Higher IL-6 and IL-4 plasma levels in depressed elderly women are influenced by diabetes mellitus

Abstract Objective This study aimed at investigating a set of peripheral cytokines in elderly female patients with MDD, comparing them to controls, and assessing the potential influence of clinical comorbidities on inflammatory markers. Methods Twenty-five elderly female patients diagnosed with MDD and 19 age-matched female controls were enrolled on this study. Plasma levels of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-γ and tumor necrosis factor (TNF)-α were evaluated with commercially-available assays. Results Elderly female patients with MDD exhibited higher plasma IL-6 and IL-4 levels when compared to controls. In a logistic regression model taking cytokine levels, comorbidities, and age into account, only type 2 diabetes mellitus (DM2) remained associated with MDD. Conclusion Diabetes influences the association between MDD and higher levels of cytokines in elderly female patients. Future studies should take this evidence into account in order to mitigate confounding factors.

Cognitive impairment in hoarding disorder: a systematic review.

OBJECTIVE: In the present study, we aimed to perform a systematic review evaluating the cognitive performance of patients with hoarding disorder (HD) compared with controls. We hypothesized that HD patients would present greater cognitive impairment than controls. METHODS: A systematic search of the literature using the electronic databases MEDLINE, SCOPUS, and LILACS was conducted on May 2020, with no date limit. The search terms were "hoarding disorder," "cognition," "neuropsychology," "cognitive impairment," and "cognitive deficit." We included original studies assessing cognitive functioning in patients with HD. RESULTS: We retrieved 197 studies initially. Of those, 22 studies were included in the present study. We evaluated 1757 patients who were 41 to 72 years old. All selected studies comprised case-control studies and presented fair quality. Contrary to our hypothesis, HD patients showed impairment only in categorization skills in comparison with controls, particularly at confidence to complete categorization tasks. Regarding attention, episodic memory, working memory, information-processing speed, planning, decision-making, inhibitory control, mental flexibility, language, and visuospatial ability, HD patients did not show impairment when compared with controls. There is a paucity of studies on social cognition in HD patients, although they may show deficits. The impact of emotion in cognition is also understudied in HD patients. CONCLUSION: Except for categorization skills, the cognitive performance in HD patients does not seem to be impaired when compared with that in controls. Further work is needed to explore social cognition and the impact of emotion in cognitive performance in HD patients.

Depressive disorders in the elderly and dementia: An update.

The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer's disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly - or at least a subgroup of them - and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aß42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established.

A relação entre transtornos depressivos em idosos e demência, particularmente a doença de Alzheimer (DA), é altamente complexa. Embora a natureza desse relacionamento ainda seja motivo de debate, o diagnóstico e o tratamento diferenciais continuam sendo um grande desafio clínico. Revisamos descobertas recentes sobre o dilema de transtornos depressivos em idosos e DA. Existe um contínuo biológico entre os transtornos depressivos em idosos ­ ou pelo menos um subgrupo deles ­ e a DA. Enquanto indivíduos idosos com depressão e pacientes com DA exibem níveis circulantes mais altos de moléculas pró-inflamatórias e menor BDNF do que os controles correspondentes, os níveis de Aß42 no LCR podem discriminar a DA de distúrbios depressivos em idosos. O papel do tratamento antidepressivo como estratégia para minimizar o risco de DA ainda precisa ser estabelecido.

Depressive disorders in the elderly and dementia: an update / Transtornos depressivos em idosos e demência: uma atualização

ABSTRACT. The relationship between depressive disorders in the elderly and dementia, particularly Alzheimer's disease (AD), is highly complex. While the nature of this relationship is still a matter of debate, differential diagnosis and treatment remain a great clinical challenge. We review recent findings on the conundrum of depressive disorders in the elderly and AD. There is a biological continuum between depressive disorders in the elderly ­ or at least a subgroup of them ­ and AD. While elderly subjects with depression and patients with AD exhibit higher circulating levels of pro-inflammatory molecules and lower BDNF than matched controls, CSF levels of Aß42 can discriminate AD from depressive disorders in the elderly. The role of antidepressant treatment as a strategy to minimize the risk of AD remains to be established.

RESUMO. A relação entre transtornos depressivos em idosos e demência, particularmente a doença de Alzheimer (DA), é altamente complexa. Embora a natureza desse relacionamento ainda seja motivo de debate, o diagnóstico e o tratamento diferenciais continuam sendo um grande desafio clínico. Revisamos descobertas recentes sobre o dilema de transtornos depressivos em idosos e DA. Existe um contínuo biológico entre os transtornos depressivos em idosos ­ ou pelo menos um subgrupo deles ­ e a DA. Enquanto indivíduos idosos com depressão e pacientes com DA exibem níveis circulantes mais altos de moléculas pró-inflamatórias e menor BDNF do que os controles correspondentes, os níveis de Aß42 no LCR podem discriminar a DA de distúrbios depressivos em idosos. O papel do tratamento antidepressivo como estratégia para minimizar o risco de DA ainda precisa ser estabelecido.

Decreased percentage of CD4+ lymphocytes expressing chemokine receptors in bipolar disorder.

OBJECTIVE: Although accumulating evidence supports the hypothesis that immune/inflammatory mechanisms are associated with the pathophysiology of bipolar disorder (BD), data about the profile of chemokines (chemotactic cytokines) and chemokine receptors are still scarce. The current study was designed to evaluate the expression of chemokine receptors on lymphocytes of patients with BD in comparison with controls. METHODS: Thirty-three patients with type I BD (N = 21 in euthymia; N = 6 in mania/hypomania; N = 6 in depression) and 22 age- and sex-matched controls were subjected to clinical evaluation and peripheral blood draw. The expression of chemokine receptors CCR3, CCR5, CXCR4, and CXCR3 on CD4+ and CD8+ lymphocytes was assessed by flow cytometry. RESULTS: Patients with BD had decreased percentage of CD4+CXCR3+ (p = 0.024), CD4+CCR3+ (p = 0.042), and CD4+CCR5+ (0.013) lymphocytes in comparison with controls. The percentage of both CD4+ and CD8+ lymphocytes expressing the chemokine receptor CXCR4 was similar in patients with BD and controls. Likewise, the percentages of CD8+CXCR3+, CD8+CCR3+, and CD8+CCR5+ lymphocytes were similar in patients with BD and controls. CONCLUSION: Our findings reinforce the hypothesis that immune pathways, especially involving CD4+ lymphocytes, are involved in the physiopathology of BD.

Plasma Levels of Tumor Necrosis Factor Superfamily Molecules Are Increased in Bipolar Disorder.

OBJECTIVE: Patients with bipolar disorder (BD) exhibit peripheral low-grade inflammation. The aim of the current study was to investigate the involvement of hitherto unexplored components of the tumor necrosis factor (TNF) superfamily in BD. METHODS: Eighty patients with type I BD and 50 healthy controls matched for age and gender were enrolled in this study. All subjects were assessed with the Mini-Plus to evaluate psychiatric comorbidities; the Young Mania Rating Scale and the Hamilton Depression Rating Scale to evaluate manic and depressive symptoms severity, respectively. TNF superfamily molecules (TNF, TNF-related weak inducer of apoptosis [TWEAK], TNF-related apoptosis-inducing ligand [TRAIL], soluble TNF receptor type 1 [sTNFR1], and soluble TNF receptor type 2 [sTNFR2]) levels were measured by ELISA. RESULTS: Patients with BD, regardless of mood state, presented increased plasma levels of sTNFR1 and TWEAK in comparison with controls. CONCLUSION: These findings corroborate the view that TNF superfamily may play a role in BD pathophysiology.

Decreased plasma neurotrophin-4/5 levels in bipolar disorder patients in mania

Objective: To evaluate two poorly explored neurotrophins (NT), NT-3 and NT-4/5, in bipolar disorder (BD). Methods: Forty patients with type I BD (18 in remission and 22 in mania) and 25 healthy controls matched for age, gender, and educational attainment were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview; the Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to evaluate severity of symptoms in BD patients. Plasma levels of NT-3 and NT-4/5 were measured by enzyme-linked immunosorbent assay (ELISA). Results: BD patients in mania presented decreased NT-4/5 plasma levels in comparison with controls (p < 0.05). There were no significant differences in NT-3 plasma levels between BD patients and controls. Conclusion: These findings corroborate the view that neurotrophin dysfunction is associated with mood states in patients with BD. .

Decreased plasma neurotrophin-4/5 levels in bipolar disorder patients in mania.

OBJECTIVE: To evaluate two poorly explored neurotrophins (NT), NT-3 and NT-4/5, in bipolar disorder (BD). METHODS: Forty patients with type I BD (18 in remission and 22 in mania) and 25 healthy controls matched for age, gender, and educational attainment were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview; the Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to evaluate severity of symptoms in BD patients. Plasma levels of NT-3 and NT-4/5 were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: BD patients in mania presented decreased NT-4/5 plasma levels in comparison with controls (p < 0.05). There were no significant differences in NT-3 plasma levels between BD patients and controls. CONCLUSION: These findings corroborate the view that neurotrophin dysfunction is associated with mood states in patients with BD.

Eletroconvulsoterapia na terapêutica da mania em paciente com hidrocefalia / Eletroconvulsotherapy in the treatment of patient with mania and hydrocephalus

A evidência de segurança e eficácia do emprego de eletroconvulsoterapia (ECT) no tratamento de transtornos psiquiátricos em pacientes com distúrbios neurológicos é fundamentada, em geral, em relatos de casos. Em relação ao emprego em pacientes com hidrocefalia, há apenas oito casos descritos: seis abordando o tratamento de episódios depressivos, um para estado catatônico e um relato em paciente com auto-agressão. Os autores descrevem o caso de um paciente com 20 anos de idade, diagnóstico de hidrocefalia aos 12 anos, internado em ala psiquiátrica com episódio maníaco com sintomas psicóticos. Houve remissão completa da sintomatologia após quatro sessões de ECT. Não houve deterioração neurológica ou outros efeitos colaterais. O resultado sugere que a ECT é segura e eficaz no tratamento de episódios maníacos em pacientes com hidrocefalia.

Safety and efficacy evidence on the use of electroconvulsive therapy (ECT) in the treatment of psychiatric patients with neurological diseases is generally based on case reports. In relation to the use of ECT on patients with hydrocephalus, there are only eight case reports: six for depressive episodes, one for catatonic state and one for self-aggression. In this article the authors describe the case of a 20-year-old male patient, with a hydrocephalus diagnosis since the age of 12, admitted to a psychiatric hospital suffering from a manic episode with psychotic symptoms. There was complete remission of symptoms after four sessions of ECT, with no neurological damage or other side effects. The result suggests that ECT is safe and effective in treating manic episodes in patients with hydrocephalus.