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.

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.

Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence.

This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.

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.

Screening for Frailty With the FRAIL Scale: A Comparison With the Phenotype Criteria.

BACKGROUND: Reliable and valid frailty screening instruments are lacking. The aim of the present study was to compare the diagnostic properties of the FRAIL-BR with Fried's frailty phenotype (CHS), which has not been done. METHODS: Cross-sectional observational study of 124 older adults aged 60 or older from 2 university-based geriatric outpatient units in the state of São Paulo, Brazil. In ROC analyses, we evaluated different cutoff points and AUC areas of the FRAIL-BR compared with the CHS criteria. Also, components of both diagnostic strategies had head-to-head comparisons whenever possible. RESULTS: The sample was composed mostly of overweight (mean BMI = 29.5 kg/m2) women (83%) with mean age of 78.6 (±7.1) years. Prevalence of frailty varied according to the FRAIL-BR (23.3%) and the CHS criteria (14.5%) (P = .04). A cutoff of 3 points in the FRAIL-BR presented a sensitivity of 28% and specificity of 90% (P = .049). A cutoff of 2 points resulted in a sensitivity of 54% and specificity of 73% (P = .01). Comparisons of 4 FRAIL-BR items (ie, weight loss, aerobic capacity, fatigue, and physical resistance) to the respective CHS components showed an independent diagnostic property of all measures, with the exception for weight loss. CONCLUSION: The FRAIL scale can be used as a screening instrument for frailty (time and cost-effective).