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Objectives: A growing literature suggests depression and anxiety increase risk of cognitive decline. However, few studies have examined their combined effects on cognition, among older adults, especially during periods of high stress., Method: Based on a sample of community dwelling older adults ( N  = 576), we evaluated the effects of pre-pandemic anxiety and depressive symptoms, obtained in September 2018, to changes in self-reported memory (SRM) assessed 3 months into the COVID-19 pandemic., Results: In separate models, we found participants with depression scores at least 1-SD above the mean and participants with anxiety scores at least 2-SD above the mean to report a significant decline in SRM. Moderation analyses revealed those with high depressive symptoms (at or above the mean) showed a decrease in SRM regardless of anxiety. The extent to which high pre-pandemic anxiety symptoms influenced SRM is dependent on whether pre-pandemic depression was at or above the mean., Conclusions: Pre-pandemic depression predicted a decline in SRM regardless of anxiety. Moderation analyses revealed that the extent to which anxiety symptoms influenced SRM was dependent on depression being at or above the mean. Those with high anxiety and depression are at highest risk of experiencing cognitive consequences related to stressful exposures like COVID-19.

Objectives: Although socioemotional selectivity (SST) suggests that people experience more positive affect as they age, symptoms of anxiety and depression persist and are often greater in older women than men. Coping strategies may influence the extent to which older adults experience these symptoms. The purpose of the current study is to examine possible gender differences in the use of an adaptive (cognitive reappraisal (CR) and a maladaptive (emotive suppression (ES) emotion regulation strategy in relation to depressive and anxiety symptoms., Method: Our study uses cross-sectional data drawn from a community sample of older adults (60+; n  = 906). We used OLS regression and moderation analyses to test our study hypotheses., Results: Gender moderated the association between CR in both depressive and anxiety symptoms. Women reported greater use of CR relative to men. Further, CR use was negatively related to symptoms of anxiety and depression in women, but not men. In contrast, men used ES more frequently than women, though older men and women's use of ES was unrelated to anxiety or depressive symptoms., Conclusion: Our findings provide initial evidence that greater CR use in older women is related to lower symptoms of both anxiety and depression relative to older men. Age-related increases in CR use (e.g. SST) among women may serve to decrease anxiety and depression symptoms. Findings suggest decreasing anxiety and depressive symptoms via CR may benefit older women more than older men. Future research is needed to identify the coping strategies that are most beneficial for men.

Objectives: There is an association between depression and diminished social support; indeed, interpersonal dysfunction is often a central feature of depression. The purpose of this study is to examine the role that an emotion regulation (ER) strategy, cognitive reappraisal, plays in influencing the association between depressive symptoms and perceived social support in older adults., Method: Data for this cross-sectional study come from a community-based survey of older adults (60+, N  = 910). We examined the effects of depressive symptoms and cognitive reappraisal on perceived social support. We then examined the potential moderating role of cognitive reappraisal on the association between depressive symptoms and perceived social support., Results: Depressive symptoms were associated with lower levels of perceived social support. Cognitive reappraisal was associated with higher levels of perceived social support. Cognitive reappraisal moderated the negative consequences of depressive symptoms on perceived social support. Whereas depressive symptoms had a negative effect on perceived social support, the negative effect was greater for those with lower levels of cognitive reappraisal compared to those with higher levels of cognitive reappraisal., Discussion: ER strategies may play a role in attenuating the negative consequences of depressive symptoms on social support in older age. It may be possible to help individuals maintain social support in later life, even in the face of mental health challenges, if they cultivate ER skills.

The Diagnostic Statistical Manual-5 (DSM-5) has included a category named the neurocognitive disorder which was formally known in DSM-IV as 'dementia, delirium, amnestic, and other cognitive disorders'. The DSM-5 distinguishes between 'mild' and 'major' neurocognitive disorders. Major neurocognitive disorder replaces the DSM-IV's term 'dementia or other debilitating conditions'. A pivotal addition is 'mild neurocognitive disorder (mNCD)' defined by a noticeable decrement in cognitive functioning that goes beyond normal changes seen in aging. It is a disorder that may progress to dementia - importantly, it may not. Presently, our understanding of mNCD is derived from research on mild cognitive impairment (MCI). Whereas there is currently no clear treatment for mNCD, many experimental therapies now and into the future will focus upon secondary prevention, namely decreasing the risk of progression to major NCD. In this article, we will focus on mNCD by reviewing the relevant literature on MCI. We will review the research on the incidence and prevalence of MCI, conversion rates from MCI to dementia, risk factors for conversion of MCI to dementia, comorbidity of MCI with other neuropsychiatric disorders (NPS), and the development of treatment strategies for neuropsychiatric disorders in MCI. The presence of NPS is common among individuals with MCI and is an important risk for progression to dementia. However, there has been little research on effective treatments for NPS in MCI. Clinicians and investigators must determine if the treatment of the NPS in mNCD will improve quality of life and help reduce the progression of the cognitive impairment.

Rumination is a cognitive process that involves repetitively focusing on the causes, situational factors and consequences of one's negative emotion, and it is a potent risk factor for depression. Parental depression and neuroticism may exert an influence on offspring's development of rumination, which may increase offspring's risk for depression. The current study included 375 biological parent-offspring dyads. Parents were assessed for depressive symptoms and neuroticism; adult offspring were assessed for depressive symptoms and rumination. Structural equation modelling was used to examine the effects of parental depressive symptoms and parental neuroticism on adult offspring's depression, and to determine whether offspring's rumination mediated this relationship. Results provided evidence that offspring's rumination fully mediated the relationship between parental neuroticism and offspring's depressive symptoms. Parental depressive symptoms and neuroticism may contribute a genetic predisposition for depressive symptoms in offspring, but it also may promote an environment in which maladaptive cognitive processes, such as rumination, are learned. Given the role that rumination plays in mediating the association between neuroticism and depressive symptoms-targeting rumination in the treatment of high risk individuals would be important in reducing onset of depressive disorders., (Copyright © 2014 John Wiley & Sons, Ltd.)

Older adults with major depressive disorder (MDD) may also have preclinical Alzheimer's disease (AD). Differential diagnosis is quite challenging due to the overlapping symptoms of MDD and AD. In the current study, we predicted that impaired long-term memory (an area most affected in early AD), but not executive function (an area affected in MDD and AD), would distinguish older depressed patients who developed AD from those who did not. Patients (N = 120) assessed as having MDD but not dementia at baseline were administered tests of cognitive function and followed longitudinally for subsequent diagnosis of AD. Using structural equation modeling we found a latent construct of long-term memory to be associated with AD to a greater extent than executive functioning. Additional analyses to enhance clinical utility of findings indicated that individual tests of episodic memory were most predictive of AD status. Tests of long-term memory can be utilized by the clinician when assessing for preclinical AD among depressed elderly.

Objectives: Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes., Method: At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery-Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging., Results: Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD., Conclusions: EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Objective: The aim of this study was to develop and test a model of depression, hippocampal changes, and cognitive decline., Method: Participants were 248 community-dwelling, depressed patients and 147 healthy, non-depressed individuals 60 years and older. Participants received a structured interview assessing current depressive symptoms and past depressive episodes, completed cognitive testing with the Mini Mental State Examination (MMSE), and underwent structural Magnetic Resonance Imaging (MRI) of the brain. For up to 10 years, assessment of depressive symptoms and MMSE administration was repeated at least annually, and MRI was repeated every two years., Results: Regression analyses demonstrated that depression diagnosis at baseline predicted decrease in right (but not left) hippocampal volume over a four-year period. Analyses using structural equation modeling demonstrated that a decrease in left and right hippocampal volumes predicted decrease in MMSE score over four years., Conclusion: Results provide some evidence for relationships between depression and decrease in right hippocampal volume, and between hippocampal volume and MMSE score. This would be consistent with depression as a causal factor in subsequent cognitive decline. Plausible biological mechanisms include a glucocorticoid cascade or a facilitating effect of depression on amyloid-beta plaque formation. Future studies should examine the relationship between hippocampal volume and specialized memory measures, as well as between depression diagnosis and volume of other brain structures.

Objectives: The apolipoproteinE epsilon4 (APOE epsilon4) allele and a history of depression are each separate risk factors for cognitive decline (CD). However, little research has investigated whether a history of depression influences the relationship between APOE epsilon4 and CD. The present study examined whether depressive symptoms had greater influence on subsequent CD among participants with APOE epsilon4 than those without the allele., Design: Prospective 6-year longitudinal study., Setting: Community in-home interviews., Participants: A biracial sample of community dwelling older adults (N = 1,992) from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE)., Measurements: Data were drawn from Waves 1 to 3 of the EPESE, which were conducted 6 years apart. Cognitive functioning and depressive symptoms were assessed at both waves, and APOE genotyping was completed during the Wave 3 assessment., Results: Regression analyses revealed that depressive symptoms and the APOE epsilon4 allele independently predicted CD. Importantly, the influence of depressive symptoms on CD was greater for individuals with the APOE epsilon4 allele compared with those without the allele., Conclusion: Depressive symptoms and the APOE epsilon4 allele are independent contributors to CD. Moreover, the influence of depressive symptoms on CD is greater among individuals with the APOE epsilon4 allele. Depression and the APOE epsilon4 allele may act together in disrupting neurological functioning, which may in turn lower an individual's cognitive reserve capacity. Given the efficacious treatments currently available for depression, future research should investigate the extent to which interventions for depression may reduce the risk for subsequent CD.

Based on clinical experience, anecdotal reports, and past empirical and conceptual work, we predicted that when people with narcissistic tendencies experience depressive symptoms, they are prone to develop paranoid attitudes. Moreover, we expected that this process was unidirectional, and that the combination of paranoid tendencies and depressive symptoms would not be associated with an increase in narcissistic symptoms. In both cases, results from our 6-month longitudinal study of 71 previously suicidal adults conformed to our expectations.

Objective: Although the long-term health risks associated with obesity in older adults have been well documented, less is known about the psychological consequences. The current study examined the relationship between body mass index (BMI) and subsequent depressive symptoms. The authors anticipated that BMI would predict depressive symptoms, and that this relationship would be greater among women, individuals of higher socioeconomic status (SES), and white subjects., Methods: A three-year longitudinal epidemiological design was employed. Participants were obtained from a biracial sample of community-dwelling older adults (N = 2,406) and were interviewed in their home by trained interviewers. A comprehensive survey assessed age, gender, race, SES (education and income), and health functioning variables. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. BMI was derived from self-reported weight and height., Results: BMI was found to predict depressive symptoms. Contrary to predictions, the influence of BMI on depressive symptoms was greater for African Americans than whites and, in particular, African Americans with less education. There were no sex differences., Conclusion: Among older adults, BMI was associated with depressive symptoms although the effect size was small. Factors contributing to this relationship may differ from those observed in younger populations, for example, health functioning may play a larger role. Obesity appears to have the most adverse impact on those who are most likely to be overweight, lower SES African Americans.

Background: In previous studies we found that, among older adults (>64 years), perception that basic needs were not being met increased mortality risk and risk for functional decline. In this study, we determined, controlling for reported income and functional status, if perceived inadequate basic needs predicted depressive symptoms., Methods: Repeated-measures analysis was used to determine, during three intervals in a 10-year longitudinal study (the Duke Established Populations for Epidemiologic Studies of the Elderly, n = 4162 at baseline), if perceived inadequate basic needs at the beginning of each interval predicted more depressive symptoms at the end of the interval. We included time invariant covariates known to be associated with depressive symptoms--age, sex, race, and education. We also included time-varying covariates at the beginning of the three intervals--income, cognitive status, functional status, depressive symptoms, and interval., Results: In the repeated-measures controlled analyses, the perception of inadequate basic needs was a highly significant predictor of future depressive symptoms (p <.0001). Race, education, baseline depression, baseline function, interval, and income were also significant predictors of depression. The interaction between interval and depression was not significant., Conclusions: The perception that one's basic needs are not being met predicted future depressive symptoms in a highly controlled analysis. These results suggest that perception of inadequate basic needs, even when income and other known correlates of depression are controlled, is a strong predictor of future depressive symptoms.

Objective: The present study examined ethnic differences in pain reports between Hispanics (n = 147) and Caucasians (n = 1308) with serious health problems. It was predicted that Hispanics would report more pain in relation to their health problems than would Caucasians, depression would be associated with increased pain reports in both groups, and depression's influence on pain reports would be greater for Hispanics compared with Caucasians., Methods: Data from Hispanic and Caucasian participants with a current health problem were utilized from the National Comorbidity Survey, a nationally representative epidemiological sample. Participants' pain reports, relative to their health problems, were obtained. Hierarchal regression analyses were conducted to examine the relationship between ethnicity and reported pain and the potentially moderating role of depression., Results: Findings indicated that Hispanics reported more pain compared with Caucasians and that depression was associated with higher pain reports in both groups. Depression moderated the relationship between ethnicity and pain such that ethnic differences in pain reports were even greater among depressed participants than among nondepressed participants. That is, pain reports for Hispanics were higher in the presence of depression than was found for the Caucasian participants., Conclusions: Cultural differences in the acceptability and the expression of distress may be related to higher pain reports among Hispanics as compared with Caucasians, particularly in the presence of depression. The interplay of biological, psychological and sociocultural processes involved in both pain and depression were considered.

In a biracial sample of community dwelling elders (n=4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.

Objective: An association between depression and cognitive decline (CD) has been observed in cross-sectional and case/control studies of elderly populations. Whereas a handful of longitudinal community studies have found depressive symptoms to predate the onset of CD, others have found no association between depression and subsequent cognitive dysfunction. The authors examined the association between depressive symptoms and cognitive errors measured 3 years apart in a longitudinal sample of community-dwelling elderly persons., Methods: Data were obtained from 4,162 subjects assessed as part of the Established Populations for Epidemiologic Studies of the Elderly, a population survey assessing physical, psychological, and social functioning of persons 65 years and older., Results: Depressive symptoms were associated with subsequent CD even after controlling for baseline cognitive status, as well as demographic (e.g., race, gender, age, and socioeconomic status) and physical functioning variables. This was true for the sample as a whole, as well as for a subsample of participants who evidenced no baseline cognitive difficulties., Conclusion: Study results are consistent with others finding an association between depressive symptoms and subsequent CD. Theories regarding the causal mechanisms underlying the association between depression and cognitive decline are discussed.

Background: Interpersonal skill deficits are associated with depression; however, the nature of the relationship is not clear. This study examined whether interpersonal skill deficits are a temporary symptom of depression or a stable characteristic of depression-prone individuals, in a large adult general population sample (N=4749)., Methods: Interpersonal functioning (IF) was compared among never depressed individuals and three groups of individuals with a history of depression: current depressives, recently remitted, and remitted depressives., Results: State effects of depression were clearly observed and a strong association between IF difficulties and current depression was found. Individuals with an early onset of depression showed some indication of an 'interpersonal scar'; but, in general, we did not find evidence that repeated depression 'scarred' the individual., Limitations: The cross-sectional methodology limited our ability to examine whether interpersonal deficits were more the result of a depressive episode or were present beforehand. In addition, it would have been more informative to follow participants over the course of several months in order to examine the relation between depression and interpersonal functioning deficits as it unfolded longitudinally., Conclusions: Our findings suggest that interpersonal functioning deficits are in some regards a stable feature among people with a history of depression; however, they possess temporary features as well. Depression may scar interpersonal functioning, but only if it occurs early in life.