Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes

Chapter 4 outlines late-life depression. It explores the causes of depression (including medical conditions, medication, and alcohol), treatments for depression, and other diagnoses (bipolar disorder, co-occuring anxiety, and personality disorders), depression and cognitive impairment, and collaborative care.

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Depression and mild cognitive impairment – Comorbidity and/or continuum?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.430 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S190-S191

Author(s):

G. Sobreira ◽

M.A. Aleixo ◽

C. Moreia ◽

J. Oliveira

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Late Life ◽

The Elderly ◽

Late Life Depression ◽

Pubmed Database ◽

Competing Interest ◽

The Relationship

IntroductionDepression and mild cognitive impairment are common among the elderly. Half the patients with late-life depression also present some degree of cognitive decline, making the distinction between these conditions difficult.ObjectivesTo conduct a database review in order to understand the relationship between these entities, and treatment approaches.AimsTo create and implement clinical guidelines at our institution, to evaluate and treat elderly patients presenting with depression and mild cognitive impairment.MethodsA PubMed database search using as keywords “late life depression”, “depression”; “cognitive impairment”; “mild cognitive impairment” and “dementia” between the year 2008 and 2015.ResultsLate-life depression and cognitive impairment are frequent among the elderly (10–20%). Depression is also common in the early stages of dementia decreasing as the cognitive decline progresses. The causal relationship between these entities is not well understood and some authors advocate a multifactorial model (genetic risk factors; neuroendocrine changes; vascular risk factors) and the cognitive impairment of said changes is dependent on the individual's cognitive reserve. Regarding treatment of depression in patients with cognitive impairment, most authors advocate a stepped approach with watchful waiting and then, if symptoms persist, the introduction of pharmacotherapy and psychosocial intervention.ConclusionsThe relationship between cognitive impairment and depression is still not clear and probably multifactorial. The diagnosis of depressive symptoms in patients with severe cognitive impairment can be difficult and most forms of pharmacological treatment in this population are not beneficial, making it important to carefully evaluate the benefits of introducing new medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cognitive impairment and dementia in late-life bipolar disorder

Current Opinion in Psychiatry ◽

10.1097/yco.0b013e32835ac5f6 ◽

2013 ◽

Vol 26 (1) ◽

pp. 120-123 ◽

Cited By ~ 11

Author(s):

Ivan Aprahamian ◽

Paula V. Nunes ◽

Orestes V. Forlenza

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Late Life

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Risk Factors and Clinical Outcomes of Cognitive Impairment in Diabetic Patients Undergoing Peritoneal Dialysis

Kidney & Blood Pressure Research ◽

10.1159/000514172 ◽

2021 ◽

pp. 1-10

Author(s):

Xuan Huang ◽

Chunyan Yi ◽

Meiju Wu ◽

Yagui Qiu ◽

Haishan Wu ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Peritoneal Dialysis ◽

Clinical Outcomes ◽

Demographic Data ◽

Diabetic Patients ◽

Lower Survival Rate ◽

Technique Survival ◽

Risk Of Mortality ◽

Patients With Diabetes

Introduction: Cognitive impairment (CI) is common in patients with CKD or diabetes mellitus (DM). However, the relevance between DM and CI in diabetic patients undergoing peritoneal dialysis (PD) has not been clearly established. This study aimed to explore the role of DM in CI, the association of glycemic control with CI, and clinical outcomes of CI in diabetic PD patients. Methods: Continuous ambulatory PD (CAPD) patients followed up in our PD center between 2014 and 2016 were enrolled. The participants were followed until an endpoint was reached or December 2017. Demographic data and clinical characteristics were collected, and laboratory parameters were measured. The Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function, and a score of <26 was considered to indicate CI. A propensity score matching according to age, gender, and mean arterial pressure was conducted between the DM and non-DM groups. Results: A total of 913 CAPD patients were enrolled, of whom 186 (20.4%) had diabetes. After appropriate matching, 175 patients in the DM group and 270 patients in the non-DM group were included. Patients with diabetes had a higher prevalence of CI and lower scores for visuospatial/executive function, naming, language, delayed recall, and orientation. Higher HbA1c (odds ratio [OR], 1.547; 95% confidence interval [95% CI], 1.013–2.362) and cardiovascular disease (CVD; OR, 2.926; 95% CI, 1.139–7.516) significantly correlated with a risk of CI in diabetic patients. During a median of 26.0 (interquartile range 13.5–35.6) months of follow-up, diabetic patients with CI demonstrated a significantly lower survival rate than those without CI, and CI was an independent risk factor for mortality after adjustment (hazard ratio, 7.224; 95% CI, 1.694–30.806). However, they did not show worse technique survival or higher peritonitis rate than patients without CI. Conclusions: HbA1c and CVD are independent risk factors for CI in diabetic patients undergoing CAPD, and CI is independently associated with a higher risk of mortality.

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Late-onset depressive disorders: a preventable variant of cerebrovascular disease?

Psychological Medicine ◽

10.1017/s0033291797006090 ◽

1998 ◽

Vol 28 (5) ◽

pp. 1007-1013 ◽

Cited By ~ 59

Author(s):

IAN HICKIE ◽

ELIZABETH SCOTT

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Depressive Disorders ◽

Late Onset ◽

Late Life ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Late Life Depression ◽

Age Related ◽

Medical Morbidity

The severe depressive disorders of late life are associated with high rates of medical morbidity and mortality, cognitive impairment, suicide, disability, complex treatment regimens, institutionalization and high costs to the community (Murphy, 1983; Murphy et al. 1988; Bruce & Leaf, 1989; NIH Consensus Development Panel, 1992; Alexopoulos et al. 1993a, b; Brodaty et al. 1993; Bruce et al. 1994; Forsell et al. 1994; Hickie et al. 1995; Blazer, 1996). Those disorders that are accompanied by cognitive impairment and/or concurrent medical morbidity have a particularly poor outcome (Bruce & Leaf, 1989; Alexopoulos et al. 1993b; Hickie et al. 1995, 1997a). Although psychosocial models of late-life depression place considerable importance on age-related psychological and social risk factors, those who survive into later life may actually be characterized by psychological resilience (Henderson, 1994; Blazer, 1997).Current aetiological research in late-life depression, therefore, places particular emphasis on the potential role of biological risk factors. The potential importance of vascular risk factors is receiving renewed attention and may provide opportunities for specific prevention and intervention strategies in high-risk populations. This emphasis on possible vascular risk factors, and the wider importance of vascular pathologies in late-life neuropsychiatric disorders, mirrors the emphasis of much earlier clinico-pathological studies (Binswanger, 1894; Alzheimer, 1895). The specific focus on the importance of small progressive changes within the subcortical white matter, as distinct from more discrete cortical infarcts (Olszewski, 1962), is now supported by the emerging neuroimaging literature and theoretical constructs in late-life depression (Krishnan, 1991, 1993; Hickie et al. 1996, 1997b; Krishnan et al. 1997).

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Midlife Vascular Factors and Prevalence of Mild Cognitive Impairment in Late-Life in Mexico

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000539 ◽

2021 ◽

pp. 1-11

Author(s):

Miguel Arce Rentería ◽

Jennifer J. Manly ◽

Jet M.J. Vonk ◽

Silvia Mejia Arango ◽

Alejandra Michaels Obregon ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Rural Areas ◽

Memory Impairment ◽

Late Life ◽

Older Age ◽

Cognitive Domain ◽

Urban And Rural Areas ◽

The Impact

Abstract Objective: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes and investigate the impact of midlife cardiovascular risk factors on late-life MCI among the aging Mexican population. Method: Analyses included a sample of non-demented adults over the age of 55 living in both urban and rural areas of Mexico (N = 1807). MCI diagnosis was assigned based on a comprehensive cognitive assessment assessing the domains of memory, executive functioning, language, and visuospatial ability. The normative sample was selected by means of the robust norms approach. Cognitive impairment was defined by a 1.5-SD cut-off per cognitive domain using normative corrections for age, years of education, and sex. Risk factors included age, education, sex, rurality, depression, insurance status, workforce status, hypertension, diabetes, stroke, and heart disease. Results: The prevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged from 4.2% to 7.7%. MCI with and without memory impairment was associated with older age (OR = 1.01 [1.01, 1.05]; OR = 1.03 [1.01, 1.04], respectively) and residing in rural areas (OR = 1.49 [1.08, 2.06]; OR = 1.35 [1.03, 1.77], respectively). Depression (OR = 1.07 [1.02, 1.12]), diabetes (OR = 1.37 [1.03, 1.82]), and years of education (OR = 0.94 [0.91, 0.97]) were associated with MCI without memory impairment. Midlife CVD increased the odds of MCI in late-life (OR = 1.76 [1.19, 2.59], which was driven by both midlife hypertension and diabetes (OR = 1.70 [1.18, 2.44]; OR = 1.88 [1.19, 2.97], respectively). Conclusions: Older age, depression, low education, rurality, and midlife hypertension and diabetes were associated with higher risk of late-life MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are multifactorial and vary by MCI subtype.

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Pathogenesis, Diagnosis, and Treatment of Vascular and Mixed Dementias

Neurobiology of Mental Illness ◽

10.1093/med/9780199934959.003.0068 ◽

2013 ◽

pp. 900-903

Author(s):

Helena Chang Chui

Keyword(s):

Public Health ◽

Risk Factors ◽

Cognitive Impairment ◽

Mr Imaging ◽

Early Identification ◽

Late Life ◽

Vascular Cognitive Impairment ◽

Prevention And Treatment ◽

The Brain ◽

Alzheimer Pathology

This chapter addresses five common questions surrounding vascular cognitive impairment (VCI): pathogenesis, diagnostic accuracy, incidence and prevalence, relationship between VBI and Alzheimer disease (AD), and prevention/treatment. Although vascular cognitive impairment is considered to be the second most common form of cognitive impairment and dementia in late life, it can be argued that public health emphasis should be placed more on the prevention and treatment of vascular brain injury (VBI), which for example may be detectable by MR imaging. We review the historical syndromes and current diagnostic criteria, which have focused on defining various subtypes of VCI and have influenced estimates of incidence and prevalence. Recent neuropathological studies have highlighted the frequent concurrence of Alzheimer pathology and VBI in late life. Converging evidence suggests that AD and VBI impose differential but additive deleterious effects on cognitive function. The field is moving increasingly to earlier detection of the brain at risk using MR imaging, as well as to the early identification and treatment of vascular risk factors.

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