Inflammation and interleukin-1 signaling network contribute to depressive symptoms but not cognitive decline in old age

The association between inflammation and neuropsychiatric symptoms in old age is generally accepted but poorly understood. The purpose of this study was to examine whether inflammation precedes depressive symptoms and cognitive decline in old age, and to identify specific inflammatory pathways herein. We measured serum C-reactive protein (CRP) and lipopolysaccharide-induced production of Interleukin (IL)-1beta, IL-6, Tumor Necrosis Factor (TNF)-alpha, IL-1 receptor antagonist (ra), and IL-10 levels in 85-year-old participants free from neuropsychiatric symptoms at baseline (n=267). Participants were prospectively followed for depressive symptoms (Geriatric Depression Scale) and cognitive functioning (Mini Mental State Examination) from 85 to 90 years. Higher baseline CRP levels preceded accelerated increase in depressive symptoms (p<0.001). A higher production capacity of the pro-inflammatory cytokine IL-1beta preceded a greater increase of depressive symptoms (p=0.06), whereas that of its natural antagonist IL-1ra preceded a smaller increase of depressive symptoms (p=0.003). There was no relation of CRP, IL-1beta, and IL-1ra with cognitive decline. Our findings show that in old age inflammatory processes contribute to the development of depressive symptoms but not cognitive decline. A high innate IL-1ra to IL-1beta production capacity reflects a better ability to neutralize inflammation and may therefore protect against depressive symptoms.     

Determinants of depressive symptoms in Filipino senior citizens of the community-based ENGAGE study

ObjectiveThis study investigated the factors associated with depressive symptoms among community-dwelling Filipino senior citizens.MethodsWe conducted a cross-sectional study among 1021 Filipino senior citizens aged 60–91 years. We used multiple linear regression analysis to identify the factors independently associated with levels of depressive symptoms. We predicted the model using hierarchical regression analysis.ResultsBoth men and women who had higher subjective psychological well-being showed a lower level of depressive symptoms while those who had negative self-rated health and reported to be lonely showed a contrasting result. Among women, those who reported positive self-rated health, and had higher psychological resilience and social interaction, showed a lower level of depressive symptoms. Moreover, among women, those who had chronic diseases showed a higher level of depressive symptoms. Hierarchical regression analysis revealed that loneliness was the most powerful predictor of depressive symptoms among Filipino senior citizens.DiscussionLoneliness and chronic diseases are the major risk factors for depressive symptoms while a higher level of subjective psychological well-being is the primary protective factor against it among Filipino senior citizens. To be free from depression, their psychological well-being should be strengthened through active social engagement and healthcare service improvement.     

Adherence to Mediterranean diet moderates the association between multimorbidity and depressive symptoms in older adults

AimAdherence to Mediterranean Diet (Med-Diet) has been associated with a lower incidence of chronic diseases and may be associated with lower risk for depression. The aim of the present study was to investigate (i) the association of adherence to Med-Diet with depressive symptoms and multimorbidity in a cohort of geriatric medical outpatients, and (ii) the role of Med-Diet in mediating the association between depressive symptoms and multimorbidity.MethodsA total of 143 geriatric patients (mean age: 73.1 ± 8.35) were included. Adherence to Med-Diet was evaluated using a validated 14-item questionnaire; depressive and cognitive symptoms were assessed through the 15-item Geriatric Depression Scale (GDS) and Mini Mental State Examination (MMSE) respectively; multimorbidity was evaluated using the Cumulative Illness Rating Scale for Geriatrics (CIRSG-SI).ResultsSignificant associations were found between MDQ score, GDS and CIRSG-SI (MDQ score and GDS: r= -0.206, p = 0.014; MDQ score and CIRSG-SI: r= -0.247, p = 0.003; GDS and CIRSG-SI: r = 0.251; p = 0.003). These associations remained significant after adjusting for potential confounding factors. A mediational model analysis showed that the direct effect of CIRSG-SI on GDS was significant (b = 1.330; se = 0.59; p = 0.028) with this effect being counterbalanced by higher MDQ scores (indirect effect of CIRS-G on GDS through MDQ: b = 0.382; se = 0.19; p = 0.048).ConclusionThese findings (i) add to the accumulating evidence that Med-Diet may have a positive impact on mental health in the elderly, and (ii) suggest that Med-Diet may contribute, at least in part, to protect geriatric patients with multimorbidity from the development of depressive symptoms, ultimately promoting healthy aging.     

Update on cognitive decline and dementia in elderly patients with diabetes

AimThis article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.Methods and resultsThe number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.ConclusionClinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients’ cognitive and functional status.     

Depressive symptoms and functional decline in an elderly sample of urban center in northeastern Brazil

Objective

To examine the association between depressive symptoms and functional status in elderly people living in an urban center in northeastern Brazil.

Methods

In this cross-sectional, observational, analytic study, 313 community-dwelling elderly (age ≥ 65 years) individuals of both sexes who resided in Natal, Rio Grande do Norte, were evaluated. The Brazilian version of the Center for Epidemiologic Studies Depression Scale was used to screen for depressive symptoms. Physical performance was assessed using the Short Physical Performance Battery. A multivariate linear regression model adjusted for clinical and socioeconomic variables was used to analyze the association between depressive symptoms and functional performance.

Results

Our findings showed that the presence of depressive symptoms influenced functional performance, even when analyses controlled for variables such as age, sex, poor perceived health, cognitive status, and body mass index (BMI).

Conclusion

The results of this study reinforce the association between depressive symptoms and functional performance in an elderly population in an urban center in northeastern Brazil. These findings provide useful information for the identification of potential targets for research and therapeutic interventions aimed at preventing a decline in mobility in elderly individuals.     

Factors associated with happiness in the elderly persons living in the community

ObjectiveThe aim of the present study was to evaluate factors associated with happiness in a sample of Brazilian older adults.MethodsA study was conducted with 263 elderly people in the area of coverage of a family health unit located in the state of São Paulo, Brazil. The Subjective Happiness Scale was used to measure happiness, the final score of which determined one of three outcomes: not happy, intermediate, and happy. Disability, sociodemographic characteristics, and psychological, cognitive, and physical factors were considered for the multinomial logistic regression analysis.ResultsStatistically significant differences were found among the three groups regarding satisfaction with life, disability, social phobia, anxiety, depression, and frailty (p ≤ 0.05). In the multinomial regression analysis, being “not happy” was significantly associated with satisfaction with life (RRR: 0.53), depression (RRR: 1.46), social phobia (RRR: 1.24), and age (RRR: 1.06).ConclusionThe present findings indicate that psychological factors and age influence the levels of happiness in older adults living in the community. Furthermore, better screening, diagnosis, and treatment of mental health disorders could increase the feeling of happiness among older adults.     

北京城区老年人心理健康状况及其相关因素分析

目的　调查北京城区老年人心理健康状况 ,分析其主要相关因素 ,并提出相应的改善措施。方法　对象为北京城区老年人 1 0 1 0例。采用自编老年心理健康问卷作为评定工具。结果　老年人心理健康总分存在显著的性别、教育水平和职业差异 ,年龄和婚姻差异不显著 ;健康满意度、生活满意度、经济满意度、夫妻关系满意度、亲子关系满意度、患病数、重大生活事件数与心理健康总分或分量表分相关显著 ;回归分析发现 ,健康满意度和教育水平对总分有显著影响。结论　北京城区老年人心理健康保持尚好 ,促进老年人身体健康和提高其教育水平将有助于改善其心理健康状况。     

针刺对主观认知下降人群认知功能的调节作用

目的观察"调和气血,补心益智"针刺法对主观认知下降(SCD)人群认知功能的调节作用。方法纳入2017年12月至2018年9月期间首都医科大学附属北京中医医院公众号广告平台以及北京地区多个社区义诊招募的SCD者26例,按就诊顺序分为针刺组(n=14)和空白对照组(n=12)。2组受试者在治疗期间均予内科常规治疗,针刺组在常规治疗基础上采用"调和气血,补心益智"针刺法进行为期3个月的针刺治疗,空白对照组进行为期3个月的等待治疗。观察2组受试者治疗前和治疗结束后主观认知下降量表(SCD-Q)、简易智能精神状态量表(MMSE)、动物词语流畅性量表(AFT)、听觉词语学习测验量表(AVLT-H)、形状连线测验A和B量表(TMT A-B)评分以及神经心理学量表综合Z分数的变化情况。采用SPSS 22.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或秩和检验或χ~2检验。结果与治疗前相比,针刺组SCD-Q[(7.35±1.32)vs(3.46±1.63)分]、MMSE[(27.00±1.66)vs(28.32±1.56)分]、AVLT-H即刻回忆[(14.85±2.03)vs(19.14±2.31)分]、AVLT-H短延时回忆[(4.28±1.58)vs(6.64±1.15)分]、AVLT-H长延时回忆[(4.14±1.56)vs(6.57±1.08)分]、AFT[(15.64±4.19)vs(19.36±3.75)分]和综合Z分数[0.03(-0.22,0.24)vs 0.04(-0.30,0.49)分]评分均有显著改善(P0.05);对照组MMSE评分[(27.16±1.40)vs(26.16±1.52)分]有下降趋势(P0.05)。与对照组比较,针刺组的SCD-Q[(3.46±1.63)vs(7.20±1.33)分]、MMSE[(28.32±1.56)vs(26.16±1.52)分]、AFT[(19.36±3.75)vs(15.33±5.17)分]、综合Z分数[0.04(-0.30,0.49)vs-0.06(-0.37,0.30)分]评分改善更为明显(P0.05)。结论 "调和气血,补心益智"针刺法能够明显减少SCD人群对自身认知功能的抱怨,对SCD人群的记忆和言语功能具有较好的调节作用,但对执行功能未见明显影响。     

Association of sarcopenia with depressive symptoms and functional status among ambulatory community-dwelling elderly

ObjectiveSarcopenia, functional disability, and depression are common problems in the elderly. Sarcopenia is associated with physical disability, functional impairment, depression, cardiometabolic diseases, and even mortality. This study aims to determine the association of sarcopenia with depression and functional status among ambulatory community-dwelling elderly aged 65 years and older.Materials and methodThe sample of this cross-sectional study consisted of 28,323 people, aged 65 years and older, living in Bornova, Izmir. Multi-stage sample selection was performed to reach 1007 individuals. However, 966 elderly people could be reached, and 861 elderly people who can walk were included in the study. The data were collected by the interviewers at home through face-to-face interview.ResultsThe mean age was 72.2 ± 5.8 (65–100) years. The prevalence of functional disability, depressive symptoms, and sarcopenia were 21.7%, 25.2%, and 4.6%, respectively. In multivariate analysis depression was associated with sarcopenia, being illiterate and divorced, perception of the economic situation as poor/moderate, increased number of chronic diseases, and having at least one physical disability. IADL associated functional disability with sarcopenia, being illiterate/literate and female, increased age and number of medications, and the BMI.ConclusionSarcopenia in ambulatory community-dwelling elderly is significantly associated with depressive symptoms and functional disability. Elderly people at high risk of sarcopenia should be screened for functional disability and depression. Appropriate interventions should also be implemented.     

老年人才资源开发的心理学依据

目的　探讨老年人才资源开发的心理学依据。方法　比较不同年龄高、中低教育组间认知功能和心理健康水平 ,并分析年龄和教育两个因素对认知功能和心理健康状况的影响。结果　 (1 )高教育老年人的认知功能相当或好于中低教育中年人 ;(2 )高教育老年人的心理健康状况较中低教育老年人好。结论　高教育老年人的认知功能和心理健康状况普遍良好 ,为老年人才资源的开发提供了相关的心理学依据     

The effect of physical activity on depressive symptoms and quality of life among elderly nursing home residents: Randomized controlled trial

ObjectivesPhysical activity may have positive effects on decreasing anxiety, stress and depression, maintaining mental health and ensuring psychological vitality.This study aimed to determine how a “Physical Activity Program” for elderly people in nursing homes affected their depressive symptoms and quality of life.MethodsWe included 80 individuals aged >65 years (40 in the intervention group, 40 controls) in this experimental, randomized, controlled pretest-posttest study. Besides socio-demographic data, depressive symptoms and quality of life were assessed by standardized procedures (Beck Depression Scale [BDI], SF 36 Quality of Life Questionnaire) before and after a ten-weeks lasting “Physical Activity Program”, consisting of 10 min warm-up activities, 20 mintes rhythmic exercices, 10 min cool-down exercises and a 30 mintes free walking period on four days of the week.ResultsIn contast to controls, individuals of the intervention group presented with a significant decrease in the BDI after the “Physical Activity Program”. Likewise, eight-subscales and two sub-dimensions of the SF 36 Quality of Life Questionnaire significantly improved only in the experimental group (p < 0.05).ConclusionsOur results suggest that a structured physical activity program positively impacts depressive symptoms and quality of life in elderly individuals.     

增龄对老年高血压病患者动态血压的影响

目的：观察增龄对老年高血压病患动态血压（ABP）的影响。方法：比较478例高血压患（分为3个年龄组）和229例血压正常的ABP资料。结果：60－岁组高血压患的收缩压（SBP）和日／夜（N／D）血压比值低于70－岁和＞80岁组的；而舒张压（DBP）则前高于后两组（P＜0.05)，各组脉压（PP）值均呈现随年龄增大而增高之趋势（P＜0.05)；60－岁组的血压波动曲线类似于灼型，而后两组均为非杓型。结论：PP随年龄增大而增高可能与大动脉硬化加重有关，而血压昼夜节律的消失可能为增龄所致的自主神经功能紊乱及白天、夜间活动变化的表现。     

氟西汀对合并抑郁症老年冠心病的治疗作用

冠心病是老年人中的常见病、多发病,而冠心病患者中的抑郁症也有较高的发生率,有报道,抑郁症在冠心病患者中的患病率达到20%左右[1-2]。冠心病患者中一些表现为躯体化的抑郁症状常常被忽略,本文采用抗抑郁药物对伴有抑郁症状的老年冠心病人进行抗抑郁治疗,以期明确抗抑郁治疗对     

Neuronal and morphological bases of cognitive decline in aged rhesus monkeys

Rhesus monkeys provide a valuable model for studying the basis of cognitive aging because they are vulnerable to age-related decline in executive function and memory in a manner similar to humans. Some of the behavioral tasks sensitive to the effects of aging are the delayed response working memory test, recognition memory tests including the delayed nonmatching-to-sample and the delayed recognition span task, and tests of executive function including reversal learning and conceptual set-shifting task. Much effort has been directed toward discovering the neurobiological parameters that are coupled to individual differences in age-related cognitive decline. Area 46 of the dorsolateral prefrontal cortex (dlPFC) has been extensively studied for its critical role in executive function while the hippocampus and related cortical regions have been a major target of research for memory function. Some of the key age-related changes in area 46 include decreases in volume, microcolumn strength, synapse density, and α1- and α2-adrenergic receptor binding densities. All of these measures significantly correlate with cognitive scores. Interestingly, the critical synaptic subtypes associated with cognitive function appear to be different between the dlPFC and the hippocampus. For example, the dendritic spine subtype most critical to task acquisition and vulnerable to aging in area 46 is the thin spine, whereas in the dentate gyrus, the density of large mushroom spines with perforated synapses correlates with memory performance. This review summarizes age-related changes in anatomical, neuronal, and synaptic parameters within brain areas implicated in cognition and whether these changes are associated with cognitive decline.     

Age-related changes in human and non-human primate white matter: from myelination disturbances to cognitive decline

The cognitive decline associated with normal aging was long believed to be due primarily to decreased synaptic density and neuron loss. Recent studies in both humans and non-human primates have challenged this idea, pointing instead to disturbances in white matter (WM) including myelin damage. Here, we review both cross-sectional and longitudinal studies in humans and non-human primates that collectively support the hypothesis that WM disturbances increase with age starting at middle age in humans, that these disturbances contribute to age-related cognitive decline, and that age-related WM changes may occur as a result of free radical damage, degenerative changes in cells in the oligodendrocyte lineage, and changes in microenvironments within WM.     

Increased QT dispersion and P wave dispersion in major depressive disorder

BACKGROUND:

QT and P wave dispersion parameters can indicate abnormalities in autonomic nervous system and cardiac functioning.

OBJECTIVES:

To determine QT and P wave dispersion in patients with major depressive disorder compared with healthy volunteers.

METHODS:

Fifty newly diagnosed patients with major depressive disorder and 50 age- and sex-matched healthy volunteers underwent 12-lead electrocardiography. QT interval, QT dispersion, heart rate-corrected QT dispersion and P wave dispersions were calculated manually by a blinded specialist.

RESULTS:

Groups were comparable in terms of age, sex, body mass index, smoking status, metabolic diseases and left ventricular ejection fraction. The major depressive disorder group had significantly higher QT dispersion (58.5±9.9 versus 41.7±3.8; P<0.001), heart rate-corrected QT dispersion (62.5±10.0 versus 45.2±4.3; P<0.001) and P wave dispersion (46.9±4.8 versus 41.5±5.1; P<0.001).

CONCLUSION:

Increased QT dispersion, heart-rate corrected QT dispersion and P wave dispersion in major depressive disorder patients may be indicative of autonomic imbalance and increased risk of cardiac morbidity and mortality.     

Functional decline in older adults one year after hospitalization

We studied the change in personal ability to perform the activities of daily living (P-ADL) one year after hospitalization (T2) of patients at least 65 years old at baseline (T1). The study included 363 (175 men) medical inpatients with age range 65–98 (mean 80.2, SD 7.5) years. Information was collected at baseline and at a 12 month follow-up using Lawton and Brody's physical self-maintenance scale (PSMS) (termed the P-ADL score), as the dependent variable, and the mini-mental state examination (MMSE), the hospital anxiety and depression scale (HAD) and the WHOQOL-BREF questionnaire as independent variables. For the total sample, the mean P-ADL was significantly worsened from T1 to T2 (mean change 0.5, SD 2.8; p < 0.01). In a fully adjusted linear regression analysis, worsened P-ADL from T1 to T2 was independently associated with cognitive impairment at T1, increasing cognitive impairment from T1 to T2, the tendency to fall between T1 and T2, increase in depressive symptoms from T1 to T2, poor physical QOL at T1 and change toward a poorer QOL from T1 to T2. In conclusion, worse P-ADL at T2 was, independently of age and baseline P-ADL, associated with impaired cognitive function and QOL related to physical ability at baseline, as well as worsening depression, cognition and QOL from T1 to T2. Our findings highlight the importance of applying results from screening measures of cognitive function and emotional health when planning care for older people after hospitalization.     

Functional decline in older adults one year after hospitalization

We studied the change in personal ability to perform the activities of daily living (P-ADL) one year after hospitalization (T2) of patients at least 65 years old at baseline (T1). The study included 363 (175 men) medical inpatients with age range 65–98 (mean 80.2, SD 7.5) years. Information was collected at baseline and at a 12 month follow-up using Lawton and Brody's physical self-maintenance scale (PSMS) (termed the P-ADL score), as the dependent variable, and the mini-mental state examination (MMSE), the hospital anxiety and depression scale (HAD) and the WHOQOL-BREF questionnaire as independent variables. For the total sample, the mean P-ADL was significantly worsened from T1 to T2 (mean change 0.5, SD 2.8; p < 0.01). In a fully adjusted linear regression analysis, worsened P-ADL from T1 to T2 was independently associated with cognitive impairment at T1, increasing cognitive impairment from T1 to T2, the tendency to fall between T1 and T2, increase in depressive symptoms from T1 to T2, poor physical QOL at T1 and change toward a poorer QOL from T1 to T2. In conclusion, worse P-ADL at T2 was, independently of age and baseline P-ADL, associated with impaired cognitive function and QOL related to physical ability at baseline, as well as worsening depression, cognition and QOL from T1 to T2. Our findings highlight the importance of applying results from screening measures of cognitive function and emotional health when planning care for older people after hospitalization.     

Beyond church attendance: Religiosity and mental health among rural older adults

Data from 2 independent random samples of thepopulation of community-dwelling older adults ineastern North Carolina are used to assess the effectsof Christian religious subdimensions, including churchattendance and participation, belief that religiousfaith affects health, and belief that prayer and Godcombine with medical treatment to cure illness, uponmental health. Self-reported religiosity in thispopulation across dimensions is described and theeffects of selected demographic characteristics uponreligiosity are assessed. Lastly, the main effects ofdemographic characteristics, religiosity, and healthstatus upon the mental health of respondents areexplored. Findings suggest that Christian religiousbeliefs and practices are widespread in this mainlyrural population and that females and African Americanelderly people are more likely than others to professreligious beliefs and to participate in church-relatedactivities. Multivariate results suggest that reducedhealth status, including functional ability, combineswith limited participation in church activities toresult in poorer self-rated mental health and moresymptoms of depression. The implications of thefindings for the role of Christian religiosity inhealth and mental health are discussed.     

Brain-derived neurotrophic factor gene polymorphisms, neurotransmitter levels, and depressive symptoms in an elderly population

A large number of studies have examined associations between brain-derived neurotrophic factor (BDNF) gene polymorphisms and depressive symptoms. However, results still remain controversial. Recent studies suggested a significant age and gender effect on the heritability of depression. The potential neurobiological pathways that could possibly mediate this relationship have not been examined so far. Since BDNF is involved in the regulation of neurotransmitter production, a mediating role of neurotransmitters seems plausible. The present study aims to examine the association between three common BDNF single-nucleotid polymorphisms (SNPs; rs7103411, rs7124442, and rs6265) and depressive symptoms in a community-based elderly population taking into account the serum levels of four neurotransmitters, serotonin, dopamine, adrenalin, and noradrenalin, as potential mediating factors. We also examined whether age and gender had a modifying effect on this association. We collected and analyzed the genetic and laboratory data as well as Center for Epidemiologic Studies-Depression scores of 350 community-dwelling elderly individuals (aged 65+ years). We found that the BDNF rs6265 polymorphism was related to the severity of depressive symptoms, and that this association was independent of neurotransmitter levels. Stratified analyses showed that this association was restricted to older individuals (≥74 years) and men. The associations of SNPs rs7103411 or rs7124442 SNP with depressive symptoms were not statistically significant. This study importantly adds to the existing literature by affirming previous assumptions on an age and gender difference in the relation between BDNF genotype and depression. We moreover first-time report a missing mediating role of neurotransmitters in this association.