GDS Score Research Articles

Accumulation of depressive symptoms over time in cognitively impaired individuals

AbstractBackgroundDepressive symptoms in elderly are common, but the persistence of depressive symptoms in older adults with and without cognitive impairment (CI) is less studied. Accumulation of depressive symptoms over time might be a sign of developing chronic depressive course and therefore increased risk for cognitive decline and dementia. The aim of the present study was to assess patterns of depressive symptom accumulation over time among older adults, and to explore the association between the course of depressive symptoms over time and demographic and clinical characteristics at baseline.MethodA data‐driven approach was used to cluster ADNI participants based of their longitudinal Geriatric Depression Scores (GDS‐15). We leveraged modern time‐series analysis techniques including the Dynamic Time Warping and Dynamic Barycenter Averaging as the clustering generation technique. ADNI participants were clustered to data‐driven groups presenting with unique time course of depressive symptom accumulation.ResultWe ran a search for the optimal number of clusters using the silhouette score as the indicator of a strong clustering. This resulted in the generation of 3 unique profiles with differing patient demographics. Specifically, 1st group presented with the lowest baseline depressive symptoms (GDS=0.44±0.61) and stayed stable over the course of ADNI study (GDS=1.03±1.25). P2nd group presented with slightly elevated depressive symptoms at baseline (GDS=1.78±1.10) and accumulated depressive symptoms (GDS=2.74±2.05). In contrast, 3rd group presented with significant depressive symptoms (GDS=3.80±1.42) and accumulated more symptoms over time (GDS=4.50±2.56). Although groups did not different in age at the baseline or prevalence of females, patients that have CI, indicated by both the clinical diagnosis and the patient's Clinical Dementia Rating, are more likely to have higher GDS scores and are at higher risk of developing depressive symptoms (i.e., baseline CI prevalence of 40% in Group 1 compared to 74% and 75% in Groups 2 and 3, respectively).ConclusionThe data shows that there are differences in the persistence of the depressive symptoms in elderly population with and without CI. Identifying individuals that are more susceptible to depressive symptom accumulation might significantly improved patient outcomes and higher quality of life.

Approaches to engage an aging cohort in rural India during the COVID‐19 crisis and the psychological impact of COVID‐19 in this cohort

BackgroundThe COVID‐19 crisis brought most cohort studies around the world to a standstill. India, which had implemented one of the strictest nation‐wide lockdowns in the world, was no exception. Owing to this, recruitments and assessments in our aging cohort in rural India, namely, Srinivaspura Aging Neurosenescence and COGnition (SANSCOG), had to be abruptly suspended.MethodThe SANSCOG study team undertook active measures to keep our subjects engaged remotely during the COVID‐19‐related lockdown period and also, provided useful services telephonically, to address their anxiety and distress. We collaborated with a local digital health service initiative, to offer counselling on awareness about the disease and safety precautions to be adopted. To assess the psychological impact of the pandemic on our cohort, the study team’s clinicians telephonically administered the Geriatric Depression Scale (GDS‐7) and the Generalized Anxiety Disorder (GAD‐7) questionnaire to consenting subjects. These instruments are brief, validated and sensitive instruments to screen for depression and anxiety disorder, respectively. Among subjects who had pre‐COVID GDS scores (obtained from their baseline clinical assessments), the proportion of subjects having pre‐COVID versus post‐COVID depression was compared.ResultA total of 1890 subjects from the rural (SANSCOG) cohort were contacted during the lockdown period. Our periodic telephone calls to enquire about the subjects’ well‐being as well as our providing of psychological support and medical advice, when necessary, were appreciated by our subjects. Our collaborative initiative to provide awareness about the pandemic was well‐received, as many of our subjects had inadequate awareness about the pandemic. Overall, these strategies resulted in better bonding between our study team and our cohort. On screening for depression and anxiety disorder, 28.4% scored above the threshold score for depressive disorder on GDS‐7, whereas 5.5% scored above the threshold score for anxiety disorder on GAD‐7. We found that the proportion of subjects with depression had quadrupled after the COVID‐19 pandemic (pre‐COVID ‐ 7.74%, post‐COVID ‐ 28.98%).ConclusionThe above approaches of cohort engagement during times of crisis are deemed valuable by subjects and we envisage that this would improve subject retention. This rural Indian cohort had a severe psychological impact due to the COVID‐19 pandemic.

Geriatric Depression and Inappropriate Medication: Benefits of Interprofessional Team Cooperation in Nursing Homes.

An investigation of inappropriate medication use in treatment of depressivity in institutionalized older adults, based on a nurse-led evaluation of functional status and depressive symptoms in nursing home residents. Methods: A cross-sectional multicenter study was performed using records from 1087 residents cared for in fifteen nursing homes (NHs) in the Czech Republic. Inclusion criteria were being a permanent resident of one of the facilities, being 60 years of age or older, having a Geriatric Depression Scale score of 6 or more, and having a Mini Mental State examination score 10 or more. The final sample for analysis included 317 depressed NH residents. Results: 52 percent of NH residents with depressivity had no antidepressant treatment. Benzodiazepines were the only medication in 16 percent of depressed residents, and were added to antidepressant treatment in 18 percent of residents. Benzodiazepine users had significantly higher GDS scores compared to non-users (p = 0.007). Conclusion: More than half of depressed NH residents remained without antidepressant treatment. Residents inappropriately treated with benzodiazepines were more depressed than residents treated with antidepressants only, or even not treated at all. Cooperation of the interprofessional team in the screening of depressive symptoms has the potential to improve the quality of care.

Caregiving for a Spouse with Cognitive Impairment: Effects on Nutrition and Other Lifestyle Factors.

Being a spousal caregiver (SCG) for a patient with cognitive impairment is well known to be associated with increased risk for dementia and cognitive decline. This study examined the impact of the care-recipient's cognitive status on lifestyle factors influencing cognitive decline in SCGs, focusing on nutritional status and blood biomarkers. Fifty-one SCGs participated (mean age 73.5±7.0 years) in this study. All participants underwent clinical assessment including the Mini Nutritional Assessment (MNA), Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and International Physical Activity Questionnaire to evaluate lifestyle factors, and the Mini-Mental State Examination to assess global cognition. Also, nutritional blood biomarkers were measured. SCGs caring for a demented spouse showed significantly higher depression scores (t = -3.608, p = 0.001) and malnutrition risk (t = 2.894, p = 0.006) compared to those caring for a non-demented spouse. Decreased care recipients' cognition was significantly correlated with higher GDS (β= -0.593, t = -4.471, p < 0.001) and higher MNA scores (β= 0.315, t = 2.225, p = 0.031) and lower level of high-density lipoprotein (HDL) cholesterol (β= 0.383, t = 2.613, p = 0.012) in their SCGs. Gender had moderating effects on association of care-recipients' cognition with sleep quality (B[SE] = 0.400[0.189], p = 0.041) and HDL cholesterol (B[SE] = -1.137[0.500], p = 0.028) among SCGs. Poorer care-recipient's cognition was associated with worse sleep quality and low HDL cholesterol among wives but not husband caregivers. This study provides substantial evidence that SCGs are at risk for depression and malnutrition, which can further affect cognitive decline. As such, these factors should be well assessed and monitored among SCGs for patient with cognitive impairment.

The Effect of Laughter Therapy for Depression Level among Geriatric Patients at Pangesti Lawang Nursing Home

Background: The elderly will experience decreased organ function and social changes experienced. 1 in 5 elderly suffers from mental or neurological disorders. Depression is underdiagnosed and undertreated in primary care settings because they appear together with other elderly problems. Depression in the elderly can reduce the quality of life and increases the risk of suicide. As a non-pharmacological alternative treatment, laughter and classical music therapy positively affect mental health, especially depression. Methods: The Design of this study is a quasi-experimental research with pre and post-test control group design. Data were collected with a short-form GDS questionnaire 15 Statements. Results: A total of 32 participants were from the elderly at the PangestiLawang Nursing Home. Laughter Therapy showed a significant GDS score before and after being given therapy p-value = 0.000. Classical Music Therapy also showed a significant GDS score before and after given therapy p-value = 0.002. In the comparison between both therapies, there was no significant difference between the treatment p-value = 0.541. Conclusion: There was a difference GDS before and after the elderly were given laughter therapy and classical music therapy, but there was no significant difference in GDS score between laughter therapy and classical music therapy, Both of them were given the same effect on decreasing GDS Score for the Elderly at PangestiLawang Nursing Home

Comprehensive geriatric assessment in newly diagnosed older myeloma patients: a multicentre, prospective, non-interventional study.

Multiple myeloma is a disease of the older people, whose prognoses are highly heterogeneous. The International Myeloma Working Group (IMWG) proposed a geriatric assessment (GA) based on age, functional status and comorbidities to discriminate between fit and frail patients. Given the multidimensional nature of frailty and the relatively recent exploration of frailty in the field of MM, reaching a consensus on the measurement of frailty in MM patients remains challenging. We sought to assess the feasibility of performing a comprehensive GA (CGA) in older MM patients in a real-world and multicentre setting and to evaluate their baseline CGA profiles. We studied 349 older patients with newly diagnosed MM (age range, 65-86years). Our results showed that a CGA is feasible for older MM patients. Using the IMWG-GA criteria, we identified significantly more frail patients in our cohort comparing to in the IMWG cohort (43% vs 30%, P = 0.002). In the IMWG-GA 'fit' group, risk of malnutrition, depression and cognitive impairment remains. The median follow-up time was 26months (range 1-38). The median overall survival (OS) was 34.7months, and the estimated 3-year OS rate was 50%. A high MNA-SF score (MNA-SF ≥ 12), low GDS score (GDS ≤ 5) and high CCI score (CCI ≥ 2) can be used to predict the OS of older patients with newly diagnosed MM. This study is registered at www.clinicaltrials.gov (NCT03122327). Our study justifies the need for a CGA in older patients with newly diagnosed MM.

The beneficial effect of physical activity on cognitive function in community-dwelling older persons with locomotive syndrome

BackgroundCognitive decline is closely related to motor decline. Locomotive syndrome (LS) is defined as a state associated with a high risk of requiring support because of locomotive organ disorders, and can be evaluated using a questionnaire. This study aimed to clarify the effectiveness of daily goal-targeted exercise on cognitive function in two different populations classified by scores on the Locomo 25 questionnaire.MethodsSeventy community-dwelling older people who participated in a 13-week health class were divided into two populations based on Locomo 25 scores: <7 (non-LS) and ≥7 (LS). Participants were presented with a daily target steps and worked towards that goal. Cognitive function was evaluated using the Japanese version of Addenbrooke’s Cognitive Examination-Revised (ACE-R). Average daily physical activity (exercise [Ex]) for 13 weeks was measured using a portable activity meter. Depression status was assessed using the Geriatric Depression Scale (GDS-15).ResultsNo significant differences were observed in age, years of education, body mass index, smooth muscle mass index, GDS-15 scores, or ACE-R scores between the non-LS and LS populations. Multiple logistic regression analysis showed that Ex (odds ratio = 5.01, p = 0.002) for 13 weeks was significantly associated with increased cognitive function in the LS population. The Ex threshold for the increase in cognitive function based on receiver operating curve analysis was 2.29 metabolic equivalents of task (METs) × h (METs · h/day) (p = 0.047) in the LS population. After 13 weeks, ACE-R scores were significantly higher in the Ex ≥ 2.29 than in the Ex < 2.29 METs · h/day group (p = 0.024, ηp2 = 0.241) in the LS population based on two-way analysis of covariance. Furthermore, a significant increase in the ACE-R memory domain was seen in the Ex ≥ 2.29 group (p = 0.035, ηp2 = 0.213).ConclusionsThese results suggest that Ex ≥ 2.29 METs · h/day is important for improving cognitive function in LS populations.

546 - Attachment, loneliness, and depression among residents in long-term care (LTC) homes

Background:Little is known regarding attachment styles among residents in long-term care homes and the relationship with depression and lonelinessResearch Objective:The study evaluated the distribution of attachment among residents in long-term care (LTC) homes and identified their association with depression and loneliness.Method:This study involved 132 residents in LTC homes in Thailand. All of them were cognitively intact based on Mini-Cog. The Thai version of the Experiences of Close Relationships-Revised questionnaire (ECR-R-18), the Relationships Questionnaire (RQ) were used to assess attachment. The Thai version of Geriatric Depression Scale (GDS-6) and the 6-item Revised version of The University of California Los Angeles Loneliness Scale (RULS-6) were completed.Preliminary results of the ongoing study:Participants included 85 females (64.4%) with mean age 74.89 (SD 7.89) years. The mean number of years of education was 6.81(SD 4.46) years. Most of the attachment styles were insecure (60.7%). The distribution of attachment style was 39.4% for secure, 15.2% for fearful, 16.7% for preoccupied, and 28.8% for dismissing. The mean score of attachment- anxiety was 3.58 and of attachment-avoidance was 3.61. Mean GDS score was 1.17 (SD 1.58), while depression based on the GDS cut-off was found in 31.1% of the residents. Mean RULS score was 2.36 (SD 0.75). Factors associated with Depression includes male (c2= 4.50, p &lt;.05), anxious attachment (t = 3.51, p = 0.001) and loneliness (t = 4.90, p &lt;0.001). Anxious attachment was associated with loneliness (p &lt;0.001) and depression score (p &lt;0.001), while avoidant attachment was not.Conclusion:The majority attachment style among residents in LTC homes is insecure attachment, with dismissing style the most prevalent. Attachment with high anxiety i.e., preoccupied, and fearful was associated with loneliness and depression.

Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study

BackgroundFrailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS).MethodsA cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants.ResultsThe FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70).ConclusionsThe FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.

The CITIDEMAGE Study: Combined Treatment with a Cholinergic Precursor in Dementia Patients

Certain previous studies have demonstrated the benefits of the addition of citicoline, a cholinergic precursor, to acetylcholinesterase inhibitors (AchEIs) or memantine in patients with Alzheimer’s disease (AD). The present study showed the effectiveness of oral citicoline plus AchEIs plus memantine in outpatients with AD. This was a retrospective case-control study involving 169 patients aged 65 years old or older having AD (mean age: 78.7 ±4.9 years). In addition, 84 patients were treated with AchEIs plus memantine plus citicoline 1 g/day given orally (group A), and 85 patients were treated with AchEIs plus memantine (group B). In both groups, memantine and AchEIs were used at the highest dosage tolerated. Tests were administered at baseline (T0), after 6 (T1), and 12 months (T2) and included MMSE, ADL, IADL, NPI, CIRS, GDS-short form, the EuroQoL, and the Sleep questionnaire. The primary outcomes were the effects of combined treatment versus AchEIs plus memantine on cognitive functions assessed by MMSE. The secondary outcomes were possible side effects of treatment in both groups, the influence on daily life functions, behavioral symptoms, quality of life, and sleep. Patients in group A showed a mild increase in MMSE at 6 (15.85 ±2.86 vs. 16.39 ±2.93) and 12 months (16.39 ±2.93 vs. 16.43 ±3.08). On comparing the two groups, the difference in MMSE score was significant, both at T1 (p = 0.003) and T2 (p = 0.011). Moreover, a significant improvement in GDS and EuroQoL scores was observed. No differences in secondary outcomes, including side effects, were observed between the two groups. This study strengthens the role of citicoline plus AchEIs plus memantine in patients with AD.

940Physical frailty and the onset of depressive symptom in older Japanese women

Abstract Background The co-occurrence of physical frailty and depressive symptoms is highly prevalent in late life. However, their causal direction remains unclear. This study examined whether frailty and its components (slowness, weakness, exhaustion, low activity, and weight loss) predict the onset of depressive symptoms among older Japanese women. Methods In a two-year cohort study conducted in a metropolitan area of Tokyo, we collected baseline data in October 2017 and follow-up data in September 2019. Participants were community-dwelling older Japanese women, aged 65 to 80 years without any neurological diseases or depressive symptoms. Logistic regression analyses were applied to estimate odds ratios (OR) of the onset of depressive symptoms (15-item Geriatric Depression Scale [GDS] score ≥ 6) across the baseline frailty status or its components classified by the Japanese version of Cardiovascular Health Study criteria. Results Of the 477 women analysed (275 robust and 202 prefrail/frail). 6 (2.2%) robust and 16 (7.9%) prefrail or frail women developed depressive symptoms. After being adjusted for various covariates including baseline GDS score, the OR of the depressive symptom onset was 3.04 (95% confidence interval [CI]: 0.99, 10.47) in the prefrail or frail women. Among the five frailty components, slowness (OR: 7.55, 95%CI: 1.11, 48.98) and exhaustion (OR: 5.00, 95%CI: 1.60, 16.13) were independently associated with the onset of depressive symptoms. Conclusions Physical frailty status, particularly slowness and exhaustion, predict future depressive symptoms in older women. Key messages Early detection and intervention targeting physical frailty may help prevent depressive symptoms in later life.

The Association of Metabolic Dysfunction and Mood Across Lifespan Interacts With the Default Mode Network Functional Connectivity.

Background: Numerous studies suggest a relationship between depression and metabolic syndrome, which is likely influenced by age. Interestingly, functional imaging analysis has shown an association between functional connectivity in the default mode network (DMN-FC) and components of metabolic syndrome, which is explored in this study.Methods: From a larger longitudinal cohort study on healthy aging, 943 individuals were extensively characterized for mood and cognition. Among these, 120 individuals who were selected for displaying extreme cognitive performance within the normal range (good and poor performers) were further studied. Here, in a cross-sectional design, using confirmatory factor analysis (CFA), the association between metabolic dysfunction and depressive mood as a function of age and its relationship with DMN-FC was studied.Results: Metabolic dysfunction was modeled as a second-order latent variable using CFA. First-order latent variables were obesity, glucose dysmetabolism, lipids imbalance, and blood pressure. Using multiple linear regression models, this study observed that metabolic dysfunction, glucose dysmetabolism, and lipids imbalance were linearly associated with depressive mood, and the association with obesity was U-shaped. The association of metabolic dysfunction, obesity, and glucose dysmetabolism with depressive mood is positive for the younger individuals in our sample and vanishes with aging. The FC of the right superior temporal gyrus with the DMN correlated with both obesity and depressive mood. In participants with higher obesity scores, FC increased with higher GDS scores, while in those with lower GDS scores, FC decreased. Age and blood pressure were associated with a more complex pattern of association between FC of the right supramarginal gyrus and GDS score.Conclusion: The association of metabolic dysfunction with depressive mood is influenced by age and relates with differential patterns of DMN-FC. The combination of the effects of age, mood, and metabolic dysfunction is likely to explain the heterogeneity of DMN-FC, which deserves further investigation with larger and longitudinal studies.

Computer use and cognitive decline among Japanese older adults: A prospective cohort study

IntroductionThis study aimed to examine the prospective association between computer use and cognitive decline among community-dwelling Japanese older adults, considering the characteristics of computer users. MethodsThis four-year prospective cohort study was conducted in Obu, Japan. Participants who were cognitive intact at Wave 1 (2011-2012) were followed through the study period. Cognitive decline was defined as scoring below the standard threshold in at least one of four neuropsychological tests at Wave 2 (2015-2016). The association between computer use at Wave 1 and cognitive decline was examined using logistic regression for complete samples (n = 2010, 52.5% female, mean 71.0 ± 4.7 years) and imputed samples (n = 3435, 51.8% female, mean 71.5 ± 5.3 years). ResultsThe computer use group had a reduced adjusted odds ratio (aOR) of cognitive decline, after adjustment for covariates, in both the complete and imputed samples (complete samples: aOR 0.71, 95% confidence interval [CI] 0.52-0.97, p = 0.030; imputed samples: aOR 0.67, 95% CI 0.51-0.88, p < 0.003). Stratified analysis of both samples showed that computer users with ≥ 10 years’ education, a GDS score of < 6, or a walking speed of ≥ 1.0m/s, showed reduced aOR for cognitive decline (aOR 0.61 to 0.69, p < 0.05). Those with < 10 years of education years, GDS scores ≥ 6 of GDS, or walking speed < 1.0m/s did not show significant association. ConclusionComputer use is longitudinally associated with protected cognitive function, based on computer user characteristics.

P 11. Intraoperative EEG parameters associated with the Frailty-Syndrome

Background. Frailty is a multidimensional geriatric syndrome characterized by a decline across multiple physiological systems [1]. It is accompanied by an increased vulnerability to stressors and is associated with adverse postoperative outcomes [2]. Frailty is linked to poor cognitive function and dementia, as well as structural changes of the brain [3,4]. However, it has not been investigated whether frail patients present with alterations in the electroencephalogram (EEG). We compared pre- and intraoperative EEG parameters in frail and non-frail patients. Methods. Patients aged ≥65 years undergoing elective surgery were included in this prospective observational study (NCT02265263; EA2/092/14). Frailty was assessed one day before surgery using a modified version of the Fried frailty phenotype comprising five criteria: slowness, weakness, exhaustion, weight loss and a level of low activity. Continuous frontal EEGs were recorded and analysed during 2 min periods before induction of anesthesia (preoperative) and during a stable intraoperative period (intraoperative). Only patients who received propofol for induction and volatile anesthetics for maintenance of anesthesia were included in the analyses. We compared the power spectrum within different frequency bands (δ: 1.5-4Hz, θ: 4-8Hz, α: 8-12Hz; β: 12-30Hz), as well as the spectral edge frequency (SEF) of frail and non-frail patients. Results. Of the 112 patients included in this study 14 (12,5%) were frail. No significant difference in power or SEF was found during the preoperative EEG measurements between the two groups. In the intraoperative EEG, frail patients presented with significantly lower a-power compared to non-frail patients (a-power: non-frail −3.67 [−7.77; −1.08] dB vs frail −8.71 [-13.75; −7.11] dB, p = 0.006). Moreover, intraoperative SEF values were significantly lower in frail patients (SEF: frail 10.71 [7.96; 11.34] Hz vs non-frail 13.70 [11.36; 15.62] Hz, p=0,001). In a multiple linear regression model adjusting for age, sex, ASA score, GDS Score, dose of anesthetics and cognitive abilities, frailty remained significantly associated with lower SEF values ( p = 0,011). Conclusion. Preoperative frailty was associated with lower intraoperative a-power, as well as lower SEF values. This should be taken into consideration when interpreting intraoperative EEGs of elderly patients.

Relation between depression and dyslipidemia in Geriatric patients attending Family medicine Outpatients clinics, Kasralainy hospital: A cross sectional study

Background: Aging is a worldwide phenomenon. The elderly in Egypt is expected to rise to 10.9% by 2026. Prevalence of depression and cardiovascular diseases are common among the elderly population. Objective: This study was conducted to estimate the prevalence of depression among the elderly and to determine its relationship with their lipid profile. Methods: A cross-sectional descriptive study was conducted in family medicine clinics at Kasralainy hospital. One hundred and 50 elderly patients were included. Screening for depression using the short form of the Arabic version of the Geriatric Depression Scale. Levels of total cholesterol (TC), triglycerides (TG), high-density and low-density lipoprotein cholesterol (HDL and LDL) are assessed. Results: The mean age of the studied group was 73.51±8.24 years, the females represent 53.3%. More than three-fourth of the studied population had depressive symptoms with score >5. There was a statistically significant difference between normal and those with depressive symptoms regarding mean levels of cholesterol, LDL and TG with higher levels in the depression group. Also, there was a significant correlation between GDS score and levels of cholesterol, LDL and triglycerides. Conclusion: Depressive symptoms are associated with dyslipidemia characterized by high total cholesterol, high triglycerides, high LDL. Further studies assessing this relationship and its underlaying mechanism are needed. Keywords: Depressive symptoms, Dyslipidemia, Geriatrics.

The course of depressive symptoms and mortality in older patients with cancer

Objective The Geriatric Depression Scale (GDS-15), a self-report questionnaire, emphasizes the psychological dimension of depression. We aimed to investigate whether GDS-15 scores were associated with mortality in older patients with cancer and describe the course of individual symptoms on the GDS-15. Methods An observational, multicenter, prospective study of 288 patients 70 years or older with cancer followed over 24 months. The patients were assessed with the GDS-15 at inclusion, and after four and 12 months. An extended Cox regression model assessed the association between time-dependent GDS-15 scores and mortality. Results After adjusting for cancer-related prognostic factors, a one-point increase in GDS-15 sum score increased risk of death by 12%. GDS-15 mean score increased during the first four months of the study, as did odds for the presence of the GDS-15 symptoms ‘feel you have more problems with memory than most’, ‘not feel full of energy’, and ‘think that most people are better off than you’. The most prevalent and persistent GDS-15 symptom was ‘prefer to stay at home, rather than going out and doing new things’, and ‘not to be in good spirits most of the time’ was the least prevalent. Conclusions More severe depressive symptoms, as measured by the GDS-15, were associated with higher mortality in older patients with cancer. The importance of emotional distress and how to alleviate it should be investigated further in these patients.

Factors Related to the Depression Score in the Elderly at the Social Service of the Dharma Asri Binjai Nursing Home

BACKGROUND: Depression is the most common psychiatric problem in the elderly. Suicidal thoughts or recurring thoughts of death are common in people suffering from depression. Depression in the elderly has a very poor prognosis compared to people in other age groups because they have a relatively higher risk of suicide and death. Elderly people in nursing homes is a condition that significantly affects the quality of life and survival and harms the psychology of the elderly, cause stress is due to elderly people in nursing homes associated with medical and psychosocial problems such as divorce/widows, poverty, and social isolation. AIM: We aimed to find out the factors that affect the Geriatric Depression Scale (GDS 15) score in elderly people at the Social Service of the Dharma Asri Binjai Nursing Home. METHODS: This study used a cross-sectional approach to 91 subjects at the Dharma Asri Binjai Nursing Home Social Service starting from June to July 2020 utilizing sampling, namely, simple random sampling. The tests conducted in this study consisted of a bivariate test and a multivariate linear regression test to determine which factors are associated with depression. The measuring instrument used was the GDS 15. RESULTS: After the multivariate test was carried out, the variables that were statistically significant to the total score of depression in the elderly at the Binjai Dharma Asri nursing home were Gender (p &lt; 0.001) and activity of daily living (ADL) Score (p &lt; 0.001). CONCLUSION: The factors associated with the GDS score of 15 and the occurrence of depression in the elderly were found in the gender variable and the ADL score variable.

Effects of hearing aid on improving cognition and depressive symptoms in elderly

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The prevalence of dementia among people aged over 60 years is between 5–7%, with the numbers of those affected globally predicted to double every 20 years between 2010 and 2050. While cognitive impairment and dementia have a negative impact on the individual, caregivers and society, the financial burden of cognitive decline and dementia are also a major source of concern. However, there is some cause for optimism in the form of potentially modifiable risk factors which can prevent or delay dementia. In this study we investigate the effect of hearing aid on improving cognition and depressive symptoms in elderly individuals with hearing impairment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with hearing impairment were selected based on inclusion and exclusion criteria and prescribed with similar type of hearing aid. MMSE and GDS scores were obtained before fitting hearing aid and 3 months after fitting hearing aid.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;A&lt;strong&gt; &lt;/strong&gt;total number of 66 patients, 40 males (61%) and 26 females (39%) were included in the study. Before using hearing aids, the mean MMSE score was 18.98±5.37 (range 10–26), and it increased to 21.08±4.77 (range 12–27) after 3 months of hearing aid use (p&amp;lt;0.005). The GDS analysis revealed a mean score of 6.85±2.81 (range 3–11) before using hearing aid and it decreased to 5.44±1.82 (range 3–8 after using the hearing aid (p&amp;lt;0.005).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Treating hearing loss with hearing aid may reduce burden associated with cognitive decline and depression.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Predictors of Depression and Insomnia in Community-Dwelling Elderly People: A Cross-Sectional Evidence of Their Bidirectional Relationship.

ObjectiveThe aim of this study was to examine associated factors of depression and insomnia in community-dwelling elderly people in order to identify independent predictors.Materials and methodsA cross-sectional study was conducted among 250 older people aged 60 years and over living in an urban area. A stratified random sampling method was used for recruiting samples from five Open Care Centers for Elderly People of the Municipality of Larissa, Greece. Data were obtained through a questionnaire that included demographic, socioeconomic, and health-related characteristics, 15-item Geriatric Depression Scale (GDS-15), and Athens Insomnia Scale (AIS). Simple and multiple logistic regression analysis was performed.ResultsThe prevalence of depression and insomnia was 28.4% (95% CI: 22.9-33.9) and 39.2% (95% CI: 33.0-45.4), respectively. Our findings showed that the overall GDS-15 score was positively related to the overall AIS score (r = 0.405; p < 0.001). The best-fit regression analysis demonstrated four significant predictors (marital status, monthly income, body weight status, and insomnia) explaining 31.6% of the variance in depression risk. Moreover, community-dwelling elderly Greek people with insomnia symptoms were females, had a lower monthly income, and more likely to suffer from chronic diseases and depression.ConclusionThese findings point to the importance of recognizing risk factors for both depression and insomnia in attempting to apply preventive interventions in the elderly and optimize their quality of life.

Cognitive consequences of COVID-19 in older adults with cognitive impairment

IntroductionCoronavirus disease 2019 (COVID-19) is due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with significant morbidity and mortality that is well documented. This includes significant central nervous system (CNS) involvement that ranges from acute delirium to meningoencephalitis. While acute symptoms and manifestations have been noted, long-term neuropsychiatric and cognitive outcomes remain unclear in convalescent COVID-19 patients. Characterizing the convalescence is particularly important since 80% recover, yet the relationship between exacerbated cognitive dysfunction and COVID-19 remains unclear. We describe 3 adults above age 65 who reported worsening cognitive symptoms in the convalescent stage of COVID-19.MethodsThree adults above the age of 65 who noted worsening cognitive difficulties after SARS-CoV-2 infection and COVID-19 were evaluated in the Memory Clinic of the Duke Neurological Disorders Clinic. Electronic medical records were retrospectively reviewed. Exam included a comprehensive neurological evaluation, formal neuropsychological evaluation, and neuroimaging. Prior history was collected for comparison with their current clinical evaluation profile data.ResultsPatient 1 is a 69 year old diabetic, hypertensive male with a history of depression and a first-order relative and a maternal aunt with late-onset Alzheimer's disease dementia who presented for evaluation of memory loss first noted about one year prior but had significantly worsened in the five months since his recovery from COVID-19. He had documented antibodies to SARS-CoV-2. The patient reported forgetting when he had eaten and now evinces navigation issues even when driving on familiar roads. Head CT without contrast obtained before COVID-19 infection showed mild bilateral hippocampal atrophy. He scored 4/8 on the AD8 Dementia Screening and 20/30 on the Montreal Cognitive Assessment (MoCA). PHQ9 was 10, GAD7 was 0, and NPI was 1. Formal neuropsychological evaluation data were collected. A diagnosis of late-onset Alzheimer's disease without behavioral disturbance was made during his clinic visit. Donezepil was started. Other comorbidities included vitamin B12 deficiency, atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity.Patient 2 is a 68 year old male with a history of anxiety, depression, and attention deficit disorder who presented for evaluation of poor memory, inability to “visually map,” and daily “senior moments” as well as a prolonged period of confusion while driving four months after recovering from COVID-19. He had documented antibodies to SARS-CoV-2. He had transient memory problems two years ago that improved after changing his bupropion dosage. He also takes fluoxetine. He now regularly misplaces objects and often stops a task midway through, thinking that he completed it. His GDS score was 5. Head CT was unremarkable. MRI of the brain demonstrated mild hippocampal and biparietal lobe atrophy as well as mild cerebral white matter disease. He scored 7/8 on the AD8 Dementia Screening and 27/30 on the MoCA. A diagnosis of dementia with behavioral disturbance was made. PHQ9 was 9, GAD7 was 6, and NPI was 7. B12 was normal. There is no family history of cognitive impairment.Patient 3 is a 76-year-old female with a history of bipolar 1, diabetes, hypothyroidism, hyperlipidemia who presented for evaluation of memory loss that started 6 months ago but worsened since she had recovered from COVID-19 diagnosed about 8 weeks earlier. After testing positive, she was hospitalized for 3 weeks due to acute encephalopathy attributed to lithium toxicity. She was also taking trazodone. Her GDS score was 7. She scored 8/8 on the AD8 Dementia Screening. MoCA could not be completed. PHQ9 was 3, GAD7 was 9, and NPI was 19. Formal neuropsychological evaluation data were collected. Head CT without contrast three weeks after COVID-19 diagnosis showed calcification in the right basal ganglia, a mild hypodense signal periventricularly, and gray-white differentiation. Brain MRI without contrast showed subtle hippocampal and perisylvian atrophy on T1, mild to moderate parietal lobe atrophy bilaterally, and mild to moderate periventricular leukoaraiosis/white matter hyperintensities on FLAIR sequence. A diagnosis of dementia without behavioral disturbance was made. There is a family history of bipolar disorder in siblings and cognitive impairment in her father but no specific diagnosis of dementia.ConclusionsThis case series describes the exacerbation of pre-existing psychiatric and cognitive conditions after COVID-19 recovery in 3 older adults with formal neuropsychological evaluation data. Longitudinal investigation of convalescent patients is warranted to better clinically characterize and provide insight into the long-term effects of COVID-19. This will allow further investigation into the pathophysiology regarding the long-term consequences of SARS-CoV-2 infection.FundingNot Applicable.