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

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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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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A Cross-Sectoral Comparison of Prevalence and Predictors of Symptoms of Depression Over Time Among Older Adults in Ontario, Canada

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988720901790 ◽

2020 ◽

Vol 34 (1) ◽

pp. 11-20

Author(s):

Eva Neufeld ◽

Shannon Freeman ◽

Lina Spirgiene ◽

Urszula Horwath

Keyword(s):

Older Adults ◽

Protective Factors ◽

Rating Scale ◽

Burden Of Illness ◽

Late Life ◽

Risk And Protective Factors ◽

Late Life Depression ◽

Term Care ◽

Symptoms Of Depression ◽

Over Time

Objectives: Late-life depression, a common mental health issue, poses a significant burden of illness globally. We investigated factors associated with symptoms of depression among older adults across 3 health sectors in Ontario, Canada. Method: Electronic health assessment data on older adults aged 60 years+ in home care (HC; N = 359 217), long-term care (LTC; N = 125 496), and palliative care (PC; N = 29 934) were examined. Change in symptoms of depression, measured using the interRAI Depression Rating Scale (DRS), over time was examined, including predictors of the development of depression. Results: At baseline, symptoms of depression were observed in 19.1% (HC), 24.2% (LTC), and 11.9% (PC). This increased to 20.6% (HC), 33.8% (LTC), and 13.2% (PC) at follow-up. For most older adults, DRS scores remained the same across sectors over time. Three independent variables emerged consistently across sectors as the main risk and protective factors for symptoms of depression. Conclusion: Although variations in the risk and protective factors for late-life depression were demonstrated across each sector, some commonalities emerged including unmanaged pain, symptoms of depression at baseline, social connectedness, and activity.

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Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa242 ◽

2020 ◽

Cited By ~ 1

Author(s):

Katharine K Brewster ◽

Mei-Chen Hu ◽

Sigal Zilcha-Mano ◽

Alexandra Stein ◽

Patrick J Brown ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Depression Scale ◽

Late Life ◽

Mediation Effect ◽

Late Life Depression ◽

Data Set ◽

Age Related ◽

Increased Risk ◽

Over Time

Abstract Background Hearing loss (HL), late-life depression, and dementia are 3 prevalent and disabling conditions in older adults, but the interrelationships between these disorders remain poorly understood. Methods N = 8529 participants ≥60 years who were free of cognitive impairment at baseline were analyzed from National Alzheimer’s Coordinating Center Uniform Data Set. Participants had either No HL, Untreated HL, or Treated HL. Primary outcomes included depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia. A longitudinal logistic model was fit to examine the association between HL and changes in depressive symptoms across time. Two Cox proportional hazards models were used to examine HL and the development of dementia: Model A included only baseline variables and Model B included time-varying depression to evaluate for the direct effect of changes in depression on dementia over time. Results Treated HL (vs no HL) had increased risk for depression (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04–1.54, p = .02) and conversion to dementia (hazard ratio [HR] = 1.29, 95% CI = 1.03–1.62, p = .03). Baseline depression was a strong independent predictor of conversion to dementia (HR = 2.32, 95% CI = 1.77–3.05, p < .0001). Development/persistence of depression over time was also associated with dementia (HR = 1.89, 95% CI = 1.47–2.42, p < .0001), but only accounted for 6% of the direct hearing–dementia relationship (Model A logHR = 0.26 [SE = 0.12] to Model B logHR = 0.24 [SE = 0.12]) suggesting no significant mediation effect of depression. Conclusions Both HL and depression are independent risk factors for eventual conversion to dementia. Further understanding the mechanisms linking these later-life disorders may identify targets for early interventions to alter the clinical trajectories of at-risk individuals.

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Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽

10.1024/1662-9647/a000127 ◽

2015 ◽

Vol 28 (2) ◽

pp. 67-76

Author(s):

Grace C. Niu ◽

Patricia A. Arean

Keyword(s):

Older Adults ◽

Mental Illness ◽

Brain Plasticity ◽

Late Life ◽

Aging Population ◽

The United States ◽

Future Research ◽

Evidence Based ◽

Late Life Depression ◽

Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011–2014

Journal of Psychiatric Research ◽

10.1016/j.jpsychires.2019.01.012 ◽

2019 ◽

Vol 111 ◽

pp. 30-35 ◽

Cited By ~ 12

Author(s):

Jingkai Wei ◽

Meiling Ying ◽

Liyang Xie ◽

Eeshwar K. Chandrasekar ◽

Haidong Lu ◽

...

Keyword(s):

Older Adults ◽

Cognitive Function ◽

National Health ◽

Late Life ◽

Nutrition Examination Survey ◽

Late Life Depression ◽

Health And Nutrition ◽

The U.S

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Vascular lesions and functional limitations among older adults: does depression make a difference?

International Psychogeriatrics ◽

10.1017/s1041610214000829 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1501-1509 ◽

Cited By ~ 5

Author(s):

Celia F. Hybels ◽

Carl F. Pieper ◽

Lawrence R. Landerman ◽

Martha E. Payne ◽

David C. Steffens

Keyword(s):

Risk Factors ◽

Older Adults ◽

White Matter ◽

Functional Impairment ◽

Functional Limitations ◽

Late Life ◽

Cognitive Status ◽

Cerebral White Matter ◽

Late Life Depression ◽

Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

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The relationships between brain structural changes and perceived loneliness in older adults suffering from late‐life depression

International Journal of Geriatric Psychiatry ◽

10.1002/gps.4831 ◽

2017 ◽

Vol 33 (4) ◽

pp. 606-612 ◽

Cited By ~ 4

Author(s):

Emily L.L. Sin ◽

Ho‐Ling Liu ◽

Shwu‐Hua Lee ◽

Chih‐Mao Huang ◽

Yau‐Yau Wai ◽

...

Keyword(s):

Older Adults ◽

Structural Changes ◽

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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