Objectives: Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. Method: Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. Results: Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. Conclusion: Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.
RESUMO -(Cleistogamia em Ruellia menthoides (Nees) Hiern e R. brevifolia (Pohl) C. Ezcurra (Acanthaceae) em fragmento florestal do Sudeste brasileiro). São abordados a morfologia e a biologia floral de Ruellia menthoides (Nees) Hiern e R. brevifolia (Pohl) C. Ezcurra, na Reserva Florestal Mata do Paraíso, remanescente de Floresta Atlântica, em Viçosa, Zona da Mata de Minas Gerais, Brasil. Ruellia menthoides e R. brevifolia são espécies cleistógamas, ou seja, apresentam dimorfismo floral, produzindo flores casmógamas normais (CA) e cleistógamas (CL). Além disso, formas intermediárias entre esses tipos florais (flores casmógamas reduzidas e semicleistógamas) também são observadas. Em R. menthoides a cleistogamia é inédita, ampliando o número de espécies desse gênero com esse mecanismo reprodutivo. A alogamia, nessas espécies, é favorecida pela produção de flores CA hercogâmicas, especialmente em R. menthoides, e pela dicogamia parcial. A floração de ambas as espécies ocorreu durante todo o ano. Houve pequena sobreposição do período de produção dos dois tipos florais em R. menthoides e ampla sobreposição em R. brevifolia. Em R. menthoides, o início da produção de flores CL coincidiu com o período de transição da estação úmida para a seca, e em R. brevifolia, a produção desse tipo floral ocorreu principalmente na estação seca. A complexidade taxonômica de Ruellia parece estar relacionada à escassez de informações sobre a biologia reprodutiva de suas espécies, que é agravada com o polimorfismo floral das espécies cleistógamas.Palavras-chave: cleistogamia, Floresta Atlântica, morfologia floral, polimorfismo floral, Ruellia ABSTRACT -(Cleistogamy in Ruellia menthoides (Nees) Hiern and R. brevifolia (Pohl) C. Ezcurra (Acanthaceae) in a forest fragment of Southeastern Brazilian). Floral morphology and biology of Ruellia menthoides (Nees) Hiern and R. brevifolia (Pohl) C. Ezcurra were analyzed in Reserva Florestal Mata do Paraíso, a remainder of the Atlantic forest, in Viçosa, Zona da Mata, Minas Gerais State, Brazil. R. menthoides and R. brevifolia are cleistogamous, e.g., they show floral dimorphism, with normal chasmogamous (CA) and cleistogamous (CL) flowers. Intermediate forms between these two floral types (miniature chasmogamous and semicleistogamous flowers) are also observed. R. menthoides cleistogamy is a novel discovery, which augments the number of species of this genus with that reproductive system. In these species, alogamy is favored by CA hercogamic flower production, verified mainly in R. menthoides, and by partial dichogamy. In both species, flowers production occurs throughout the year. There was a small production period overlap of both types of flowers in R. menthoides and a large overlap in R. brevifolia. The initial production of CL flowers in R. menthoides coincided with the transition period from the wet to the dry season and in R. brevifolia, such type of flowers was produced mainly in the dry season. The taxonomic complexity of Ruellia may be related to the scarcity of information on the reprodu...
OBJECTIVES:The aim of the present study was to investigate whether late-life depression (LLD) is associated with incident frailty over time. DESIGN: Prospective cohort study, one-year follow-up. SETTING: Geriatric outpatient clinic, Southwestern of Brazil. PARTICIPANTS: 181 follow-up participants aged 60 years or over. MEASUREMENTS: Depressive disorders were classified as Major Depressive disorder (MDD) or Subthreshold Depression (STD) according to DSM-5 criteria. Depressive symptoms were assessed with validated versions of 15-item Geriatric Depression Scale (GDS-15) and 9-item Patient Health Questionnaire (PHQ-9). We performed binary logistic regressions to estimate the odds ratio (OR) for frailty in LLD adjusting for multiple confounders. Participants who were frail at baseline were excluded from the analyses according to measures of frailty (FRAIL questionnaire and 36-item Frailty Index, FI-36). We also estimated the risk ratio or relative risk (RR) and the risk difference (RD) for incident frailty. RESULTS: We observed a 2 to 4-fold increased risk for incident frailty among participants with LLD. The presence of a depressive disorder was significantly associated with the onset of frailty (adjusted OR for FRAIL and FI-36: 3.07 [95% CI = 1.03 -9.17] and 3.76 [95% CI = 1.09 -12.97], respectively. Notably, the risk for frailty due to LLD was significantly higher with the FI-36 compared to the FRAIL (RR: 3.03 versus 2.23). RD was of 17.3% and 12.7% with the FRAIL and the FI-36, respectively. CONCLUSION: Our data support the association between LLD and incident frailty over one year among geriatric outpatients, reinforcing longitudinal evidence from population-based studies.
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