Depressive symptoms in older people with metabolic syndrome: Is there a relationship with inflammation?

"Predictive Medicine Unit", Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy. .
International Journal of Geriatric Psychiatry (Impact Factor: 2.87). 03/2013; 28(3). DOI: 10.1002/gps.3817
Source: PubMed


OBJECTIVE: To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers. METHODS: Physical parameters, standard blood analytes, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) were assessed. Fifteen-item Geriatric Depression Scale and mini mental state examination (MMSE) were administered. RESULTS: One hundred thirty-three subjects were enrolled. MetS patients (57) exhibited higher prevalence of depressive symptoms (p < 0.0001), worse cognitive function (p < 0.0001), and higher levels of ESR and hsCRP were higher (p < 0.0001). The univariate analysis showed a linear strong correlation of depressive symptoms (p < 0.0001) with the MMSE score (r = -0.422), body mass index (r = 0.414), MetS (r = 0.582), number of MetS components (r = 0.663), fasting blood glucose (r = 0.565), ESR (r = 0.565), hsCRP (r = 0.745), central obesity (r = 0.269; p = 0.002), and high-density lipoprotein cholesterol (r = -0.241; p = 0.005). However, the multivariate analysis showed that only age (B = -0.093; p = 0.032), MetS (B = 1.446; p = 0.025), fasting blood glucose (B = 0.039; p = 0.005), and hsCRP (B = 7.649; p < 0.0001) were independently associated with depressive symptoms. CONCLUSIONS: MetS and inflammation are independently associated with depressive symptoms in older people. Inflammation may explain cognitive decline too. Further investigations are needed to better understand the direction of these associations and to determine whether these can be reversible. Copyright © 2012 John Wiley & Sons, Ltd.

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    • "Patients with DM2 have a high incidence of depression (Ali et al., 2006), and reciprocally, patients with depression are at increased risk of developing DM2 (Golden et al., 2004) possibly due to poor lifestyle habits (Yu et al., 2014). Insulin resistance (IR), a subclinical state that often precedes the development of DM2, is often accompanied by depressive symptomatology (Golden et al., 2004; Viscogliosi et al., 2013) and patients with mood disorders have biomarkers suggestive of high IR (Gold et al., 2005; Soczynska et al., 2011). In the general population, it is estimated that approximately 1/3 of healthy, non-obese adults are insulin resistant , even after controlling for body mass index (BMI) (Reaven, 2011). "
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    ABSTRACT: Unlabelled: The current preliminary cross sectional study sought to examine the effects of insulin resistance (IR) and body mass index (BMI) on cognitive performance in adult patients with a history depression, currently not in an acute Major Depressive Episode (MDD). As an exploratory post hoc investigation, special consideration was given to adults <45 years and ≥45 years old. Subjects included men and women ages 19-71 (N = 39) with a history of a non-psychotic, non-melancholic MDD. All subjects underwent an insulin suppression test to determine Steady-State Plasma Glucose (SSPG), a battery of neuropsychological tests, and measurement of BMI. Multiple linear regressions were conducted to determine whether there were differential effects of direct (SSPG) and indirect (BMI) measures on cognition in the whole sample and within dichotomized age groups (<45 and ≥45 years). Preliminary results showed that in the sample as a whole, SSPG was not associated with worse performance on any cognitive variables, while higher BMI was associated with worse dominant hand fine motor skills. Within age groups, differential effects on cognition were found in relation to SSPG and BMI. Higher SSPG was associated with worse cognitive flexibility in the group <45 years, whereas higher BMI was associated with worse estimate of global intelligence in the group ≥45 years. The potential negative impact of IR in younger adults with depression raises concerns regarding the long-term impact on cognition and risk for Alzheimer's disease in undiagnosed younger adults with IR and depression. These negative consequences may not be seen with indirect measures of IR in younger adult populations. Overweight and obesity in older adults with a history of depression appear to have further negative impacts on cognition similar to deficits seen in patients with diabetes. Clinicaltrialsgov identifier: Clinical Trial NCT01106313.
    Journal of Psychiatric Research 10/2014; 60. DOI:10.1016/j.jpsychires.2014.10.001 · 3.96 Impact Factor
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    • "However, decline in cognitive domains is not uniform across all individuals, and even in the same individual, throughout aging (Riddle, 2007). For instance, factors that can possibly confer a risk of decline in cognitive performance, other than age in itself, are low(er) level of schooling, institutionalization, female gender, depressive mood, and the presence of " unhealthy " lifestyle factors and/or of clinical pathologies (Ardila et al., 2000; Van Gool et al., 2003, 2007; Wilson et al., 2009; Yamamoto et al., 2009; Paulo et al., 2011; Köhler et al., 2012; Santos et al., 2012; Costa et al., 2013; Viscogliosi et al., 2013). This heterogeneity in cognitive aging, and the need to reach larger population samples, challenges the available instruments that currently exist to efficiently assess global cognition and screen/detect deviations from healthy ( " normal " ) cognitive aging to cognitive impairments and dementia. "
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    ABSTRACT: The decline of cognitive function in old age is a great challenge for modern society. The simultaneous increase in dementia and other neurodegenerative diseases justifies a growing need for accurate and valid cognitive assessment instruments. Although in-person testing is considered the most effective and preferred administration mode of assessment, it can pose not only a research difficulty in reaching large and diverse population samples, but it may also limit the assessment and follow-up of individuals with either physical or health limitations or reduced motivation. Therefore, telephone-based cognitive screening instruments can be an alternative and attractive strategy to in-person assessments. In order to give a current view of the state of the art of telephone-based tools for cognitive assessment in aging, this review highlights some of the existing instruments with particular focus on data validation, cognitive domains assessed, administration time and instrument limitations and advantages. From the review of the literature, performed using the databases EBSCO, Science Direct and PubMed, it was possible to verify that while telephone-based tools are useful in research and clinical practice, providing a promising approach, the methodologies still need refinement in the validation steps, including comparison with either single instruments or neurocognitive test batteries, to improve specificity and sensitivity to validly detect subtle changes in cognition that may precede cognitive impairment.
    Frontiers in Aging Neuroscience 02/2014; 6:16. DOI:10.3389/fnagi.2014.00016 · 4.00 Impact Factor
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    • "Additionally, certain clinical indices of disease and risk factors have been associated with depressed mood and cognition (van Gool et al., 2003, 2007). For instance, older individuals with metabolic syndrome also exhibit higher prevalence of depressive symptoms (Viscogliosi et al., 2013). Also, while chronic conditions such as diabetes mellitus, stroke and/or transient ischemic attack (TIA) may not necessarily contribute to cognitive decline over time, preventing/diagnosis of metabolic and cardiovascular diseases may be essential to cognitively healthy aging (Köhler et al., 2012). "
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    ABSTRACT: It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function). Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: "less than 4," "4, completed primary education," and "more than 4." Participants (n = 1051) were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal) relationship between clinical indices of disease and risk factors and mood and cognition throughout aging.
    Frontiers in Aging Neuroscience 02/2014; 6:21. DOI:10.3389/fnagi.2014.00021 · 4.00 Impact Factor
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