Depression and Anxiety in Dementia Subjects

(Reprinted with permission from American Psychiatric Association, http://psychiatryonline.org/guidelines).

Depressive Symptoms and Mild Cognitive Impairment in the Elderly: An Ominous Combination

Systemic immunological disorders are associated with various geriatric conditions, including cognitive dysfunction. However, in patients with diabetic retinopathy, the changes of blood interleukin profile were studied without considering the severity of cognitive impairment. The aim of this study was to analyze blood plasma levels and intercorrelations of interleukins in the patients with diabetic retinopathy accompanied by mild and moderate cognitive impairment. Fifty-four elderly patients with diabetic retinopathy and mild cognitive impairment, and 62 patients with diabetic retinopathy and moderate cognitive disorders underwent inpatient examination and treatment at the Tambov branch of the S. Fedorov Center of Eye Microsurgery over 2021-2022. The interleukins contents in blood plasma were studied by enzyme immunoassay using the Protein Contour kit, including IL-1α, IL-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-17, IL-18. The diagnostics of diabetic retinopathy was based on comprehensive ophthalmological examination, according to the Clinical recommendations of the Society of the Russian Association of Ophthalmologists «Diabetes mellitus: diabetic retinopathy, diabetic macular edema». Cognitive functions were assessed according to a valid Mini- Mental-State-Examination scale. It has been shown that the patients with diabetic retinopathy and moderate cognitive impairment have a significantly increased level of all the studied proinflammatory interleukins, as compared to similar cohort with diabetic retinopathy accompanied by a mild cognitive impairment. In mild cognitive disorders, the content of IL-6 in blood plasma was higher (24.4±2.1 pg/mL versus 5.1±0.8 pg/mL, p < 0.001). Development of moderate cognitive impairment in the patients with diabetic retinopathy was also accompanied by a statistically significant increase of plasma IL-8 to 36.7±3.5 pg/mL versus 10.5±2.3 pg/mL with mild cognitive impairment; IL-17, to 21.9±1.8 pg/mL versus 8.5±1.1 pg/mL, respectively. Concentrations of anti-inflammatory interleukins in blood plasma of the patients with diabetic retinopathy and moderate cognitive dysfunction were significantly decreased, i.e., IL-4 to 2.1±0.3 pg/mL versus 3.4±0.5 pg/mL in cases of mild mental deterioration; IL-10, to 8.7±0.5 pg/mL versus 15.4±1.3 pg/mL, respectively. A sufficient correlation was shown between the levels of systemic interleukins and moderate cognitive disorders in the patients with diabetic retinopathy. For the proinflammatory interleukins in cases of moderate cognitive impairment, an inverse correlations with IL-1β (r = -0.336; p = 0.021), IL-6 (r = -0.584; p = 0.019), IL-8 (r = -0.469; p = 0.006), and with IL-17 (r = -0.348; p = 0.018) were shown. The content of IL-4 and IL-10 in blood plasma of the patients with diabetic retinopathy correlated with moderate cognitive impairment at a significant level of r = +0,407 (p = 0.016) and r = +0.359 (p = 0.008), respectively. In mild cognitive impairment, the correlations with fewer numbers of interleukins were revealed, i.e., IL-1β, IL-6, IL-8 and IL-10, and exhibit weaker connections, except of IL-6 (a moderate connection level). Development of moderate cognitive impairment among the patients with diabetic retinopathy may be caused by increase in IL-1β, IL-6, IL-8, IL-17, and a decrease in IL-10.

ObjectiveCognitive stimulation (CS) is a non-pharmacological intervention aimed at enhancing cognitive function. However, the effectiveness of CS in individuals diagnosed with mild cognitive impairment (MCI) remains inconclusive. Therefore, this study aimed to assess the effectiveness of CS in improving cognitive function, psychological well-being, instrumental activities of daily living (IADL) and quality of life (QoL) in individuals with MCI, based on randomised controlled trials (RCTs).DesignSystematic review and meta-analysis.Data sourcesSix English databases were systematically searched, including PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, American Psychological Association PsycInfo and Academic Search Premier.Eligibility criteriaRCTs about CS for individuals with MCI, published between January 2003 and December 2024.Data extraction and synthesisData were extracted and assessed using the revised Cochrane risk of bias tool for randomised trials by independent researchers. The meta-analysis was conducted using the standardised mean difference (SMD) and 95% CIs of the included studies.ResultsThe meta-analysis included five eligible studies for the primary outcomes of cognitive function and three eligible studies for the secondary outcomes of psychological wellness. In the pooled samples, the CS intervention had a significant effect on cognitive function (SMD=0.63, 95% CI 0.25 to 1.01; p=0.001) and depression symptoms (SMD=−0.29, 95% CI −0.55 to −0.03; p=0.03) in individuals with MCI. However, no significant improvements in anxiety symptoms were identified after the CS intervention (SMD=−0.05; 95% CI −0.31 to 0.21; p=0.71).ConclusionThe CS intervention can effectively improve cognitive function and alleviate depression symptoms. Although a meta-analysis was not conducted for IADL and QoL due to the limited number of included studies, positive trends in enhancing IADL performance and augmenting QoL were observed in individuals with MCI. However, due to the scarcity of relevant studies in this research field, more comprehensive RCTs are warranted to provide a better understanding of the potential benefits of CS and to guide its clinical application in the future.PROSPERO registration numberCRD42023494685.

Mild Cognitive Impairment: A Tricky but Relevant Diagnosis

Few randomized controlled trials (RCTs) investigated the effects of mindfulness intervention on affective and cognitive symptoms in older adults with mild cognitive impairment (MCI). Furthermore, no RCTs on mindfulness followed participants beyond two years. To examine the longitudinal effects of a mindful awareness practice (MAP) intervention on depressive, anxiety, and cognitive symptoms in MCI. In this parallel-arm and assessor-blinded RCT, 55 community-dwelling older adults with MCI were randomized into the MAP or active control, i.e., health education program (HEP). Intervention sessions were conducted weekly for three months and monthly for the subsequent six months. Assessments and follow-up were conducted at baseline, 3-month, 9-month, and 5-year time points. Depressive, anxiety, and cognitive symptoms were measured using the Geriatric Depression Scale-15 (GDS-15), Geriatric Anxiety Inventory-20 (GAI-20), and Mini-Mental State Examination (MMSE), respectively. Linear-mixed models, following the intention-to-treat principle, were used for data analyses. A total of 55 participants aged 60 to 86 (Mean age: 71.3±6 years old) was recruited, with n = 28 allocated to the MAP arm and n = 27 allocated to the HEP arm. Compared to HEP, GDS-15, GAI-20, and MMSE scores did not differ significantly in MAP during follow-ups. Compared to HEP, MAP did not improve affective symptoms nor delay deteriorations in general cognition in community-dwelling older adults with MCI. Compared to our previous findings showing domain-specific improvements in MAP over HEP in attention and memory up to 9 months, this study highlights the importance of examining domain-specificity using detailed cognitive measures in non-pharmacological intervention with MCI.

Objective and objectives: Patients with cognitive disorders such as Alzheimer's disease (AD) and mild cognitive impairment (MCI) frequently exhibit depressive symptoms. Depressive symptoms can be evaluated with various measures and questionnaires. The geriatric depression scale (GDS) is a scale that can be used to measure symptoms in geriatric age. Many questionnaires sum up symptom scales. However, core symptoms of depression in these patients and connections between these symptoms have not been fully explored yet. Thus, the objectives of this study were (1) to determine core symptoms of two cognitive disorders, Alzheimer's disease and mild cognitive impairment, and (2) to investigate the network structure of depressive symptomatology in individuals with cognitive impairment in comparison with those with Alzheimer's disease. Materials and Methods: This study encompassed 5354 patients with cognitive impairments such as Alzheimer's disease (n 1889) and mild cognitive impairment (n = 3464). The geriatric depression scale, a self-administered questionnaire, was employed to assess depressive symptomatology. Using exploratory graph analysis (EGA), a network analysis was conducted, and the network structure was evaluated through regularized partial correlation models. To determine the centrality of depressive symptoms within each cohort, network parameters such as strength, betweenness, and closeness were examined. Additionally, to explore differences in the network structure between Alzheimer's disease and mild cognitive impairment groups, a network comparison test was performed. Results: In the analysis of centrality indices, "worthlessness" was identified as the most central symptom in the geriatric depression scale among patients with Alzheimer's disease, whereas "emptiness" was found to be the most central symptom in patients with mild cognitive impairment. Despite these differences in central symptoms, the comparative analysis showed no statistical difference in the overall network structure between Alzheimer's disease and mild cognitive impairment groups. Conclusions: Findings of this study could contribute to a better understanding of the manifestation of depressive symptoms in patients with cognitive impairment. These results are expected to aid in identifying and prioritizing core symptoms in these patients. Further research should be conducted to explore potential interventions tailored to these core symptoms in patients with Alzheimer's disease and mild cognitive impairment. Establishing core symptoms in those groups might have clinical importance in that appropriate treatment for neuropsychiatric symptoms in patients with cognitive impairment could help preclude progression to further impairment.

Background: The prevalence of chronic heart failure (CHF) within in the Western World remains high and is rapidly increasing in developing nations. The clinical trajectory of CHF is often characterised by chronic symptoms with periods of acute decompensation requiring hospitalisations for treatment. Yet almost half of these readmissions are potentially preventable through better adherence with self-care practices. For patients with CHF, self-care involves a level of confidence to adhere to behaviours that maintain physiological stability as well as recognising and making pertinent decisions in response to symptom changes. These self-care skills are not readily learnt and there are many barriers that account for this. Cognitive impairment occurs frequently in adults with CHF and is hypothesised to be a barrier in the acquisition of self-care skills. Aims: The research program is a series of systematically designed studies the specific aims were to: Review the literature surrounding the management of heart failure and teaching patients self-care behaviours; Identify clinical tools that measure heart failure self-care; Identify factors that appear to hinder the practice of self-care; Develop (Phase 1) and test (Phase 2) a conceptual model of factors that predict CHF self-care; compare the Mini Mental State Exam (MMSE) with the Montreal Cognitive Assessment (MoCA) in screening for Mild Cognitive Impairment (MCI); Examine the influence experience with heart failure symptoms has on self-care behaviours. Methods: The program consisted of comprehensive reviews of the literature, identification of clinical tools to measure self-care and cognitive function and two studies using descriptive survey methodology to develop (Phase 1) and test (Phase 2) a conceptual model of variables deemed to predict self-care.;Patients were recruited for the studies during their index hospital admission patients with CHF were assessed for self-care (Self-Care of Heart Failure Index) and screened for MCI and depressive symptoms (scores Scale). In Phase 1, patients were coded as MCI by scores 2, patients were coded as MCI by scores /or scores (MoCA). Adequate self-care was indicated by scores >70 on self-care domains: maintenance, management and confidence of the SCHFI. These factors along with demographic and clinical characteristics (age, gender, social isolation, education level, new diagnosis and co-morbid illnesses) were tested in multiple regression models for self-care. Results: In Phase 1 (n=50), seven variables (cognitive function, depressive symptoms, age, gender, social isolation, self-care confidence and co-morbid illnesses) explained 39% (F (7, 42) 3.80, p=0.003) of the variance in self-care maintenance and 38% (F (7,42) 3.73 p=0.003) of the variance in self-care management. Two variables were significant in predicting self-care maintenance: Age (p2 months. Conclusion: This systematically designed research program enhances the knowledge of heart failure self-care and provides a unique contribution in understanding the relationship between this phenomena and cognitive function. Cognitive impairment is a hidden co-morbidity in patients with CHF and to reflect this, the research program has henceforth been named the 'The InCOGNITO Heart Failure Study'. This co-morbidity impacts negatively upon self-care actions and decisions, potentially increasing the risk of hospital readmissions or even premature death. Such evidence suggests that CHF patients with MCI require ongoing support in developing self-care skills and behaviours directed at reducing CHF symptoms and improving their health and quality of life.;The research program provides further insight into the patient's experience of coping and adjusting to living with CHF. A number of other factors also help to predict self-care behaviours including the presence of symptoms causing functional limitations (NYHA class III or IV), higher co-morbidity, younger age and absence of depressive symptoms. These factors are a reflection of the complex nature of this syndrome and highlight the need for an integrated multidisciplinary health team in the long-term management of CHF. In order to clearly identify and articulate effective support and educational strategies directed at patients with CHF, ongoing research is required to further explore factors that hinder the application of teaching and counselling strategies and develop programs of care to specifically address these barriers.

Depression is a modifiable predictor of dementia, but its underlying relationships with cognition is unclear. Most research studied their relationships in spontaneous contexts, lacking insight into their interactions during interventions. This research examined the longitudinal relationships between depressive symptoms (DS) and cognitive function (CF) across psychosocial intervention in older adults with intact cognition and mild cognitive impairment (MCI). Data were from JC JoyAge, a community stepped-care program for late-life mental health. Participants (≥ 60 years) with mild to moderate DS (n = 4448) completed assessments of DS (PHQ-9) and CF (MoCA 5-min) before and after the program. Bivariate latent change score models were computed to examine the interactions between DS and CF by modeling changes as latent variables and testing individual-level relationships, with multigroup modeling for comparisons. Participants experienced improvements in DS and CF. For both participants with intact cognition and MCI, higher baseline CF predicted greater reduction in DS (est = -0.04, se = 0.01, z = -3.83, p < .001), lower baseline DS predicted greater improvement in CF (est = -0.04, se = 0.01, z = -3.76, p < .001). Greater reduction in DS was associated with greater improvement in CF (est = -0.51, se = 0.11, z = -4.65, p < .001). The findings evidenced the bidirectional relationships between depressive symptoms and cognitive function, and showed their hand-in-hand improvements during psychosocial intervention. Results suggested the benefits of treating depressive symptoms for both mental health and cognitive function, no matter at the stages of intact cognition or MCI.

This prospectively designed longitudinal study assesses prevalence, incidence and prognosis of depressive symptoms among cognitively normal elderly volunteers compared with patients with mild cognitive impairment (MCI), dementia of Alzheimer type (DAT), and vascular dementia (VAD). Possible relationships between depressive symptoms, cognitive performance, disease types, and effects of antidepressant treatment were analyzed. Two hundred and ninety four subjects exhibiting different levels of cognitive performance were admitted to this study. Demographics, cardiovascular and neurodegenerative risk factors, together with measures of neuropsychological test performance, were obtained at sequential visits. Depressive symptoms were selectively treated with antidepressant medications. One hundred and forty six subjects with normal cognition, 19 subjects with MCI, 42 patients with DAT, and 32 patients with VAD were followed for a mean of 3.5 years. With the passage of time, there were trends showing prevalence of depressive symptoms to decrease among DAT and to increase among VAD patients. VAD patients exhibited the highest incidences of new-onset depressive symptoms, followed in incidence by DAT and MCI groups. Depressive symptoms among VAD and MCI patients were more persistent and refractory to antidepressant medications than for DAT patients. Trends suggested that antidepressant treatment might benefit MCI and VAD subjects more than DAT patients. Motivationally related depressive symptoms accounted for major components of elevated Hamilton depression rating scale scores. Depressive symptoms among DAT patients have higher rates of spontaneous resolution, without requiring intensive drug treatment, than among VAD patients in whom depressive symptoms are more persistent and refractory to drug treatment. Early depressive symptoms among subjects with MCI may represent a preclinical sign and should be considered as a risk factor for impending DAT or VAD among the elderly.

BackgroundDepression and anxiety are two frequent neuropsychiatric symptoms in Alzheimer’s disease (AD). Moreover, depressive symptoms and anxiety are frequently associated with greater amyloid deposition and risk of Alzheimer’s dementia. The aim of the present study is to assess the association between anxiety and depression and amyloid burden.MethodIn the AMPYAD study, participants with subjective cognitive decline (SCD+, n = 244), mild cognitive impairment (MCI, n = 341) and dementia (n = 255) were enrolled in eight European memory clinics between 2018 and 2020. They underwent three study visits (baseline, six months, thirteen months) with collection of cognitive data and symptoms of depression and anxiety (Hospital Anxiety and Depression Scale, HADS) as well as measures of quality of life and coping strategies. Amyloid burden was obtained as the standardized centiloid values (CL). Correlation analyses were carried out for HADS‐Scores and CL. We analyzed the progression of depressive and anxiety symptoms over time between patients with and without presence of amyloid (CL≥21) using mixed‐model‐ANOVA. All analyses were corrected for time of PET result disclosure.ResultA total of 840 patients (46.2% female; mean age of 70.9 (SD = 7.8)) were included. Among SCD+ patients, CL values were positively correlated with baseline anxiety scores (r(216) = .14, p = .038). In contrast, MCI and dementia patients showed a negative correlation between CL and depressive symptoms (r(296) = ‐.16, p = .005; r(209) = ‐.23, p<.001). In SCD+, there was no significant interaction between time and CL status for anxiety (p = .512), but a significant main effect of time (F(2,302) = 3.4, p = .036, η² = .02), indicating a decline in anxiety symptoms over time. A trend indicated higher anxiety for amyloid positive participants, but the effect missed statistical significance (p = .068). For depressive symptoms, we found no main effects and no significant interaction of time and CL status.ConclusionThe AMYPAD study contains a large amyloid‐PET data set of patients from eight European memory clinics. We observed an association of increased anxiety scores with amyloid load in SCD+, but reduced symptoms of depression with higher amyloid load in the MCI and dementia group. These findings and their longitudinal development over time will be put into a broader context of patient characteristics.

Depression and mild cognitive impairment (MCI) are often comorbid mental health issues in older adults. The current study explored the prospective mediating role of loneliness in the relationship between depression and the quality of life in elderly with MCI. A second aim was to examine differences in depression, loneliness, and the quality of life in the elderly with MCI among gender groups, and type of residence groups. A cross-sectional survey with purposive sampling was used. Older adults with MCI (N=170) from old age homes in Lahore and Rawalpindi (n=82) and family residences in Sargodha (n=88) in Pakistan completed UCLA Loneliness Scale, Depression Anxiety Stress Scale, and Mild Cognitive Impairment Scale. Most of the participants had severe to extreme depression (98.2%), and moderate to moderately high levels of loneliness (85.3%). Depression was significantly associated with loneliness (b=0.29, P < 0.05) and poor quality of life in MCI (b=0.49, P < 0.001). The indirect effect of depression on the quality of life in MCI through loneliness was significant (95% confidence interval (CI) [0.002, 0.156]). However, the indirect effect of quality of life in MCI on depression through loneliness was not significant (95% CI [-0.001, 0.043]). The elderly with MCI living in old age homes had higher depression, loneliness, and poor quality of life. Elderly women had higher levels of depression and poor quality of life, whereas older men were lonelier. The relationship between depression and quality of life in the elderly with MCI may be bidirectional, and loneliness partially mediates only one of these relationships.

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