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Anxiety in late-life depression: Associations with brain volume, amyloid beta, white matter lesions, cognition, and functional ability
- Maria Kryza-Lacombe, Michelle T. Kassel, Philip S. Insel, Emma Rhodes, David Bickford, Emily Burns, Meryl A. Butters, Duygu Tosun, Paul Aisen, Rema Raman, Susan Landau, Andrew J. Saykin, Arthur W. Toga, Clifford R. Jack, Jr, Robert Koeppe, Michael W. Weiner, Craig Nelson, R. Scott Mackin
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- Journal:
- International Psychogeriatrics , First View
- Published online by Cambridge University Press:
- 25 January 2024, pp. 1-12
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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.
53 Hoarding Behaviors are Associated with Greater Perceived Cognitive Dysfunction and Disability in Individuals with Late Life Depression
- Katie Firestone, John Bello, Divya Shridar, Michelle Kassel, Maria Kryza-Lacombe, Philip Insel, Kai Woodworth, Derek Satre, Craig Nelson, Carol Mathews, Duygu Tosun, Scott Mackin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 839
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- Article
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Objective:
Perceived cognitive dysfunction is a common feature of late-life depression (LLD) that is associated with diminished quality of life and greater disability. Similar associations have been demonstrated in individuals with Hoarding Disorder. The degree to which hoarding behaviors (HB) are associated with greater perceived cognitive dysfunction and disability in individuals with concurrent LLD is not known.
Participants and Methods:Participants with LLD (N=83) completed measures of hoarding symptom severity (Savings Inventory-Revised; SI-R) and were classified into two groups based on HB severity: LLD+HB who exhibited significant HB (SI-R . 41, n = 25) and LLD with low HB (SI-R < 41, n = 58). Additional measures assessed depression severity (Hamilton Depression Rating Scale; HDRS), perceived cognitive difficulties (Everyday Cognition Scale; ECOG), and disability (World Health Organization Disability Assessment Scale [WHODAS]-II-Short). Given a non-normal distribution of ECOG and WHODAS-II scores, non-parametric Wilcoxon-Mann-Whitney tests were used to assess group differences in perceived cognitive dysfunction and disability. A regression model assessed the extent to which perceived cognitive dysfunction was associated with hoarding symptom severity measured continuously, covarying for age, education, gender, and depression severity. A separate regression model assessed the extent to which disability scores were associated with perceived cognitive dysfunction and HB severity covarying for demographics and depression severity.
Results:LLD+HB endorsed significantly greater perceived cognitive dysfunction (W = 1023, p = 0.003) and greater disability (W = 1006, p = < 0.001) compared to LLD. Regression models accounting for demographic characteristics and depression severity revealed that greater HB severity was associated with greater perceived cognitive dysfunction (β = 0.009, t = 2.765, p = 0.007). Increased disability was associated with greater perceived cognitive dysfunction (β = 4.792, t(71) = 3.551, p = 0.0007) and HB severity (β = 0.080, t(71) = 1.944, p = 0.056) approached significance after accounting for variance explained by depression severity and demographic covariates.
Conclusions:Our results suggest that hoarding behaviors are associated with increased perceived cognitive dysfunction and greater disability in individuals with LLD. Screening for HB in individuals with LLD may help identify those at greater risk for poor cognitive and functional outcomes. Interventions that target HB and perceived cognitive difficulties may decrease risk for disability in LLD. However, longitudinal studies would be required to further evaluate these relationships.