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Objective: Despite the effectiveness of electroconvulsive therapy (ECT), patients and practitioners are often reluctant to start it due to the risk of transient cognitive side effects, particularly in older patients. Inflammatory processes may be associated with the occurrence of these effects. This study assessed whether inflammatory markers prior to ECT are associated with cognitive functioning in depressed patients treated with ECT., Methods: Between 2011 and 2013, 97 older patients (mean [SD] age = 73.1 [8.1] years) with severe unipolar depression (according to DSM-IV ) referred for ECT were included. Mini-Mental State Examination (MMSE) scores were used to determine cognitive functioning prior to, weekly during, and in the first week after a course of ECT. Serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) were assessed prior to ECT., Results: In fully adjusted models, there was an association between TNF-α and cognitive functioning (β = -1.05; 95% CI, -2.04 to -0.06; f 2  = 0.06). An association was also found between baseline levels of IL-10 and TNF-α and lower MMSE scores during ECT (IL-10: β = -2.08; 95% CI, -3.22 to -0.95; TNF-α: β = -0.65; 95% CI, -1.07 to -0.22). In addition, an association was found between baseline CRP and lower MMSE scores directly after a course of ECT (β = -0.51; 95% CI, -0.93 to -0.09; f 2  = 0.10). Associations with IL-6 did not reach significance., Conclusions: This study suggests that inflammatory processes are associated with lower cognitive functioning prior to ECT and predispose for further cognitive dysfunction during and after a course of ECT., Trial registration: ClinicalTrials.gov identifier: NCT02667353., (© Copyright 2021 Physicians Postgraduate Press, Inc.)

Background: Older age patients with bipolar disorder (OABD) have often passive coping styles, generally considered as detrimental for functioning. The aim of the current study is to identify the contribution of cognitive functioning, subjective cognitive complaints and mood symptoms to passive and active coping styles in older age BD., Methods: In 90 euthymic patients (age > 60) with BD I or II, we examined coping, neuropsychological profile including memory, attention, executive function and fluency, subjective cognitive complaints and mood symptoms., Results: Better executive functioning and fewer depressive symptoms were associated with more active coping (p = .02 and p = .001 respectively). Associations between executive functioning and coping styles turned nonsignificant when combined with depressive symptoms in one model, indicating the importance of mood on coping styles. No associations were found between subjective cognitive complaints and coping styles., Limitations: Cross-sectional data were used and no conclusions about causality can be made., Conclusions: Even in euthymic patients, subclinical depressive symptoms may influence active coping negatively. Subjective cognitive complaints and objectified cognitive functioning seem to be of less importance for coping styles. Important implications are on the one hand optimizing treatment on reducing depressive symptoms and on the other hand focusing therapeutic interventions on coping in bipolar patients., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Superior cognitive functioning for electroconvulsive therapy (ECT) with right unilateral (RUL) ultrabrief pulse (UBP) stimulation compared to RUL brief pulse (BP) stimulation is not clearly established and long-term data is needed., Methods: We conducted a prospective naturalistic follow-up of 87 inpatients from three tertiary psychiatric hospitals. Before these patients entered the follow up phase, they had participated in a RCT comparing twice weekly RUL BP (1.0 ms) with RUL UBP (0.3-0.4 ms) ECT eight times seizure threshold until remission (MADRS < 10), for a maximum of six weeks. Three and six months after the index ECT patients were monitored for relapse and cognitive performance (retrograde amnesia, semantic memory and lexical memory). We compared relapse rate and cognitive performance between RUL BP and RUL UBP stimulation., Results: Of the 50 patients who remitted after index ECT 44 (24 BP; 20 UBP) were monitored for follow up. Relapse occurred in 25% of the BP group and in 25% of the UBP group (χ(2) = 0.00, p = 1.0) at three-month follow-up; whereas 43.5% of the BP group and 35% of the UBP group relapsed (χ(2) = 0.322, p = 0.57) at six months follow-up. Cognitive assessments (17 BP; 16 UBP) showed no significant differences between BP and UBP groups, except for an advantage for the BP group in the autobiographical incident questions at three months follow-up only (p = 0.04; d = 0.77)., Limitations: This study may be limited since relapse in a naturalistic follow-up can be influenced by medication and other unknown factors, like social support, medical comorbidity, and psychotherapy. The small numbers of our subgroups hamper statistical significance., Conclusions: Patients that achieved remission after RUL BP or RUL UBP ECT showed similar relapse rates after three and six months. There was no cognitive advantage of UBP over BP ECT in follow up., Clinical Trials Registration: Netherlands trial register www.trialregister.nl registration number NTR1304., (Copyright © 2015. Published by Elsevier B.V.)

Background: Late-life depression is a heterogeneous disorder, whereby cognitive impairments are often observed. This study examines which clinical characteristics and symptom dimensions of late-life depression are especially impacting on specific cognitive domains., Methods: Cross-sectional data of 378 depressed and 132 non-depressed older adults between 60-93 years, from the Netherlands Study of Depression in Older adults (NESDO) were used. Depressed older adults were recruited from both inpatient and outpatient mental healthcare institutes and general practices, and diagnosed according to DSM-IV-TR criteria. Multivariable associations were examined with depression characteristics (severity, onset, comorbidity, psychotropic medication) and symptom dimensions as independent variables and cognitive domains (episodic memory, processing speed, interference control, working memory) as dependent variables., Results: Late-life depression was associated with poorer cognitive functioning. Within depressed participants, higher severity of psychopathology and having a first depressive episode was associated with poorer cognitive functioning. The use of tricyclic antidepressants, serotonergic and noradrenergic working antidepressants, and benzodiazepines was associated with worse cognitive functioning. Higher scores on the mood dimension were associated with poorer working memory and processing speed, whereas higher scores on a motivational and apathy dimension were associated with poorer episodic memory and processing speed., Conclusions: Heterogeneity in late-life depression may lead to differences in cognitive functioning. Higher severity and having a first depressive episode was associated with worse cognitive performance. Additionally, different domains of cognitive functioning were associated with specific symptom dimensions. Our findings on the use of psychotropic medication suggest that close monitoring on cognitive side effects is needed.

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

Objective: Should we treat older, patients with depression with white matter hyperintensities (WMH) with electroconvulsive therapy (ECT)? WMH, inflammation, depression and cognitive functioning are suggested to be intertwined. Hence, this study investigates whether the association between inflammation and cognition is different in patients with depression with or without WMH.Methods: Cognitive functioning was assessed using the Mini-Mental State Examination during and after a course of ECT in 77 older patients with depression. Serum samples (C-reactive protein [CRP], interleukin-6 [IL-6], interleukin-10 [IL-10] and tumour necrosis factor-alpha [TNF-α]) and 3T magnetic resonance imaging were obtained prior to ECT.Results: An interaction effect was found for IL-10, but not for CRP, IL-6 or TNF-α.Conclusion: In general, the association between inflammatory markers and cognition in patients with depression treated with ECT is not different in patients with WMH compared to patients without WMH. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment in patients with bipolar disorder (BD) is viewed as an integral part of the disorder that seems to be rather stable and even present in euthymic state. Current mood symptoms influence cognition negatively and multiple mood episodes could lead to more severe psychopathology and cognitive impairment, resulting in a hypothesized neuroprogressive course of BD. The influence of current mood symptoms and recurrent mood episodes on cognitive functioning warrants further exploration.Methods: Cohort 1 included 20 hypomanic and 21 depressed older adults with bipolar disorder (OABD) of which 20 were reassessed in the euthymic state and 50 healthy subjects. Cohort 2 included 27 OABD who had no recurrent mood episodes during 5 years and 29 who had recurrent mood episodes during 5 years. Neuropsychological examination including tests for memory, executive function, attention and verbal fluency was performed repeatedly in all subjects.Results: In cohort 1 cross-sectional analyses showed that hypomanic, depressed and euthymic patients groups did not differ from each other with respect to their cognitive functioning, except for attention, which was poorer only in depressed patients. Regardless of mood state patients experienced significantly worse cognitive functioning compared to the healthy subjects. Within subject comparisons revealed that performance on memory tasks was worse in patients with current mood symptoms; depressed patients were more impaired in the learning condition and hypomanic patients were more impaired in delayed recall. In cohort 2 cognitive functioning was not different in patients with or without recurrence in 5 year follow-up.Conclusions: Although OABD had worse cognitive functioning than healthy subjects, there was a quite stable pattern of cognitive impairment, regardless of current or recurrent mood episodes. These results do not provide consistent support for the hypothesis of neuroprogression in BD. [ABSTRACT FROM AUTHOR]

Objective: Electroconvulsive therapy (ECT) is an effective treatment for severe late-life depression; however, ECT-induced cognitive side effects frequently occur. The cholinergic system is thought to play an important role in the pathogenesis. We systematically reviewed the evidence for acetylcholinesterase inhibitors (Ache-I) to prevent or reduce ECT-induced cognitive side effects.Methods: A systematic search was performed in Pubmed, EMBASE, PsychINFO, and the Cochrane database to identify clinical trials investigating the effect of Ache-I on ECT-induced cognitive side effects. Key search terms included all synonyms for ECT and Ache-I. Risk of bias assessment was conducted by using the Cochrane Collaboration's tool.Results: Five clinical trials were eligible for inclusion. All studies focused on cognitive functioning as primary endpoint, but assessment of cognitive functioning varied widely in time point of assessment and in cognitive tests that were used. There was also great variety in study medication, route and time of administration and dosages, duration of drug administration, and ECT techniques. Finally, only two out of five studies were considered at low risk of bias. Despite the aforementioned shortcomings, without exception, all studies demonstrated significantly better cognitive performance in individuals treated with Ache-I.Conclusions: Despite large heterogeneity in studies, Ache-I appear to have beneficial effects on ECT-induced cognitive side effects, supporting an association with the cholinergic system in ECT-induced cognitive impairment. Methodological sound studies controlling for putative confounders are warranted. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To identify clinically relevant subtypes of apathy in older persons using latent class analysis (LCA) and investigate the distribution of different characteristics across these subtypes.Measurements: Cross-sectional data of 122 older persons (mean age 84 years, 60% female) participating in the general population-based PROactive Management Of Depression in the Elderly study, with apathy according to a score of 14 or higher on the Apathy Scale, were included for LCA. All 14 items of the Apathy Scale were used as indicator variables. Several characteristics were examined including sociodemographics, depressive, and anxiety symptoms; global cognitive function; quality of life indicators; hazardous alcohol intake (drinking ≥ 14 consumptions per week); and perceived chronic pain.Results: Three distinct LCA classes were found classifying 17%, 7%, and 76% of the participants respectively. Individuals in the first class had a higher level of education and were less likely to live alone. Those in the second class had higher apathy and depression scores, lived more frequently alone and used more alcohol. Individuals in the third class showed a lower level of education and worse cognitive function. In multivariable multinomial analyses, only a lower educational level and higher scores on the Apathy Scale were significant predictors for class membership.Conclusion: Differences between LCA-derived classes were minimal, suggesting that in a general population-based cohort the Apathy Scale measures a homogeneous construct. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To date, cognitive impairment has been thought to be an integral part of bipolar disorder. In clinical staging models, cognitive impairment is one of the hallmarks to define the clinical stage and it plays an important role in identifying the risk factors for progression to later stages of the illness. It is important to examine neurocognitive performance over longer periods to test the hypothesis of neuroprogression of bipolar disorder. Methods A comprehensive neuropsychological test battery was applied at baseline and five years later to 56 euthymic older outpatients with bipolar disorder (mean age = 68.35 years, range: 60-90 years) and to a demographically matched sample of 44 healthy subjects. A group-by-time repeated measures multivariate analysis of variance was performed to measure changes over time for the two groups. The impact of baseline illness characteristics on the intra-individual change in neurocognitive performance within the bipolar disorder group was studied by using logistic regression analysis. Results At baseline and at follow-up, patients with bipolar disorder performed worse on all neurocognitive measures compared to the matched healthy subjects. However, there was no significant group-by-time interaction between the patients with bipolar disorder and the comparison group. Conclusions Although older patients with bipolar disorder had worse cognitive function than healthy subjects, they did not have greater cognitive decline over a five-year period. The change in acquired cognitive impairment of patients with bipolar disorder might parallel the cognitive development as seen in normal aging. [ABSTRACT FROM AUTHOR]

Background:It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT.Methods:In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied.Results:Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes.Conclusions:In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT. [ABSTRACT FROM AUTHOR]

Schouws SNTM, Stek ML, Comijs HC, Dols A, Beekman ATF. Cognitive decline in elderly bipolar disorder patients: a follow-up study. Bipolar Disord 2012: 14: 749-755. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: Older individuals with bipolar disorder may exhibit greater cognitive decline over time compared to mentally healthy elderly individuals. We aimed to investigate neurocognitive performance in bipolar disorder over a period of two years. Methods: A comprehensive neuropsychological test battery was applied at baseline and two years later to 65 euthymic elderly outpatients with bipolar disorder (mean age = 68.35, range: 60-90 years) and to a demographically comparable sample of 42 healthy elderly controls. A general linear model was used to measure changes over time for the two groups. The impact of baseline illness characteristics on intra-individual change in neurocognitive performance within the bipolar group was studied by using logistic regression analysis. Results: At baseline and at follow up, bipolar disorder patients performed worse on all neurocognitive measures compared to the healthy elderly group. However, there was no significant group-by-time interaction between the bipolar disorder patients and the comparison group. Conclusions: Although older bipolar disorder patients have worse cognitive function than normal controls, they did not have greater cognitive decline over a period of two years. [ABSTRACT FROM AUTHOR]

Background: Late onset disorders are often associated with cerebral disfunctioning and cognitive impairment in elderly patients. It is unknown whether the age of onset affects cognition in patients with bipolar disorder. The authors compare cognition and clinical characteristics of early- and late-onset bipolar patients in a stable and euthymic condition. Method: One hundred and nineteen older patients (age >60) with an early- (<40 years) or late-onset bipolar disorder and a group of 78 comparison subjects were extensively tested for cognitive functioning. Results: Bipolar subjects scored lower on most cognitive measures. The late-onset patients were more impaired in psychomotor performance and mental flexibility than the early-onset patients. These differences could not be explained by differences in exposure to cerebrovascular risk factors. Conclusions: Older patients with bipolar disorder have substantial cognitive impairments. Late onset bipolar disorder is associated with more severe cognitive impairment than early-onset bipolar disorder. For clinical practice, it is important to develop treatment strategies which take this into account. [ABSTRACT FROM AUTHOR]

Background Electroconvulsive therapy (ECT) as a single course or in maintenance form (M-ECT) is an effective treatment in depressed elderly. However, ECT may have adverse effects on cognition. Objective To review all studies from 1980–2006 on ECT and cognition in the elderly with a minimum age of 55 years or a mean age of 55 years, and with valid measurements of cognition before and after ECT. Results Nine out of the 15 eligible studies were focused exclusively on the elderly. Three studies reported verbal learning- and recall problems post ECT, while three studies found positive effects of ECT on memory, speed of processing and concentration. Global cognitive functioning in patients with cognitive impairment improved in all studies. At follow up, most studies reported improvement of cognitive functions. Learning verbal information and executive functioning were impaired in M-ECT patients whereas global cognition remained stable after M-ECT over a year. Conclusions To date research of ECT on cognitive functioning in the elderly is very limited. Small sample size, lack of controls, use of a single screening instrument and a short follow up period may explain the conflicting results. Given the clinical importance, more extensive research on cognition in elderly treated with ECT is urgently needed. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To examine the temporal relation between depression and cognitive impairment in old age. Design Prospective, population based study with four years of follow up. Setting City of Leiden, the Netherlands. Participants 500 people aged 85 years at recruitment. Main outcome measures Annual assessments of depressive symptoms (15 item geriatric depression scale), global cognitive function (mini-mental state examination), attention (Stroop test), processing speed (letter digit coding test), and immediate and delayed recall (12 word learning test). Results At 85 years old, participants' depressive symptoms and cognitive impairment were highly significantly correlated (P < 0.001). During follow up, an accelerated annual increase of depressive symptoms was associated with impaired attention (0.08 points (95% confidence interval 0.01 to 0.16)), immediate recall (0.17 points (0.09 to 0.25)), and delayed recall (0.10 points (0.02 to 0.18)) at baseline. In contrast, depressive symptoms at baseline were not related to an accelerated cognitive decline during follow up (P> 0.05). Conclusion Caregivers should be aware of the development of depressive symptoms when cognitive impairment is present. However, the presence of depression only does not increase the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

Abstract: Background: Neurocognitive functioning is well known to be affected after ECT. However quantified data about the severity of the cognitive impairment after ultrabrief pulse and brief pulse ECT are limited, which makes it hard to judge its clinical relevance. Methods: To review all prospective studies using right unilateral (ultra) brief pulse index electroconvulsive therapy published up until February 2011 which used at least one instrument for cognitive assessment before and after ECT. The severity and persistence of neurocognitive side effects immediately (one to seven days post ECT), between one and six months and after six months post ECT were assessed by calculating effect sizes using Cohen''s d. Results: Ten studies fulfilled the inclusion criteria and provided detailed information to compute effect sizes. The results indicate loss of autobiographical memory and impairment of verbal fluency, anterograde verbal and non-verbal memory immediately after brief pulse RUL ECT. To a lesser extent impairment of working memory and reduced speed of processing is found. Autobiographical memory is the only domain still being impaired between one and six months post ECT, but improved in this period. Verbal fluency normalized to baseline performance between one and six months post ECT whereas anterograde verbal and non-verbal memory normalized or even improved. Speed of processing improved within six months after ECT. Long-term data on these cognitive domains were not available. Based on two of the ten included studies the results suggest that ultrabrief pulse RUL ECT causes less decline in autobiographical and anterograde memory after ECT than brief pulse RUL ECT. Limitations: This review may be limited because of the small number of included studies and due to unreliable effect sizes. Furthermore, few data were available for non-memory domains and cognitive functioning after six months. Conclusions: Loss of autobiographical memory is still present between one and six months after unilateral brief pulse ECT. Ultrabrief pulse RUL ECT shows less decline in autobiographical memory. Other neurocognitive impairments after brief pulse RUL ECT seem to be transient. [Copyright &y& Elsevier]

Abstract: Background: Symptomatic remission and its associated factors have been evaluated in several studies of younger schizophrenic patients. Although the number of older individuals with schizophrenia is rapidly growing, evaluations of remission in elderly patients are scarce and limited to samples of convenience, questioning their generalizability to unselected patient populations. Methods: We assessed the rate of symptomatic remission in a cohort of older Dutch schizophrenic patients within a psychiatric catchment area. In addition, we examined the association of symptomatic remission with measures of mental health treatment, social functioning, cognition, mood, and quality of life. Results: With a rate of 29.4%, symptomatic remission in this catchment area based cohort of older schizophrenic patients (mean age 68years) was markedly lower than the rates reported for convenience samples. Remission was more frequent in schizoaffective patients, compared to patients with schizophrenia. Remitted patients were more adherent to psychiatric services and scored higher on measures of social functioning. No association with symptomatic remission could be demonstrated for cognition, mood, and quality of life. Conclusion: The modest rate of symptomatic remission in this treated sample of elderly schizophrenic patients questions the notion that old age is associated with high levels of symptomatic remission. The concurrent validity of the remission concept in elderly patients merits further investigation, given the limited number of demonstrated associations. [Copyright &y& Elsevier]