scholarly journals Late-onset depression: issues affecting clinical care

2008 ◽  
Vol 14 (2) ◽  
pp. 152-158 ◽  
Author(s):  
Hannele Variend ◽  
Y. Vishnu Gopal
Keyword(s):  
Clinical Features ◽  
Cognitive Deficits ◽  
Early Onset ◽  
Late Onset ◽  
Clinical Care ◽  
Later Life ◽  
Recurrent Depression ◽  
Vascular Depression ◽  
Structural Abnormalities ◽  
First Time

A growing body of evidence suggests that late-onset depression (depression occurring for the first time in later life) differs from early-onset (recurrent) depression in terms of clinical features, aetiology, neuroanatomical substrates and prognosis. Some evidence suggests that late-onset depression is more associated with somatic symptoms, cognitive deficits, cerebral structural abnormalities, vascular disease (‘vascular depression’) and poorer treatment outcomes than is early-onset depression. Both general adult and old age psychiatrists face the challenges of managing late-onset depression. In this article we attempt to clarify specific issues relating to late-onset depression in terms of clinical features, aetiology, treatment response and prognosis.

P.309 Late-life depression: How do patients with early-onset vs late-onset differ in clinical features and treatment response?

2020 ◽  
Vol 31 ◽  
pp. S52-S53
Author(s):  
W.R. Chae ◽  
M. Fuentes Casan ◽  
F. Gutknecht ◽  
A. Ljubez ◽  
S.M. Gold ◽  
...  
Keyword(s):  
Treatment Response ◽  
Clinical Features ◽  
Early Onset ◽  
Late Onset ◽  
Late Life ◽  
Late Life Depression

scholarly journals Outcome measures and treatment effectiveness in late onset myasthenia gravis

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Francesca Pasqualin ◽  
Silvia V. Guidoni ◽  
Mario Ermani ◽  
Elena Pegoraro ◽  
Domenico M. Bonifati
Keyword(s):  
Side Effects ◽  
Myasthenia Gravis ◽  
Outcome Measures ◽  
Clinical Features ◽  
Early Onset ◽  
Treatment Effectiveness ◽  
Late Onset ◽  
Positive Outcome ◽  
Response To Treatment

Abstract Background Recently different subtypes of myasthenia gravis (MG) have been described. They differ for clinical features and pathogenesis but the prognosis and response to treatment is less clear. The aim of the study was to evaluate outcome and treatment effectiveness including side effects in late onset MG (LOMG) compared with early onset MG (EOMG). Methods We analysed retrospectively 208 MG patients. Clinical features were recorded as well as treatment and side effects. Outcome at the last follow-up was evaluated with MGSTI and MGPIS scales. Results The 208 patients included were classified as follow: 36 ocular MG, 40 EOMG, 72 LOMG, 25 thymoma-associated, 14 anti-MuSK and 21 double seronegative. Similar positive outcome was achieved in either early and late onset subgroup. We found pharmacological remission and minimal manifestations at the MGFA-PIS in the 95% and 94,4% of EOMG and LOMG respectively but in LOMG a lower dose of immunosuppressors (MGSTI< 2) was required compared to EOMG (p = 0,048). Severe side effects were present in a small percentage of patients in both group but diabetes was more frequent in LOMG vs EOMG (2,2% vs 5%, p = 0.017). Conclusions Despite LOMG has more comorbidities that might interfere with treatment and outcome, therapeutic management does not seem to differ between EOMG and LOMG. A similar positive outcome was seen in both subgroups but LOMG group seems to require lower doses of medication to control symptoms.

scholarly journals Fetal Growth Restriction – Diagnostic Work-up, Management and Delivery

2020 ◽  
Vol 80 (10) ◽  
pp. 1016-1025 ◽  
Author(s):  
Dietmar Schlembach
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Fetal Monitoring ◽  
Later Life ◽  
Growth Restriction ◽  
Growth Potential ◽  
Ductus Venosus ◽  
Optimum Approach ◽  
Diagnostic Work ◽  
Genetically Determined

AbstractFetal or intrauterine growth restriction (FGR/IUGR) affects approximately 5 – 8% of all pregnancies and refers to a fetus not exploiting its genetically determined growth potential. Not only a major cause of perinatal morbidity and mortality, it also predisposes these fetuses to the development of chronic disorders in later life. Apart from the timely diagnosis and identification of the causes of FGR, the obstetric challenge primarily entails continued antenatal management with optimum timing of delivery. In order to minimise premature birth morbidity, intensive fetal monitoring aims to prolong the pregnancy and at the same time intervene, i.e. deliver, before the fetus is threatened or harmed. It is important to note that early-onset FGR (< 32 + 0 weeks of gestation [wks]) should be assessed differently than late-onset FGR (≥ 32 + 0 wks). In early-onset FGR progressive deterioration is reflected in abnormal venous Doppler parameters, while in late-onset FGR this manifests primarily in abnormal cerebral Doppler ultrasound. According to our current understanding, the “optimum” approach for monitoring and timing of delivery in early-onset FGR combines computerized CTG with the ductus venosus Doppler, while in late-onset FGR assessment of the cerebral Doppler parameters becomes more important.

Suicide in later life: A comparison between cases with early-onset and late-onset depression

2011 ◽  
Vol 132 (1-2) ◽  
pp. 185-191 ◽  
Author(s):  
Richard C. Oude Voshaar ◽  
Nav Kapur ◽  
Harriet Bickley ◽  
Alyson Williams ◽  
Nitin Purandare
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Later Life

“The Old Lady and the Dead Bird”–A Case of Very-late-onset Schizophrenia-like Psychosis

2017 ◽  
Vol 41 (S1) ◽  
pp. S647-S648
Author(s):  
V. Covelo ◽  
M. Marinho ◽  
A.S. Machado ◽  
J. Rebelo ◽  
R. Moreira
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Late Onset ◽  
Single Woman ◽  
Persecutory Delusions ◽  
Dead Bird ◽  
The Past ◽  
Schizophrenia Group ◽  
Competing Interest ◽  
First Time

IntroductionIn 1943, Bleuler defined “late-onset schizophrenia” as a form of schizophrenia with onset after the age of 40. Half a century had passed with no consensus on the late psychosis’ terminology, when in 1998 the international late- onset schizophrenia group Consensus proposed a nosology for these disorders: late-onset schizophrenia and very-late-onset schizophrenia-like psychosis.ObjectivesPresentation of a case and diagnostic discussion.MethodsInterviews with the patient during his hospitalisation.ResultsWe present a case of a 73-year-old single woman, with no psychiatric history, who was driven to the emergency department by her relatives when they noticed her bizarre behaviour: she had drowned and strangled her pet bird. At examination she was agitated, had persecutory delusions, thought broadcasting, cenesthetic and auditory hallucinations in the form of a masculine voice, who sang and dialogued with her. Symptoms had evolved during the past six months with no apparent functional impairment. During hospitalisation she was treated with risperidone (up to 5 mg/day) with improvement in a few days. There were no significant abnormalities on cerebral tomography and analytical exams. Neuropsychological evaluation ruled out cognitive deficits. At the time of discharge although the patient kept referring auditory hallucinatory activity, she had an appropriate behaviour, and no evidence of negative symptoms.ConclusionsThe small group of patients who meet schizophrenia's criteria for the first time at a later age present some particular clinical characteristics to be taken into account. This case highlights some of them, drawing attention to this uncommon diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression in Later Life

1995 ◽  
Vol 167 (5) ◽  
pp. 649-652 ◽  
Author(s):  
R. C. Baldwin ◽  
Barbara Tomenson
Keyword(s):  
Vascular Disease ◽  
Early Onset ◽  
Rating Scale ◽  
Late Onset ◽  
Later Life ◽  
The Elderly ◽  
Course Of Illness ◽  
Anxiety Item ◽  
History Of ◽  
Item Scores

BackgroundDepression in later life is often thought to differ from that at other times of adulthood. The evidence for this is controversial but is important to any proposed organic model of depression in the elderly. Here, early- and late-onset depressions in later life are compared.MethodFifty-seven depressed patients with a mean age of 74 were studied, 21 with an early onset (aged 59 or less) and 36 with a late onset. All were suffering from major depression according to DSM–III–R. The measures at entry included severity and symptoms, cognitive function, antecedent life events, physical health and vascular risk factors and/or vascular disease. We also recorded any family history of mood disorders, as well as the course of illness.ResultsThe anxiety item scores of the Hamilton Depression Rating Scale were significantly higher in those with an early onset, but otherwise symptoms differed little. Heritability was greater in the early-onset group. There was a striking association of vascular disease and/or risk with late-onset patients.ConclusionsVascular disease is associated with late-onset depression. This is consistent with the hypothesis that depression in later life is a more ‘biological’ disorder.

Ethnicity and Age at Onset in Bipolar Spectrum Disorders

CNS Spectrums ◽  
2011 ◽  
Vol 16 (6) ◽  
pp. 127-134 ◽  
Author(s):  
Naima Javaid ◽  
James L. Kennedy ◽  
Vincenzo De Luca
Keyword(s):  
Substance Abuse ◽  
Clinical Features ◽  
Early Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Admixture Analysis ◽  
Bipolar Spectrum ◽  
Clinical Marker ◽  
Bipolar Spectrum Disorders ◽  
Spectrum Disorders

AbstractIntroductionTo determine the influence of ethnicity on the age at onset (AAO) and further understand the significance of AAO as a clinical marker of bipolar and schizoaffective disorders.MethodsAdmixture analysis was used to identify sub-groups characterized by differences in AAO. Differences in clinical features were analyzed for these sub-groups using multivariate logistic regression. Comparisons were made with previous studies using the 2-Sample Kolmogorov-Smirnov Test.ResultsAdmixture analysis yielded a combination of 2 normal theoretical distributions with means (SD) of 16.9 (3.6) for the early-onset sub-group and 24.4 (9.2) years for the late-onset sub-group. The sub-groups were divided by a cut-off of 22 years. There were significant differences between the early and late onset bipolar patient populations regarding substance abuse comorbidity (P=.044) and psychotic features (P=.015). Ethnicity did not have a significant influence on the AAO.DiscussionThe associations between early-onset and higher incidence of psychosis and substance abuse in our sample are consistent with other studies exploring the AAO in bipolar disorder.ConclusionOur findings support the notion of AAO as a clinical marker for the underlying heterogeneity of bipolar spectrum disorders. In particular, we found a strong overlap of early AAO with clinical features associated with greater severity and poor outcome.

Clinical Features of Late-onset Ankylosing Spondylitis: Comparison with Early-onset Disease

2012 ◽  
Vol 39 (5) ◽  
pp. 1008-1012 ◽  
Author(s):  
CARLOS MONTILLA ◽  
JAVIER DEL PINO-MONTES ◽  
EDUARDO COLLANTES-ESTEVEZ ◽  
PILAR FONT ◽  
PEDRO ZARCO ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Clinical Features ◽  
Early Onset ◽  
Late Onset ◽  
Age At Onset ◽  
Young Patients ◽  
Lower Limbs ◽  
Joint Disease ◽  
Control Group ◽  
Onset Group

Objective.Ankylosing spondylitis (AS) is generally observed in young patients but can occur later in life or in persons ≥ 50 years of age. Our objective was to characterize the clinical features of late-onset AS in a large multicenter national cohort.Methods.We studied late-onset AS in the National Registry of Spondyloarthritis of the Spanish Society of Rheumatology (REGISPONSER database) cohort (n = 1257), of whom 3.5% had onset at age ≥ 50 years versus a control group with onset at < 50 years.Results.There were no differences between late-onset and early-onset AS according to sex and family history of spondyloarthropathies. Patients in the late-onset group more often showed involvement of the cervical spine (22.7% vs 9.7%; p = 0.03) and arthritis of the upper (13.6% vs 3.0%; p = 0.002) and lower limbs (27.3% vs 15.2%; p = 0.03) as first manifestations than did patients in the early-onset group. A higher percentage of mixed forms (axial and peripheral joint disease) during the course of the disease was also recorded in the late-onset group (50% vs 24%; p = 0.0001).Conclusion.Our study suggests that age at onset of AS affects the patients’ presenting clinical form. Arthritis of the upper limbs requires a differential diagnosis with other conditions frequent in patients over 50 years of age, such as rheumatoid arthritis or crystal-induced arthropathy.

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