Decision-making executive function profile and performance in older adults with major depression: a case-control study.

OBJECTIVES: Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD: The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS: In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION: Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.

Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?

OBJECTIVES: This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. METHODS: Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a self-report questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30-item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. RESULTS: Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. CONCLUSIONS: Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. CLINICAL IMPLICATIONS: Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.

Serotonin receptor inhibitor is associated with falls independent of frailty in older adults.

OBJECTIVES: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. METHODS: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. RESULTS: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. CONCLUSION: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.

Relationship between affective temperament and major depressive disorder in older adults: A case-control study.

BACKGROUND: In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. METHODS: A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. RESULTS: In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1-7.2). LIMITATIONS: The sample was relatively small, and their educational level was very low. CONCLUSION: A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.

Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms.

OBJECTIVE: Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment. DESIGN: Cross-sectional analysis of a cohort study on cognitive aging. PARTICIPANTS: 143 older adults. SETTING: University-based memory clinic. METHODS: Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles. RESULTS: The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007). CONCLUSION: Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Depression is associated with self-rated frailty in older adults from an outpatient clinic: a prospective study.

ABSTRACTObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults. DESIGN: Prospective cohort study, 12-month follow-up. SETTING: Geriatric outpatient clinic in São Paulo, Brazil. PARTICIPANTS: A total of 811 elderly adults aged 60 or older. MEASUREMENTS: Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities. RESULTS: Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23). CONCLUSION: It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder A systematic review.

Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM). OBJECTIVE: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD. METHODS: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: 'depression', 'depressive', 'depressive symptoms' AND 'decision making' OR 'game task'. RESULTS: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task. CONCLUSION: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed.

O Transtorno Depressivo Maior (TDM) pode ocorrer em paralelo com o comprometimento cognitivo. A busca por um perfil neuropsicológico da depressão tem sido perseguida nas últimas duas décadas. No entanto, poucas pesquisas foram feitas sobre funções executivas e capacidade de decisão (DM). OBJETIVO: Realizar uma revisão sistemática das evidências do desempenho do DM avaliado pela Iowa Gambling Task (IGT) em adultos com TDM. MÉTODOS: Uma pesquisa sistemática de acordo com a declaração PRISMA foi realizada na MEDLINE para estudos em inglês usando as seguintes palavras-chave: "depressão", "depressivo", "sintomas depressivos" e "tomada de decisão" OU "tarefa de jogo". RESULTADOS: Foram identificados 5 artigos que atenderam aos critérios de inclusão e exclusão. Três relataram diferenças significativas entre indivíduos deprimidos e não deprimidos. Os resultados indicaram que os jovens adultos com TDM exibiram menor desempenho em todos ou quase todos os estágios da IGT. Um estudo que avaliou o DM em idosos com TDM mostrou que os participantes deprimidos não apáticos não adotaram nenhuma estratégia vantajosa e continuaram tomando decisões arriscadas durante a tarefa. CONCLUSÃO: Os resultados sugerem que o desempenho na tarefa de DM por jovens e adultos idosos com TDM diferiu em comparação com os participantes não deprimidos. Dado o pequeno número de artigos, mais estudos devem ser realizados.

Early-Onset Alzheimer Disease (EOAD) With Aphasia: A Case Report.

Background: Alzheimer's disease (AD) is traditionally subdivided into early onset (EOAD) and late onset (LOAD). EOAD has an onset before age 65 years and accounts for 1-5% of all cases. Two main presentation types of AD are familial and sporadic. Case presentation: The authors present the case of a 68-year-old retired white man, with a college level educational background. At 55 years of age, the patient presented cognitive decline with short-term memory impairment and slowed, hesitant speech. At 57 years, he was unable to remember the way to work, exhibiting spatial disorientation. PET-CT: revealed hypometabolism and atrophy in the left temporal lobe and posterior region of the parietal lobes. Disease course: Evolving with difficulties in comprehension and sentence repetition over past 3 years and with global aphasia in past 6 months, beyond progressive memory impairment. Discussion: Possibly due to the young age and atypical presentation, and the diagnosis of EOAD is often delayed. To the best of our knowledge, this case can be classified as a sporadic EOAD with aphasia. Clinical variant and neuroimaging findings were crucial to the diagnosis and treatment of this atypical presentation of AD.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder: a systematic review / Tomada de decisão avaliada pela Iowa Gambling Task e pelo Transtorno Depressivo Maior: uma revisão sistemática

Abstract Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM). Objective: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD. Methods: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: 'depression', 'depressive', 'depressive symptoms' AND 'decision making' OR 'game task'. Results: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task. Conclusion: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed.

Resumo O Transtorno Depressivo Maior (TDM) pode ocorrer em paralelo com o comprometimento cognitivo. A busca por um perfil neuropsicológico da depressão tem sido perseguida nas últimas duas décadas. No entanto, poucas pesquisas foram feitas sobre funções executivas e capacidade de decisão (DM). Objetivo: Realizar uma revisão sistemática das evidências do desempenho do DM avaliado pela Iowa Gambling Task (IGT) em adultos com TDM. Métodos: Uma pesquisa sistemática de acordo com a declaração PRISMA foi realizada na MEDLINE para estudos em inglês usando as seguintes palavras-chave: "depressão", "depressivo", "sintomas depressivos" e "tomada de decisão" OU "tarefa de jogo". Resultados: Foram identificados 5 artigos que atenderam aos critérios de inclusão e exclusão. Três relataram diferenças significativas entre indivíduos deprimidos e não deprimidos. Os resultados indicaram que os jovens adultos com TDM exibiram menor desempenho em todos ou quase todos os estágios da IGT. Um estudo que avaliou o DM em idosos com TDM mostrou que os participantes deprimidos não apáticos não adotaram nenhuma estratégia vantajosa e continuaram tomando decisões arriscadas durante a tarefa. Conclusão: Os resultados sugerem que o desempenho na tarefa de DM por jovens e adultos idosos com TDM diferiu em comparação com os participantes não deprimidos. Dado o pequeno número de artigos, mais estudos devem ser realizados.

Review of Decision-Making in Game Tasks in Elderly Participants with Alzheimer Disease and Mild Cognitive Impairment.

BACKGROUND: Changes in decision-making (DM) have recently been investigated in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI). DM is highly relevant to everyday functioning and autonomy. It relies on several cognitive abilities, such as semantic and episodic memory, as well as aspects of executive functioning. We conducted a systematic review of DM in older adults with MCI and AD. SUMMARY: Only 5 studies whose main objective was to evaluate the DM performance were selected. The results extracted indicated that DM in ambiguity and in at-risk situations are both impaired in probable AD patients. MCI patients have difficulty making advantageous decisions under ambiguity and at risk, similar to patients with probable AD but they are less impaired. Key Messages: DM deficits may be a predictor of cognitive impairment and conversion to dementia and its potential clinical value should be further explored in longitudinal studies involving direct comparison between MCI and AD patients.