Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-14T10:30:37.226Z Has data issue: false hasContentIssue false
  • English
  • Français

Anxiety in late-life depression: Associations with brain volume, amyloid beta, white matter lesions, cognition, and functional ability

Published online by Cambridge University Press:  25 January 2024

Maria Kryza-Lacombe Open the ORCID record for Maria Kryza-Lacombe [Opens in a new window] ,
Michelle T. Kassel ,
Philip S. Insel ,
Emma Rhodes ,
David Bickford ,
Emily Burns ,
Meryl A. Butters ,
Duygu Tosun ,
Paul Aisen  and
Rema Raman
...Show all authors
Maria Kryza-Lacombe*
Affiliation:
Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Michelle T. Kassel
Affiliation:
Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Philip S. Insel
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Emma Rhodes
Affiliation:
Mental Illness Research Education and Clinical Centers, Veterans Affairs Medical Center, San Francisco, CA, USA Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
David Bickford
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Emily Burns
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Meryl A. Butters
Affiliation:
Department of Psychiatry Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Duygu Tosun
Affiliation:
Veterans Affairs Medical Center, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
Paul Aisen
Affiliation:
University of Southern California, Los Angeles, CA, USA Keck School of Medicine, Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
Rema Raman
Affiliation:
University of Southern California, Los Angeles, CA, USA Keck School of Medicine, Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, CA, USA
Susan Landau
Affiliation:
Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
Andrew J. Saykin
Affiliation:
Department of Radiology and Imaging Sciences and the Indiana Alzheimer’s Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
Arthur W. Toga
Affiliation:
Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Clifford R. Jack Jr
Affiliation:
Department of Radiology, Mayo Clinic, Rochester, MN, USA
Robert Koeppe
Affiliation:
Department of Radiology, University of Michigan, Ann Arbor, USA
Michael W. Weiner
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA Veterans Affairs Medical Center, San Francisco, CA, USA Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
Craig Nelson
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
R. Scott Mackin
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA Veterans Affairs Medical Center, San Francisco, CA, USA
*
Correspondence should be addressed to: M. Kryza-Lacombe, Mental Illness Research Education and Clinical Centers, San Francisco VA Health Care System, San Francisco, CA 94121, USA. Tel: (415) 221-4810 x23114. E-mail: maria.kryza-lacombe@ucsf.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Late-life depression (LLD) is common and frequently co-occurs with neurodegenerative diseases of aging. Little is known about how heterogeneity within LLD relates to factors typically associated with neurodegeneration. Varying levels of anxiety are one source of heterogeneity in LLD. We examined associations between anxiety symptom severity and factors associated with neurodegeneration, including regional brain volumes, amyloid beta (Aβ) deposition, white matter disease, cognitive dysfunction, and functional ability in LLD.

Participants and Measurements:

Older adults with major depression (N = 121, Ages 65–91) were evaluated for anxiety severity and the following: brain volume (orbitofrontal cortex [OFC], insula), cortical Aβ standardized uptake value ratio (SUVR), white matter hyperintensity (WMH) volume, global cognition, and functional ability. Separate linear regression analyses adjusting for age, sex, and concurrent depression severity were conducted to examine associations between anxiety and each of these factors. A global regression analysis was then conducted to examine the relative associations of these variables with anxiety severity.

Results:

Greater anxiety severity was associated with lower OFC volume (β = −68.25, t = −2.18, p = .031) and greater cognitive dysfunction (β = 0.23, t = 2.46, p = .016). Anxiety severity was not associated with insula volume, Aβ SUVR, WMH, or functional ability. When examining the relative associations of cognitive functioning and OFC volume with anxiety in a global model, cognitive dysfunction (β = 0.24, t = 2.62, p = .010), but not OFC volume, remained significantly associated with anxiety.

Conclusions:

Among multiple factors typically associated with neurodegeneration, cognitive dysfunction stands out as a key factor associated with anxiety severity in LLD which has implications for cognitive and psychiatric interventions.

Keywords

Late-life depressionAnxietygray matter volumeAmyloid betaCognition
Type
Original Research Article
Information
International Psychogeriatrics , First View , pp. 1 - 12
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of International Psychogeriatric Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Press.Google Scholar
Andreescu, C., Butters, M. A., Begley, A., Rajji, T., Wu, M., Meltzer, C. C., Reynolds, C. F. lll, & Aizenstein, H. (2008). Gray matter changes in late life depression—a structural MRI analysis. Neuropsychopharmacology, 33(11), 2566–2572. https://doi.org/10.1038/sj.npp.1301655 Google Scholar
Andreescu, C., Dew, M. A., Begley, A. E., Mulsant, B. H., Dombrovski, A. Y., Pollock, B. G., Stack, J., Miller, M. D., & Reynolds, C. F. (2007). Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: Controlled study. The British Journal of Psychiatry, 190, 344–349. https://doi.org/190/4/344 Google Scholar
Andreescu, C., Tudorascu, D., Sheu, L. K., Rangarajan, A., Butters, M. A., Walker, S., Berta, R., Desmidt, T., & Aizenstein, H. (2017). Brain structural changes in late-life generalized anxiety disorder. Psychiatry Research: Neuroimaging, 268, 15–21. https://doi.org/10.1016/j.pscychresns.2017.08.004 Google Scholar
Anstey, K. J., von Sanden, C., Sargent-Cox, K., & Luszcz, M. A. (2007). Prevalence and risk factors for depression in a longitudinal, population-based study including individuals in the community and residential care. The American Journal of Geriatric Psychiatry, 15(6), 497–505. https://doi.org/15/6/497 Google Scholar
Banning, L. C. P., Ramakers, I. H. G. B., Köhler, S., Bron, E. E., Verhey, F. R. J., de Deyn, P. P., Claassen, J. A. H. R., Koek, H. L., Middelkoop, H. A. M., van der Flier, W. M., van der Lugt, A., & Aalten, P. (2020). The association between biomarkers and neuropsychiatric symptoms across the Alzheimer’s disease spectrum. The American Journal of Geriatric Psychiatry, 28(7), 735–744.Google Scholar
Beaudreau, S. A., & O’Hara, R. (2008). Late-life anxiety and cognitive impairment: A review. The American Journal of Geriatric Psychiatry, 16(10), 790–803. https://doi.org/10.1097/JGP.0b013e31817945c3 Google Scholar
Beaudreau, S. A., & O’Hara, R. (2009). The association of anxiety and depressive symptoms with cognitive performance in community-dwelling older adults. Psychology and Aging, 24(2), 507–512. https://doi.org/10.1037/a0016035 Google Scholar
Beekman, A. T., De Beurs, E., Van Balkom, A. J., Deeg, D. J., Van Dyck, R., & Van Tilburg, W. (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of psychiatry, 157(1), 89–95.Google Scholar
Bierman, E. J., Comijs, H. C., Jonker, C., & Beekman, A. T. (2005). Effects of anxiety versus depression on cognition in later life. American Journal of Geriatric Psychiatry, 13(8), 686–693. https://doi.org/10.1176/appi.ajgp.13.8.686 Google Scholar
Clancy, U., Gilmartin, D., Jochems, A. C., Knox, L., Doubal, F. N., & Wardlaw, J. M. (2021). Neuropsychiatric symptoms associated with cerebral small vessel disease: A systematic review and meta-analysis. The Lancet Psychiatry, 8(3), 225–236.Google Scholar
DeLuca, A. K., Lenze, E. J., Mulsant, B. H., Butters, M. A., Karp, J. F., Dew, M. A., Pollock, B. G., Shear, M. K., Houck, P. R., & Reynolds, C. F. lll (2005). Comorbid anxiety disorder in late life depression: Association with memory decline over four years. International Journal of Geriatric Psychiatry, 20(9), 848–854. https://doi.org/10.1002/gps.1366 Google Scholar
Diefenbach, G. J., Bragdon, L. B., & Blank, K. (2014). Geriatric anxiety inventory: Factor structure and associations with cognitive status. The American Journal of Geriatric Psychiatry, 22(12), 1418–1426. https://doi.org/10.1016/j.jagp.2013.04.014 Google Scholar
Diniz, B. S., Butters, M. A., Albert, S. M., Dew, M. A., & Reynolds, C. F. (2013). Late-life depression and risk of vascular dementia and Alzheimer’s disease: Systematic review and meta-analysis of community-based cohort studies. British Journal of Psychiatry, 202(5), 329–335.Google Scholar
Dixon, M. L., Thiruchselvam, R., Todd, R., & Christoff, K. (2017). Emotion and the prefrontal cortex: An integrative review. Psychological Bulletin, 143(10), 1033–1081. https://doi.org/10.1037/bul0000096 Google Scholar
Dong, L., Freedman, V. A., & de Leon, C. F. M. (2020). The association of comorbid depression and anxiety symptoms with disability onset in older adults. Psychosomatic Medicine, 82(2), 158–164.Google Scholar
Fung, A. W. T., Lee, J. S. W., Lee, A. T. C., & Lam, L. C. W. (2018). Anxiety symptoms predicted decline in episodic memory in cognitively healthy older adults: A 3-year prospective study. International Journal of Geriatric Psychiatry, 33(5), 748–754. https://doi.org/10.1002/gps.4850 Google Scholar
Gunter, J., Thostenson, K., Borowski, B., Reid, R., Arani, A., Bernstein, M. A., Fox, N. C., Thomas, D., Decarli, C., Tosun, D., Thompson, P. M., Weiner, M., & Jack, C. R. (2017). ADNI-3 MRI protocol. Alzheimer’s Dementia, 13(7), P104–P105.Google Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56–62.CrossRefGoogle ScholarPubMed
Hanseeuw, B. J., Jonas, V., Jackson, J., Betensky, R. A., Rentz, D. M., Johnson, K. A., Sperling, R. A., & Donovan, N. J. (2020). Association of anxiety with subcortical amyloidosis in cognitively normal older adults. Molecular Psychiatry, 25(10), 2599–2607.Google Scholar
Jeste, N. D., Hays, J. C., & Steffens, D. C. (2006). Clinical correlates of anxious depression among elderly patients with depression. Journal of Affective Disorders, 90(1), 37–41. https://doi.org/10.1016/j.jad.2005.10.007 CrossRefGoogle ScholarPubMed
Johansson, M., Stomrud, E., Johansson, P. M., Svenningsson, A., Palmqvist, S., Janelidze, S., van Westen, D., Mattsson-Carlgren, N., & Hansson, O. (2022). Development of apathy, anxiety, and depression in cognitively unimpaired older adults: Effects of Alzheimer’s disease pathology and cognitive decline. Biological Psychiatry, 92(1), 34–43. https://doi.org/10.1016/j.biopsych.2022.01.012 Google Scholar
Kang, H.-J., Bae, K.-Y., Kim, S.-W., Shin, H.-Y., Shin, I.-S., Yoon, J.-S., & Kim, J.-M. (2017). Impact of anxiety and depression on physical health condition and disability in an elderly Korean population. Psychiatry Investigation, 14(3), 240–248. https://doi.org/10.4306/pi.2017.14.3.240 Google Scholar
Karim, H. T., Ly, M., Yu, G., Krafty, R., Tudorascu, D. L., Aizenstein, H. J., & Andreescu, C. (2021). Aging faster: Worry and rumination in late life are associated with greater brain age. Neurobiology of Aging, 101, 13–21.Google Scholar
Kim, J.-T., Park, M.-S., Yoon, G.-J., Jung, H.-J., Choi, K.-H., Nam, T.-S., Lee, S.-H., Choi, S.-M., Kim, B.-C., Kim, M.-K., & Cho, K.-H. (2011). White matter hyperintensity as a factor associated with delayed mood disorders in patients with acute ischemic stroke. European Neurology, 66(6), 343–349. https://doi.org/10.1159/000332585 Google Scholar
Klumpp, H., Angstadt, M., & Phan, K. L. (2012). Insula reactivity and connectivity to anterior cingulate cortex when processing threat in generalized social anxiety disorder. Biological Psychology, 89(1), 273–276. https://doi.org/10.1016/j.biopsycho.2011.10.010 Google Scholar
Krause-Sorio, B., Siddarth, P., Milillo, M. M., Kilpatrick, L. A., Narr, K. L., & Lavretsky, H. (2023). Regional gray matter volume correlates with anxiety, apathy, and resilience in geriatric depression. International Psychogeriatric Association, 35(12), 698–706.Google Scholar
Krell-Roesch, J., Lowe, V. J., Neureiter, J., Pink, A., Roberts, R. O., Mielke, M. M., Vemuri, P., Stokin, G. B., Christianson, T. J., Jack, C. R. Jr., Knopman, D. S., Boeve, B. F., Kremers, W. K., Petersen, R. C., & Geda, Y. E. (2018). Depressive and anxiety symptoms and cortical amyloid deposition among cognitively normal elderly persons: The mayo clinic study of aging. International psychogeriatrics, 30(2), 245–251.Google Scholar
Krell-Roesch, J., Syrjanen, J. A., Mielke, M. M., Christianson, T. J., Kremers, W. K., Machulda, M. M., Knopman, D. S., Petersen, R. C., Vassilaki, M., & Geda, Y. E. (2020). Association between neuropsychiatric symptoms and functional change in older non-demented adults: mayo clinic study of aging. Journal of Alzheimer’s Disease, 78(3), 911–917.Google Scholar
Laird, K. T., Siddarth, P., Krause-Sorio, B., Kilpatrick, L., Milillo, M., Aguilar, Y., Narr, K. L., & Lavretsky, H. (2019). Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression. Journal of Affective Disorders, 256, 282–287.Google Scholar
Landau, S. M., Lu, M., Joshi, A. D., Pontecorvo, M., Mintun, M. A., Trojanowski, J. Q., Shaw, L. M., Jagust, W. J., & for the Alzheimer’s Disease Neuroimaging Initiative (2013). Comparing positron emission tomography imaging and cerebrospinal fluid measurements of β-amyloid. Annals of Neurology, 74(6), 826–836.Google Scholar
Lavretsky, H., Zheng, L., Weiner, M. W., Mungas, D., Reed, B., Kramer, J. H., Jagust, W., Chui, H., & Mack, W. J. (2008). The MRI brain correlates of depressed mood, anhedonia, apathy, and anergia in older adults with and without cognitive impairment or dementia. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life and allied sciences, 23(10), 1040–1050.Google Scholar
Lenze, E. J., & et al. (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry, 157(5), 722–728.CrossRefGoogle ScholarPubMed
Lewis, C. K., Bernstein, O., Grill, J., Gillen, D., & Sultzer, D. (2022). Anxiety and depressive symptoms and cortical amyloid-β burden in cognitively unimpaired older adults. The Journal of Prevention of Alzheimer’s Disease, 9(2), 286–296.Google Scholar
Mackin, R. S., Insel, P. S., Landau, S., Bickford, D., Morin, R., Rhodes, E., Tosun, D., Rosen, H. J., Butters, M., Aisen, P., Raman, R., Saykin, A., Toga, A., Jack, C. Jr., Koeppe, R., Weiner, M. W., & Nelson, C. (2021). Late-life depression is associated with reduced cortical amyloid burden: Findings from the Alzheimer’s disease neuroimaging initiative depression project. Biological Psychiatry, 89(8), 757–765.Google Scholar
Mah, L., Binns, M. A., & Steffens, D. C. (2015). Anxiety symptoms in amnestic mild cognitive impairment are associated with medial temporal atrophy and predict conversion to Alzheimer disease. The American Journal of Geriatric Psychiatry, 23(5), 466–476. https://doi.org/10.1016/j.jagp.2014.10.005 Google Scholar
Martinussen, L. J., Šaltytė Benth, J., Almdahl, I. S., Borza, T., Selbæk, G., Mcpherson, B., & Korsnes, M. S. (2019). The effect of anxiety on cognition in older adult inpatients with depression: Results from a multicenter observational study. Heliyon, 5(8), e02235. https://doi.org/10.1016/j.heliyon.2019.e02235 Google Scholar
Milad, M. R., & Rauch, S. L. (2007). The role of the orbitofrontal cortex in anxiety disorders. Annals of the New York Academy of Sciences, 1121(1), 546–561. https://doi.org/10.1196/annals.1401.006 Google Scholar
Morin, R. T., Nelson, C., Bickford, D., Insel, P. S., & Mackin, R. S. (2020). Somatic and anxiety symptoms of depression are associated with disability in late life depression. Aging & Mental Health, 24(8), 1225–1228.Google Scholar
Morris, J. C. (1993). The clinical dementia rating (CDR): Current version and scoring rules. Neurology, 43(11), 2412–2414. https://doi.org/10.1212/wnl.43.11.2412-a Google Scholar
Norton, J., Ancelin, M. L., Stewart, R., Berr, C., Ritchie, K., & Carrière, I. (2012). Anxiety symptoms and disorder predict activity limitations in the elderly. Journal of Affective Disorders, 141(2-3), 276–285. https://doi.org/10.1016/j.jad.2012.04.002 Google Scholar
Petkus, A. J., Reynolds, C. A., Wetherell, J. L., Kremen, W. S., & Gatz, M. (2017). Temporal dynamics of cognitive performance and anxiety across older adulthood. Psychology and Aging, 32(3), 278–292. https://doi.org/10.1037/pag0000164 Google Scholar
Pink, A., Przybelski, S. A., Krell-Roesch, J., Stokin, G. B., Roberts, R. O., Mielke, M. M., Spangehl, K. A., Knopman, D. S., Jack, C. R. Jr, Petersen, R. C., & Geda, Y. E. (2017). Cortical thickness and anxiety symptoms among cognitively normal elderly persons: The mayo clinic study of aging. The Journal of Neuropsychiatry and Clinical Neurosciences, 29(1), 60–66. https://doi.org/10.1176/appi.neuropsych.15100378 Google Scholar
Porensky, E. K., Dew, M. A., Karp, J. F., Skidmore, E., Rollman, B. L., Shear, M. K., & Lenze, E. J. (2009). The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization. The American Journal of Geriatric Psychiatry, 17(6), 473–482. https://doi.org/10.1097/jgp.0b013e31819b87b2 Google Scholar
Potvin, O., Catheline, G. B., Bernard, C., Meillon, C., Bergua, V., Allard, M., Dartigues, J.-F., Chauveau, N., Celsis, P., & Amieva, H. (2015). Gray matter characteristics associated with trait anxiety in older adults are moderated by depression. International Psychogeriatrics, 27(11), 1813–1824.Google Scholar
Rensma, S. P., van Sloten, T. T., Launer, L. J., & Stehouwer, C. D. (2018). Cerebral small vessel disease and risk of incident stroke, dementia and depression, and all-cause mortality: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 90, 164–173.Google Scholar
Rosen, W. G., Mohs, R. C., & Davis, K. L. (1984). A new rating scale for Alzheimer’s disease. The American Journal of Psychiatry, 141(11), 1356–1364.Google Scholar
Schoenbaum, G., Roesch, M. R., Stalnaker, T. A., & Takahashi, Y. K. (2009). A new perspective on the role of the orbitofrontal cortex in adaptive behaviour. Nature Reviews Neuroscience, 10(12), 885–892. https://doi.org/10.1038/nrn2753 Google Scholar
Schoevers, R. A., Beekman, A. T., Deeg, D. J., Jonker, C., & van Tilburg, W. (2003). Comorbidity and risk-patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. International Journal of Geriatric Psychiatry, 18(11), 994–1001. https://doi.org/10.1002/gps.1001 Google Scholar
Schultz, S. K., Hoth, A., & Buckwalter, K. (2004). Anxiety and impaired social function in the elderly. Annals of Clinical Psychiatry, 16(1), 47–51. https://doi.org/10.1080/10401230490281429 Google Scholar
Schwarz, C., Fletcher, E., DeCarli, C., & Carmichael, O. (2009). Fully-automated white matter hyperintensity detection with anatomical prior knowledge and without FLAIR. International Conference on Information Processing in Medical Imaging.Google Scholar
Simning, A., & Seplaki, C. L. (2020). Association of the cumulative burden of late-life anxiety and depressive symptoms with functional impairment. International Journal of Geriatric Psychiatry, 35(1), 80–90. https://doi.org/10.1002/gps.5221 Google Scholar
Smith, L., Jacob, L., López-Sánchez, G. F., Butler, L., Barnett, Y., Veronese, N., Soysal, P., Yang, L., Grabovac, I., Tully, M. A., Shin, J. I., & Koyanagi, A. (2021). Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries. Journal of Affective Disorders, 291, 57–64. https://doi.org/10.1016/j.jad.2021.04.076 Google Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.Google Scholar
Steffens, D. C., & McQuoid, D. R. (2005). Impact of symptoms of generalized anxiety disorder on the course of late-life depression. American Journal of Geriatric Psychiatry, 13(1), 40–47. https://doi.org/10.1176/appi.ajgp.13.1.40 Google Scholar
Teodorczuk, A., O’Brien, J. T., Firbank, M. J., Pantoni, L., Poggesi, A., Erkinjuntti, T., Wallin, A., Wahlund, L.-O., Gouw, A., Waldemar, G., Schmidt, R., Ferro, J. M., Chabriat, H., Bäzner, H., & Inzitari, D. (2007). White matter changes and late-life depressive symptoms: Longitudinal study. British Journal of Psychiatry, 191(3), 212–217.Google Scholar
Vogels, R. L. C., Oosterman, J. M., van Harten, B., Gouw, A. A., Schroeder-Tanka, J. M., Scheltens, P., van der Flier, W. M., & Weinstein, H. C. (2007). Neuroimaging and correlates of cognitive function among patients with heart failure. Dementia and Geriatric Cognitive Disorders, 24(6), 418–423. https://doi.org/10.1159/000109811 Google Scholar
Wild, B., Eckl, A., Herzog, W., Niehoff, D., Lechner, S., Maatouk, I., Schellberg, D., Brenner, H., Müller, H., & Löwe, B. (2014). Assessing generalized anxiety disorder in elderly people using the GAD-7 and GAD-2 scales: Results of a validation study. The American Journal of Geriatric Psychiatry, 22(10), 1029–1038. https://doi.org/10.1016/j.jagp.2013.01.076 Google Scholar
Yesavage, J. A. (1988). Geriatric depression scale. Psychopharmacology Bulletin, 24(4), 709–711.Google Scholar
Supplementary material: File

Kryza-Lacombe et al. supplementary material

Kryza-Lacombe et al. supplementary material
Download Kryza-Lacombe et al. supplementary material(File)
File 22.2 KB