Prior research has found that disability and apathy are associated with late-life depression. However, the effect of age on these associations in "late-life," an ambiguous term encompassing all individuals typically older than 60 years, has not been examined. We investigated the association of depression with disability, apathy and resilience across the age range of late-life.
One hundred and five community-dwelling elderly with moderate levels of disability were assessed using the Geriatric Depression Scale (GDS), Hardy-Gill Resilience Scale, Starkstein Apathy Scale and IADL/ADL questionnaire. Multiple regression analysis was used to assess relationships between depression, disability, apathy and resilience, stratified by age (<80 vs. >80).
In the <80 year old subject group, resilience, apathy and disability scores (partial type III R(2) = 11.1%, 10.4% and 12.8%, respectively) equally contributed to the variability of GDS score. In contrast, in the >80 year old subject group, apathy (partial type III R(2) = 18.7%) had the greatest contribution to GDS score.
In elderly persons under age 80, resilience, apathy and disability all have relatively equal contributions to depression scores, whereas in those over age 80, depression is most highly correlated with apathy. These data suggest that depressive symptoms in elderly persons have different clinical features along the age spectrum from young-old to old-old.
"Apathy is common in depression, affecting more than 30% of individuals with major depression, and is most prevalent in depressed older adults (Forsell et al., 1993; Krishnan et al., 1995; Lampe and Heeren, 2004; Mehta et al., 2008; Chase, 2011). The syndrome of apathy is defined as a primary motivational impairment that in depression results in diminished goal-oriented behavior, lack of intellectual interest, and indifference or flattening of affect (Marin, 1990). "
[Show abstract][Hide abstract] ABSTRACT: Objective
Apathy is prevalent in late-life depression and predicts poor response to antidepressants, chronicity of depression, disability, and greater burden to caregivers. However, little is known about its neurobiology. Salience processing provides motivational context to stimuli. The aim of this study was to examine the salience network (SN) resting-state functional connectivity (rsFC) pattern in elderly depressed subjects with and without apathy. Methods
Resting-state functional MRI data were collected from 16 non-demented, non-MCI, elderly depressed subjects and 10 normal elderly subjects who were psychotropic-free for at least 2weeks. The depressed group included 7 elderly, depressed subjects with high comorbid apathy and 9 with low apathy. We analyzed the rsFC patterns of the right anterior insular cortex (rAI), a primary node of the SN. ResultsRelative to non-apathetic depressed elderly, depressed elderly subjects with high apathy had decreased rsFC of the rAI to dorsal anterior cingulate and to subcortical/limbic components of the SN. Depressed elderly subjects with high apathy also exhibited increased rsFC of the rAI to right dorsolateral prefrontal cortex and right posterior cingulate cortex when compared to non-apathetic depressed elderly. Conclusions
Elderly depressed subjects with high apathy display decreased intrinsic rsFC of the SN and an altered pattern of SN rsFC to the right DLPFC node of the central executive network when compared to elderly non-apathetic depressed and normal, elderly subjects. These results suggest a unique biological signature of the apathy of late-life depression and may implicate a role for the rAI and SN in motivated behavior. Copyright (c) 2014 John Wiley & Sons, Ltd.
International Journal of Geriatric Psychiatry 11/2014; 29(11). DOI:10.1002/gps.4171 · 2.87 Impact Factor
"Apathy is a common feature of late-life depression (Chase, 2011; Krishnan et al., 1995; Mehta et al., 2008). It afflicts 19–88% of those suffering from major depression, and is most prevalent in depressed older adults (Forsell et al., 1993; Lampe and Heeren, 2004; Mehta et al., 2008). The syndrome of apathy is defined as a primary motivational impairment that in depression results in diminished goal-oriented behavior, lack of intellectual interest, and indifference or flattening of affect (Marin, 1990). "
[Show abstract][Hide abstract] ABSTRACT: Background
Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from non-responders and healthy controls.
Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10 mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate gray matter and associated white matter tracts.
35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi.
Modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner
While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.
"It is unclear whether specific somatic disease and depression are related because of an etiological cause or whether somatic disease contributes to disability and disability causes depression (Schillerstrom et al., 2008). With growing age, relationships change as well: Mehta et al. (2008) concluded that among young-old (65–80) resilience, apathy and disability all equally contributed to the variance in depression score, whereas among the old–old (480) apathy alone had the greatest contribution to depression. "
[Show abstract][Hide abstract] ABSTRACT: Objective
Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age.
Cross sectional survey.
Outpatient and inpatient clinics of regional facilities for mental health care and primary care.
Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons.
Depression diagnoses were assessed with the CIDI version 2.1. Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements.
Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60–69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities.
Results are based on cross sectional data. No inferences about causal relationships can be drawn.
Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.
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