Neuropsychological Functioning in the Acute and Remitted States of Late-Life Depression

Koenig, Aaron M.; DeLozier, Isaac J.; Zmuda, Michelle; Marron, Megan M; Begley, Amy; Anderson, Stewart J.; Reynolds, Charles F.; Arnold, Steven E.; Becker, James T.; Butters, Meryl A.

doi:10.1016/j.jagp.2014.12.096

Cited by 11 publications

(19 citation statements)

References 30 publications

(52 reference statements)

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“…In addition to the efficacy of deep rTMS in LLD, we also sought to determine its impact on cognitive functioning, including executive functioning which is frequently impaired in LLD [33,34]. Previous studies in younger adults have found that rTMS treatment is associated with improvements in cognitive functioning independent of mood changes [35], and a recent systematic review of the association between rTMS and executive functioning in older adults found the executive function benefits from rTMS were positively related to mood improvement in LLD [36].…”

Section: Introductionmentioning

confidence: 99%

Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial

Kaster

Daskalakis

Noda

et al. 2018

Neuropsychopharmacol

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121

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Late-life depression (LLD) is a growing worldwide problem due to demographic changes, with limited treatment options due to high rates of pharmacotherapy adverse effects, accessibility of psychotherapy, and tolerability of electroconvulsive therapy. Novel neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), may overcome these limitations. The objective of this study is to determine the efficacy, tolerability, and cognitive effects of high-dose deep rTMS in LLD. In this study we randomized older adults between 60 and 85 years old with major depressive disorder (MDD) to sham or active deep rTMS (H1 coil, 6012 pulses, 18 Hz, 120% of resting motor threshold) delivered over the dorsolateral and ventrolateral prefrontal cortex 5 days per week over 4 weeks. Our primary outcome was remission of depression in an intention-to-treat analysis. We also assessed change in cognitive functioning with rTMS treatment and tolerability based on adverse effects. Fifty-two participants were randomized to active (n = 25) or sham H1 coil (n = 27). Remission rate was significantly higher with active than sham rTMS (40.0% vs 14.8%) with a number needed to treat of 4.0 (95% CI: 2.1-56.5). There was no change on any measure of executive function and no serious adverse events. Adverse effect profiles were similar between active and sham rTMS, except for reports of pain being significantly more common in the active condition (16.0% vs 0%). High-dose deep rTMS appears to be safe, well tolerated, and efficacious in the treatment of LLD.

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Section: Introductionmentioning

confidence: 99%

Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial

Kaster

Daskalakis

Noda

et al. 2018

Neuropsychopharmacol

Self Cite

121

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“…Previous studies on younger ages have indicated a generally bidirectional association between cognitions and depressiveness. Cognitive impairment is associated with an increased risk of depression, and depressive episodes are associated with cognitive decline and for example reduction of the size of hippocampus [96,217,[220][221][222]. Why we did not find any such significant association could be explained by statistical interaction effects of comorbidity, or by differential loss of participants to follow-up (which is further commented upon in the methodological discussion 5.4).…”

Section: Depression and Ssdmentioning

confidence: 87%

“…Such remarks are hard to refute completely, which is why relevant covariates need to be included in the design and implementation of etiologic studies. The critical remarks about using the concept of causality in natural associations can in certain examples of depressiveness be answered by the finding that the specific association may be bidirectional or reciprocal between depressiveness and other factors [96,216,217].…”

Section: Longitudinal Associations With Ssd and Causalitymentioning

confidence: 99%

Subsyndromal Depression in Very Old Persons

Ludvigsson¹

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Background: Subsyndromal depression (SSD) or subthreshold depression is a common affective condition that can be described as depressiveness below the threshold of what is called a syndromal or a major depressive episode. The point prevalence for SSD has been reported to be about 10% in the community, or about two or three times higher than the prevalence for syndromal depression. In elderly persons, SSD compared to non-depression (ND) is associated with impaired activities of daily living (ADL), lower cognitive function, lower self-perceived health, worse psychiatric outcomes and higher mortality. However, most studies on SSD in elderly persons have been done in the young old age group (age 60-80 years), while few studies have investigated SSD in very old persons (age 80+). As many aspects (e.g. multimorbidity, frailty, functional decline and social dependence) increase between the young old and the very old ages, there is a need for more knowledge about SSD in the very old. The overall aim of this doctoral thesis was to describe SSD, or the unclear area between syndromal depression and normal aging, in very old persons. Method: Paper 1 was based on qualitative interviews (n=27), while papers 2-4 were based largely on data from a prospective observational cohort study "Elderly in Linköping Screening Assessment" (ELSA85), with a population-based design following the participants from the age of 85 in three waves of follow-up. The 15-item Geriatric Depression Scale (GDS-15) was used for measuring depressiveness and to define SSD in the studies. Results: The analysis of the qualitative interviews (paper 1) resulted in four themes (life curve and the body go down, to manage on one's own, to keep up with life, and taking one day at a time), giving a comprehensive picture of SSD in very old age. In a comparison among SSD, ND and syndromal depression, SSD differed qualitatively from syndromal depression, but not clearly from ND. A cross-sectional analysis of data from baseline (paper 2) identified factors associated with SSD in very old persons, and according to analyses with multiple logistic and linear regressions, four domains (sociodemographic factors, declining physical functioning, neuropsychiatric factors, and existential factors) were significantly associated with SSD. A five-year longitudinal follow-up (paper 3) showed that direct healthcare costs per month of survival for persons with SSD exceeded those of persons with ND by a ratio of 1.45 (€634 vs €436), a difference that was significant even after controlling for somatic multimorbidity. An eight-year longitudinal follow-up (paper 4) showed that morbidity was elevated for persons with SSD compared to ND regarding basic ADL, I-ADL, loneliness, self-perceived health and depressiveness, whereas cognitive speed, executive functions and global cognitive function were not significantly lower when adjusting for covariates. Contrary to our hypotheses, mortality over

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“…Sådana invändningar är svåra att fullständigt vederlägga varför de behöver finnas med vid design, genomförande och analys av framtida forskningsstudier. Invändningarna kan i vissa fall bemötas med att sambanden i flera fall tycks vara bidirektionella eller reciproka mellan depressivitet och andra faktorer [96,216,217]. Om ett samband går i bägge riktningar, t.ex.…”

Section: Om Longitudinella Associationer Till Ssd Och Om Kausalitetunclassified

“…Ett oväntat fynd i vår studie 4 apropå kausalitet och bidirektionella samband, var att det inte återfanns någon signifikant skillnad i kognitiva utfall mellan SSD och ND över tid när man kontrollerade för potentiella störfaktorer. Tidigare studier i yngre urvalsgrupper har indikerat ett generellt bidirektionellt samband mellan kognitioner och depressivitet, vilket exempelvis syns i att depressiva episoder tycks leda till påverkade hjärnstrukturer med exempelvis reducerad storlek av hippocampus [96,217,[220][221][222]. Varför det inte syntes något signifikant samband i vår studie skulle kunna förklaras av relativa interaktiva statistiska effekter av samsjuklighet, eller differentiellt bortfall av deltagare i studien (vilket kommenteras närmare i stycket 5.4.2 om intern validitet).…”

Section: Om Longitudinella Associationer Till Ssd Och Om Kausalitetunclassified

Subsyndromal depression hos äldre äldre personer

Ludvigsson¹

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Neuropsychological Functioning in the Acute and Remitted States of Late-Life Depression

Cited by 11 publications

References 30 publications

Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial

Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression: a prospective randomized controlled trial

Subsyndromal Depression in Very Old Persons

Subsyndromal depression hos äldre äldre personer

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