Symptoms Geriatric Depression Research Articles

TREATING POST-STROKE DEPRESSION WITH ECT

Introduction Post-stroke depression (PSD) is a common and potentially debilitating sequelae after a stroke, presenting in over 30% of stroke patients. PSD often does not respond to pharmacotherapy and significantly prevents recovery of stroke patients. In addition, depression in geriatric PSD patients may present with more somatic complaints and pain rather than traditional depressive symptoms. Central post-stroke pain syndrome (CPSP), found in 10.6% of patients with ischemic strokes, may present with similar pain and may overlap with symptoms of depression. Multiple studies have demonstrated that ECT is safe and effective in PSD patients, with two studies reporting 88% and 95% efficacy rates. According to the American Psychiatric Association's Task Force on ECT, there are no contraindications to ECT and studies have demonstrated safety in post-stroke patients. After initial ECT treatment, many patients with PSD require maintenance ECT. We present a case of a 62?y/?o female with post-stroke depression with catatonia who responded successfully after 5 ECT sessions but required maintenance ECT to sustain effect. Methods The hospital EMR was used to obtain information regarding this patient and her course of treatment. Results The patient suffered a left MCA infarct in March 2015 which resulted in transcortical motor aphasia. After rehabilitation, she was unable to return to her job as a physical therapist. She experienced worsening depression and suicidal ideation (SI) and required inpatient level psychiatric care, her first psychiatric hospitalization. She was treated with mirtazapine, trazodone, and methylphenidate. Two years later in 2017, she had another depressive episode. During this hospitalization, the patient complained of generalized weakness, diffuse body pain, and inability to move. This resulted in medical hospitalization for malnourishment, complicated by a pulmonary embolus due to immobility. She required PEG tube placement for nourishment, and was continued on mirtazapine, methylphenidate and started on risperidone and venlafaxine. About one year later, in August 2018, she had another depressive episode with catatonia. She refused food and water and refused anticoagulation and other oral medications. Similar to her previous hospitalization, she complained of generalized weakness and chronic pain but denied feelings or symptoms of depression. She was started on unilateral frontal ECT for several sessions and then switched to bitemporal (BT) placement. After about 5 sessions of BT ECT, she began to show improvement and started eating and accepting medications. This patient would have three additional hospitalizations with similar presentations: depression with SI and catatonia-like symptoms with refusal to eat or accept oral medications. She would also complain of pain and generalized weakness as the main reason why should could not move or eat. During these subsequent hospitalizations, ECT was initiated sooner with bitemporal placement which resulted in a more rapid improvement in depression and catatonia. It was determined to start maintenance ECT to prolong the beneficial effects and prevent relapse. Conclusions Post-stroke depression is a common sequalae of cerebrovascular accidents and may not respond adequately to psychopharmacology alone. In the patient presented above, PSD caused life-threatening symptoms: she became suicidal, malnourished, and refused anti-coagulation therapy. After initiation of ECT, symptoms improved, and she became more communicative and less depressed. Due to multiple relapses, maintenance ECT was initiated which helped to prolong duration of time between relapses. This case exemplifies the importance for geriatric providers to recognize weakness and pain as potential symptoms of geriatric depression, specifically PSD and CPSP. As evidenced by our patient, ECT should be more readily considered as symptoms are often refractory to pharmacotherapy alone and ECT maintenance can better prevent relapse of significant depressive symptoms. While additional studies are needed, ECT is safe and should be considered along with pharmacotherapy in PSD patients. This research was funded by: Not applicable

Mediating Effect of Cognitive Social Capital on the Relationship Between Physical Disability and Depression in Elderly People of Rural Pakistan.

Cognitive social capital is crucial for mental wellbeing and physical disability in order to avoid late-life depression. The objective of this study was to investigate the mediating effect of cognitive social capital (interpersonal trust and reciprocity) on the relationship between physical disability and depression in elderly people of rural Pakistan. For this purpose, 146 respondents aged 60 years or above and residents of rural areas of district Muzaffargarh (Punjab, Pakistan) were approached for data collection. The questionnaire includes socio-demographic variables (gender, age, education, marital status, family system, living status, household income, and number of chronic diseases); the geriatric depressive symptoms scale (GDS-15) was used to measure depression, physical disability was evaluated through ADL and IADL scales, and cognitive social capital, which includes interpersonal trust and reciprocity, was measured using single-item questions. It was found that interpersonal trust, reciprocity, depression, and physical disability were significantly correlated with each other and physical disability was directly associated with depression. In mediation analysis, reciprocity mediated the relationship between physical disability and depression. Our findings highlight the need to enhance cognitive social capital interventions and develop policies to promote mental and physical health of rural elderly.

Geriatric Depressive Symptoms in Myanmar: Incidence and Associated Factors.

Myanmar is one of many countries currently facing a growing older adult population; yet, the mental health status of the country's older adults is understudied. This is the first article to investigate the prevalence of geriatric depressive symptoms and its associated factors in Myanmar. We use data from the most recent large-scale older adult survey conducted in 2016, which employed the four-item short version of the Geriatric Depression Scale (GDS-4). Descriptive statistics reveal that, depending on the threshold applied, about 16% to 56% of the surveyed older adults have indications of depressive symptoms. We find that both economic and health status have a statistically significant association with depressive symptoms, but no basic individual characteristics are associated with it. Our findings suggest the importance of a social security system for older adults. Expanding the scope of the pension scheme and improving the provision of health care may be among the important policy options.

Gender Differences in Geriatric Depressive Symptoms in Rural China: The Role of Physical Housing Environments and Living Arrangements.

Physical housing environment and living arrangements are significant determinants of health, particularly in developing countries, although results are mixed. We conducted this study to examine the gender differences in geriatric depressive symptoms in rural China, and further explored the influence of housing environments and living arrangements on depressive symptoms. The data used for this study were from the third wave of the nationally representative China Health and Retirement Longitudinal Study (CHARLS) survey in 2015; a total of 2056 females and 2529 males were included in this study. According to the analysis findings, 46.15% of the respondents had depressive symptoms based on the CES-D, with a statistically significant gender difference of 54.32% in females and 39.50% in males. Logistic Regression findings identified that with regard to the items of physical housing environments, toilets without seats (OR = 1.349) and the unavailability of bathing facilities (OR = 1.469) were statistically associated with depressive symptoms among male participants, whereas for female participants the use of polluting fuels (OR = 1.248) and living arrangements (i.e., living with children, OR = 1.430) was statistically associated with depressive symptoms. Statistically significant gender differences were found for having shower or bath facilities and our findings underscored that physical housing environments and living arrangements were associated with depressive symptoms for both genders. Moreover, the study revealed that a slight gender difference exists in terms of geriatric depression in rural China. Females are more likely to become depressed than their male counterparts with the same characteristics.

Serum cystatin C, impaired kidney function, and geriatric depressive symptoms among older people living in a rural area: a population-based study

BackgroundThe relationship between kidney function and depressive symptoms among elderly people has been rarely investigated in settings of the general population. The aim of our study was to examine the association of serum cystatin C (cysC) and impaired kidney function with geriatric depressive symptoms among older people living in a rural community in China.MethodsThis population-based cohort study included 1440 individuals (age ≥ 60 years) who were recruited for the Confucius Hometown Aging Project in 2010–2011; of the 1124 persons who were free of depressive symptoms, 669 (59.5%) were re-examined in 2014–2016. At baseline, data on demographics, lifestyle factors, health conditions, and medical history were collected through interviews, clinical examinations, and laboratory tests. We defined impaired kidney function as the cystatin C-based estimated glomerular filtration rate (eGFRcysC) < 60 ml/min/1.73 m2, and depressive symptoms as a score ≥ 5 on the 15-item Geriatric Depression Scale. Data were analyzed using multiple logistic and Cox proportional-hazards models.ResultsOf the 1440 participants, 316 (21.9%) were defined to have geriatric depressive symptoms at baseline. Serum cysC levels of 1.01–1.25 and > 1.25 mg/L (vs. ≤1.00 mg/L) were associated with a multiple-adjusted odds ratio (OR) of 1.41 (95% CI 1.01–1.97) and 3.20 (2.32–4.41), respectively, for having geriatric depressive symptoms (Ptrend < 0.001). Of the 669 people who were free of depressive symptoms at baseline, 157 had incident depressive symptoms at the follow-up examination. The multiple-adjusted hazard ratio (HR) for incident depressive symptoms were 2.16 (95% CI 1.43–3.27) for serum cysC > 1.25 mg/L (vs. < 1.00 mg/L). Impaired kidney function was cross-sectionally (multiple-adjusted OR = 2.95; 95% CI 2.22–3.92) and longitudinally (multiple-adjusted HR 1.54; 95% CI 1.03–2.30) associated with an increased risk of geriatric depressive symptoms.ConclusionElevated serum cysC levels and impaired kidney function are associated with an increased risk of geriatric depressive symptoms among Chinese older people living in a rural community.

Effects of Dance Exergaming on Depressive Symptoms, Fear of Falling, and Musculoskeletal Function in Fallers and Nonfallers Community-Dwelling Older Women.

The aim of this study was to evaluate the effects of a pop dance exergaming protocol on fall risk factors-depressive symptoms, fear of falling, and musculoskeletal function-in community-dwelling older female fallers and nonfallers. There were 47 community-dwelling older women assigned to the intervention group (IG) [fallers (n = 10, 69.8 ± 4.3 years); nonfallers (n = 12, 68.9 ± 3.3 years)] and the control group (CG) [fallers (n = 12, 73.6 ± 5.4 years); nonfallers (n = 13, 68.7 ± 4.8 years)]. The CG maintained their lifestyle and the IG performed a videogame dance training three times per week for 12 weeks. The Dance Central game for Xbox 360® and Kinect motion sensor were used. The primary outcomes were geriatric depressive symptoms, fear of falling, and concentric and eccentric isokinetic peak torque (PT) of quadriceps and hamstrings. Secondary outcomes included cross-sectional area of quadriceps and hamstring muscles, functionality (Timed Up and Go test, gait speed, the Five Times Sit-to-Stand test), and a fall circumstances and outcomes recording. The depressive symptoms decreased in the Intervention Fallers Group. The eccentric hamstrings PT at 180°/s increased in the Intervention Nonfallers Group. There were no significant differences between groups for the other variables analyzed. The training attendance was 83% for the Intervention Fallers Group and 88% for the Intervention Nonfallers Group. Dance exergaming can be indicated to decrease depressive symptoms in fallers and increase the PT in nonfallers among community-dwelling older women.

Synbiotic supplementation, systemic inflammation, and symptoms of brain disorders in elders: A secondary study from a randomized clinical trial

Objectives: We aimed to investigate the effect of a symbiotic substance on symptoms of brain disorders and inflammation in the elderly.Methods: Forty-nine elders, both genders, assigned into two groups: S-group (synbiotic) and P-group (placebo). Evaluations at the beginning and at the end of the experiment: geriatric depressive symptoms scale-15 (GDS-15); mini-mental status examination (MMSE); % of body fat (%fat); serum IL-6, TNF-α and IL-10; serum diamine-oxidase (DAO), intestinal fatty-acid binding protein (IFABP), and lipopolysaccharide (LPS).Results: Both groups had reduced their %Fat, TNF-α, and DAO. The IL-6, GDS-15, and MMSE were increased in both groups. IL-10 was significantly increased only in the S-group, and LPS was significantly reduced only in the P-group. The GDS-15final was negatively explained by DAO, IL-10, TNF-α, %Fat, being woman, and being allocated in the P-group. The variables that positively explained the GDS-15final were the IL-6, the IFABP, and the LPS. MMSEfinal was positively associated with the IL-10, DAO, being woman, and being allocated in the P-group; and negatively associated with IL-6, TNF-α, %Fat, IFABP, and LPS.Conclusions: We found weak effects of symbiotic on depressive symptoms and more optimistic effects on cognition in apparently healthy elderly. Other studies, with individuals diagnosed with depressive morbidity or cognitive decline, are needed.Registration of Clinical Studies – REBEC (RBR-6qr9xx)].

Influence of childhood abuse and neglect subtypes on late-life suicide risk beyond depression

The association of childhood maltreatment and suicide has been extensively examined within the population. Depression figures as a main cause for the elevated suicide rate in advanced ages and is often related to childhood maltreatment. The purpose of the present study was to examine the relationship between childhood maltreatment subtypes and suicide risk, testing geriatric depression as a moderator. This is a cross-sectional study looking at a sample of 449 individuals 60 year s old or older from the Multidimensional Study of the Elderly of Porto Alegre Family Health Strategy, Brazil (EMI-SUS/POA). Childhood maltreatment (Childhood Trauma Questionnaire), geriatric depressive symptoms (Geriatric Depression Scale), and suicide risk (Mini International Neuropsychiatric Interview) were assessed. The subtypes of childhood abuse and neglect were significantly associated with suicide risk. In the multivariate analysis, controlling for age, gender, income, marital status, ethnicity, smoking, and geriatric depression symptoms, all trauma subtypes remained associated with suicide risk with the exception of physical neglect (EA = 3.65; PA = 3.16; SA = 5.1; EN = 2.43; PN = 1.76). The present study showed that childhood maltreatment subtypes predicted suicide risk, and geriatric depression does not directly mediate this relation.

A 12-Week Multi-Domain Lifestyle Modification to Reduce Depressive Symptoms in Older Adults: A Preliminary Report.

Objective The objective of this study was to compare the effectiveness of usual care management (UCM) and a newly-developed lifestyle modification with contingency management (LMCM) for geriatric depressive symptoms in the community. Methods A randomized controlled trial was conducted in 93 older adults with major depressive disorder at community mental health centers. A 12 week multi-domain LMCM was developed by providing positive reinforcement using ‘gold medal stickers’ as a symbolic incentive to motivate their participation and adherence. Participants were allocated to LMCM (n=47) and UCM (n=46) groups. They were then subjected to the 12 week treatment. Effects of the two intervention methods on Geriatric Depression Scale were determined using mixed model analysis. Results Participants in the LMCM group had greater decline in GDS score per month than participants in the UCM group after adjusting for age, sex, years of education, living alone, and MMSE scores at baseline examination [coefficient for GDS score (95% CI): -1.08 (-1.51, -0.65), p<0.001, reference: UCM group]. Conclusion LMCM is safe and easy to use with a low cost. LMCM is suitable as psychosocial intervention for older adults with depressive symptoms in the community.

The effects of an interprofessional patient-centered communication intervention for patients with communication disorders

Purpose of the studyThis small scale study examined the influence of an interprofessional (IP) evidence based patient-centered communication intervention (PCCI), delivered by trained nurses in collaboration with Speech Language Pathologists, on patient outcomes in an active stroke rehabilitation setting. Design and methodsThe setting constraints imposed the use of a single-group pretest and post-test design to determine the influence of the intervention on patient outcomes. Validated tools measured patient quality of life (QOL), depressive symptoms and satisfaction with care. ResultsPatients (n=34) showed improvement in all outcomes from pretest to post-test, including quality of life, geriatric depressive symptoms, and satisfaction with care. ImplicationsThe findings indicate that a comprehensive person-centered communication intervention has the potential to enhance patient outcomes at discharge. Challenges to implementing and evaluating evidence-based interventions in practice are highlighted.

Social Support as a Mediator of Physical Disability and Depressive Symptoms in Chinese Elderly

The relationship between physical disability and depressive symptoms has been associated with social support. Different aspects of social support may play distinct roles in health-related quality of life. The aim of this study was to examine the mediation of social support in the relationship between physical disability and depressive symptoms among old people in Mainland China. Subjective support and utilization of support mediated the relationship between ADL and depressive symptoms, with the indirect effect of subjective support and utilization of support at 0.038 and 0.030 respectively (the total effect was 0.180). Subjective support was negatively associated with depressive symptoms in independent elderly people, utilization of support was negatively associated with depressive symptoms in partially dependent elderly people, and utilization of support had a greater association with geriatric depressive symptoms than subjective support in severely dependent elderly people. Social support mechanism and positive psychological intervention should be established and introduced in accordance with the physical disability of the elderly people, to protect them from depressive symptoms.

Mental Health in Cypriot Citizens of the Rural Health Centre Kofinou.

Objective: The main purpose of this study was to investigate the mental health of Cypriot citizens living in the current difficult period of economic recession. The specific objective was to investigate the different factors (gender, age, socio-economic factors, etc.) that may affect the levels of emotional distress, anxiety, and depression in patients attending the Rural Health Centre of Kofinou. Materials and Methods: The sample consisted of a total of 300 Cypriots who visited Kofinou Health Centre in the period between July and September 2015. For the middle-aged citizens, the Greek version of the Hospital Anxiety Depression Scale (HADS) was applied to 150 persons [1], while for the visiting senior citizens (aged over 65 years), the Greek version of the Geriatric Depression Scale (GDS) was used [2]. Results: HADS: A total of 150 people of average age 47 ± 11.5 years (min 23–max 64) participated in the study. Fifty-six percent were women. Seventy-seven percent stated they had a reduction in income (mean reduction 35% ± 25%) and 46.7% suffered from chronic disease. The 36.6% and 28.7% of the visitors showed moderate or severe forms of anxiety and depression, accordingly. Higher emotional distress is associated with lower educational level (b = −2.63, p < 0.001), lower income (b = −1.07, p = 0.017), and the presence of a chronic disease (b = 5.45, p < 0.001). The same factors are significantly associated with higher anxiety (Education: b = −1.20, p = 0.003; Income: b = −0.64, p = 0.01; Chronic disease: b = 2.82, p = 0.001). Additionally, a reduction in income (>35%) is associated with increased depression (p = 0.028). GDS: 150 patients out of which 77 were women (51.3%). The average age of participants was 72 ± 5.5 years. Ninety-three (62%) participants declared a reduction in income due to the financial crisis (mean reduction 20% ± 8%), while 139 (92.7%) stated that they had chronic disease. Fifty-three participants (35.3%) thought they had symptoms of depression after the economic crisis. The women showed higher level of geriatric depression symptoms than men (b = −1.96, p = 0.005), while age is associated with higher levels of GDS (b = 0.16, p = 0.006). Conclusions: The study shows that stress levels, depression, and emotional distress are increased in specific population groups. The main variables associated with the mental health of the participants are the presence of a chronic disease, income, and level of education.

Delusions in Patients with Alzheimer's Disease: A Multidimensional Approach.

In Alzheimer's disease (AD) patients with delusions, clinical outcomes and mortality result from a combination of psychological, biological, functional, and environmental factors. We determined the effect of delusions on mortality risk, clinical outcomes linked to comprehensive geriatric assessment (CGA), cognitive, depressive, and neuropsychiatric symptoms (NPS) in 380 consecutive AD patients with Mini-Mental State Examination, Clinical Dementia Rating scale, 15-item Geriatric Depression Scale, and Neuropsychiatric Inventory (NPI), assessing one-year mortality risk using the Multidimensional Prognostic Index (MPI). We included 121 AD patients with delusions (AD-D) and 259 AD patients without delusions (AD-noD). AD-D patients were significantly older, with higher age at onset and cognitive impairment, a more severe stage of dementia, and more depressive symptoms than AD-noD patients. Disease duration was slightly higher in AD-D patients than in those without delusions, although this difference was not statistically significant. At CGA, AD-D patients showed a higher grade of disability in basic and instrumental activities of daily living, and an increased risk of malnutrition and bedsores. The two groups of patients significantly differed in MPI score (AD-D: 0.65 versus AD-noD: 0.51, p < 0.0001) and MPI grade. AD-D patients showed also a significant higher score in NPI of the following NPS than AD-noD patients: hallucinations, agitation/aggression, depression mood, apathy, irritability/lability, aberrant motor activity, sleep disturbances, and eating disorders. Therefore, AD-D patients showed higher dementia severity, and higher impairment in cognitive and depressive symptoms, and several neuropsychiatric domains than AD-noD patients, and this appeared to be associated with higher multidimensional impairment and increased risk of mortality.

Geriatric depression symptoms coexisting with cognitive decline: A comparison of classification methodologies

Geriatric depression is a pathological process that causes a great number of symptoms resulting in limited mental and physical functionality. The computation of oscillatory and synchronization patterns in certain brain areas may facilitate the early and robust identification of depressive symptoms. In this study electroencephalographic (EEG) data were recorded from 34 participants suffering from both cognitive impairment and geriatric depression (mean age 69.81) and 32 control subjects (mean age 70.33). Both groups were matched according to their cognitive status. The study aims at evaluating neurophysiological features of elderly participants suffering from depression and neurodegeneration. The current work focuses on the identification of depression symptoms that coexist with cognitive decline, the correlation of the examined neurophysiological features with geriatric depression combined with cognitive impairment and the investigation of the role of data mining techniques in the analysis of EEG data. The EEG features were estimated through synchronization analysis (Orthogonal Discrete Wavelet Transform). Depressive patterns were detected through data mining techniques. Random Forest, Random Tree, Multilayer Perceptron (MPL Network) and Support Vector Machines (SVM) were employed for data classification. The efficiency of the classifiers varied from 92.42 to 95.45%. Random Forest demonstrated the highest accuracy (95.5%). Both synchronization and oscillatory features contributed to the decision trees’ formation, with the former prevailing. Moreover, synchronization features significantly contributed to the decision trees’ formation. In line with previous neuroscientific findings, synchronization among right frontal–midline anteriofrontal regions showed great correlation with depressive symptoms. Evaluation of the classifiers indicated the Random Forest as being the most robust algorithm. Synchronization of certain brain regions is more indicative of identifying depression symptoms than oscillatory since synchronization features contributed the most to the formation of the classification trees.

Differential effects of white matter hyperintensity on geriatric depressive symptoms according to APOE-ε4 status

BackgroundWe aimed to examine differential effects of WMH on progression of depressive symptoms according to APOE ε4 status in the elderly. MethodsWe obtained data from elderly Korean subjects (n=707) aged 60 years or older at baseline from the CREDOS study from November 2005 to July 2014. A linear mixed model stratified according to APOE genotype (APOE ε4 carrier vs. non-carrier) was constructed using GDS score as a primary outcome and degree of overall, deep, periventricular WMH evaluated by a visual rating scale as a risk factor of interest. We also tested interaction between APOE ε4, WMH and time as predictors of clinical progression on GDS scores to examine the moderating effect of APOE ε4 allele on the relationship between degree of WMH and progression of geriatric depressive symptoms. ResultsThe mean (SD) follow-up duration of the participants was 2.0 (0.8) years. Among APOE ε4 carriers, a severe degree of overall and deep WMH, but not periventricular WMH, predicted progression of geriatric depressive symptoms (overall WMH: coefficient=0.96, p=0.010; deep WMH: 0.87, p=0.016). There were significant interaction between APOE ε4, degree of WMH and time in predicting GDS increase (5df, F=2.28, p=0.046). LimitationsOnly subjects seeking medical attention and with follow-up measurements were enrolled in this study. Specific location of WMH and use of antidepressant were uncontrolled. ConclusionsConsidering biological markers such as degree of WMH and APOE ε4 status may be clinically relevant to predicting progression of geriatric depressive symptoms.

Developmental and contextual factors in the role of severe childhood trauma in geriatric depression: The sample case of former indentured child laborers

The purpose of this study was to quantify the association between childhood traumatic experiences and geriatric depression (GDS) in a population of elderly who were exposed to severe childhood trauma. We aimed to identify the role of childhood maltreatment exposure in geriatric depression and the developmental and contextual factors that exacerbate this relationship. We interviewed 141 former indentured child laborers (58 females) about their experiences as children and their current depressive symptoms (Mage=77, SD=6.8). Participants provided their age, the year they were first indentured, duration indentured, current physical health, completed the Childhood Trauma Questionnaire (CTQ) and the Geriatric Depression Scale (GDS). Child maltreatment, specifically emotional abuse, was strongly associated with geriatric depression symptoms. These effects were specific to individuals who were removed from their biological families between the ages of 3 and 9 years, and for children who were indentured for 6–12 years. Finally, depression partially mediated the association between medical conditions and daily health impairment, but not for individuals “at risk” for depression by virtue of their maltreatment experiences. This study was conducted with a specific subpopulation of elderly and therefore may not generalize to all geriatric depression, nor to all generations or populations with exposure to childhood adversity. This study demonstrates the importance of using a developmental framework to understand how childhood maltreatment facilitates increased risk for the development of depression in late life.

A self-help behavioral activation treatment for geriatric depressive symptoms

This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N = 26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.

The inflammation hypothesis in geriatric depression

A large body of research has focused on "mediating mechanisms" and predisposing brain abnormalities to geriatric depression, but little is known about its etiology. This paper examines whether age-related and comorbid disease-related immune deregulation is an etiologic contributor to geriatric depression. This article reviews findings on neuroinflammation during the aging process and depression as well as studies of anti-inflammatory actions of classical antidepressants and antidepressant actions of anti-inflammatory agents. Aging results in increased peripheral immune responses, impaired peripheral-CNS immune communication, and a shift of the CNS into a pro-inflammatory state. These exaggerated and prolonged immune responses may lead to changes in the function of emotional and cognitive networks pertinent to geriatric depression and to behavioral changes reminiscent of the depressive and cognitive symptoms of geriatric depression. Some antidepressants may reduce the expression of inflammation markers. Limited data suggest that some anti-inflammatory agents may have antidepressant properties. A synthesis of available findings suggests that aging-related and comorbid disease-related inflammatory processes may promote changes in the neural systems predisposing to geriatric depression or facilitating metabolic changes that mediate depressive syndromes. The "inflammation hypothesis" in geriatric depression cannot be tested in its entirety, but it can lead to testable hypotheses and data on mechanisms by which inflammatory processes promote geriatric depression. The significance of such an effort is that it may lead to a novel treatment development model bringing to bear recent advances of anti-inflammatory pharmacology to the treatment of depressed elderly patients.

Depressive Symptoms Impair Everyday Problem-Solving Ability Through Cognitive Abilities in Late Life

The association between depression and functional disability in late life remains unclear. This study aimed to explore the relationship between depressive symptoms and daily functioning through the mediation of cognitive abilities, measured by memory, reasoning, and speed of processing. The authors recruited 2,832 older adults (mean age = 73.6 years, standard deviation = 5.9) participating in the Advanced Cognitive Training for Independent and Vital Elderly Study. Structural equation modeling was applied to illustrate the relationship between depressive symptoms and everyday problem-solving ability through the mediation of cognitive abilities. Depressive symptoms were associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning. Although depressive symptoms were associated with speed of processing, speed of processing was not significantly related to everyday problem-solving ability. This study conceptualizes the possible relationships between depressive symptoms and daily functioning with mediation of cognitive abilities and provides a feasible model for the prevention of functional impairment related to geriatric depressive symptoms.

Psychotherapy for Depression With Executive Dysfunction

Psychotherapy for Depression With Executive Dysfunction