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Supplemental Material, Sociodemographic_apathy_scores_sites_2sep2019 for Are Apathy and Depressive Symptoms Related to Vascular White Matter Hyperintensities in Severe Late Life Depression? by Mardien Leoniek Oudega, Amna Siddiqui, Mike P. Wattjes, Frederik Barkhof, Mara ten Kate, Majon Muller, Filip Bouckaert, Mathieu Vandenbulcke, François-Laurent De Winter, Pascal Sienaert, Max L. Stek, Hannie C. Comijs, Nicole C. M. Korten, Louise Emsell, Piet Eikelenboom, Didi Rhebergen, Eric van Exel and Annemieke Dols in Journal of Geriatric Psychiatry and Neurology

ispartof: Handboek ouderenpsychiatrie pages:221-236 ispartof: pages:221-236 status: published

Cost-effectiveness planes and cost-efectiveness acceptability curves for the sensitivity analyses. (DOCX 56 kb)

Background and Objectives: Apathy is a behavioral syndrome that often co-occurs with depression. Nonetheless, the etiology of apathy and depression may be different. We hypothesized that apathy occurs more often in depressed compared to non-depressed older persons; and that independent correlates for apathy will be different in depressed and non-depressed older persons. Methods: In this cross-sectional study of Netherlands Study of Depression in Older Persons (NESDO), a total of 350 depressed older persons according to the Composite International Diagnostic Interview (CIDI) and 126 non-depressed older persons, aged at least 60 years were recruited in several Medical Centres and general practices. In both depressed and non-depressed older persons, those with and without apathy as assessed with the Apathy Scale (score >= 14) were compared with regard to socio-demographic, clinical, and biological characteristics. Results: Apathy was present in 75% of the depressed and 25% of the non-depressed older persons. Independent correlates of apathy in both depressed and non-depressed older persons were male gender and less education. Furthermore, in depressed older persons, higher scores on the Inventory of Depressive Symptomatology (IDS) and, in non-depressed older persons, a higher C-reactive protein (CRP) level correlated independently with apathy. Conclusions: Apathy occurred frequently among both depressed and non-depressed older persons. Among depressed older persons, apathy appeared to be a symptom of more serious depression, whereas among non-depressed persons apathy was associated with increased CRP being a marker for immune activation, suggesting a different aetiology for apathy in its own right.

Importance In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. Objective To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. Design, Setting, and Participants This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. Exposures Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. Main Outcomes and Measures The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. Results Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism-cross-sectionally (-0.06 standardized mean difference in score; 95% CI, -0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, -0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. Conclusions and Relevance In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.

Among older persons, the prevalence of a depressive disorder is high. Almost half of the depressed patients suffer from significant anxiety symptoms. In clinical practice this combination of depression and anxiety is challenging as high levels of anxiety in depression are associated with more impairment and a worse prognosis. Anxiety in late-life depression has many faces. It can represent itself in a physical or mental form, like tension or worry. With all its complications it can also be categorized as a separate anxiety disorder, like a panic disorder or a generalized anxiety disorder. Many former studies that examined this so-called ‘anxious depression’ did not differentiate between depression with high levels of anxiety and a depression with a concurrent anxiety disorder.Our general message stresses the importance to differentiate between these depressive states. Different characteristics are found, like certain personality traits or the impact of life-events. These characteristics differentiate even further when we look at separate concurrent anxiety disorders. The combination of anxiety and depression shows a less favorable course and has a negative impact on complete remission over a period of two years. In one of the studies, we investigated the feasibility of a method of intensive repeated measurements. The patient reported about her depressive and anxiety symptoms five times a day during her daily activities. This provided a detailed insight in her symptom dynamics and stimulated a dialogue on possible treatment targets and interventions.

Frailty is a condition in which there is a reduced reserve capacity of the physiological systems that can lead to serious health problems when exposed to physical and psychosocial stressors. Although the clinical relevance of frailty is increasingly recognized within somatic health care, this concept is hardly applied in mental health care. Possibly the complex relationship and interaction between frailty and psychopathology underlies this. After all, many forms of psychopathology seem to be associated with accelerated biological aging and can actually be seen as a frailty model. In addition, geriatric studies often exclude patients with a psychiatric disorder. Our research shows that frailty, defined according to the biomedical frailty model, can be validly measured in elderly people with a depressive disorder. First, frailty was associated with various biomarkers of aging, such as increased inflammation parameters, shortened telomere length and decreased vitamin D levels. Second, frailty also predicted premature death within a group of depressed elderly. Frailty also appears to be clinically relevant as a predictor for a worse course of depression and may provide an explanation for medically unexplained symptoms in the elderly. Our findings indicate the existence of a so-called "depression-frailty subtype", a group of depressed elderly people with a poor mental and physical prognosis. Integrated somatic and mental health care seems appropriate for this group. Future treatment studies will have to show which interventions can improve the prognosis of these vulnerable groups. This could include a reduction in polypharmacy, more physical activity, nutritional interventions and psychotherapeutic interventions.

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promotiedatum: 31-10-2014 � prom-id: 11320