Risk Factors for Geriatric Depression: The Importance of Executive Functioning Within the Vascular Depression Hypothesis

Mast, Benjamin T.; Yochim, Brian P.; MacNeill, Susan E.; Lichtenberg, Peter A.

doi:10.1093/gerona/59.12.1290

Cited by 42 publications

(31 citation statements)

References 27 publications

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“…The discrimination between the two subtypes of clinical presentation can be further detailed by neuropsychological evaluation, with special importance for diagnosis and cognitive rehabilitation approach. Late onset depressive symptoms and lack of motivation are also largely described in vascular patients and can be strongly associated to subcortical WML 24 . Possibly, interruption of neuronal loops that connect basal ganglia, thalamus and limbic areas may play a role in the etiology of these manifestations 25,26 .…”

Section: Resultsmentioning

confidence: 99%

“…Taken together, the co-existence of white matter lesions, executive dysfunction, apathy and depression underlines frontal lobe syndrome as the central characteristic of sIVd 5,27 . In terms of clinical picture and medical intervention, this association may represent a longer duration and greater severity of affective symptoms and also a worse response to antidepressive treatment 24 . Although all patients selected for the present study presented severe WML, six of them had no diagnosis of dementia (cdr=0.5).…”

Section: Resultsmentioning

confidence: 99%

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Clinical characteristics in subcortical ischemic white matter disease

Alves

Lanna

et al. 2009

Arq. Neuro-Psiquiatr.

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-Background: Vascular white matter lesions (WML) represent one of the main neuroimage findings in individuals older than 65 years and its clinical significance is still partially understood. Objective: To describe and analyze the clinical profile of a high severity sample with WML focusing on the frontal executive control. Method: Outpatients (n=20) with high severity WML evaluated with magnetic resonance imaging were selected using the Fazekas scale. Results: Most patients (n=17; 85%) presented an altered Trail Making Test ratio (section B/section A); on verbal fluency, 15 individuals (75%) performed below the cutoff score. Apathy (5.9±4.65) and depression (3.05±3.67) were frequent as assessed by the Neuropsychiatric Inventory. The impairment in functional activities strongly correlated with apathy (r=0.814, p<0.001) and verbal fluency (r=0.744, p<0.001). Conclusion: Executive dysfunction, apathy, and ratio depression were the main characteristics found. Extension of WML may have distinct impact on the clinical picture, but further studies with methodological adjustments are necessary to provide more definitive conclusions.KEy WOrds: neuropsychology, cognition, behavior, function, vascular dementia, white matter lesions.Características clínicas na doença isquêmica da substância branca subcortical resumo -Fundamento: Lesões vasculares em substância branca (LsB) são um dos principais achados de neuroimagem em indivíduos acima de 65 anos e sua importância em termos clínicos é ainda parcialmente conhecida. Objetivo: descrever e analisar o perfil clínico de amostra com LsB grave enfocando as alterações do controle executivo frontal. Método: Pacientes ambulatoriais (n=20) avaliados pela ressonância nuclear magnética e com maior proporção de LsB foram selecionados através da escala de Fazekas. Resultados: A maioria dos pacientes (n=17; 85%) apresentou alteração na proporção teste das trilhas (seção B/A); na fluência verbal, 15 indivíduos (75%) apresentaram desempenho abaixo do ponto de corte. Apatia (5,9±4,65) e depressão (3,05±3,67) foram freqüentes na avaliação pelo Inventário Neuropsiquiátrico. O prejuízo nas atividades funcionais correlacionou-se fortemente à apatia (r=0, 814, p<0,001) e à fluência verbal (r=0, 744, p<0,001). Conclusão: disfunção executiva, apatia e depressão foram as principais características encontradas. A extensão e localização das LsB parecem exercer um impacto distinto nas manifestações clínicas, porém estudos futuros com ajustes metodológicos são necessários para conclusões mais definitivas.PALAVrAs-chAVE: neuropsicologia, cognição, comportamento, função, demência vascular, lesões de substância branca.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical characteristics in subcortical ischemic white matter disease

Alves

Lanna

et al. 2009

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

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“…Replication is needed to exclude the possibility that our findings were substantially influenced by biases inherent to relying on morbidity data recorded by GPs. Ideally, such future research should take into account several other variables that appear to moderate the association of CVRFs with later-life depression, including executive functioning (Mast et al, 2004c), severe life stress preceding onset of depression (Holley et al, 2006;Van den Berg et al, 2001) and physical symptoms and limitations . Ultimately, subgroups of patients could be identified for whom the vascular depression concept is particularly relevant, which, in turn, may guide prevention of depression in later life through modification of CVRFs.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular risk factors and subsequent depression in older general practice patients

Nuyen

Spreeuwenberg

Beekman

et al. 2007

Journal of Affective Disorders

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“…There is also evidence to suggest that the relationship between depression and chronic illness is moderated by executive functioning, e.g., patients with a chronic illness and low executive functioning tend to be more depressed than patients with higher executive functioning (Mast, Yochim, MacNeill, & Lichtenberg, 2004). In addition, impaired cognitive abilities have been found to independently predict increased risk of mortality among chronic disease patients (Feil, Marmon, & Unutzer, 2003).…”

Section: Cognitive Training For Problems In Attention Memory and Exmentioning

confidence: 99%

Deconstructing Demons: The Case of Geoffrey

Mohlman

Cedeno

Price

et al. 2008

PCSP

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Research in late life mental health has not kept pace with the rapidly aging population of the U.S. Older adults (over age 65), more specifically the "baby boomer" cohort, are likely to pose unique challenges to mental health care providers. This report describes the case of Geoffrey, a 66-yearold African American male who presented with a complex range of psychiatric conditions (e.g., major depressive disorder, social anxiety disorder, and a history of polysubstance dependence), and challenging life circumstances (e.g., limited financial and social resources, and poorly controlled medical illness). Because Geoffrey also evidenced impairment in several cognitive domains (attention, memory, executive functions), a combined intervention of executive skills training (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) and cognitive behavior therapy (CBT) was selected. Furthermore, because time for conducting therapy was limited (fourteen, 90-minute sessions over a ten-week period), a "transdiagnostic" approach was taken to maximize efficiency. Results suggest the utility of augmented, transdiagnostic therapies to achieve optimal response with older clients. Although Geoffrey's intervention progressed well, an event occurring late in treatment changed the course of therapy and led to an unexpected outcome. Several noteworthy aspects of the intervention, including the relevance of Geoffrey's case to the current aging trend in the U.S., the use of a combined transdiagnostic intervention, and aspects of the therapy process are discussed throughout.

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Risk Factors for Geriatric Depression: The Importance of Executive Functioning Within the Vascular Depression Hypothesis

Cited by 42 publications

References 27 publications

Clinical characteristics in subcortical ischemic white matter disease

Clinical characteristics in subcortical ischemic white matter disease

Cerebrovascular risk factors and subsequent depression in older general practice patients

Deconstructing Demons: The Case of Geoffrey

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