RESUMEN
OBJECTIVES: Late-life depression (LLD) is a common and debilitating disorder. Previously, resting-state studies have revealed abnormal functional connectivity (FC) of brain networks in LLD. Since LLD is associated with emotional-cognitive control deficits, the aim of this study was to compare FC of large-scale brain networks in older adults with and without a history of LLD during a cognitive control task with emotional stimuli. METHODS: Cross-sectional case-control study. Twenty participants diagnosed with LLD and 37 never-depressed adults 60-88 years of age underwent functional magnetic resonance imaging during an emotional Stroop task. Network-region-to-region FC was assessed with seed regions in the default mode, the frontoparietal, the dorsal attention, and the salience networks. RESULTS: FC between salience and sensorimotor network regions and between salience and dorsal attention network regions were reduced in LLD patients compared to controls during the processing of incongruent emotional stimuli. The normally positive FC between these networks were negative in LLD patients and inversely correlated with vascular risk and white matter hyperintensities. CONCLUSIONS: Emotional-cognitive control in LLD is associated with aberrant functional coupling between salience and other networks. This expands on the network-based LLD model and proposes the salience network as a target for future interventions.
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Mapeo Encefálico , Depresión , Humanos , Anciano , Depresión/diagnóstico por imagen , Depresión/psicología , Estudios de Casos y Controles , Estudios Transversales , Encéfalo/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVES: Understanding the biological changes that occur prior to onset of late-life depression (LLD) is key to its prevention. To investigate potential predictors of LLD, we assessed cognitive scores and neurodegenerative and vascular biomarkers in healthy older adults who later developed depression. METHODS: Longitudinal data from the Alzheimer's Disease Neuroimaging Initiative of 241 cognitively unimpaired and non-depressed older adults aged 56-90 at baseline with at least 4 years of follow-up were included. Participants were classified based on whether they developed an incident depression (n = 96) or not (n = 145). Cognitive measures of memory, executive functioning, and language, and biomarkers proposed to be related to LLD: hippocampal volume, white matter hyperintensity volume (WMH), and cortical and cerebrospinal fluid (CSF) amyloid beta levels, were compared between the incident depression and the never-depressed groups at four time points: at baseline, the visit prior to onset, at onset, and after the onset of depression. RESULTS: In the incident depression group, there was a mild decline in cognitive scores from baseline to the visit before depression onset compared with the never-depressed group. The cognitive differences between the groups became more marked after depression onset. Baseline cortical amyloid burden, CSF amyloid beta levels, and WMH were significant predictors of incident depression. Compared to the non-depressed group, hippocampal volume was not reduced before onset, but was reduced following depression. CONCLUSIONS: Amyloid pathology and WMH can predict future development of LLD in cognitively unimpaired individuals and may be involved in precipitating vulnerability for depression in older adults.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Anciano , Enfermedad de Alzheimer/patología , Amiloide , Péptidos beta-Amiloides/metabolismo , Biomarcadores , Encéfalo/metabolismo , Cognición , Disfunción Cognitiva/patología , Depresión , Hipocampo/diagnóstico por imagen , Hipocampo/patología , Humanos , Imagen por Resonancia Magnética/métodosRESUMEN
INTRODUCTION: Successful inhibition of distracting emotions is important for preserving well-being and daily functioning. There is conflicting evidence regarding the impact of healthy aging on emotional inhibition, and possible age-related alterations in the neuronal underpinnings of emotional interference processing are unexplored. METHODS: Thirty younger (mean age 26 years; 15 women) and 30 older (mean age 71 years; 13 women) healthy adults performed a face-word emotional Stroop task while undergoing functional magnetic resonance imaging of the brain. A resting-state scan was acquired for calculating the amplitude of low-frequency fluctuations as an estimate of vascular reactivity. Comparisons of brain activation during the task were assessed in a whole-brain, voxel-wise analysis, contrasting congruent, and incongruent conditions. The canonical regions of the frontoparietal, salience, dorsal attention, and default mode networks were used as seed regions for assessing functional connectivity within and between large-scale brain networks. Task performance was evaluated using response accuracy and response time. RESULTS: The older adults had longer response times and lower task accuracy than the younger adults, but the emotional interference effect was not significantly different between the groups. Whole-brain analysis revealed no significant age-related differences in brain activation patterns. Rescaling the data for estimated variability in vascular reactivity did not affect the results. In older adults, there was relatively stronger functional connectivity with the default mode network, the sensorimotor network, and the dorsal attention network for the frontoparietal and salience network seeds during the task. Conversely, younger adults had relatively stronger connections within and between the frontoparietal and salience networks. CONCLUSION: In this first fMRI study of emotional Stroop interference in older and younger adults, we found that the emotional interference effect was unchanged in healthy aging and replicated the finding from non-emotional task studies that older adults have greater between-network and less within-network connectivity compared to younger adults.
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Envejecimiento Saludable , Adulto , Anciano , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Emociones , Femenino , Humanos , Imagen por Resonancia Magnética , Vías Nerviosas/diagnóstico por imagenRESUMEN
OBJECTIVE: To evaluate the feasibility and effectiveness of the CORDIAL program, a psychosocial intervention consisting of cognitive behavioral therapy (CBT), cognitive rehabilitation, and reminiscence to manage depressive symptoms for people with mild cognitive impairment (MCI) or dementia. DESIGN: We conducted a randomized controlled trial, based on a two-group (intervention and control), pre-/post-intervention design. SETTING: Participants were recruited from five different old age psychiatry and memory clinics at outpatients' hospitals. PARTICIPANTS: Hundred and ninety-eight people with MCI or early-stage dementia were included. INTERVENTION: The intervention group (n = 100) received 11 individual weekly sessions of the CORDIAL program. This intervention includes elements from CBT, cognitive rehabilitation, and reminiscence therapy. The control group (n = 98) received treatment-as-usual. MEASUREMENTS: We assessed Montgomery-Åsberg Depression Rating Scale (MADRS) (main outcome), Neuropsychiatric Inventory Questionnaire, and Quality of Life in Alzheimer's disease (secondary outcomes) over the course of 4 months and at a 10-month follow-up visit. RESULTS: A linear mixed model demonstrated that the depressive symptoms assessed by MADRS were significantly more reduced in the intervention groups as compared to the control group (p < 0.001). The effect persisted for 6 months after the intervention. No significant differences between groups were found in neuropsychiatric symptoms or quality of life. CONCLUSION: Our multicomponent intervention, which comprised 11 individual sessions of CBT, cognitive rehabilitation, and reminiscence therapy, reduced depressive symptoms in people with MCI and dementia.
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Disfunción Cognitiva/terapia , Demencia/psicología , Demencia/terapia , Depresión/psicología , Depresión/terapia , Psicoterapia , Anciano , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/psicología , Demencia/complicaciones , Depresión/complicaciones , Femenino , Humanos , Masculino , Calidad de VidaRESUMEN
OBJECTIVES: To examine the mediating effects of depression and anxiety in the relationship between self-efficacy and quality of life among people with mild cognitive impairment (MCI) or mild dementia. METHOD: A total of 196 patients diagnosed with MCI or dementia due to Alzheimer disease completed structured measures of self-efficacy, quality of life, and depressive and anxiety symptoms. We examined direct and mediated effects by fitting structural equation models to data. RESULTS: Our analyses supported that the effects of self-efficacy on quality of life may be partially mediated by depression and anxiety. Both anxiety and depression had significant mediating effects, with depression showing a stronger effect. CONCLUSION: These results suggest that increased self-efficacy may have a positive effect on quality of life in people with MCI or dementia-partly by reducing depression and anxiety. These findings may have important practical implications for tailoring therapeutic interventions.
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Disfunción Cognitiva/psicología , Demencia/psicología , Calidad de Vida/psicología , Autoeficacia , Anciano , Enfermedad de Alzheimer , Ansiedad , Depresión/psicología , Femenino , Humanos , MasculinoRESUMEN
Earlier detection of dementia requires increased knowledge of how to help people in the early stages of dementia. However, few studies have focused on how psychotherapy should be adapted to improve the outcome of therapy for people with Alzheimer's disease. The aims of the present study were to identify and to explore possible obstacles encountered during the use of manual-based psychotherapy for people with early-stage Alzheimer's disease. The study found that individual adaptations to the treatment manual were necessary, particularly the modification of memory aids in order to adapt them to patients' functional level and previous experience with modern technology. In addition, caregivers were essential for both treatment and homework completion, while reduced awareness constituted an obstacle for adherence to the manual.
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Enfermedad de Alzheimer/psicología , Concienciación , Psicoterapia/métodos , Anciano , Agnosia , Cuidadores/psicología , Femenino , Humanos , Masculino , Memoria , Persona de Mediana EdadRESUMEN
Men are often believed to have a functionally more asymmetrical brain organization than women, but the empirical evidence for sex differences in lateralization is unclear to date. Over the years we have collected data from a vast number of participants using the same consonant-vowel dichotic listening task, a reliable marker for language lateralization. One dataset comprised behavioral data from 1782 participants (885 females, 125 non-right-handers), who were divided in four age groups (children <10 yrs, adolescents = 10-15 yrs, younger adults = 16-49 yrs, and older adults >50 yrs). In addition, we had behavioral and functional imaging (fMRI) data from another 104 younger adults (49 females, aged 18-45 yrs), who completed the same dichotic listening task in a 3T scanner. This database allowed us to comprehensively test whether there is a sex difference in functional language lateralization. Across all participants and in both datasets a right ear advantage (REA) emerged, reflecting left-hemispheric language lateralization. Accordingly, the fMRI data revealed a leftward asymmetry in superior temporal lobe language processing areas. In the N = 1782 dataset no main effect of sex but a significant sex by age interaction emerged: the REA increased with age in both sexes but as a result of an earlier onset in females the REA was stronger in female than male adolescents. In turn, male younger adults showed greater asymmetry than female younger adults (accounting for <1% of variance). There were no sex differences in children and older adults. The males in the fMRI dataset (N = 104) also had a greater REA than females (accounting for 4% of variance), but no sex difference emerged in the neuroimaging data. Handedness did not affect these findings. Taken together, our findings suggest that sex differences in language lateralization as assessed with dichotic listening exist, but they are (a) not necessarily reflected in fMRI data, (b) age-dependent and (c) relatively small.