Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia

Kaup, Allison R.; Byers, Amy L.; Falvey, Cherie; Simonsick, Eleanor M.; Satterfield, Suzanne; Ayonayon, Hilsa N.; Smagula, Stephen F.; Rubin, Susan M.; Yaffe, Kristine

doi:10.1001/jamapsychiatry.2016.0004

Cited by 217 publications

(196 citation statements)

References 33 publications

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“…Recent longitudinal studies, with up 10 years of follow-up, demonstrated that persistently high levels or increasing levels of depressive symptoms are the most important predictors of dementia in LLD [77, 78]. The association with depressive symptoms is stronger for the MCI subtype with memory impairment [79], but this was independent of underlying vascular disease [80–82].…”

Section: Resultsmentioning

confidence: 99%

Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

187

145

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BackgroundVascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition – a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term “MRI-defined vascular depression”.DiscussionThis diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal–subcortical–limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed.ConclusionThe multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.

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Section: Resultsmentioning

confidence: 99%

Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

187

145

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“…The authors found 4 trajectory classes: a quick recovery class, a persistent moderate symptom class, a persistent high symptom class, and a slow recovery class. Both these studies and others [14,27] excluded patients with dementia and significant cognitive impairment. Additionally, the study by Hybels et al is one of just a very few studies on DLL trajectories that also included inpatients from specialist health care services of old age psychiatry.…”

Section: Trajectoriesmentioning

confidence: 99%

Trajectories of Depression in Late Life: A 1-Year Follow-Up Study

Borza

Engedal²,

Bergh³

et al. 2017

Dement Geriatr Cogn Disord

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Aims: To investigate the prognosis of depression in late life (DLL) in terms of the course of depression over 1 year and assess clinical factors related to the prognosis. Methods: We performed an observational, multicenter, longitudinal study of 160 patients aged ≥60 years who were admitted to inward treatment of DLL. The patients were followed with 3 assessments: at inclusion (T₀), at discharge from the hospital (T₁), and after 1 year (T₂). Growth mixture modeling was applied to identify patient classes following distinct trajectories of the Montgomery-Åsberg Depression Rating Scale (MADRS) score. Two regression models were estimated to assess clinical factors for the trajectories and for a clinical assessment of the depression course between T₁ and T₂. Results: Two trajectory classes were identified: one with higher and one with lower MADRS scores. Not being in remission at T₁ and a longer hospital stay were associated with higher odds of being in the trajectory class with more severe depression. Early-onset depression (EOD) was associated with higher odds of being in a group with a poorer clinical course between T₁ and T₂. Conclusion: EOD and not being in remission at discharge were important negative prognostic factors for DLL.

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“…In addition, most studies have shown that SCD is more associated with subclinical anxiety and depression than to actual cognitive performances [9][10][11][12][13][14][15][16]33,[45][46][47]. Interestingly, evidence also suggests that the psychoaffective symptomatology usually increases in early or preclinical stages of cognitive decline [48,49] and/or that it could even constitute a risk factor for subsequent cognitive decline [50,51] (for review and discussion, see [52,53]).…”

Section: Introductionmentioning

confidence: 99%