The aim of this thesis was to investigate cardiovascular determinants of neurocognitive functioning in old age, in particular cognitive dysfunction, depressive symptoms, and apathy. First, we found... Show moreThe aim of this thesis was to investigate cardiovascular determinants of neurocognitive functioning in old age, in particular cognitive dysfunction, depressive symptoms, and apathy. First, we found that the Geriatric Depression Scale(GDS)-3A, the apathy sub set of the GDS-15, moderately discriminates between presence and absence of apathy, and can be used in large study populations to investigate associations with apathy. Next, we demonstrated that higher levels of high sensitivity cardiac troponin T (hs-cTnT), a clinical cardiac biomarker, are related to accelerated cognitive decline, but not to apathy or depression.In the next chapters, we tested the hypothesis that in those older persons with more vascular brain damage, a lower rather than a higher blood pressure is related to worse neurocognitive function. Indeed, we found that only in those older persons with worse daily functioning and those with more cerebral small vessel disease, lower blood pressure was related to more symptoms of apathy. This pattern was not observed for depression or cognitive function.In conclusion, we found that cardiovascular risk factors are important for neurocognitive functioning in older persons. Moreover, we found that specific cardiovascular determinants, such as blood pressure and hs-cTnT, have different associations with apathy than with depression and cognitive function. Show less
Veltman, E.; Kok, A.; Lamers, F.; Stek, M.; Mast, R. van der; Rhebergen, D. 2020
Background: The heterogeneity of late-life depression hampers diagnosis and treatment. Data-driven methods have identified several subtypes of depression in older persons, but the longitudinal... Show moreBackground: The heterogeneity of late-life depression hampers diagnosis and treatment. Data-driven methods have identified several subtypes of depression in older persons, but the longitudinal stability of these subtypes remains unknown.Methods: In total 111 older persons with a major depressive disorder both at baseline and 2-year follow-up from the Netherlands Study of Depression in Older persons (NESDO) were included. Latent class analysis was performed to identify subtypes of depression at baseline and at 2-year follow-up, and latent transition analysis was used to examine the stability of these subtypes over time. Transition rates between subtypes and characteristics of groups were examined.Results: Two subtypes were identified in both baseline (TO) and follow-up data (T1), including a 'melancholic' subtype (prevalence 80.2% (T0) and 62.2% (T1)), and an 'atypical' subtype (prevalence 19.8% (T0) and 37.8% (T1)). The melancholic subtype was characterized by decreased appetite and weight and had a stability of 0.86. The atypical subtype was characterized by increased appetite and weight and had a stability of 0.93, although the discriminating power of different symptoms had decreased at Tl. Mean age and education differed significantly between stable and transitioning subgroups, other characteristics did not differ between subgroups.Limitations: Limited sample size might have hampered the analyses.Conclusions: Subtypes of late-life depression are relatively stable, but symptoms of depression (like weight loss) seem to blur with symptoms of (patho)physiological aging. This underlines the clinical relevance of depression subtyping, but also the importance of further research into subtypes and the influence of aging. Show less
In this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression.... Show moreIn this thesis the heterogeneity of late-life depression is being examined. The first part of the thesis focuses on data-driven analyses as a way of identifying subtypes of late-life depression. Through latent class analysis, we have identified three subtypes: a severe melancholic subtype, an atypical subtype, and a moderately severe subtype. These subtypes had different sociodemographic and clinical characteristics, but no specific biological disturbances could be addressed to the different subtypes. This is probably because of the tangle of (patho)physiological processes in aging itself, muddling the results. The stability of these subtypes over a two-year follow-up was however high, strengthening the clinical relevance of found subtypes.The second part of this thesis examines psychomotor disturbances in melancholic depression as a possible predicting symptom of response in electroconvulsive therapy. We have found that psychomotor disturbances predict to a certain amount the response to electroconvulsive therapy, but this effect was overruled by the predictive value of psychotic symptoms in depression. Finally, we have examined the speed of response of different depressive symptoms on electroconvulsive therapy in older depressed persons, and have found that all ten symptoms show response in two weeks, underlining the safety and efficacy of electroconvulsive therapy in older persons. Show less
The work in this thesis focuses on investigation of the appearance of depression in later life. Although a different presentation of late-life compared to early-life has been suggested for... Show more The work in this thesis focuses on investigation of the appearance of depression in later life. Although a different presentation of late-life compared to early-life has been suggested for many decades, it remains unclear whether this really is the case. Our studies focus on the impact of age and somatic diseases on the appearance of late-life depression. Somatic diseases in older age may affect both the symptom profile and the course of depression. We found that neither higher somatic disease burden nor higher age contribute to more severe somatic symptoms of late-life depression. However, higher somatic disease burden does contribute to higher severity of mood symptoms of late-life depression. Furthermore, we found that older old compared with younger old depressed persons show less mood and motivational symptoms of depression. This finding implies that, particularly in older old persons aged ≥70 years, late-life depression may not be recognized properly. In line with previous studies, we confirmed that the overall somatic disease burden is associated with a poor course of late-life depression. The course of late-life depression is particularly unfavourable in the presence of cardiovascular disease, musculoskeletal disease and chronic non-specific lung diseases. Show less
In the Netherlands the Coping with Depression (CWD; Lewinsohn & Clark, 1984) course for elderly has been implemented in the prevention arm of the community-based mental health care system. The... Show moreIn the Netherlands the Coping with Depression (CWD; Lewinsohn & Clark, 1984) course for elderly has been implemented in the prevention arm of the community-based mental health care system. The study’s aim was the effectiveness (immediate and long-term) of the course in this real life setting. Enrolment of all 318 participants was the responsibility of the mental health care professionals in charge of the course. The immediate effect was studied in a random design using a waitlist group as control group; the long-term effect was analyzed in a naturalistic design. The Center for Epidemiological studies Depression scale (CES-D; Radloff, 1977) was used as the outcome measure. A wide range of variables related to incidence, severity, course and remittance of depression were included as predictors of immediate and long-term outcome. Results. The level of depressive symptoms varied from slight to being severely depressed i.e., meeting the criteria for a major depressive episode (MDE). Effect size: for non-depressed 0.32, for those with a MDE 0.92. The four predictors – anxiety, MDE, previous MDE, and education level - that were statistically significant had no clinical significance and did not justify further triage at intake. At the conclusion of the course 62% still had a CES-D score above 16, which is an indication that a clinical relevant depression is persisting. These participants should be advised to seek further treatment. Show less
