The Serotonin Transporter Gene Locus in Late-Life Major Depressive Disorder.
Am J Geriatr Psychiatry. 2012 Jan 31;
Authors: Seripa D, Panza F, Dʼonofrio G, Paroni G, Bizzarro A, Fontana A, Paris F, Cascavilla L, Copetti M, Masullo C, Pilotto A
Abstract
OBJECTIVE:: Polymorphism C in the solute carrier family 6 (neurotransmitter transporter, serotonin), member 4 (SLC6A4) gene has been variously associated with contrasting results with major depressive disorder (MDD). To the best of our knowledge, no data were reported regarding the locus SLC6A4 in late-life MDD. The aim of this study was to explore the possible involvement of the SLC6A4 locus in these patients by means of a haplotype-tagged approach. DESIGN:: Case-control study. SETTING:: Older patients attending a geriatric unit. PARTICIPANTS:: A total of 218 patients with late-life MDD (61 men and 157 women) age 65 to 92 years (76.29 ± 6.53 years) and 363 depression-free healthy subjects (156 men and 207 women) age 41 to 65 years (48.33 ± 5.94 years). MEASUREMENTS:: Genotyping and haplotype estimation of the three markers rs4795541, rs140701, and rs3813034 spanning a 39-kb block the SLC6A4 locus. Diagnoses of late-life MDD, mild cognitive impairment, Alzheimer disease, vascular dementia, and other dementing diseases were made using current clinical criteria. RESULTS:: No significant differences were observed in allele or genotype distribution for the three SLC6A4 markers across the study groups. Because the comparison group could not be matched for age, a sensitivity analysis for the misclassification of controls was performed according to different scenarios. For each simulated scenario, the same nonsignificant result was observed. However, the results are limited to late-life MDD that is specifically not associated with cognitive impairment, and there was limited power for detecting very small effect sizes. CONCLUSIONS:: Our findings suggested that the three investigated markers of the SLC6A4 locus play a minor role, if any, in the pathogenesis of late-life MDD. Also, tempering our conclusions, we were unable to account for population stratification, recurrence or chronicity of depression, nor the influence of coexisting medical, cognitive, and psychosocial stressors.
PMID: 22301456 [PubMed - as supplied by publisher]
Alexithymia Is a Non-Motor Symptom of Parkinson Disease.
Am J Geriatr Psychiatry. 2012 Feb;20(2):133-141
Authors: Assogna F, Palmer K, Pontieri FE, Pierantozzi M, Stefani A, Gianni W, Caltagirone C, Spalletta G
Abstract
OBJECTIVES:: To investigate whether alexithymia is linked to the disease process or to psychopathology, particularly depression, in Parkinson disease (PD) patients. DESIGN:: Cross-sectional study. SETTING:: Neuropsychiatry outpatient clinic. PARTICIPANTS:: One hundred PD patients and 100 comparison subjects (CS). MEASUREMENTS:: PD patients and CS underwent a clinical and neuropsychiatric evaluation. Alexithymia was assessed with the 20-item Toronto Alexithymia Scale (TAS-20). Severity of depressive symptoms was measured with the Beck Depression Inventory. A structured psychiatric interview was used to diagnose major and minor depression. Logistic regression analyses with 95% confidence intervals (CI) were used to assess the association between alexithymia and PD. RESULTS:: Alexithymia occurred twice as often in PD patients (22%) as in CS (11%) and major depressive disorder occurred twice as often in CS (30%) than in PD (16%). The frequency of minor depression was almost identical (about 40%) in the 2 groups. Alexithymia was also associated with PD independently from depression. Indeed, after adjustment for sociodemographic factors, antidepressant use and depression severity, PD patients had an almost fourfold higher risk of having alexithymia (OR: 3.9, 95% CI: 1.5-10.0) and 24 times increased odds of having high scores on the TAS-20 items assessing difficulty in identifying emotions than CS (OR: 23.7, 95% CI: 10.1-55.6). CONCLUSIONS:: Our findings suggest that alexithymia is a depression-independent phenomenon in PD patients and may be associated with the disease process. Alexithymia is an important nonmotor symptom of PD and should be considered in patient assessment and management.
PMID: 22273734 [PubMed - as supplied by publisher]
Authors: Marras C, Gruneir A, Wang X, Fischer H, Gill SS, Herrmann N, Anderson GM, Hyson C, Rochon PA
Abstract
BACKGROUND:: The use of antipsychotic medications is associated with an increased risk of death in older adults with dementia. The risk of death in patients with preexisting parkinsonism who receive antipsychotic drugs is not known. METHODS:: Using a nested case-control design, we examined the risk of death within 30 days of newly starting antipsychotic medications among people with Parkinsonism aged 70 years and older in Ontario, Canada. Data were obtained from Ontario’s healthcare administrative databases. RESULTS:: Among 5,391 individuals with parkinsonism who died during the study period (2002-2008) and a matched comparison group of 25,937 who were still alive, individuals exposed to atypical antipsychotic drugs had a higher risk of death (unadjusted odds ratio [OR] = 2.8, 95% CI: 2.1-3.8, adjusted OR: 2.0, 95% CI: 1.4-2.7). Results were similar for quetiapine use compared with no antipsychotic use (unadjusted OR: 2.5, 95% CI: 1.6-4.0, adjusted OR = 1.8, 95% CI: 1.1-3.0). Typical antipsychotics were associated with an increased odds of death compared with atypical antipsychotics (unadjusted OR = 2.4, 95% CI 1.1-5.2, adjusted OR = 2.4, 95% CI: 1.1-5.7). CONCLUSIONS:: Individuals with parkinsonism who are newly prescribed antipsychotic medications have a higher risk of death within 30 days than those who do not start these medications. Although it is not possible to establish causality, the results suggest an increased risk. It is important to be vigilant for accompanying serious medical conditions that may increase mortality in individuals requiring treatment with antipsychotics and to consider alternative approaches to treating psychosis, agitation, and aggression in this population.
PMID: 22273735 [PubMed - as supplied by publisher]
Disability in the Oldest-Old: Incidence and Risk Factors in The 90+ Study.
Am J Geriatr Psychiatry. 2012 Feb;20(2):159-168
Authors: Berlau DJ, Corrada MM, Peltz CB, Kawas CH
Abstract
OBJECTIVES:: To measure the incidence of disability in individuals aged 90 years and older and examine factors that may increase risk of disability. DESIGN AND SETTING:: The 90+ Study, a longitudinal study of aging, initiated in January 2003 with follow-up through May 2009. PARTICIPANTS:: A total of 216 nondisabled, prospectively followed participants who were aged 90 years or older at baseline. MEASUREMENTS:: The incidence of disability was measured as needing help on one or more activities of daily living and calculated using person years. Risk factors were examined by using a Cox proportional hazards analysis. RESULTS:: The overall incidence of disability was 16.4% per year (95% confidence interval: 13.3-20.0) and did not differ by gender. Disability incidence increased with age from 8.3% in the 90-94 age group to 25.7% in the 95 years and older age group. Several factors were associated with increased risk of disability, including history of congestive heart failure, depression, poor self-rated quality of life, and cognitive impairment. CONCLUSION:: Disability incidence is high and increases rapidly with age in the oldest-old, with rates essentially tripling between ages 90-94 years and 95+ years. Some factors associated with increased risk of disability in younger elderly continue to be risk factors in the oldest-old. Because of the tremendous social and financial impact of disability and the rapid growth of the oldest-old, the development of strategies to delay disability in the elderly should be a priority for healthcare research.
PMID: 22273736 [PubMed - as supplied by publisher]
National Survey of Geriatric Psychiatry Fellowship Programs: Comparing Findings in 2006/07 and 2001/02 From the American Geriatrics Society and Association of Directors of Geriatric Academic Programs’ Geriatrics Workforce Policy Studies Center.
OBJECTIVE:: To document the development of geriatric psychiatry (GP) fellowship training in the United States through 2008. METHODS:: A cross-sectional survey of the 56 U.S. GP fellowship programs was conducted in summer 2007. Longitudinal data from the American Medical Association and the Association of American Medical Colleges’ National Graduate Medical Education Census and data from the Accreditation Council for Graduate Medical Education were also analyzed. RESULTS:: Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs has decreased over the past 7 years. During 2006/07, 72 fellows were in training, as compared with 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 as compared with the mean of 10 applications per program in 2001/02. The fill rate for first-year GP fellowship positions dropped from 61% in 2001/02 to 48% in 2006/07. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Seventeen programs reported having no United States medical school graduates as first-year fellows. CONCLUSION:: The number of GP fellows in training has declined by 23% from 2001/02 to 2006/07. This decline has occurred at the same time when the number of older adults continues to expand rapidly. It is critical that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists in the care of the elderly. Specific strategies need to be developed urgently to stimulate interest in careers in clinical and academic GP.
PMID: 22273737 [PubMed - as supplied by publisher]
OBJECTIVES:: To examine the associations of dimensions of religiousness with the presence and severity of depression in older adults. DESIGN:: Cross-sectional analysis of clinical and interview data. SETTING:: Private university-affiliated medical center in the Southeastern United States. PARTICIPANTS:: Four hundred seventy-six psychiatric patients with a current episode of unipolar major depression, and 167 nondepressed comparison subjects, ages 58 years or older (mean = 70 years, SD = 7). MEASUREMENTS:: Diagnostic Interview Schedule, Montgomery-Åsberg Depression Rating Scale, and Duke Depression Evaluation Schedule were used in the study. RESULTS:: Presence of depression was related to less frequent worship attendance, more frequent private religious practice, and moderate subjective religiosity. Among the depressed group, less severe depression was related to more frequent worship attendance, less religiousness, and having had a born-again experience. These results were only partially explained by effects of social support and stress buffering. CONCLUSIONS:: Religion is related to depression diagnosis and severity via multiple pathways.
PMID: 22273738 [PubMed - as supplied by publisher]
OBJECTIVES:: The purpose of this pilot study was to assess the feasibility and preliminary efficacy of prolonged exposure psychotherapy in older Veterans with posttraumatic stress disorder (PTSD). Exposure therapy has broad empirical support for PTSD, but it has not been studied systematically in older adults, partly due to published concerns that older adults would not tolerate the treatment. METHODS:: The trial followed a prospective pre-post design of 11 men recruited from a Veterans Affairs (VA) PTSD Clinical Team program. After baseline assessment, eight participants completed prolonged exposure therapy. Results were compared with a nonrandomized treatment-as-usual comparison group. The traumatic events identified by the Veterans in our samples had occurred, on average, 40 years prior to their study participation. RESULTS:: Results revealed that conducting 6 weeks of exposure therapy with older Veterans with PTSD was feasible and efficacious, with evidence of some superiority to treatment-as-usual therapy. CONCLUSIONS:: As hypothesized, Veterans showed a significant decrease in symptoms of PTSD (clinician-rated and self-reported) following exposure therapy.
PMID: 22273763 [PubMed - as supplied by publisher]
Can Mild Cognitive Impairment Be Accurately Diagnosed in English Speakers From Linguistic Minorities? Results From the Sydney Memory and Ageing Study.
Am J Geriatr Psychiatry. 2012 Jan 18;
Authors: Low LF, Harrison F, Kochan NA, Draper B, Slavin MJ, Reppermund S, Sachdev PS, Brodaty H
Abstract
OBJECTIVES:: The aim of this article was to examine the prevalence and incidence over 2 years of mild cognitive impairment (MCI) in English speakers from linguistic minorities. DESIGN:: Cross-sectional and longitudinal with 2-year follow-up. SETTING:: Eastern suburbs of Sydney, New South Wales, Australia. PARTICIPANTS:: Eight hundred twenty-seven community-dwelling participants from English-speaking backgrounds (ESB) and 160 participants from non-English-speaking backgrounds (NESB) recruited through the electoral roll. MEASUREMENTS:: Participants were assessed using 11 neuropsychological tests measuring memory, language, attention/processing speed, and executive function. Questionnaires measuring functional impairment and subjective cognitive complaints were completed by participants or informants. RESULTS:: We found a two- to threefold higher prevalence of MCI in NESB participants than ESB participants depending on the impairment criterion applied. This difference was because of higher rates of objective cognitive impairment in NESB participants; rates of functional impairment and subjective cognitive complaints did not differ between the groups. This association between MCI prevalence and NESB status was accounted for by the proportion of time the participant spoke English and the proportion of life they had lived in Australia, but not by age, gender, and education. There were no differences between NESB and ESB groups in MCI incidence, dementia incidence, or rates of conversion from MCI to dementia. NESB participants had lower rates of reversion from MCI to normal. CONCLUSIONS:: It is difficult to accurately diagnose MCI in persons from linguistic minority groups, even when proficient in English as neuropsychological test scores may not be valid for these groups. English language ability and level of acculturation should be considered when assessing older persons from ethnic minority groups.
PMID: 22261551 [PubMed - as supplied by publisher]
A Comparison of the E-BEHAVE-AD, NBRS, and NPI in Quantifying Clinical Improvement in the Treatment of Agitation and Psychosis Associated With Dementia.
OBJECTIVES:: The aim of this study is to compare the Empirical Behavioral Rating Scale (E-BEHAVE-AD), Neurobehavioral Rating Scale (NBRS), and Neuropsychiatric Interview (NPI) in detecting behavioral disturbance and psychotic symptoms in dementia and characterizing changes in response to treatment. DESIGN:: Eighty-seven subjects in the randomized controlled trial “Continuation Pharmacotherapy for Agitation of Dementia” were included in this analysis. We compared the detection in, and changes of, both agitation and psychosis, using these three instruments. A receiver operating characteristic analysis was performed to compare the performance of the three instruments in detecting global improvement. RESULTS:: The instruments were equally likely to detect agitation. The NBRS was most likely to detect psychosis. Although the NPI best detected improvement in agitation, the instruments were equal for detecting improvement in psychosis. In the receiver operating characteristic analysis for overall clinical improvement in response to treatment, there were no differences in the areas under the correlated curves for the three instruments, but they demonstrated different sensitivity and specificity at different cutoff points for target symptom reduction. The E-BEHAVE-AD performed best at a cut point of 30% target symptom reduction and the NBRS and NPI both performed best at 50%. CONCLUSION:: The E-BEHAVE-AD, NBRS, and NPI were more similar than different in characterizing symptoms but differed in detecting response to treatment. Differences in sensitivity and specificity may lead clinicians to prefer a specific instrument, depending on their goal and the expected magnitude of response to any specific intervention.
PMID: 22237247 [PubMed - as supplied by publisher]
PubMed requires this notice of disclaimer is present.
