Occurrence of Cognitive Impairment and Depressive Symptoms Among the Elderly in a Nursing Home Facility.

Occurrence of cognitive impairment and depressive symptoms among the elderly in a nursing home facility.

Adv Clin Exp Med. 2013 Jan-Feb; 22(1): 111-7
Kowalska J, Rymaszewska J, Szczepa?ska-Gieracha J

The aim of the study was to assess the occurence of cognitive impairment and depressive symptoms in elderly patients rehabilitated in a Nursing Home Facility (NHF) in Poland.The study involved a group of 254 patients out of 410 subsequently admitted to NHF in years 2007 – 2010. The group included 205 (80.7%) women, the mean age was 77.7 (± 7.8) years. 52.7% of patients had had a stroke, 29.9% – orthopedic injuries, and 17.3% were suffering from chronic diseases of old age. The patients’ mental status was assessed in the first week of their stay by the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15).Cognitive impairment (MMSE < 24) was found in 71.6% of the patients, mild cognitive impairment (MMSE = 26-24) in 16.5%. The mean MMSE was 18.96 (±6.36). Only 11.8% of the seniors achieved a normal score. The highest percentage of people with dementia was reported among stroke patients (79.1%, 106/134). The mean GDS was 7.30 (±3.37). Over 65% of patients had depressive symptoms at admission (GDS>5). Low mood was detected in nearly 70% of patients hospitalised for orthopedic injuries and after a stroke. The correlation analysis showed a significant relationship between MMSE scores and the age among patients after stroke (p < 0.03).The results indicate that it is justified and necessary to do screening tests in order to detect cognitive impairment and depressive symptoms at NHFs. Introducing such a protocol enables us to provide patients with essential medical and psychological help, which in turn influences the effectiveness of the physiotherapy process. HubMed – depression

CYTOKINE TARGETS IN THE BRAIN: IMPACT ON NEUROTRANSMITTERS AND NEUROCIRCUITS.

Depress Anxiety. 2013 Mar 6;
Miller AH, Haroon E, Raison CL, Felger JC

Increasing attention has been paid to the role of inflammation in a host of illnesses including neuropsychiatric disorders such as depression and anxiety. Activation of the inflammatory response leads to release of inflammatory cytokines and mobilization of immune cells both of which have been shown to access the brain and alter behavior. The mechanisms of the effects of inflammation on the brain have become an area of intensive study. Data indicate that cytokines and their signaling pathways including p38 mitogen-activated protein kinase have significant effects on the metabolism of multiple neurotransmitters such as serotonin, dopamine, and glutamate through impact on their synthesis, release, and reuptake. Cytokines also activate the kynurenine pathway, which not only depletes tryptophan, the primary amino acid precursor of serotonin, but also generates neuroactive metabolites that can significantly influence the regulation of dopamine and glutamate. Through their effects on neurotransmitter systems, cytokines impact neurocircuits in the brain including the basal ganglia and anterior cingulate cortex, leading to significant changes in motor activity and motivation as well as anxiety, arousal, and alarm. In the context of environmental challenge from the microbial world, these effects of inflammatory cytokines on the brain represent an orchestrated suite of behavioral and immune responses that subserve evolutionary priorities to shunt metabolic resources away from environmental exploration to fighting infection and wound healing, while also maintaining vigilance against attack, injury, and further pathogen exposure. Chronic activation of this innate behavioral and immune response may lead to depression and anxiety disorders in vulnerable individuals. HubMed – depression

PSYCHOLOGICAL RESILIENCE IN OLDER U.S. VETERANS: RESULTS FROM THE NATIONAL HEALTH AND RESILIENCE IN VETERANS STUDY.

Depress Anxiety. 2013 Mar 6;
Pietrzak RH, Cook JM

BACKGROUND: Although a large body of empirical research has examined negative psychological outcomes in older veterans, relatively little is known about the prevalence and determinants of psychological resilience in this population. METHODS: A nationally representative sample of 2,025 U.S. veterans aged 60 and older (mean = 71.0, standard deviation = 7.1, range = 60-96) completed a web-based survey as part of the National Health and Resilience in Veterans Study (NHRVS). Cluster analysis of measures of lifetime potentially traumatic events, and current PTSD, major depression, and generalized anxiety symptoms was used to classify psychological outcomes. RESULTS: A three-group solution best fit the data: Control (low number of lifetime traumas, low current psychological distress; 60.4%); Resilient (high number of lifetime traumas, low current psychological distress; 27.5%); and distressed (high number of lifetime traumas, high current psychological distress; 12.1%). Among older veterans with a high number of traumas, 69.5% were in the Resilient group. Compared to the Distressed group, the Resilient group was more likely to have college or higher level of education, and to be married or living with a partner. They also scored higher on measures of emotional stability, social connectedness (i.e., secure attachment style, social support), protective psychosocial characteristics (e.g., community integration, purpose in life), and positive perceptions of the military’s effect on one’s life; and lower on measures of physical health difficulties and psychiatric problems, and openness to experiences. CONCLUSIONS: Among older U.S. veterans who have endured a high number of traumas in their lifetimes, nearly 70% are psychologically resilient in later life. Prevention efforts targeted toward bolstering social connectedness, community integration, and purpose in life may help promote psychological resilience in older veterans who endured a significant number of traumas in their lives. HubMed – depression

COGNITIVE DEFICITS AND FUNCTIONAL OUTCOMES IN MAJOR DEPRESSIVE DISORDER: DETERMINANTS, SUBSTRATES, AND TREATMENT INTERVENTIONS.

Depress Anxiety. 2013 Mar 6;
McIntyre RS, Cha DS, Soczynska JK, Woldeyohannes HO, Gallaugher LA, Kudlow P, Alsuwaidan M, Baskaran A

BACKGROUND: Few reports have aimed to describe the mediational effect of cognitive deficits on functional outcomes in major depressive disorder (MDD), and relatively few interventions are demonstrated to mitigate cognitive deficits in MDD. METHODS: Studies enrolling subjects between the ages of 18-64 were selected for review. Bibliographies from identified articles were reviewed to identify additional original reports aligned with our objectives. RESULTS: Cognitive deficits in MDD are consistent, replicable, nonspecific, and clinically significant. The aggregated estimated effect size of cognitive deficits in MDD is small to medium. Pronounced deficits in executive function (?1 SD below the normative mean) are evident in ?20-30% of individuals with MDD). Other replicated abnormalities are in the domains of working memory, attention, and psychomotor processing speed. Mediational studies indicate that cognitive deficits may account for the largest percentage of variance with respect to the link between psychosocial dysfunction (notably workforce performance) and MDD. No conventional antidepressant has been sufficiently studied and/or demonstrated robust procognitive effects in MDD. CONCLUSIONS: Cognitive deficits in MDD are a principal mediator of psychosocial impairment, notably workforce performance. The hazards posed by cognitive deficits in MDD underscore the need to identify a consensus-based neurocognitive battery for research and clinical purposes. Interventions (pharmacological, behavioral, neuromodulatory) that engage multiple physiological systems implicated in cognitive deficits hold promise to reduce, reverse, and prevent cognitive deficits. HubMed – depression