[Neurocognitive markers of suicide vulnerability in the elderly: a review]. / Marqueurs neurocognitifs de la vulnérabilité suicidaire de la personne âgée : revue de la littérature.

OBJECTIVE: a comprehensive literature review suggests that suicidal behaviour results from a complex interplay between stressful events and vulnerability factors including cognitive deficits. The aim of this systematic literature review was to identify the neurocognitive markers associated with suicide vulnerability in elderly people. METHOD: a systematic English Medline literature search of cohort studies, case-control studies and cross-sectional studies published between January 1960 and December 2012 was performed, combining the MeSH terms "Suicide", "Neuropsychology", "Neuropsychological Tests", "Executive Function", "Magnetic Resonance Imaging", "Diffusion Magnetic Resonance Imaging", "Positron-Emission Tomography", "Prefrontal Cortex", "Tomography, Emission-Computed, Single-Photon", and "Diffusion Tensor Imaging". The abstract selection was based on the Strobe checklist for observational studies. RESULTS: of the 446 original articles, 10 neuropsychological and 4 brain imaging studies were selected. The number of suicidal subjects ranged from 10 to 29 (mean age=66.8 to 79.1 years old, 0-85% women). Executive functions, in particular decision-making and cognitive inhibition, were more impaired in the depressed elderly with a history of suicide attempts compared to those without such a history. fMRI data, which need to be confirmed in further details, showed abnormalities of fronto-limbic circuits which are involved in suicide vulnerability in the elderly independently of any associated psychopathological conditions including depression. CONCLUSION: this literature review confirms the existence of neurocognitive markers of suicide vulnerability in elderly people. A neuropsychological assessment could thus help to identify the suicide vulnerability of a depressed elderly person, a first step for both pharmacological and psychotherapeutic cares.

[A same deficit of cognitive inhibition in early and late-onset depression in elderly women: a pilot study]. / Déficit de l'inhibition cognitive identique dans la dépression précoce et tardive chez la femme âgée.

OBJECTIVE: Late-life depression has been associated with frontostriatal abnormalities that are thought to lead to deficits of cognitive inhibition. However, it remains unclear, whether age-of-onset identifies subgroups of depression. The objective of this study was to compare cognitive inhibition in depressed women aged 60 and older, according to age of the first onset depression (before or after 60 years old). METHODS: We compared 10 currently depressed women (HDRS-17≥18) with a late-onset depression to 10 depressed women with an early-onset depression, and to 10 healthy controls. We examined cognitive inhibition (Stroop, Hayling, Go/No-Go), shifting (TMT), updating in working memory (WAIS) and executive functions (BREF). All groups were matched for age, education level, and MMSE score (MMSE≥24). RESULTS: Depressed elderly women with a late and an early-onset depression had a greater impairment in executive functions and cognitive inhibition compared with healthy controls (p<0,001), but without significant differences according to the age of the first onset depression. Futhermore, late-onset depression in women was significantly correlated with a deficit of cognitive inhibition (rs=0.55; p=0.012). CONCLUSION: Cognitive inhibition should be assessed in late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of late-life depression, to identify those who are the most vulnerable to relapse.