Search Results (104)

Background: Vascular dysfunction is increasingly recognized as a shared contributor to both cognitive impairment and late-life depression (LLD). However, the combined diagnostic value of cerebral hemodynamics, neuroimaging markers, and neuropsychological outcomes remains underexplored. This study aimed to investigate the associations be-tween transcranial Doppler (TCD) ultrasound parameters, cognitive performance, and depressive symptoms in older adults with mild cognitive impairment (MCI) and LLD. Importantly, we evaluated the integrative value of TCD-derived indices alongside MRI-confirmed white matter lesions (WMLs) and standardized neurocognitive and affective assessments. Methods: In this cross-sectional study, 96 older adults were enrolled including 78 cognitively unimpaired individuals and 18 with MCI. All participants underwent structured clinical, neuropsychological, and imaging evaluations including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS-15), MRI-based Fazekas scoring of WMLs, and TCD ultrasonography of the middle cerebral artery. Hemodynamic variables included mean blood flow velocity (MBFV), end-diastolic velocity (EDV), pulsatility index (PI), and resistive index (RI). Logistic regression and receiver operating characteristic (ROC) analyses were used to identify independent predictors of MCI. Results: Participants with MCI showed significantly lower MBFV and EDV, and higher PI and RI (p < 0.05 for all) compared with cognitively unimpaired participants. In multivariate analysis, lower MBFV (OR = 0.64, p = 0.02) and EDV (OR = 0.70, p = 0.03), and higher PI (OR = 3.2, p < 0.01) and RI (OR = 1.9, p < 0.01) remained independently associated with MCI. ROC analysis revealed excellent discriminative performance for RI (AUC = 0.919) and MBFV (AUC = 0.879). Furthermore, PI correlated positively with depressive symptom severity, while RI was inversely related to the GDS-15 scores. Conclusions: Our findings underscore the diagnostic utility of TCD-derived hemodynamic parameters—particularly RI and MBFV—in identifying early vascular contributions to cognitive and affective dysfunction in older adults. The integration of TCD with MRI-confirmed WML assessment and standardized cognitive/mood measures represents a novel and clinically practical multi-modal approach for neurovascular profiling in aging populations. Full article

Background/Objectives: The rapid ageing of the European population presents growing challenges for mental health, highlighting the need to identify factors that can prevent or delay psychological decline and promote a higher quality of life in later life. This study aims to provide an updated and comprehensive overview of mental health among older adults in Europe by examining the prevalence of depressive symptoms and identifying key associated factors. Methods: We analysed data from individuals (n = 45,601) aged 65 years and older across 27 European countries and Israel who participated in Wave 9 of the Survey of Health, Ageing and Retirement in Europe (SHARE). This study assessed the prevalence of depressive symptoms, which were evaluated using the EURO-D scale (score range: 0–12), with a cut-off of ≥4 indicating clinically relevant symptoms. It also explored associations with sociodemographic characteristics, physical health, behavioural factors, social participation, internet skills and living conditions. Results: Our findings confirm that depressive symptoms remain highly prevalent among older adults in Europe, with 35.1% of women and 21.5% of men affected, reflecting persistent gender disparities in mental health. Depression in later life was significantly associated with poor physical health, loneliness and lower quality of life. Conversely, moderate involvement in grandchild care and in social participation emerged as potential protective factors. Conclusions: Late-life depression has substantial implications for both mental and physical well-being. Our findings suggest that social integration, gender related factors and physical health are closely associated with depressive symptoms in older adults. These associations highlight the importance of considering these domains when designing interventions and policies aimed at promoting mental health in ageing populations. Full article

Background and Objectives: Thailand’s demographic shift toward an aging population increases vulnerability among older adults to the long-term mental health effects of childhood trauma. While childhood adversity is linked to heightened risks of late-life depression and PTSD, the moderating role of resilience remains underexplored in Thai older adults. This study investigated whether resilience moderates the association between childhood trauma and depressive or PTSD symptoms in this population. Materials and Methods: A cross-sectional survey was conducted with 201 older patients (mean age 68.6 years) from the Family Medicine and Geriatric Psychiatry Clinics at Maharaj Nakorn Chiang Mai Hospital. Participants completed validated measures on trauma history, resilience, depression, and PTSD symptoms. A moderation analysis was performed, adjusting for covariates including education, family support, and psychiatric history. Results: The findings revealed that resilience significantly buffered the impact of childhood trauma on depression but did not mitigate PTSD symptoms. Conclusions: These results underscore the protective role of resilience against depression following childhood trauma in older adults, yet also point to its limitations in alleviating trauma-specific responses such as PTSD. This study highlights the need for trauma-informed geriatric mental health strategies and calls for further research on resilience, focusing on cultural context and adaptive mechanisms, including emotion regulation and social connectedness, in older populations. Full article

Background/Objectives: Depression, anxiety and apathy are often associated with subjective cognitive complaints (SCCs) in people with Parkinson’s disease (PwPD) without cognitive impairment. Cognitive reserve (CR) enhances emotional resilience, allowing people to better cope with stress and emotional challenges, factors affecting quality of life. We aimed to explore the relationship between CR and mood/anxiety in cognitively intact PwPD with and without SCCs. Methods: In this cross-sectional study we enrolled 133 PwPD and normal cognitive function (age 59.8 ± 6.7 years; disease duration 9.0 ± 5.5 years; male/female 84/49). We assessed cognitive reserve (CR scale), subjective cognitive complaints (with PD-CFRS), QoL (PDQ8), mood, anxiety and apathy (BDI-II; STAI, PAS, Apathy scales). We used a t-test to compare groups (with/without SCC; M/F); correlations and moderation analysis to evaluate the relation between CR and behavioral features and the interplay between CR, behavioral discomfort and QoL. Results: The group with SCCs had significantly (p < 0.05) higher scores in PDQ8, Apathy, STAI, PAS-C and BDI-II scales than those with no SCCs. Males with SCCs had higher scores in PDQ8, Apathy scale and BDI-II while females differed in PDQ8 and Apathy scale scores. In the SCC group, late-life CR was negatively correlated with PAS-C (avoidance behavior) and BDI-II; correlations were confirmed in the male group where CR also correlated with PDQ-8 and PAS persistent anxiety. Conclusions: PwPD and SCCs are more depressed and anxious compared to people without SCCs. Furthermore, we found a relationship between depressive symptoms, anxiety and CR: PwPD with SCCs may rely on cognitive reserve to better cope with the feeling of anxiety and depression, especially in male gender. Full article

Background/Objectives: Major depressive disorder (MDD), including late-onset forms, is a prevalent and disabling condition. Despite multiple pharmacological treatment options, over half of patients fail to achieve full remission. This systematic review aims to assess current evidence on the influence of pharmacogenetic factors on antidepressant response and safety, with a focus on patients with major and late-life depression. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD42020212345). Studies published in the past five years involving adult patients with MDD or late-onset depression and pharmacogenetic data were included. Results: From 793 abstracts screened, 29 studies with 39,975 participants were included. CYP2C19 and CYP2D6 were the most frequently analyzed genes (41% and 17% of studies, respectively). Poor metabolizers for CYP2C19 showed higher plasma levels of SSRIs, leading to increased adverse effects. In contrast, ultrarapid metabolizers had significantly lower response rates. Variants in SLC6A4 and other genes (e.g., HTR2A, ABCB1) were also associated with treatment outcomes. Combinatorial pharmacogenetic testing showed superior predictive value compared to single-gene approaches. Conclusions: Genetic variants in CYP2C19, CYP2D6, and SLC6A4 may affect the efficacy and tolerability of antidepressant therapy. Integrating this information into clinical practice may allow more personalized prescribing and improved outcomes. Full article

Background/Objectives: Depression impairs the quality of life in older adults and represents a significant public health issue. Cognitive reserve may act as a protective factor against depressive symptoms in older adults. Additionally, interaction with pets may serve as another potential protective factor against these symptoms. Thus, this study aimed to evaluate whether higher cognitive reserve could predict a reduction in depressive symptoms in older adults and to investigate the moderating role of pet companionship in this relationship. Methods: The following instruments were used: a Sociodemographic Data Sheet, the Modified Telephone Interview for Cognitive Status (TICS-M), the Cognitive Reserve Index Questionnaire (CRIq), and the Geriatric Depression Scale (GDS-15). Data were collected via video calls through WhatsApp and analyzed using a moderation analysis with PROCESS for SPSS. Results: The final sample consisted of 215 older adults with a mean age of 69.13 years (SD = 6.89). Among the participants, 53% owned pets and 47% did not. The overall model revealed a significant association between the predictor variables and the outcome (F(3, 211) = 4.24, p < 0.01). For the group without pets, the effect was not significant (β = −0.1082, p = 0.2916), but for the group with pets, the effect was substantial and negative on the GDS (β = −0.1936, p < 0.05). Conclusions: We concluded that the relationship between cognitive reserve and depressive symptoms is moderated by the presence of pets in individuals’ lives. These findings highlight the role of pets in protecting against depressive symptoms in older adults. Future studies should explore this relationship with more diverse samples. Full article

Background: Late-life depression is a critical public health concern, particularly among older adults with chronic multimorbidity. Existing studies often focus on single-disease associations, neglecting the complex interplay of coexisting conditions. Understanding how multimorbidity patterns contribute to depression risk and identifying high-risk subgroups through integrated statistical and machine learning approaches remain underexplored, limiting targeted prevention strategies. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), latent class analysis (LCA) was employed to cluster multimorbidity patterns. Associations between these patterns and depression were analyzed using multivariable logistic regression, while predictive performance and interaction effects were evaluated via an XGBoost machine learning model. Results: Four distinct multimorbidity patterns were identified: cardio-metabolic, digestive–joint, respiratory, and cardiovascular–digestive pattern. All clusters showed significant independent associations with depression, with the cardiovascular–digestive pattern exhibiting the strongest association (OR = 4.56). However, the digestive–joint pattern demonstrated the highest predictive effects for depression. Sociodemographic factors—low income, limited education, female gender, and rural residence—emerged as robust predictors, amplifying depression risk in older adults with multimorbidity. Conclusions: This study bridges epidemiological insights with predictive analytics to inform depression risk stratification. We recommend routine depression screening for all individuals with cardiovascular–digestive diseases and prioritize screening for women with digestive–joint diseases. Additionally, low-income and rural-dwelling older adults with chronic conditions warrant heightened clinical vigilance. These findings provide a framework for integrating multimorbidity profiling into depression prevention protocols, addressing both biological and socioeconomic determinants. Full article

Background: Emerging evidence suggests a potential link between heavy metals and Alzheimer’s disease and related dementias (AD/ADRD). This study compiled epidemiological evidence from research published over the past 11 years on the impact of metals on AD/ADRD in women. Women have unique risk factors for late onset of AD/ADRD, in addition to genetic factors, apolipoprotein E allele (APOE4), and longer life expectancy. Furthermore, women are twice likely as men to experience depression, which increases their risk of developing AD/ADRD. Our narrative review underscored the necessity of a sex-specific approach to address women’s vulnerability to AD/ADRD. Methods: Electronic databases, including PubMed, Google Scholar, NIOSH Toxline, and Scopus, were thoroughly searched to identify primary epidemiological studies on older women exposed to metals and published between 2014 to 2024. Results: We identified 34 epidemiological studies that met the inclusion criteria. The findings revealed a complex interplay between environmental metals such as lead (Pb), cadmium (Cd), arsenic (As), manganese (Mn), selenium (Se), iron (Fe), zinc (Zn), copper (Cu), magnesium (Mg), and calcium (Ca) and the risk of AD/ADRD in women. Significant adverse effects were reported for Cu, Cd, As, Pb, and Mn while significant protective effects were found between Se, Fe, and Zn in blood and AD/ADRD among older women. However, some studies also reported no correlations. Conclusions: Overall, our review identified contrasting results regarding the effects of metals on AD/ADRD in women. Future studies should collect additional evidence to understanding the effects of heavy metals on AD/ADRD in women for developing preventive measures. Full article

Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, to evaluate the efficacy, safety, and clinical applications of TMS in older adults with depression. Results: The review examines various TMS modalities, including repetitive TMS (rTMS), deep TMS, and theta burst stimulation (TBS), with most protocols targeting the dorsolateral prefrontal cortex (DLPFC). Adverse effects were rare, mild, and transient, supporting the treatment’s safety profile. Pharmacological co-treatment was common but not essential for clinical improvement, highlighting TMS’s potential as a standalone therapy. A subset of studies used neuroplasticity (SICI, ICF, CSP) or neuroimaging measures (MRI and MRI-based neuronavigation), revealing that age-related cortical inhibition may limit plasticity rather than depression itself. Conclusions: Overall, TMS demonstrates promising effectiveness and tolerability in managing late-life depression. Across studies, remission rates varied from 20% to 63%, with higher efficacy generally observed in bilateral stimulation or high-frequency protocols. Standardization of protocols and further research into individualized targeting and long-term outcomes are warranted to support broader clinical adoption. Full article

Background: Late-onset depression (LOD) has been increasingly recognized as a risk factor for dementia, yet the temporal and causal nature of this relationship remains unclear. Objective: The purpose of this review is to investigate the temporal association between LOD and dementia. Methods: A comprehensive search for studies examining the temporal relationship between LOD and dementia was conducted using MEDLINE via Ovid. The end date of the search was 9 September 2024. A total of 3450 studies were identified, of which 27 met the inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and an article quality assessment was completed. Results: The review demonstrated a significant temporal association between LOD and the risk of dementia, with the highest risk observed within the first decade following depression onset. LOD was consistently associated with an increased likelihood of developing dementia, particularly Alzheimer’s disease, compared to depression at earlier life stages. Conclusions: This systematic review highlights the significant association between LOD and dementia risk, emphasizing the need for early recognition and intervention. Future research should investigate the age at which LOD becomes a risk factor for dementia, the relationship between depression severity, family history of dementia, and dementia risk, as well as the efficacy of preventative treatments. Full article

Background/Objectives: This study aims to investigate whether rural community elderly care services can enhance older adults’ subjective well-being, with a specific focus on examining whether late-life stress mediates this association. Methods: Subjective well-being is operationalized through three dimensions: life satisfaction, positive life attitude, and depression levels. Data were collected from a sample of 796 rural Chinese adults aged 60 years and older. Regression analysis was used to assess the direct effects of rural community elderly care services on subjective well-being outcomes, while an instrumental variable two-stage least squares model was employed to test the robustness of these findings. A mediation analysis further explored the underlying mechanisms through which these services influence well-being. Results: Results indicate that rural community elderly care services exert significant direct and indirect effects on all three dimensions of subjective well-being. The indirect effects arise because these services provide social support that mitigates late-life stressors and buffers the negative impacts of adverse life events, thereby enhancing psychological well-being. Conclusions: These findings clarify the mediating role of stress in the relationship between community care services and subjective well-being among rural older adults, highlighting the importance of addressing age-related stressors in gerontological interventions. This study contributes to the literature by providing empirical evidence for the efficacy of rural community elderly care programs and offering actionable insights for developing contextually appropriate service models to meet the needs of aging rural populations. This study elucidates how rural older adults perceive community elderly care services, providing empirical evidence for government agencies to evaluate the effectiveness of policy-driven services. It further identifies key entry points for enhancing rural care service quality and promoting elderly well-being, bridging research insights with actionable strategies for policy improvement. Full article

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen’s kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population. Full article

Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status in older populations remain limited for Türkiye. This study aimed to estimate the prevalence of depression among individuals aged 65 years or older, examine its associations with instrumental and basic activities of daily living, and identify key sociodemographic and behavioral correlates. Methods: In this study, data obtained from a population-based survey in 2264 clusters by the Turkish Statistical Institute (TUIK) were used, and weighted data were yielded from 6,036,396 adults aged 65 and over. Depression was measured using the Geriatric Depression Scale (GDS), categorizing participants as “not depressed”, “mildly depressed”, or “severely depressed”. Functional status was evaluated using the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale and the Katz Activities of Daily Living (ADL) Scale. Logistic regression models, adjusted for age and body mass index (BMI), were used to determine the associations of depression with functional impairment and various covariates, including gender, education, marital status, chronic disease, physical activity, smoking, and alcohol use. Results: Overall, the prevalence of depression in this cohort was 49.9% [95% CI = 48.7–51%], with 36.0% [95% CI = 34.8–37.0%] classified as mild and 13.9% [95% CI = 13.1–14.7%] as severe depression. IADL and ADL scores were negatively correlated with GDS scores (r = −0.416 and r = −0.321, respectively; p < 0.001). In logistic models, lower IADL scores were linked to higher odds of mild (OR = 0.797, 95% CI = [0.796–0.798], p < 0.001) and severe depression (OR = 0.689, 95% CI = [0.688–0.690], p < 0.001). Being semi-dependent or dependent in ADL further escalated depression risk. Female gender, lower education, single/divorced status, chronic disease, and inactivity also emerged as strong predictors. Conclusions: The findings of this study suggest that depression is highly prevalent among older adults in Türkiye, with functional impairment, unfavorable health behaviors, and sociodemographic vulnerabilities heightening risk. Integrating depression screening into geriatric care—alongside interventions to maintain functional independence—may help mitigate the burden of late-life depression in similar contexts. Full article

Introduction: Advanced magnetic resonance imaging (MRI) techniques in neuroplasticity evaluations provide important information on stroke disease and the underlying mechanisms of neuronal recovery. It has been observed that gray matter density or volume in brain regions closely related to motor function can be a valuable indicator of the response to treatment. Objective: To compare structural MRI-evaluated gray matter volume changes in patients with post-stroke upper limb spasticity for >1 year between those undergoing surgery and those treated with botulinum toxin A (BoNT-A) and to relate these findings to upper limb function and quality of life outcomes. Materials and Methods: Design. A two-arm controlled and randomized clinical trial in patients with post-stroke upper limb spasticity. Participants. Thirty post-stroke patients with spastic upper limbs. Intervention. Participants were randomly assigned (1:1 allocation ratio) for surgery (experimental group) or treatment with BoNT-A (control group). Main outcome measures. The functional parameters were analyzed with Fugl-Meyer, Zancolli, Keenan, House, Ashworth, pain visual analogue, and hospital anxiety and depression scales. Quality of life was evaluated using SF-36 and Newcastle stroke-specific quality of life scales. The carer burden questionnaire was also applied. Clinical examinations and MRI scans were performed at baseline and at six months post-intervention. Correlations between brain volume/thickness and predictors of interest were examined across evaluations and groups. Results: Five patients were excluded due to the presence of intracranial implants. Eleven patients were excluded from analyses since they were late dropouts. Changes were observed in the experimental group but not in the control group. Between baseline and six months, gray matter volume was augmented at the hippocampus and gyrus rectus and cortical thickness was increased at the frontal pole, occipital gyrus, and insular cortex, indicating anatomical changes in key areas related to motor and behavioral adaptation These changes were significantly related to subjective pain, Ashworth spasticity scale, and Newcastle quality of life scores, and marginally related to the carer burden score. Conclusions: The structural analysis of gray matter by MRI revealed differences in patients with post-stroke sequelae undergoing different therapies. Gray matter volume and cortical thickness measurements showed significant improvements in the surgery group but not in the BoNT-A group. Volume was increased in areas associated with motor and sensory functions, suggesting a neuroprotective or regenerative effect of upper limb surgery. Full article

Depressive disorders are highly prevalent among older adults (60+) in Europe. Activating these patients was a core component of the GermanIMPACT study, which evaluated collaborative care in a cluster-randomized primary care setting. The intervention group showed a significant improvement in PHQ-9 remission. The aim of this secondary analysis was to investigate which activities were planned and whether their implementation or non-implementation was associated with depressive symptoms (PHQ-9) after 12 months. Behavioural activation data were collected by the care managers. A categorization for activity type (collected as free text) and activity implementation status was developed. The association of successfully implemented activities, planned-not-implemented activities, and the number of activities per patient with the 12-month PHQ-9 total score was calculated using logistic regressions (adjusted for age, gender, living situation/baseline PHQ-9). A total 2188 activities were planned for 136 patients; 66% were successfully implemented. Mean age was 71 (±7) years (78% female; 52% living alone). Activities focusing on “self-care/spirituality” improved the PHQ-9 outcome (OR 1.540; p = 0.048), while planned-not-implemented activities overall worsened it (OR 1.16; p = 0.007). Patient activation is key to treating depressive symptoms in old age. Particularly ‘self-care/spirituality’ activities could be planned, and organizational activities should be closely supported. Full article