Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality

IntroductionCognitive frailty has recently been defined as the co-occurrence of physical frailty and cognitive impairment. Late-life depression is associated with both physical frailty and cognitive impairment, especially processing speed and executive functioning.Aim and objectivesIn this study, we investigated the association between physical frailty and cognitive functioning in depressed older persons.MethodsIn a total of 378 patients (> 60 years) with depression according to DSM-IV criteria and a MMSE score of 24 points or higher, the physical frailty phenotype as well as its individual criteria (weight loss, weakness, exhaustion, slowness, low activity) was studied. Cognitive functioning was examined in 4 domains: verbal memory, working memory, interference control, and processing speed.ResultsOf the 378 depressed patients (range 60–90 years; 66.1% women), 61 were classified as robust (no frailty criteria present), 214 as prefrail (1 or 2 frailty criteria present), and 103 as frail (> 3 criteria). Linear regression analyses, adjusted for confounders, showed that the severity of physical frailty was associated with poorer verbal memory, slower processing speed, and decreased working memory, but not with changes in interference control.ConclusionIn late-life depression, physical frailty is associated with poorer cognitive functioning, although not consistently for executive functioning. Future studies should examine whether cognitive impairment in the presence of physical frailty belongs to cognitive frailty and is indeed an important concept to identify a specific subgroup of depressed older patients, who need multimodal treatment strategies integrating physical, cognitive, and psychological functioning.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Association of Subjective Cognitive Complaints and Objective Cognitive Impairment in Late Life Depression

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2018.01.110 ◽

2018 ◽

Vol 26 (3) ◽

pp. S90-S91

Author(s):

Ruth Morin ◽

David D. Bickford ◽

Yiu Ho Au ◽

Kelly B. Scherer ◽

Daniel C. Catalinotto ◽

...

Keyword(s):

Cognitive Impairment ◽

Late Life ◽

Late Life Depression ◽

Cognitive Complaints ◽

Subjective Cognitive Complaints

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Overview of Late-Life Depression

10.1093/med:psych/9780195382242.003.0005 ◽

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.

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MRI-Based Classification Models in Prediction of Mild Cognitive Impairment and Dementia in Late-Life Depression

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2017.00013 ◽

2017 ◽

Vol 9 ◽

Cited By ~ 21

Author(s):

Aleksandra K. Lebedeva ◽

Eric Westman ◽

Tom Borza ◽

Mona K. Beyer ◽

Knut Engedal ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Late Life ◽

Classification Models ◽

Late Life Depression

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The pattern and course of cognitive impairment in late-life depression

Psychological Medicine ◽

10.1017/s0033291709990833 ◽

2009 ◽

Vol 40 (4) ◽

pp. 591-602 ◽

Cited By ~ 80

Author(s):

S. Köhler ◽

A. J. Thomas ◽

N. A. Barnett ◽

J. T. O'Brien

Keyword(s):

Cognitive Impairment ◽

Executive Functioning ◽

Cognitive Deficits ◽

Processing Speed ◽

Age Of Onset ◽

Late Onset ◽

Late Life ◽

Late Life Depression ◽

Remission Status ◽

Current Mood

BackgroundCognitive deficits persist despite clinical recovery in subjects with late-life depression, but more needs to be known about their longer-term outcome and factors affecting their course. To investigate this, we followed the pattern of cognitive impairments over time and examined the effects of current mood, remission status, age of depression onset and antidepressant (AD) treatment on these deficits.MethodSixty-seven subjects aged ⩾60 years with DSM-IV major depressive disorder and 36 healthy comparison subjects underwent tests of global cognition, memory, executive functioning and processing speed at baseline, 6 and 18 months, with some subjects tested again after 4 years. z scores were compared between groups, with analyses of clinical factors that may have influenced cognitive performance in depressed subjects.ResultsHalf of the patients exhibited a generalized cognitive impairment (GCI) that persisted after 18 months. Patients performed worse across all cognitive domains at all time points, without substantial variability due to current mood, remission status or AD treatment. Late age of onset was associated significantly with decline in memory and executive functioning. Impaired processing speed may be a partial mediator of some deficits, but was insufficient to explain differences between patients and controls. Four-year follow-up data suggest impairments persist, but do not further decline.ConclusionsCognitive deficits in late-life depression persist up to 4 years, affect multiple domains and are related to trait rather than state effects. Differences in severity and course between early and late onset depression suggest different pathogenic processes.

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

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.430 ◽

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.

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