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Objectives: To explore the strength of the association between cognitive functioning and depression and anxiety in older people without dementia. Methods: An exploratory, cross‐sectional analysis of Wave 1 (2004–2007) data from the Lothian Birth Cohort 1936 dataset. Three subgroups were based on Hospital Anxiety and Depression Scale (HADS) subscales: no probable anxiety or depression (N = 592), probable anxiety no depression (N = 122), probable depression with/without anxiety (depression) (N = 30). Regression analyses determined relationships between subgroups and identified cognitive test variables. Results: Participants were 744 individuals (male = 385 [51.5%]; mean [M] age = 69.5 years [Standard deviation = 0.83]); characteristics for subgroups were similar. Participants with probable depression had slower simple reaction time scores than those with no anxiety or depression (regression slope [β] on the log10 scale = 0.05, 95% Confidence Interval [0.03, 0.08], p ≤ 0.001). Those with probable anxiety had significantly worse scores on other tests: Spatial span (β = −0.80 [−1.36, −0.25], p ≤ 0.005), Symbol Search (β = −1.67 [−2.90, −0.45], p ≤ 0.01), Matrix Reasoning (β = −1.58 [−2.55, −0.60], p ≤ 0.005) and Block Design (β = −3.33 [−5.29, −1.37], p ≤ 0.001), than those without probable anxiety or depression. Conclusion: Probable depression and anxiety were found to be associated with lower cognitive function in those without evidence of dementia. People with probable anxiety showed poorer performance in tests that concerned making decisions. People with probable depression showed slower processing speed. [ABSTRACT FROM AUTHOR]

Objectives: Problem adaptation therapy (PATH) is a relatively new psychotherapy that recognises the importance of simultaneously targeting cognitive impairment and functional disability in the treatment of late‐life depression. This is the first systematic review to examine the effectiveness of PATH. Methods: Ageline, Embase, Medline, PsycINFO, Scopus and ProQuest databases were searched from 2010 until 5 April 2024, for studies that evaluated PATH for older people. Where possible, effect sizes (Hedges' g) with 95% confidence intervals and p values were calculated and pooled using a random effects model. The reporting quality of included studies was assessed using Joanna Briggs Institute Critical Appraisal tools and certainty of the evidence behind each result assessed with The Grading of Recommendations Assessment, Development and Evaluation method. Results: Twelve papers, from seven independent studies and a pooled sample of 579 older adults with multiple comorbidities, were included in this review. PATH participants experienced immediate reductions in depression symptom ratings (gw = 0.72, p < 0.01, Nstudies = 5), alongside small improvements in disability (gw = 0.61, p = 0.04, Nstudies = 4) compared to peers that received supportive therapy, brief psychoeducation, or usual care. The overall evidence quality was, however, characterised by bias, inconsistency, and imprecision in effect estimates. Positive participant feedback and low dropout rates (15%–31%) suggested treatment satisfaction, although these data were not routinely provided. Conclusions: PATH may be a viable treatment for older people living with mental and cognitive disorders, however there is a need for more rigorous research incorporating follow‐up assessments to consolidate the effectiveness of PATH relative to other treatments. Incorporating measures of treatment fidelity are also critical to interpreting and generalising these data. The protocol for this study was prospectively published on the Open Science Framework (https://osf.io/gx57a). [ABSTRACT FROM AUTHOR]

Background: The association between depression and dementia is still unclear, particularly regarding depression as a potential risk factor preceding dementia. Therefore, we aimed to verify if the presence of depression at baseline may increase the risk of dementia and cognitive impairment during 15 years of follow‐up in the SHARE (Survey of Health, Aging and Retirement in Europe) study. Methods: Depressive symptoms were defined using the EURO‐D, with a score ≥4 indicative of depression. Incident dementia was ascertained using self‐reported data and caregivers' information, cognitive impairment using objective cognitive tests. Cox regression analysis, adjusted for 10 baseline confounders, was run and hazard ratios (HRs), with their 95% confidence intervals, were estimated. Results: In total 22,789 participants were included in the present analysis (mean age 64.2 years) and were predominantly female. The prevalence of depression at baseline was 24.9%. Over 15 years of follow‐up, the onset of dementia occurred a median 2 years earlier in people with depression compared to those without. Depression at the baseline significantly increased the risk of dementia in the overall sample (HR = 1.74; 95% CI: 1.54–1.95) and the risk of cognitive impairment (HR = 1.15; 95% CI: 1.06–1.25). For dementia, the association was stronger in people less than 60 years (HR = 2.07; 95% CI: 1.42–3.02) than in participants aged ≥80 years (HR = 1.47; 95% CI: 1.14–1.91). A similar trend was observed for cognitive impairment. Among the single items of the EURO‐D, loss of concentration was the strongest individual variable predicting the onset of dementia. Conclusions: Depression increased the risk of dementia and cognitive impairment, particularly in younger adults, whereas loss of concentration was the strongest individual predicting variable of dementia. These findings demonstrate the need for early detection of depression for preventing future cognitive worsening. Key points: Depression is a common condition. Its role as a potential risk factor for dementia has been explored in several studies, but these have limitations, for example, differences in study population, insufficient numbers of younger patients, limited follow‐up duration, and differences in the assessment of depression and dementia.Our study, carried out using data from the SHARE project, showed that the presence of depression at baseline increased the risk of dementia by 74% and of cognitive impairment of 15%. The effect was stronger when considering young‐age depression. Among the single items of the questionnaire proposed for assessing depression, loss of concentration showed the strongest association.Our study indicates that depression may be associated with dementia and cognitive impairment in later life. Therefore, in the early recognition of depression we should remember that cognitive aspects are of critical importance for better individualizing pharmacological and non‐pharmacological approaches. [ABSTRACT FROM AUTHOR]

Objectives: Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity. Methods: We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self‐reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness. Results: The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: −0.025 (−0.048, −0.011), via loneliness (−0.011 [95% CI: −0.028, −0.002]), and via psychological distress (−0.017 [95% CI: −0.042, −0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone. Conclusions: The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity. Key points: We evaluated whether psychosocial factors mediate the association between visual impairment and cognitive decline.With data from the Memory and Aging Project and the Minority Aging Research Study, we used structural equation models to estimate the total, direct, and indirect associations through each mediator (depressive symptoms, loneliness, lower social activity, and a latent variable, psychological distress, combining depressive symptoms and loneliness).We found evidence for partial mediation via social activity and loneliness. [ABSTRACT FROM AUTHOR]

Background: Apathy and depression are common neuropsychiatric symptoms across neurodegenerative disorders and are associated with impairment in several cognitive domains, yet little is known about the influence of sex on these relationships. Objectives: We examined the relationship between these symptoms with neuropsychological performance across a combined cohort with mild or major neurodegenerative disorders, then evaluated the impact of sex. Design, Setting and Participants: We conducted a cohort analysis of participants in the COMPASS‐ND study with mild cognitive impairment (MCI), vascular MCI, Alzheimer's disease, mixed dementia, Parkinson's disease, frontotemporal dementia, and cognitively unimpaired (CU) controls. Measurements: Participants with neurodegenerative disease and CU controls were stratified by the presence (severity ≥1 on Neuropsychiatric Inventory Questionnaire) of either depressive symptoms alone, apathy symptoms alone, both symptoms, or neither. A neuropsychological battery evaluated executive function, verbal fluency, verbal learning, working memory, and visuospatial reasoning. Analysis of covariance was used to assess group differences with age, sex, and education as covariates. Results: Groups included depressive symptoms only (n = 70), apathy symptoms only (n = 52), both (n = 68), or neither (n = 262). The apathy and depression + apathy groups performed worse than the neither group on tests of working memory (t(312) = −2.4, p = 0.02 and t(328) = −3.8, p = 0.001, respectively) and visuospatial reasoning (t(301) = −2.3, p = 0.02 and t(321) = −2.6, p = 0.01, respectively). The depression, apathy, and depression + apathy groups demonstrated a similar degree of impairment on tests of executive function, processing speed, verbal fluency, and verbal learning when compared to participants without apathy or depression. Sex‐stratified analyses revealed that compared to the male neither group, the male apathy and depression + apathy groups were impaired broadly across all cognitive domains except for working memory. Females with depression alone showed deficits on tests of executive function (t(166) = 2.4, p = 0.01) and verbal learning (t(167) = −4.3, p = 0.001) compared to the female neither group. Conclusions: This study demonstrated that in neurodegenerative diseases, apathy with or without depression in males was associated with broad cognitive impairments. In females, depression was associated with deficits in executive function and verbal learning. These findings highlight the importance of effectively treating apathy and depression across the spectrum of neurodegenerative disorders with the goal of optimizing neuropsychological outcomes. Key points: Apathy and depression are common symptoms that patients with dementia face during the course of illness, and these symptoms are associated with impairments in several cognitive domains.We examined differences in cognitive performance between patients with either apathy alone, depression alone, both, or neither across a combined cohort with mild or major neurodegenerative disorders. Further, we evaluated this relationship within each sex.Among males, apathy with or without depression was associated with broad cognitive deficits. In females, depression was associated with deficits in executive function and verbal learning.These findings highlight the importance of effectively treating apathy and depression across the spectrum of neurodegenerative disorders with the goal of optimizing neuropsychological outcomes. [ABSTRACT FROM AUTHOR]

Background: Geriatric depression and anxiety have been identified as mood disorders commonly associated with the onset of dementia. Currently, the diagnosis of geriatric depression and anxiety relies on self‐reported assessments for primary screening purposes, which is uncomfortable for older adults and can be prone to misreporting. When a more precise diagnosis is needed, additional methods such as in‐depth interviews or functional magnetic resonance imaging are used. However, these methods can not only be time‐consuming and costly but also require systematic and cost‐effective approaches. Objective: The main objective of this study was to investigate the feasibility of training an end‐to‐end deep learning (DL) model by directly inputting time‐series activity tracking and sleep data obtained from consumer‐grade wrist‐worn activity trackers to identify comorbid depression and anxiety. Methods: To enhance accuracy, the input of the DL model consisted of step counts and sleep stages as time series data, along with minimal depression and anxiety assessment scores as non‐time‐series data. The basic structure of the DL model was designed to process mixed‐input data and perform multi‐label‐based classification for depression and anxiety. Various DL models, including the convolutional neural network (CNN) and long short‐term memory (LSTM), were applied to process the time‐series data, and model selection was conducted by comparing the performances of the hyperparameters. Results: This study achieved significant results in the multi‐label classification of depression and anxiety, with a Hamming loss score of 0.0946 in the Residual Network (ResNet), by applying a mixed‐input DL model based on activity tracking data. The comparison of hyper‐parameter performance and the development of various DL models, such as CNN, LSTM, and ResNet contributed to the optimization of time series data processing and achievement of meaningful results. Conclusions: This study can be considered as the first to develop a mixed‐input DL model based on activity tracking data for the multi‐label identification of late‐life depression and anxiety. The findings of the study demonstrate the feasibility and potential of using consumer‐grade wrist‐worn activity trackers in conjunction with DL models to improve the identification of comorbid mental health conditions in older adults. The study also established a multi‐label classification framework for identifying the complex symptoms of depression and anxiety. Key points: Deep learning (DL) models, notably ResNet, significantly enhance depression and anxiety classification using activity tracking data, outperforming traditional models in accuracy.Mixed‐input models that combine activity tracking with minimal assessment data demonstrate superior performance, underscoring the advantages of integrating diverse data types for mental health diagnosis.This study confirms the practicality of employing consumer‐grade wearable devices for the multi‐label classification of geriatric mood disorders, presenting an affordable and effective tool for healthcare [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 pandemic and accompanying public health measures exacerbated many known risk factors for depression, while also increasing numerous health‐related stressors for people with stroke history. Using a large longitudinal sample of older adults, the current study examined the prevalence of incident and recurrent depression among participants with stroke history, and also identified factors that were associated with depression during the pandemic among this population. Methods: Data came from four waves of the Canadian Longitudinal Study on Aging's (CLSA) comprehensive cohort (n = 577 with stroke history; 46.1% female; 20.8% immigrants; mean age = 74.56 SD = 9.19). The outcome of interest was a positive screen for depression, based on the CES‐D‐10, collected during the 2020 CLSA COVID autumn questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors that were associated with depression. Results: Approximately 1 in 2 (49.5%) participants with stroke history and a history of depression experienced a recurrence of depression early in the pandemic. Among those without a history of depression, approximately 1 in 7 (15.0%) developed depression for the first time during this period. The risk of depression was higher among immigrants, those who were lonely, those with functional limitations, and those who experienced COVID‐19 related stressors, such as increased family issues, difficulty accessing healthcare, and becoming ill or having a loved one become ill or die during the pandemic. Conclusions: Interventions that target those with stroke history, both with and without a history of depression, are needed to buffer against the stressors of the COVID‐19 pandemic and support the mental health of this population. Key points: One in seven older adults with a history of stroke experienced depression for the first time in their life during the COVID‐19 pandemic.One in two older adults with a history of stroke and depression experienced a recurrence or persistence of depression during the pandemic.Key factors that were associated with depression during the pandemic included feeling lonely at the beginning of the pandemic, being an immigrant, and experiencing functional limitations.COVID‐19 related stressors that were associated with depression included difficulty accessing healthcare, becoming ill or having a loved one become ill or die, and increased family stress, such as separation from family or increased time spent caregiving. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive impairment and change are a focus of research into late‐life depression. The aims of this 5‐year prospective study were (1) to observe cognitive status change; (2) to investigate the rate and risk ratio of dementia or cognitive decline; and (3) to examine the cognitive domain predictors for conversion to dementia within 5 years among a clinical cohort with remitted major depressive disorder (MDD). Methods: The study cohort included 130 elderly persons with late‐life remitted MDD and 100 normal controls. Comprehensive neuropsychological tests were conducted to determine cognitive domain status. Diagnoses of mild cognitive impairment (MCI) and dementia were made at baseline and at a follow‐up visit at the 5‐year point. In total, 98 cases and 55 normal controls completed the 5‐year follow‐up assessment. Results: Of the study cohort with late‐life remitted MDD, 28.6% had MCI and 25.5% developed dementia within 5 years. Patients with late‐life remitted MDD had an approximate 3 times higher risk of subsequent cognitive decline as compared with the normal controls. Information‐processing speed (p = 0.009) and memory (p = 0.041) could predict subsequent progression to dementia within 5 years among patients with MDD. Conclusions: This study demonstrated that compared with the general elderly population, elderly patients with depression have more significant impairment in cognitive function after 5 years. Further, we found that in depressed patients, deficits in information‐processing speed and memory domains were highly suggestive of progression to dementia within 5 years. Key points: Elderly patients with depression had higher risk of subsequent cognitive decline.In elder patients with remitted major depressive disorder (MDD), deficits in information‐processing speed and memory domains were highly suggestive of progression to dementia within 5 years. [ABSTRACT FROM AUTHOR]

Objectives: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. Methods/Design: Data from "Survey on quality of life and subjective well‐being of the very old in North Rhine‐Westphalia (NRW80+)" were used. This study includes community‐dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine‐Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex‐stratified regressions were also conducted. Results: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. Conclusions: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group. Key points: Using longitudinal, representative data of the North Rhine‐Westphalia (NRW80+), the objective of this study was to investigate the determinants of psychosocial outcomes among the oldest oldEstablished tools were used to quantify the key variables. Gender‐stratified regressions were also conductedPoorer psychosocial outcomes: linked to spousal loss and functional impairment in particularEfforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes [ABSTRACT FROM AUTHOR]

Objectives: The likelihood of depression symptoms in those with type 2 diabetes (T2D) is high. Psychological risk factors enhancing comorbidity of depression symptoms in T2D are yet to be determined. The present study examines the cross‐sectional and longitudinal relationship between personality traits and distinct depression dimensions in older adults with T2D. Methods: Participants were older adults (age ≥65yeas) with T2D from the Israel Diabetes and Cognitive Decline (IDCD) study (N = 356), with complete data on depression [Geriatric Depression Scale (GDS) ‐ 15 item version] and its dimensions‐ namely, dysphoric mood, apathy, hopelessness, memory complains and anxiety, and on personality [Big Five Inventory (BFI)]. Logistic and mixed linear regression models examined cross‐sectional and longitudinal associations while adjusting for socio‐demographics, cognition, cardiovascular and diabetes‐related factors. Results: Cross‐sectionally, high neuroticism was associated with high scores in total GDS and in all depression‐dimensions, except memory complaints. Higher extroversion was associated with lower total GDS and with lower scores on all depression dimensions, except anxiety. High levels of neuroticism were associated with increase in total number of depression symptoms over time. Conclusions: In older adults with T2D, neuroticism and extroversion are associated with most depression dimensions suggesting that these traits relate to a global depression symptomatology rather than to any specific dimension or phenomenology. High neuroticism was associated with increase in depression symptoms over time, highlighting its role in the development of depression symptoms in older adults with T2D. Highlights: What is the primary question addressed by this study? Do specific personality traits predict depression dimensions and contribute to the development of depression symptoms in older adults with T2D? What is the main finding of this study? Cross‐sectionally, high neuroticism and low extroversion are associated with most depression dimensions, and only high levels of neuroticism with an increase in overall depression symptoms over time. What is the meaning of the finding? In the context of T2D, personality traits are associated with global depression state rather than to any specific depression dimensions, with neuroticism specifically implicated in the development of depression symptoms. [ABSTRACT FROM AUTHOR]

Objectives: Depression may be a risk factor or a prodromal symptom of dementia, and decreased serum levels of brain‐derived neurotrophic factor (BDNF) have been observed in both depression and dementia. The aim of the present study was to determine whether serum levels of BDNF in the remitted or acute phase of depression predicted the transition from depression to dementia. Methods: Serum levels of BDNF were measured in the acute phase of depression (n = 204) and after remission (n = 117), and we followed (mean: 24.3 months) the participants to assess the subsequent onset of dementia or mild cognitive impairment (MCI). Results: Serum levels of BDNF after remission, but not those in the acute depressive phase, predicted the future development of dementia or MCI. Conclusions: Patients with low serum BDNF levels, even after depression remission, might have an increased risk of developing dementia. These findings suggest a potential association between residual low serum BDNF levels after remission and the prodromal state of dementia, or the involvement of BDNF in the transition from depression to dementia. However, given that this study is low‐powered and preliminary, interpretation of the results should be approached with caution. Key points: Serum brain‐derived neurotrophic factor (BDNF) levels in acute depressive phase did not predict the future development of dementia or mild cognitive impairment (MCI).Serum BDNF levels after remission predicted the future development of dementia or MCI.Residual low serum BDNF levels after remission may reflect the prodromal state of dementia.BDNF may be involved in the transition from depression to dementia. [ABSTRACT FROM AUTHOR]

Background: Observational studies have shown the relationship between sarcopenia and psychiatric disorders. However, due to the limitations of traditional research methods, the causal relationship between them has not been accurately concluded. At the same time, considering that sarcopenia is mainly manifested by low muscle strength and low muscle mass, we used Mendelian randomization (MR) analysis in this study to explore the causal relationship of anxiety, depression, and neuroticism with muscle strength and muscle mass, respectively. Methods: Genetic variants associated with depression were obtained from FinnGen Biobank (Ncase = 33,812, Ncontrol = 271,380), those associated with anxiety were from FinnGen Biobank (Ncase = 21,519, Ncontrol = 307,558), and those associated with neuroticism, including 12 items, were from a large‐scale genome‐wide association study (N range: 366,301–375,913). Muscle strength was represented by the hand grip strength (HGS), and muscle mass was represented by the appendicular lean mass (ALM) and the body fat percentage. The inverse‐variance weighted (IVW) method was used as the primary analysis method, and the Mendelian Randomization Egger (MR‐Egger) and the weighted median were used as supplementary methods to test whether the three psychological factors were causally related to these two main indicators of sarcopenia severity. Results: Depression and neuroticism had different degrees of causal influence on muscle mass and strength, which was statistically significant. Specifically, the depression predicted by genes was significantly associated with ALM (beta = −0.043, p = 0.027), low hand grip strength (LHGS, measured for people of 60 years and older) (odds ratio (OR) = 1.129 (1.019–1.251), p = 0.019), right HGS (beta = −0.050, p = 0.001), left HGS (beta = −0.06, p = 0.001), and body fat percentage (beta = 0.035, p = 0.0138). The neuroticism predicted by genes was significantly associated with ALM (beta = −0.073, p = 0.034), LHGS (OR = 1.222 (1.085–1.377), p = 0.001), right HGS (beta = −0.058, p = 0.000), left HGS (beta = −0.080, p < 0.000), and body fat percentage (beta = 0.063, p = 0.008). However, anxiety was only significantly associated with LHGS (OR = 1.215 (1.008–1.465), p = 0.041) but not significantly associated with ALM (beta = 0.033, p = 0.313), right HGS (beta = −0.008, p = 0.678), left HGS (beta = 0.007, p = 0.712), or body fat percentage (beta = 0.022, p = 0.559). Conclusion: This study supported the causal association of depression and neuroticism with muscle strength and mass, which are the two main indicators of sarcopenia. At the same time, there was no sufficient evidence for the causal relationship between anxiety and muscle strength or mass. The results of this study pointed to the need to intervene in the mental health of the elderly to prevent sarcopenia or reduce its severity. Key points: Muscle strength and mass are two main indicators of sarcopenia.Genetically predicted depression and neuroticism were causally associated with muscle strength and mass; and anxiety was not, which may be related to population selection.Focusing on the mental health of elderly patients can prevent the occurrence of sarcopenia or alleviate its severity. [ABSTRACT FROM AUTHOR]

Background: Older adults with mild cognitive impairment (MCI) and depression have a higher dementia conversion rate, which requires timely intervention. Objectives: A non‐randomized controlled trial was conducted to explore the effect of a nurse‐led positive psychological intervention (PPI) in relieving depression and promoting cognition in this population. Methods: A total of 70 older adults were enrolled, with 35 each in the intervention and control groups. The control group received one‐to‐one health education, and the intervention group received a 40‐ to 60‐minute PPI for eight successive weeks. Results: During the intervention, most participants reached the standard of active participation, and 2.86% continued to complete homework every day during follow‐up. The Patient Health Questionnaire‐9 (PHQ‐9) score in the intervention group was significantly lower than that in the control group at the end of intervention (t = −3.64, p < 0.05) and at 3‐month follow‐up (t = −4.48, p < 0.05). Interaction effects of time and group on PHQ‐9 scores (F = 8.11, p < 0.001), with significant differences between the groups in scores (F = 9.11, p < 0.05) and times (F = 23.58, p < 0.05) was observed. In the Montreal Cognitive Assessment (MoCA) scale, the intervention group had significantly higher scores than controls at the end of intervention (t = 7.28, p < 0.05) and 3‐month follow‐up (t = 8.01, p < 0.05). Cognition in the two groups was significantly affected by intergroup effects (F = 42.80, p < 0.001), interaction effects (F = 30.38, p < 0.001), and time effects (F = 33.67, p < 0.05). Conclusions: Although the effects tended to decrease in follow‐up, the nurse‐led PPI was feasible and valid in relieving depression and promoting cognition among older participants with MCI and depression. The present findings warrant further exploration. A nurse‐led positive psychological intervention was applicable among elderly MCI adults with depression and effective in relieving depression and promoting cognition. Key points: Older adults with mild cognitive impairment (MCI) and depression exhibited higher conversion rate to dementia.Positive psychology emphasized transforming negative emotions and strengthening positive emotions to reduce mental illness and increase well‐being.A positive psychology intervention could be conducted by nursing staff and acceptable by elder MCI with depression resident in community.The nurse‐led eight‐week positive psychology intervention with a frequency of once a week and 40‐ to 60‐minute sessions was effective in relieving depression and promoting cognition among participants. [ABSTRACT FROM AUTHOR]

Background: Psychiatric comorbidity is high in adults with posttraumatic stress disorder (PTSD), with up to 90% having at least one additional condition, and two‐thirds having two or more other diagnoses. With an increasing aging population in industrialized counties, knowing which psychiatric disorders frequently co‐occur in older adults with PTSD can have implications to improve diagnosis and treatment. This systematic literature review explores the current empirical literature on psychiatric comorbidity in older adults with PTSD. Method: Literature databases PubMed, Embase, PsycINFO, and CINAHL were searched. The following inclusion criteria were applied: research done since 2013, PTSD diagnosis based on diagnostic criteria according to Diagnostic and Statistics Manual‐Fifth Edition, International Classification of Diseases—10th Revision (ICD‐10), or ICD‐11, and studies include individuals aged 60 years or older. Results: Of 2068 potentially relevant papers identified, 246 articles were examined based on titles and abstracts. Five papers met the inclusion criteria and were included. Major depressive disorder and alcohol use disorder were the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD. Conclusions and implications: Screening for depression and substance use in older adults should include an assessment of trauma and PTSD. Additional studies in the general older adult population with PTSD and a broader range of comorbid psychiatric disorders are needed. Key points: Major depressive disorder and alcohol use disorders are the most frequently studied and diagnosed psychiatric comorbidities in older adults with PTSD.Based on this, screening for trauma and PTSD should be included in older adults with depression and substance useQualitative epidemiological studies on psychiatric comorbidities, such as personality disorders, in older adults with PTSD are limited and needed. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the association between depression and non‐compliance with COVID‐19 preventive behaviors among community‐dwelling South Korean older adults. Methods: We utilized the 2020 Korean Community Health Survey—a community‐based nationwide survey. A score of 10 points or higher on the Patient Health Questionnaire‐9 was defined as depression. Non‐compliance with COVID‐19 preventive behaviors was assessed on the following three behaviors: washing hands, wearing masks, and watching distance. We also included socio‐demographic characteristics, health behaviors, and COVID‐19‐related characteristics as covariates. Multiple logistic regression analyses were performed, and all statistical analyses were stratified by sex. Results: The 70,693 participants included 29,736 men and 40,957 women. Notably, 2.3% of men and 4.2% of women had depression. Non‐compliance with washing hands was significantly higher in men than women (1.3% vs. 0.9%), whereas no significant differences were observed in wearing masks and watching distance. The adjusted logistic regression analysis showed that depression was positively associated with non‐compliance with washing hands and watching distance in both sexes. The association between depression and non‐compliance with wearing masks was significant only in women. Conclusions: There was an association between depression and non‐compliance with COVID‐19 preventive behaviors in South Korean older adults. This signifies that health providers need to reduce depression to improve compliance with preventive behaviors in older adults. Key points: Men are less likely to comply with washing hands than are women.Depression is associated with non‐compliance with COVID‐19 preventive behaviors in both sexes. [ABSTRACT FROM AUTHOR]

Background: As we age, cognitive abilities decline which can lead to a decrease in quality of life (QoL) and an increase in depressive symptoms even in healthy (i.e., non‐clinical) older adults. Cognitive trainings (CT) are a promising approach to not only improve cognition, but also QoL and mood. However, it is unclear which prognostic factors are associated with changes in QoL and depression after CT. Objective: To identify prognostic factors and models of changes in QoL and depressive symptoms after a multi‐domain CT in healthy older adults. Methods: MEDLINE, Web of Science Core Collection, CENTRAL and PsycInfo were systematically searched for multi‐domain CT studies in healthy older adults until August 2022. Studies investigating prognostic factors and/or models on QoL and depressive symptoms were included. Risk of bias was assessed using the QUIPS and the PROBAST tool. Results: Our search revealed N = 12,916 studies, of which only 6 could be included in the review. Prognostic factors included were sociodemographics, cognitive reserve, cognitive baseline level, and cognitive change. However, data were too rare and heterogenous regarding the assessment measures of QoL and depressive scores, the used multi‐domain CT and the investigated prognostic factors to draw clear conclusions or conduct meta‐analyses. Conclusion: There is an urgent need for research on prognostic factors and models of changes in QoL and depressive symptoms after CT in healthy older participants as they could help to tailor interventions to individuals in terms of future precision medicine approaches. Key points: Although cognitive training (CT) is known to have positive effects on quality of life (QoL) and depression, a systematic review examining prognostic factors and models for these effects was lacking.Prognostic factors included were sociodemographics, cognitive reserve, cognitive baseline level, and cognitive change.Data were too heterogenous to draw clear conclusions or conduct meta‐analyses.Future research should enlighten which factors and models predict CT changes on QoL and depression to foster individualized cognitive interventions. [ABSTRACT FROM AUTHOR]

Background Detection of suicidal ideation (SI) is key for trying to prevent suicide. The aim of this study was to analyze the frequency of SI and related factors in Spanish people with Parkinson's Disease (PwPD) and to compare them with a control group. Methods PD patients and controls recruited from the Spanish cohort COPPADIS from January 2016 to November 2017 were included. Two visits were conducted: V0 (baseline); V2 (2-year ± 1 month follow-up). SI was defined as a score ≥1 on item nine of the Beck Depression Inventory-II (BDI-II). Regression analyses were conducted to identify factors related to SI. Results At baseline, 693 PwPD (60.2% males; 62.59 ± 8.91 years old) and 207 controls (49.8% males; 60.99 ± 8.32 years old) were included. No differences between PwPD and controls were detected in SI frequency at either V0 (5.1% [35/693] vs. 4.3% [9/207]; p = 0.421) or at V2 (5.1% [26/508] vs. 4.8% [6/125]; p = 0.549). Major depression (MD) and a worse quality of life were associated with SI at both visits in PwPD: V0 (MD, OR = 5.63; p = 0.003; PDQ-39, OR = 1.06; p = 0.021); V2 (MD, OR = 4.75; p = 0.027; EUROHIS-QOL8, OR = 0.22; p = 0.006). A greater increase in the BDI-II total score from V0 to V2 was the only factor predicting SI at V2 (OR = 1.21; p = 0.002) along with an increase in the total number of non-antiparkinsonian drugs (OR = 1.39; p = 0.041). Conclusion The frequency of SI (5%) in PwPD was similar to in controls. Depression, a worse quality of life, and a greater comorbidity were related to SI. [ABSTRACT FROM AUTHOR]

Background: Recent research suggests that abnormalities in the habenula (HB), a core area of the brain that transmits reward information, may be a determinant of depression. However, it is not clear whether the functional connectivity (FC) pattern of the mild cognitive impairment (MCI) with and without depression symptoms is abnormal. Methods: In this study, we used resting‐state functional magnetic resonance imaging (fMRI) to examine the FC pattern of the HB in MCI patients with depression symptoms (D‐MCI). We acquired fMRI data from 54 subjects on a 3T MRI. Subjects collected included 16 patients with D‐MCI, 18 patients with MCI with no depression, and 20 healthy controls. One way ANCOVA and post hoc t‐test were used to compare the difference in FC strength between the three groups. Results: The D‐MCI group had altered FC between the left HB and the right superior temporal gyrus, right inferior frontal gyrus/opercular part, and right middle frontal gyrus. The D‐MCI group had increased FC between the right HB and precuneus. Conclusions: These results suggest that the dysfunction of the HB–Default model network might be involved in the neural mechanism underlying depression in MCI. Key points: Recent research suggests that abnormalities in the habenula may be a determinant of depression.We used resting‐state functional magnetic resonance imaging to examine the functional connectivity (FC) pattern of the habenula in mild cognitive impairment (MCI) patients with depression symptoms.The MCI patients with depression symptoms had altered FC between the left habenula and the right superior temporal gyrus, right inferior frontal gyrus/opercular part, and right middle frontal gyrus. The MCI patients with depression symptoms group had increased FC between the right habenula and precuneus.The dysfunction of the habenula–Default model network might be involved in the neural mechanism underlying depression in MCI. [ABSTRACT FROM AUTHOR]

Objectives: Hearing loss, depression, and cognitive decline are common among older people. We investigated the association of hearing loss with depressive symptoms and cognitive function in a nationally representative sample of people aged 50+ in Brazil. Methods: Data from the Brazilian Longitudinal Study of Aging (ELSI‐Brazil) included information on self‐reported hearing loss, hearing aid use (effective or not effective), depressive symptoms (CES‐D‐8), and a global cognitive score (composed of immediate and late recall, verbal fluency, orientation and prospective memory) in a sample of 9412 individuals. Multiple linear regression was used to estimate the association of hearing loss and hearing aid use with both depressive symptoms and cognitive performance. The analyses were conducted with 7837 participants with complete data, and then repeated with data from the whole sample after multiple imputation. Results: Compared to those without hearing loss, those with hearing loss were more likely to have a higher number of depressive symptoms (β: 0.53 (0.40–0.67) p < 0.001) but not worse cognitive performance (β: −0.01 (−0.03 to 0.19) p = 0.631). Among those with hearing loss, the use of hearing aid was neither associated with cognitive performance (β: −0.08 (−0.19 to 0.03) p = 0.169) or depressive symptoms (β: −0.42 (−0.98 to 0.14) p = 0.143); its effective use was associated with less depressive symptoms (β: −0.62 (−1.23 to −0.01) p = 0.045) but not worse cognitive performance (β: −0.15 (−0.030 to 0.03) p = 0.057). Sensitivity analyses revealed that hearing loss is associated with a worse performance in two non‐amnestic cognitive domains. Conclusions: Hearing loss may negatively affect specific cognitive domains and depressive symptoms among older people, and the use of a hearing aid may mitigate the association with depressive symptoms. Key points: Hearing loss is highly prevalent among older people and may contribute to an increased risk of depression, cognitive impairment, and dementia.In our nationally representative sample of Brazilians aged 50 and older, those with hearing loss had more depressive symptoms compared to those without hearing loss, and individuals with hearing loss with an effective use of a hearing aid had fewer depressive symptoms than those without hearing aid.Individuals with hearing loss had more depressive symptoms compared to those without hearing loss, but did not have a poorer cognitive performance. An effective use of hearing aids was associated with fewer depressive symptoms but was not associated with cognitive performance.Hearing rehabilitation in the older people might be a feasible public health intervention to reduce the burden of depression among older adults. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the association of comorbid depression with health‐care utilization among dementia patients. This study compared health‐care utilization between dementia patients with and without comorbid depression. Methods: Using Taiwan's National Health Insurance Research Database, we identified 10,710 patients with newly diagnosed dementia between 2005 and 2014: 1785 had comorbid depression (group 1) and 8925 did not (group 2). Patients were tracked for 1 year to evaluate outpatient, emergency, and inpatient service utilization and length of hospital stay (LOS). Multivariable regression was applied to examine the association between comorbid depression and health‐care utilization and analyze factors associated with inpatient visits and LOS. Results: Group 1 had significantly fewer outpatient visits (β = −0.115; p < 0.001), more inpatient visits (β = 0.157; p = 0.005), and a longer LOS (β = 0.191; p < 0.001) than did group 2. The groups did not differ significantly in emergency visits (β = 0.030; p = 0.537). In group 1, age, gender, and specific comorbidities were predictors of inpatient visits; those factors and salary‐based insurance premiums were predictors of LOS. Conclusion: Group 1 utilized less outpatient care but more inpatient care, suggesting health‐care service for these patients may be needed to improvement. Key points: We investigated whether dementia with comorbid depression was associated with higher health‐care utilization.Compared with dementia patients only, patients coexisting dementia and depression had no significant emergency visits and even significantly less outpatient visits. However, patients coexisting dementia and depression had higher inpatient visits and longer length of stay (LOS) than those with dementia only. The significant predictors associated with hospitalization utilizations among dementia patients with comorbid depression are age, gender, salary‐based insurance premiums, and specific comorbidities.Our findings suggest that outpatient and emergency health‐care services for dementia patients with comorbid depression may be insufficient and are not integrated with inpatient care services. [ABSTRACT FROM AUTHOR]

Objectives: This narrative review describes the clinical features of apathy and depression in individuals with neurocognitive disorders (NCDs), with the goal of differentiating the two syndromes on the basis of clinical presentation, diagnostic criteria, neuropathological features, and contrasting responses to treatments. Methods: Literature was identified using PubMed, with search terms to capture medical conditions of interest; additional references were also included based on our collective experience and knowledge of the literature. Results: Evidence from current literature supports the distinction between the two disorders; apathy and depression occur with varying prevalence in individuals with NCDs, pose different risks of progression to dementia, and have distinct, if overlapping, neurobiological underpinnings. Although apathy is a distinct neuropsychiatric syndrome, distinguishing apathy from depression can be challenging, as both conditions may occur concurrently and share several overlapping features. Apathy is associated with unfavorable outcomes, especially those with neurodegenerative etiologies (e.g., Alzheimer's disease) and is associated with an increased burden for both patients and caregivers. Diagnosing apathy is important not only to serve as the basis for appropriate treatment, but also for the development of novel targeted interventions for this condition. Although there are currently no approved pharmacologic treatments for apathy, the research described in this review supports apathy as a distinct neuropsychiatric condition that warrants specific treatments aimed at alleviating patient disability. Conclusions: Despite differences between these disorders, both apathy and depression pose significant challenges to patients, their families, and caregivers; better diagnostics are needed to develop more tailored treatment and support. Key points: Apathy and depression are distinct neuropsychiatric syndromes that share overlapping features and may occur concurrently in individuals with neurocognitive disorders (NCDs)Distinguishing apathy from depression can be challenging, but proper identification of each syndrome is important for appropriate interventionThis narrative review describes clinical features associated with apathy and depression and differentiates each syndrome based on clinical presentation and diagnostic criteria, neuropathological features, and differences in response to treatment [ABSTRACT FROM AUTHOR]

Background: Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.Method: Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.Results: Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.Conclusion: The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population. [ABSTRACT FROM AUTHOR]

Depressive and subthreshold depressive symptomatology are common but often neglected in older adults. Objective: This study aimed to assess rates of depressive and subthreshold depressive symptomatology, and the characteristics associated, among older adults living in a socioeconomically deprived area of Brazil. Methods: This study is part of the PROACTIVE cluster randomised controlled trial. 3356 adults aged 60+ years and registered in 20 primary health clinics were screened for depressive symptomatology with the Patient Health Questionnaire‐9 (PHQ‐9). Depressive status was classified according to the total PHQ‐9 score and the presence of core depressive symptoms (depressed mood and anhedonia) as follows: no depressive symptomatology (PHQ‐9 score 0–4, or 5–9 but with no core depressive symptom); subthreshold depressive symptomatology (PHQ‐9 score 5–9 and at least one core depressive symptom); and depressive symptomatology (PHQ‐9 score ≥ 10). Sociodemographic information and self‐reported chronic conditions were collected. Relative risk ratios and 95% CIs were obtained using a multinomial regression model. Results: Depressive and subthreshold depressive symptomatology were present in 30% and 14% of the screened sample. Depressive symptomatology was associated with female gender, low socioeconomic conditions and presence of chronic conditions, whereas subthreshold depressive symptomatology was only associated with female gender and having hypertension. Conclusions: Depressive and subthreshold depressive symptomatology is highly prevalent in this population registered with primary care clinics. Strategies managed by primary care non‐mental health specialists can be a first step for improving this alarming and neglected situation among older adults. Key points: This is the first study to assess subthreshold depressive symptomatology in a large sample of older adults in Brazil.Individuals registered in primary care clinics and living in socioeconomically deprived areas were assessed for depressive and subthreshold depressive symptomatology.Depressive and subthreshold depressive symptomatology rates were high among this population.Higher levels of depressive symptomatology were associated with female gender, worse socioeconomic conditions and the presence of other chronic health conditions. [ABSTRACT FROM AUTHOR]

Objectives: To shield vulnerable persons, particularly the elderly, during the Covid‐19 pandemic governments around the world have advised to use social distancing and self‐isolation. Social isolation might put older adults at an increased risk for mental health problems such as depression. There is a need for brief, easy‐accessible psychological treatments for depressive symptoms that can be delivered remotely. The aim of this study was to investigate the feasibility, acceptability, and preliminary efficacy of telephone‐delivered Behavioral Activation with Mental Imagery (BA‐MI) for the treatment of depressive symptoms in individuals 65 years and older living in isolation during the Covid‐19 pandemic. Methods: In this open‐label pilot randomized clinical trial, N = 41 individuals aged 65 years or older with clinically significant symptoms of depression were randomly assigned to either a BA‐MI treatment condition, or an Attention‐Assessment control condition delivered over the telephone over a 4‐week period. Results: Depressive symptoms decreased more in the treatment condition compared to the control condition. At post‐treatment, 2 out of 16 participants in the treatment condition met diagnostic criteria for depression compared to 9 out of 13 in the control condition. Most participants in the treatment condition were satisfied with the treatment and few adverse effects were observed. Conclusions: This pilot study suggests that behavioral activation with mental imagery delivered over the telephone is feasible, acceptable, and potentially efficacious for the treatment of depressive symptoms in older individuals living in isolation. Replication in larger samples is needed. Key points: The Covid‐19 pandemic has exacerbated the need for brief, accessible psychological treatments for depressive symptoms that can be remotely delivered to isolated older adults.This pilot RCT investigated the feasibility and preliminary efficacy of telephone‐based Behavioral Activation with Mental Imagery (BA‐MI) for depression in this sample.BA‐MI led to a greater decrease in depressive symptoms and increases in behavioral activation in the treatment group compared to the control group.BA‐MI may help to alleviate depressive symptoms in isolated older adults. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to estimate the prevalence of depression and to explore the association of specific chronic conditions as well as multi‐morbidity with depression among the older population. Method: The study utilized data from the Longitudinal Ageing Study in India Wave 1 (2017–2018). The total sample size for the present study was 31,464 older adults aged 60 and above, including 14,931 males and 16,533 females. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives. Results: The overall prevalence of depression among the elderly population in India was 8.7%. Older women had shown a greater prevalence rate of depression than older men. Among chronic conditions, hypertension, stroke, and bone‐related diseases were found to be significantly associated with depression in the case of both men and women. The prevalence of depression among older adults with three or more chronic conditions was higher in males (14.5%) than in females (11.2%). The association between the number of chronic conditions and depression exhibited a linear trend with an increased odds ratio indicating a higher risk of depression among older adults with multiple chronic conditions. Conclusion: Older individuals with a greater number of chronic illnesses have a higher risk of depression and the risk is proportional to the number of chronic conditions. This signifies the need for the identification of depressive symptoms at an early stage by focussing on the elderly suffering from chronic conditions and educating family members and the community about effective treatments and counselling. Key points: Older women have exhibited a greater prevalence rate of depression than older menHypertension, stroke, and bone‐related diseases are significantly associated with depression among the older populationOlder adults with a greater number of chronic conditions have a higher risk of depression, and the risk is proportional to the number of chronic conditionsFunctional disability is a strong predictor of depression in later life [ABSTRACT FROM AUTHOR]

Objectives: Whether and how symptom clusters are associated with care utilization remains understudied. This study aims to investigate the economic impact of symptom clusters. Methods: We conducted cross‐sectional analyses of data collected from 3255 older adults aged 60 years and over in Hong Kong using the Patient Health Questionnaire‐9 and the Client Service Receipt Inventory to measure depressive symptoms and service utilization to calculate 1‐year care expenditure. Based on Research Domain Criteria framework, we categorized depressive symptoms into four clusters: Negative Valance Systems and Externalizing (NVSE; anhedonia and depression), Negative Valance Systems and Internalizing (guilt and self‐harm), Arousal and Regulatory Systems (sleep, fatigue, and appetite), and Cognitive and Sensorimotor Systems (CSS; concentration and psychomotor). Two‐part models were used with four symptom clusters to estimate economic impacts on care utilization. Results: Core affective symptoms had the largest economic impact on non‐psychiatric care expenditure; a one‐point increase in NVSE was associated with USD$ 571 additional non‐psychiatric care expenditure. The economic impacts of CSS on non‐psychiatric care expenditure was attenuated when the severity level of NVSE was higher. Conclusions: Our findings highlight the importance of understanding economic impacts on care utilization based on symptom profiles with a particular emphasis on symptom combinations. Policymakers should optimize care allocation based on older adults' depressive symptom profiles rather than simply considering their depression sum‐score or the severity defined by cut‐off points. Key points: Whether and how symptom clusters are associated with care utilization remains understudiedWe found that the economic impact of four depressive symptom clusters and their interactions were heterogeneous across the health, social, and rehabilitation care sectorsCore affective symptoms had the largest economic impact on non‐psychiatric care expenditurePolicymakers should optimize care allocation, taking account of older adults' depressive symptom profiles [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. Material and Methods: We carried out a secondary data analysis of a cross‐sectional study that included older adults (60 years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance‐based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). Results: We included 442 older adults with a mean age of 73 ± 6.9 in the analysis; 63.1% (n = 279) were women, and 79.9% (n = 353) had no education or incomplete primary school. 50.9% (n = 225) of the participants had depressive symptoms, and 49.8% (n = 220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR = 1.67; 95% CI: 1.34–2.08; p < 0.001) in older adults living at high altitude. Conclusions: Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes. Key points: Approximately one in two older adults from high Andean communities had depressive symptoms or disabilityDepressive symptoms was associated with a greater probability of disability in older adults living at high altitudeTo our knowledge, this is the first study that evaluates the association between depressive symptoms and disability in elderly residents in high altitude communitiesIt is relevant to improve health services at the primary health care level to generate timely interventions and reduce the impact of depression and disability in this population group [ABSTRACT FROM AUTHOR]

Objectives: It is unclear whether and to what extent depression subcases and cases in older age were associated with all‐cause mortality. Little is known about gender differences in the associations. We assess these in older Chinese. Methods: We examined a random sample of 6124 participants aged ≥60 years across five provinces in China. They were interviewed using a standard method of the GMS‐AGECAT to diagnose depression subcase and case and record sociodemographic and disease risk factors at baseline, and to follow up their vital status. We employed Cox regression models to determine all‐cause mortality in relation to depression subcases and cases, with adjustment for important variables, including social support and co‐morbidities. Results: Over the 10‐year follow‐up, 928 deaths occurred. Compared to those without depression at baseline, participants with depression subcase (n = 196) and case (n = 264) had increased risk of mortality; adjusted hazard ratios (HRs) were 1.46 (95% CI 1.07–2.00) and 1.45 (1.10–1.91). The adjusted HRs in men were 1.15 (0.72–1.81) and 1.85 (1.22–2.81), and in women 1.87 (1.22–2.87) and 1.22 (0.83–1.77) respectively. In participants aged ≥65 years, the adjusted HRs were 1.12 (0.68–1.84) and 1.99 (1.28–3.10) in men, and 2.06 (1.32–2.24) and 1.41 (0.94–2.10) in women. Increased HR in depression subcases was higher in women than man (ratio of HRs was 1.84, p = 0.034). Conclusions: Older people with depression subcase could have increased all‐cause mortality to a similar extent to those with depression case. More attention should be paid to subcases of depression in women to tackle gender inequalities and improve survival. Key points: This study is the first to report that there were significant impacts of depression subcase and case on all‐cause mortality in older people in China, and their impacts were stronger than those from other countries averaged levels.Older Chinese with depression subcase had a similar increase in all‐cause mortality to those with depression case.This study is the first to examine gender differences in the impact of depression subcase in older age on all‐cause mortality in low and middle‐income countries.Older women in China had a higher impact of depression subcase on all‐cause mortality than their male counterparts, which needs to be addressed for intervention. [ABSTRACT FROM AUTHOR]

Objectives: Depression is the commonest mental disorder in older adults worldwide, affecting 7% of the world's older population and accounting for 5.7% of years lived with disability among adults aged over 60 years. We conducted a secondary data analysis to determine the point prevalence, associated risk factors and treatment gap for DSM‐IV depression among older adults in the Hai District, rural Tanzania. Methods: The primary data source was a cross‐sectional two‐stage community‐based dementia study where older adults aged ≥70 years (n = 296) were fully‐assessed for dementia and depression in the second stage. Age‐adjusted prevalence of depression was determined based on the WHO standard population using the Direct Method. Univariate and multivariate logistic regression models were performed. Results: Of the 296 older adults assessed for depression, 48 were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders‐IV criteria. The median (Inter Quartile Range; QR) age was 80 (75–88) years. Age‐adjusted point prevalence of depression was 21.2% (95% CI: 16.6–21.9) and the treatment gap for depression was 100%. There was reduced odds of depression in older adults who rated their physical health as good or very good (adjusted odds ratio [AOR] = 0.22; 95%CI: 0.10–0.46; p < 0.001), or moderate (AOR 0.26; 95%CI: 0.10–0.66; p = 0.005). Conclusions: Depression in older adults is associated with physical health status and there is an alarmingly high treatment gap. Future research on depression in older adults should focus on effective interventions to address physical morbidity, psychosocial factors and the treatment gap. Key Points: Despite depression being the commonest mental disorder in older adults reported worldwide, in Sub‐Saharan Africa, the epidemiological data on depression in this population group are limited.We found point prevalence estimates of depression in older adults similar to those reported in community‐based studies in high income countries.Self‐rated overall physical health status was associated with depression in older adults.Future research on depression in older adults should focus on the physical morbidity, psychosocial factors and the treatment gap. [ABSTRACT FROM AUTHOR]

Objectives: The APOE‐ε4 genotype has been associated with old‐age depression, but this relationship has been rarely investigated in type 2 diabetes (T2D) older adults, who are at significantly increased risk for depression, a major contributor to T2D complications. We examined whether trajectories of depression symptoms over time differ by APOE‐ε4 genotype in older adults with T2D. Methods: Participants (n = 754 [13.1% APOE‐ε4 carrier]s) were from the longitudinal Israel Diabetes and Cognitive Decline (IDCD) study. They were initially cognitively normal and underwent evaluations of depression approximately every 18 months using the 15‐item version of the Geriatric Depression Scale (GDS) and the depression subscale of the Neuropsychiatric Inventory (NPI). APOE was defined as a dichotomy of ε4 carriers and non‐carriers. We used Hierarchical Linear Mixed Models (HLMM) that modeled the effects of APOE status on repeated GDS and NPI‐depression scores in an unadjusted model (Model 1), adjusting for demographic factors (Model 2) and additionally adjusting for cardiovascular factors and global cognition (Model 3). Results: Participants' mean age was 71.37 (SD = 4.5); 38.2% female. In comparison to non‐carriers, APOE‐ε4 carriers had lower mean GDS scores (β = −0.46, p = 0.018) and lower NPI‐depression scores (β = −0.170, p = 0.038) throughout all study follow period. The groups did not differ in the slope of change over time in GDS (β = −0.005, p = 0.252) or NPI‐depression (β = −0.001, p = 0.994) scores. Additional adjustment for cardiovascular factors and global cognition did not alter these results. Conclusions: In older adults with T2D, APOE‐ε4 carriers have less depressive symptoms in successive measurements suggesting they may be less susceptible to depression. Key points: Lower depression scores at baseline and over time are observed in older adults with T2D and without dementia carrying the APOE ε4 genotype, compared to non carriersThe phenomenology or underlying mechanisms of depression may differ by APOE genotype [ABSTRACT FROM AUTHOR]

Background: Both the quality of sleep and depression impact short-term memory (STM) while they influence each other. However, the underlying mechanisms are not yet clear. Herein, we aimed to explore the mediating effect of depression between sleep quality and STM in older adults and further test the gender differences in this relationship.Methods: A cluster sampling survey was carried out among 903 residents that were aged 60+ years in a semi-closed island of Xiamen, China, in 2019. The subjects' sleep quality and depression were measured using the Pittsburgh Sleep Quality Index (PSQI) and the 15-item Geriatric Depression Scale (GDS-15), respectively. The three-item recall test was utilized to measure STM function. Mediation analyses were performed using the structural equation model and bias-corrected bootstrap method. Next, the Wald-test was utilized to determine gender differences in the pathway.Results: Overall, 355 men and 508 women, with a mean age of 69.55 and 70.97, respectively, had valid data on the main variables. Depression was found to mediate the effect of sleep quality on STM (a*b = -0.076, p < 0.05). Interestingly, while this indirect effect existed in the female group (af *bf  = -0.126, p < 0.05), it did not in the male group (am *bm  = 0.017, p = 0.677). The Wald-test indicated no gender differences in the pathway from sleep quality to depression (p = 0.303). However, the pathway from depression to STM function was found to be significantly stronger for females than males (p = 0.0198).Conclusion: Higher sleep quality was found to be associated with improved STM function. Furthermore, the association was found to be regulate indirectly by lower depressive symptoms for females, but directly for males. Therefore, appropriate psychological interventions may be beneficial to the maintenance of STM for older adults, particularly for women. [ABSTRACT FROM AUTHOR]

Objectives: Family caregivers are important to older adults' health, but few studies have examined how caregivers' mental health is associated with older adults' cognitive function. This study examined the trajectories of cognitive function of older adults and whether caregivers' depressive symptoms shape the pattern of cognitive function trajectories. Methods: This 6-year longitudinal sample consisted 1188 older adults aged =75 years with deficits in activities of daily living (ADL) and their family caregivers in Shanghai, China (Rounds 1-3). Cognitive function trajectories were identified based on an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression tested the association between caregivers' depressive symptoms and older adults' cognitive function trajectory. Results: Three trajectory groups were identified: a "newly onset" group (50.4%) had an increased risk of being cognitive impaired during the 6-year period; a "never" group (46.2%) remained cognitive active; and a "chronic" group was largely persistently cognitive impaired (3.4%). Caregivers' depressive symptoms increased the relative risk of having the "onset" or "chronic" versus "never" trajectory. Among the four dimensions of depressive symptoms, only somatic complaints were associated with a higher risk of the "newly onset" trajectory in 6 years. Conclusion: The progression of cognitive function among older adults with deficits in ADL followed three distinct trajectories during a 6-year period. Addressing the mental health of caregivers may prevent or delay progression of cognitive impairment among older adults. [ABSTRACT FROM AUTHOR]

Objectives: While vitamin D is involved in frailty as well as depression, hardly any study has examined the course of vitamin D levels prospectively. The objective of this study is to examine whether a change of vitamin D in depressed older adults is associated with either depression course, course of frailty, or both. Methods: The study population consisted of 232 of 378 older adults (60–93 years) with a DSM‐IV defined depressive disorder participating in the Netherlands Study of Depression in Older persons, a prospective clinical cohort study. Baseline and 2‐year follow‐up data on depressive disorder (DSM‐IV diagnosis), symptom severity (inventory of depressive symptoms), frailty phenotype (and its individual components) and vitamin D levels were obtained. Linear mixed models were used to study the association of change in vitamin D levels with depression course, course of frailty, and the combination. Results: Vitamin D levels decreased from baseline to follow‐up, independent from depression course. An increase in frailty was associated with a significantly sharper decrease of vitamin D levels over time. Post hoc analyses showed that this association with frailty might be driven by an increase of exhaustion over time and counteracted by an increase in walking speed. Conclusions: Our findings generate the hypothesis that vitamin D supplementation in late‐life depression may improve frailty, which may partly explain inconsistent findings of randomised controlled trials evaluating the effect of vitamin D for depression. We advocate to consider frailty (components) as an outcome in future supplementation trials in late‐life depression. Key Points: Change in serum vitamin D is related to the course of frailty, and not independently to depression courseFuture vitamin D supplementation trials in depression should consider frailty (components) as an outcome [ABSTRACT FROM AUTHOR]

Objectives: Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low‐income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality. Methods: In a 3‐arm randomized clinical trial, 277 low‐income homebound individuals aged 50+ participated in behavioral activation tele‐delivered by bachelor's‐level lay counselors (Tele‐BA), problem‐solving therapy tele‐delivered by licensed clinicians (Tele‐PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24‐item Hamilton Rating Scale for Depression and disability with the 12‐item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects. Results: Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross‐lagged model, in which autoregressive and contemporaneous effects were included, only the depression‐to‐disability path exhibited mediation. There was no evidence of difference between Tele‐BA and Tele‐PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement. Conclusions: Brief depression treatments for low‐income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele‐BA and Tele‐PST. Lay‐counselor model is a promising alternative to clinician‐delivered psychotherapy for growing numbers of homebound older adults. [ABSTRACT FROM AUTHOR]

Background: Sense of coherence (SOC) is an important protective factor for carer well‐being but research to date remains cross‐sectional, focusing primarily on the direct effects of SOC on carers' mental health. The study's aim was to investigate the mediating role of SOC in the longitudinal relationship between caregiver strain and carers' psychological health, and its stability over time. Methods: Prospective longitudinal study conducted in Jaén (Spain) with a probabilistic sample of 132 carers of older people, with data collected at baseline and at 1‐year follow‐up. We measured SOC, caregiver strain, anxiety and depressive symptoms, and several care‐recipient characteristics and intensity of care provided. We used multiple linear regression modelling and the Sobel test to analyse mediation effects. Results: SOC was significantly negatively longitudinally associated with both anxiety (β = −0.38, p = 0.001) and depressive symptoms (β = −0.28, p = 0.023), after controlling for several confounders. SOC mediated both the relationship between caregiver strain and anxiety, and caregiver strain and depressive symptoms (Sobel test: p < 0.001 for anxiety and p < 0.001 for depressive symptoms). Differences between baseline and 1‐year follow‐up SOC scores were not statistically significant (p = 0.617). Conclusions: SOC appears to buffer the impact of caregiver strain on symptoms of depression and anxiety in informal carers of older people. Our data showed that SOC is an important psychological resource for carers that remained relatively stable under non‐experimental conditions over a period of 1 year in this sample. The findings suggest that interventions aimed at strengthening SOC may protect carer psychological well‐being. [ABSTRACT FROM AUTHOR]

Objectives: Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression‐specific treatment, and (3) inpatient psychiatric admission. Methods/Design: Longitudinal analyses were based on data from three follow‐up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self‐reported at baseline of each follow‐up cycle using the 12‐item EURO‐D scale. Health care utilization was self‐reported at the end of each follow‐up cycle. Results: After adjustment for sex, age, country of interview, follow‐up time, educational attainment, presence of a partner in household, body‐mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission. Conclusions: Specific symptoms of depression may determine utilization of different types of health care among elderly. [ABSTRACT FROM AUTHOR]

Background: Prior research on cognitive and functional outcomes after coronary artery bypass graft (CABG) surgery has largely explored these two domains in isolation. In this study, we assess baseline depression and cognition as risk factors for decline in the Clinical Dementia Rating Sum-of-Boxes (CDR-SB) 1 month post-CABG surgery, which a combined measure of cognition and function.Design: The Neuropsychiatric Outcomes After Heart Surgery study is a prospective observational cohort study.Setting: A tertiary care, academic center.Participants: Of a total study sample of 148 patients undergoing CABG surgery, 124 (83.8%) completed 1-month follow-up assessment. Mean age was 66.3, 32 (25.8%) female and 112 (90.3%) White.Measurements: Cognition, function, and depression were assessed on semi-structured clinical interviews. Cognitive and functional status were defined using CDR-SB; mild or major depression was defined by the Hamilton Depression Rating Scale. Additionally, neuropsychological battery was performed at baseline.Results: CDR-SB decline occurred in 18 (14.5%) subjects. Older age, depression, baseline CDR-SB, and postoperative delirium were associated with 1-month decline on univariate analysis. Older age (OR 1.1 [1.0-1.2]) and depression (OR 6.2 [1.1-35.0]) remained significant on multivariate regression. In separate models, baseline performance on visual Wechsler memory scale (delayed), Hopkins verbal learning test (immediate and delayed), controlled oral word fluency test, and Trails B predicted CDR-SB decline.Conclusion: Roughly one in seven patients experienced CDR-SB decline 1 month after CABG surgery. Also, preoperative depression deserves recognition for being a predictor of CDR-SB decline one month post-CABG. [ABSTRACT FROM AUTHOR]

Objectives: To examine trajectories of depression and apathy over a 5‐year follow‐up period in (prodromal) Alzheimer's disease (AD), and to relate these trajectories to AD biomarkers. Methods: The trajectories of depression and apathy (measured with the Neuropsychiatric Inventory or its questionnaire) were separately modeled using growth mixture models for two cohorts (National Alzheimer's Coordinating Center, NACC, n = 22 760 and Alzheimer's Disease Neuroimaging Initiative, ADNI, n = 1 733). The trajectories in ADNI were associated with baseline CSF AD biomarkers (Aβ42, t‐tau, and p‐tau) using bias‐corrected multinomial logistic regression. Results: Multiple classes were identified, with the largest classes having no symptoms over time. Lower Aβ42 and higher tau (ie, more AD pathology) was associated with increased probability of depression and apathy over time, compared to classes without symptoms. Lower Aβ42 (but not tau) was associated with a steep increase of apathy, whereas higher tau (but not Aβ42) was associated with a steep decrease of apathy. Discussion: The trajectories of depression and apathy in individuals on the AD spectrum are associated with AD biomarkers. [ABSTRACT FROM AUTHOR]

Objectives: As aging progresses, older adults experience several health changes, including changes in cholesterol levels, which increases their risk for other diseases. Older adults are particularly vulnerable to cognitive impairment and depression, which may be due to several factors. The aim of this study was to evaluate the association between serum cholesterol level and cognitive impairment and depression in older adults. Methods: This study used senior cohort data from the National Health Insurance Service of South Korea. A total of 128 371 participants contributed repeated measures to this dataset. Cognitive impairment was measured via a self‐reported questionnaire and depression was measured using claim data. Generalized estimating equations were used to identify associations between serum cholesterol level and cognitive impairment and depression, including subgroup analyses by sex. Results: There was no significant association between low‐density lipoprotein cholesterol (LDL‐C), total cholesterol (TC), or triglycerides (TG) with cognitive impairment. Low high‐density lipoprotein cholesterol (HDL‐C) was significantly associated with a higher risk of cognitive impairment, whereas high HDL‐C was associated with lower cognitive impairment. Higher LDL‐C was significantly associated with lower depression. Higher TC also was significantly associated with depression. Conclusion: HDL‐C is associated with depressive symptoms, and may be a key factor in predicting psychiatric symptoms or cognitive decline. Our study suggest that routine health screenings may aid in the early detection of high‐risk individuals. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the association between visual impairment (VI) and depression in low‐ and middle‐income countries (LMICs) and the mediating role of disability and social participation. Methods/Design: The World Health Organization Study on global AGEing and adult health (SAGE) provided data on objective and subjective visual function, depression, disability (WHODAS‐12), and social participation for nationally representative samples of adults 50 years and older in China, India, Ghana, Mexico, Russia, and South Africa. Multivariable logistic and linear models were used to test the association between VI and depression and the indirect pathways through disability and social participation. Analyses were adjusted for sociodemographics, medical comorbidities, and complex survey design features. Results: Visual acuity was worse in respondents with depression compared to those without depression in China (0.32 vs 0.23 logMAR; P <.001), Ghana (0.26 vs 0.18 logMAR; P <.001), and India (0.36 vs 0.30 logMAR; P <.001); self‐reported vision was also significantly worse in these three countries, but not in Mexico, Russia, or South Africa. Greater disability significantly mediated the association of both objective and self‐reported VI with depression in China and India. Social participation significantly mediated the association between subjective vision and depression in Ghana. Conclusions: There is variability in the association between VI and depression across LMICs and in the mediating role of disability and social participation. Culture‐specific instruments may be needed to better characterize the association between VI and depression and further research is needed to assess causality. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to identify whether the onset and the end of fear of falling (FOF) are associated with psychosocial consequences (in terms of depressive symptoms, loneliness, social isolation, autonomy, and subjective well-being).Methods/design: Longitudinal data for this study were taken from the nationally representative German Ageing Survey which included community-dwelling individuals ≥40 years (wave 5 and wave 6). Psychosocial outcome measures were assessed using widely established and well-validated scales. The presence of FOF was used as the main explanatory variable. It was adjusted for age, family status, labor force participation, self-rated health, physical functioning, as well as the number of chronic conditions.Results: Linear fixed effects regressions revealed that FOF was associated with adverse psychosocial outcomes (increased depressive symptoms, lower life satisfaction, lower positive affect, higher negative affect, and lower perceived autonomy). Asymmetric fixed effects regressions analysis showed that the onset of FOF was associated with reduced life satisfaction as well as reduced autonomy, whereas the end of FOF was associated with reduced depressive symptoms, decreased loneliness scores, as well as decreased negative affect.Conclusions: The study findings suggest that future studies should analyze the consequences of FOF differently (onset and end of FOF) which has practical important implications. More specifically, while strategies to avoid the onset of FOF may help to maintain satisfaction with life and autonomy, strategies to end FOF may contribute to avoid increased loneliness, feelings of negative affect, as well as increased depressive symptoms. J Am Geriatr Soc 68:-, 2020. [ABSTRACT FROM AUTHOR]

Objectives: Age-related hearing loss (ARHL) is a prevalent condition associated with increased risk for depression and cognitive decline. This 12-week prospective, double-blind pilot randomized controlled trial (RCT) of hearing aids (HAs) for depressed older adults with ARHL evaluated the feasibility of a novel research design.Methods/design: N = 13 individuals aged ≥60 years with Major Depressive Disorder or Persistent Depressive Disorder and at least mild hearing loss (pure tone average ≥ 30 dB) were randomized to receive full- (active) vs low-amplification (sham) HAs added to psychiatric treatment as usual. Duration of HA use in hours/day, adverse events frequency, attrition rate, and maintenance of the study blinding were the primary outcome measures.Results: Compliance with HAs was excellent (>9 hours/day for both groups) and rates of adverse events and drop-outs did not differ between groups. Preliminary data demonstrated differential improvement for active vs sham HAs on hearing functioning (Hearing Handicap Inventory for the Elderly [nonparametric effect size (np-ES) = 0.62]), depressive symptoms (Inventory for Depressive Symptomatology [np-ES = 0.31]), cognition (Repeatable Battery for the Assessment of Neuropsychological Status Immediate Memory [np-ES = 0.25]), and general functioning (World Health Organization Disability Assessment Schedule [np-ES = 0.53]). Significantly greater than 50% of both groups correctly guessed their treatment assignment, indicating incomplete concealment of treatment allocation.Conclusions: This pilot RCT for ARHL and late-life depression was feasible to execute and showed clinical promise, but improved methods of blinding the experimental treatments are needed. Larger studies should investigate whether hearing remediation may be an effective preventative and/or therapeutic strategy for late-life depression and cognitive decline. [ABSTRACT FROM AUTHOR]

Objectives: Intensive control of hypertension has been reported to decrease risk of cognitive decline. However, the effect of this in older adults with hypertension and comorbid depression is not well understood. We aim to identify whether intensive control of systolic blood pressure (BP) is associated with reduced risk of Alzheimer's dementia (AD) in a clinical population.Methods: Using data from the National Alzheimer's Coordinating Center, we conducted survival analyses in older adults with normal cognition at baseline and treated hypertension. We also examined those with comorbid depression, to determine if intensive control of systolic BP (≤120 mmHg) was associated with reduced risk of AD.Results: In all older adults with treated hypertension (n = 4505), 298 (6.6%) developed AD during a median follow-up duration of 4.2 years. In the comorbid depression subgroup (n = 1327), 152 (11.5%) developed AD. Intensive control of systolic BP was not significantly associated with reduced risk of AD in the overall sample (HR 1.13, 95%, 0.79-1.64). However, in the comorbid depression subgroup, intensive control of systolic BP (≤120 mmHg) was associated with increased risk of AD (HR 1.49, 95%, 1.03-2.15) compared to standard control (121-139 mmHg).Conclusions: In a clinical population of older adults with hypertension and comorbid depression, we found that an intensive systolic BP target of ≤120 mmHg was associated with increased risk of AD. While these findings are preliminary, they suggest that a more cautious approach to hypertension treatment may be warranted in this vulnerable subgroup. [ABSTRACT FROM AUTHOR]

Aim: The aims of this study were to describe the prevalence of screening-positive depression and to identify the frequency and factors related to self-reported depression diagnosis in people with screen-positive depression.Methods: Using the Geriatric Depression Scale (GDS-15), 4065 older Chileans were screened for depression. Social and health variables were included. Self-reported depression diagnosis and antidepressant use were analyzed according to screen-positive depression (GDS-15 ≥ 5). Chi-square and logistic regression analyses were conducted to identify factors related to screen-positive depression, and self-reported diagnosis and current antidepressant use.Results: Overall, mean age was 71.0 years, 60.9% women, and 71.4% had ≤8 years of education. 28.3% of the population screened positive for depression (mild: 21.7%; moderate-severe: 6.5%). Only 35.9% of screen-positive depression individuals self-reported a depression diagnosis (mild: 32.6%; moderate-severe: 47.0%), with significant differences between the sexes (women: 42.2%; men: 22.5%; P < .01). No education (OR = 2.00, 95% CI = 1.20-3.32), multimorbidity (OR = 1.88, 95% CI = 1.42-2.48), dependence (OR = 4.14, 95% CI = 3.11-5.51) and pain (OR = 2.49, 95% CI = 2.01-3.07) were related to screen-positive depression. In people screen-positive depression, men (OR = 0.48, 95% CI = 0.35-0.65) and 80 years or older were less likely to self-report depression diagnosis (OR = 0.35, 95% CI = 0.23-0.54), and current antidepressant use (OR = 0.31, 95% CI = 0.14-0.70).Conclusions: A high prevalence of depressive symptoms and low agreement with self-reported depression is observed. There is a need to increase the diagnosis of depression especially in men and people 80 years or older. [ABSTRACT FROM AUTHOR]

Objectives: Patient expectations of treatment effects could influence neuropsychological and clinical outcomes in clinical trials of behavioral and lifestyle interventions, which could potentially confound the interpretation of findings. Our aim was to examine whether patient expectancy mediated effectiveness of Mindfulness-Based Stress Reduction (MBSR) for improving cognitive function and clinical outcome.Methods: The present study uses data from a single-blind, multi-site, randomized controlled trial comparing MBSR to a health education attention control in older adults with anxiety and/or depressive disorders and subjective cognitive concerns. Using the Credibility and Expectations Questionnaire, we measured expectancy and perceived credibility of the interventions assigned to patients. Using mediational analysis, we examined the influence of expectancy and credibility on two key outcomes: memory performance and clinical global improvement.Results: Neither expectancy nor perceived credibility of intervention accounted significantly for MBSR's effectiveness for memory test performance or clinical global improvement.Conclusion: In this clinical trial, expectancy for improvement did not account for the effectiveness of MBSR on memory performance or clinical outcomes in depressed and anxious older adults. We advise that clinical trials of behavioral and lifestyle interventions for brain health in older adults should measure and test the role of expectancy. [ABSTRACT FROM AUTHOR]

Objective: The transition from hospital to home is a period where older adults are at risk of experiencing depressive symptoms. The present study applied the Social Antecedent Model of Psychopathology (SAMP) to identify factors present at hospital discharge associated with depressive symptoms at discharge and future symptoms at 3- and 6-month post-discharge home.Method: 286 older adults aged over 65 (M = 78.38, SD = 7.68, 57% female) reported on a range of variables that were mapped to the SAMP at hospital discharge, 3- and 6-month post-discharge.Results: At baseline assessment, male gender, increased anxiety symptoms, low social support and low perceived coping ability were associated with concurrent baseline depressive symptoms. Depressive symptoms at baseline were strongly associated with future depressive symptoms at 3- and 6-month post-discharge. Low household physical activity was also associated with depressive symptoms at 3 months and elevated baseline anxiety symptoms and low social support were associated with depressive symptoms at 6-month post-discharge.Conclusion: Pre-discharge screening of depressive and anxiety symptoms, social support, household physical activity and coping ability may assist in identifying elderly patients at risk of developing depressive symptoms during the hospital-to-home transition. These factors may also serve as potential targets for preventative interventions post-discharge for older adults. [ABSTRACT FROM AUTHOR]

Background: Air pollution, especially PM2.5 (particulate matter with a diameter of below 2.5 μm), has been recognized as a key environmental factor that affects mental health, but few studies have focused on its influence on older adults, who are a vulnerable group.Objective: This study focused on the influence of PM2.5 on health-related behaviors, such as physical activities and social contact, to assess their role as mediators of depression among older adults in China.Methods: We used data (N = 24 623) from the CHARLS (China Health and Retirement Longitudinal Study) of 2011-2015. CES-D 10 (Center for Epidemiology Studies of Depression scale) was used to measure depression. Using multilevel linear models, we examined the relationships between the variables, with different times nested within the same individual and individuals nested within the cities.Results: Before mediators were added, depression symptoms among older adults increased with annual concentration of PM2.5 (Coeff = 0.57, SE = 0.11). However, after the mediators were added, the coefficient of the annual concentration of PM2.5 decreased (Coeff = 0.37, SE = 0.10). While both physical activities (Sobel test Z score = 2.37, P value = .02) and social contact (Z score = 7.33, P value = .00) mediated the relationship between PM2.5 and depression, the mediating effects decreased with increasing PM2.5 .Conclusions: Exposure to PM2.5 , therefore, increases depressive symptoms in older Chinese adults by decreasing their physical activities and social contact. Also, the positive effects of physical activities and social contact on depression decreased with increasing PM2.5 concentrations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Anxiety and depression are common and deleterious comorbidities in people living with dementia (PLWD). Cognitive behavioural therapy (CBT) is one of the few promising treatments; however, it is unclear whether PLWD have the necessary prerequisites to engage in this. Having an understanding of cognitive mediation, that a thought mediates the relationship between an antecedent event and its emotional consequence, is key for engaging with CBT and is also a critical component of emotion regulation. There are no measures of this construct validated for PLWD. This study aims to adapt and validate an existing measure for this population. A secondary aim is to assess its applicability in older adults (OA) without a recognised neurocognitive impairment.Methods: A measure of cognitive mediation was adapted via expert and service user consultation for use in PLWD. A total of 102 PLWD and 77 OA without neurocognitive impairments completed the adapted measure along with two measures of emotion recognition and reasoning. Factor structure was examined separately in both samples, and the measure reduced, with convergent validity assessed.Results: A final measure of 10 items (named the CM-Dem) was subject to factor analysis yielding a single factor solution. The measure showed good psychometric properties in PLWD, including good model fit, high internal consistency, inter-rater reliability, and moderate convergent validity with related constructs. In contrast, poor validity was found in OA, especially a lack of convergent validity.Conclusions: The CM-Dem has clinical and research utility as a measure of cognitive mediation in PLWD, but less so in OA. [ABSTRACT FROM AUTHOR]