Clinical Presentation of the “Depression–Executive Dysfunction Syndrome” of Late Life

Alexopoulos, George S.; Kiosses, Dimitris N.; Klimstra, Sibel; Kalayam, Balkrishna; Bruce, Martha L.

doi:10.1097/00019442-200201000-00012

Cited by 168 publications

(152 citation statements)

References 53 publications

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“…That is less than reported for a cohort of 126 elderly hospitalized patients with major depression but no history of stroke, of whom 42% had DES [5]. This probably reflects the impact that major depression has on cognitive functions, especially on executive functions.…”

Section: Discussionmentioning

confidence: 72%

“…Post-stroke dementia, cognitive impairment, depression, DES, and cerebral white-matter lesions are all known predictors of post-stroke mortality or morbidity [2,18,22,32]. Post-stroke depression and post-stroke dementia should be considered as specific, distinct forms of vascular depression and vascular dementia, with a causal link postulated between the ischaemic lesions and the respective cognitive or affective symptom [5,6,33]. All these factors seem to be closely linked conditions and might just be different facets of a distinct stroke aetiology such as the small-vessel disease [2].…”

Section: Discussionmentioning

confidence: 99%

“…Dysfunction of the frontostriatal pathways is associated with both depression and executive dysfunction. This subtype of depression is often referred to as depression-executive dysfunction syndrome (DES) [1,5,6]. DES is characterized by disturbances in sequencing, organizing, planning, abstracting, reduced interest in activities, and psychomotor retardation but less pronounced vegetative symptoms than are seen in depressed elderly patients without significant executive dysfunction [7].…”

Section: Introductionmentioning

confidence: 99%

“…DES has been recognized as a core feature in vascular depression [5,8]. Vascular depression is characterized by older age, vascular risk factors and vascular lesions such as lacunae and cerebral white-matter changes that occur in small-vessel disease [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Vascular depression is characterized by older age, vascular risk factors and vascular lesions such as lacunae and cerebral white-matter changes that occur in small-vessel disease [5,6]. Previous cerebrovascular attacks increase the risk of DES [9].…”

Section: Introductionmentioning

confidence: 99%

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Post-Stroke Depression and Depression-Executive Dysfunction Syndrome Are Associated with Recurrence of Ischaemic Stroke

et al. 2013

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Background: Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence. Methods: We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ², Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia). Results: The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke. Conclusions: Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-Stroke Depression and Depression-Executive Dysfunction Syndrome Are Associated with Recurrence of Ischaemic Stroke

et al. 2013

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Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction

Alexopoulos¹,

Raue²,

Kiosses³

et al. 2011

Arch Gen Psychiatry

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178

189

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Context Older patients with depression and executive dysfunction represent a population with significant disability and high likelihood of failing pharmacotherapy. Objective To examine whether Problem Solving Therapy (PST) reduces disability more than Supportive Therapy (ST) in older patients with depression and executive dysfunction, and whether this effect is mediated by improvement in depressive symptoms. Design Randomized controlled trail, with participant recruitment from 12/02-11/07 and follow-up for 36 weeks. Setting Weill Cornell and University of California, San Francisco. Participants Adults (>59 years) with major depression and executive dysfunction. Intervention 12 sessions of either PST modified for older depressed adults with executive impairment, or ST. Main Outcome Measure Disability as quantified by the World Health Organization Assessment Schedule II (WHODAS II)-12 item form. Results 653 individuals were referred to this study, 221 of whom met criteria and were randomized to PST or ST. PST and ST led to comparable improvement of disability in the first 6 weeks of treatment, but a more prominent reduction in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and higher number of previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was in part due to greater reduction of disability by PST. While disability increased during the 24 weeks following the end of treatment, the advantage of PST over ST-treated patients was retained. Conclusions This study suggests that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.

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Clinical Features of Depressive Disorders in the Elderly

Devanand

Roose

2010

Principles and Practice of Geriatric Psychiatry

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Clinical Presentation of the “Depression–Executive Dysfunction Syndrome” of Late Life

Cited by 168 publications

References 53 publications

Post-Stroke Depression and Depression-Executive Dysfunction Syndrome Are Associated with Recurrence of Ischaemic Stroke

Post-Stroke Depression and Depression-Executive Dysfunction Syndrome Are Associated with Recurrence of Ischaemic Stroke

Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction

Clinical Features of Depressive Disorders in the Elderly

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