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Background: As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical. Objective: To investigate the factors associated with a high level of suicide risk among patients with LLD. Methods: A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses' Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD. Results: The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD. Conclusion: This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? Does childhood maltreatment affect the psychological treatment outcomes in late-life depression? • What is the main finding of this study? In older individuals with depression and childhood maltreatment, both specific and non-specific psychotherapy equally reduce depressive symptoms. However, in patients without childhood maltreatment, cognitive behavioral therapy for late-life-depression demonstrates greater efficacy over non-specific supportive psychotherapy. • What is the meaning of the finding? Practioners should consider a history of early trauma in their choice between specific and non-specific interventions. This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD). This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS). In the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F (1,201.31) = 4.71; p =.031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype 'physical neglect' was associated with a smaller depressive symptom reduction (F (1,207.16) = 5.37; p =.021). Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches. [ABSTRACT FROM AUTHOR]

Background: Although depression is linked to an increased risk of dementia, the association between late-onset depression (LOD) and amyloid burden remains unclear. This study aimed to determine amyloid deposition in patients with LOD compared to healthy controls (HC) using amyloid-beta (Aβ) positron emission tomography (PET) images and neuropsychological assessments. Methods: Forty patients first diagnosed with major depressive disorder after the age of 60 (LOD) and twenty-one healthy volunteers (HC) were enrolled. Depression and anxiety were evaluated using the 17-item Hamilton Depression Scale, Hamilton Anxiety Rating Scale, and Clinical Global Impression Scale. Cognitive function was assessed using the Korean versions of the Mini-Mental Status Examination, Montreal Cognitive Assessment, and Seoul Neuropsychological Screening Battery at baseline and 3-month follow-up. 18F-florbetapir PET images were co-registered with T1-weighted magnetic resonance images. Results: There was no significant difference in Aβ deposition between LOD and HC groups. No significant correlation between Aβ burden and depressive symptom severity was found in LOD patients. Higher somatic anxiety was correlated with lower Aβ burden in multiple brain regions, including the left inferior frontal lobe (p = 0.009), right anterior cingulate (p = 0.003), and right superior frontal lobe (p = 0.009). Despite cognitive recovery in areas such as attention (Digit Span Forward, p = 0.026), memory (Auditory Verbal Learning Test Recall Total, p = 0.010; Rey Complex Figure Test Delayed Recall, p = 0.039), and frontal executive function (Contrasting Program, p = 0.033) after three months of antidepressant treatment, cognitive improvement showed no association with amyloid deposition. Conclusions: These findings suggest distinct mechanisms may underlie amyloid deposition in neurodegenerative changes associated with depression. While amyloid burden in specific brain regions negatively correlated with somatic anxiety, it showed no significant correlation with the severity of depression or overall cognitive function. [ABSTRACT FROM AUTHOR]

Background: Depression and dementia are known to be associated. The identification of characteristics distinguishing depression prodromal to dementia from other depressive symptoms would be of value for early identification of dementia. The study of risk factors for depressive symptoms prodromal to dementia could improve preventive care and provide clues to the causes of dementia. Method: Dementia‐free 82‐year‐old participants were stratified into groups that did (n = 126) and did not (n = 378) subsequently develop dementia. Examinations took place from 2003 to 2005 and follow‐up ended 1 January 2015. Their baseline characteristics and depressive symptoms, measured using the 15‐item Geriatric Depression Scale (GDS‐15), were compared. Multivariate regression analyses were performed for the two groups separately, with the total GDS‐15 score as the dependent variable. Results: The groups did not differ significantly in answers to any of the GDS‐15 questions, or mean ± SD score, which was 2.4 ± 2.5 among those who developed dementia and 2.1 ± 2.3 among those who did not. (p = 0.33). Stroke before the age of 82 years and the inability to use stairs had significant impacts on the GDS‐15 scores in both groups. For those who did not develop dementia, age, dependence in activities of daily living, and cancer also had significant impacts. Cancer had opposite associations with depressive symptoms in the two groups. Conclusions: No difference was found in depressive symptoms preceding and not preceding dementia using the GDS‐15. The results suggest that risk factors for depressive symptoms may differ depending on whether they precede dementia. [ABSTRACT FROM AUTHOR]

Aim: Chemosensory anhedonia refers to the lack of hedonic ability to experience pleasure through the senses of smell and taste, which reduces the pleasure and comfort of food, and increases the risk of nutritional and immune deficiencies. However, there is no direct scientific evidence regarding chemosensory anhedonia in patients with late‐life depression (LLD). The aim of this study was to investigate chemosensory anhedonia in patients with LLD, and its potential association with depressive symptoms and cognitive function. Methods: A total of 114 patients with LLD and 92 normal controls were included in this study. They experienced clinical assessment, Chemosensory Pleasure Scale assessment, 17‐item Hamilton Depression Rating Scale assessment and cognitive assessments, which contain the Verbal Fluency Test. The associations between chemosensory pleasure and depressive symptoms or cognitive function in patients with LLD were explored using partial correlation analysis and mediation analysis. Results: The Chemosensory Pleasure Scale scores were lower in the LLD group than in the normal control group, and were negatively correlated with the total scores and factors' scores (retardation, cognitive bias and anxiety/somatization) of the 17‐item Hamilton Depression Rating Scale, and positively correlated with the Verbal Fluency Test scores. The scores for the Food and Imagination dimensions of the Chemosensory Pleasure Scale showed partial mediating effects on the differences in Cognitive bias (a factor of the 17‐item Hamilton Depression Rating Scale) between patients with LLD and normal controls. Conclusions: Patients with LLD showed significant chemosensory anhedonia, and both depressive symptoms and cognitive impairment were associated with the severity of chemosensory anhedonia. Enhancing chemosensory pleasure in patients with LLD could potentially ameliorate their depressive symptoms. Geriatr Gerontol Int 2024; 24: 1022–1029. [ABSTRACT FROM AUTHOR]

Disrupted cellular communication, inflammatory responses and mitochondrial dysfunction are consistently observed in late-life depression (LLD). Exosomes (EXs) mediate cellular communication by transporting molecules, including mitochondrial DNA (EX-mtDNA), playing critical role in immunoregulation alongside tumor necrosis factor (TNF). Changes in EX-mtDNA are indicators of impaired mitochondrial function and might increase vulnerability to adverse health outcomes. Our study examined EX-mtDNA levels and integrity, exploring their associations with levels of TNF receptors I and II (TNFRI and TNFRII), and clinical outcomes in LLD. Ninety older adults (50 LLD and 40 controls (HC)) participated in the study. Blood was collected and exosomes were isolated using size-exclusion chromatography. DNA was extracted and EX-mtDNA levels and deletion were assessed using qPCR. Plasma TNFRI and TNFRII levels were quantified by multiplex immunoassay. Correlation analysis explored relationships between EX-mtDNA, clinical outcomes, and inflammatory markers. Although no differences were observed in EX-mtDNA levels between groups, elevated levels correlated with poorer cognitive performance (r = −0.328, p = 0.002) and increased TNFRII levels (r = 0.367, p = 0.004). LLD exhibited higher deletion rates (F (83,1) = 4.402, p = 0.039), with a trend remaining after adjusting for covariates (p = 0.084). Deletion correlated with poorer cognitive performance (r = −0.335, p = 0.002). No other associations were found. Cross-sectional study with a small number of participants from a specialized geriatric psychiatry treatment center. Our findings suggest that EX-mtDNA holds promise as an indicator of cognitive outcomes in LLD. Additional research is needed to further comprehend the role of EX-mtDNA levels/integrity in LLD, paving the way for its clinical application in the future. • Depressed older adults exhibited higher estimated deletion rate in mitochondrial DNA within exosomes (EX-mtDNA). • EX-mtDNA instability, marker of impaired mitochondrial function, may heighten susceptibility to adverse health outcomes. • The EX-mtDNA instability holds potential as indicator of inflammation status and cognitive outcomes in late-life depression. [ABSTRACT FROM AUTHOR]

Positron emission tomography (PET) and magnetic resonance spectroscopy (1H-MRS) are complementary techniques that can be applied to study how proteinopathy and neurometabolism relate to cognitive deficits in preclinical stages of Alzheimer's disease (AD)—mild cognitive impairment (MCI) and late-life depression (LLD). We acquired beta-amyloid (Aβ) PET and 7 T 1H-MRS measures of GABA, glutamate, glutathione, N-acetylaspartate, N-acetylaspartylglutamate, myo-inositol, choline, and lactate in the anterior and posterior cingulate cortices (ACC, PCC) in 13 MCI and 9 LLD patients, and 13 controls. We used linear regression to examine associations between metabolites, Aβ, and cognitive scores, and whether metabolites and Aβ explained cognitive scores better than Aβ alone. In the ACC, higher Aβ was associated with lower GABA in controls but not MCI or LLD patients, but results depended upon MRS data quality control criteria. Greater variance in California Verbal Learning Test scores was better explained by a model that combined ACC glutamate and Aβ deposition than by models that only included one of these variables. These findings identify preliminary associations between Aβ, neurometabolites, and cognition. [Display omitted] • Astudy of mild cognitive impairment, late-life depression, and healthy controls. • We examined beta-amyloid (Aβ) and neurometabolites using PET and 7 T MRS. • We report novel associations between brain metabolites and Aβ. • Glu + Aβ predicts verbal learning scores better than Aβ-only models. [ABSTRACT FROM AUTHOR]

Objectives: Mental and cognitive health is crucial to ensure well-being in older age. However, prolonged periods of stress, grief, and bereavement might compromise mental health balance, leading to profound changes. This study investigated the sex-stratified associations between midlife bereavement experiences (e.g. sibling loss, spousal loss, and multiple losses) and late-life depression (LLD) and cognitive impairment. Method: Linked data from the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were used. Multiple logistic regressions were performed to examine the associations between midlife bereavement and LLD (n = 1078) and cognitive impairment (n = 995), separately. Results: Sibling loss and multiple losses in midlife were associated with lower odds of LLD, especially among women. Among men, sibling loss in midlife was associated with lower odds of cognitive impairment, while the experience of two losses among women suggested an increased (but non-significant) risk of cognitive impairment. Interaction analyses did not show significant effects between bereavement and gender on LLD and cognitive impairment. Conclusion: Midlife bereavement might have gendered implications on LLD and cognitive impairment, but associations need to be confirmed by well-powered studies. Further research is warranted to elucidate the association between multiple midlife losses and reduced LLD risk. [ABSTRACT FROM AUTHOR]

Background: Elevated homocysteine levels and late‐life depression are risk factors for cognitive decline: a comparative study highlighted the association of late‐onset depression (LOD) with more significant cognitive deficits and brain pathology than early‐onset depression (EOD). Limited research has explored the possible interaction between homocysteine levels and their correlation with cognitive performance in patients with EOD and LOD. Methods: Fifty‐seven individuals with EOD, 56 with LOD, and 89 matched healthy controls (HC) were recruited. Global cognition, memory, execution, language, attention, visuospatial skills, and plasma homocysteine levels were examined. Results: Compared with HC and patients with EOD, patients with LOD had higher plasma homocysteine levels (p < 0.05), with no significant difference between HC and patients with EOD (p > 0.05). Furthermore, homocysteine levels and diagnosis groups showed significant main effects on depression and cognition, with no significant interaction effects being observed. Additionally, plasma homocysteine levels were negatively correlated with global cognition, attention, visuospatial skills, and executive function in patients with LOD (p < 0.05). Conclusions: Compared with HC and patients with EOD, elevated homocysteine levels in patients with LOD were independently associated with cognitive performance. The potential therapeutic efficacy of homocysteine‐lowering B‐vitamin supplementation could be explored as a viable intervention to mitigate the documented debilitating effects of cognitive deficits in this population. [ABSTRACT FROM AUTHOR]

Objectives: There is a large treatment gap for mental health conditions in sub‐Saharan Africa where most patients who receive any care do so from lay primary health care workers (PHCW). We sought to examine the experiences of PHCW who provide care for older people with depression in Nigerian primary health care (PHC) settings. Methods: Qualitative study design. A total of 24 PHCW participated. Using in‐depth key informant interviews (KIIs), we explored the views of 15 PHCW selected from 10 rural and urban PHCs in South‐Western Nigeria. An additional focus group discussion comprising nine participants was also conducted to discuss emerging themes from KIIs. Data were analysed using thematic analysis. Results: Three overall themes were identified: views about depression, treatment options, and community outreach implications. Participants perceived depression in older people as being characterised by a range of mood, behavioural, and cognitive symptoms which made clinical assessments particularly challenging. Common treatment options used by PHCW included general advice and counselling, as well as frequent need to prescribe mild analgesics, vitamins and occasional sedatives in line with patients' expectations. Antidepressants were rarely used even though PHCW are authorised. While home visits are part of their expected work schedule, PHCW rarely implemented these due to non‐availability of transport facilities. Mobile technology was identified as a possible way of overcoming this constraint to providing community based mental healthcare for older people. Conclusion: PHCWs perceived that patients' poor cognitive performance, expectations to prescribe sedatives, analgesics and vitamins, as well as non‐existence of community‐based services were existing barriers to providing evidenced based continued care for older people with depression in the study settings. [ABSTRACT FROM AUTHOR]

Abstract Background As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical. Objective To investigate the factors associated with a high level of suicide risk among patients with LLD. Methods A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses’ Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD. Results The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p

Abstract Background Although depression is linked to an increased risk of dementia, the association between late-onset depression (LOD) and amyloid burden remains unclear. This study aimed to determine amyloid deposition in patients with LOD compared to healthy controls (HC) using amyloid-beta (Aβ) positron emission tomography (PET) images and neuropsychological assessments. Methods Forty patients first diagnosed with major depressive disorder after the age of 60 (LOD) and twenty-one healthy volunteers (HC) were enrolled. Depression and anxiety were evaluated using the 17-item Hamilton Depression Scale, Hamilton Anxiety Rating Scale, and Clinical Global Impression Scale. Cognitive function was assessed using the Korean versions of the Mini-Mental Status Examination, Montreal Cognitive Assessment, and Seoul Neuropsychological Screening Battery at baseline and 3-month follow-up. 18F-florbetapir PET images were co-registered with T1-weighted magnetic resonance images. Results There was no significant difference in Aβ deposition between LOD and HC groups. No significant correlation between Aβ burden and depressive symptom severity was found in LOD patients. Higher somatic anxiety was correlated with lower Aβ burden in multiple brain regions, including the left inferior frontal lobe (p = 0.009), right anterior cingulate (p = 0.003), and right superior frontal lobe (p = 0.009). Despite cognitive recovery in areas such as attention (Digit Span Forward, p = 0.026), memory (Auditory Verbal Learning Test Recall Total, p = 0.010; Rey Complex Figure Test Delayed Recall, p = 0.039), and frontal executive function (Contrasting Program, p = 0.033) after three months of antidepressant treatment, cognitive improvement showed no association with amyloid deposition. Conclusions These findings suggest distinct mechanisms may underlie amyloid deposition in neurodegenerative changes associated with depression. While amyloid burden in specific brain regions negatively correlated with somatic anxiety, it showed no significant correlation with the severity of depression or overall cognitive function.

Late-life depression (LLD) is a prevalent mental disorder among older adults. Previous studies revealed that many pathologic factors are associated with the onset and development of LLD. However, the precise mechanisms that cause LLD remain elusive. Aging induces chronic inflammatory changes mediated by alterations of immune responses. The chronic systemic inflammation termed “inflammaging” is linked to the etiology of aging-related disorders. Aged microglia induce senescence-associated secretory phenotype (SASP) and transition to M1-phenotype, cause neuroinflammation, and diminish neuroprotective effects. In addition, there is an age-dependent loss of blood–brain barrier (BBB) integrity. As the BBB breakdown can lead to invasion of immune cells into brain parenchyma, peripheral immunosenescence may cause microglial activation and neuroinflammation. Therefore, it is suggested that these mechanisms related to brain inflammaging may be involved in the pathogenesis of LLD. In this review, we described the role of brain inflammaging in LLD. Pharmacologic approaches to prevent brain inflammaging appears to be a promising strategy for treating LLD. [ABSTRACT FROM AUTHOR]

Suicide is more prevalent among older adults compared to younger individuals. Late-life depression (LLD) poses the highest risk for suicide. However, early recognition of suicidal ideation is challenging. Dysfunction in odor identification (OI), a characteristic of LLD, may hold potential for early identification of suicidal ideation. This study aims to compare OI between LLD patients with suicidal ideation (LLD-S) and LLD patients without suicidal ideation (LLD-NS), and examine its relationship with cognitive function. A total of 262 LLD-NS patients, 63 LLD-S patients, and 316 healthy normal older adults (HOAs) underwent OI testing, standardized clinical interviews, and comprehensive neuropsychological assessments. (1) LLD-S patients exhibited lower OI scores and poorer cognitive performance (including global cognition, information processing speed, memory, language, executive function, and visuospatial ability) compared to LLD-NS patients and HOAs. (2) There were interactive effects between suicidal ideation and OI dysfunction, leading to lower scores in information processing speed and visuospatial ability. (3) OI dysfunction mediated the differences in cognition between the LLD-NS and LLD-S groups. The present study was a cross-sectional design. LLD-S patients had worse odor identification than LLD-NS patients and HOAs, suggesting that OI testing could be a valuable approach for identifying suicidal ideation in LLD and screening for suicide risk. The presence of both OI impairment and suicidal ideation was associated with poorer cognitive performance in LLD. • LLD-S exhibited lower OI scores compared to LLD-NS and HOAs. • Interaction between SI and OI dysfunction contributed to lower information processing speed and visuospatial ability. • OI dysfunction mediated the differences in cognition between LLD-NS and LLD-S groups. • OI examination could be a valuable approach for identifying SI in LLD and screening for suicide risk. [ABSTRACT FROM AUTHOR]

Abstract Background The national volume-based procurement (NVBP) policy has significantly decreased prices and increased the accessibility of NVBP drugs. Nevertheless, issues such as heightened adverse reactions and suboptimal efficacy have arisen. Concerns regarding the quality of low-cost medications and the absence of long-term research have been widely recognized. This has led to caution among patients with late-life depression (LLD) due to their delicate health and the severity of their condition. This study evaluated the choice intention for NVBP drugs and associated factors in older patients with LLD. Methods A weighted sample of 408 participants between December 2022 and March 2023 were included. Data were collected via face-to-face interviews and questionnaires. To identify significant associated factors of choice intention, a multilevel logistic regression model was employed. Results Over half (53.68%) of older patients with LLD intended to choose NVBP drugs. Associated factors included self-assessed poor economy, higher out-of-pocket expenses, monthly household income exceeding CNY 6000, absence of other non-communicable chronic diseases, ordinary registration, urban employee medical insurance, no requirements for brand-name drugs, adverse reactions after using NVBP drugs, and rejection of physicians’ recommendation for NVBP drugs. The interaction effect between the real economic condition and patients self-assessed economy significantly influences choice intention for NVBP drugs. Among 124 patients with self-assessed poor economy, 75 showed a higher intention to use NVBP drugs. In these patients, age, medical insurance reimbursement, and brand awareness were significantly associated with choice intention. Conclusion Economic factors, physical conditions, medical needs, and physician recommendations significantly influenced the choice intention for NVBP drugs. The choice intention can be improved by strengthening physician-patient communication, increasing the scope and proportion of medical insurance reimbursement, improving substitution studies, and conducting post-marketing re-evaluations of NVBP drugs.

Jingyi Lao,1,&ast; Yijie Zeng,1,&ast; Zhangying Wu,1 Gaohong Lin,1 Qiang Wang,1 Mingfeng Yang,1 Si Zhang,1 Danyan Xu,1 Min Zhang,1 Kexin Yao,1 Shuang Liang,1 Qin Liu,1 Jiafu Li,1 Xiaomei Zhong,1 Yuping Ning1– 4 1Geriatric Neuroscience Center, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China; 2The First School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 3Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, People’s Republic of China; 4Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yuping Ning; Xiaomei Zhong, The Affiliated Brain Hospital of Guangzhou Medical University, No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, People’s Republic of China, Email ningjeny@126.com; lovlaugh@163.comBackground: Late-life depression (LLD) is characterized by disrupted brain networks. Resting-state networks in the brain are composed of both stable and transient topological structures known as microstates, which reflect the dynamics of the neural activities. However, the specific pattern of EEG microstate in LLD remains unclear.Methods: Resting-state EEG were recorded for 31 patients with episodic LLD (eLLD), 20 patients with remitted LLD (rLLD) and 32 healthy controls (HCs) using a 64-channel cap. The clinical data of the patients were collected and the 17-Item Hamilton Rating Scale for Depression (HAMD) was used for symptom assessment. Duration, occurrence, time coverage and syntax of the four microstate classes (A-D) were calculated. Group differences in EEG microstates and the relationship between microstates parameters and clinical features were analyzed.Results: Compared with NC and patients with rLLD, patients with eLLD showed increased duration and time coverage of microstate class D. Besides, a decrease in occurrence of microstate C and transition probability between microstate B and C was observed. In addition, the time coverage of microstate D was positively correlated with the total score of HAMD, core symptoms, and miscellaneous items.Conclusion: These findings suggest that disrupted EEG microstates may be associated with the pathophysiology of LLD and may serve as potential state markers for the monitoring of the disease.Keywords: late-life depression, microstate, electroencephalogram, resting-state networks

Background: The national volume-based procurement (NVBP) policy has significantly decreased prices and increased the accessibility of NVBP drugs. Nevertheless, issues such as heightened adverse reactions and suboptimal efficacy have arisen. Concerns regarding the quality of low-cost medications and the absence of long-term research have been widely recognized. This has led to caution among patients with late-life depression (LLD) due to their delicate health and the severity of their condition. This study evaluated the choice intention for NVBP drugs and associated factors in older patients with LLD. Methods: A weighted sample of 408 participants between December 2022 and March 2023 were included. Data were collected via face-to-face interviews and questionnaires. To identify significant associated factors of choice intention, a multilevel logistic regression model was employed. Results: Over half (53.68%) of older patients with LLD intended to choose NVBP drugs. Associated factors included self-assessed poor economy, higher out-of-pocket expenses, monthly household income exceeding CNY 6000, absence of other non-communicable chronic diseases, ordinary registration, urban employee medical insurance, no requirements for brand-name drugs, adverse reactions after using NVBP drugs, and rejection of physicians' recommendation for NVBP drugs. The interaction effect between the real economic condition and patients self-assessed economy significantly influences choice intention for NVBP drugs. Among 124 patients with self-assessed poor economy, 75 showed a higher intention to use NVBP drugs. In these patients, age, medical insurance reimbursement, and brand awareness were significantly associated with choice intention. Conclusion: Economic factors, physical conditions, medical needs, and physician recommendations significantly influenced the choice intention for NVBP drugs. The choice intention can be improved by strengthening physician-patient communication, increasing the scope and proportion of medical insurance reimbursement, improving substitution studies, and conducting post-marketing re-evaluations of NVBP drugs. [ABSTRACT FROM AUTHOR]

Late-life depression (LLD) is highly prevalent, especially in people aged 80 years and older. We aimed to investigate predictors and their influence on depressive symptoms in LLD. We analysed data from the NRW80+ study, a population-based cross-sectional study of individuals aged 80 years and older. Data from n = 926 cognitively unimpaired participants were included. We reduced 95 variables to 21 predictors of depressive symptoms by using a two-step cluster analysis (TSCA), which were assigned to one of four factors (function, values and lifestyle, autonomy and contentment, biological-somatic) according to a principal component analysis. A second TSCA with complete data sets (n = 879) was used to define clusters of participants. Using weighted mean composite scores (CS) for each factor group, binary logistic regression analyses were performed to predict depressive symptoms for each cluster and the total population. The second TSCA yielded two clusters (cluster 1 (n = 688), cluster 2 (n = 191)). The proportion of participants with depressive symptoms was significantly higher in cluster 2 compared to cluster 1 (39 % vs. 15 %; OR = 3.6; 95 % CI 2.5–5.1; p <.001). Participants in cluster 2 were significantly older (mean age 88 vs. 85 years; p <.001), with a higher proportion of women (56 % vs. 46 %; OR = 1.5; 95 % CI 1.1–2.0; p =.016), had a higher BMI (p =.017), lower financial resources (OR = 2.3; 95 % CI 1.6–3.5; p <.001), lower educational level (OR = 1.8; 95 % CI 1.2–2.5; p =.002), higher proportion of single, separated or widowed participants (OR = 1.9; 95 % CI 1.3–2.6; p <.001) and a smaller mean social network (p =.044) compared to cluster 1. Binary logistic regression analyses showed that the weighted mean CS including the autonomy and contentment predictors explained the largest proportion of variance (22.8 %) for depressive symptoms in the total population (Nagelkerke's R 2 = 0.228, p <.001) and in both clusters (cluster 1: Nagelkerke's R 2 = 0.171, p <.001; cluster 2: Nagelkerke's R2 = 0.213, p <.001), respectively. The main limitations are the restriction to cognitively unimpaired individuals and the use of a self-rated questionnaire to assess depressive symptoms. Psychological factors such as autonomy and contentment are critical for the occurrence of depressive symptoms at higher age, independent of the functional and somatic status and may serve as specific targets for psychotherapy. • Population-based cross-sectional data from individuals aged 80 years and older (79/85) • Hypothesis-free, data-driven approach with two-step clustering (64/85) • Psychological variables are most important predictors of depressive symptoms in older age (83/85). • Autonomy and contentment play central role in development of depressive symptoms (82/85). [ABSTRACT FROM AUTHOR]

Background: The longitudinal course of late-life depression remains under-studied. Aims: To describe transitions along the depression continuum in old age and to identify factors associated with specific transition patterns. Method: We analysed 15-year longitudinal data on 2745 dementia-free persons aged 60+ from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression (minor and major) was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; subsyndromal depression (SSD) was operationalised as the presence of ≥2 symptoms without depression. Multistate survival models were used to map depression transitions, including death, and to examine the association of psychosocial (social network, connection and support), lifestyle (smoking, alcohol consumption and physical activity) and clinical (somatic disease count) factors with transition patterns. Results: Over the follow-up, 19.1% had ≥1 transitions across depressive states, while 6.5% had ≥2. Each additional somatic disease was associated with a higher hazard of progression from no depression (No Dep) to SSD (hazard ratio 1.09; 1.07–1.10) and depression (Dep) (hazard ratio 1.06; 1.04–1.08), but also with a lower recovery (HRSSD−No Dep 0.95; 0.93–0.97 [where 'HR' refers to 'hazard ratio']; HRDep−No Dep 0.96; 0.93–0.99). Physical activity was associated with an increased hazard of recovery to no depression from SSD (hazard ratio 1.49; 1.28–1.73) and depression (hazard ratio 1.20; 1.00–1.44), while a richer social network was associated with both higher recovery from (HRSSD−No Dep 1.44; 1.26–1.66; HRDep−No Dep 1.51; 1.34–1.71) and lower progression hazards to a worse depressive state (HRNo Dep−SSD 0.81; 0.70–0.94; HRNo Dep−Dep 0.58; 0.46–0.73; HRSSD−Dep 0.66; 0.44–0.98). Conclusions: Older people may present with heterogeneous depressive trajectories. Targeting the accumulation of somatic diseases and enhancing social interactions may be appropriate for both depression prevention and burden reduction, while promoting physical activity may primarily benefit recovery from depressive disorders. [ABSTRACT FROM AUTHOR]

The clinical phenotype of the so-called late-onset depression (LOD) affecting up to 30% of older adults and yielding heterogeneous manifestations concerning symptoms, severity and course has not been fully elucidated yet. This European, cross-sectional, non-interventional, naturalistic multicenter study systematically investigated socio-demographic and clinical correlates of early-onset depression (EOD) and LOD (age of onset ≥ 50 years) in 1410 adult in- and outpatients of both sexes receiving adequate psychopharmacotherapy. In a total of 1329 patients (94.3%) with known age of disease onset, LOD was identified in 23.2% and was associated with unemployment, an ongoing relationship, single major depressive episodes, lower current suicidal risk and higher occurrence of comorbid hypertension. In contrast, EOD was related to higher rates of comorbid migraine and additional psychotherapy. Although the applied study design does not allow to draw any causal conclusions, the present results reflect broad clinical settings and emphasize easily obtainable features which might be characteristic for EOD and LOD. A thoughtful consideration of age of onset might, hence, contribute to optimized diagnostic and therapeutic processes in terms of the globally intended precision medicine, ideally enabling early and adequate treatment allocations and implementation of respective prevention programs. [ABSTRACT FROM AUTHOR]

Suicide is one of the most lethal complications of late-life depression (LLD), and habenular dysfunction may be involved in depression-related suicidality and may serve as a potential target for alleviating suicidal ideation. This study aimed to investigate abnormal functional connectivity of the habenula in LLD patients with suicidal ideation. One hundred twenty-seven patients with LLD (51 with suicidal ideation (LLD-S) and 76 without suicidal ideation (LLD-NS)) and 75 healthy controls (HCs) were recruited. The static functional connectivity (sFC) and dynamic functional connectivity (dFC) between the habenula and the whole brain were compared among the three groups, and correlation and moderation analyses were applied to investigate whether suicidal ideation moderated the relationships of habenular FC with depressive symptoms and cognitive impairment. The dFC between the right habenula and the left orbitofrontal cortex (OFC) increased in the following order: LLD-S > LLD-NS > control. No significant difference in the habenular sFC was found among the LLD-S, LLD-NS and control groups. The dFC between the right habenula and the left OFC was positively associated with global cognitive function and visuospatial skills, and the association between this dFC and visuospatial skills was moderated by suicidal ideation in patients with LLD. The increased variability in dFC between the right habenula and left OFC was more pronounced in the LLD-S group than in the LLD-NS group, and the association between habenular-OFC dFC and visuospatial skills was moderated by suicidal ideation in patients with LLD. • LLD-S exhibited increased dFC between habenula and OFC than LLD-NSl The association between dFC and cognition was moderated by suicidal ideation [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What are the cognitive profiles of older adults with remitted major depressive disorder (rMDD) with or without mild cognitive impairment (MCI)? How do these profiles differ in terms of clinical, demographic, and brain structure features? • What is the main finding of this study? Using latent profile analysis, we identified three cognitive profiles, with differences in cognition, physical health, education, and brain structure. • What is the meaning of the finding? Older patients with rMDD can be grouped cross-sectionally based on distinct data-driven cognitive profiles that differ from the absence or presence of a diagnosis of MCI. To identify data-driven cognitive profiles in older adults with remitted major depressive disorder (rMDD) with or without mild cognitive impairment (MCI) and examine how the profiles differ regarding demographic, clinical, and neuroimaging measures. Secondary cross-sectional analysis using latent profile analysis. Multisite clinical trial in Toronto, Canada. One hundred seventy-eight participants who met DSM-5 criteria for rMDD without MCI (rMDD-MCI; n = 60) or with MCI (rMDD + MCI; n = 118). Demographic, clinical, neuroimaging measures, and domain scores from a neuropsychological battery assessing verbal memory, visuospatial memory, processing speed, working memory, language, and executive function. We identified three latent profiles: Profile 1 (poor cognition ; n = 75, 42.1%), Profile 2 (intermediate cognition ; n = 75, 42.1%), and Profile 3 (normal cognition ; n = 28, 15.7%). Compared to participants with Profile 3, those with Profile 1 or 2 were older, had lower education, experienced a greater burden of medical comorbidities, and were more likely to have MCI. The profiles did not differ on the severity of residual symptoms, age of onset of rMDD, number of depressive episodes, psychotropic medication, cerebrovascular risk, ApoE4 carrier status, or family history of depression, dementia, or Alzheimer's disease. The profiles differed in cortical thickness of 15 regions, with the most prominent effects for left precentral and pars opercularis, and right inferior parietal and supramarginal. Older patients with rMDD can be grouped cross-sectionally based on data-driven cognitive profiles that differ from the absence or presence of a diagnosis of MCI. Future research should determine the differential risk for dementia of these data-driven subgroups. [ABSTRACT FROM AUTHOR]

Objective To explore the influencing factors of cognitive impairment in elderly patients with depressive disorder. Methods 119 elderly patients with depression were recruited in the 1st Affiliated Hospital of Kunming Medical University. MoCA was used to evaluate the cognitive function of the patients, and a regression model was established to analyze the influencing factors of cognitive impairment in elderly patients with depression. Results Age had a significant effect on the total score of cognition, visuospatial ability, executive function and language function ( P < 0.05) . The degree of anxiety had a significant effect on the total score of cognition, visuospatial ability, executive function, attention and working memory (P < 0.05）. Dyslipidemia had a statistically significant effect on the total score of cognition, visuospatial ability and executive function (P < 0.05）. The past medical history had a significant effect on the total score of cognition and language function (P < 0.05）. The sex, onset time, degree of depression, ApoE gene, occupation status and psychotic symptoms had statistically significant effects on individual cognitive function ( P < 0.05) . Conclusion Patients with late-life depressive disorder have obvious cognitive impairment. Age, anxiety, dyslipidemia, and past medical history may be the risk factors for cognitive impairment in elderly patients with depressive disorder. [ABSTRACT FROM AUTHOR]

Study rational and purpose: Web-based education has been proven effective in enhancing knowledge and confidence of health professionals in addressing mental health conditions. However, no web-based training, specific to geriatric depression, exists to date in Canada for educating future health and allied health professionals. The goal of this study was to develop, implement and evaluate a web-based learning module, Depression Assessment Training in Elderly (DATE), to enhance knowledge and confidence in screening for geriatric depression among social work, psychiatric nursing, and nursing students in an undergraduate Canadian university. Design/methodology/approach: This cross-sectional study utilized a set of quantitative surveys of undergraduate students in three different health and mental health disciplines in Canada. Findings: Findings suggest that the DATE module significantly improves confidence of all students in recognizing geriatric depression. Also, it increases clinical knowledge of geriatric depression in social work and psychiatric nursing students. Practical implications: The DATE module is now available for Canadian and international community of clinicians. Further research is needed to test the DATE in a larger sample of Canadian students of social work, psychiatric nursing, and nursing as well as among practicing clinicians. What is original/value of paper: The DATE is the first web-based learning module in Canada that contains clinical simulation case studies on the screening of geriatric depression. [ABSTRACT FROM AUTHOR]

Summary: Background: Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting. Methods: Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis. Findings: To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families’ involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients. Interpretation: Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs’ ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families. Funding: This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project “Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients’ Voice in Primary Care” [NUHSRO/2022/049/NUSMed/DFM].

With the acceleration of the aging process and change in social lifestyle， the prevalence rate of late-life depression （LLD） in the elderly is increasing year by year. As the most common mental disorder in the elderly， LLD seriously affects the quality of life of patients， and thus brings a heavy burden to the family and society. It may even become life-threatening for the elderly patients. The pathogenesis of LLD is still unclear， which may be caused by a combination effects of biological， social and psychological factor. Given the declined body functions and more comorbid physical diseases in the elderly population， the diagnosis and treatment of LLD patients would be different from that of younger adult patients with depression. This paper reviews the epidemiological characteristics， clinical evaluation， diagnosis， comorbidity， treatment and intervention of LLD， and focuses on the selection of therapeutic drugs and adverse reactions， in order to provide references for better diagnosis and treatment of LLD and improve the prognosis of patients.

BackgroundUnderlying inflammation is associated with an increased risk of depression in older adults. In this study, we examined the role of inflammatory biomarkers in antidepressant response in depressed older adults undergoing adjunct Tai Chi Chih (TCC) or Health education interventions.MethodsOlder adults aged 60 years and above with a diagnosis of major depression were randomized to 12 weeks of TCC versus Health and Wellness Education (HEW) as an adjunct therapy to their stable antidepressant treatment regimen. A panel of 19 cytokine/chemokines was measured at baseline and 12 weeks. Five factors were derived using factor analysis. General linear models were estimated to examine the change in factor scores and the association of these changes on depression remission rates, controlling for age, sex, and body mass index.ResultsOf the 170 randomized participants (TCC: n = 85 and HEW: n = 85), 55 TCC and 58 HEW completed the 3-month assessment. The groups did not differ at baseline in any measure. At follow-up, neither the changes in cytokine/chemokines scores nor the depression remission rate differed significantly between TCC and HEW. However, remitters and non-remitters differed significantly in changes in a factor composed of growth-regulated oncogene protein-alpha (GRO-alpha), epidermal growth factor (EGF), and soluble CD40 ligand (sCD40L). GRO-alpha and EGF levels (in both groups) were significantly increased in remitters compared to non-remitters.ConclusionChanges in certain cytokines/chemokines may accompany improvement in depressive symptoms in older adults. Future studies will need to explore the role of these molecules in remission of late-life depression.

Background: Global research hotspots and future research trends in the neurobiological mechanisms of late-life depression (LLD) as well as its diagnosis and treatment are not yet clear. Objectives: This study profiled the current state of global research on LLD and predicted future research trends in the field. Methods: Literature with the subject term LLD was retrieved from the Web of Science Core Collection, and CiteSpace software was used to perform econometric and co-occurrence analyses. The results were visualized using CiteSpace, VOSviewer, and other software packages. Results: In total, 10,570 publications were included in the analysis. Publications on LLD have shown an increasing trend since 2004. The United States and the University of California had the highest number of publications, followed consecutively by China and England, making these countries and institutions the most influential in the field. Reynolds, Charles F. was the author with the most publications. The International Journal of Geriatric Psychiatry was the journal with the most articles and citations. According to the co-occurrence analysis and keyword/citation burst analysis, cognitive impairment, brain network dysfunction, vascular disease, and treatment of LLD were research hotspots. Conclusion: Late-life depression has attracted increasing attention from researchers, with the number of publications increasing annually. However, many questions remain unaddressed in this field, such as the relationship between LLD and cognitive impairment and dementia, or the impact of vascular factors and brain network dysfunction on LLD. Additionally, the treatment of patients with LLD is currently a clinical challenge. The results of this study will help researchers find suitable research partners and journals, as well as predict future hotspots. [ABSTRACT FROM AUTHOR]

Introduction: Impairment in mentalization is implicated in the development and maintenance of depression. Major depressive disorders showed significant impairment in social cognition and such impairment appears to be positively associated with the severity of depression. Self-referential gaze perception (SRGP), a measurement of mentalization, was predominantly measured in patients with psychosis but rarely examined in late-life depression (LLD). Methods: To assess the effect of cognition on the interpretation bias of mentalization, 29 LLD patients and 29 healthy controls were asked to judge if various gaze directions were directed to self in SRGP. Results: Patients with better cognition showed less unambiguous-SRGP bias than those with worse cognitive scores; this difference was not found in healthy controls. Global cognition and executive function contributed to the SRGP rate in patients. Conclusion: The current study is the first study to explore the relationship between cognition and SRGP in the LLD population. Our study findings suggested that the cognitive function of LLD patients may contribute to the modulation of interpretation bias, which in turn underlie the role of SRGP bias. Greater SRGP bias in patients may reflect social cognition deterioration, impairing the social interaction and functioning of LLD patients. This highlights the need for early intervention and cognitive decline identification to facilitate better prognosis and treatment effectiveness; thus, further studies could navigate the potential of SRGP task as a screening tool for high-risk group of LLD likely to develop dementia. [ABSTRACT FROM AUTHOR]

Objectives: Electroconvulsive therapy (ECT) is effective in treating late‐life depression. There is limited research on suicidal behavior and all‐cause mortality in the oldest old after ECT. Methods: Older adults aged 75 years and above who had been inpatients for moderate to severe depression between January 1, 2011, and December 31, 2017, were included in the study. We used exact and propensity score matching to balance groups. We compared suicidal behavior (fatal and non‐fatal) and all‐cause mortality in those who had received ECT and those with other depression treatments. Results: Of the study population, 1802 persons who received ECT were matched to 4457 persons with other treatments. There were no significant differences in the risk of suicidal behavior between groups, (within 3 months: odds ratio 0.73; 95% confidence intervals (CI), 0.44–1.23, within 4 months to 1 year: aOR 1.34; 95% CI, 0.84–2.13). All‐cause mortality was lower among ECT recipients compared to those who had received other treatments, both within 3 months (aOR, 0.35; 95% CI, 0.23–0.52), and within 4 months to 1 year (aOR 0.65; 95% CI, 0.50–0.83). Conclusions: Compared to other depression treatments, ECT is not associated with a higher risk of suicidal behavior in patients aged 75 and above. ECT is associated with lower all‐cause mortality in this age group, but we advise caution regarding causal inferences. Key points: Electroconvulsive therapy (ECT) was not significantly associated with lower odds of suicidal behavior compared to other antidepressant treatments.ECT was associated with lower all‐cause mortality compared to other antidepressant treatments. [ABSTRACT FROM AUTHOR]

Background: Executive function deficits (EFD) in late‐life depression (LLD) has been reported to be associated with antidepressant treatment resistance, increased disability, and poor quality of life. However, the underlying neutral mechanisms of EFD in patients with the first episode of LLD remains unclear. Methods: A total of 27 patients with first‐episode, drug‐naive LLD and 27 non‐depressed controls (NC) were recruited for the present research. Participants underwent the Trail Making Test, the 17‐item Hamilton depression rating scale (HAMD‐17) test, and task‐state functional magnetic resonance imaging scans under the neutral Stroop task. LLD patients' executive functions, depressive symptoms, and brain activity were examined again after 6 months of antidepressant treatment. Results: Of the 27 LLD patients, 16 cases completed 6‐month follow‐ups. Patients in the LLD baseline group spent more time on the Trail Making Test A test than those in the NC group (p < 0.05). In the presence of an incongruency between the word color and meaning, the accuracy rate of the neutral Stroop task in the LLD baseline group was lower, and the reaction time was greater than that in the NC group, with statistically significant difference (p < 0.05). The HAMD‐17 score in the LLD follow‐up group was significantly lower than that in the LLD baseline group (p < 0.05). More activated brain regions were present in the LLD baseline group than in the NC group when performing the neutral Stroop task. Compared with the LLD baseline group, abnormal activation of relevant brains in the cingulate‐prefrontal‐parietal network of LLD patients still existed in the LLD follow‐up group. Conclusions: LLD patients engaged more brain areas than the NC group while performing the neutral Stroop task. Abnormal activation of the cingulate‐prefrontal‐parietal network could be a contributing factor to EFD in LLD. Trial registration: ChiCTR, ChiCTR2100042370 (Date of registration: 21/01/2021). Limits: We didn't enroll enough first‐episode, LLD patients, the robustness of the findings need to be confirmed by large sample clinical trials. Key points: The findings of this study suggest that there is no significant correlation between the relief of depressive symptoms and the improvement of executive dysfunction in individuals with first‐episode, late‐life depression (LLD).Patients with first‐episode, LLD engaged more brain areas than the normal control group while performing the neutral Stroop task.Abnormal activation of the cingulate‐prefrontal‐parietal network could be a contributing factor to executive function deficits in LLD. [ABSTRACT FROM AUTHOR]

Hippocampal neurogenesis (HN) occurs throughout the life course and is important for memory and mood. Declining with age, HN plays a pivotal role in cognitive decline (CD), dementia, and late-life depression, such that altered HN could represent a neurobiological susceptibility to these conditions. Pertinently, dietary patterns (e.g. Mediterranean diet) and/or individual nutrients (e.g. vitamin D, omega 3) can modify HN, but also modify risk for CD, dementia, and depression. Therefore, the interaction between diet/nutrition and HN may alter risk trajectories for these ageing-related brain conditions. Using a subsample (n  = 371) of the Three-City cohort—where older adults provided information on diet and blood biobanking at baseline and were assessed for CD, dementia, and depressive symptomatology across 12 years—we tested for interactions between food consumption, nutrient intake, and nutritional biomarker concentrations and neurogenesis-centred susceptibility status (defined by baseline readouts of hippocampal progenitor cell integrity, cell death, and differentiation) on CD, Alzheimer's disease (AD), vascular and other dementias (VoD), and depressive symptomatology, using multivariable-adjusted logistic regression models. Increased plasma lycopene concentrations (OR [95% CI]  =  1.07 [1.01, 1.14]), higher red meat (OR [95% CI]  =  1.10 [1.03, 1.19]), and lower poultry consumption (OR [95% CI]  =  0.93 [0.87, 0.99]) were associated with an increased risk for AD in individuals with a neurogenesis-centred susceptibility. Increased vitamin D consumption (OR [95% CI]  =  1.05 [1.01, 1.11]) and plasma γ-tocopherol concentrations (OR [95% CI]  =  1.08 [1.01, 1.18]) were associated with increased risk for VoD and depressive symptomatology, respectively, but only in susceptible individuals. This research highlights an important role for diet/nutrition in modifying dementia and depression risk in individuals with a neurogenesis-centred susceptibility. [ABSTRACT FROM AUTHOR]

Late-life depression (LLD) is associated with risk of dementia, yet intervention of LLD provides an opportunity to attenuate subsequent cognitive decline. Omega-3 polyunsaturated fatty acids (PUFAs) supplement is a potential intervention due to their beneficial effect in depressive symptoms and cognitive function. To explore the underlying neural mechanism, we used resting-state functional MRI (rs-fMRI) before and after omega-3 PUFAs supplement in older adults with LLD. A 52-week double-blind randomized controlled trial was conducted. We used multi-scale sample entropy to analyze rs-fMRI data. Comprehensive cognitive tests and inflammatory markers were collected to correlate with brain entropy changes. A total of 20 patients completed the trial with 11 under omega-3 PUFAs and nine under placebo. While no significant global cognitive improvement was observed, a marginal enhancement in processing speed was noted in the omega-3 PUFAs group. Importantly, participants receiving omega-3 PUFAs exhibited decreased brain entropy in left posterior cingulate gyrus (PCG), multiple visual areas, the orbital part of the right middle frontal gyrus, and the left Rolandic operculum. The brain entropy changes of the PCG in the omega-3 PUFAs group correlated with improvement of language function and attenuation of interleukin-6 levels. Sample size is small with only marginal clinical effect. These findings suggest that omega-3 PUFAs supplement may mitigate cognitive decline in LLD through anti-inflammatory mechanisms and modulation of brain entropy. Larger clinical trials are warranted to validate the potential therapeutic implications of omega-3 PUFAs for deterring cognitive decline in patients with late-life depression. • Brain entropy decreased in left posterior cingulate gyrus (PCC) and various brain regions after omega-3 PUFAs use in late-life depressed patients. • The reduction of brain entropy in left PCG correlated with improvement in language function and IL-6 level. • Only marginal improvement in processing speed was found clinically after omega-3 PUFAs supplement. • The anti-inflammatory and beneficial cognitive effects of omega-3 PUFAs in late-life depression are associated with brain entropy changes in left PCG. [ABSTRACT FROM AUTHOR]

Background: Functional abnormalities of the habenula in patients with depression have been demonstrated in an increasing number of studies, and the habenula is involved in cognitive processing. However, whether patients with late‐life depression (LLD) exhibit disrupted habenular functional connectivity (FC) and whether habenular FC mediates the relationship between depressive symptoms and cognitive impairment remain unclear. Methods: Overall, 127 patients with LLD and 75 healthy controls were recruited. The static and dynamic FC between the habenula and the whole brain was compared between LLD patients and healthy controls, and the relationships of habenular FC with depressive symptoms and cognitive impairment were explored by correlation and mediation analyses. Results: Compared with the controls, patients with LLD exhibited decreased static FC between the right habenula and bilateral inferior frontal gyrus (IFG); there was no significant difference in dynamic FC of the habenula between the two groups. Additionally, the decreased static FC between the right habenula and IFG was associated with more severe depressive symptoms (especially psychomotor retardation) and cognitive impairment (language, memory, and visuospatial skills). Last, static FC between the right habenula and left IFG partially mediated the relationship between depressive symptoms (especially psychomotor retardation) and cognitive impairment (verbal fluency and working memory). Conclusions: Patients with LLD exhibited decreased static FC between the habenula and IFG but intact dynamic FC of the habenula. This decreased static FC mediated the relationship between depressive symptoms and cognitive impairment. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? The question addressed by the study must limited to only one sentence. This study assesses the rates, stability, and trajectories of clinically significant hoarding symptoms in older adults with depression (late-life depression). • What is the main finding of this study? The finding must be limited to two sentences. Hoarding symptoms were present in up to 33% of older adults with active depression in two independent cohorts. Hoarding severity was stable over time and did not co-vary with depression severity. • What is the meaning of the finding? The meaning of the finding must be limited to one sentence. Hoarding is a more common comorbidity in late life depression than previously suggested and should be considered in screening and management in this population, and the interaction of these conditions should be further characterized with attention to determining factors which may improve hoarding outcomes. Hoarding disorder (HD) is a debilitating neuropsychiatric condition that affects 2%–6% of the population and increases in incidence with age. Major depressive disorder (MDD) co-occurs with HD in approximately 50% of cases and leads to increased functional impairment and disability. However, only one study to date has examined the rate and trajectory of hoarding symptoms in older individuals with a lifetime history of MDD, including those with current active depression (late-life depression; LLD). We therefore sought to characterize this potentially distinct phenotype. We determined the incidence of HD in two separate cohorts of participants with LLD (n = 73) or lifetime history of MDD (n = 580) and examined the reliability and stability of hoarding symptoms using the Saving Inventory-Revised (SI-R) and Hoarding Rating Scale-Self Report (HRS), as well as the co-variance of hoarding and depression scores over time. HD was present in 12% to 33% of participants with MDD, with higher rates found in those with active depressive symptoms. Hoarding severity was stable across timepoints in both samples (all correlations >0.75), and fewer than 30% of participants in each sample experienced significant changes in severity between any two timepoints. Change in depression symptoms over time did not co-vary with change in hoarding symptoms. These findings indicate that hoarding is a more common comorbidity in LLD than previously suggested, and should be considered in screening and management of LLD. Future studies should further characterize the interaction of these conditions and their impact on outcomes, particularly functional impairment in this vulnerable population. [ABSTRACT FROM AUTHOR]

With the acceleration of the aging process and change in social lifestyle, the prevalence rate of late-life depression (LLD) in the elderly is increasing year by year. As the most common mental disorder in the elderly, LLD seriously affects the quality of life of patients, and thus brings a heavy burden to the family and society. It may even become life-threatening for the elderly patients. The pathogenesis of LLD is still unclear, which may be caused by a combination effects of biological, social and psychological factor. Given the declined body functions and more comorbid physical diseases in the elderly population, the diagnosis and treatment of LLD patients would be different from that of younger adult patients with depression. This paper reviews the epidemiological characteristics, clinical evaluation, diagnosis, comorbidity, treatment and intervention of LLD, and focuses on the selection of therapeutic drugs and adverse reactions, in order to provide references for better diagnosis and treatment of LLD and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Cognitive impairments are prevalent in late-life depression (LLD). However, it remains unclear whether there are concurrent brain oscillation alterations in resting condition across varying level of depression severity. This cross-sectional study aims to investigate the characteristics of altered resting-state oscillations, including power spectrum and functional connectivity, and their association with the cognitive impairments in LLD with different depression severity. A total of 65 patients with LLD and 40 elder participants without depression were recruited. Global cognition and subtle cognitive domains were evaluated. A five-minute resting-state electroencephalography (EEG) was conducted under eyes-closed conditions. Measurements included the ln-transformed absolute power for power spectrum analysis and the weighted phase lag index (wPLI) for functional connectivity analysis. Attentional and executive dysfunction were exhibited in Moderate-Severe LLD group. Enhanced posterior upper gamma power was observed in both LLD groups. Additionally, enhanced parietal and fronto-parietal/occipital theta connectivity were observed in Moderate-Severe LLD group, which were associated with the attentional impairment. Limitations include a small sample size, concomitant medication use, and a relatively higher proportion of females. Current study observed aberrant brain activity patterns in LLD across different levels of depression severity, which were linked to cognitive impairments. The altered posterior brain oscillations may be trait marker of LLD. Moreover, cognitive impairments and associated connectivity alterations were exhibited in moderate-severe group, which may be a state-like marker of moderate-to severe LLD. The study deepens understanding of cognitive impairments with the associated oscillation changes, carrying implications for neuromodulation targets in LLD. • Firstly explored altered brain oscillations in late-life depression (LLD) across severity, linking them to cognitive impairments. • Elevated posterior gamma power in LLD may be a trait marker. • Theta connectivity increased in LLD, serving as state-like marker linked to attentional impairments. • Highlights link between cognitive deficits and altered brain ocsillation in LLD, suggesting neuromodulation targets and interventions. [ABSTRACT FROM AUTHOR]

In task-sharing models, specific mental health tasks typically delivered by a licensed mental health clinician are assigned instead to a non-licensed individual. These approaches may address unmet mental health needs in rural and other low-resource areas. A growing body of evidence supports the feasibility, acceptability, and effectiveness of task sharing. Do More, Feel Better (DMFB) is an example of a mental health task-sharing approach for older adults with elevated depressive symptoms. DMFB is a streamlined behavioral activation program provided virtually by older adult peers, other volunteers, and social work interns who have been certified as coaches. [ABSTRACT FROM AUTHOR]

Abstract Background Extensive evidence demonstrates correlations among gut microbiota, lipid metabolism and cognitive function. However, there is still a lack of researches in the field of late-life depression (LLD). This research targeted at investigating the relationship among gut microbiota, lipid metabolism indexes, such as total free fatty acids (FFAs), and cognitive functions in LLD. Methods Twenty-nine LLD patients from the Cognitive Outcome Cohort Study of Depression in Elderly were included. Cognitive functions were estimated through the Chinese version of Montreal Cognitive Assessment (MoCA). Blood samples were collected to evaluate serum lipid metabolism parameters. Fecal samples were evaluated for gut microbiota determination via 16S rRNA sequencing. Spearman correlation, linear regression and mediation analysis were utilized to explore relationship among gut microbiota, lipid metabolism and cognitive function in LLD patients. Results Spearman correlation analysis revealed significant correlations among Akkermansia abundance, total Free Fatty Acids (FFAs) and MoCA scores (P

Yan Chen,1 Dansheng Le,1 Jiaxi Xu,2 Piaopiao Jin,3 Yuhan Zhang,4 Zhengluan Liao1 1Center for Rehabilitation Medicine, Department of Psychiatry, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Psychiatry, Yiwu Central Hospital, Jin Hu, Zhejiang, People’s Republic of China; 4The Second Clinical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Zhengluan Liao, Center for Rehabilitation Medicine, Department of Psychiatry, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Hangzhou, Zhejiang, People’s Republic of China, Tel/Fax +86-571-87312143, Email liaozhengluan@163.comPurpose: There are some challenges to diagnosis in the context of similar diagnostic criteria for late-life depression (LLD) and adult depression due to cognitive impairment and other clinical manifestations. The association between gut microbiota and inflammation remains unclear in LLD. We analyzed gut microbiota characteristics and serum inflammatory cytokines in individuals with LLD to explore the combined role of these two factors in potential biomarkers of LLD.Methods: This was an observational cross-sectional study. Fecal samples and peripheral blood from 29 patients and 33 sex- and age-matched healthy controls (HCs) were collected to detect gut microbiota and 12 inflammatory factors. We analyzed differences in diversity and composition of gut microbiota and evaluated relations among gut microbiota, inflammatory factors, and neuropsychological scales. We extracted potential biomarkers using receiver-operating characteristic curve analysis to predict LLD utilizing the combination of the microbiota and inflammatory cytokines.Results: Elevated systemic inflammatory cytokine levels and gut microbiota dysbiosis were found in LLD patients. Relative abundance of Verrucomicrobia at the phylum level and Megamonas, Citrobacter, and Akkermansia at the genus level among LLD patients was lower than HCs. Abundance of Coprococcus, Lachnobacterium, Oscillospira, and Sutterella was higher in LLD patients. Notably, IL6, IFNγ, Verrucomicrobia, and Akkermansia levels were correlated with depression severity. Our study identified IL6, Akkermansia, and Sutterella as predictors of LLD, and their combination achieved an area under the curve of 0.962 in distinguishing LLD patients from HCs.Conclusion: This research offers evidence of changes within gut microbiota and systemic inflammation in LLD. These findings possibly help elucidate functions of gut microbiota and systemic inflammation in LLD development and offer fresh ideas on biomarkers for clinical practise in the context of LLD.Keywords: late-life depression, gut microbiota, inflammation, inflammatory cytokines

Abstract Background Anemia is strongly associated with late-life depression (LLD), however, few studies have investigated the relationship between anemia and suicide attempts in LLD patients. It is still challenging to predict suicide risk in patients with depression. Therefore, there is growing interest in potential biomarkers of depressive disorders and suicidal behavior, which may play a significant role in the early diagnosis and treatment of depression. This study aimed to compare serum ferritin, folate, vitamin B12, and erythrocyte parameter levels in patients with LLD with those in healthy older adults, and the relationship between serum ferritin, folate, vitamin B12, and suicide attempts in patients. Methods Serum ferritin, folate, vitamin B12, and erythrocyte parameter levels were measured in 66 hospitalized LLD patients (30 without suicide attempt, 36 with suicide attempt) and 47 healthy individuals. All participants were surveyed for basic conditions and suicide attempts, and depression was assessed in LLD patients. Results Serum ferritin, folate, vitamin B12, red blood cell count, hemoglobin, hematocrit, mean platelet volume and plateletcrit levels were significantly lower in LLD patients compared with healthy older adults (P

Background: Extensive evidence demonstrates correlations among gut microbiota, lipid metabolism and cognitive function. However, there is still a lack of researches in the field of late-life depression (LLD). This research targeted at investigating the relationship among gut microbiota, lipid metabolism indexes, such as total free fatty acids (FFAs), and cognitive functions in LLD. Methods: Twenty-nine LLD patients from the Cognitive Outcome Cohort Study of Depression in Elderly were included. Cognitive functions were estimated through the Chinese version of Montreal Cognitive Assessment (MoCA). Blood samples were collected to evaluate serum lipid metabolism parameters. Fecal samples were evaluated for gut microbiota determination via 16S rRNA sequencing. Spearman correlation, linear regression and mediation analysis were utilized to explore relationship among gut microbiota, lipid metabolism and cognitive function in LLD patients. Results: Spearman correlation analysis revealed significant correlations among Akkermansia abundance, total Free Fatty Acids (FFAs) and MoCA scores (P < 0.05). Multiple regression indicated Akkermansia and total FFAs significantly predicted MoCA scores (P < 0.05). Mediation analysis demonstrated that the correlation between decreased Akkermansia relative abundance and cognitive decline in LLD patients was partially mediated by total FFAs (Bootstrap 95%CI: 0.023–0.557), accounting for 43.0% of the relative effect. Conclusion: These findings suggested a significant relationship between cognitive functions in LLD and Akkermansia, as well as total FFAs. Total FFAs partially mediated the relationship between Akkermansia and cognitive functions. These results contributed to understanding the gut microbial-host lipid metabolism axis in the cognitive function of LLD. [ABSTRACT FROM AUTHOR]

Twenty years ago, we confirmed the effectiveness of life review therapy and reminiscence (LRT-REM) to treat late-life depression in a meta-analysis. In the current study, we aimed to examine the most updated evidence on the effects of LRT-REM in older adults with depression. We systematically searched records in English and Chinese databases up to December 2022 and included randomized controlled studies comparing LRT-REM with control conditions in older adults with depression. Outcomes included depression, anxiety, quality of life, and life satisfaction. Effect sizes (Hedges' g) at post-treatment were pooled with random effects meta-analyses. 42 studies with 3361 depressed older adults (≥60 years) met the selection criteria. We found a significant and large effect of LRT-REM (g = 1.41, p < 0.001) on late-life depression, corresponding to a number-needed-to-treat (NNT) of 1.98. Heterogeneity shrunk from high (I 2 = 86.78) to moderate (I 2 = 46.87) after excluding eight detected outliers. There were no significant differences between the examined subgroups except for the type of control condition. The effects of LRT-REM were not statistically significant at follow-up when corrected for publication bias. The quality of many included studies was not optimal. The quality of many included studies was not optimal, with a high risk of bias. LRT-REM may be effective for treating late-life depression, but long-term effects are unclear. More research is needed on the effects of LRT-REM, especially when guided by (para)professional or lay therapists in low- and middle-income countries. • Due to a rise in trials on LRT-REM effects on late-life depression, we conducted an updated meta-analysis. • LRT-REM effectively eases late-life depression by treatment end, with comparable effectiveness by professionals or paraprofessionals, across diverse income levels. • LRT-REM could be a promising psychotherapy for late-life depression, especially in low- and middle-income countries with limited access to mental health resources. [ABSTRACT FROM AUTHOR]

Objectives: Depressive symptoms are common among older adults and many of them did not seek for professional help. Although Zentangle has been widely implemented in service centers for older adults in many societies, very limited empirical study has been conducted on the effects of this method. This study aims to evaluate the effects of Zentangle on community-dwelling older adults with depressive symptoms. Methods: A randomised waitlist-controlled trial of Zentangle was conducted. Forty-six community-dwelling older adults with mild to moderate depression were recruited and randomly assigned to a six session Zentangle group or a waitlist control group. The effects were examined by comparing the participants who received a six-week Zentangle intervention with those in the waitlist control group. Patient Health Questionnaire (PHQ-9), Self-compassion Scale – Short form (SCS-SF) and other mental health outcomes were assessed at baseline, post-intervention and six-week follow-up. Results: Repeated measure ANOVA revealed significant Time x Group effects for depression (F (2, 88) = 21.29, p <.001) and self-compassion (F (2, 88) = 18.50, p <.001) with a large net effect size. Six-week follow-up indicated that such improvements were sustained. Conclusion: This study provides preliminary support that the Zentangle programme is an effective alternative treatment approach for older adults with mild to moderate depression. The original Zentangle method can reduce depressive symptoms and cultivate self-compassion. Further research is necessary to expand our understanding of the underlying mechanisms of how the original Zentangle method works. Trial registration: ISRCTN66410347. [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) is an effective and well-established treatment for major depressive disorder (MDD). Deep TMS utilizes specially designed H-Coils to stimulate the deep and broad cerebral regions associated with the reward system. The improved depth penetration of Deep TMS may be particularly important in late-life patients who often experience brain atrophy. The aim of this phase IV open-label study was to evaluate the safety and efficacy of Deep TMS in patients with late-life MDD. Data were collected from 247 patients with MDD aged 60–91 at 16 sites who had received at least 20 Deep TMS sessions for MDD. The outcome measures included self-assessment questionnaires (Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory-II (BDI-II)) and clinician-based scales (21-item Hamilton Depression Rating Scale (HDRS-21)). Following 30 sessions of Deep TMS, there was a 79.4% response and 60.3% remission rate on the most rated scale. The outcomes on the PHQ-9 were similar (76.6% response and 54.7% remission rate). The highest remission and response rates were observed with the HDRS physician-rated scale after 30 sessions (89% response and a 78% remission rate). After 20 sessions, there was a 73% response and 73% remission rate on the HDRS. Consistent with prior studies, the median onset of response was 14 sessions (20 days). The median onset of remission was 15 sessions (23 days). The treatment was well tolerated, with no reported serious adverse events. These high response and remission rates in patients with treatment-resistant late-life depression suggest that Deep TMS is a safe, well-tolerated and effective treatment for this expanded age range of older adults. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the efficacy of mindfulness-based cognitive therapy (MBCT) in alleviating depression in older adults. Methods: A comprehensive search was conducted in 4 electronic databases and 1 registered database from inception up to July 2021 to identify relevant trials. The meta-analysis employed Hedge’s g, along with its 95% CI, and associated z and P-values for the included studies, utilizing Comprehensive Meta-Analysis software. Results: Qualitative synthesis was performed on 5 eligible studies. Evaluation of methodological quality and bias risk across the papers involved scrutiny of key variables due to the heterogeneous research formats. Our findings indicated a significant moderating effect of MBCT against current depressive symptoms in older adults (g=0.53, 95% Confidence Intervals (CI) =0.31-0.75) and a similar effect size for anxiety (g=0.43, 95% CI=0.20-0.65). However, caution is warranted due to the limited number of studies and potential publication bias. Further extensive research with longer follow-up measures and larger sample sizes is essential. Conclusion: This study underscores the effectiveness of MBCT as a treatment for anxiety and despair in older individuals. Mindfulness-based cognitive therapy should be recommended for its positive impact on older adults with depression, and the involvement of authorized psychiatric nurses is crucial for conducting successful MBCT interventions. However, caution is warranted due to the limited number of studies and potential publication bias. Further extensive research with longer follow-up measures and larger sample sizes is essential. [ABSTRACT FROM AUTHOR]

Objectives. To study the outcomes of depression in late age in a three-year prospective follow-up study in patients with different immunophenotypes. Materials and methods. A cohort of patients with depressive disorders who were treated in a geriatric psychiatric hospital were followed up at one and three years. A group with immunophenotype A (with increased leukocyte elastase (LE) activity and complex depression comorbid with anxiety and senestho-hypochondriacal disorders) consisted of 20 patients: six men (30.0%) and 14 women (70.0%), median age 68 years. Depressive episode (DE) as part of recurrent depressive disorder (RDD) was diagnosed in 13 patients (65.0%) and as part of bipolar affective disorder (BAD) in seven patients (35.0%). A group with immunophenotype B (with reduced LE activity and prolonged apathetic- adynamic depression) consisted of 31 patients: 10 (32.3%) men and 21 (67.7%) women, median age 68 years. Twenty patients (64.5%) were diagnosed with DE in the framework of RDD and nine patients (29.0%) in the framework of BAD, while two patients (6.5%) had single-episode DE. Patients were examined using clinical, psychometric, immunological, and clinical follow-up methods (at one and three years). Results. A more favorable course of illness with high-quality remissions was observed in patients with immunophenotype A (in 95% of cases at one and three years; χ2 = 10.44; p = 0.001 and χ2 = 11.97; p = 0.001, respectively). Patients with immunophenotype B showed a prevalence of an unfavorable course of illness (in 83.9% and 87.1% of cases at one and three years; χ2 = 11.32; p = 0.001 and χ2 = 11.77; p = 0.001, respectively), with low-quality remissions (with residual depressive disorders, developing on the background of repeated depressive episodes and chronicization of depression). Conclusions. This study revealed a relationship between clinical and biological features and the course of late-life depression. [ABSTRACT FROM AUTHOR]