The Role of Vitamin D in Depression: From a Curious Idea to a Therapeutic Option

International audienc

Influence of gender and age on cognitive inhibition in late-onset depression: a case-control study

ObjectiveTo compare cognitive inhibition performance between people with early-onset (EOD) or late-onset depression (LOD) and controls, and between women and men with LOD.MethodsOn the basis of a case-control design, global executive performance (Frontal Assessment Battery); verbal (Hayling), attention (Stroop), and motor (Go/No-Go) components of cognitive inhibition; mental shifting (Trail Making Test parts A and B); and updating in working memory (Wechsler Adult Intelligence Scale) were assessed in 40 participants (10 depressed women with LOD (i.e., 60years old), 10 depressed women with EOD (i.e., <60years old), 10 healthy women and 10 depressed men with LOD (i.e., 60years old)). ResultsOlder depressed women, irrespective of age of depression onset, had greater cognitive inhibition impairments (attention and verbal component) compared with healthy women. LOD was significantly associated with the attention component of cognitive inhibition impairment, unlike EOD (p=0.026). No executive differences were found regarding age of first-onset depression in older depressed women, and between women and men with LOD. ConclusionCognitive inhibition impairment, and more specifically its attention component, was the main characteristic of depression in the studied sample of older adults, independently of gender and age of depression onset. It is essential to perform similar studies in both genders in view of future tailor-made therapeutic modalities. Copyright (c) 2013 John Wiley & Sons, Ltd

Crise suicidaire et maladie d’Alzheimer débutante : intérêt d’une analyse neuropsychologique détaillée

RésuméIntroduction Le risque de développer une maladie d’Alzheimer augmente avec l’âge. Le rôle de celle-ci comme un facteur de risque indépendant de suicide n’est pas bien compris et demeure complexe et mal élucidé. L’objectif de cet article est d’envisager une compréhension neuropsychologique de la crise suicidaire dans le cas d’une maladie d’Alzheimer débutante. Méthode Une évaluation cognitive globale (Mini-Mental State Examination, Batterie Rapide d’Évaluation Frontale) complétée de l’exploration de l’inhibition cognitive selon ses fonctions d’accès (tâche de lecture en présence de distracteurs), de suppression (Trail Making Test), et de freinage (Stroop, Hayling, Go/No-Go) a été réalisée chez une femme souffrant d’une maladie d’Alzheimer (MMSE à 21/30) avant et après réalisation d’une tentative de suicide dans un contexte de dépression. Résultats L’échelle d’Hamilton était cotée à 24/52, l’échelle de dépression de Cornell à 21/38. L’intentionnalité suicidaire était modérée avec un score à 15/25 à l’échelle d’intentionnalité suicidaire de Beck. Initialement préservées, le déclin des fonctions exécutives a coïncidé avec l’émergence d’une crise suicidaire dans un contexte de dépression chez une patiente souffrant de maladie d’Alzheimer. Les fonctions de l’inhibition cognitive étaient altérées dans ses trois composantes, après ajustement des facteurs de confusion. Conclusion Une évaluation détaillée des fonctions exécutives et singulièrement de l’inhibition cognitive dans la population des patients atteints d’une maladie d’Alzheimer permettrait de détecter les personnes les plus à risque de passage à l’acte et de proposer une surveillance plus étroite dans le cadre des soins généraux de leur maladie. AbstractIntroduction The role of Alzheimer\u27s disease as a risk factor for suicide is unclear. The aim of this study was to understand neuropsychological component of the suicidal crisis in Alzheimer\u27s disease. Method Using an extensive neuropsychological battery, different aspects of cognitive inhibition were particularly examined: Access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). One female Alzheimer depressed case was assessed before and after a suicide attempt. Results Ten days after the patient\u27s suicide attempt, dementia was still moderate with a MMSE score at 21/30 but with a worsening of executive functions (FAB at 8/18) in the context of depression and suicide. The Hamilton-Depression Rating Scale was at 24 (maximal score at 52), and the Cornell Scale for Depression was at 21 (maximal score at 38). Suicidal intent was moderate with a score of 9 on the Beck Suicide Intent Scale (maximal score at 25). The patient did not present a delirium, psychotic symptoms, or anosognosia. Her episodic memory was altered as shown by her semantic performance on verbal fluency (naming 12 animals in 120 seconds) and on lexical fluency (naming 8 words beginning with the letter P). Initially preserved, executive function declined during a suicidal crisis in a context of depression in Alzheimer\u27s disease case. Neuropsychological testing confirmed a dysexecutive syndrome (FAS at 8/18), with an impairment in her conceptualization capacity (MCST) and a deficit in cognitive inhibition and its access (reading task in the presence of distractors), deletion (TMT) and restraint (Stroop, Go/No-Go, Hayling) functions. Computed tomography has shown no signs of intracranial expansive process. Conclusion Assessing predictors of suicide and means of completion in patients with dementia may help the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. Because of Alzheimer\u27s-related cognitive inhibition impairment, identification and intervention addressing the complex issues of depression, executive dysfunction and dementia may help clinicians to mitigate the risk of suicide in patients with Alzheimer\u27s disease

Meta-Analysis of Memory and Executive Dysfunctions in Relation to Vitamin D

Background: Hypovitaminosis D is associated with global cognitive impairment in adults. It remains unclear which domain-specific cognitive functions are affected with hypovitaminosis D.Objective: To systematically review and quantitatively synthesize the association of serum 25-hydroxyvitamin D (25OHD) concentrations with episodic memory and executive functions in adults. Methods: A Medline and PsycINFO (R) libraries search was conducted on May 2012, with no limit of date, using the Medical Subject Headings (MeSH) terms "Vitamin D" OR "Hydroxycholecalciferols" combined with the MeSH terms "Memory" OR "Memory Disorders" OR "Executive Function" OR "Attention" OR "Cognition" OR "Cognition disorders" OR "Dementia" OR "Alzheimer disease" OR "Neuropsychological Tests". Fixed-effects meta-analysis was performed from 12 eligible studies using an inverse-variance method. Results: Of the 285 selected studies, 14 observational studies (including 3 prospective cohort studies) and 3 interventional studies met the selection criteria. All were of good quality. The number of participants ranged from 44-5,692 community-dwellers (0-100% women). In the pooled analysis, although episodic memory disorders showed only modest association with lower 25OHD concentrations (summary effect size of the difference (ES) =-0.09 [95% CI:-0.16;-0.03]), associations of greater magnitude were found with executive dysfunctions (processing speed: mean difference of Trail Making Test (TMT)-A score = 4.0 [95% CI: 1.20;6.83]; mental shifting: mean difference of TMT-B score = 12.47 [95% CI: 6.78; 18.16]; information updating tests: ES =-0.31 [95% CI:-0.5;-0.09]). The pooled risk of incident decline of TMT-B score was OR = 1.25 [95% CI: 1.05; 1.48] in case of initial lower 25OHD concentrations. Vitamin D repletion resulted in improved executive functions (ES =-0.50 [95% CI:-0.69;-0.32] for before-and-after comparison), but exhibited no difference with control groups (ES = 0.14 [95% CI:-0.04; 0.32] for between-group comparison after intervention). Conclusion: Lower serum 25OHD concentrations predict executive dysfunctions, especially on mental shifting, information updating and processing speed. The association with episodic memory remains uncertain

Les unités médico-psychiatriques : les soins partagés en santé mentale

Cet article décrit le fonctionnement d’une unité hospitalière originale, couplant approche somatique et psychiatrique sous rubrique générique d’une Unité Médico-Psycho-Sociale (UMPS) implantée au sein du CHU d’Angers depuis 1996. Nous proposons d’examiner l’intérêt de cette mixité, tout en interrogeant ses limites et ses difficultés de fonctionnement. L’intérêt de la structure est de proposer une approche pluridisciplinaire, somatique et psychiatrique dans un même lieu de soins. Cette double compétence de la part des personnels médicaux et paramédicaux est nécessaire lorsque les avis ponctuels de la consultation-liaison ne suffisent plus et lors de situations complexes, dans lesquelles le double savoir-faire est sollicité, en lien avec les ressources d’une réanimation et des services de spécialités médicales et chirurgicales. Ce type d’unité, fondée sur un fonctionnement mixte et à binôme confirmé est peu représenté, tant en France qu’à l’étranger. La fréquence de la co-morbidité somatique et organique conduit pourtant à les considérer comme une réponse innovante aux difficultés rencontrées dans ces prises en charge. Nous décrivons deux cas cliniques afin d’argumenter notre propos

Association between hypovitaminosis D and cognitive inhibition impairment during major depression episode

BACKGROUND: Major depressive episode (MDE) has been associated with cognitive functioning alteration and hypovitaminosis D (hypoVD), but the relationship between hypoVD, depression, and cognition is not well understood. We aimed to compare patient with MDE with or without hypoVD in regard of cognitive functioning. METHODS: 91 patients (38.5 years old, 65.9% female) with MDE were included in a cross-sectional study and were evaluated with a complete cognitive battery. None of the participants were medicated at the time of the inclusion. Serum 25-hydroxyvitamin D was measured using LC-MS/MS method, and hypovitaminosis was defined as 25OHD < 50nmol/L. Covariates were gender, season of dosage, first MDE onset, age, body mass index and depression severity RESULTS: Patients with hypoVD demonstrated a higher stroop intereference index time underscoring that means low cognitive inhibition ability. Mutiple logistic regression confirmed that hypoVD was significantly associated with high stroop interference time index after controlling by gender, season of dosage, first MDE onset, age, body mass index and depression severity. CONCLUSION: Our results suggest that patient with MDE having hypoVD may be more prone to cognitive impairment

Differences and similarities in instant countertransference towards patients with suicidal ideation and personality disorders.

Previous findings showed that suicidal patients elicit mostly negative countertransference such as distress, hopelessness, feelings of inadequacy, and apprehension, and that a concurrent personality disorder is associated with more feelings of entrapment and mistreatment, among other adverse reactions. No studies were however conducted on instant countertransference (iCT), i.e., after a single encounter, for example in an emergency setting. We aimed to evaluate the impact of suicidal ideations, self-harm and presence of personality disorders on instant Countertransference (iCT). Caregivers rated their iCT with two validated and standardized questionnaires after a first emergency or outpatient consultation. Suicidal ideation, self-harm and personality disorders were tested as predictors for iCT in a multivariate and multilevel analysis. Thirty caregivers rated their iCT towards 321 patients. Personality disorders and suicidal ideation, but neither recent nor past history of self-harm, predicted iCT. Common iCT included tension, lack of self-confidence and feeling of being tied. iCT specifically associated with suicidal ideation included distress, lack of hope, confusion, and sense that the patient's life had little worth. In contrast, iCT towards patients with personality disorders suggested tension in the therapeutic relationship (low affiliation with patient, anger, disappointment, devaluation). Caregiver's characteristics were not considered in the analysis. Furthermore, while countertransference also includes unconscious phenomena, only conscious iCT was assessed. Patients with suicidal ideation and personality disorders elicit common but also specific negative iCT. Mental health institutions need to devote specific resources (such as clinical supervision and training) to help caregivers manage their iCT

Cognitive deficit in suicidal depressed Alzheimer’s patient: A specific vulnerability?

International audienc

Deficit of cognitive inhibition in depressed elderly: a neurocognitive marker of suicidal risk

BACKGROUND: Cognitive deficits, in relation to ventral and dorsal prefrontal cortex dysfunctions, have been associated with a higher risk of suicidal acts in young adult patients. Although a public health concern, much less is known about the neurocognitive basis of suicidal behavior in elderly. Here, we aimed at assessing alterations in cognitive inhibition, a suspected major mechanism of the suicidal vulnerability, in suicidal depressed elderly.METHODS: We compared 20 currently depressed patients, aged 65 and older who recently attempted suicide to 20 elderly subjects with a current depression but no personal history of suicide attempt and 20 elderly controls. Using an extensive neuropsychological battery, we particularly examined different aspects of cognitive inhibition: access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). RESULTS: After adjustment for age, intensity of depression, Mini-Mental State Examination score and speed of information processing, suicidal depressed elderly showed significant impairments in all 3 domains of cognitive inhibition in comparison to both control groups. LIMITATIONS: Our results need replication in a larger sample size. CONCLUSIONS: Our study suggests that the inability to inhibit neutral information access to working memory, restrain and delete irrelevant information may impair the patient\u27s capacity to respond adequately to stressful situations subsequently leading to an increased risk of suicidal behavior during late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of suicide in depressed elderly