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Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset.

ABSTRACT: To test the hypothesis that the degree of vascular burden and/or age of onset may influence the degree to which cognition can improve during the course of treatment in late-life depression.Measurement of cognition both before and following 12 weeks of treatment with sertraline.University medical centers (Washington University and Duke University).One hundred sixty-six individuals with late-life depression.Sertraline treatment.The cognitive tasks were grouped into five domains (language, processing speed, working memory, episodic memory, and executive function). We measured vascular risk using the Framingham Stroke Risk Profile measure. We measured T2-based white matter hyperintensities using the Fazekas criteria.Both episodic memory and executive function demonstrated significant improvement among adults with late-life depression during treatment with sertraline. Importantly, older age, higher vascular risk scores, and lower baseline Mini-Mental State Examination scores predicted less change in working memory. Furthermore, older age, later age of onset, and higher vascular risk scores predicted less change in executive function.These results have important clinical implications in that they suggest that a regular assessment of vascular risk in older adults with depression is necessary as a component of treatment planning and in predicting prognosis, both for the course of the depression itself and for the cognitive impairments that often accompany depression in later life.

SUBMITTER: Barch DM

PROVIDER: S-EPMC3382028 | biostudies-literature | 2012 Aug

REPOSITORIES: biostudies-literature

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Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset.

Barch Deanna M DM DʼAngelo Gina G Pieper Carl C Wilkins Consuelo H CH Welsh-Bohmer Kathleen K Taylor Warren W Garcia Keith S KS Gersing Kenneth K Doraiswamy P Murali PM Sheline Yvette I YI

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20120801 8

<h4>Objectives</h4>To test the hypothesis that the degree of vascular burden and/or age of onset may influence the degree to which cognition can improve during the course of treatment in late-life depression.<h4>Design</h4>Measurement of cognition both before and following 12 weeks of treatment with sertraline.<h4>Setting</h4>University medical centers (Washington University and Duke University).<h4>Participants</h4>One hundred sixty-six individuals with late-life depression.<h4>Intervention</h4 ...[more]

PMID: 22430020

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Project description:Late-life depression (LLD) and amnestic mild cognitive impairment (aMCI) are associated with medial temporal lobe structural abnormalities. However, the hippocampal functional connectivity (HFC) similarities and differences related to these syndromes when they occur alone or coexist are unclear. Resting-state functional connectivity MRI (R-fMRI) technique was used to measure left and right HFC in 72 elderly participants (LLD [n = 18], aMCI [n = 17], LLD with comorbid aMCI [n = 12], and healthy controls [n = 25]). The main and interactive relationships of LLD and aMCI on the HFC networks were determined, after controlling for age, gender, education and gray matter volumes. The effects of depressive symptoms and episodic memory deficits on the hippocampal functional connections also were assessed. While increased and decreased left and right HFC with several cortical and subcortical structures involved in mood regulation were related to LLD, aMCI was associated with globally diminished connectivity. Significant LLD-aMCI interactions on the right HFC networks were seen in the brain regions critical for emotion processing and higher-order cognitive functions. In the interactive brain regions, LLD and aMCI were associated with diminished hippocampal functional connections, whereas the comorbid group demonstrated enhanced connectivity. Main and interactive effects of depressive symptoms and episodic memory performance were also associated with bilateral HFC network abnormalities. In conclusion, these findings indicate that discrete hippocampal functional network abnormalities are associated with LLD and aMCI when they occur alone. However, when these conditions coexist, more pronounced vulnerabilities of the hippocampal networks occur, which may be a marker of disease severity and impending cognitive decline. By utilizing R-fMRI technique, this study provides novel insights into the neural mechanisms underlying LLD and aMCI in the functional network level.

Dataset Information

Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset.

Publications

Cognitive improvement following treatment in late-life depression: relationship to vascular risk and age of onset.

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