2 results
Chronic and remitting trajectories of depressive symptoms in the elderly. Characterisation and risk factors
- I. Carrière, A. Farré, C. Proust-Lima, J. Ryan, M.L. Ancelin, K. Ritchie
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 26 / Issue 2 / April 2017
- Published online by Cambridge University Press:
- 15 January 2016, pp. 146-156
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- Article
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Background.
In elderly general population sub-syndromal clinically significant levels of depressive symptoms are highly prevalent and associated with high co-morbidity and increased mortality risk. However changes in depressive symptoms over time and etiologic factors have been difficult to characterise notably due to methodological shortcomings. Our objective was to differentiate trajectories of depressive symptoms over 10 years in community-dwelling elderly men and women using statistical modelling methods which take into account intra-subject correlation and individual differences as well as to examine current and life-time risk factors associated with different trajectories.
Methods.Participants aged 65 and over were administered standardised questionnaires and underwent clinical examinations at baseline and after 2, 4, 7 and 10 years. Trajectories over time of the Center for Epidemiologic Studies Depression scores were modelled in 517 men and 736 women separately with latent class mixed models which include both a linear mixed model to describe latent classes of trajectories and a multinomial logistic model to characterise the latent trajectories according to baseline covariates (socio-demographic, lifestyle, clinical, genetic characteristics and stressful life events).
Results.In both genders two different profiles of symptom changes were observed over the 10-year follow-up. For 9.1% of men and 25% of women a high depressive symptom trajectory was found with a trend toward worsening in men. The majority of the remaining men and women showed decreasing symptomatology over time, falling from clinically significant to very low levels of depressive symptoms. In large multivariate class membership models, mobility limitations [odds ratio (OR) = 4.5, 95% confidence interval (CI) 1.6–12.9 and OR = 4.9, 95% CI 2.3–10.7, in men and women respectively], ischemic pathologies (OR = 2.9, 95% CI 1.0–8.3 and OR = 3.1, 95% CI 1.0–9.9), and recent stressful events (OR = 4.5, 95% CI 1.1–18.5, OR = 3.2, 95% CI 1.6–6.2) were associated with a poor symptom course in both gender as well as diabetes in men (OR = 3.5, 95% CI 1.1–10.9) and childhood traumatic experiences in women (OR = 3.1, 95% CI 1.6–5.8).
Conclusions.This prospective study was able to differentiate patterns of chronic and remitting depressive symptoms in elderly people with distinct symptom courses and risk factors for men and women. These findings may inform prevention programmes designed to reduce the chronic course of depressive symptomatology.
The association between caffeine and cognitive decline: examining alternative causal hypotheses
- K. Ritchie, M.L. Ancelin, H. Amieva, O. Rouaud, I. Carrière
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- Journal:
- International Psychogeriatrics / Volume 26 / Issue 4 / April 2014
- Published online by Cambridge University Press:
- 15 January 2014, pp. 581-590
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Background:
Numerous studies suggest that higher coffee consumption may reduce the rate of aging-related cognitive decline in women. It is thus potentially a cheap and widely available candidate for prevention programs provided its mechanism may be adequately understood. The assumed effect is that of reduced amyloid deposition, however, alternative pathways notably by reducing depression and diabetes type 2 risk have not been considered.
Methods:A population study of 1,193 elderly persons examining depressive symptomatology, caffeine consumption, fasting glucose levels, type 2 diabetes onset, serum amyloid, and factors known to affect cognitive performance was used to explore alternative causal models.
Results:Higher caffeine consumption was found to be associated with decreased risk of incident diabetes in men (HR = 0.64; 95% CI 0.42–0.97) and increased risk in women (HR = 1.51; 95% CI 1.08–2.11). No association was found with incident depression. While in the total sample lower ratio Aβ42/Aβ40 levels (OR = 1.36, 95% CI 1.05–1.77, p = 0.02) were found in high caffeine consumers, this failed to reach significance when the analyses were stratified by gender.
Conclusions:We found no evidence that reduced risk of cognitive decline in women with high caffeine consumption is moderated or confounded by diabetes or depression. The evidence of an association with plasma beta amyloid could not be clearly demonstrated. Insufficient proof of causal mechanisms currently precludes the recommendation of coffee consumption as a public health measure. Further research should focus on the high estrogen content of coffee as a plausible alternative explanation.