Is apathy in late-life depressive illness related to age-at-onset, cognitive function or vascular risk?

Background: Apathy has been shown to be an important feature of degenerative, vascular or traumatic brain disorder. Its presence is associated with high depression scores, higher age, low performance on frontal tasks, and more severe deep white matter hyperintensities. In late-life depression, lack of interest or motivation are often more prominent than depressed mood, especially in the late-onset type. It was hypothesized that in a heterogeneous sample of elderly depressed patients, apathy is associated with late-onset type of depression, cognitive dysfunction or vascular risk factors.Method: The Apathy Evaluation Scale (AES) was administered to twenty-nine elderly (≥60 years) inpatients with a DSM-IV major depression or dysthymic disorder. The severity of the depression was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS) and cognitive function with the Mini-mental State Examination (MMSE). The presence of vascular risk factors was traced in the patient's medical records.Results: Apathy was found in 86% of the patients. The AES-score was correlated with the negative symptom score, but not with total MADRS or MMSE-score. No difference in AES-score between early-onset depressed (n = 16) and late-onset depressed (n = 13) patients was found, and between patients with or without vascular risk.Conclusion: Apathy is a main feature of moderate to severe depressive illness in elderly patients and related to the negative symptoms of the disorder. Further studies should include less severely depressed patients and investigate the relation between depression severity and apathy.

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Prevalence of hippocampal enlarged perivascular spaces in a sample of patients with hypertension and their relation with vascular risk factors and cognitive function

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2017-316724 ◽

2018 ◽

Vol 89 (6) ◽

pp. 651-656 ◽

Cited By ~ 8

Author(s):

Joan Jiménez-Balado ◽

Iolanda Riba-Llena ◽

Edurne Garde ◽

Marta Valor ◽

Belen Gutiérrez ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Rating Scale ◽

Brain Mri ◽

Treatment Compliance ◽

Vascular Risk Factors ◽

Study Cohort ◽

Perivascular Spaces ◽

Vascular Risk ◽

Verbal Reasoning

ObjectivesThe clinical importance of hippocampal enlarged perivascular spaces (H-EPVS) remains uncertain. We aimed to study their association with vascular risk factors, cognitive function and mild cognitive impairment (MCI).MethodsData were obtained from the ISSYS (Investigating Silent Strokes in hYpertensives, a magnetic resonance imaging Study) cohort, which is a prospective study of patients with hypertension aged 50–70 with no prior stroke or dementia. Participants were clinically evaluated and underwent a cognitive screening test, Dementia Rating Scale-2, which includes five cognitive subscales (attention, initiation/perseveration, conceptualisation, construction and memory). Besides, they were diagnosed with MCI or normal ageing following standard criteria. H-EPVS were manually counted on brain MRI according to a previous scale and defined as extensive when H-EPVS count was ≥7 (upper quartile). Multivariate models were created to study the relationship between H-EPVS, vascular risk factors and cognitive function.Results723 patients were included; the median age was 64 (59–67) and 51% were male. Seventy-two patients (10%) were diagnosed with MCI and 612 (84.6%) had at least 1 H-EPVS. Older age (OR per year=1.04, 95% CI 1.01 to 1.08) and poor blood pressure treatment compliance (OR=1.50, 95% CI 1.07 to 2.11) were independently associated with extensive H-EPVS. Regarding cognitive function, H-EPVS were independently and inversely correlated with verbal reasoning (β=−0.021, 95% CI −0.038 to −0.003). No association was found between H-EPVS and MCI.ConclusionsH-EPVS are a frequent finding in patients with hypertension and are associated with ageing and poor hypertension treatment compliance. Besides, H-EPVS are associated with worse verbal reasoning function.

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Vascular Risk Factors Decrease the Risk of Cognitive Impairment in Amyotrophic Lateral Sclerosis: A Case-Control Study

10.21203/rs.3.rs-552777/v1 ◽

2021 ◽

Author(s):

Tianmi Yang ◽

Qianqian Wei ◽

Chunyu Li ◽

Bei Cao ◽

Ruwei Ou ◽

...

Keyword(s):

Risk Factors ◽

Amyotrophic Lateral Sclerosis ◽

Cognitive Impairment ◽

Cognitive Function ◽

Rating Scale ◽

Case Control ◽

Vascular Risk Factors ◽

Sensitivity Analyses ◽

Vascular Risk ◽

Lateral Sclerosis

Abstract Background The disease-modifying effects of diabetes mellitus (DM), hyperlipidemia, and overweight on risk and prognosis of amyotrophic lateral sclerosis (ALS) have gained significant attention in recent years. However, whether these well-known vascular risk factors increase the cognitive burden in patients with ALS remains unclear. We aim to evaluate the association between vascular risk factors (including hypertension, DM, hyperlipidemia, overweight and smoking) and cognitive function in patients with ALS. Methods Patients with ALS were consecutively recruited between June 2012 and November 2019 from a tertiary referral center for ALS at the West China Hospital. Vascular risk factors were confirmed based on clinical data, while cognitive function was evaluated by the Chinese version of the Addenbrooke’s Cognitive Examination-revised. Case-control design to investigate the association between vascular risk factors and cognitive impairment in ALS. With careful confounder adjustment, multivariable logistic regression analysis was performed separately (for each factor) and accumulatively (based on the sum of factors) to determine the association between cognitive impairment and vascular risk factors in ALS. Results Of 870 patients, 561 (64.5%) were men, the mean age at registeration was 54.1 (11.3) years and 266 had cognitive impairment. No cognitive burden from vascular risk factors was found in patients with ALS. On the contrary, we first observed that DM (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.25–0.98; P = 0.04) and hyperlipidemia (OR, 0.50; 95% CI, 0.26–0.97; P = 0.04) showed protective effects against cognitive decline in ALS, adjusted for age, sex, educational level, site of onset, Revised-ALS Functional Rating Scale score, predominant upper motor neuron phenotype, family history of ALS, and the remaining vascular risk factors. Furthermore, patients with > 2 vascular risk factors showed a significantly lower risk of cognitive impairment (OR, 0.18; 95% CI, 0.07–0.48; P = 0.001). Sensitivity analyses of sex did not substantially reverse the risk estimates. Conclusions DM and hyperlipidemia decrease the risk of cognitive impairment in patients with ALS. The fitness hypothesis in ALS has been tested and expanded in our work.

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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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