Astrid Lugtenburg1,2, Marij Zuidersma2, Klaas J Wardenaar2, Ivan Aprahamian3, Didi Rhebergen4,5, Robert A Schoevers2, Richard C Oude Voshaar2. 1. Department Old Age Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands. 2. University Center of Psychiatry and Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, The Netherlands. 3. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, São Paulo, Brazil. 4. Amsterdam University Medical Center, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands. 5. GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
Abstract
BACKGROUND: With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. METHODS: A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. RESULTS: A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression ("mild" and "severe" depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as "amnestic depression," "frail-depressed, physically dominated," and "frail-depressed, cognitively dominated." The prospective analyses showed that patients in the subgroup of "mild depression" and "amnestic depression" had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. CONCLUSIONS: Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.
BACKGROUND: With increasing age, symptoms of depression may increasingly overlap with age-related physical frailty and cognitive decline. We aim to identify late-life-related subtypes of depression based on measures of depressive symptom dimensions, cognitive performance, and physical frailty. METHODS: A clinical cohort study of 375 depressed older patients with a DSM-IV depressive disorder (acronym NESDO). A latent profile analysis was applied on the three subscales of the Inventory of Depressive Symptomatology, as well as performance in five cognitive domains and two proxies for physical frailty. For each class, we investigated remission, dropout, and mortality at 2-year follow-up as well as change over time of depressive symptom severity, cognitive performance, and physical frailty. RESULTS: A latent profile analysis model with five classes best described the data, yielding two subgroups suffering from pure depression ("mild" and "severe" depression, 55% of all patients) and three subgroups characterized by a specific profile of cognitive and physical frailty features, labeled as "amnestic depression," "frail-depressed, physically dominated," and "frail-depressed, cognitively dominated." The prospective analyses showed that patients in the subgroup of "mild depression" and "amnestic depression" had the highest remission rates, whereas patients in both frail-depressed subgroups had the highest mortality rates. CONCLUSIONS: Late-life depression can be subtyped by specific combinations of age-related clinical features, which seems to have prospective relevance. Subtyping according to the cognitive profile and physical frailty may be relevant for studies examining underlying disease processes as well as to stratify treatment studies on the effectiveness of antidepressants, psychotherapy, and augmentation with geriatric rehabilitation.
Authors: M K Borges; C V Romanini; N A Lima; M Petrella; D L da Costa; V N An; B N Aguirre; J R Galdeano; I C Fernandes; J F Cecato; E C Robello; R C Oude Voshaar; I Aprahamian Journal: J Nutr Health Aging Date: 2021 Impact factor: 4.075
Authors: Junhao Wen; Cynthia H Y Fu; Duygu Tosun; Yogasudha Veturi; Zhijian Yang; Ahmed Abdulkadir; Elizabeth Mamourian; Dhivya Srinivasan; Ioanna Skampardoni; Ashish Singh; Hema Nawani; Jingxuan Bao; Guray Erus; Haochang Shou; Mohamad Habes; Jimit Doshi; Erdem Varol; R Scott Mackin; Aristeidis Sotiras; Yong Fan; Andrew J Saykin; Yvette I Sheline; Li Shen; Marylyn D Ritchie; David A Wolk; Marilyn Albert; Susan M Resnick; Christos Davatzikos Journal: JAMA Psychiatry Date: 2022-05-01 Impact factor: 25.911