344 The Relationship between Late Life Depressive Symptoms and Cerebral White Matter Disease is Modified by Systemic and Orthostatic Blood Pressure

Abstract Background Cerebral white matter hyperintensity (WMH) burden is a key biological risk factor underpinning late life depression (LLD) and cerebral hypoperfusion has been identified as an important cause of WMH. The aim of this study therefore is to clarify if orthostatic hypotension (OH) and lower systemic blood pressure (BP), both of which cause reduced cerebral blood flow, modify the relationship between depression and cerebral white matter disease in a cohort of community-dwelling older people aged ≥70 years. Methods This study uses data from wave 3 of TILDA. Participants were included if they were aged ≥70 years and had undergone assessment for depressive symptoms, brain MRI and cardiovascular measures. Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale. Scheltens Score was used by a trained radiologist to calculate overall WMH burden. Orthostatic BP was measured by active stand. OH was defined as a drop in Systolic BP≥20 mmHg or drop in diastolic BP≥10 mmHg at 30, 60 or 90 seconds post standing. Results Participants with depressive symptoms (8%, 16/202) had a significantly higher burden of WMH measured by Scheltens Score (14.6 (95% CI:11.0–18.2) vs. 11.0 (95% CI:10.1–11.8); p=0.0211). Two-way interaction models demonstrated that the association between depressive symptoms and WMH burden is significant only in those with co-existing OH. Similarly, the two-way interaction between depressive symptoms and systolic BP shows that this association remains statistically significant only in those with both depressive symptoms and lower BP, i.e. <130 mm Hg. Conclusion This study demonstrates that depressive symptoms are associated with cerebral WMH in a cohort of community-dwelling people aged ≥70 years but this relationship is modified by co-existing OH or lower BP. Identifying the processes that lead to WMH accumulation and progression in depression is crucial in order to inform strategies aimed at preventing and ameliorating LLD.

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Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support

The Gerontologist ◽

10.1093/geront/gnaa072 ◽

2020 ◽

Vol 60 (8) ◽

pp. 1466-1475 ◽

Cited By ~ 1

Author(s):

Yaru Jin ◽

Huaxin Si ◽

Xiaoxia Qiao ◽

Xiaoyu Tian ◽

Xinyi Liu ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Rating Scale ◽

Depression Scale ◽

Community Dwelling ◽

Linear Regression Models ◽

Frailty Phenotype ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Background and Objectives Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression. Research Design and Methods This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain. Results Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson–Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset. Discussion and Implications Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.

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BROODING MODERATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR BURDEN AND VASCULAR DEPRESSION

Innovation in Aging ◽

10.1093/geroni/igz038.3216 ◽

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.

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Relationship between Depressive Symptoms and Cognitive, Psychological, and Physical Performance in Community-Dwelling Older People with Cognitive Impairment

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000520853 ◽

2021 ◽

pp. 1-9

Author(s):

Isabella Khoo ◽

Jacqueline C.T. Close ◽

Stephen R. Lord ◽

Kim Delbaere ◽

Morag E. Taylor

Keyword(s):

Cognitive Impairment ◽

Depressive Symptoms ◽

Physical Performance ◽

Sex Education ◽

Depressive Symptomatology ◽

Controlled Trial ◽

Depression Scale ◽

Community Dwelling ◽

Future Research ◽

The Relationship

Introduction: Dementia and depression often coexist. Understanding how concomitant comorbidities affect function can improve assessment and management strategies. We examined the relationship between cognitive, psychological, and physical function and depressive symptoms in people with cognitive impairment. Methods: Cross-sectional study using baseline data from the iFOCIS randomized controlled trial involving 309 participants with mild-moderate cognitive impairment. The association between cognitive (Addenbrooke’s Cognitive Examination-III [ACE-III], Frontal Assessment Battery), psychological (Goldberg Anxiety Scale; Iconographical Falls Efficacy Scale), and physical (Physiological Profile Assessment; Short Physical Performance Battery [SPPB]) function, and quality of life (QoL), physical activity levels and activities of daily living, and depressive symptoms (15-item Geriatric Depression Scale [GDS]) were assessed (adjusted for age, sex, education, and ACE-III as appropriate). Results: Participants with depressive symptoms (GDS ≥4) had significantly more falls in the previous year and a higher number of comorbidities than people without depressive symptoms (GDS <4). Each point increase in the GDS was associated with better memory, higher levels of anxiety and concern about falling, poorer balance, slower gait speed, and reduced QoL. The relationship between the GDS and poor balance and QoL withstood additional adjustment for comorbidity tertiles. The relationship between GDS and concern about falls withstood additional adjustment for previous falls (12 months) and SPPB scores. Conclusions: Depressive symptomatology is associated with poorer physical and psychological function and reduced QoL in people with cognitive impairment. These factors should be considered when assessing and intervening in this group. Future research could examine these relationships longitudinally to establish causality and examine intervention efficacy in this group.

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Magnetic Resonance Brain Imaging in Regularly Transfused Beta Thalassemia Major and Intermedia Subjects and Prevalence of Thrombophilia Mutations

Blood ◽

10.1182/blood.v120.21.5175.5175 ◽

2012 ◽

Vol 120 (21) ◽

pp. 5175-5175 ◽

Cited By ~ 1

Author(s):

Patricia Jane Giardina ◽

Dorothy A. Kleinert ◽

Suzanne O. Salamon ◽

Linda A. Heier

Keyword(s):

White Matter ◽

Magnetic Resonance ◽

Brain Mri ◽

Thalassemia Major ◽

Cerebral White Matter ◽

Compound Heterozygous ◽

White Matter Disease ◽

Mri Findings ◽

Brain Infarcts ◽

Pai 1

Abstract Abstract 5175 Introduction/Background: Recent reports of magnetic resonance (MRI) brain imaging have emerged detecting covert cerebral infarcts in thalassemia subjects. The thalassemia phenotype, and splenectomy and hypercoagulation are suggested mechanisms. Methods: We conducted a retrospective review of all brain MRIs performed in thalassemia subjects at the Weill Cornell/New York Presbyterian Hospital Thalassemia Center over the past 15 years (yrs). Blood counts, platelet counts and ferritin levels at the time of MRI as well as genotype and phenotype diagnoses, splenectomy status and thrombophilia mutational analysis historically performed were reviewed. Results: 16 thalassemia subjects: 7M:9F, mean age = 29. 9 yrs (range: 11 to 45 yrs) were identified who underwent brain MRI studies from 1998 to 2012. Brain MRIs were performed for evaluation of various symptoms including: headaches (6), dizziness (2), growth hormone efficiency (2), unilateral hearing loss (1), optic neuritis (1), cerebral hypoxia (1), acquired human immunodeficiency syndrome (1), s/p craniopharyngioma excision (1), and paresis (1). MRI findings included 3 chronic infarcts, 2 cerebral white matter disease images consistent with chronic ischemia, 1 acute infarct, 2 opacified maxillary sinuses, 1 sphenoid sinusitis, 1 acute hemorrhage, 1 recurrent hemorrhage, 1 cerebellopontine angle schwannoma and 4 unremarkable studies. Clinical diagnosis included: 12 Thalassemia Major (TM) subjects who were on regular red blood cell (RBC) hypertransfusion regimens since infancy to maintain pre-transfusion hemoglobin (Hgb) levels greater than 10 gm/dl and 4 Thalassemia Intermedia (TI) subjects (3M/1F) were periodically transfused until adolescence or early adulthood when they were placed on regular RBC hypertransfusion support owing to complications including extramedullary hematopoiesis causing spinal cord compression, progressive anemia with fatigue and thrombosis. All but 2 subjects were splenectomized; all but 6 subjects had platelet counts greater than 500 (mean platelet count = 567; range 175 to 1101). All were on iron chelation therapy including 2 Deferoxamine (DFO), 1 on DFO and Deferiprone (DFP) and 13 on Deferasirox (DFX). Prothrombotic genetic mutations were identified in 10 subjects including: (2) homozygous PAI-1, (5) heterozygous PAI-1, (2) homozygous MTHFR and (4) heterozygous for MTHFR; those 3 TM subjects with lacunar infarcts were heterozygous PAI-1 or negative for other thrombophilia mutations however 1 TM also had a patent foramen ovale. In addition, the 2 TI subjects with cerebral white matter disease had compound heterozygous MTHFR or PAI-1 in association with homozygous PAI-1 or homozygous MTHFR respectively. Conclusion: Chronic brain infarcts and cerebral white matter disease consistent with ischemia were detected on MRI in 5/16 adolescent and adult thalassemia subjects (31%): TM = 3/16 (19%) and TI = 2/16 (10%) thalassemia subjects. Headache, pain and dizziness were the predominant symptoms in those subjects with brain MRI findings of chronic infarcts and white matter disease. Thrombocytosis was common in all splenectomized subjects Homozygous and compound heterozygous co-inheritance of thrombophilia mutations PAI-1 and MTHFR were relatively more common in subjects with chronic infarcts and white matter disease. Further brain MRI studies need to be performed to address the prevalence, pathogenesis, risk factors, neurological and cognitive outcomes of brain infarcts in at risk adolescent and adult thalassemia subjects for the prevention and development of therapeutic strategies. Disclosures: No relevant conflicts of interest to declare.

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Corpus callosum size may predict late-life depression in women: A 10-year follow-up study

European Psychiatry ◽

10.1016/j.eurpsy.2014.09.332 ◽

2014 ◽

Vol 29 (S3) ◽

pp. 546-547

Author(s):

F. Cyprien ◽

P. Courtet ◽

P. Poulain ◽

J. Maller ◽

C. Meslin ◽

...

Keyword(s):

White Matter ◽

Corpus Callosum ◽

Elderly Women ◽

Late Life ◽

Magnetic Resonance Images ◽

Community Dwelling ◽

Cerebral White Matter ◽

Intracranial Volume ◽

Late Life Depression

BackgroundRecent research on late-life depression (LLD) pathophysiology suggests the implication of abnormalities in cerebral white matter [1] and particularly in interhemispheric transfer [2]. Corpus callosum (CC) is the main brain interhemispheric commissure [3]. Hence, we investigated the association between baseline CC measures and risk of LDD.MethodsWe studied 467 non-demented individuals without LLD at baseline from a cohort of community-dwelling people aged 80 years or younger (the ESPRIT study). LLD was assessed at year 2, 4, 7 and 10 of the study follow-up. At baseline, T1-weighted magnetic resonance images were manually traced to measure the mid-sagittal areas of the anterior, mid and posterior CC. Multivariate Cox proportional hazards models stratified by sex were used to predict LLD incidence over 10 years.ResultsA significant interaction between gender and CC size was found (P = 0.02). LLD incidence in elderly women, but not in men, was significantly associated with smaller anterior (HR 1.37 [1.05–1.79] P = 0.017), mid (HR 1.43 [1.09–1.86] P = 0.008), posterior (HR1.39 [1.12–1.74] P = 0.002) and total (HR 1.53 [1.16–2.00] P = 0.002) CC areas at baseline in Cox models adjusted for age, education, global cognitive impairment, ischemic pathologies, left-handedness, white matter lesion, intracranial volume and past depression.LimitationsThe main limitation was the retrospective assessment of major depression.ConclusionsSmaller CC size is a predictive factor of incident LLD over 10 years in elderly women. Our finding suggests a possible role of CC and reduced interhemispheric connectivity in LLD pathophysiology. Extensive explorations are needed to clarify the mechanisms leading to CC morphometric changes in mood disorders.

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PM2.5 associated with gray matter atrophy reflecting increased Alzheimers risk in older women

Neurology ◽

10.1212/wnl.0000000000011149 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011149

Author(s):

Diana Younan ◽

Xinhui Wang ◽

Ramon Casanova ◽

Ryan Barnard ◽

Sarah A. Gaussoin ◽

...

Keyword(s):

White Matter ◽

Gray Matter ◽

Brain Mri ◽

Late Life ◽

Community Dwelling ◽

Supervised Machine Learning ◽

Parahippocampal Gyrus ◽

Intracranial Volume ◽

Gray Matter Atrophy ◽

Pattern Similarity

Objective:To examine whether late-life exposure to PM2.5 (particulate matter with aerodynamic diameters <2.5-µm) contributes to progressive brain atrophy predictive of Alzheimer’s disease (AD) using a community-dwelling cohort of women (aged 70-89) with up to two brain MRI scans (MRI-1: 2005-6; MRI-2: 2010-11).Methods:AD pattern similarity (AD-PS) scores, developed by supervised machine learning and validated with MRI data from the AD Neuroimaging Initiative, was used to capture high-dimensional gray matter atrophy in brain areas vulnerable to AD (e.g., amygdala, hippocampus, parahippocampal gyrus, thalamus, inferior temporal lobe areas and midbrain). Based on participants’ addresses and air monitoring data, we implemented a spatiotemporal model to estimate 3-year average exposure to PM2.5 preceding MRI-1. General linear models were used to examine the association between PM2.5 and AD-PS scores (baseline and 5-year standardized change), accounting for potential confounders and white matter lesion volumes.Results:For 1365 women aged 77.9±3.7 years in 2005-6, there was no association between PM2.5 and baseline AD-PS score in cross-sectional analyses (β=-0.004; 95% CI: -0.019, 0.011). Longitudinally, each interquartile range increase of PM2.5 (2.82-µg/m3) was associated with increased AD-PS scores during the follow-up, equivalent to a 24% (hazard ratio=1.24; 95% CI: 1.14, 1.34) increase in AD risk over 5-years (n=712; aged 77.4±3.5 years). This association remained after adjustment for socio-demographics, intracranial volume, lifestyle, clinical characteristics, and white matter lesions, and was present with levels below US regulatory standards (<12-µg/m3).Conclusions:Late-life exposure to PM2.5 is associated with increased neuroanatomical risk of AD, which may not be explained by available indicators of cerebrovascular damage.

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The Relationship Between Perceived Barriers for Physical Activity and Depression in Low Active Community-Dwelling Women

10.21203/rs.3.rs-135211/v1 ◽

2021 ◽

Author(s):

Caroline Figueroa ◽

Adrian Aguilera ◽

Thomas Hoffmann ◽

Yoshimi Fukuoka

Keyword(s):

Physical Activity ◽

Depressive Symptoms ◽

Social Influence ◽

Controlled Trial ◽

Depression Scale ◽

Community Dwelling ◽

Perceived Barriers ◽

Effect Estimate ◽

Cross Sectional ◽

The Relationship

Abstract Background: Women are less physically active, report greater perceived barriers for exercise and show higher levels of depression. This contributes to high global disability. The relationship between perceived barriers for physical activity and depressive symptoms in women remains largely unexplored. The aims of this cross-sectional analysis were to examine the association between physical activity barriers and depressive symptoms, and identify types of barriers in low active community dwelling women. Methods: 318 physically inactive women aged 25-65 years completed the Barriers to Being Active Quiz (BBAQ) developed by the Centers for Disease Control and Prevention, and the Center for Epidemiological Studies Depression Scale (CES-D) at the baseline visit of the mobile phone based physical activity education (mPED) trial. The BBAQ consists of 6 subscales (lack of time, social influence, lack of energy, lack of willpower, fear of injury, lack of skill, and lack of resources). We used multivariate regression analyses, correcting for sociodemographics. Results: Higher physical activity barriers were associated with greater depression scores (linear effect, estimate=0.75, 95% CI: 0.39 – 1.12, p<0.001). This effect appeared to taper off for the higher barrier scores (quadratic effect, estimate: -0.02, 95% CI: -0.03 – -0.01, p=0.002). Exploratory analyses indicated that score differences were most driven by the social influence (p=0.027) and lack of energy subscales (p=0.017).Conclusions: Higher depression scores were associated with higher physical activity barriers. Social influence and lack of energy were particularly important barriers. Thus, addressing these barriers may improve the efficacy of physical activity interventions in women with higher depressive symptoms. However, a randomized controlled trial is warranted. Trial Registration ClinicalTrials.gov#: NCTO1280812 registered January 21, 2011

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The Relationship between Cerebral White Matter Changes, Mental Function and Blood Pressure in Normal Elderly.

Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics ◽

10.3143/geriatrics.28.546 ◽

1991 ◽

Vol 28 (4) ◽

pp. 546-550 ◽

Cited By ~ 2

Author(s):

Kazuya Yamashita ◽

Shotai Kobayashi ◽

Hitoshi Fukuda ◽

Hiromi Koide ◽

Kazunori Okada ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Cerebral White Matter ◽

Mental Function ◽

White Matter Changes ◽

The Relationship

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Gender Differences in the Relationship between Living alone and Depressive Symptoms in Elderly Korean Adults

Iranian Journal of Public Health ◽

10.18502/ijph.v48i3.890 ◽

2019 ◽

Author(s):

Young Bum KIM ◽

Seung Hee LEE

Keyword(s):

Gender Differences ◽

Depressive Symptoms ◽

Activities Of Daily Living ◽

Daily Living ◽

Short Form ◽

Depression Scale ◽

Late Life ◽

Living Alone ◽

Korean Adults ◽

The Relationship

Background: This study examined gender differences in the relationship between living alone and depressive symptoms in elderly Korean adults and the variables that influence this relationship. Methods: We conducted a secondary analysis using fourth-wave data from adults 65 yr of age or older who participated in the Korean Longitudinal Study of Aging. Depressive symptoms were measured using the 10-item short-form of the Center for Epidemiological Studies Depression Scale. Multiple logistic regression analyses were used. Results: After controlling for the factors of formal and informal social activities, financial support from children, employment, activities of daily living, instrumental activities of daily living, self-rated health, frequency of meals, and gender, living alone (AOR=1.45, 95% CI =1.09-1.93, P=0.010) was an independent risk factor that contributed to depressive symptoms in late life. Living alone was more likely to elevate depressive symptoms in older women but not in older men. Conclusion: Gender differences in the depressive effect of living alone in late life may differ across diverse cultures.

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Abstract WP186: Association Between Blood Pressure, Internal Carotid Artery Flow Parameters And Age-related White Matter Disease

Stroke ◽

10.1161/str.44.suppl_1.awp186 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Benjamin S Aribisala ◽

Maria C Valdes Hernandez ◽

Natalie A Royle ◽

Susana Maniega ◽

Mark Bastin ◽

...

Keyword(s):

Blood Pressure ◽

White Matter ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Brain Mri ◽

Community Dwelling ◽

Intracranial Volume ◽

Flow Parameters ◽

The Brain

Background: White matter lesions (WML) are associated with hypertension. Blood pressure (BP) is transmitted to the brain via the carotid arteries, and autoregulation helps protect the brain. We investigated if BP via carotid waveform parameters were associated with WML. Methods: We obtained BP measurements from a cohort of community dwelling subjects at mean ages 70±1 and 73±1 years; brain MRI and carotid artery ultrasound at mean age 73±1 years. We calculated mean values of BP (systolic, diastolic, mean, variability and pulsatility), measured WML by volume, and Fazekas scale. We calculated internal carotid artery (ICA) mean blood flow velocity, pulsatility index (PI), and resistivity index (RI). We tested associations between BP and ICA flow parameters and WML using multiple linear regression, corrected for intracranial volume (ICV), age, gender, BMI, previous MI, diabetes, hypertension, smoking, hypercholesterolaemia, PVD and stroke. Results: Amongst 694 subjects, diastolic and mean BP decreased and hence BP pulsatility increased significantly between ages 70 and 73 years. Lower diastolic BP and higher BP pulsatility were associated with higher ICA PI (standardized β, age 70= -0.24, age 73= -0.19, both p<0.001; age 70 β=0.18, p<0.001, age 73 β=0.10, p=0.008 respectively). WML volume was weakly associated with BP at age 70 (diastolic β=0.08, systolic β=0.08, mean β=0.09, all p<0.05) but not with BP variability or pulsatility. Similar but weaker associations were seen at age 73. After adjusting for BP, larger WML volume was associated with higher ICA PI (β=0.10, p=0.012), but not any other measures. All associations were the same for WML Fazekas scores. Conclusions: The relatively weak association between BP and WML may be mediated via ICA pulsatility which is largely driven by falling diastolic BP. This questions the nature of the apparent link between BP and WML.

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