scholarly journals Cognitive Functioning and Late-Life Depression

2014 ◽  
Vol 20 (5) ◽  
pp. 461-467 ◽  
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)

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

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.

Culturally adapted and lay-delivered cognitive behaviour therapy for older adults with depressive symptoms in rural China: a pilot trial

2020 ◽  
pp. 1-5
Author(s):  
Jiaqi Yuan ◽  
Yi Yin ◽  
Xinfeng Tang ◽  
Tan Tang ◽  
Qinshu Lian ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Health Workers ◽  
Pilot Trial ◽  
Depression Scale ◽  
Late Life ◽  
Late Life Depression ◽  
Mixed Effect ◽  
Culturally Adapted ◽  
Cognitive Behaviour

Abstract Background: Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression. Aim: This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care. Method: Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS). Results: The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU. Conclusion: Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.

scholarly journals BROODING MODERATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR BURDEN AND VASCULAR DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S877-S878
Author(s):  
Manuel Herrera Legon ◽  
Daniel Paulson
Keyword(s):  
Older Adults ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Late Life ◽  
Community Dwelling ◽  
Self Report ◽  
Future Research ◽  
Late Life Depression ◽  
Vascular Depression ◽  
The Relationship

Abstract Objective: The vascular depression hypothesis posits that cerebrovascular burden confers risk for late-life depression. Though neuroanatomical correlates of vascular depression (prefrontal white matter hyperintensities) are well established, little is known about cognitive correlates; the identification of which may suggest therapeutic targets. Aims of this study are to examine the hypothesis that the relationship between cerebrovascular burden and depressive symptoms is moderated by brooding, a type of rumination. Method: A sample of 52 community-dwelling, stroke-free, individuals over the age of 70, without history of severe mental illness or dementia completed the Ruminative Responses Scale, and provided self-report (cardiac disease, hypertension, diabetes, high cholesterol) CVB data. The Geriatric Depression Scale was used to assess depressive symptomatology. Results: Results of a bootstrapped model were that self-reported measures of CVB predicted depressive symptomatology. This relationship was significantly moderated by brooding. Among older adults, those who self-reported high CVB and medium to elevated levels of rumination experienced disproportionately more depressive symptomatology. Conclusions: These findings suggest that brooding rumination may be one correlate of the vascular depression syndrome. Future research should examine neuroanatomical correlates of rumination among older adults, and further explore brooding as a therapeutic target for those with late-life depression.

Heterogeneity of late-life depression: relationship with cognitive functioning

2014 ◽  
Vol 26 (6) ◽  
pp. 953-963 ◽  
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.

Educational level as a protective factor against the influence of depressive symptoms on cognition in older adults: implications for functional independence during a 10-year follow-up

2021 ◽  
pp. 1-13
Author(s):  
Irene Cano-López ◽  
Marta Aliño ◽  
Aránzazu Duque ◽  
Paula Martínez ◽  
Mercedes Almela ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Educational Level ◽  
Social Life ◽  
Protective Factor ◽  
Functional Independence ◽  
Face To Face ◽  
Proposed Model ◽  
The Relationship

ABSTRACT Objectives: To examine whether the educational level moderates the relationship between baseline depressive symptoms and cognitive functioning at 5- and 10-year follow-ups in older adults, considering the association between cognitive functioning and difficulty with activities of daily living (ADL). Design: Using a prospective design, a path analysis was performed. Setting: In-home, face-to-face interviews and self-administered questionnaires, within the National Social Life, Health, and Aging Project. Participants: In total, 1,461 participants (mean age = 66.62) were followed up from Wave 1 (baseline) to Wave 2 (at 5 years) and Wave 3 (at 10 years). Measurements: Depressive symptoms were assessed at baseline. Cognitive functioning and difficulty with ADL were assessed at baseline and at 5 and 10 years. Results: Educational level moderates the relationship between depressive symptoms and cognitive functioning at 5 years (β = 0.07, SE = 0.03, p = 0.04, Cohen’s f2 = 0.02), being depressive symptoms related to poor cognitive functioning only at low educational levels. Cognitive functioning predicts difficulty with ADL at 5 and 10 years (β = −0.08, SE = 0.03, p = 0.008, Cohen’s f2 = 0.01; β = −0.09, SE = 0.03, p = 0.006, Cohen’s f2 = 0.02). The proposed model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, 90% CI 0.0001–0.03, SRMR = 0.004, and χ2(8) = 7.16, p = 0.52). Conclusions: Cognitive reserve may act as a protective factor against the effect of depressive symptoms on cognition in older adults, which, in turn, is relevant to their functional independence.

The Recognition and Treatment of Late-Life Depression: A View from Primary Care

1996 ◽  
Vol 26 (2) ◽  
pp. 155-171 ◽  
Author(s):  
Christopher M. Callahan ◽  
Hugh C. Hendrie ◽  
William M. Tierney
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Primary Care Physicians ◽  
Late Life ◽  
Primary Care Providers ◽  
Future Research ◽  
Care Providers ◽  
Late Life Depression ◽  
Primary Care Patients

Objective: Efforts to improve the recognition and treatment of late-life depression in primary care are often based on the assumption that primary care physicians underutilize currently available and effective treatments. This article reviews the validity of this assumption and offers recommendations for future research. Methods: Clinical trials designed to improve the recognition and treatment of late-life depression in primary care are reviewed. Because studies limited to older adults are rare, we also include studies enrolling younger patients. These data are reviewed in the context of recent reviews on the prevalence of depression in primary care settings and the effectiveness of available treatments. Results: Although depressive symptoms are common among older adults, there is insufficient literature documenting the proportion of these patients who respond to currently available treatments. Patients with uncomplicated major depressive disorder constitute the minority of primary care patients with depressive symptoms. Nearly all available studies of treatment effectiveness of pharmacotherapy or psychotherapy focus on older adults with uncomplicated major depression. Currently available treatment options may apply to less than 15 percent of depressed primary care patients. Conclusions: More research is needed to help primary care providers manage their depressed patients with comorbid medical conditions, functional disability, or minor or chronic depressions. In addition, more research is needed to identify those patients who would benefit from specialized or interdisciplinary care.

Educational level influenced the gold standard diagnosis of late-life depression in the GreatAGE study

2017 ◽  
Vol 41 (S1) ◽  
pp. S173-S173
Author(s):  
M. Lozupone ◽  
F. Veneziani ◽  
L. Lofano ◽  
I. Galizia ◽  
E. Stella ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Educational Level ◽  
Depressive Disorders ◽  
Depression Scale ◽  
Late Life ◽  
Population Based ◽  
Cognitive Variables ◽  
Late Life Depression ◽  
Axis I

IntroductionThe validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.ObjectiveTo compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.MethodsThe sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.ResultsAccording to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).ConclusionsAt the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals DISCRIMINATION AND DEPRESSION IN MID- TO LATE LIFE: THE ROLE OF OPTIMISM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S315-S316
Author(s):  
Elliottnell Perez ◽  
Joseph Dzierzewski ◽  
Scott Ravyts
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Positive Association ◽  
Late Life ◽  
The United States ◽  
Future Research ◽  
Cross Sectional ◽  
Life Orientation Test ◽  
The Impact ◽  
The Relationship

Abstract he positive association between discrimination and depression is well-supported throughout the literature. Previous evidence exploring potential mechanisms suggest discrimination is associated with depression via changes in social cognition. The goal of the current study was to investigate whether optimism explained the relationship between discrimination and depressive symptoms in mid-to-late life. Furthermore, the study assessed whether this mediated relationship was moderated by race or sex. This study included cross-sectional and longitudinal secondary data analysis of 2453 middle-aged and older adults (M age=68.30,SD=8.93) from the Midlife in the United States study. Discrimination was measured using an 11-item count of the number of discriminatory events experienced. Optimism was measured using the 6-item Life Orientation Test. Depressive symptoms were assessed using a 7-item count of the number of symptoms experienced. Optimism mediated the relationship between discrimination and depressive symptoms cross-sectionally, 95% CI:[.012, .034], and longitudinally, 95% CI:[.008, .024]. There was no evidence of moderated mediation; however, sex did moderate the direct relationship between discrimination and depressive symptoms cross-sectionally, b=.10, 95% CI:[.001, .194], and longitudinally, b=.03, 95% CI:[.01, .05]. The current study extends the literature by providing cross-sectional and longitudinal support for optimism as a mechanism through which discrimination leads to depressive symptoms in older adults. Evidence also suggests that women experience greater depressive symptoms than men in response to discrimination. Future research may wish to examine the developmental course of observed relationships and the impact of multiple marginalized identities on these relationships.

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