Depression and Cerebrovascular Disease: a phenomenological study

The main topic of this thesis is the clinical presentation of depression in subjects with cerebrovascular disease. It concerns patients with post-stroke depression, depression in subjects with vascular risk factors or in subjects with vascular lesions on MRI- or CT-scan. Some of the studies presented do indicate that there might be a specific symptom profile of depression in these subjects. These subjects show more so-called 'motivational' symptoms of depression and less 'mood' symptoms. This relation is more prominent in a clinical sample. In population-based studies, we only found this relation in one study, but could not confirm it in another. The motivational symptoms are also found to be related to more prominent cognitive disturbances in stroke or vascular subjects. In the general discussion the complex relation between vascular damage of the brain and its cognitive and affective consequences is described. Various levels of explanation are at hand and! the findings of this study could contribute to a part of the complex, explanatory etiological pathway that leads to development of post-stroke and vascular depression or dementia

Acoustic characteristics of depression in older adults’ speech:The role of covariates

Depression in older adults is often associated with various physical conditions and is hence different from depression at a younger age. Ageing may come with cognitive decline, medication use, and frailty, which are known to be predictors of late-life depression. One common symptom of depression is psychomotor retardation, that may also affect speech production. Most speech studies on depression so far have focused on younger or middle-aged adults. In this study, we used speech data from a large longitudinal Dutch study on late-life depression and its comorbid symptoms to compare speech acoustics in persons with depression (PWD) and controls. We investigated whether groups differed by taking several covariates into account (e.g., frailty, slowness, and medication use). Group differences were found in within-vowel F2 range, speech rate and mean pause duration. These data indicate that speech acoustics can be used to differentiate PWDs and controls, even with low-quality speech data

Effectiveness of late-life depression interventions on functional limitations:A systematic review

Depression is one of the most prevalent mental disorders in older adults and leads to considerable decreases in health, well-being, and impaired functioning. Intervention studies have focused on the effects on symptomatic recovery, and most do not include functional recovery as an outcome. Reduction of functional limitations as a treatment goal in old-age psychiatry aligns with the values of older persons. The objective of this review was therefore to evaluate the effectiveness of late-life depression interventions on functional limitations. This systematic review identified 15 randomized controlled trials in which the effectiveness of different interventions on functional limitations was evaluated in patients with late-life depression. The interventions were categorized into four categories: psychological interventions, drug treatment, physical exercise, and collaborative care. Multicomponent and collaborative-care interventions appear to be the most promising for improvement of functional limitations, particularly in primary care and community-dwelling populations of older persons with symptoms of depression. There is, however, a lack of evidence regarding studies in specialized mental health care

Pain characteristics of older persons with medically unexplained symptoms, older persons with medically explained symptoms and older persons with depression

Objectives: The main objective of the current study is to compare chronic pain characteristics of older patients with Medically Unexplained Symptoms (MUS), to those of patients with Medically Explained Symptoms (MES), and to those of patients with Major Depressive Disorder (MDD). Method: By combining data from the OPUS and NESDO study, we compared pain characteristics of 102 older (&gt;60 years) MUS-patients to 145 older MES-patients and 275 older MDD-patients in a case-control study design. Group differences were analyzed using ANCOVA, adjusted for demographic and physical characteristics. Linear regression was applied to examine the association between pain characteristics and somatization (BSI-53 somatization scale) and health anxiety (Whitely Index). Results: Older MUS-patients have approximately two times more chance of having chronic pain when compared to older MES-patients (OR = 2.01; p = .013) but equal chances as opposed to MDD-patients. After adjustments, MUS-patients report higher pain intensity and disability scores and more pain locations when compared to MES-patients, but equal values as MDD-patients. Health anxiety and somatization levels were positively associated with the number of pain sites in MUS-patients, but not with pain severity or disability. Conclusion: Older MUS-patients did not differ from MDD-patients with respect to any of the chronic pain characteristics, but had more intense and disabling pain, and more pain locations when compared to older MES-patients.</p

The symptom profile of vascular depression

SUMMARY Objectives Vascular depression is regarded as a subtype of depression, especially in--but not limited strictly to--older persons, and characterized by a specific clinical presentation and an association with (cerebro)vascular risk and disease. It is also known that depression is a risk factor in the development of myocardial infarction. The possibility of identifying depressed subjects at risk of a first cardiac event by their clinical presentation in general practice would have significant implications. Methods We studied the baseline depression symptom profiles of subjects in the Longitudinal Aging Study Amsterdam and compared the profile of depressed subjects who had and had not suffered a first cardiac event at a follow-up after eight years. Results We could not confirm the specific symptom profile in depressed subjects who suffered from a first cardiac event at follow-up. Most notably, the presumed specific symptoms of vascular depression, psychomotor retardation, and anhedonia were not significantly associated with the occurrence of a first cardiac event at follow-up. Conclusions In this large community study we failed to identify a difference in the depression symptom profile between incident cardiac and non-cardiac cases

Skin autofluorescence assessment of cardiovascular risk in people with severe mental illness

Background People with severe mental illness (SMI) show significantly shorter life expectancy, mostly due to more prevalent cardiovascular disease. Although age is a prominent contributor to contemporary risk assessment and SMI usually affects younger people, these assessments still do not reveal the actual risk. By assessing advanced glycation end products (AGEs), cardiovascular risk can be assessed independent of age. Aims To establish whether detection of AGEs with the AGE-reader will give a more accurate cardiovascular risk assessment in people with SMI. Method We compared assessment with the AGE-reader with that of the Systematic Coronary Risk Evaluation (SCORE) table in a group of 120 patients with SMI. Results The AGE-reader showed an increased cardiovascular risk more often than the SCORE table, especially in the youngest group. Conclusions Because of its ease of use and substantiation by studies done on other chronic diseases, we advocate use of the AGE-reader in daily care for patients with SMI to detect cardiovascular risk as early as possible. However, the findings of the current study should be evaluated with caution and should be seen as preliminary findings that require confirmation by a prospective longitudinal cohort study with a substantial follow-up observation period. (c) The Royal College of Psychiatrists 2018

Symptomatic and functional recovery in depression in later life

Objectives: Functional limitations give an indication of the total impact of diseases, such as depression, on individuals health and recovery. This study examines the change in several domains of functioning over 2 years in older persons depressed at baseline (non-remitted group and remitted group after 2 years) and in a non-depressed comparison group. Methods: Data were used from a cohort study (Netherlands Study of Depression in Older persons [NESDO]) consisting of depressed older persons ≥ 60 years (N = 378) and a non-depressed comparison group (N = 132) with 2 years of follow-up (attrition rate 24%). Functional limitations (outcome) were assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire every 6 months. Total scores and domain scores were used. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at 2-year follow-up. Severity of depression (predictor) was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. Results: Linear mixed models showed that the level of functional limitations differed between the three groups during 2 years of follow-up. The non-remitted group had the highest level of functional limitations during 2 years, followed by the remitted group. Stable low levels of functional limitations were found for the non-depressed group. Remission from depression was accompanied by improvements in functioning, however, compared to the non-depressed comparison group significant functional limitations remained. Higher severity of depression appeared as risk factor for a declining course of functioning, especially the social aspects of functioning. Methodological considerations: Participants that were more severely depressed and more functionally impaired at baseline had higher attrition rates than the participants that were included in the analytical sample. Conclusion: This study showed that depression in later life has long-term debilitating effects on functioning, enduring even after remission from depression. This implies that depression treatment in later life should aim broader than just symptomatic recovery, but also include functional recovery

Striatal neuropeptides enhance selection and rejection of sequential actions

The striatum is the primary input nucleus for the basal ganglia, and receives glutamatergic afferents from the cortex. Under the hypothesis that basal ganglia perform action selection, these cortical afferents encode potential “action requests.” Previous studies have suggested the striatum may utilize a mutually inhibitory network of medium spiny neurons (MSNs) to filter these requests so that only those of high salience are selected. However, the mechanisms enabling the striatum to perform clean, rapid switching between distinct actions that form part of a learned action sequence are still poorly understood. Substance P (SP) and enkephalin are neuropeptides co-released with GABA in MSNs preferentially expressing D1 or D2 dopamine receptors respectively. SP has a facilitatory effect on subsequent glutamatergic inputs to target MSNs, while enkephalin has an inhibitory effect. Blocking the action of SP in the striatum is also known to affect behavioral transitions. We constructed phenomenological models of the effects of SP and enkephalin, and integrated these into a hybrid model of basal ganglia comprising a spiking striatal microcircuit and rate–coded populations representing other major structures. We demonstrated that diffuse neuropeptide connectivity enhanced the selection of unordered action requests, and that for true action sequences, where action semantics define a fixed structure, a patterning of the SP connectivity reflecting this ordering enhanced selection of actions presented in the correct sequential order and suppressed incorrect ordering. We also showed that selective pruning of SP connections allowed context–sensitive inhibition of specific undesirable requests that otherwise interfered with selection of an action group. Our model suggests that the interaction of SP and enkephalin enhances the contrast between selection and rejection of action requests, and that patterned SP connectivity in the striatum allows the “chunking” of actions and improves selection of sequences. Efficient execution of action sequences may therefore result from a combination of ordered cortical inputs and patterned neuropeptide connectivity within striatum

A Cross-National Analysis of the Psychometric Properties of the Geriatric Anxiety Inventory

10.1093/geronb/gbz002J Gerontol B Psychol Sci Soc Sc

Human Breast Milk and Antiretrovirals Dramatically Reduce Oral HIV-1 Transmission in BLT Humanized Mice

Currently, over 15% of new HIV infections occur in children. Breastfeeding is a major contributor to HIV infections in infants. This represents a major paradox in the field because in vitro, breast milk has been shown to have a strong inhibitory effect on HIV infectivity. However, this inhibitory effect has never been demonstrated in vivo. Here, we address this important paradox using the first humanized mouse model of oral HIV transmission. We established that reconstitution of the oral cavity and upper gastrointestinal (GI) tract of humanized bone marrow/liver/thymus (BLT) mice with human leukocytes, including the human cell types important for mucosal HIV transmission (i.e. dendritic cells, macrophages and CD4+ T cells), renders them susceptible to oral transmission of cell-free and cell-associated HIV. Oral transmission of HIV resulted in systemic infection of lymphoid and non-lymphoid tissues that is characterized by the presence of HIV RNA in plasma and a gradual decline of CD4+ T cells in peripheral blood. Consistent with infection of the oral cavity, we observed virus shedding into saliva. We then evaluated the role of human breast milk on oral HIV transmission. Our in vivo results demonstrate that breast milk has a strong inhibitory effect on oral transmission of both cell-free and cell-associated HIV. Finally, we evaluated the effect of antiretrovirals on oral transmission of HIV. Our results show that systemic antiretrovirals administered prior to exposure can efficiently prevent oral HIV transmission in BLT mice