executive functioning. Future studies should examine whether cognitive impairment in the presence of physical frailty belongs to cognitive frailty and is indeed an important concept to identify a specific subgroup of depressed older patients, who need multimodal treatment strategies integrating physical, cognitive, and psychological functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The pattern and course of cognitive impairment in late-life depression

Psychological Medicine ◽

10.1017/s0033291709990833 ◽

2009 ◽

Vol 40 (4) ◽

pp. 591-602 ◽

Cited By ~ 80

Author(s):

S. Köhler ◽

A. J. Thomas ◽

N. A. Barnett ◽

J. T. O'Brien

Keyword(s):

Cognitive Impairment ◽

Executive Functioning ◽

Cognitive Deficits ◽

Processing Speed ◽

Age Of Onset ◽

Late Onset ◽

Late Life ◽

Late Life Depression ◽

Remission Status ◽

Current Mood

BackgroundCognitive deficits persist despite clinical recovery in subjects with late-life depression, but more needs to be known about their longer-term outcome and factors affecting their course. To investigate this, we followed the pattern of cognitive impairments over time and examined the effects of current mood, remission status, age of depression onset and antidepressant (AD) treatment on these deficits.MethodSixty-seven subjects aged ⩾60 years with DSM-IV major depressive disorder and 36 healthy comparison subjects underwent tests of global cognition, memory, executive functioning and processing speed at baseline, 6 and 18 months, with some subjects tested again after 4 years. z scores were compared between groups, with analyses of clinical factors that may have influenced cognitive performance in depressed subjects.ResultsHalf of the patients exhibited a generalized cognitive impairment (GCI) that persisted after 18 months. Patients performed worse across all cognitive domains at all time points, without substantial variability due to current mood, remission status or AD treatment. Late age of onset was associated significantly with decline in memory and executive functioning. Impaired processing speed may be a partial mediator of some deficits, but was insufficient to explain differences between patients and controls. Four-year follow-up data suggest impairments persist, but do not further decline.ConclusionsCognitive deficits in late-life depression persist up to 4 years, affect multiple domains and are related to trait rather than state effects. Differences in severity and course between early and late onset depression suggest different pathogenic processes.

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Be Fit, Be Sharp, Be Well: The Case for Exercise as a Treatment for Cognitive Impairment in Late-life Depression

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000710 ◽

2021 ◽

pp. 1-14

Author(s):

Vonetta M. Dotson ◽

Andrew M. Gradone ◽

Hannah R. Bogoian ◽

Lex R. Minto ◽

Zinat Taiwo ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Functioning ◽

Antidepressant Treatment ◽

Late Life ◽

Poor Response ◽

Adjunctive Treatment ◽

Late Life Depression ◽

Research Findings ◽

Brain Changes ◽

Neurochemical Changes

Abstract Objective: To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD). Method: This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD. Results: Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention. Conclusions: Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.

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Heterogeneity of late-life depression: relationship with cognitive functioning

International Psychogeriatrics ◽

10.1017/s1041610214000155 ◽

2014 ◽

Vol 26 (6) ◽

pp. 953-963 ◽

Cited By ~ 29

Author(s):

Nicole C. M. Korten ◽

Brenda W. J. H. Penninx ◽

Rob M. Kok ◽

Max L. Stek ◽

Richard C. Oude Voshaar ◽

...

Keyword(s):

Older Adults ◽

Working Memory ◽

Cognitive Functioning ◽

Psychotropic Medication ◽

Processing Speed ◽

Depressive Episode ◽

Late Life ◽

Late Life Depression ◽

Symptom Dimensions ◽

Cognitive Domains

ABSTRACTBackground:Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains.Methods:Cross-sectional data of 378 depressed and 132 non-depressed older adults between 60–93 years, from the Netherlands Study of Depression in Older adults (NESDO) were used. Depressed older adults were recruited from both inpatient and outpatient mental healthcare institutes and general practices, and diagnosed according to DSM-IV-TR criteria. Multivariable associations were examined with depression characteristics (severity, onset, comorbidity, psychotropic medication) and symptom dimensions as independent variables and cognitive domains (episodic memory, processing speed, interference control, working memory) as dependent variables.Results:Late-life depression was associated with poorer cognitive functioning. Within depressed participants, higher severity of psychopathology and having a first depressive episode was associated with poorer cognitive functioning. The use of tricyclic antidepressants, serotonergic and noradrenergic working antidepressants, and benzodiazepines was associated with worse cognitive functioning. Higher scores on the mood dimension were associated with poorer working memory and processing speed, whereas higher scores on a motivational and apathy dimension were associated with poorer episodic memory and processing speed.Conclusions:Heterogeneity in late-life depression may lead to differences in cognitive functioning. Higher severity and having a first depressive episode was associated with worse cognitive performance. Additionally, different domains of cognitive functioning were associated with specific symptom dimensions. Our findings on the use of psychotropic medication suggest that close monitoring on cognitive side effects is needed.

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Intrinsic connectivity identifies the sensory-motor network as a main cross-network between remitted late-life depression- and amnestic mild cognitive impairment-targeted networks

Brain Imaging and Behavior ◽

10.1007/s11682-019-00098-4 ◽

2019 ◽

Vol 14 (4) ◽

pp. 1130-1142 ◽

Cited By ~ 3

Author(s):

Jiu Chen ◽

Hao Shu ◽

Zan Wang ◽

Yafeng Zhan ◽

Duan Liu ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Late Life ◽

Amnestic Mild Cognitive Impairment ◽

Late Life Depression ◽

Motor Network ◽

Intrinsic Connectivity ◽

Sensory Motor

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Pathways to Remission of Late Life Depression, Across the Spectrum of Cognitive Functioning

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2012.12.085 ◽

2013 ◽

Vol 21 (3) ◽

pp. S65-S66

Author(s):

Aaron M. Koenig ◽

Meryl Butters ◽

Amy Begley ◽

Semhar Ogbagaber ◽

Abdus S. Wahed ◽

...

Keyword(s):

Cognitive Functioning ◽

Late Life ◽

Late Life Depression

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Cognitive Functioning and Late-Life Depression

Journal of the International Neuropsychological Society ◽

10.1017/s1355617714000198 ◽

2014 ◽

Vol 20 (5) ◽

pp. 461-467 ◽

Cited By ~ 47

Author(s):

Aaron M. Koenig ◽

Rishi K. Bhalla ◽

Meryl A. Butters

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Cognitive Functioning ◽

Neuropsychological Assessment ◽

Cognitive Deficits ◽

Late Life ◽

Cognitive Outcomes ◽

Review Of The Literature ◽

Late Life Depression ◽

The Relationship

AbstractThis brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)

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Longitudinal associations between late-life depression dimensions and cognitive functioning: a cross-domain latent growth curve analysis

Psychological Medicine ◽

10.1017/s003329171600297x ◽

2016 ◽

Vol 47 (4) ◽

pp. 690-702 ◽

Cited By ~ 20

Author(s):

A. Brailean ◽

M. J. Aartsen ◽

G. Muniz-Terrera ◽

M. Prince ◽

A. M. Prina ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Processing Speed ◽

Memory Function ◽

Somatic Symptoms ◽

Late Life ◽

Late Life Depression ◽

Latent Growth ◽

Depressed Affect ◽

Over Time

BackgroundCognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected.MethodThe study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall).ResultsPoorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time.ConclusionsOur findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.

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Mild cognitive impairment, poor episodic memory, and late-life depression are associated with cerebral cortical thinning and increased white matter hyperintensities

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2014.00306 ◽

2014 ◽

Vol 6 ◽

Cited By ~ 36

Author(s):

Motonobu Fujishima ◽

Norihide Maikusa ◽

Kei Nakamura ◽

Masahiro Nakatsuka ◽

Hiroshi Matsuda ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

White Matter ◽

Episodic Memory ◽

White Matter Hyperintensities ◽

Late Life ◽

Late Life Depression ◽

Cortical Thinning

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Subtypes of Late-Life Depression: A Data-Driven Approach on Cognitive Domains and Physical Frailty

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa110 ◽

2020 ◽

Vol 76 (1) ◽

pp. 141-150 ◽

Cited By ~ 1

Author(s):

Astrid Lugtenburg ◽

Marij Zuidersma ◽

Klaas J Wardenaar ◽

Ivan Aprahamian ◽

Didi Rhebergen ◽

...

Keyword(s):

Depressive Symptom ◽

Cognitive Performance ◽

Latent Profile Analysis ◽

Profile Analysis ◽

Late Life ◽

Late Life Depression ◽

Physical Frailty ◽

Cognitive Domains ◽

Age Related ◽

Latent Profile

Abstract Background With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. Methods A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. Results A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression (“mild” and “severe” depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as “amnestic depression,” “frail-depressed, physically dominated,” and “frail-depressed, cognitively dominated.” The prospective analyses showed that patients in the subgroup of “mild depression” and “amnestic depression” had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. Conclusions Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.

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