Mood disorders in the elderly

2012 ◽  
pp. 1550-1558
Author(s):  
Robert Baldwin
Keyword(s):  
Bipolar Disorder ◽  
Mood Disorders ◽  
Late Life ◽  
Later Life ◽  
The Elderly ◽  
Clinical Syndrome ◽  
Late Life Depression ◽  
Increased Risk

This chapter considers some of the commonly asked questions about mood disorders in later life. Is depression in later life a distinct clinical syndrome? How common is it? Is there an organic link, for example to cerebral changes, and if so, is there an increased risk of later dementia? Is it more difficult to diagnose and treat late-life depression, and once treated, is the outcome good, bad, or indifferent? The emphasis will be on depression but bipolar disorder and mania will also be considered.

Late-life depression

2014 ◽  
Vol 29 (S3) ◽  
pp. 577-577 ◽  
Author(s):  
K. Ritchie
Keyword(s):  
Depressive Symptomatology ◽  
Late Onset ◽  
Late Life ◽  
Later Life ◽  
The Elderly ◽  
Conclusive Evidence ◽  
First Episode ◽  
Hormonal Changes ◽  
Late Life Depression ◽  
Incident Cases

Late-life depression is highly heterogeneous in clinical presentation, and is also commonly resistant to treatment. While some cases are a continuation of the chronic course of illness beginning in early adulthood, a large number of persons will have a first episode of depression in later life following alife-time of relatively good mental health. While incident cases of major depression tend to decrease with age, the number of persons with clinically significant depressive symptomatology rises. À distinction has often been made between early-onset and late-onset depression, however, there is no conclusive evidence to suggest these are distinct clinical entities. On the other hand observations from a fifteen year prospective population study of psychiatric disorder in the elderly (the ESPRIT Study) supports the alternative idea that depression may be divided into sub-types according to postulated aetiology; for example depression with a strong genetic component, related to hormonal changes, the consequence of trauma; the result of cerebrovascular insult. Exposure to these putative causes may be more common at different points in the life span, thus suggesting age-differences. Our research further suggests that even cases of depression appearing for the first time in late-life, may be initially triggered by risk factors occurring decades before. Our findings suggest, for example, that childhood events may lead to changes in the biology of stress management, which continue throughout life, increasing vulnerability to depression and persisting even after effective treatment of symptoms. Together these observations suggest it may be more meaningful to classify depression in the elderly according to probable principle precipitating factors rather than age.

scholarly journals Mental Disorders, Cognitive Impairment and the Risk of Suicide in Older Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Agnieszka Kułak-Bejda ◽  
Grzegorz Bejda ◽  
Napoleon Waszkiewicz
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Older People ◽  
Mood Disorders ◽  
The Elderly ◽  
Increased Risk ◽  
The World

More than 600 million people are aged 60 years and over are living in the world. The World Health Organization estimates that this number will double by 2025 to 2 billion older people. Suicide among people over the age of 60 is one of the most acute problems. The factors strongly associated with suicide are mentioned: physical illnesses, such as cancer, neurologic disorder, pain, liver disease, genital disorders, or rheumatoid disorders. Moreover, neurologic conditions, especially stroke, may affect decision-making processes, cognitive capacity, and language deficit. In addition to dementia, the most common mental disorders are mood and anxiety disorders. A common symptom of these disorders in the elderly is cognitive impairment. This study aimed to present the relationship between cognitive impairment due to dementia, mood disorders and anxiety, and an increased risk of suicide among older people. Dementia is a disease where the risk of suicide is significant. Many studies demonstrated that older adults with dementia had an increased risk of suicide death than those without dementia. Similar conclusions apply to prodromal dementia Depression is also a disease with a high risk of suicide. Many researchers found that a higher level of depression was associated with suicide attempts and suicide ideation. Bipolar disorder is the second entity in mood disorders with an increased risk of suicide among the elderly. Apart from suicidal thoughts, bipolar disorder is characterized by high mortality. In the group of anxiety disorders, the most significant risk of suicide occurs when depression is present. In turn, suicide thoughts are more common in social phobia than in other anxiety disorders. Suicide among the elderly is a serious public health problem. There is a positive correlation between mental disorders such as dementia, depression, bipolar disorder, or anxiety and the prevalence of suicide in the elderly. Therefore, the elderly should be comprehensively provided with psychiatric and psychological support.

scholarly journals Insulin resistance and sarcopenia: mechanistic links between common co-morbidities

2016 ◽  
Vol 229 (2) ◽  
pp. R67-R81 ◽  
Author(s):  
Mark E Cleasby ◽  
Pauline M Jamieson ◽  
Philip J Atherton
Keyword(s):  
Insulin Resistance ◽  
Skeletal Muscle ◽  
Mammalian Target Of Rapamycin ◽  
Later Life ◽  
The Elderly ◽  
Clinical Syndrome ◽  
Physiological Processes ◽  
Age Related ◽  
Increased Risk ◽  
Amp Activated Protein Kinase

Insulin resistance (IR) in skeletal muscle is a key defect mediating the link between obesity and type 2 diabetes, a disease that typically affects people in later life. Sarcopenia (age-related loss of muscle mass and quality) is a risk factor for a number of frailty-related conditions that occur in the elderly. In addition, a syndrome of ‘sarcopenic obesity’ (SO) is now increasingly recognised, which is common in older people and is applied to individuals that simultaneously show obesity, IR and sarcopenia. Such individuals are at an increased risk of adverse health events compared with those who are obese or sarcopenic alone. However, there are no licenced treatments for sarcopenia or SO, the syndrome is poorly defined clinically and the mechanisms that might explain a common aetiology are not yet well characterised. In this review, we detail the nature and extent of the clinical syndrome, highlight some of the key physiological processes that are dysregulated and discuss some candidate molecular pathways that could be implicated in both metabolic and anabolic defects in skeletal muscle, with an eye towards future therapeutic options. In particular, the potential roles of Akt/mammalian target of rapamycin signalling, AMP-activated protein kinase, myostatin, urocortins and vitamin D are discussed.

Treatment Considerations for Anxiety in the Elderly

CNS Spectrums ◽  
2003 ◽  
Vol 8 (S3) ◽  
pp. 6-13 ◽  
Author(s):  
Eric J. Lenze ◽  
Bruce G. Pollock ◽  
M. Katherine Shear ◽  
Benoit H. Mulsant ◽  
Ashok Bharucha ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Behavioral Therapy ◽  
Late Life ◽  
The Elderly ◽  
Anxiety Symptoms ◽  
Mood Stabilizers ◽  
Elderly Persons ◽  
Late Life Depression ◽  
Increased Risk ◽  
Treatment Considerations

AbstractAnxiety is common in the elderly and can present as a primary anxiety disorder or as a symptom of another disorder. Generalized anxiety disorder, in particular, is a common syndrome in late life. Anxiety symptoms are also common features of late-life depression and dementia. Treatment of anxiety in elderly persons has typically involved the use of benzodiazepines, which are often effective but problematic because they are associated with increased risk of cognitive impairment, falls, and fractures. Based on their safety and efficacy, antidepressants, particularly serotonergic medications, are considered first-line treatment for most anxiety disorders as well as anxiety symptoms of major depressive disorder. Psychotherapy, particularly cognitive-behavioral therapy, may be effective in these disorders as well; research is underway to adapt this therapy to the needs of elderly persons. Anxiety symptoms in dementia are poorly understood but may respond to atypical antipsychotics, serotonergic antidepressants, or mood stabilizers. Overall, the research in late-life anxiety has not caught up to the literature in late-life depression and, for the most part, treatment recommendations must be extrapolated from studies in young adults.

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

2014 ◽  
Vol 26 (9) ◽  
pp. 1501-1509 ◽  
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.

scholarly journals When Cognitive Decline and Depression Coexist in the Elderly: CSF Biomarkers Analysis Can Differentiate Alzheimer's Disease from Late-Life Depression

2018 ◽  
Vol 10 ◽  
Author(s):  
Claudio Liguori ◽  
Mariangela Pierantozzi ◽  
Agostino Chiaravalloti ◽  
Giulia M. Sancesario ◽  
Nicola B. Mercuri ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Decline ◽  
Late Life ◽  
The Elderly ◽  
Csf Biomarkers ◽  
Late Life Depression

Overview of Late-Life Depression

2015 ◽  
Author(s):  
Mark D. Miller
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Personality Disorders ◽  
Collaborative Care ◽  
Late Life ◽  
Medical Conditions ◽  
Late Life Depression ◽  
Alcohol Treatments

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.

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

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.

Mood Disorders in Late Life

2016 ◽  
pp. 298-310
Author(s):  
Pat Arean ◽  
Eric Lenze ◽  
Joaquin A. Anguera
Keyword(s):  
Major Depression ◽  
Access To Care ◽  
Mood Disorders ◽  
Late Life ◽  
Later Life ◽  
Standardized Assessment ◽  
Younger Adults ◽  
Assessment Scores ◽  
Assessment And Treatment

This chapter discusses how clinicians will need to prepare for a worldwide exponentially growing aging community by describing the current scope of practices with respect to the assessment and treatment mood disorders, including minor and major depression. Particularly for those in later life, the meaningful interpretation of standardized assessment scores requires consideration of medical and neurological complexities. Clinicians must be flexible not only with respect to characterization, but especially with respect to treatment, given the inherent challenges associated with access to care and the range of disability amongst these individuals. Indeed, these late-life individuals are typically assessed in a similar fashion to younger adults (which may obscure meaningful interpretations), making understanding the nuances underlying existing behavioral and pharmaceutical approaches an essential endeavor.

Origins of depression in later life

2005 ◽  
Vol 35 (9) ◽  
pp. 1241-1252 ◽  
Author(s):  
DAN G. BLAZER ◽  
CELIA F. HYBELS
Keyword(s):  
Older Adults ◽  
Stressful Life Events ◽  
Cognitive Distortions ◽  
Late Life ◽  
Later Life ◽  
Late Life Depression ◽  
Younger Adults ◽  
Social Risks ◽  
Clinically Significant ◽  
The Many

Background. Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike.Method. We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed.Results. Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks.Conclusions. A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.

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