RESUMO
Psychotic symptoms can manifest at any age, but in the elderly they represent a real diagnostic challenge. Thought disorders, hallucinations (usually visual), mood disorders with delusions, impairment of social interaction and occasionally verbal or physical aggression may be observed (Karon & VandenBos, 1998). Since the first descriptions of classical psychiatry, attempts have been made to define the psychoses observed in the elderly and determine whether they are primary "psychiatric" syndromes or, conversely, whether they can be attributed to other pathologies. Thus, different concepts have emerged, such as Late Onset Psychosis or Late-Onset Schizophrenia, Very Late-Onset Psychosis or Very Late-Onset Schizophrenia-Like Psychosis VLOSL), Late-Life Psychosis, etc.
Los síntomas psicóticos pueden manifestarse a cualquier edad, pero en las personas mayores representan un verdadero desafío diagnóstico. Pueden observarse trastornos del pensamiento, alucinaciones (usualmente visuales), trastornos del estado de ánimo con ideas delirantes, trastornos en la interacción social y ocasionalmente agresividad verbal o física (Karon & VandenBos, 1998). Desde las primeras descripciones de la psiquiatría clásica se ha intentado definir a las psicosis observadas en las personas mayores y determinar si se trata de síndromes "psiquiátricos" primarios o, por el contrario, si se los puede atribuir a otras patologías. Así, han surgido diferentes conceptos, como psicosis de comienzo tardío (Late Onset Psychosis) o esquizofrenia de comienzo tardío (Late-Onset Schizophrenia - LOS), psicosis de comienzo muy tardío (Very Late-Onset Psychosis)o psicosis esquizofreniforme de comienzo muy tardío (very late-onset schizophrenia-like psychosis - VLOSL), psicosis de la vida avanzada (Late-Life Psychosis), etc.
Assuntos
Transtornos Psicóticos , Humanos , Estudos RetrospectivosRESUMO
Late-Life Depression (LLD) is one of the most prevalent psychiatric disorders in elderly, causing significant functional impairments. MicroRNAs are small molecules involved in the post-transcriptional regulation of gene expression. Elderly individuals diagnosed with LLD present down regulation of miR-184 (hsa-miR-184) expression compared to healthy patients. Therefore, this miR-184 can be used as a biomarker to diagnose LLD. Current LLD diagnosis depends primarily on clinical subjective identification, based on symptoms and variable scales. This work introduces a novel and facile approach for the LLD diagnosis based on the development of an electrochemical genosensor for miR-184 detection in plasma, using differential pulse voltammetry (DPV) and electrochemical impedance spectroscopy (EIS). DPV results presented a 2-Fold increase in current value for healthy patients, compared to individuals with LLD when monitoring ethidium bromide oxidation peak. For EIS, a 1.5-fold increase in charge transfer resistance for healthy elderly subjects was observed in comparison with depressed patients. In addition, the analytical performance of the biosensor was evaluated using DPV, obtaining a linear response ranging from 10-9 mol L-1 to 10-17 mol L-1 of miR-184 in plasma and a detection limit of 10 atomoles L-1. The biosensor presented reusability, selectivity and stability, the current response remained 72% up to 50 days of storage. Thus, the genosensor proved to be efficient in the diagnosis of LLD, as well as the accurate quantification of miR-184 in real plasma samples of healthy and depressed patients.
Assuntos
Técnicas Biossensoriais , MicroRNAs , Humanos , Idoso , Depressão/diagnóstico , Depressão/genética , Técnicas Eletroquímicas/métodos , Biomarcadores , Regulação da Expressão Gênica , Técnicas Biossensoriais/métodosRESUMO
OBJECTIVE: Suicide is an outcome arising from a combination of risk and protective factors. Examining psychological resilience traits associated with successful aging may help to better understand late-life suicide and depression. We examined self-reported protective factors including mindfulness, life satisfaction and engagement, flourishing, and subjective and objective social support in a high suicide-risk sample of depressed older adults. METHODS: Participants were 297 individuals aged 55+ (mean age: 64.2): 92 depressed suicide attempters, 138 depressed individuals who never attempted suicide, and 67 non-psychiatric comparisons. Using linear and binomial logistic regression, we examined the effects of a combined Protective Factor value on presence and severity of depression and suicidal ideation, and history of suicide attempt. RESULTS: Relative to the non-psychiatric comparison group, all depressed participants had significantly lower Protective Factor values. Higher Protective Factor value was associated with lower likelihood of depression, depression severity, and likelihood of ideation, but was not associated with ideation severity or history of suicide attempt. Participants with one standard deviation higher Protective Factor had lower odds of ideation incidence by a factor of OR=0.68 (95%CI=0.48-0.96). CONCLUSION: Resiliency characteristics relevant to psychological wellbeing and successful aging may mitigate the emergence of depression and suicidal ideation, as well as the severity of depression in late-life. The Resilience Factor used in this study can help clinicians nuance their appraisal of depression and suicide risk.
Assuntos
Atenção Plena , Tentativa de Suicídio , Humanos , Idoso , Tentativa de Suicídio/prevenção & controle , Tentativa de Suicídio/psicologia , Ideação Suicida , Depressão/epidemiologia , Depressão/psicologia , Satisfação Pessoal , Fatores de RiscoRESUMO
Depression is a complex and multifactorial disease, affecting about 6.5% of the elderly population in what is referred to as late-life depression (LLD). Despite its public health relevance, there is still limited information about the molecular mechanisms of LLD. We analyzed the blood plasma of 50 older adults, 19 with LLD and 31 controls, through untargeted mass spectrometry, and used systems biology tools to identify biochemical pathways and biological processes dysregulated in the disease. We found 96 differentially expressed proteins between LLD patients and control individuals. Using elastic-net regression, we generated a panel of 75 proteins that comprises a potential model for determining the molecular signature of LLD. We also showed that biological pathways related to vesicle-mediated transport and voltage-dependent calcium channels may be dysregulated in LLD. These data can help to build an understanding of the molecular basis of LLD, offering an integrated view of the biomolecular alterations that occur in this disorder. SIGNIFICANCE: Major depressive disorder in the elderly, called late-life depression (LLD), is a common and disabling disorder, with recent prevalence estimates of 6.5% in the general population. Despite the public health relevance, there is still limited information about the molecular mechanisms of LLD. The findings in this paper shed light on LLD heterogeneous biological mechanisms. We uncovered a potential novel biomolecular signature for LLD and biological pathways related to this condition which can be targets for the development of novel interventions for prevention, early diagnosis, and treatment of LLD.
Assuntos
Transtorno Depressivo Maior , Idoso , Canais de Cálcio , Humanos , Plasma , Proteínas , ProteômicaRESUMO
OBJECTIVE: Impaired cognition increases suicide risk while social connectedness protects against suicide risk in late life. We examined the independent and interactive effects of social connectedness and cognition on suicide risk in late life. METHODS: Participants included 570 individuals aged 50+ from a late-life suicide study. The Interpersonal Support Evaluation List and Social Network Index were used to assess perceived and objective social connectedness, respectively, while the Mattis Dementia Rating Scale and Executive Interview were used to assess cognition. RESULTS: Suicide attempters and ideators reported lower perceived social connectedness and exhibited worse executive function than non-suicidal depressed and healthy comparison participants, while only attempters had worse objective social connectedness relative to the other groups. Executive dysfunction was linked to low objective social connectedness in attempters but higher objective social connectedness in healthy comparisons. CONCLUSION: Interventions targeting suicide risk may consider bolstering social connectedness, particularly in those with low cognitive health.
Assuntos
Transtornos Cognitivos , Prevenção do Suicídio , Suicídio , Cognição , Transtornos Cognitivos/psicologia , Humanos , Ideação Suicida , Suicídio/psicologia , Tentativa de Suicídio/psicologiaRESUMO
OBJECTIVES: Late-life depression (LLD) is the most common mental disorder among the elderly, but its clinical features remain unclear, especially among older adults. We sought to investigate if age, sex and education could influence the severity or frequency of LLD symptoms. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the Mini International Neuropsychiatric Interview to diagnose major depression according to DSM-IV criteria and the GDS-15 to measure depression severity. RESULTS: Excluding 174 individuals diagnosed with dementia, 54 (11.6%) of the remaining 457 individuals were diagnosed with LLD; 77.8% of which were female. On average, these participants were aged 81.0 ± 4.8 years and had 2.7 ± 3.3 years of schooling. Symptom severity was not influenced by sociodemographic variables. Death/suicidal ideation was more frequent among men, while psychomotor disturbance was more present in women (p = 0.04 and p = 0.042). More educated individuals (≥ 4 years) also reported a higher frequency of psychomotor disturbance (p = 0.039). CONCLUSIONS: Severity of depressive episode was not influenced by sociodemographic variables. Sex and educational level had a significant impact on symptom profiles.
Assuntos
Depressão , Transtorno Depressivo Maior , Idoso , Brasil/epidemiologia , Depressão/epidemiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Escolaridade , Feminino , Humanos , Masculino , Escalas de Graduação PsiquiátricaRESUMO
Los trastornos del ánimo en el adulto mayor, especialmente aquellos de inicio tardío son difíciles de diferenciar de la demencia en su etapa inicial, dado que existe un traslape sintomático. Esto puede llevar a errar o a retrasar el diagnóstico e impedir la entrega de un tratamiento adecuado. Para el diagnóstico diferencial es fundamental obtener una historia rigurosa tanto del paciente como de la familia, un examen mental y neurológico. Se complementa con un estudio neuropsicológico y con biomarcadores de demencia. Hoy en día se dispone de nuevas técnicas de diagnóstico precoz en la demencia como la volumetría de hipocampos, el PET/CT F18-FDG y PET de amiloide, beta-amiloide y proteína Tau en el LCR, entre otras, que ayudan en casos complejos de diagnóstico diferencial. Este artículo de revisión reúne elementos clínicos y estudios complementarios, con el objetivo de ayudar al psiquiatra en la tarea de diferenciar ambos cuadros.
Mood disorders in the elderly, especially those with late onset are difficult to differentiate from Dementia in its initial stage, given that there is a symptomatic overlap. This can lead to miss or delay the diagnosis and subsequently prevent an appropriate treatment. For the differential diagnosis it is essential to obtain a rigorous history of both the patient and the family, a mental and neurological examination. It is complemented with a neuropsychological assessment and with biomarkers of Dementia. Nowadays, new early diagnosis techniques are available in Dementia such as hippocampal volumetry, PET/CT F18-FDG and PET of amyloid, beta-amyloid and Tau protein in the CSF, among others, which help in complex cases of differential diagnosis. This article reviews clinical elements and complementary studies that help the psychiatrist in the task of differentiating both disorders.
Assuntos
Humanos , Transtornos do Humor/diagnóstico , Demência/diagnóstico , Transtorno Bipolar/diagnóstico , Transtornos do Humor/diagnóstico por imagem , Demência/diagnóstico por imagem , Depressão/diagnóstico , Diagnóstico DiferencialRESUMO
OBJECTIVES: More than half of patients with major depression who do not respond to initial antidepressants become treatment resistant (TRD), and while electroconvulsive therapy (ECT) is effective, it involves anesthesia and other medical risks that are of concern in geriatric patients. Past studies have suggested that theta cordance (TC), a correlate of cerebral metabolism measured by electroencephalography, could guide treatment decisions related to patient selection and engagement of the therapeutic target. METHODS/DESIGN: Eight patients with late-life treatment resistant depression (LL-TRD) underwent magnetoencephalography (MEG) at baseline and following seven sessions of ECT. We tested whether the mean and regional frontal cortex TC were able to differentiate early responders from nonresponders. RESULTS: Five patients whose depression severity decreased by >30% after seven sessions were considered early responders. We found no baseline differences in mean frontal TC between early responders compared with nonresponders, but early responders exhibited a significant increase in TC following ECT. Further, we found that compared with nonresponders, early responders exhibited a greater change in TC specifically within the right prefrontal cortex. CONCLUSIONS: These results support the hypothesis that increases in frontal TC are associated with antidepressant response. We expand on previous findings by showing that this change is specific to the right prefrontal cortex. Validation of this neural marker could contribute to improved ECT outcomes, by informing early clinical decisions about the acute efficacy of this treatment.
Assuntos
Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia , Lobo Frontal/fisiologia , Ritmo Teta/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: Characterization of clinical course in old age bipolar disorder (OABD) is scarce and based solely on episode density (ED). The aim of this study was to explore mood instability (MI) and subsyndromal symptomatology (SS) in a prospective cohort of OABD. Further, we contrasted these measures with a cohort of young age bipolar disorder (YABD). METHODS: Life charts from weekly mood ratings were used to compute the number of weeks spent with subsyndromal symptoms (SD), the ED, and the MI during follow-up for a cohort of OABD (N = 38) that excluded late onset BD. Linear and logistic regression models were fitted to compare the clinical course of OABD with a cohort of YABD (N = 52) and to explore the relationship between these measures and functional outcomes. RESULTS: Median follow-up was 5 years (IQR: 3.6-7.9). OABD (61.6 years, SD: 8.3) spent 15%, 6%, and 3% of their follow-up with depressive, manic, and mixed symptoms, respectively, and suffered 4.2 mood changes per year (SD: 2.6). No significant differences between OABD and YABD regarding ED or MI emerged in multivariate analysis, while a higher subsyndromal manic symptom burden was observed in OABD (ß coefficient: 3.79, 95%CI: 0.4-7.2). Both SS and MI were associated with functional outcomes in OABD. CONCLUSIONS: The course of illness throughout OABD was similar to the one observed in YABD except for a higher subsyndromal manic burden. This study extended the association of MI and SD with global functioning to the late-life BD.
Assuntos
Transtorno Bipolar/psicologia , Memória Episódica , Transtornos do Humor/psicologia , Adolescente , Adulto , Idoso , Transtorno Bipolar/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Adulto JovemRESUMO
Changes in microRNAs (miRNAs) expression have been described in major depressive disorder in young and middle-aged adults. However, no study has evaluated miRNA expression in older adults with major depression (or late-life depression [LLD]). Our primary aim was to evaluate the expression of miRNAs in subjects with LLD. We first evaluated the miRNA expression using next-generation sequencing (NGS) and then we validated the miRNAs found in NGS in an independent sample of LLD patients, using RT-qPCR. Drosophila melanogaster model was used to evaluate the impact of changes in miRNA expression on behavior. NGS analysis showed that hsa-miR-184 (log2foldchangeâ¯=â¯-4.21, pâ¯=â¯1.2â¯×â¯10-03) and hsa-miR-1-3p (log2foldchangeâ¯=â¯-3.45, pâ¯=â¯1.3â¯×â¯10-02) were significantly downregulated in LLD compared to the control group. RT-qPCR validated the downregulation of hsa-miR-184 (pâ¯<â¯0.001), but not for the hsa-miR-1-3p. The knockout flies of the ortholog of hsa-miR-184 showed significantly reduced locomotor activity at 21-24â¯d.p.e (pâ¯=â¯0.04) and worse memory retention at 21-24â¯d.p.e (24h post-stimulus, pâ¯=â¯0.02) compared to control flies. Our results demonstrated that subjects with LLD have significant downregulation of hsa-miR-184. Moreover, the knockout of hsa-miR-184 in flies lead to depressive-like behaviors, being more pronounce in older flies.
Assuntos
Envelhecimento/genética , Comportamento Animal , Disfunção Cognitiva/genética , Transtorno Depressivo Maior/genética , Locomoção , MicroRNAs/genética , Retenção Psicológica , Fatores Etários , Idoso , Animais , Animais Geneticamente Modificados , Modelos Animais de Doenças , Regulação para Baixo , Proteínas de Drosophila , Drosophila melanogaster , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Locomoção/genética , Masculino , Pessoa de Meia-Idade , Análise de Sequência de RNA , Pesquisa Translacional BiomédicaRESUMO
An early stage of behavioral variant frontotemporal dementia (bvFTD) often displays a mix of behavioral disturbances and personality changes hindering a differential diagnosis from elderly bipolar disorder (BD), making this process a big challenge. However, no studies have compared these pathologies from neuropsychological and neuroanatomical perspectives. The aim of the present study was to compare the executive functions (EF) and social cognition profiles as well as the structural neuroimaging of bvFTD and elderly patients with BD. First, we compared the executive and social cognition performances of 16 bvFTD patients, 13 BD patients and 22 healthy controls. Second, we compared grey matter volumes in both groups of patients and controls using voxel-based morphometry. Lastly, we examined the brain regions where atrophy might be associated with specific impairments in bvFTD and BD patients. Compared to controls, bvFTD patients showed deficits in working memory, abstraction capacity, inhibitory control, cognitive flexibility, verbal fluency and theory of mind (ToM). Patients with BD showed lower performance than controls in terms of abstraction capacity and verbal inhibitory control. In bvFTD patients, atrophy of frontal, temporal and insular cortices was related to EF deficits. Atrophy of the amygdala, the hippocampus, the parahippocampal gyrus, the putamen, the insula, the precuneus, the right temporo-parietal junction and superior temporal pole was associated to ToM impairments. No significant associations between atrophy and EF performance were observed in BD patients. BvFTD patients showed greater EF and ToM deficits than BD patients. Moreover, compared to BD, bvFTD patients exhibited a significant decrease in GM volume in frontal, temporal and parietal regions. Our results provide the first comparison of EF, social cognition and neuroanatomical profiles of bvFTD and elderly BD patients. These findings shed light on differential diagnosis of these disorders and may have important clinical implications.
Assuntos
Transtorno Bipolar/patologia , Transtorno Bipolar/fisiopatologia , Córtex Cerebral/patologia , Função Executiva/fisiologia , Demência Frontotemporal/patologia , Demência Frontotemporal/fisiopatologia , Substância Cinzenta/patologia , Percepção Social , Teoria da Mente/fisiologia , Idade de Início , Idoso , Atrofia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS: Overall, 639 individuals (64% female, with a mean age of 81.1⯱â¯5.2 and 2.6⯱â¯2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS: The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION: Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.
Assuntos
Fatores Etários , Transtorno Depressivo/epidemiologia , Vida Independente/psicologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Transtorno Depressivo/psicologia , Países em Desenvolvimento/estatística & dados numéricos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Escolaridade , Feminino , Humanos , Masculino , Pobreza/psicologia , Prevalência , Qualidade de VidaRESUMO
Study Objectives: Sleep is multidimensional, with domains including duration, timing, continuity, regularity, rhythmicity, quality, and sleepiness/alertness. Individual sleep characteristics representing these domains are known to predict health outcomes. However, most studies consider sleep characteristics in isolation, resulting in an incomplete understanding of which sleep characteristics are the strongest predictors of health outcomes. We applied three multivariable approaches to robustly determine which sleep characteristics increase mortality risk in the osteoporotic fractures in men sleep study. Methods: In total, 2,887 men (mean 76.3 years) completed relevant assessments and were followed for up to 11 years. One actigraphy or self-reported sleep characteristic was selected to represent each of seven sleep domains. Multivariable Cox models, survival trees, and random survival forests were applied to determine which sleep characteristics increase mortality risk. Results: Rhythmicity (actigraphy pseudo-F statistic) and continuity (actigraphy minutes awake after sleep onset) were the most robust sleep predictors across models. In a multivariable Cox model, lower rhythmicity (hazard ratio, HR [95%CI] =1.12 [1.04, 1.22]) and lower continuity (1.16 [1.08, 1.24]) were the strongest sleep predictors. In the random survival forest, rhythmicity and continuity were the most important individual sleep characteristics (ranked as the sixth and eighth most important among 43 possible sleep and non-sleep predictors); moreover, the predictive importance of all sleep information considered simultaneously followed only age, cognition, and cardiovascular disease. Conclusions: Research within a multidimensional sleep health framework can jumpstart future research on causal pathways linking sleep and health, new interventions that target specific sleep health profiles, and improved sleep screening for adverse health outcomes.
Assuntos
Nível de Saúde , Mortalidade , Transtornos do Sono-Vigília/fisiopatologia , Sono/fisiologia , Actigrafia/métodos , Idoso , Envelhecimento , Doenças Cardiovasculares/mortalidade , Cognição/fisiologia , Humanos , Masculino , Fraturas por Osteoporose/mortalidade , Polissonografia , Modelos de Riscos ProporcionaisRESUMO
OBJECTIVE: Depressive symptoms are common among older adults with obesity and diabetes. Nonetheless, the mechanisms for this association are not clear but may involve changes in the insulin cascade signaling. We aimed to investigate the association, and potential mediators, between obesity, insulin resistance, and depressive symptoms among older adults from a homogenous cohort of Mexican-Americans. METHODS: We included a total of 500 Mexican-American older adults assessed in the Cameron County Health Study. We evaluated depressive symptoms using the Center for Epidemiologic Survey Depression Scale (CES-D). Central obesity was defined by waist circumference. Insulin resistance was evaluated by the HOMA-IR index. We estimated the association between obesity, insulin resistance, and depressive symptoms by carrying out univariate and multivariate regression analyses. RESULTS: In unadjusted regression analysis, HOMA-IR (unstandardized ß = 0.31 ± 0.12, P = 0.007), waist circumference (unstandardized ß = 0.066 ± 0.0.028, P = 0.017), and Hb1Ac levels (unstandardized ß = 0.52 ± 0.24, P = 0.03) were significantly associated with CES-D scores. The association of HOMA-IR and CES-D remained statistically significant after controlling for socio-demographic and clinical variables in multivariate analysis (unstandardized ß = 0.28 ± 0.11, P = 0.01). CONCLUSION: Our results suggest that depressive symptoms are associated with insulin resistance in older Mexican-American adults. In addition, poorer glucose control and obesity are important mediators of this relationship. Additional studies are needed to evaluate whether interventions that increase insulin sensitivity can also reduce depressive symptoms in this population.
Assuntos
Depressão/psicologia , Transtornos do Metabolismo de Glucose/psicologia , Resistência à Insulina , Americanos Mexicanos/estatística & dados numéricos , Obesidade/psicologia , Adulto , Idoso , Estudos de Coortes , Depressão/epidemiologia , Diabetes Mellitus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Escalas de Graduação Psiquiátrica , Análise de Regressão , Inquéritos e Questionários , Texas , Circunferência da CinturaRESUMO
ABSTRACT Objective: This study evaluated Jamaican community dwelling older adults' levels of anxiety and the predictors of such anxiety. Methods: For this cross-sectional study, participants aged 65 years and over were selected from urban lower-middle and working-class communities. Data collection tools were the geriatric anxiety scale (GAS) and a demographic questionnaire. Using the statistical package for the social sciences (SPSS), data were analysed using descriptive and inferential statistics. The GAS data was skewed, hence a log transformation was performed to obtain a normal distribution prior to analysis. Cronbach's alpha indicated a high level of internal consistency for the GAS in this group of participants. Results: One hundred and fourteen persons participated in the study. Results overall showed a low level of anxiety (GAS mean score = 9.2 ± 8.3). Persons who were female (p = 0.01), had primary level education only (p = 0.02), unemployed (p = 0.01), were lonely (p = 0.00) and had poor relationships with their adult children (p = 0.05) had higher mean GAS scores, indicating higher levels of anxiety. Predictor variables for anxiety were identified as, loneliness, gender and education. Together, these variables predicted 23% of the variability in GAS scores (R2 = 0.233, R = 0.48, p = 0.04). Conclusion: Anxiety levels are low in Jamaican older adults. Females with primary level education who are lonely are at greatest risk. Investigation of other factors such as religion is necessary, as the factors explored in this study, accounted for only 23% of the variance in GAS scores.
RESUMEN Objetivo: El presente estudio evaluó los niveles de ansiedad y los predictores de dicha ansiedad en los adultos mayores residentes en la comunidad urbana jamaicana. Métodos: Para este estudio transversal, se eligieron participantes de 65 años o más de comunidades urbanas de clase media baja y clase trabajadora. Los instrumentos de la recolección de datos fueron la Escala de Ansiedad Geriátrica (EAG) y un cuestionario demográfico. Utilizando el paquete estadístico para las ciencias sociales (SPSS), se analizó el conjunto de datos mediante estadísticas descriptivas e inferenciales. Los datos de EAG eran asimétricos. Por lo tanto, se realizó una transformación logarítmica con el propósito de obtener una distribución normal antes del análisis. El Alfa de Cronbach indicó un alto nivel de consistencia interna para EAG en este grupo de participantes. Resultados: Ciento catorce personas participaron en el estudio. Los resultados en general mostraron un bajo nivel de ansiedad (puntuación promedio de EAG = 9.2 ± 8.3). Las mujeres (p = 0.01), los que tenían sólo nivel de educación primaria (p = 0.02), los desempleados (p = 0.01), los que estaban solos (p = 0.00), y los que tenían malas relaciones con sus hijos adultos (p = 0.05), tuvieron puntuaciones promedio de EAG más altas, indicando niveles más altos de ansiedad. Se identificaron variables predictoras de ansiedad como la soledad, el género y la educación. En conjunto, estas variables predijeron el 23% de la variabilidad en las puntuaciones de EAG (R2 = 0.233, R = 0.48, p = 0.04). Conclusión: Los niveles de ansiedad son bajos en los adultos mayores jamaicanos. Las mujeres con nivel de educación primaria que están solas presentan un mayor riesgo. Se necesita la investigación de otros factores tales como la religión, ya que los factores explorados en este estudio representaron solamente el 23% de la variación en las puntuaciones de EAG.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Envelhecimento/psicologia , Ansiedade/psicologia , Fatores Socioeconômicos , Índice de Gravidade de Doença , Avaliação Geriátrica , Estudos Transversais , Fatores de Risco , JamaicaRESUMO
BACKGROUND: Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ). RESULTS: Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = -0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD. CONCLUSION: Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.
Assuntos
Envelhecimento/psicologia , Cognição , Disfunção Cognitiva/diagnóstico , Transtorno Depressivo Maior/psicologia , Memória de Curto Prazo , Idoso , Idoso de 80 Anos ou mais , Atenção , Brasil , Escalas de Graduação Psiquiátrica Breve , Estudos Transversais , Feminino , Humanos , Vida Independente , Modelos Logísticos , Masculino , Análise Multivariada , Índice de Gravidade de Doença , Percepção EspacialRESUMO
OBJECTIVE: Late-life depression is an under-diagnosed and under-treated disease that reduces the well-being of older adults. Executive dysfunction is another critical impairment in elderly depressed individuals which further disrupts their everyday functioning. This systematic review aims to analyze the association between executive function and depression severity in elderly individuals diagnosed with major depressive disorder. METHOD: The studies were retrieved from MEDLINE/PubMed, ISI Web of Knowledge and PsychInfo, after a search strategy combining the terms "depression", "executive function", "neuropsychological assessment", "elderly" and "late life". Study selection, data collection and quality ratings was performed by two independent raters. RESULTS: A total of 1,130 articles were found but only 8 studies met the defined eligibility criteria and evaluated the association between depression severity and executive functioning. Six out of 8 studies found an association between depression severity and executive function, with correlations ranging from small to large (r= -0.15 to -0.53). The included reports had several methodological limitations such as selective data reporting, non-comprehensive executive function assessment and not controlling potential biases. CONCLUSION: Depression severity may be more strongly correlated with a specific set of executive abilities although it also seems to be a broad-based association with executive functioning as a whole. Future high-quality prospective studies are recommended in order to understand the causal relationship between depression severity and executive functioning taking into account possible mediators such as age-related or neurodegenerative cognitive impairment, educational level and other clinic characteristics (e.g. age of onset, medication).
OBJETIVO: A depressão de início tardio é uma doença subdiagnosticada e subtratada que reduz o bem-estar da pessoa idosa. A disfunção executiva é outra alteração crítica em idosos deprimidos, perturbando ainda mais o seu funcionamento diário. Esta revisão sistemática tem como objetivo analisar a associação entre o funcionamento executivo e a severidade dos sintomas depressivos em idosos diagnosticados com transtorno depressivo major. MÉTODOS: Foi realizada uma busca nas bases de dados MEDLINE/PubMed, ISI Web of Knowledge e PsychInfo utilizando os termos "depression", "executive function", "neuropsychological assessment", "elderly" e "late life". A seleção, classificação dos estudos e coleta de dados foram realizadas por dois avaliadores independentes. RESULTADOS: Foram encontrados 1130 artigos, mas apenas 8 estudos preencheram os critérios de elegebilidade. Três avaliaram a associação entre a severidade dos sintomas e o funcionamento executivo. Seis dos 8 estudos encontraram uma associação entre a severidade dos sintomas e o funcionamento executivo, com correlações de diversas magnitudes (r= -0,15 a -0,53). Os artigos incluídos apresentaram várias limitações metodológicas, tais como descrição seletiva de dados, avaliação não compreensiva do funcionamento executivo e falha no controlo de possíveis vieses. CONCLUSÃO: A severidade dos sintomas depressivos pode ser fortemente correlacionada com um conjunto específico de habilidades executivas, embora pareça também existir uma associação mais ampla com o funcionamento executivo como um todo. Recomenda-se a realização de estudos prospetivos com o fim de compreender a relação causal entre a severidade dos sintomas depressivos e o funcionamento executivo, tendo em conta possíveis mediadores tais como défices cognitivos associados ao envelhecimento ou outros processos neuro-degenerativos, nível de escolaridade e outras características clínicas (idade de início da doença, medicação).
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Depressão , Transtorno Depressivo Maior , Envelhecimento Cognitivo/fisiologiaRESUMO
Older Colombians face significant adversities: poverty, violence and displacement. However, there is evidence that Latinos are often resilient. We examine resilience in older Colombians living in poverty using an ecological framework that identifies three levels: individual; community; and societal. In this paper we examine data from 16 semi-structured interviews with older Colombians that explore resilience within the context of poverty. We analyze our data using three stages: (1) modified grounded theory; (2) assignment of resilience status; (3) identification of components of the ecological framework which contribute to resilience in these participants. The most striking feature is that some participants are able to adapt to their situation, demonstrating resilience, whilst others are not. Individual characteristics such as psychological and material resources contribute to resilience. At the community level, family, social support, participation and cohesion promote resilience. Finally, at the societal level, social and welfare services, finance, religion and social policy, are important factors. These different levels of resilience are co-dependent, and we illustrate how this is so. We suggest that older Colombians living in poverty often demonstrate resilience, but that more can be done to enhance their lives. This includes interventions at the individual and community levels alongside changes in social policy.
Assuntos
Adaptação Psicológica , Hispânico ou Latino/psicologia , Pobreza/psicologia , Características de Residência , Resiliência Psicológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Religião , Apoio Social , Seguridade Social , Violência/psicologiaRESUMO
OBJECTIVE: To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression." METHODS: A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change. RESULTS: At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy. CONCLUSION: A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.
Assuntos
Ansiedade/prevenção & controle , Terapia Cognitivo-Comportamental/métodos , Depressão/prevenção & controle , Osteoartrite do Joelho/psicologia , Dor/psicologia , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Satisfação do Paciente , Modelos de Riscos Proporcionais , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Estresse PsicológicoRESUMO
This study aimed to evaluate differences in plasma and cerebrospinal fluid (CSF) levels of Aß peptides in older adults with late-life depression compared to non-depressed older controls. We conducted a systematic review and meta-analysis of the literature using PubMed, Web of science and Scopus databases with no search limits for publication dates or languages. Two independent reviewers extracted data and assessed quality. Six hundred references were retrieved, and we included 12 studies in the meta-analysis after eligibility screening. Older adults with late-life depression (LLD) had a higher plasma Aß40:Aß42 ratio compared to non-depressed participants (SMD = 1.10, CI95% [0.28; 1.96], p = 0.01), and marginally significant reduction of CSF Aß42 levels (SMD = -1.12, CI95% [-2.47; 0.22], p = 0.1). The present results evidence that older adults with depression have significant differences in Aß metabolism, in the same direction observed in individuals with AD. These differences in the Aß metabolism may help identify a subgroup of subjects with LLD at higher risk of developing AD.