Geriatric Mental State Research Articles

Mild behavioral impairment in the general population aged 55+ and its association with incident dementia.

This study aimed to investigate the dementia risk associated with mild behavioral impairment (MBI) and its domains in older community-dwelling individuals. A total 4803 community-dwelling individuals aged over 55 years were followed for 4.5 years (ZARADEMP study). MBI was assessed according to the International Society to Advance Alzheimer's Research and Treatment (ISTAART) diagnostic criteria using the Geriatric Mental State (GMS). Odds ratios (OR) for incident dementia and Alzheimer's disease (AD) were determined using logistic regression models adjusted for potential confounders (such as age, disability, or vascular disease). In cognitively normal individuals, decreased motivation was the only MBI domain that was associated with an increased risk of all-cause dementia (OR: 2.30 [95% confidence interval {CI}: 1.16-4.61]) in multivariable analyses, although the increase in the risk of AD was not statistically significant. Our findings suggest that decreased motivation may be a phenotypic marker for individuals at risk of dementia. Further research is required to evaluate the association between MBI domains and different types of dementia.

The association between air pollution and dementia: results from the Cognitive Function and Ageing Study II and Wales

AbstractBackgroundAir pollution has been recognised as one of the key modifiable risk factors for dementia. In the UK, there is a lack of evidence from population‐based cohort studies including older people from different backgrounds and living environments. Using two multicentre ageing cohorts in England and Wales, the aim of this study is to investigate the potential impact of air pollution on dementia in later life.MethodThis study was based on the Cognitive Function and Ageing Study (CFAS) II (2008‐2011) and Wales (2011‐2013), two longitudinal studies of people aged 65 or above across five centres in England (Cambridgeshire, Newcastle upon Tyne, Nottingham) and Wales (Gwynedd, Neath Port Talbot). A two‐year follow‐up wave was carried out for both studies. Dementia was identified using the Geriatric Mental State and its diagnostic algorithm, Automated Geriatric Examination for Computer Assisted Taxonomy (GMS‐AGEACT). Based on the participants’ postcodes at the baseline, exposure to four air pollutants in 2012, including nitrogen dioxide (NO2), ozone (O3), particulate matter with a diameter ≤10 microns (PM10) and ≤2.5 microns (PM2.5), was estimated using the Community Multiscale Air Quality pollution modelling at a resolution of 20×20 m. Multistate modelling was used to investigate the effects of air pollution exposure on risk of developing dementia over the follow‐up period, incorporating mortality (from national death certification) and adjusting for age, sex, education, study centre and area deprivation.ResultAmong the 11329 participants in CFAS II (N = 7753) and Wales (N = 3576), the median exposure was 17.7 (IQR = 11.6) µg/m3 for NO2, 43.8 (IQR = 11.1) µg/m3 for O3, 15.5 (IQR = 3.1) µg/m3 for PM10 and 10.1 (IQR = 2.8) µg/m3 for PM2.5 and large variation was observed across the five centres. Per unit increase in NO2 exposure was associated with a higher risk of dementia in CFAS II (HR: 1.07; 95%CI: 1.03, 1.12) but not the Welsh cohort (HR: 0.93; 95%CI: 0.86, 1.00) after adjustment. For the other air pollutants, the associations were unclear.ConclusionOur study suggests limited evidence for the impacts of air pollution on dementia. Other environmental factors may influence individual exposure to air pollution and altogether have a complex effect on cognitive health in later life.

P154: Mild Behavioral Impairment (MBI) in a sample of general population aged > 55: associations with degree of cognitive impairment.

Objective:The present study aims to determine the prevalence estimates of MBI and specific MBI domains in a large sample of the general population, by degree of cognitive impairment (CI).Method:A representative community sample of individuals aged 55+ (n=4803) (ZARADEMP Study) was studied. MBI, and specific MBI domains, were assessed according to ISTAART-AA MBI criteria, using the Geriatric Mental State (GMS). In accordance with these criteria, clinically significant anxiety, depression, and dementia were excluded. For the standardized degree of CI Perneczky et al. ́s criteria were applied: normal (MMSE 30), questionable (MMSE 26-29), mild CI (MMSE 21-25), moderate-severe CI (MMSE <21).Results:The prevalence of MBI, and specifically the domain Decrease Motivation (DM), increased progressively and significantly by degree of CI, the differences being significant between all cognitive groups. After control by age and education, DM was 2- and 4.5-times more frequent in subjects with mild CI (10.6%) and moderate-severe CI (18.3%), respectively, than in cognitive normal (5.8%). Affective Dysregulation (AD) was 1.7-times more frequent in mild CI (26.4%) (vs 20.4% in normal). Impulsive Dyscontrol (ID) was 2- and 7.9-times more frequent in mild CI (8%) and moderate-severe CI (23.5%) than in cognitive normal (4.7%). And Abnormal Perception and Thoughts (APT) was 6-times more frequent in moderate-severe CI (10%) (vs 1.4% in cognitive normal).Conclusion:Our results confirm an increase of MBI prevalence across the spectrum of CI. However, each specific domain of MBI shows a different pattern of association with CI. Our results support the relevance of studying MBI domains independently.

Loneliness and social isolation association with incidence of disability, dementia and mortality in Mexican older adults: three follow‐up years

AbstractBackgroundLoneliness is defined as the feeling of being alone and can be considered as persistent, unavoidable and unpleasant. Social isolation is characterized by low frequency of contact with the social network, which may or may not include family members. The study of each of these entities is important because of their high frequency in OA and their association with negative outcomes as disability, dementia even mortality.MethodWe performed a secondary analysis of 1,668 adults aged 65 years or older, evaluated within Dementia Research Group 10/66 protocols in Mexico, after 3‐year follow‐up. Loneliness presence was assessed based on three questions included in the Geriatric Mental State Inventory (GMS): do you feel lonely, does this feeling of loneliness generate discomfort or sadness, can you avoid feeling lonely. Social isolation was identified by assessing friends, relatives and neighbors contact frequency; co‐residence; church attendance and social gatherings. Association of loneliness with and without emotional discomfort, as well as social isolation with incidence of disability, dementia, and mortality after three years of follow‐up was estimated using multivariate competing risk models.ResultLoneliness without emotional discomfort was about 35.4%, 24.0% reported loneliness with emotional discomfort, meanwhile social isolation prevalence was 41.1%. A differential distribution of loneliness with and without emotional discomfort, age groups and education by catchment area was observed (Table 2). After three years of follow‐up loneliness was found to be associated with incident dementia subHR = 1.5 (95%CI:1.1‐2.1), and social isolation with mortality, subHR = 1.5 (95%CI:1.1‐2.0).ConclusionAfter three years follow‐up one out 3 OA reported feeling lonely without emotional discomfort, 1 out 4 felt lonely with emotional discomfort, while 2 out 5 reported social isolation. Loneliness without emotional discomfort showed an association with dementia development, meanwhile social isolation was associated with mortality. Finally, no association was found between loneliness with emotional discomfort with disability, dementia or mortality in the analyzed sample.

Impact of fish consumption on all-cause mortality in older people with and without dementia: a community-based cohort study

BackgroundIncreased fish consumption reduces the risk of dementia. However, it is unknown whether fish consumption reduced all-cause mortality in people with dementia. The purpose of the study is to investigate the association of fish consumption with all-cause mortality in older people with dementia versus those without dementia.MethodsUsing a standard method of the Geriatric Mental State, we interviewed 4165 participants aged ≥ 60 years who were randomly recruited from five provinces in China during 2007–2009 to collect the baseline data of socio-demography, disease risk factors, histories of disease, and details of dietary intakes, and diagnosed dementia (n = 406). They were followed up for vital status until 2012.ResultsThe cohort follow-up documented 329 deaths; 61 were in participants with dementia (55.3 per 1000 person-years) and 224 were those without dementia (22.3). In all participants, the risk of all-cause mortality was reduced with fish intake at “ ≥ twice a week” (multivariate-adjusted hazard ratio 0.58, 95% CI 0.34–0.96) and at “once a week or less” (0.79, 0.53–1.18) compared to “never eat” over the past two years. In participants without baseline dementia, the corresponding HRs for all-cause mortality were 0.57 (0.33–0.98) and 0.85 (0.55–1.31), while in participants with dementia were 1.36 (0.28–6.60) and 1.05 (0.30–3.66), respectively.ConclusionThis study reveals that consumption of fish in older age reduced all-cause mortality in older people without dementia, but not in people with dementia. Fish intake should be increased in older people in general, prior to the development of dementia in the hope of preventing dementia and prolonging life.

Validation of EURO-D, a geriatric depression scale in South India: Findings from the Mysore study of Natal effects on Ageing and Health (MYNAH)

IntroductionMany of the assessment tools used to study depression amongst older people in low- and middle- income countries (LMICs) are adaptations of instruments developed in other cultural settings. There is a need to validate those instruments in LMICs. Methods721 men and women aged 55–80 years from the Mysore Birth Records Cohort underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, cognitive function and mental health. Sensitivity, specificity and level of agreement of EURO-D diagnosis of depression with diagnosis of depression derived by the Geriatric Mental State (GMS) examination were calculated. To validate the EURO-D score against GMS depressive episode, we used maximum Youden's index as the criterion for each cut-off point. Concurrent validity was assessed by measuring correlations with the WHO Disability Assessment Schedule (WHO DAS II). ResultsOf the 721 (408 men and 313 women) who participated in this study, 138 (54 men and 84 women) were diagnosed with depression. Women had higher depression scores on the EURO-D scale and disability on the WHO DAS II scale. A maximum Youden's Index of 0.60 was observed at a EURO-D cut-off of 6, which corresponded to 95% sensitivity, 64% specificity, kappa value of 0.6 and area under the curve (AUC) of 80%. There was significant and positive correlation between EURO-D and WHO DAS II scores. LimitationsFuture independent validation studies in other settings are required. DiscussionThis study supports the use of the EURO-D scale for diagnosing depression amongst older adults in South India.

Depression, cognitive reserve markers, and dementia risk in the general population

Objectives We investigated depression, cognitive reserve, and their interaction as risk factors for incident dementia among community-dwelling older adults. Methods In total, 2099 participants, aged ≥65 years with no dementia during baseline assessment, who completed the follow-up two years later were included from the Cognitive Function and Ageing Study Wales. Baseline depression and dementia and dementia at follow-up were evaluated using the Geriatric Mental State Examination and the Automated Geriatric Examination for Computer Assisted Taxonomy. Cognitive reserve was measured by combining overall education, mid-life occupational complexity, and later-life social and cognitive activities. Risk of dementia in relation to depression and cognitive reserve was estimated using penalized maximum likelihood logistic regression. Interactions between cognitive reserve and depression were assessed using both multiplicative and additive scales. Results Baseline depression and low cognitive reserve significantly increased the risk of subsequent dementia at follow-up. No multiplicative interaction between cognitive reserve and depression existed. We observed an additive interaction between case-level depression and cognitive reserve. A significant association between depression and dementia was only found among people with low cognitive-reserve levels. Conclusions Greater cognitive reserve attenuated the depression-associated risk of developing dementia. This suggests the need to emphasize prodromal dementia detection among older adults with lower cognitive reserve and depression.

Depression and anxiety among older people in central africa: Epidemca population-based study

IntroductionThe burden of depression and anxiety is poorly documented in Central African populations.ObjectivesTo present the epidemiology of depressive and anxiety disorders among older people in two Central African countries.MethodsA cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among people aged ≥ 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3). Probable cases were defined as having a GMS-AGECAT score ≥ 3. Logistic regression models were used to investigate the association between potential risk factors collected and presence of at least one of both symptoms.ResultsOverall 2002 participants were included in the EPIDEMCA study. Median age of the participants was 72 years [interquartile range: 68 – 78 years] and 61.8% were females. Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety. In total 40.1% had least one of both symptoms. In multivariable models, the following factors were associated with the presence of at least one of both symptoms: female sex, residence area, frailty, cognitive disorders, a high happiness score (protective) and hypertension (adjusted Odds Ratios from 1.3 to 1.7; p<0.01).ConclusionsIn light of the high prevalence of both psychiatric symptoms among Central African older people, evidence on their epidemiology is important for better management and policy planning.

Anhedonia as a Potential Risk Factor of Alzheimer's Disease in a Community-Dwelling Elderly Sample: Results from the ZARADEMP Project.

(1) Introduction: Dementia is a major public health problem, and Alzheimer’s disease (AD) is the most frequent subtype. Clarifying the potential risk factors is necessary in order to improve dementia-prevention strategies and quality of life. Here, our purpose was to investigate the role of the absence of hedonic tone; anhedonia, understood as the reduction on previous enjoyable daily activities, which occasionally is underdetected and underdiagnosed; and the risk of developing AD in a cognitively unimpaired and non-depressed population sample. (2) Method: We used data from the Zaragoza Dementia and Depression (ZARADEMP) project, a longitudinal epidemiological study on dementia and depression. After excluding subjects with dementia, a sample of 2830 dwellers aged ≥65 years was followed for 4.5 years. The geriatric mental state examination was used to identify cases of anhedonia. AD was diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. A multivariate survival analysis and Cox proportional hazards regression model were performed, and the analysis was controlled by an analysis for the presence of clinically significant depression. (3) Results: We found a significant association between anhedonia cases and AD risk in the univariate analysis (hazard ratio (HR): 2.37; 95% CI: 1.04–5.40). This association persisted more strongly in the fully adjusted model. (4) Conclusions: Identifying cognitively intact individuals with anhedonia is a priority to implement preventive strategies that could delay the progression of cognitive and functional impairment in subjects at risk of AD.

Self‐reported and informant‐reported assessments of neuropsychological conditions in a Lebanese sample of community‐dwelling older adults in Lebanon

AbstractBackgroundAccumulated data highlight a significant role for mental health in influencing and exacerbating the risk, detection, and progression of cognitive decline and aging‐related disorders. In parallel, several findings suggest cultural and contextual differences in the manifestation and recognition of mental health problems. In Lebanon, data on mental and cognitive health and on their assessments are scarce. We examined the agreement between self‐reported and informant‐reported assessments of depressive and anxiety symptoms in a Lebanese community‐based sample of older adults.MethodData come from a Lebanese cohort of older adults (n=502, age=75.5 (SD=7.2); 56.2% women). Depressive and anxiety symptoms were self‐rated using the Geriatric Mental State (GMS) AGECAT and informant‐rated using the Neuropsychiatric Inventory Questionnaire (NPI‐Q). We estimated Cohen’s Kappa and investigated factors related to mismatch in reports using logistic regression models; explanatory factors included participants’ cognitive functioning and participants’ and informants’ demographic and socioeconomic indicators. Data processing is still ongoing to include more participants.ResultPreliminary results showed that 10.6% and 1.6% of participants self‐reported depression and anxiety symptoms and 4.6% and 2% had depression and anxiety symptoms based on informant’s reports, respectively. Cohen’s Kappa was 0.38 for depression and 0.32 for anxiety symptoms; 69.8% and 62.5% of those reporting depressive and anxious symptoms were not reported to have these symptoms by their informants and 30% and 70.4% of informant‐reported depression and anxiety were not reported by participants. Men and participants with higher educational attainment had lower odds of mismatch between self‐ and informant‐reports (OR=0.46 (95% CI=0.24, 0.88) and OR=0.54 (95% CI=0.28, 1.04)); current employment of both participants and informants was associated with lower mismatch (OR=0.19 (95% CI=0.07, 0.54) and OR=0.58 (95% CI=0.32, 1.1). Higher cognitive scores were associated with lower mismatch (OR=0.90 (95% CI=0.81, 0.99).ConclusionResults indicate a weak agreement between self‐reported and informant‐reported neuropsychological symptoms and that the majority of older adults with symptoms were not identified by their informants. More work is needed to improve assessments of neuropsychological symptoms and identify mechanisms underlying discrepancies in assessments in the Lebanese population to better track neurocognitive and health changes at older age.

Prevalence and pattern of neuropsychiatric conditions among community‐dwelling older Lebanese adults and their relation to cognitive function

AbstractBackgroundNeuropsychological and behavioral changes are an important source of burden for older adults and present a high and complex co‐morbidity with cognitive decline. Several reports suggest that these constructs may differ in their manifestations across cultures yet the vast majority of data come from higher‐income countries. Data on mental and cognitive health are particularly scarce in Lebanon. We examined the prevalence and overlap of depression, anxiety, and sleep disturbances at older age and their association with cognitive functioning in a community‐dwelling cohort of older adults (65 and above) in Lebanon (n=502; mean age=75.52 (SD=7.22); 56% women).MethodDepression, anxiety, and reported sleep problems or changes were measured using the Geriatric Mental State (GMS) Agecat Package. Using adjusted linear regression models, we estimated how the presence of these conditions is related to cognitive function, measured with the Community Screening Instrument for Dementia (CSI‐D). Data processing is still ongoing to include more participants.ResultPreliminary results showed that in our sample, 13.1% had at least one neuropsychological problems and 4.4% had two or more. Estimated prevalence was 10.6% for depression, 1.6% for anxiety, and 10.6% for the presence of sleep disturbances. With regards to overlap, all participants with anxiety had concomitant depression and 50% had sleep problems. Among participants with depression, 15% had anxiety and 33% had sleep disturbances. Among participants with sleep disturbances, 33% had depression and 7.5% had anxiety. The odds of depression, anxiety, or sleep disturbances were 2.9, 2.3, and 1.7 times higher for women than they were for men, respectively. Socioeconomic indicators were not associated with depression, anxiety, or sleep disturbances. The presence of any neuropsychological problem was not related to cognitive scores, and depression and sleep disturbances were not related to cognitive scores; in contrast participants with anxiety symptoms had lower cognitive scores (beta=‐3.28 (95% CI=‐5.074,‐1.492)).ConclusionResults suggest an important overlap in the presence of neuropsychological problems in this cohort and a potential differential relationship between anxiety – which was highly correlated to the presence of other mental health problems – and cognitive functioning in Lebanese older adults.

330 - Depression and Anxiety among Older people in Central Africa: Results of the EPIDEMCA population-based study

Introduction:Depression and anxiety are two very common psychiatric disorders in late-life. They are markers of poor quality of life and are strongly associated with death among older people. Yet, few studies on these comorbidities have been conducted in the African population. This study aims to present the epidemiology of depression and anxiety among older people in Central Africa.Method:A cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among older people aged ? 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3) and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system (AGECAT), probable cases were defined as having a GMS-AGECAT level of 3 or more. Logistic regression models were used to investigate the association between potential risk factors collected and each symptom.Results:Overall 2002 participants were included in the EPIDEMCA study (500 in Brazzaville and 529 in Gamboma in ROC, 500 in Bangui and 473 in Nola (473) in CAR). Median age of the participants was 72 years [interquartile range: 68 – 78 years] and females were mostly represented (61.8%). Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety and 5.7% (95% CI: 4.6% - 6.7%) for the co-occurrence of both disorders. For all three outcomes, prevalence was significantly higher among females and in rural areas. Only depression increased with age. Preliminary analyses showed that female sex, living in a rural area, and living without a partner were associated with the three outcomes (Odds Ratios from 1.59 to 3.27; p<0.01). In-depth results regarding correlates of depression, anxiety and the co-occurrence of both will be presented.Conclusion:The prevalence of depression and anxiety was high among Central African older people. Evidence on the epidemiology of these common psychiatric symptoms are of importance for care management and also emphasize the need to maintain and/or strengthen social support around older people in the region.

Subjective Cognitive Decline, Cognitive Reserve Indicators, and the Incidence of Dementia

ObjectiveBoth cognitive reserve and subjective cognitive decline are closely related to the risk of dementia. We investigated whether cognitive reserve can modify the risk of dementia developing from subjective cognitive decline. DesignLongitudinal population-based study. Setting and ParticipantsThe prospective study analyzed data from 2099 participants aged 65 or over from the Cognitive Function and Ageing Study–Wales (CFAS-Wales). MethodsDementia was ascertained through the comprehensive judgment symptoms of geriatric mental state automated geriatric examination for computer assisted taxonomy (GMS-AGECAT). Subjective cognitive decline was evaluated by 2 questions in the baseline interview. Cognitive reserve indicators were derived from 3 previously identified factors: early life education, mid-life occupational complexity, and late-life cognitive activities. We used logistic regression models to estimate dementia risk in relation to subjective cognitive decline and indicators of cognitive reserve. The interaction between subjective cognitive decline and cognitive reserve were evaluated by additive and multiplicative scales. ResultsBaseline subjective cognitive decline and low cognitive reserve significantly increased the risk of dementia, after 2 years of follow-up. There was an additive interaction between subjective cognitive decline and cognitive reserve [the relative excess risk due to interaction = −0.63, 95% confidence interval (CI) = −0.89 to −0.36, P for additive interaction <0.001]. There was no multiplicative interaction between subjective cognitive decline and cognitive reserve indicator (P = .138). Statistically significant association between subjective cognitive decline and dementia was found only in the low-level and medium-level cognitive reserve group (OR = 3.78, 95% CI = 1.50–9.55 and OR = 3.64, 95% CI = 1.09–12.2, respectively), but not in the high-level groups. Conclusion and ImplicationsCognitive reserve attenuated subjective cognitive decline associated risk of developing dementia. This finding suggests the need for greater emphasis on detecting prodromal dementia when older patients having lower cognitive reserve present with subjective cognitive decline.

Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort studies

BackgroundA growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.MethodsThis study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State−Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants’ residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health.ResultsLiving far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).ConclusionsThe different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.

Anxiety and Risk of Vascular Dementia in an Elderly Community Sample: The Role of Sex.

Background: To assess the association between anxiety and risk of vascular dementia (VaD), as well as potential sex differences, in a community-based cohort. Methods: A random sample of 4057 dementia-free community participants aged 55 or older, from the longitudinal, community-based Zaragoza Dementia and Depression Project (ZARADEMP) study were followed for 4.5 years. Geriatric Mental State B (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) was used for the assessment and diagnosis of anxiety, and a panel of research psychiatrists diagnosed the incident cases of VaD according to DSM-IV (Diagnostic and Statistical Manual of mental disordes). Multivariate survival analysis with competing risk regression model was performed. Results: In men, the incidence rate of VaD was significantly higher among anxiety subjects compared with non-anxiety subjects (incidence rate ratio (IRR) (95% confidence interval (CI)): 3.24 (1.13–9.35); p = 0.029), and no difference was observed in women (IRR (95%CI): 0.68 (0.19–2.23); p = 0.168). In the multivariate model, for men, cases of anxiety had 2.6-fold higher risk of VaD (subdistribution hazard ratio (SHR): 2.61; 95%CI: 0.88–7.74) when all potential confounding factors were controlled, with no statistical significance (p = 0.084), but a clinically relevant effect (Cohen’s d: 0.74). No association was found in women. Conclusions: In men, but not in women, risk of VaD was higher among individuals with anxiety, with a clinically relevant effect. Potential anxiety-related preventive interventions for VaD might be tailored to men and women separately.

Cognition and daily activities in a general population sample aged +55

ABSTRACT Objective: We tested the association of individual cognitive domains measured with the Mini-Mental State Examination (MMSE) and disability. Method: Cross-sectional study in a population-based cohort aged ≥55 years (n = 4,803). Sample was divided into two groups: individuals with cognition within the normal range (CNR) (n = 4,057) and those with cognitive impairment (CI) (n = 746). Main outcome measures: The MMSE, the Katz Index (Basic Activities of Daily Living, bADL), the Lawton and Brody Scale (Instrumental Activities of Daily Living, iADL), and the Geriatric Mental State (GMS-AGECAT). Results: MMSE-orientation was associated with disability in bADL, iADL and a decrease in social participation, regardless of cognitive status. MMSE-attention was associated with disability in iADL, but only in CNR. MMSE-language was associated with disability in bADL, iADL and with reduced social participation, but only in CI. Conclusions: The associations observed between disability and orientation may have clinical and public health implications.

Happiness and Cognitive Impairment Among Older Adults: Investigating the Mediational Roles of Disability, Depression, Social Contact Frequency, and Loneliness.

Background: Understanding the lower level of happiness among older adults with cognitive impairment has been a largely neglected issue. This study (1) reports on the level of happiness among older adults in Singapore and (2) examines the potential mediating roles of depression, disability, social contact frequency, and loneliness in the relationship between cognitive scores and happiness. Methods: Data for this study were extracted from the Well-being of the Singapore Elderly (WiSE) study: a cross-sectional; comprehensive single-phase survey conducted among Singapore citizens and permanent residents that were aged 60 years and above (n = 2565). The Geriatric Mental State examination (GMS) was administered to the participants. Questions pertaining to socio-demographic characteristics; happiness; loneliness; social contact; depression; and, disability were utilized in this study. Logistic regression analyses and mediation analyses were used to explore the correlates of happiness and potential mediating factors. Results: Overall, 96.2% of older adults in Singapore reported feeling either fairly happy or very happy. In the regression analysis, individuals of Malay descent, those who were married/cohabiting, or had higher education levels were more likely to report feeling happy. After controlling for socio-demographic factors, higher cognitive scores were associated with higher odds of reporting happiness. We found that the positive association between cognition and happiness was fully mediated by disability, depression, loneliness, and frequency of contact with friends. Conclusion: The majority of the older adult population reported feeling fairly or very happy. While cognitive impairment has shown limited reversibility in past studies, unhappiness among older adults with cognitive impairment might be potentially mitigated through interventions addressing accompanying issues of social isolation, disability, and depression

The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study.

ObjectivesDepression and anxiety are common mental disorders in later life. Few population‐based studies have investigated their potential impacts on mortality in low‐ and middle‐income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity, and mortality in later life using a population‐based cohort study across eight LMICs.MethodsThis analysis was based on the 10/66 cohort study including 15 991 people aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China, and India, with an average follow‐up time of 3.9 years. Subthreshold and clinical levels of depression were determined using EURO‐D and ICD‐10 criteria, and anxiety was based on Geriatric Mental State (GMS)–Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard modelling was used to estimate how having depression, anxiety, or both was associated with mortality adjusting for sociodemographic and health factors.ResultsParticipants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24‐1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15‐1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Comorbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I2 = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21‐3.27).ConclusionsDepression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.

Changing prevalence and treatment of depression among older people over two decades.

Depression is a leading cause of disability, with older people particularly susceptible to poor outcomes. To investigate whether the prevalence of depression and antidepressant use have changed across two decades in older people. The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based cohort studies of older people aged ≥65 years, with baseline measurements for each cohort conducted two decades apart (between 1990 and 1993 and between 2008 and 2011). Depression was assessed by the Geriatric Mental State examination and diagnosed with the Automated Geriatric Examination for Computer-Assisted Taxonomy algorithm. In CFAS I, 7635 people aged ≥65 years were interviewed, of whom 1457 were diagnostically assessed. In CFAS II, 7762 people were interviewed and diagnostically assessed. Age-standardised depression prevalence in CFAS II was 6.8% (95% CI 6.3-7.5%), representing a non-significant decline from CFAS I (risk ratio 0.82, 95% CI 0.64-1.07, P = 0.14). At the time of CFAS II, 10.7% of the population (95% CI 10.0-11.5%) were taking antidepressant medication, more than twice that of CFAS I (risk ratio 2.79, 95% CI 1.96-3.97, P < 0.0001). Among care home residents, depression prevalence was unchanged, but the use of antidepressants increased from 7.4% (95% CI 3.8-13.8%) to 29.2% (95% CI 22.6-36.7%). A substantial increase in the proportion of the population reporting taking antidepressant medication is seen across two decades for people aged ≥65 years. However there was no evidence for a change in age-specific prevalence of depression.

Prevalence of mental disorders in China: a cross-sectional epidemiological study

The China Mental Health Survey was set up in 2012 to do a nationally representative survey with consistent methodology to investigate the prevalence of mental disorders and service use, and to analyse their social and psychological risk factors or correlates in China. This paper reports the prevalence findings. We did a cross-sectional epidemiological survey of the prevalence of mental disorders (mood disorders, anxiety disorders, alcohol-use and drug-use disorders, schizophrenia and other psychotic disorders, eating disorder, impulse-control disorder, and dementia) in a multistage clustered-area probability sample of adults from 157 nationwide representative population-based disease surveillance points in 31 provinces across China. Face-to-face interviews were done with a two-stage design by trained lay interviewers and psychiatrists with the Composite International Diagnostic Interview, the Structured Clinical Interview for DSM-IV Axis I disorders, the Community Screening Instrument for Dementia from the 10/66 dementia diagnostic package, and the Geriatric Mental State Examination. Data-quality control procedures included logic check by computers, sequential recording check, and phone-call check by the quality controllers, and reinterview check by the psychiatrists. Data were weighted to adjust for differential probabilities of selection and differential response as well as to post-stratify the sample to match the population distribution. 32 552 respondents completed the survey between July 22, 2013, and March 5, 2015. The weighted prevalence of any disorder (excluding dementia) was 9·3% (95% CI 5·4-13·3) during the 12 months before the interview and 16·6% (13·0-20·2) during the participants' entire lifetime before the interview. Anxiety disorders were the most common class of disorders both in the 12 months before the interview (weighted prevalence 5·0%, 4·2-5·8) and in lifetime (7·6%, 6·3-8·8). The weighted prevalence of dementia in people aged 65 years or older was 5·6% (3·5-7·6). The prevalence of most mental disorders in China in 2013 is higher than in 1982 (point prevalence 1·1% and lifetime prevalence 1·3%), 1993 (point prevalence 1·1% and lifetime prevalence 1·4%), and 2002 (12-month prevalence 7·0% and lifetime prevalence 13·2%), but lower than in 2009 (1-month prevalence 17·5%). The evidence from this survey poses serious challenges related to the high burdens of disease identified, but also offers valuable opportunities for policy makers and health-care professionals to explore and address the factors that affect mental health in China. National Health Commission of Health (Ministry of Health) and Ministry of Science and Technology of China.