Depression and Dementia: The Role of Cortisol and Vascular Brain Lesions. AGES-Reykjavik Study

2021 ◽  
pp. 1-11
Author(s):  
Lotte Gerritsen ◽  
Emma L. Twait ◽  
Palmi V. Jonsson ◽  
Vilmundur Gudnason ◽  
Lenore J. Launer ◽  
...  
Keyword(s):  
Brain Mri ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Diagnostic Interview ◽  
Late Life Depression ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Background: Late-life depression (LLD) is related to an increased risk of developing dementia; however, the biological mechanisms explaining this relationship remain unclear. Objective: To determine whether the relationship between LLD and dementia can be best explained by the glucocorticoid cascade or vascular hypothesis. Methods: Data are from 4,354 persons (mean age 76±5 years) without dementia at baseline from the AGES-Reykjavik Study. LLD was assessed with the MINI diagnostic interview (current and remitted major depressive disorder [MDD]) and the Geriatric Depression Scale-15. Morning and evening salivary cortisol were collected (glucocorticoid cascade hypothesis). White matter hyperintensities (WMH; vascular hypothesis) volume was assessed using 1.5T brain MRI. Using Cox proportional hazard models, we estimated the associations of LLD, cortisol levels, and WMH volume with incident all-cause dementia, AD, and non-AD dementia. Results: During 8.8±3.2 years of follow-up, 843 persons developed dementia, including 397 with AD. Current MDD was associated with an increased risk of developing all-cause dementia (HR = 2.17; 95% CI 1.66–2.67), with risks similar for AD and non-AD, while remitted MDD was not (HR = 1.02; 95% CI 0.55–1.49). Depressive symptoms were also associated with increased risk of dementia, in particular non-AD dementias. Higher levels of evening cortisol increased risk of dementia, but this was independent of MDD. WMH partially explained the relation between current MDD and dementia risk but remained increased (HR = 1.71; 95% CI 1.34–2.08). Conclusion: The current study highlights the importance of LLD in developing dementia. However, neither the glucocorticoid cascade nor the vascular hypotheses fully explained the relation between depression and dementia.

scholarly journals Case-Finding for Depression in Elderly People: Balancing Ease of Administration With Validity in Varied Treatment Settings

2004 ◽  
Vol 59 (4) ◽  
pp. M378-M384 ◽  
Author(s):  
Karen Blank ◽  
Cynthia Gruman ◽  
Julie T. Robison
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Nursing Homes ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Diagnostic Interview ◽  
Case Finding ◽  
Late Life Depression ◽  
Cut Points

Abstract Background. Little is known about the performance of brief and ultrabrief (1- and 2-question) depression screens in older patients across varied treatment sites. This study (1) assesses their validity in clinics, hospitals, and nursing homes and (2) assesses cut-points for optimal clinical application. Methods. 360 patients aged 60 years and older from 2 urban primary care practices (n = 125), 1 general hospital (n = 150), and 8 nursing homes (n = 85) were assessed using the Yale 1-question screen, the 2-question instrument derived from the Primary Care Evaluation of Mental Disorders, and long and short versions of the Center for Epidemiologic Studies Depression (CES-D) scale and Geriatric Depression Scale (GDS). Sensitivity and specificity were calculated for each screen compared with the criterion standard Diagnostic Interview Schedule (DIS) depression diagnosis and receiver operating characteristic curves generated. Results. 9% of patients met DIS criteria for major depression and 7% for subsyndromal depression. Overall, the 10-item CES-D showed the best sensitivity/specificity for major depression in clinics (79%/81%) and hospitals (92%/77%), and the short GDS in nursing homes (86%/82%). Specificity of 1- and 2-question instruments was generally low. Established cut-points generally worked best for the short screens, while modifications were useful for longer versions. Conclusions. Consideration of site of use is important in selecting brief case-finding instruments for late-life depression, with the 10-item CES-D working best in medical settings and the 15-item GDS in nursing homes.

scholarly journals Motor and Sensory Function as Predictors of MCI and Dementia in the Baltimore Longitudinal Study of Aging (BLSA)

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 439-439
Author(s):  
Amal Wanigatunga ◽  
Yurun Cai ◽  
Hang Wang ◽  
Yuri Agrawal ◽  
Susan Resnick ◽  
...  
Keyword(s):  
Gait Speed ◽  
Joint Effect ◽  
Sensory Function ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Sensory Impairments ◽  
Cox Proportional Hazard Models ◽  
Baltimore Longitudinal Study

Abstract Motor and sensory impairments are linked with dementia risk, but whether there is a joint effect of deficits in motor and sensory function is unknown. We analyzed 649 BLSA participants (aged 72±11 years; 55% women; 68% white) who had concurrent baseline 6-meter usual gait speed and sensory function (vision, hearing) between 2012-2019. Mild cognitive impairment (MCI) and dementia were adjudicated during an average follow-up of 3 years. We examined the association between baseline gait speed, z-scored sensory function, and a gait*sensory interaction with risk of MCI/dementia using Cox proportional hazard models, adjusted for demographics and chronic conditions. Each .01 m/s faster baseline gait was associated with a reduced risk (HR:0.98 (0.96-0.99)) of MCI/dementia, and each 1 SD higher in hearing and vision z-score was associated with an increased risk (HR:1.84 (1.1-3.1)) increased risk. The was no significant interaction, suggesting motor and sensory impairments may be independently associated with MCI/dementia risk.

scholarly journals Role of depressive symptoms in cardiometabolic diseases and subsequent transitions to all-cause mortality: an application of multistate models in a prospective cohort study

2021 ◽  
pp. svn-2020-000693
Author(s):  
Yanan Qiao ◽  
Siyuan Liu ◽  
Guochen Li ◽  
Yanqiang Lu ◽  
Ying Wu ◽  
...  
Keyword(s):  
Heart Disease ◽  
Depressive Symptoms ◽  
Depression Scale ◽  
European Population ◽  
Multistate Models ◽  
Cardiometabolic Diseases ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Patients With Diabetes

Background and purposeThe role of depression in the development and outcome of cardiometabolic diseases remains to be clarified. We aimed to examine the extent to which depressive symptoms affect the transitions from healthy to diabetes, stroke, heart disease and subsequent all-cause mortality in a middle-aged and elderly European population.MethodsA total of 78 212 individuals aged ≥50 years from the Survey of Health Ageing and Retirement in Europe were included. Participants with any baseline cardiometabolic diseases including diabetes, stroke and heart disease were excluded. Depressive symptoms were measured by the Euro-Depression scale at baseline. Participants were followed up to determine the occurrence of cardiometabolic diseases and all-cause mortality. We used multistate models to estimate the transition-specific HRs and 95% CIs after adjustment of confounders.ResultsDuring 500 711 person-years of follow-up, 4742 participants developed diabetes, 2173 had stroke, 5487 developed heart disease and 7182 died. Depressive symptoms were significantly associated with transitions from healthy to diabetes (HR: 1.12, 95% CI: 1.05 to 1.20), stroke (HR: 1.31, 95% CI: 1.18 to 1.44), heart disease (HR: 1.26, 95% CI: 1.18 to 1.34) and all-cause mortality (HR: 1.41, 95% CI: 1.34 to 1.49). After cardiometabolic diseases, depressive symptoms were associated with the increased risk of all-cause mortality in patients with diabetes (HR: 1.54, 95% CI: 1.25 to 1.89), patients who had stroke (HR: 1.29, 95% CI: 1.03 to 1.61) and patients with heart disease (HR: 1.21, 95% CI: 1.02 to 1.44).ConclusionsDepressive symptoms increase the risk of diabetes, stroke and heart disease, and affect the risk of mortality after the onset of these cardiometabolic conditions. Screening and treatment of depressive symptoms may have profound implications for the prevention and prognosis of cardiometabolic diseases.

scholarly journals Colorectal cancer survival among Ministry of National Guard-Health Affairs (MNG-HA) population 2009–2017: retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mesnad Alyabsi ◽  
Fouad Sabatin ◽  
Majed Ramadan ◽  
Abdul Rahman Jazieh
Keyword(s):  
Colorectal Cancer ◽  
Distant Metastasis ◽  
Cancer Survival ◽  
National Guard ◽  
Population Based ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Cox Proportional Hazard Models

Abstract Background Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors. Methods Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC. Results A total of 1012 CRC patients were diagnosed during 2009–2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival. Conclusions Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered.

scholarly journals A network approach on the relation between apathy and depression symptoms with dementia and functional disability

2019 ◽  
Vol 31 (11) ◽  
pp. 1655-1663 ◽  
Author(s):  
Lennard L. van Wanrooij ◽  
Denny Borsboom ◽  
Eric P. Moll van Charante ◽  
Edo Richard ◽  
Willem A. van Gool
Keyword(s):  
Network Analysis ◽  
Functional Disability ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Analysis Data ◽  
Future Research ◽  
Depression Symptoms ◽  
Dementia Risk ◽  
Strongly Connected ◽  
Sum Scores

ABSTRACTBackground:Studies on the association between depression and dementia risk mostly use sum scores on depression questionnaires to model symptomatology severity. Since individual items may contribute differently to this association, this approach has limited validity.Methods:We used network analysis to investigate the functioning of individual Geriatric Depression Scale (GDS-15) items, of which, based on studies that used factor analysis, 3 are generally considered to measure apathy (GDS-3A) and 12 depression (GDS-12D). Functional disability and future dementia were also included in our analysis. Data were extracted from 3229 participants of the Prevention of Dementia by Intensive Vascular care trial (preDIVA), analyzed as a single cohort, yielding 20,542 person-years of observation. We estimated a sparse network by only including connections between variables that could not be accounted for by variance in other variables. For this, we used a repeated L1 regularized regression procedure.Results:This procedure resulted in a selection of 59/136 possible connections. GDS-3A items were strongly connected to each other and with varying strength to several GDS-12D items. Functional disability was connected to all three GDS-3A items and the GDS-12D items “helplessness” and “worthlessness”. Future dementia was only connected to the GDS-12D item “memory problems”, which was in turn connected to the GDS-12D items “unhappiness” and “helplessness” and all three GDS-3A items.Conclusion:Network analysis reveals interesting relationships between GDS items, functional disability and dementia risk. We discuss what implications our results may have for (future) research on the associations between depression and/or apathy with dementia.

scholarly journals Risk of Dementia in Patients with Leptospirosis: A Nationwide Cohort Analysis

2019 ◽  
Vol 16 (17) ◽  
pp. 3168
Author(s):  
Chun-Hsiang Chiu ◽  
Po-Chung Chen ◽  
Ying-Chuan Wang ◽  
Cheng-Li Lin ◽  
Feng-You Lee ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Cohort Analysis ◽  
Frequency Matching ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Taiwan National Health Insurance ◽  
History Of ◽  
Cox Proportional Hazard Regression ◽  
The Relationship

Background: Studies have linked some bacterial infections with an increased likelihood for development of dementia. However, there is a paucity of data on the relationship between dementia and leptospirosis. In view of this, we conducted a retrospective cohort study to determine whether leptospirosis is a risk factor for dementia. Methods: Data were collected from the Taiwan National Health Insurance Research Databases (2000–2010) to investigate the incidence of and risk factors for dementia in patients with leptospirosis. Patients with leptospirosis who did not have a history of dementia were enrolled in the study. For each leptospirosis patient, four controls were randomly selected after frequency matching of age, sex, and index date. Cox proportional hazard regression models were used for the analyses of dementia risk. Results: A greater risk of dementia was observed in the leptospirosis cohort than in the non-leptospirosis cohort both in patients without any comorbidity (adjusted HR (aHR) = 1.23, 95% CI = 1.06–1.43) and with a comorbidity (aHR = 2.06, 95% CI = 1.7–2.5). Compared with the non-leptospirosis cohort without these comorbidities, the leptospirosis cohort with ≥2 comorbidities exhibited a significantly increased risk of dementia (aHR = 6.11, 95% CI = 3.15–11.9), followed by those with any one comorbidity (adjusted HR = 3.62, 95% CI = 1.76–7.46). Conclusions: Patients with leptospirosis were at a 1.89-fold greater risk of subsequent dementia, but potential genetic susceptibility bias in the study group is a major confound.

scholarly journals A practical approach to detection and treatment of depression in Parkinson disease and dementia

2017 ◽  
Vol 7 (2) ◽  
pp. 128-140 ◽  
Author(s):  
Zahra Goodarzi ◽  
Zahinoor Ismail
Keyword(s):  
Parkinson Disease ◽  
Clinical Decision Making ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Clinical Decision ◽  
Geriatric Depression ◽  
Late Life Depression ◽  
Treatment Of Depression ◽  
Pharmacologic Management ◽  
Severity Of Depression

AbstractPurpose of review:To review the available evidence for the detection and management of depression in Parkinson disease (PD) and dementia.Recent findings:Depression is a common comorbidity in those with PD or dementia, and leads to increased morbidity. There are several available and accurate tools for the detection of depression in PD (e.g., Geriatric Depression Scale) and dementia (e.g., Cornell Scale for Depression in Dementia). Treatment of depression depends on patient preference, severity of depression, comorbidities, and available resources. Despite variable evidence, the use of nonpharmacologic strategies to manage depression is suggested. Pharmacologic management is guided by modest evidence in PD and dementia, but also informed by the management of late-life depression (LLD).Summary:There is evidence to guide the diagnosis and management of depression in PD or dementia. However, more research is required in this field to better inform clinical decision-making.

Health inequalities in hospitalisation and mortality in patients diagnosed with heart failure in a universal healthcare coverage system

2018 ◽  
Vol 72 (9) ◽  
pp. 845-851 ◽  
Author(s):  
Raquel Garcia ◽  
Rosa Abellana ◽  
Jordi Real ◽  
José-Luis del Val ◽  
Jose Maria Verdú-Rotellar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Total Mortality ◽  
Community Dwelling ◽  
Socioeconomic Groups ◽  
Universal Healthcare ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Healthcare Coverage ◽  
Cox Proportional Hazard Models ◽  
Universal Healthcare Coverage

BackgroundInformation regarding the effect of social determinants of health on heart failure (HF) community-dwelling patients is scarce. We aimed to analyse the presence of socioeconomic inequalities, and their impact on hospitalisations and mortality, in patients with HF attended in a universal healthcare coverage system.MethodsA retrospective cohort study carried out in patients with HF aged >40 and attended at the 53 primary healthcare centres of the Institut Català de la Salut in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA). Cox proportional hazard models and competing-risks regression based on Fine and Gray’s proportional subhazards were performed to analyse hospitalisations due to of HF and total mortality that occurred between 1 January 2009 and 31 December 2012.ResultsMean age was 78.1 years (SD 10.2) and 56% were women. Among the 8235 patients included, 19.4% died during the 4 years of follow-up and 27.1% were hospitalised due to HF. A gradient in the risk of hospitalisation was observed according to SES with the highest risk in the lowest socioeconomic group (sHR 1.46, 95% CI 1.27 to 1.68). Nevertheless, overall mortality did not differ among the socioeconomic groups.ConclusionsIn spite of finding a gradient that linked socioeconomic deprivation to an increased risk of hospitalisation, there were no differences in mortality regarding SES in a universal healthcare coverage system.

scholarly journals Identifying the Factors Related to Depressive Symptoms Amongst Community-Dwelling Older Adults with Mild Cognitive Impairment

2019 ◽  
Vol 16 (18) ◽  
pp. 3449 ◽  
Author(s):  
Dan Song ◽  
Doris S.F. Yu ◽  
Polly W.C. Li ◽  
Qiuhua Sun
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mild Cognitive Impairment ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Increased Risk ◽  
Community Dwelling Older Adults

High-level depressive symptoms have been reported in individuals with mild cognitive impairment (MCI), resulting in increased risk of progression to dementia. However, studies investigating the correlates of depressive symptoms among this population are scarce. This study aimed to investigate the significant socio-demographic, lifestyle-related and disease-related correlates of depressive symptoms among this cohort. Cross-sectional data were obtained from a sample of 154 Chinese community-dwelling older adults with MCI. MCI subjects were screened by the Montreal Cognitive Assessment. Depressive symptoms were measured by the Geriatric Depression Scale. Possible correlates of depressive symptoms in individuals with MCI were explored by multiple linear regressions. The prevalence of depressive symptoms among Chinese older adults with MCI was 31.8%. In multiple regression analysis, poor perceived positive social interaction, small social network, low level of physical activity, poor functional status, subjective memory complaint, and poor health perception were correlated with depressive symptoms. The findings highlight that depressive symptoms are sufficient to warrant evaluation and management in older adults with MCI. Addressing social isolation, assisting this vulnerable group in functional and physical activities, and cultivating a positive perception towards cognitive and physical health are highly prioritized treatment targets among individuals with MCI.

Do the GDS and the GDS-15 adequately capture the range of depressive symptoms among older residents in congregate housing?

2011 ◽  
Vol 23 (6) ◽  
pp. 950-960 ◽  
Author(s):  
Kathryn Betts Adams
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Oldest Old ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Diagnostic Interview ◽  
Geriatric Depression ◽  
Roc Curve Analysis ◽  
Cut Points ◽  
Hit Rates

ABSTRACTBackground: In light of inconsistencies in cut points for identifying non-major depression, this study examined the classification efficiency of the Geriatric Depression Scale (GDS and GDS-15) total scores and individual items, and four additional depressive symptoms for identification of subthreshold, minor, or criterion depression among 166 vulnerable residents of congregate housing.Methods: Depression (combined categories of major depressive episode, minor, or subthreshold depression) was determined by the Mini-International Neuropsychiatric Interview (MINI) diagnostic interview depression module administered by telephone to 166 older residents of congregate housing facilities who also completed the 30-item GDS and four other yes/no potential indicators of geriatric depression. Classification agreement and ROC curve analysis for the full and 15-item GDS scale scores were calculated. Individual item hit rates for MINI criterion were calculated for GDS items and four new items.Results: GDS and GDS-15 at standard cut points had 70–75% agreement with MINI. Best sensitivity and specificity were obtained at lower than standard cut points. Some GDS Withdrawal, Apathy, lack of Vigor (WAV) and cognitive items obtained very low hit rates. New items “I just don't feel like myself” and “I feel I am a burden to others” better discriminated MINI depression than most GDS items and had good item-to-total correlations with the GDS.Conclusions: Diagnostic criteria and GDS screen had partial agreement. Some GDS items did not adequately represent depression among functionally impaired or oldest old older adults. Feeling one is a burden and the sense of feeling “different” from usual may be useful indicators of depression among vulnerable older adults.

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