Psychotic symptoms and paranoid ideation in the non-demented elderly. A population study on prevalence, incidence, and associated factors, and their relationship to cognitive functioning and prognosis

Background: Psychotic symptoms and paranoid ideation are not commonly reported in non-demented elderly, and may be underrated in traditional epidemiological studies.Aims: The aims of this study are to characterize the incidence and prevalence of psychotic symptoms and paranoid ideation and associated factors; the relationship between neuropsychological performance and psychotic symptoms and paranoid ideation and the prognosis of psychotic symptoms and paranoid ideation in non-demented elderly. Methods: Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed with psychiatric and physical examinations and medical record reviews in a representative sample of 70-year-olds (N=392) from Gothenburg, Sweden in 1971. Psychotic symptoms that appeared after onset of dementia and during a delirium were not included. The sample was followed for 20 years at ages 75, 79, 81, 83, 85, 88 and 90. At age 85, the sample was extended to include every second 85-year-old in Gothenburg, and 494, including 100 from the original sample, were examined. At age 85, the examinations also included a key-informant interview, CT-scan of the brain and neuropsychological examinations. Results: Between ages 70-79 the incidence of psychotic symptoms was 4.4 per 1000 person-years, 7.9 per 1000 person-years between ages 79-85 and 1.9 per 1000 person-years between ages 85-90. After inclusion of information from key-informant interviews, the incidence of psychotic symptoms increased to 7.4 cases per 1000 person-years between ages 85-90. At age 85, the prevalence of psychotic symptoms was 10.1%, including hallucinations among 6.9% and delusions among 5.5%. The prevalence of paranoid ideation was 6.9%. Hallucinations were associated with major depressive syndrome, disability in daily life, and visual deficits. Delusions were associated with disability in daily life. Paranoid ideation was associated with visual deficits and myocardial infarction. Hallucinations, delusions and paranoid ideation were each related to an increased incidence of dementia between the ages of 85 and 88. Hallucinations were associated with increased 3-year mortality in women but not in men. Basal ganglia calcification on CT was observed in 19% of mentally healthy and 64% of non-demented 85-year olds with hallucinations or delusions (Odds Ratio 7.7, 95% Confidence Interval 2.9-29.7). Non-demented 85-year-olds with psychotic symptoms or paranoid ideation performed worse on tests measuring verbal ability, logical reasoning and two tests of spatial ability after adjustment for sex, education, hearing impairment, visual deficits, somatic disorders, depression, mortality, and incident dementia. Conclusions: We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported and these symptoms were associated with broad psychopathology and a poor prognosis

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

The influence of organic brain changes on the development of depression in the elderly is uncertain. Cross-sectional studies, most often from clinical samples, report associations with brain atrophy and cerebrovascular disease, while longitudinal population studies have given mixed results. Our aim was to investigate whether cortical atrophy and white matter lesions (WMLs) on computed tomography (CT) predict occurrence of depression in the elderly. This is a prospective population-based study with 5-year follow-up. The baseline sample included 525 elderly subjects, aged 70–86 years, without dementia or major depression, with a score on the Mini-Mental State Examination above 25, and without dementia at follow-up. Cortical atrophy and WMLs were evaluated at baseline using CT. The main outcome measure was development of major or minor depression at follow-up according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, as evaluated using neuropsychiatric examinations and hospital discharge registers. Logistic regression was used to estimate risk. Over the period of 5 years, 20 individuals developed major and 63 minor depression. Presence of temporal lobe atrophy (odds ratio (OR)=2.81, 95% confidence interval (CI) 1.04–7.62) and moderate-to-severe WMLs (OR=3.21, 95% CI 1.00–10.26) independently predicted major, but not minor, depression after controlling for various confounders. Other brain changes did not predict occurrence of depression. Our findings suggest that temporal lobe atrophy and WMLs represent relatively independent and complementary pathways to major depression in the elderly. This may have implications for prevention, as both neurodegeneration and cerebrovascular disease have been related to preventable factors

Association between APOE Genotype and Change in Physical Function in a Population-Based Swedish Cohort of Older Individuals Followed Over Four Years

The association between decline in physical function and age-related conditions, such as reduced cognitive performance and vascular disease, may be explained by genetic influence on shared biological pathways of importance for aging. The apolipoprotein F (APOE) gene is well-known for its association with Alzheimer\u27s disease, but has also been related to other disorders of importance for aging. The aim of this study was to investigate possible associations between APOE allele status and physical function in a population-based longitudinal study of older individuals. In 2005, at the age of 75, 622 individuals underwent neuropsychiatric and physical examinations, including tests of physical function, and APOE-genotyping. Follow-up examinations were performed at age 79. A significantly larger decline in grip strength (p = 0.015) between age 75 and 79 was found when comparing APOE epsilon 4 allele carriers with non carriers [10.3 (+/- 10.8) kg versus 7.8 (+/- 10.1) kg]. No association was seen with decline in gait speed, chair-stand, or balance. The association with grip strength remained after correction for cognitive and educational level, depression, cardiovascular disease, stroke, and BMI

A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older

Background: Adiposity measured in mid- or late-life and estimated using anthropometric measures such as body mass index (BMI) and waist-to-hip ratio (WHR), or metabolic markers such as blood leptin and adiponectin levels, is associated with late-onset dementia risk. However, during later life, this association may reverse and aging- and dementia-related processes may differentially affect adiposity measures. Objective: We explored associations of concurrent BMI, WHR, and blood leptin and high molecular weight adiponectin levels with dementia occurrence. Methods: 924 Swedish community-dwelling elderly without dementia, aged 70 years and older, systematically-sampled by birth day and birth year population-based in the Gothenburg city region of Sweden. The Gothenburg Birth Cohort Studies are designed for evaluating risk and protective factors for dementia. All dementias diagnosed after age 70 for 10 years were identified. Multivariable logistic regression models were used to predict dementia occurrence between 2000-2005, 2005-2010, and 2000-2010 after excluding prevalent baseline (year 2000) dementias. Baseline levels of BMI, WHR, leptin, and adiponectin were used. Results: Within 5 years of baseline, low BMI (<20kg/m 2) was associated with higher odds of dementia compared to those in the healthy BMI category (≥ 20-24.9kg/m 2). Compared to the lowest quartile, leptin levels in the second quartile were associated with lower odds of dementia in women (p<0.05). Conclusion: In late-life, anthropometric and metabolic adiposity measures appear to be differentially associated with dementia risk. While BMI and leptin levels are highly positively correlated, our results show that their association with dementia at age ≥70 years, is asynchronous. These data suggest that with aging, the complexity of the adiposity exposure may increase and suggests metabolic dysregulation. Additional studies are needed to better understand this complexity

Depression in relation to sex and gender expression among Swedish septuagenarians-Results from the H70 study.

ObjectiveLittle is known about the role of gender expression (femininity, masculinity, or androgyny) in relation to sex differences in depression. This study tested if gender expression was associated with depression and burden of depressive symptoms in a 70-year-old population.MethodsA cross-sectional population-based sample of 70-year-olds from The Gothenburg H70 Birth Cohort Study (n = 1203) was examined in 2014-16. Data were collected using psychiatric examinations and structured questionnaires, including the Positive-Negative Sex-Role Inventory to assess gender expression. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders criteria, and symptom burden was assessed with Montgomery Åsberg Depression Rating Scale (MADRS).ResultsGender expression was related to MADRS score and depression diagnosis. In fully adjusted models, feminine traits with low social desirability (FEM-) were associated with a higher MADRS score (R2 0.16; B 0.16; CI 0.1-0.2), while androgyny (t ratio) (R2 0.12; B 0.42; CI 0.1-0.7) and masculine traits with high social desirability (MAS+) (R2 0.13; B -0.06; CI -0.1--0.01) were associated with a lower MADRS score. Also, feminine traits with low social desirability (FEM-) were positively associated with depression (OR 1.04; CI 1.01-1.1). No associations between depression and masculinity or androgyny were observed in adjusted models. There were no interactions between sex and gender expression in relation to depression or MADRS score, indicating that the effects of gender expression were similar in men and women.ConclusionsWe found that gender expression was associated to both depression and burden of depressive symptoms. More specifically, we found that femininity was associated to higher levels of depression, irrespective of biological sex. In addition, masculinity and androgyny were associated with lower levels of depression. These results highlight the importance of taking gender expression into consideration when studying sex differences in depression among older populations in future studies